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Dr. Ashley Beckman discusses Epigenetics and Cellular Detoxification with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

4:42  Epigenetics is the study of how certain mechanisms like diet, lifestyle, and behavioral choices can switch our genes on or off.  We have a lot more control over our future and our genes are not our destiny.  In fact, according to Dr. Beckman, they are our greatest opportunity.

5:50  Cellular detoxification is a detox program specific and targeted to our genetic predispositions and our constitution our detox needs.

7:15  To determine our genetics and our epigenetics, Dr. Beckman prefers to determine our genes with a testing company like Apeiron Genomics rather than using 23andMe or Ancestry, since these companies are generally selling your data and now offer a limited number of genes.  Apeiron Genomics uses a large number of genes and provides actionable reports with recommendations for diet, exercise, supplement, and lifestyle tendencies and it does not sell your data.

12:22  Dr. Beckman explained that her patient who gets tested through Apeiron Genomics receives various categories of their tendencies.  For example, they get an insulin resistance score based upon about approximately 20 genes, which gives them a score of the likelihood of developing type II diabetes.  This can provide motivation for people to be mindful and makes changes in their diet and lifestyle, esp. if they have a high propensity for developing insulin resistance and diabetes.

23:22  Looking at your genetic tendencies can help you tailor your detox program to be more effective. Dr. Beckman said that she had been doing Dr. Schultz’s detox programs since she was a kid and did them seasonally. She eats very clean and uses clean products and doesn’t use plastic and doesn’t buy plastic bottled water, etc., but when she did the Great Plains toxin test, she was one of the most toxic folks they had ever tested. She was in the top 75-95% of the highest levels for 15 different toxins, like BPA, MTBE, and perchlorate.  She also learned from her genetic testing that she does not make or process glutathione much at all. So now her detox program involves precursors for glutathione and also binders to soak up the toxins to get rid of them, like fulvic and humic acids and modified citrus pectin, which are more effective than charcoal. For testing for toxins, she likes to run the organic acids, the mycotoxin, and the environmental toxin tests. She also likes the Quicksilver Mercury Tri-test, which is a combination of serum, urine and hair mercury testing.  She may also run a fuller heavy metals screen.  She may also run a GI Map stool test or a Gut Zoomer test.

34:25  Dr. Beckman combines the genetic testing and what shows up in the labs to tailor the detox program for each patient.  She will do a preparatory phase prior to starting the detox and if the person cannot tolerate toxins well based on the genetics, then this phase will be longer.  She will start patients with certain foundations, like optimizing nutrient levels and making sure their bowel is functioning properly and that they are not constipated and ideally pooping twice per day.  If they are constipated, the toxins will recirculate instead of being eliminated.  Dr. Beckman will also give them some nutritional formulas to support the lymph, the kidneys, and the liver.  She likes CellCore Bioscience products, including their HM-ET Binder product, which contains extracts of humic and fulvic acid, and their Biotoxin Binder, which contains humic and fulvic acid and also molybdenum, broccoli sprouts, and yucca root, as well as some products from Designs for Health and also from Quicksilver.  She likes to get her patients off eating gluten, dairy, and refined sugar.  She also works with her clients on breathing and also with dealing with stored grief and sadness and other emotions, including with acupuncture, meditation, and visualization.  Dr. Beckman works out of offices in both Beverly Hills and Malibu and she can work with clients through the phone and her website is DrAshley.com.

 

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Dr. Ashley Beckman is a Doctor of Chinese Medicine and a licensed Acupuncturist and herbalist. She received her doctorate in Healthy Aging and Longevity and wrote her thesis on Epigenetics, the study of how our genes are affected by our diet and lifestyle.  She specializes in healthy aging, epigenetics, pain management, fertility, detoxification, headaches, stress reduction and facial rejuvenation.  She also co-founded Golden Path Alchemy, an organic skincare company based on the principles of Traditional Chinese Medicine.  She can be reached through her website, DrAshley.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information.  Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello Rational Wellness podcasters. Thank you so much for joining me again today for another discussion on important functional medicine topic. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple podcast and give us a ratings and review that will help move us up the rankings and help more people find the Rational Wellness Podcast. If you’d like to see a video version of our podcast, please go to my YouTube page and if you go to my website, drweitz.com you can find detailed show notes and a complete transcript.

Our topic for today is Epigenetics, and Cellular Detox with licensed acupuncturist, Dr. Ashley Beckman.  Our genetics are the DNA code that we inherit from our parents and these direct the activities of our cells and our DNA code does not change over time. Our DNA code is a sequence of nucleotide basis known as adenine, cytosine, guanine, and thymine. I know that it’s kind of scientific jargon, but it’s the specific sequence of these A, C, G and T bases. This is the code that provides the instructions for our cells to make specific proteins that trigger various biological functions in our body, including the production of insulin, for example.  The definition of epigenetics, epigenetics is a set of triggers and switches that turn our genes off or on, and so epigenetics doesn’t modify the genetic code, but it modifies the expression of our genes. And our genes, our epigenetics is based on a whole series of factors including environmental factors, diet, lifestyle, and our exposure to toxins. Such toxins that have been shown to be drivers of epigenetic processes include heavy metals, pesticides, diesel exhaust, tobacco smoke, bis phenolate, mycotoxins, radioactivity, as well as hormones, bacteria, and basic nutrients. Some of our genes get switched on and get expressed and other of our genes get turned off and do not get expressed.

The other part of our discussion is about detoxification and detoxification is how we get rid of toxins that we’ve been exposed to over our lives and then may be stored in our cells, our organs, and even our bones. This occurs naturally on a daily basis, but we can also stimulate the detoxification process by doing a detoxification program, which often involves some form of fasting combined with taking specific nutrients to support delivery detoxification pathways to support cellular detoxification, and to support the various forms of elimination, including the digestive track and it facilitate sweating another form of elimination such as by using infrared sauna.

Dr. Ashley Beckman is a licensed acupuncturist and herbalist and a doctor of Chinese medicine practicing in Los Angeles. She received her doctorate in healthy aging and longevity and wrote her thesis on epigenetics. The study of how our genes are affected by our diet and lifestyle as I just mentioned. She specializes in healthy aging, epigenetics, detoxification, pain management, fertility, treatment of headaches, stress reduction, and facial rejuvenation. She also co-founded Golden Path Alchemy, an organic skincare company based on the principles of Traditional Chinese Medicine. Dr. Beckman, thank you so much for joining me today.

Dr. Beckman:                     It’s a pleasure to see you and be here today.

Dr. Weitz:                           Good. Let’s start by giving some definitions. I know I’ve gone into it some, but why don’t you explain what epigenetics is?

Dr. Beckman:                     Sure. Epigenetics is the study of certain mechanisms such as diet, lifestyle, behavioral choices that we have like exercise and these different factors we have in our different … in the way we live. And basically these can switch our genes on or off. One thing that I really like about this is that we have a lot more control over our health destiny than what we have been known to believe in the past. So many people just believe if something has been passed down to you by your parents, that you’re destined to get this and more likely doomed to get it.  And so people just really focus and are scared for their future. And I love this theory of epigenetics because we really have a lot more control than people had thought before.

Dr. Weitz:                           Right. Our genes are not our destiny.

Dr. Beckman:                     No. And I say they’re our greatest opportunity.

Dr. Weitz:                           Great. The other part of our discussion is going to be about cellular detox. Maybe you could explain what is cellular detox?

Dr. Beckman:                     Sure. The word detox gets thrown around all the time and people equate this with a three day juice cleanse that they picked up at a juice bar. And especially as someone coming from Chinese medicine, you really need to tailor things towards someone’s constitution. Even on the detox level, we have to know how the body is and even some genetic predispositions and how we detox, like how our phase one and phase two pathways are wired, so that we can actually tailor a detox specific to that person. Some detox that you pick up, like I said, like at a juice bar or even off the shelf at Whole Foods, it’s not going to be exactly what you specifically need.  And so a cellular detox really we want to get in, make sure that you’re targeting all the areas that really need to be addressed and taking the right supplements. And then kind of what you were speaking about, all the other lifestyle factors that accommodate what is needed in a detox with, from mindset to some fasting, the right foods and the right supplements. Something that’s very targeted and actually effective.

Dr. Weitz:                           Okay. With respect to epigenetics, how do we find out what our epigenetics are?

Dr. Beckman:                     Well, so the main way is you basically … what I do with patients is you take someone’s raw genetic data, so you get a test. There are various ones out there. I have utilized raw genetic data that people have already received from somewhere else, like 23andMe or … there’s a various amount of companies now.

Dr. Weitz:                           Ancestry.com, so why don’t we talk a bit for a minute about which is the best one to use?

Dr. Beckman:                     Sure.

Dr. Weitz:                           Because for a while I heard that 23andMe was providing the most amount of genes and then they change the way they do their testing, so they actually provide fewer genes. What do you think is the best company to use if we have a choice?

Dr. Beckman:                     Sure. I use a company called APEIRON and that’s the company that I’ve actually trained with and studied with. They do not store your data and it’s actually extremely private. Your name is not associated with the bar code on your test. That is something because they will never sell your data. And I think that that is actually one of the most important pieces right now.

Dr. Weitz:                           And you’re referring to the fact that 23andMe and Ancestry, the way they make a lot of their money is by selling your data to be used for research by Big Pharma and others?

Dr. Beckman:                     Yes, I believe that that’s accurate. I think a lot of the companies out there are data mining companies and where you get in exchange your raw genetic data. But at the same time I caution anyone who has not done that already to pick another company that does not work in the same manner.

Dr. Weitz:                           Do you mean for privacy concerns?

Dr. Beckman:                     For privacy, and the thing, this whole area is very new and nobody really knows what they’re going to be doing with gathering all this genetic data. I think privacy is of utmost concern. And sometimes I tell people, “If you want a little bit more privacy you could also maybe use a different name when you send it in,” things like that. But at the same time, my number one choice is to tell people to use another company that doesn’t do that and the one that I’m secure with is APEIRON.

Dr. Weitz:                           Okay. How do you use this APEIRON to find out about your genetic code and your epigenome?

Dr. Beckman:                     Sure. It’s the same as the little swab that you do, and the cheek swab, you send it in and then about six weeks later you’re given your raw text file. And then, so what I do is I take that information and put it through a program and then also go through it with this long Excel sheet that I have that has a lot of different of the expressions and what they can mean and what they’re significant for, for different health reasons. Then I compile this report and I go over that with my clients. And it looks at different factors, so it looks at the foods that you eat, supplements, athleticism, hormones, the way you detox and sleep patterns. Those are main areas of epigenetics.

Dr. Weitz:                           When you take the results from that test, what exactly are you getting? Are you getting a genetic code? Are you getting the epigenome? Can you explain?

Dr. Beckman:                     I’m sure. It’s the genetic data, so it’s your genetic blueprint and it is grouped in certain … it’s put in certain groups to test a variety of the SNPs together. When you’re looking at something-

Dr. Weitz:                           Can you explain what a SNP is?

Dr. Beckman:                     That’s basically just like the single nucleotide morphism. It’s the little genetic codes for each area, but what we do is we look at the ones, so you … Sorry, you need to look in a grouping of things. It’s not that great to single out one genetic code and say, now you have this. You know what I mean? We look at a group together usually-

Dr. Weitz:                           What software do you prefer to use?

Dr. Beckman:                     I use the software from APEIRON. And then I pair that with, like I said, this kind of like long Excel sheet that then I dive deeper into which one is the norm and which one is the exception. And so then it gives you some more probabilities of how this might express in your system. This is all just the genes and then

Dr. Weitz:                           How many genes are you analyzing with this software?

Dr. Beckman:                     Oh, shoot! I would have to look it up. I don’t remember.

Dr. Weitz:                           Okay.

Dr. Beckman:                     I’ll look it up so you can put it in the notes though. But it’s very comprehensive.

Dr. Weitz:                           Okay. And then how does this help us?

Dr. Beckman:                     For example, one of my favorite areas is it gives an insulin resistance score. This is a probability that you might have, based on your genes, of your probability of having an issue or developing type 2 diabetes. It basically, for me, and especially because I’m very passionate about getting people to reduce their sugar consumption and because I think that it has such long lasting effects, but a lot of these clients have a high insulin resistance score, so … And they might not even know that. They could be someone, though that tends to be eating a lot of starchy carbs and things like that and is not really that cognizant of how much sugar they’re eating.  And so when I see this in someone’s report, to me it’s a really big push for them to start being mindful of that and to change that. Because that’s, as you probably see with your clients as well, prediabetes is so rampant and most people in their 50s and 60s and unfortunately now children are getting prediabetes at much younger ages. And so it’s something we can completely prevent.

Dr. Weitz:                          Which gene or genes are the ones that most commonly code for insulin resistance? Do you know those offhand?

Dr. Beckman:                     I don’t know them offhand, but I have-

Dr. Weitz:                          Okay.

Dr. Beckman:                     Do you want me to give? I have them right here. Okay, so the thing about the genes that’s kind of … so okay, this grouping is actually about 20 genes that we use to look to-

Dr. Weitz:                           20 genes for insulin resistance, okay.

Dr. Beckman:                     Yeah. This is one thing that I think is very important and I touched on a bit, it’s these grouping of genes. Often we hear about one specific gene all the time, but it really is how they work together. That’s one thing I really like about this company too, like is that it’s never just one gene and then you create this whole idea around it.  We hear about these famous genes, sort of from certain people and I think a lot is built on that-

Dr. Weitz:                           Some of these genes are now being referred to as diseases. “I have MTHFR”

Dr. Beckman:                     Right, exactly. And there’s actually a kind of a little joke that a friend of mine who’s another Functional Medicine doctor said. He just, it’s kind of like, no one would know that unless you recently went to a Functional Medicine doctor and you were told you now have this terrible disease that you need to change all these things.

Dr. Weitz:                           Or they could have gone to Dr. Google or Dr. YouTube.

Dr. Beckman:                     Yes, I know the amount of people actually that talk to me and ask about it, again, I just say actually we look at a bit of a grouping of a lot of genes to see how big of an impact that might be for you.  But that’s just one of them. You know what I mean? There’s a whole lot that are, like I said, they are getting well known.

Dr. Weitz:                           When a patient has … How do you determine how significant these genes are? Let’s say you have one copy, which means you’re … or heterozygous or two copies, which means you’re homozygous or you could have multiple copies of one, multiple versions of one copy of these different genes. How do you know when it really matters? And then do you need to wait until they have positive testing in terms of a fasting glucose and Hemoglobin A1C, et cetera?

Dr. Beckman:                     No. One thing that I like about this is that they give us clues. They give us areas to focus on. There are certain genes that have more weight than others. That’s why these ones, it is true, the ones that are more well known have more weight. But again, it’s still the grouping. Let’s say you have one that is more weighted and more significant, but then you have three that are totally normal. Then that average is your risk down a little bit less than if you were just looking at that one gene, because you do need to look at them together. I mean, the genetic code doesn’t work independently and genes don’t work independently unless it’s something very specific that has a genetic, very specific genetic disease where there’s one …  When you have that switch on one specific thing that it actually creates a very specific pattern or disease in somebody. But those aren’t as common as these groupings creating a probability, if that make sense.

Dr. Weitz:                           Let’s say they have an increased risk for insulin resistance, but they actually have a fasting glucose of 80 and a fasting insulin of three and their Hemoglobin A1C is 5.0. What do you do with that?

Dr. Beckman:                     This is one other thing I love. I love having this and then backing it up with data. I love using even regular lab tests and then Functional labs to basically get a better idea of what’s actually happening right now. Because the genes give you your blueprint and some of your probabilities; your lifestyle, your emotions, your exercise habits. Those are what really can turn things on and off and make significant change. When you have some of these probabilities and then you look and see what their Hemoglobin A1c it’s, it’s steadily creeping up and creeping up, then this person needs to make significant changes so that they can revert back to somebody who doesn’t have those extra probabilities or increased probability of getting the type two diabetes.

Dr. Weitz:                           Does everybody who has some of those genes that code for increased insulin resistance, do they all need to follow a low carb diet?

Dr. Beckman:                     Well, so again, I would say I like to look at them individually. Certain people constitutionally, according to Chinese medicine do better with some starches and grains. A lot of people don’t, especially if there’s some sort of autoimmune issues happening, things like that. I personally don’t think anybody does well with refined sugar. I mean, that’s not any type of news, but my main thing is really getting people just cognizant of how much sugar they’re getting, that they’re not even realizing. Most people never flip something over and read the label.  I tell everybody if there’s double digits, 10 grams of sugar in something, you should not be eating it. And then I give them an amount per day, so a max of 25 grams a day. My goal, like I said, is I don’t want people really having much sugar at all. There’s no benefit of having refined sugar. It actually is just more detrimental. And people, once they get it out, they start to feel better and it has a long reach, I believe in their health span in multiple ways.

Dr. Weitz:                           Right, okay. Give us some other examples of what you get from doing the genetics. And then explain how epigenetics factors in here.

Dr. Beckman:                     Sure. The epigenetics part really is … that is not tested in kind of what you’re getting with the raw genetic data. The raw genetic data shows you what areas you could focus on, so like, which foods would be helpful to silence some genes that might create a problem or the same. It talks about supplements, so sometimes certain supplements would be toxic to somebody if they take too much. But for example, a lot of people were taking a lot of vitamin E for a long time as an antioxidant. It’s one that can be toxic for a lot of people if they take too much of it. It actually shows that-

Dr. Weitz:                          Vitamin E?

Dr. Beckman:                     Yes. But it shows that in the raw genetic data. Some of those are pretty interesting. And then also checking the types of the B vitamins to take, for vitamin D. It shows, which is pretty interesting if people can get the benefit from the sunlight and absorbing it or if they’re not someone that actually can absorb much of the D from sunlight. Because I’m sure as you’ve seen with some of your patients, some people can absorb it really well and some people don’t. Even though they’re in the sun all the time, they’re still deficient.

Dr. Weitz:                           I’m amazed in Southern California how many people get exposed to sun all the time and their vitamin D levels are low.

Dr. Beckman:                     Right. Yes.

Dr. Weitz:                           I think it’s more common than not.

Dr. Beckman:                     Yeah. And a lot of people think … they just think that, and actually I was one prior to testing it is I just thought there’s no way I’m in the sun constantly. And you know, the first time I checked, I think I was at 19 and I literally-

Dr. Weitz:                           Very low

Dr. Beckman:                     … always in the sun because I love sun. I’m just not someone that actually absorbs it from the sun, so I need the supplementation. That’s one thing that I really love again is I’m sure you go by this too, is test, don’t guess.

Dr. Weitz:                           Absolutely.

Dr. Beckman:                     We assume all the time these things that we hear and have known for a while, but they’re not always accurate.

Dr. Weitz:                           Yeah. We occasionally get people with modest amounts of supplementation that their levels shoot up, but more common, it’s really hard to get the levels up. And sometimes doing modest supplementation, like 1000 or 2000 milligrams of vitamin D doesn’t do anything. And it’s not unusual that we have to go to like 10,000 a day to get up to those target ranges that we’re trying to hit, like 50 to 70 or 60 to 80 or something like that, nanograms per milliliter.

Dr. Beckman:                     Right, yeah. And that’s not something from, sort of, in the natural medicine world, we have not heard that. We just thought, if you’re out in the sun and the right hours of day without sunscreen, you’re fine. And as you know, vitamin D is one of those precursors that it’s implicated in over 200 genetic processes. It’s crucial on so many levels that it’s actually in an optimal range.

Dr. Weitz:                           Yeah. And of course we can measure vitamin D receptors and whether people are going to respond and produce vitamin E or absorb the vitamin D that they take in.

Dr. Beckman:                     Yep.

Dr. Weitz:                           How does genetics, how does that change a detox program?

Dr. Beckman:                     Sure. I can give an example of myself for one. I’m someone who, since high school had been doing detoxes. I studied Dr. Schultz’s products, got into that. And since you’re from LA, right, or you’re in LA. I’ve been doing Dr. Schultz’s products since I was a kid. I’ve been obsessed with detoxes since I was little and I did them seasonally. All of that.

Dr. Weitz:                           And what did most of these detoxes consist of?

Dr. Beckman:                     Sorry. Okay, so it’s like a bowel, kidney, liver detox with herbs and just raw foods. It was five days, but I would say–

Dr. Weitz:                           For five days you eat raw foods and you take a series of supplements in pill or tincture form?

Dr. Beckman:                     Yeah, tinctures, pills and tea. And I did this for years. Well, I wouldn’t say I loved it, but I love detoxing. And so I really thought that I was just cleaning everything out. It was great. And then I even did these things for preconception planning. I’m a huge fan of preconception planning, checking for heavy metals, things like that. And I had my daughter almost eight years ago now, but I thought I did all this to clean myself out. I recently did some testing with Great Plains Lab. I love their organic acid tests, their environmental toxin tests. And it turns out on my environmental toxin test, it was one of the most toxic they’d ever seen. No, it was terrible.  And, and I mean, granted, I live in LA, so there’s that factor, which is very big. But I literally have … I don’t use plastic ever. I don’t use any … ever buy bottled water, only grass fed meat. I’m one of the cleanest people that you would come across. Like I said, I even created my own skincare company because I was concerned that a lot of the things were stored in plastic when they had essential oils and-

Dr. Weitz:                           What kind of toxin showed up and where do you think you got these from?

Dr. Beckman:                     Well, basically almost, I think it was 15 out of the ones that they tested were all 75 to 95%. That means that I was in the highest group possible.

Dr. Weitz:                           Right, what kinds of toxins were these?

Dr. Beckman:                     They were still the ones from the plastics, so the Bisphenol A, the ones that have … they are all with the gasoline, very high. And that makes sense because I live in LA.

Dr. Weitz:                           Okay. Like MTBE and-

Dr. Beckman:                     Yeah. The MTBE was very high, the perclorates, high. That again is from the air generally and the rocket fuel, believe.

Dr. Weitz:                           Which was dumped into the water and-

Dr. Beckman:                     Yeah. And that’s the thing, but I-

Dr. Weitz:                           Still found in Colorado River where we get some of our water in Southern California.

Dr. Beckman:                     Yeah. And again, those things aren’t filtered out with filtered water. I mean, not everything can be. I mean, again, it depends on your system that you have, but a lot of the organophosphates from pesticides, things like that. And that’s the thing that was shocking to me-

Dr. Weitz:                            That might be a good marketing strategy. Get your rocket fuel water.

Dr. Beckman:                     I know. And it seeped into the groundwater. I mean, it’s terrible. And you know, you do everything you can, right? I mean, I buy organic products, but then I still eat out at restaurants. And I tell this to patients too. I mean, the meat is not grass fed out. And generally the fruits and vegetables aren’t organic, unless you’re really going for that. That’s the thing is that I know a lot of it is because I live in Los Angeles, but the main factor which came back to my genetics is that I don’t process or make glutathione like much at all.  I had never taken any precursors for glutathione. I’d never taken glutathione. I was doing these traditional detoxes that were still very strong, but they didn’t actually work for my system. I had also gone to the process where I was doing IV glutathione and it made me so sick within about five seconds. I realized that something was … that pushed toxins into my system and they were recirculating and then I felt sick instantly.

Dr. Weitz:                            That’s one of the things that can happen when you do a detox is a lot of these toxins may be stored somewhere in your body. And if you use a strategy that helps remove some of these toxins, they may not get all the way removed. They may come out of storage into circulation and then that can create a lot of detox reactions like you’re describing.

Dr. Beckman:                     Right. And so now the products I use are very different and they go into soak those up so that you basically … my whole goal is to really minimize any detox reactions that people have. And I think a lot of the things that we used before, if your body and detox pathways weren’t prime to deal with that, that’s where everyone’s getting really sick and nauseous and headaches and those are just minimal side effects. It’s really important to do a detox properly and prime the pathways, and have the binders in there that will soak it up properly.

Dr. Weitz:                           Okay. So you’re saying your detox now that you’re doing involves binders and what are some of the substances involved in binders?

Dr. Beckman:                     I use some products that have fulvic and humic acids. I like them a lot. The way that they have been described to me is that they are much more effective and powerful at soaking up things beyond an activated charcoal because the activated charcoal does not have enough energy left in it to actually go in and soak a lot of that.

Dr. Weitz:                           Activated charcoal is one of the most common substances being sold as part of a binding product or separately. And in fact charcoal is right now being used in many consumer products. You can find-

Dr. Beckman:                     It is. Charcoal lemonade.

Dr. Weitz:                           Exactly.

Dr. Beckman:                     And charcoal toothpaste is everywhere.

Dr. Weitz:                           Yeah.

Dr. Beckman:                     I have changed what I’ve done-

Dr. Weitz:                           Those two, what other substances do you find effective for as binding agents? What about modified citrus pectin?

Dr. Beckman:                     Yeah, I like that. And it’s-

Dr. Weitz:                           Cilantro.

Dr. Beckman:                     Yes. And it just depends the … everyone is a little bit different, so some people can handle one type and other people can’t. Some people are so sensitive and so bound up that they basically really need something super gentle. And sometimes I start people off with the homeopathic detox so I can go drop by drop because there are patients that are that sensitive. There’s a wide spectrum, but I think that it’s really important to prep the body before dumping it, like getting all these toxins just dumping into your system without anywhere to go.

Dr. Weitz:                           How long should a detox program take?

Dr. Beckman:                     I would say always customize the patient kind of, so that’s why I like the testing because we want to see if there’s mold exposure, what the viral load is, possibly what the bacteria situation is, what’s going on with the gut, fungal issues, metals, parasites. So it all depends.

Dr. Weitz:                           How do you determine what testing to do and what testing is … Do you have a standard screen or does it depend on history?

Dr. Beckman:                     Yeah, it depends on history. I pretty much always run the organic acids test with Great Plains. I love the mycotoxin test if they have anything positive on the oat. I love the environmental toxin test to see what’s happening there. Some sort of heavy metal testing, I use the Mercury Tri-Test a lot from Quicksilver.

Dr. Weitz:                           Okay, so that utilizes a combination of serum, urine and hair mercury testing?

Dr. Beckman:                     Yes. And then still if they need to check for other metals, can do a metals test. Let’s see what else I love. I mean, I add in the genetics so that we can put that piece in there. And then sometimes like a GI-MAP for stool or to see what’s going on in the gut or as a Zoomer test, Gut Zoomer test.

Dr. Weitz:                            Okay. Just out of curiosity, what’s the approximate cost of that genetic test you’re talking about?

Dr. Beckman:                     The genetic test varies based on kind of how many areas you want to look at. People can get, let’s see like-

Dr. Weitz:                           Just ballpark.

Dr. Beckman:                     All right. Like $1,000.

Dr. Weitz:                           Okay. Now they can get a 23andMe or Ancestry for $100.

Dr. Beckman:                     Yes.

Dr. Weitz:                           Is it that much better?

Dr. Beckman:                     Well, I just think that 23andMe is sort of fluff. It’s not actual information that you can utilize much for your health. That’s what I’m thinking, but it has … it’s like, do you turn red when you’re drinking? Do you have-

Dr. Weitz:                           No, but even if you get the raw data, there’s not enough genes there?

Dr. Beckman:                     No. They’ve changed it a bit and there are less, but there … I mean, yes, the raw data on itself is good, but you are giving up your privacy, which I 100% think is not a good idea.

Dr. Weitz:                           I agree. But I doubt there’s any privacy in our society since they’re monitoring every phone call, every email.

Dr. Beckman:                     I know. If someone really needed to, they could link up everything that you … if they were really trying to find that out for you.

Dr. Weitz:                           Your phone is monitoring every place you’re going. Your phone right now knows that you’re talking to me, where you are. I mean, yeah.

Dr. Beckman:                     I know. It’s so scary. You could talk about something your phone’s off and then that’s all your Instagram feed, Facebook feed, you know everything. It’s true there really is no privacy.

Dr. Weitz:                           Absolutely. I got in my car this morning and my phone says it’s 13 minutes to Gold’s gym. How do you know I’m going to Gold’s gym, right?

Dr. Beckman:                     I know. It’s pretty scary.

Dr. Weitz:                          How does the detox program … you were talking about epigenetics changing your detox, so give me a little more meat on the bones there about how you change the detox according to epigenetics.

Dr. Beckman:                     Basically what I do is, I mean I have a program that I use with a lot of people, but what gets tailored is what we focus on first based on what shows up in their labs and then with their genes. If there’s somebody that can process toxins better, then they might not need as much time in the prep phase. Or if there’s somebody who tends to be more sensitive to metals, then we might need to work on that a lot longer.

Dr. Weitz:                           What’s the prep phase?

Dr. Beckman:                     Sorry, so that’s where we … Certain people need certain foundations, so that would be where I would put in certain vitamin deficiencies that they might have or just optimizing some of their nutrient levels so that they’re prepared to start a detox. And then again, and this part is a bit traditional. We still want to make sure that the bowel is functioning really well. If someone’s constipated, you have to get that under control before you start anything.

Dr. Weitz:                           Number one, you want to make sure somebody is not deficient in nutrients. How do you determine that? You do some sort of nutrient panel?

Dr. Beckman:                     Yes, I can do a nutrient panel. The organic acid test does have part of that in there utilized as well. There are special tests you can do in addition to just see. The SpectraCell has a micronutrient deficiency panel, which can be good if people like that. I use the organic acid one quite a bit.

Dr. Weitz:                           Okay, so you’ll beef them up with some nutrients first to get them ready for the detox?

Dr. Beckman:                     Yes. Then we look at their bowel and make sure that, like I said, they’re not constipated. Make sure they’re going to the bathroom twice a day as ideal.

Dr. Weitz:                           Because if they’re constipated, they’re going to be recirculating the toxins, correct?

Dr. Beckman:                     Yeah. And that happens a lot with estrogens and different toxins and things like that. And then we make sure we look at the lymph, the kidneys, and the liver. I have special supplements for that as well.

Dr. Weitz:                           How do you look at those?

Dr. Beckman:                     Sorry, not look. I just mean address-

Dr. Weitz:                           Okay, so you give them supplements to make sure those are working properly?

Dr. Beckman:                     Yes. Yeah. And then we figure out what-

Dr. Weitz:                           What do you give him to make sure the kidneys are functioning properly?

Dr. Beckman:                     Let’s see. There’s some different herbs that, sorry … There are some herbs that I use. I like some homeopathic tinctures too. You mean which specific herbs?

Dr. Weitz:                           I was just curious. You have some kidney formula you like to use in some-

Dr. Beckman:                     I use CellCore products a lot. I really like them. They have a great kidney-liver formula. And then, I mean, I’ve used other ones in the past too. I also use some products from Designs for Health. They have some great detox packets that are super simple and altogether. And then they have some that are spread out, individual products.

Dr. Weitz:                            Okay. Yeah, go ahead. So you support lymphatic’s, the kidneys, the liver?

Dr. Beckman:                     Yep. Then we need to make sure too what’s going on with the gut. We need to see if there’s any intestinal permeability to make sure that we’re working on the lining. I check, if there’s someone who has a lot of autoimmune or food sensitivities, we need to make sure that’s a big factor. See if they need to eliminate some foods just temporarily, if it’s making things worse. Often I see a lot of issues with gluten, dairy and sugar. Nobody really likes to hear that, but initially I just ask if they can try to go off things for maybe 30 days minimum to just see if we can get some information down as well from what they’re putting in their body.

Dr. Weitz:                            What’s a specific food regimen you put them on? You eliminate gluten, dairy, and what else did you say?

Dr. Beckman:                     Refined sugar. And then-

Dr. Weitz:                            And refined sugar. Are there other things or just those three?

Dr. Beckman:                     It all depends on the person. If there’s somebody who already has a lot of issues, we need to see what would be specific for them. Some people think they’re totally healthy and they don’t feel anything from food, so they … it’s a big deal for them to just get off of sugar. I work with the client to see where they are too. But if someone who-

Dr. Weitz:                           Get them off of caffeine and alcohol as well while they’re doing the detox?

Dr. Beckman:                     Yes. The caffeine is less of an issue for me. If someone can get off all those other things and they still want one cup of coffee a day, usually I say that’s okay. But-

Dr. Weitz:                           Especially if it’s organic.

Dr. Beckman:                     Yeah. And I then love Purity and Bulletproof Coffee. I at least send them to ones that are mycotoxin free and tested. And just, yeah, it’s all about, to me, making healthier choices and swaps too. If I can get people to just make some better choices in their life, get off the granola and yogurt, they start their day with that has 25 grams of sugar, get them onto something that’s healthier. I think those are all big wins and can take them a long distance.

Dr. Weitz:                           Yeah. Or their Count Chocula cereal.

Dr. Beckman:                     Oh yeah. Or even cheerios. There’s better things to do. There’s all these … We have to pick our battles, right? And food is a really one that people like grip on and hold tight to or they have, again their favorite cup of coffee with sugar and cream. And so if I can get them to switch to a healthier version of that, then I feel like I’ve had a good win. And that they will benefit greatly. Because again, I say to people, we often have to look at our daily habits cause it’s in our daily habits where we see some of these really big things that make a big difference, so we can change those. It’s very important.  And even hydration. Many people still just don’t drink enough water. And these are core foundations that if you don’t have sleep, hydration, good food and exercise and some form of meditation, it’s hard to build a base from that.

Dr. Weitz:                           How do you know if somebody is drinking enough water and how much water is enough?

Dr. Beckman:                     I look at their caffeine intake for sure. A lot of people are drinking way more caffeine than water, so that’s my first area to start with. I still do go by the half your weight and ounces. I know some people say that works, some people say it doesn’t. I think it’s a good barometer just to start with. Most people though are drinking so little water that I tell them to just double what they’re doing. And honestly for a lot of people they’re drinking two glasses of water a day. Then I say, drink four and that seems like a stretch for them, but it’s not a huge stretch. If I tell someone that’s drinking two glasses to then go to half a gallon, that doesn’t make any sense to me, and they don’t do it. Sometimes it’s baby steps and-

Dr. Weitz:                           Try to meet them where they are and get them to make changes that are reasonable.

Dr. Beckman:                     Exactly. Again, those are some of those things that are in the beginning part of a detox and the prep phase, is really just getting their foundation solid and then getting them prep so that we can then start addressing the things that are more pertinent and causing more damage, I guess I would say. Like the gut bacteria, the fungus, any sort of mycotoxins, viruses, bacteria … sorry, parasites and then metals we do last usually.

Dr. Weitz:                           Okay, so then-

Dr. Beckman:                     It can be awhile.

Dr. Weitz:                           Right, so multi-phases of this program?

Dr. Beckman:                     Yeah. And it’s based on the lab testing to see what’s there. We want to a lot … for people in general, we have things where basically a big host for a lot of different organisms. And so to think that they’re not all living in us I think is sort of inaccurate. It’s basically something’s high. You know, we have viruses that just lie dormant and then they get activated. Basically if we can create our system to be a good environment, then it’s kind of the best shot we have. And then [crosstalk 00:43:16] up things that are creating damage.

Dr. Weitz:                           Let’s do a couple of sample detox programs. Let’s say the person tests high in mercury. What’s your preferred protocol for that?

Dr. Beckman:                     I do use a lot of Quicksilver products and CellCore products. They have really great binders for pulling out heavy metals. CellCore has something called HM-ET, which I really love. But again, this is the thing. This is all done after months of preparation. You don’t just go in and start trying to pull out heavy metals, which is what everyone wants to do. And that’s where people feel really sick. And another thing is heavy metals can reside inside parasites. If you don’t kill the parasites first, then you could be pulling out all these heavy metals and then you haven’t even addressed the parasites and then you could be releasing more metals that you thought you’d cleaned up.

Dr. Weitz:                            Get rid of parasites and clean up the gut, get rid of nutritional deficiencies, show the body up that way, support the basic organs and then go for the metals and the other toxins?

Dr. Beckman:                     Yes. Yeah.

Dr. Weitz:                            Do you incorporate glutathione in that detox protocol for mercury?

Dr. Beckman:                     I do. I do use glutathione even earlier in the phase to just start helping support the liver, helping it support what already is there before we’ve really started to detox. Sometimes using a precursor like NAC, just it depends on how the person is and what they can handle. A lot of clients have had so many bad issues with taking really strong chlorella, things like that. I just have to be careful with … I tend to get a lot of patients who are really sick and really toxic, so it’s just seeing what works for them and creating something that has the minimal side effects.

Dr. Weitz:                            How long does it typically take to get rid of mercury?

Dr. Beckman:                     Kind of depends on the levels and it can take a year, but that’s the whole thing. You know what I mean? That’s at the end. I wouldn’t just target mercury and it would be so rare that nothing would come up before then. I mean, that actually wouldn’t happen. Like, you know what I mean? No one would just have a mercury issue. I’ll just say.

Dr. Weitz:                            Okay, so what’s your protocol for mycotoxins, which is for mold?

Dr. Beckman:                     Right. Again, I do use CellCore products for that. And so I love the mycotoxin test, because then you can see exactly which ones are the strongest. And again, you still have to really prep the body first, of course, which we talked about. And then in Chinese medicine too, like we want to see what’s happening with the lungs. We want to support. Sometimes I use some other herbs that are kind of like a lung support. Yeah, I know the mold … that’s the thing about mold is it can go everywhere and anywhere, so that’s why it’s extra detrimental. But a lot of people, a big part is from inhalation. I work on a bit with stored grief and sadness with the lungs and we want to make sure just to always addressed the emotional issue of things.  And detox is stir up a lot, because they deal with lungs, they deal with liver, which is related to anger and resentment and depression. A lot of people have some issues with that. We just want to make sure that we’re addressing the emotional side of things as well as the physical.

Dr. Weitz:                            Okay. How do you address the emotional side of things?

Dr. Beckman:                     Well, I love acupuncture and if someone’s not local or not getting acupuncture on the side, there’s visualizations with color that support each organ. And as with Chinese medicine and this people know, the emotional side and the physical side, they’re intertwined. When we’re treating a physical condition, we want to also address the emotional aspect of that. One of my favorite things again is acupuncture, meditation, and then some visualization.

Dr. Weitz:                            Okay. I think that’s pretty good. Everything is-

Dr. Beckman:                     Yeah, we covered a lot.

Dr. Weitz:                            Yeah. I think we covered a lot. Any other specific things you’d like to make the listeners aware of or talk about?

Dr. Beckman:                     No. My main thing is that, and this is what I talk about with my clients every day, is you have a choice every day. You choose what food you put in your body, you’re choosing what products you put on your body, you’re choosing some of the thoughts you have, the way you live or lifestyle. And it’s so crucial for us to be mindful of what we’re doing that everything that we’re doing is either feeding our body or doing something that’s going to make it harder and possibly leading to disease down the future.

We have so much control and I think we forget that. And I see our body as a machine and what we’re doing and putting into it as fuel, and we want to be putting the best quality fuel in it. And you know, we have these beautiful bodies and so we just need to take care of them and you get to do that.

Dr. Weitz:                           All right. How can listeners and viewers get a hold of you and find out … how can they contact you?

Dr. Beckman:                     Sure, my website’s, drashley.com, and that’s D-R-A-S-H-L-E-Y.com. And I always offer a complimentary call if someone wants to just see if we’re a good fit to work together.

Dr. Weitz:                           And so you can work with them by phone?

Dr. Beckman:                     Yes.

Dr. Weitz:                           And if they’re in the Los Angeles area, where’s your practice?

Dr. Beckman:                     I’m in Beverly Hills and in Malibu.

Dr. Weitz:                           Okay, great. Thank you Dr. Beckman.

Dr. Beckman:                     Sure. It’s always fun.

Dr. Weitz:                           Thank you.

 

 

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Dr. Brian Mowll discusses Preventing and Reversing Diabetes with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

3:08  Type II Diabetes is more a condition or dysfunction than it is a disease, while Type I Diabetes is a classic autoimmune disease, that usually begins in childhood.  Type I diabetics develop auto antibodies against either the insulin producing cells of the pancreas or insulin itself or against some other part of the blood sugar control system leading eventually to pancreatic destruction. They cannot make insulin and need to be on insulin for life. Prior to the discovery of insulin in the 1920s, Type I Diabetics were unable to store energy and they would lose fat and muscle and waste away and eventually die. Insulin is lifesaving for these patients. Insulin is a hormone secreted by the pancreas that allows us to take excess glucose and store it as energy.  What happens in Type II Diabetes is that the cells become resistant to insulin and our glucose levels in our blood go higher than normal.  The fat levels in our blood as triglycerides and cholesterol also become elevated. Type II Diabetes can cause a lot of damage in the body is the leading cause of adult blindness, lower limb amputation, kidney failure, which leads to dialysis, sexual dysfunction in both men and women, peripheral neuropathy leading to numbness, tingling, and pain in the feet and toes and sometimes the hands, autonomic neuropathy leading to gastrointestinal paresis, and dementia and Alzheimer’s Disease.  The term Type 1.5 Diabetes is sometimes used, but there is confusion about this. It is sometimes used to refer to when Type II Diabetics burn their pancreas out and become insulin dependent. Other people use Type 1.5 Diabetes to refer to LADA, which is Latent Autoimmune Diabetes of Adulthood, which is similar to type I but it happens later in life, tends to progress slowly, and may not lead to total pancreatic destruction. Some LADA patients may not need to be on insulin. There’s another condition called MODY, which is a mutation that leads to high blood sugar that is also sometimes referred to as Type 1.5.

9:20  Some of the reasons why Type II Diabetes is so prevalent today include poor diet, processed and refined foods, including sugar, flour, hydrogenated oils, and industrial seed oils, like corn, canola, safflower, cotton seed, and soybean oil.  These all drive metabolic dysfunction. And then there are all the additives, preservatives, and other chemicals in our food supply, as well as sedentary lifestyles.  Also, stress, poor sleep and toxins can block insulin receptors, leading to weight gain and visceral fat stored around our organs, which can lead to diabetes.  Gut dysbiosis and hormone imbalances can also be contributing factors.

12:58  To properly assess patients with prediabetes or diabetes we should monitor both blood sugar and insulin levels.  Dr. Mowll recommends that patients get a glucometer, such as the Precision Neo by Abbott, and start checking their sugar levels regularly.  Besides glucose, we should measure Hemoglobin A1C, which is a measure of damage to hemoglobin in red blood cells by elevated blood sugar. Most people think of it as a measure of blood sugar over the last three months but it is really a measure of glycation damage to proteins from sugar, which essentially carmelizes them.  When we see damage to those cells, we know there is likely damage being done to the lining of the blood vessels and to the kidneys and to the brain and to the other parts of the body. Dr. Mowl said that he likes to picture creme brulee, which is made by putting some sugar on the top and heating it up with a blow torch, forming a hard crust. That’s what happens to our cells in our brain, in our kidneys, on our blood vessels. And that’s what leads to a lot of the complications of diabetes.  Normal Hemoglobin A1C is below 5.6, but ideally it should be below 5. Hemoglobin A1C at 5.7-6.4 is considered prediabetes and at 6.5 it indicates diabetes. We should also monitor insulin levels because if the body is keeping glucose levels down with high insulin levels, that’s not good either.  High insulin is also inflammatory in the blood stream.  In order for the body to degrade a lot of insulin, it uses insulin degrading enzyme and that’s the same enzyme that degrades amyloid plaque in the brain, so high insulin can increase amyloid plaque buildup in the brain, leading to Alzheimer’s Disease.  While the lab range for normal for fasting insulin is large, such as 0 to 21, the functional range is 2.5 to 6.  If it’s above 6, it is elevated.  We can assess insulin resistance with the HOMA-IR score which is computed by multiplying your fasting glucose times your fasting insulin and dividing by 405 and it should be close to 1.  If it is above 2, that indicates insulin resistance.

24:51  The Glycomark Test is another type of calculation that estimates insulin resistance using triglyceride levels along with fasting glucose.

26:03  Insulin resistance is when our cells stop responding properly to the hormone insulin. Under normal circumstances, when we eat glucose and other carbohydrates, it triggers insulin release. But even fat and protein will stimulate some insulin release, though nowhere as much as carbohydrates. Insulin stimulates us to store extra energy in the liver, in our muscles as glycogen, and in fat cells.  What happens in insulin resistance is that if the muscle cells don’t respond to the signals from insulin to store glucose as energy, then glucose will build up in the blood stream, hyperglycemia, which is the hall mark of diabetes.  The vegan community claims that fat in the diet causes insulin resistance, but that is not true. Fat in the blood stream, in the liver, and in the muscles, which results from eating too many carbohydrates, is completely different than fat in the diet.  If somebody were to eat only a thousand calories per day of only fat, they’re not going to build up fat in their organs because they are going to use all of that fat as fuel. Fat in the organs (not fat in the diet) is one of the causes of insulin resistance, along with chronic inflammation. When we eat a lot of carbs, we secrete a lot of insulin and that down regulates the insulin receptors. Also, toxins, such persistent environmental pollutants, can cause insulin resistance.

32:23  Dr. Mowll recommends for most patients with diabetes or prediabetes to follow a low carb, though not necessarily a high fat, diet.  Even the American Diabetes Association, which has tended to promote a lower fat, higher carb diet with a focus on vegetables, whole grains, and fruit for diabetes over the years, says that carbohydrates by a long stretch have the greatest impact on blood glucose levels and blood insulin levels.  For the first time this year, the ADA even recommends that taking a lower carb approach is a viable option for diabetics.  Dr. Mowll recommends that his diabetic patients start with 75 grams of carbs per day, which is about 300 calories from carbohydrates per day, which usually ends up being 10-15% caloric intake.  Dr. Mowll means net carbs, which means that if a food has 15 gms of carbs but if 12 of those grams will come from fiber, then there is only a net 3 grams of carbs.  Fiber doesn’t really have any net effect on blood sugar.  The rest of the diet will consist of protein and healthy fats.

39:09  Carbohydrate foods that are lower on the glycemic index, slow burning carbs, are better for blood sugar control.

40:37  Intermittent or prolonged fasting can be helpful when implemented into a nutrition program at the appropriate time.  Dr. Mowll said that he does like his clients to eat a meal within an hour and then not eat again till the next meal, say 3-5 hours later and not eat in between. This period of not eating allows your system to reset and your glucose and insulin levels to fall back into line.  He does not find that grazing works well for most clients. When Dr. Mowll starts with a new client he does like them to eat a small meal within an hour of waking up to help with blood sugar regulation.  A 24 hour fast can also be helpful at some point in their program,  but it can be tricky if the client is taking medication or insulin and it is best to heal any thyroid or adrenal problems prior to doing this.

44:30  Dr. Mowll has developed some specific subtypes of Type II Diabetes, which facilitate different treatment strategies. Type O is over insulinized and these are patients that produce too much insulin and they’re insulin resistant and tend to be overweight and have an apple shape.  Type I is the insulin subtype and these patients are under insulinized. They tend to be normal weight or thinner and they don;t produce as much insulin as they’re supposed to when they eat. Type S is the stress type and this stress can come from lack of sleep, from gut dysbiosis, from mental or emotional stress, from chronic pain, from hormonal or other imbalances, or from chronic infections.  Type H is a hormone imbalance that affects blood sugar and that can be sex hormones or thyroid or adrenal hormones.  These categories can help guide the patient care.

48:42  There are various nutritional supplements that can be helpful with patients with prediabetes or diabetes.  Some of the most beneficial supplements are things that we find in our food, like omega 3 oils, vitamin D, chromium, zinc, and magnesium.  It is best to get these from our food, though supplementation can be helpful as well to get the optimal amount.  There are also herbal, botanical based supplements, like cinnamon, berberine, and turmeric or curcumin that can be very helpful.  EPA and DHA, which are omega 3 fats from fish oil, should be at a dosage of one and six grams per day. Eating fish is helpful, though there is risk with fish due to the mercury and other toxins contained.  Dr. Mowl recommends a vitamin D level of between 40 and 70 ng/mL, so typically it means supplementing with 5,000 IU per day and sometimes up to 10,000 IU per day. For people with diabetes, there’s a clear connection between vitamin D and insulin sensitivity and blood sugar regulation.  It is also a good idea to add some vitamin K2 with higher dosages of vitamin D.  Dr. Mowll also finds chromium picolinate or polynicotinate important for glucose regulation, so he recommends a supplement of between 200 and 1000 mcg per day. Dr. Mowll also likes to use vanadium at 20 mg for a short period of time since it can have insulin-like effects on the cells and he has seen it helpful for blood sugar regulation, esp. in patients who don;t make enough insulin.  Magnesium is beneficial. Berberine is an alkaloid compound found in goldenseal and other flowers and it acts in several different ways to improve glucose utilization and insulin sensitivity.  Berberine has many of the same mechanisms of action of metformin and can be used synergistically with metformin and allow a lower dosage.  Too high a dosage of metformin can be stressful on the gastrointestinal system and it can deplete vitamin B-12 and CoQ10, which doesn’t happen with berberine.  Dr. Mowll like green drinks and chlorella, which can be very detoxifying and energizing.

 

 

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Dr. Brian Mowll is the founder and medical director of SweetLife Diabetes Health Centers. He is a master licensed diabetes educator and is certified to practice Functional Medicine by the Institute of Functional Medicine. He organizes the highly successful annual Diabetes Summit and consults with clients worldwide as The Diabetes Coach and you can find more information about the Diabetes Summit and his Mastering Blood Sugar course and you can down his free Blood Sugar Manifesto at his website, DrMowll.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please give us a ratings and review on Apple podcasts or wherever you get your podcasts.

Our topic for today is the prevention and treatment of diabetes. 90 to 95 percent of those with diabetes have type two. Diabetes and prediabetes are epidemic and the prevalence continues to increase in the United States and around the world. 9.4% of adults in the U.S. are diabetic, as many as 15% in some of the states, and this equates to approximately 30 million Americans ,and 87 million people in the U.S. have prediabetes with some estimates quite a bit higher, especially since many people do not know that they have this since at this stage there may not be any symptoms. And rates are especially climbing among children and teens. At least one out of three, and possibly as many as one out of two Americans have diabetes or prediabetes.

And diabetes is a particularly nasty disease.  It significantly increases your risk of heart attack and stroke. Diabetes is the number one cause of chronic kidney disease and kidney failure, and it accounts for 60% of all lower limb amputations. Diabetes frequently results in diabetic retinopathy, which can cause vision loss and blindness. Diabetes also increases the risk of various other eye problems including glaucoma and cataracts. One of the most common complications of diabetes is diabetic neuropathy, whose symptoms include tingling, numbness, and or pain in the extremities, especially in the feet and legs. Diabetes also significantly increases the risk of cognitive decline as well as the risk of falls in older people. And the biggest tragedy is that diabetes is largely preventable.

Dr Brian Mowll is the founder and medical director of SweetLife Diabetes Health Centers. He’s a master licensed diabetes educator and certified to practice functional medicine by the Institute of Functional Medicine. He organizes the highly successful annual diabetes summit and consults with clients worldwide as a diabetes coach. Dr Mowll, thank you so much for joining me today.

Dr. Mowll:           Thank you so much for having me. Excited to be on the podcast.

Dr. Weitz:            Excellent. Can we begin by explaining … Perhaps we can begin the discussion by explaining what type two diabetes is and why is it so prevalent today?

Dr. Mowll:           Yeah, that’s a good question. You just did a good job of laying out some of the statistics and facts and some of the scary things about diabetes. You’re right, it is the leading cause of adult blindness, lower limb amputation, kidney failure, which leads to dialysis, causes sexual dysfunction in men and women, leads to other hormone imbalances. There’s common issues with thyroid disorders and we see other complications like dementia and Alzheimer’s disease and, as you mentioned, both peripheral and autonomic neuropathy, so that leads to gastrointestinal issues from the autonomic neuropathy and we see lower limb, even sometimes in the hand, usually in the feet and toes, numbness, tingling, pain, sometimes very severe pain, resulting from diabetes and the difference between type one and type two, which will help me to kind of talk about what type two is, is really night and day. They’re a totally different disease.

In fact, I oftentimes wish they didn’t have the same name. Type I is a classic disease. It’s an autoimmune condition where usually sometime in childhood, I’ve seen as young as under a year to as old as late teens, they will develop auto antibodies against something in the blood sugar regulation system. It could be the insulin producing cells of the pancreas or enzymes that are involved in insulin production or insulin itself, but some sort of auto antibody against the blood sugar control system often leading to pancreatic destruction. The pancreas, the organ that makes insulin, which controls blood sugar, gets destroyed, and therefore people with type one diabetes need to be on insulin for the rest of their lives. Before insulin was discovered in the 1920s or at least isolated and formulated in the 1920s, there was no cure or even treatment really for type one diabetes.

And what happens there is people waste away. Essentially, they can’t store energy, so they lose all their fat, they start to lose all their muscle mass, they become almost like cachectic like a cancer patient would, and eventually wither away to nothing and their organs start to malfunction. In those cases, insulin is life saving and they need to be on insulin for the rest of their life. Type two diabetes, completely different. Type two diabetes is more of a condition or a dysfunction than it is even a disease. And what happens in type two diabetes is we make plenty of insulin, but our cells become resistant to it. Again, insulin is a hormone made by particular cells called beta cells in the pancreas, which helps us to store energy, in particular glucose. We release insulin when we eat or when our glucose levels in our blood start to get higher than what is considered normal, and we take that sugar and we store it away for later use.  And that’s the role of insulin. When the cells don’t respond to that hormone anymore, though, we can’t store away that extra fuel, so the glucose levels in our blood go up. Also the fat levels in our blood typically go up, so we see high triglycerides, which ultimately leads to high cholesterol. We see high glucose, which leads to all sorts of problems, and damage that we talked about earlier.

Dr. Weitz:            I guess there’s even a diabetes type 1.5, I was talking to another doctor about.

Dr. Mowll:           Yeah, type 1.5 is kind of a slang term, but there are other forms of diabetes. So I try to steer away from that, because there’s not a lot of agreement on what it actually is.

Dr. Weitz:            Oh, okay.

Dr. Mowll:           Some people use type 1.5 to describe people who have type two diabetes and their pancreas burns out, and then they become insulin dependent, which I would call insulin dependent type two diabetes, but other people use it to describe what’s really known as LADA, L-A-D-A, Latent Autoimmune Diabetes of Adulthood, and that is a condition where it’s similar to type one, it’s an autoimmune manifestation that affects the blood sugar regulation system. Again, there’s about four or five different antibodies that can be affected here and different mechanisms within that, but oftentimes leads to destruction of the pancreas. The difference is it happens later in life, so typically past the age of 20, and it’s much more slowly progressing and may not lead to total pancreatic destruction. We have a lot of LADA clients, for example, who don’t need to be on insulin. You can just maintain good blood sugar with a low carb diet and exercise and so forth. But that’s oftentimes described as type 1.5. There’s another thing called MODY, which is a sort of a mutation that leads to high blood sugar. And there’s other things that sometimes people call type 1.5, but I think the big one is this LADA condition, which is an autoimmune diabetes that instead of affecting kids, affects adults and shows up just a little bit differently.

Dr. Weitz:            Okay, cool. And so why is diabetes so prevalent today?

Dr. Mowll:           Well, yeah, that’s a good question. And let’s say type two diabetes, for sure. I think type one diabetes is probably on the rise slightly as well, but not nearly the epidemic that we see in type two diabetes. And again, if we, I like to look at type two diabetes as a spectrum. We look at it almost like a spectrum dysfunction where we can put along that spectrum obesity, we can put along that spectrum metabolic syndrome, which is elevated blood sugar, elevated lipids, high blood pressure, overweight, and there’s other factors that can be looked at as well. Then I would say even dyslipidemia, which is just elevated cholesterol or triglycerides or abnormal lipids. PCOS, which is polycystic ovarian syndrome, is also related to this. Prediabetes and type two diabetes. To me, that’s a spectrum there and it doesn’t necessarily … You don’t necessarily get all of them and it doesn’t necessarily progress that way, but to me these are all a cluster of problems that are related to the same thing.

And ultimately, type two diabetes is the pinnacle of that. It’s sort of the ultimate metabolic disaster, where our lifestyle and our environment come together to create this perfect storm, which leads to metabolic breakdown. If we want to get more specific on that, poor diet, processed, refined foods, including sugar and grain-based foods as well as fats. We see things like hydrogenated fats, which have kind of been phased out, but most of us grew up eating a lot of those. And we still see refined vegetable oils, quote unquote vegetable oils, industrial seed oils, like corn, canola, safflower, cotton seed oil, soybean oil and so forth, these are highly processed, refined fats that can drive metabolic dysfunction. And then all the additives, preservatives, and other stuff that’s jammed into our food, we see more sedentary lifestyles.

People aren’t moving the way that we used to move. We have more sedentary jobs. We don’t get as much physical activity as we used to get in our evolutionary history. We have more stress, we’re getting poor sleep, we have more toxins in our environment, which end up blocking insulin receptors and leading to weight gain and visceral obesity or fat stored around the organs, which can lead to diabetes. We have gut dysbiosis and dysfunction hormone imbalances, and the list goes on and on. All of these things are part of this group of contributing factors and causes that lead to this metabolic sort of perfect storm, which ultimately can put us along that spectrum of gaining weight, becoming insulin resistant, which I mentioned earlier we can talk more about, and then ultimately leading to prediabetes and type two diabetes.

Dr. Weitz:            Okay, cool. Which lab tests do you think are most beneficial for patients to screen for potential diabetes or who already have existing diabetes?

Dr. Mowll:           Well, there’s really two problems in prediabetes and type two diabetes. The first is high blood sugar, but the second one is high insulin levels or hyperinsulinemia. For sure, you should be checking your blood sugar, and I actually recommend that everybody goes out and gets an over the counter blood sugar meter. I recommend one by Abbott called the Precision Neo, N-E-O. It’s relatively inexpensive, you can get it at any drug store. You don’t need a prescription and you can check your blood sugar whenever you want, after meals, first thing in the morning, before you go to bed, and it gives you some realtime feedback. It’s a great tool. I always say it’d be nice if we could measure every test that way, if we could check our thyroid function with a pinprick, if we could check our cardiovascular markers with a pinprick, it’d be, and it was cheap enough, affordable and easy to do, we’d have a lot more awareness when it comes to biomarkers.

So anyway, we have that with glucose, so let’s check it. Secondly, there is a test called hemoglobin A1C, which is sort of the … Becoming the standard, not quite the standard yet, but becoming the standard in type two diabetes management. It’s not a perfect test, but it’s a really good test, and essentially we describe it as sort of an average of your glucose over the past three to four months. What it really measures is damage to red blood cells, hemoglobin, done by elevated blood sugar. There’s a certain of these A1C receptors on hemoglobin and red blood cells that can be glycated, and when it gets glycated, it means there’s sugar molecules bound to them. And when it gets above a certain percentage, we know that the sugars are running too high, actually causing damage to those cells.

And the problem is when we see damage to those cells, we can extrapolate that and say, “Well, good chance there’s damage being done to the lining of the blood vessels and to the kidneys and to the brain and to the other parts of the body,” which are at risk when it comes to high blood sugar. Hemoglobin A1C is a much more stable marker. Normal, if anybody wants to go get one, is 5.6 or less, 5.6% or less. We like to see it around five. Most of our clients will end up with an A1C between 4.8 and 5.5 percent. Diabetes is diagnosed at 6.5 or greater, and prediabetes is 5.7 to 6.4, so that’s the hemoglobin A1C. As far as …

Dr. Weitz:            I’ve heard you describe the glycation, which not everybody is familiar with, as caramelizing the proteins.

Dr. Mowll:           Yeah, so glycation is what the hemoglobin A1C test measures on the red blood cell, but other cells can get glycated like brain tissue, like the lining of our blood vessels and you’re exactly right. What happens is that high, that sugar, that elevated glucose circulating around the bloodstream acts as an oxidant and your audience has probably heard of oxidative stress, which is like rust on a bumper or the browning of an apple when you take a bite out of and leave it on the counter, that oxidation glycation is similar, but instead of oxygen, it’s glucose doing the damage. It binds to certain protein molecules along, in those cells. And yeah, caramelizes it like we like to picture creme brulee, they put some sugar on the top and heat it up with that little blow torch and it forms that hard crust. That’s what happens to our cells in our brain, in our kidneys, on our blood vessels. And that’s what leads to a lot of the complications of diabetes.

Dr. Weitz:            That’s pretty scary.

Dr. Mowll:           Yeah, pretty nasty.

Dr. Weitz:            Do you recommend a glucose tolerance test where you challenge them with sugar and then measure the glucose again?

Dr. Mowll:           It’s an interesting test and I think it can be really helpful. If people have diabetes already, I don’t recommend doing it typically because, essentially you’re … It’s like somebody who you know has celiac disease saying, “Well, let’s have you go eat a whole loaf of bread and a bowl of pasta and just kind of see what happens.” It’s kind of mean, right? So I don’t typically recommend it for people who have diabetes, but if you are in the prediabetic range or your blood sugar, let’s say you go in and have a fasting blood sugar test, and normal by the way is around 76 to 92. Mid-80s is kind of perfect, so let’s say you come back and the test is 99 or 103 or something like that, then you may want to consider going and having a glucose tolerance test done. What you do there is take about a, it’s usually a 75 gram load of glucose, which is like a sugar syrup that you drink, they check your blood sugar before and then they’ll check it at intervals after that. Usually it’s 60, 90, 120 minutes.

You can also check insulin. So I mentioned a few minutes ago the other thing that happens with type two diabetes and prediabetes is elevated insulin levels. You can also check insulin as part of a glucose tolerance test. It’s called an insulin response test. And you would, again want to check fasting and then you can see what happens to your insulin levels. Sometimes the glucose levels look okay, so fasting glucose is okay, maybe it goes up a little bit too high after that glucose syrup. The threshold to diagnose diabetes at that point is 200, so that’s really high. If you do the glucose syrup and your blood sugar goes up to 180, they say you’re prediabetic, not type two diabetic, but that’s still very, very high. Maybe it goes up higher than it should and then comes right back down. You may not know you have a significant problem, but if you check the insulin, sometimes what you’ll see is maybe fasting, it’s normal, but when you take that glucose load, it shoots up super high. The insulin post glucose challenge should not really ever go above 30, and sometimes we’ll see it go up over a hundred …

Dr. Weitz:            Wow.

Dr. Mowll:           After a glucose challenge, and so what’s happening there is the body’s keeping the blood sugar down, but it’s doing it by releasing like a surge of industrial strength insulin in order to keep the blood sugar down, and that’s not okay, because that insulin causes us to store fat, particularly around the organs and in the liver, it causes us to, it’s inflammatory, so it circulates in our bloodstream inflaming the blood vessels. High insulin levels needs be degraded and it’s degraded by an enzyme in the brain that also degrades amyloid plaque. When we’re degrading all that insulin, we don’t have that enzyme to degrade amyloid plaque, so we get plaque build up in the brain, which is one of the main links to Alzheimer’s disease. High insulin, even without high blood sugar can be a huge problem. And so that’s why, if you’re going to do that test, I would also test insulin at the same time.

Dr. Weitz:            And when we look at fasting insulin, what is the optimal level? Because the range is actually pretty big for the normal, quote unquote.

Dr. Mowll:           Yeah. The way I explain it, a lot of people don’t realize, but that test is not a functional test. Most doctors will not order an insulin test to evaluate metabolic health or diabetes or prediabetes. They’re essentially ordering it when they order it, because they suspect an insulinoma. And insulinoma is basically a tumor on the pancreas that causes the excess release of insulin. That reference range is really tied to insulinoma, not to functionally healthy insulin release. We have to apply a functional range to that. And we do this in other things too, like thyroid. Sometimes there’s a functional range. We do the same thing with triglycerides. When people, when doctors evaluate triglycerides, they’re oftentimes evaluating for cardiovascular risk, not metabolic health. We have a functional range with triglycerides as well. But the functional range for insulin fasting is 2.5 to 6. That’s the range that we use.  And so when it gets above 6, that’s elevated. There’s a calculation you can do called HOMA-IR H-O-M-A-I-R. It stands for Homeostatic Model of Assessment of Insulin Resistance, and you multiply your fasting glucose times your fasting insulin and divide it by 405, and what happens there is it gives you a number, it should be close to one. Once it gets up over two, it’s starting to get elevated and what you’ll see is if you have a fasting glucose of 85 and a fasting insulin of 5, that puts you pretty much right at 1. Once that starts to grow, either the glucose or the insulin, your HOMA-IR score goes up and that’s what many researchers use to assess insulin resistance in research studies.

 

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                                                Now, back to our discussion.

 

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Dr. Weitz:            Are you familiar with the GlycoMark Test and is that a useful test?

Dr. Mowll:           I like it too. That one uses triglycerides and glucose, so if you don’t have a fasting insulin test, you can do that one. I can’t remember the exact formula or the reference ranges, but it’s similar. I think there’s a multiplication then you do like a, you have to use the log function I think on the, on your, on your scientific calculator, which most smartphones have, but it’s pretty cool and it’s, yeah, it’s good. I like it. And basically, it’s a similar theory. The difference is instead of looking at insulin, you’re looking at triglycerides, which is kind of a surrogate for insulin resistance. What we find is the more insulin resistance, the higher the triglycerides go. Most of our clients, after they do some care with us, their triglycerides are down between like 40 and 70, and if they have triglycerides in that range and a glucose under a hundred, they’re going to have a good GlycoMark. Once that triglyceride level starts getting up around a hundred or higher, that GlycoMark’s going to get elevated.

Dr. Weitz:            You just mentioned insulin resistance several times. Can you explain what insulin resistance is.

Dr. Mowll:           Yeah, so I mentioned it earlier, but I didn’t really dive into it too much. We make this hormone insulin, which actually is an energy preserver really. When we eat food, if we eat extra calories that we can’t necessarily burn or utilize at this time, we store them. And insulin is the hormone that’s largely responsible for that storage. What happens is in the presence of when we eat food, glucose in particular triggers the biggest insulin release, but fat will at some level, protein will at some level. When we eat those foods, we release this hormone insulin, it kind of opens up storage. Storage in the liver, storage in the muscle, storage in the fat cells, for extra energy, and we take whatever we can’t burn or use at the time, we sock it away for later use, so to speak.

And what happens in insulin resistance is for one reason or another, and we can get into some of those reasons, our cells don’t respond properly to that hormone. We describe it as like insulin is a key that opens the door that would allow the glucose to get into the cell, if we’re talking about glucose, and if that key doesn’t open the lock, like somebody stuck some gum in there or it’s an old lock and it’s just jammed, then the glucose can’t get into the cell through that door. It has to go look for another door, and fortunately there are many doors on the cells, but the more and more insulin resistance there is, the less doors open and the less we’re able to get glucose into the cell. Eventually it starts to build up outside the room, in this case, and that’s high blood sugar, hyperglycemia, and a hallmark of diabetes.

There are many causes for that insulin resistance. And one of the things I like to caution people is you’ll hear a lot, this is the cause, that is the cause. From the vegan community, we often hear, “Oh, it’s too much fat in the diet. That’s what causes insulin resistance.” Well, that is just absolutely not true. What they’re doing there is conflating this idea of elevated fat and fat in the liver contributing to insulin resistance, which is very much true with fat in the diet. And they’re two totally different things. Fat in the bloodstream and fat in the liver and fat in the muscles is completely different than fat in the diet. Somebody who eats, let’s say somebody were to eat a thousand calories a day of only fat, they’re not going to build fat in their organs, they’re not going to have extra fat floating around in their bloodstream, because they’re going to use all that fat to fuel their body.

It’s not fat in the diet, it’s fat stored in the organs and fat stored in the muscles and fat floating around the bloodstream, which can be one of the causes of insulin resistance. We also have to look at chronic systemic inflammation. That is in fact I think the main driver of insulin resistance. There’s too much insulin. My friend, Dr. Jason Fung uses this as his main cause, which again, I think that I have a little bit of a problem looking at it as the cause, but it is a cause, when you over consume carbohydrates or just over consume food in general, we release these surges of insulin and the way he described it as like an alcoholic becomes desensitized to alcohol, somebody who smokes becomes desensitized to nicotine, drug addicts become desensitized to whatever drug they’re doing. We become desensitized to insulin, and that does happen.

There are studies showing we down regulate insulin receptors when our insulin levels are high, so that’s a cause. We have to also look at toxins. Certain toxins, environmental pollutants, POPs and other chemicals that are found in plastics, in our food supply, in our water supply, in our air, will actually interfere with insulin signaling at the cell level. There’s a lot of different things that can cause insulin resistance, but the bottom line is that lock gets gummed up, the key doesn’t open the lock, the glucose can’t get in to be burned for fuel and it builds up in the bloodstream.

Dr. Weitz:            Interesting. Yeah, I’d like to touch on the toxin thing, but I just wanted to mention, I just opened up an email from Tom O’Bryan and he’s speaking at a diabetes summit and I thought, oh, it must be Dr. Mowll’s diabetes summit and it’s called the Mastering Diabetes Summit. I started looking at it and there were a number of talks about how the ketogenic diet is the worst thing in the world, and I thought, I don’t think that’s his summit.

Dr. Mowll:           Not mine. No, no, no, no. Those are, they’re friends of mine who run that, but they’re heavy duty vegan advocates. Basically they teach plant-based, ultra low fat diet, keep fat grams under 30 a day, which is basically no fat, and eat a lot of fruit. I found that that doesn’t work very well. I’ve had a lot of clients who have tried that and failed spectacularly with it, so it does help some people. There are certain genotypes, phenotypes, whatever, that seem to respond well to a low fat diet. But the large majority of our clients, and I don’t teach a high fat diet by the way either, but the large majority of our clients seem to do really well with a low carbohydrate approach and avoiding processed, refined foods, moderating protein, moderating fat, and getting plenty of exercise, and then supporting the body systems to make sure the body’s functioning optimally.

Dr. Weitz:            When you talk about a low carb, what is the best diet for most people with diabetes?

Dr. Mowll:           Again, I found that a low carb approach makes sense. Carbohydrate foods, in particular, starch and sugar, drive the production of insulin, which is known as a fat storing hormone. I mean, even the ADA and the American Association of Diabetes Educators say throughout their information and they’re very, very conservative, that carbohydrates by a long stretch have, or by a long shot, have the greatest impact on blood glucose levels and blood insulin levels.

Dr. Weitz:            But traditionally, the ADA has tended over the years to promote a whole grain type of lower fat approach until recently.

Dr. Mowll:           Yeah, I’m not saying that they’re pushing low carb, but they do say that carbohydrates have the greatest impact on blood sugar. There’s a little bit of a disconnect there. They have, you’re right. In recent years, they have started to warm up to low carb. This year, in fact, they’re even saying it’s recommended as a viable path, but they tend to go with this idea that diabetics deserve to eat what everybody else eats. That’s sort of their general mission or general approach to nutrition when it comes to people with diabetes. And so they look at it as there’s medications, so there’s no reason for you to suffer and not get to eat cheesecake just because you have diabetes. As ridiculous as it sounds, that’s their general approach. But getting back to the main question, I’ve found, doing this for over 15 years, that …

Dr. Weitz:            By the way, what do we mean by low carbs?

Dr. Mowll:           Right. Carbohydrate foods are foods that are higher in starch and sugar. All foods have carbohydrates, fat, and protein, so there is no one … Even a white potato is not purely carbohydrate. There’s a tiny bit of protein in there and a little bit of fat. They all have all three, but like a white potato is mostly starch. Starch is long chains of glucose. If you’ve ever seen a lap pool and those lane dividers, they have those little buoys that are all chained together, that’s kind of like if you imagine those as glucose molecules, that’s what a starch molecule looks like.  And that’s what’s in a potato, that’s what’s in pasta, that’s what’s in breads and things like that.  When we eat those foods, we have an enzyme called salivary amylase in our mouth that immediately starts to break those apart into sugar molecules, into glucose molecules.  Sugar, on the other hand is a simple molecule and there are different types of sugars, but table sugar, like white sugar, that people sometimes put in their tea and coffee or honey, for example, is basically a combination of fructose and glucose.  Glucose is what we measure in the blood when we measure blood sugar. Fructose is an altogether different molecule that does not raise blood sugar, but gets shuttled to the liver and ultimately, typically stored as fat in the liver. When we eat table sugar, we’re eating about half fructose, which goes to the liver and gets converted to fat, and about half glucose, which gets absorbed into our bloodstream and either gets used in the cells for fuel or gets stored. And again, the hormone that’s in control of that is insulin. Anyway, what’s a good amount of carbohydrate?

Dr. Weitz:            Yeah, like for example…

Dr. Mowll:           You measure carbohydrate in grams, right?

Dr. Weitz:            Yeah, I saw one recent paper where they were recommending a low carb diet that had 45% carbohydrates.

Dr. Mowll:           Right, exactly. So, a 2000 calorie diet, 45% is what like I don’t know, 800 calories, that’s 200 grams of carbs. That’s a lot of carbs. And the average American consumes about two to 300 grams of carbohydrate a day, and sometimes more, sometimes up to four or 500, so the average American is eating a lot of carbohydrate. And so you can see why we get these problems, because it creates these surges of insulin, leads to insulin resistance, fat storage, and all sorts of other things. We usually start at about 75 grams of carbohydrate, which is about 300 calories from carbohydrates a day. That ends up being around 10 to 15 percent of caloric intake and oftentimes will go lower. It’s really, we talk about eating to the meter. We have our clients check their blood sugar. We’ll dial in their macronutrients, starting with about 75 grams of carbs. We put together a protein recommendation and then fill the rest in with healthy fats and, then we do it in a way that’s healthy, non-refined, non-processed as much as possible, and make it accessible and doable for people.

But 75 grams is probably a good starting point. One last thing I’ll mention on carbs is there’s some confusion around net carbs, diabetic carbs, and so forth. We do recognize net carbs. Net carbs is, they’re still listing fiber as a carbohydrate on the labels, I believe. And so if there’s a, let’s say there’s 15 grams of carbs in something like an avocado, but 12 of those grams come from fiber, fiber doesn’t really have any net effect on blood sugar. Maybe a little bit, but not much, we generally subtract those out. An avocado, if it’s got 15 grams of total carbs, but 12 come from fiber, we would call that three net carbs. And that’s how we would count that food.

Dr. Weitz:            Do you find it helpful to look at glycemic index or glycemic load of carbs?

Dr. Mowll:           A little bit. I mean, if you’re eating a lot of carbohydrates, yes. If you’re maybe in the prediabetic range or you’re sort of like pre prediabetes and just, it’s on your mind a little bit or you’re like a marathon runner or an athlete that where you’re eating a fair amount of carbohydrates for fuel. I do think it’s best to eat slow carbs, so carbs that break down more slowly don’t raise your blood sugars quickly. Those would be things like …

Dr. Weitz:            Legumes…

Dr. Mowll:           Or like, yeah. Legume … Beans and legumes, certain grains, if you want to eat grains, like barley, for example, is lower on the glycemic index than something like rice would be, although I generally recommend steering away from grains. There are certain fruits like berries which are considered low-glycemic. Even apples are lower glycemic if you stick with a smaller apple or a half of an apple. You can probably get away with that. Grapefruit and some citrus lemons and limes are low-glycemic. They don’t have a ton of sugar in them. And there’s other foods like that, so you can pull up a glycemic index chart. I generally recommend sticking with the low-glycemic category, not the moderate or high glycemic categories.

Dr. Weitz:            Okay. What about intermittent fasting or fasting? And I know that for years we were preaching everybody needs to eat within an hour of waking up and then you should have a small meal or snack every three hours throughout the day, and now it’s really popular, especially in functional medicine, anti aging and wellness circles to do some version of intermittent fasting, and frequently this involves skipping breakfast.

Dr. Mowll:           Yeah, I just saw today that Dr. Oz is recommending everybody skips breakfast in 2020 now, so you know it’s hit the mainstream at this point. But yeah, intermittent fasting can be an effective strategy, and there’s many different ways to do intermittent fasting. It doesn’t just have to be skipping breakfast, but it can be a very effective strategy. When I start a new client, we actually have them eat something within an hour of waking up. I’m not a big fan of grazing, unless you’re like a vegan and you’re eating just a ton of leaves and plants and that’s the majority of your diet, like a gorilla. A gorilla will eat actually a high protein diet, but they get most of their protein from leaves, but they’re just eating like pounds and pounds, like 50 pounds of spinach a day, you know?

If that’s what you’re doing, then great, but other than that, I recommend eating all your food within an hour and then having like eating blocks. You might eat from 8:00 to 9:00 AM and then from noon to 1:00 and then 7:00 to 8:00 or 6:00 to 7:00 or something like that. And then don’t eat in between. That’ll allow your system to reset itself, your insulin levels can fall, your glucose can get back in line, your body can function normally for a little while and then you can eat again. There is a time and a place for intermittent fasting and I do recommend it a lot once we get deeper into a treatment plan with our clients, and it can be very helpful to allow insulin levels to come down. It probably is not really going to have significant longterm benefits.  Like I haven’t seen a lot with stimulating autophagy and cell repair and things like that on a, tacking on four hours to nighttime fast, but it can help with hormone fluctuations and can help to resensitize our cells to insulin when you’re kind of early in the process. I think a longer term fast can be even more beneficial, and after you fast for about 24 hours …

Dr. Weitz:            Like 24 hours or 48 hours or …

Dr. Mowll:           Yeah, 24 hours, you’re going to kind of burn through all your glycogen stores, so you’re going to deplete all your stored sugar, and so that’s when you really start to tap into your fat stores. The body starts to release more growth hormone after 24 hours, which helps to maintain lean body mass and starts to upregulate fat burning. You really start to gain some additional benefits past the 24 hour mark. Of course, a lot of our clients are on medications, they’re injecting insulin, so having them do a long fast can be really difficult in the beginning, so we don’t typically do that right out of the gate, but at some point along the way we do. And for someone who’s a little bit healthier, someone who has maybe the early signs of prediabetes or something, doing some extended fasting can be really helpful. The only time I don’t recommend doing that is so there’s a known thyroid issue that’s not being managed well or adrenal fatigue or adrenal dysregulation, those people fast, like long fast, can put a lot of stress on the body and so I think it’s best to heal those areas before we do long fasting.

Dr. Weitz:            I understand you have come up with some specific subtypes of type two diabetes as a way to change, modify your treatment strategies.

Dr. Mowll:           Yeah, so I know we’re a little short on time, so I’ll run through it pretty quickly, but there are four subtypes essentially of type two diabetes, and the first is a type O, which is over insulinized, and those are the people that we’ve mainly talked about today. They produce too much insulin, they’re insulin resistant, we can test insulin levels, it’s high, they tend to be overweight, maybe not obese, but at least overweight or have some visceral adiposity, like that apple shape. That’s the most common of the subtypes, but there are three others. The second one is I, which is the insulin subtype and it’s under insulinized. These are folks who have type two diabetes, it’s not type one, it’s not LADA, there’s no autoimmune issue here, but they’re under producing insulin, and there’s a variety of reasons for why that can happen.

They tend to be either normal weight or thinner, on the thinner side, and we check their insulin and it’s actually low and we do an insulin response test like we talked about earlier, and they don’t release insulin as much as they’re supposed to when they eat. Those folks either need to be on a little bit of insulin or oftentimes we can help to sort of revive the pancreas to make more insulin again, and there’s different strategies that we use for that. There’s two other subtypes which are almost completely ignored. The third one is a type S which is a stress type. A lot of people don’t realize the connection between stress and high blood sugar, but it is a very potent connection, and that stress can come from lack of sleep, it can come from gut dysbiosis, it can come from mental, emotional stress, it can come from a loss of a loved one or divorce or separation or move or some other type of major life stress, major life event. It can come from chronic pain. It can come from a hormone or a number of other imbalances in the body, like chronic infection in the blood. These types of stressors will cause our adrenal glands to make extra cortisol and adrenaline, which raises our blood sugar. And that can ultimately lead to adrenal dysfunction, but in the meantime, we get a prediabetes and oftentimes type II diabetes.

And so we have clients where their insulin is normal, their blood sugar is high, but it doesn’t look like a normal diabetes case. What we find out there, they’ve dealt with a tremendous amount of stress or they’ve just got this chronic pain that’s just always nagging them, driving stress into their system, and once that’s handled, oftentimes their blood sugar will come back down into the normal range. The last type is type H, which is a hormone imbalance, and that can be sex hormones like testosterone or estrogen, progesterone, or more commonly, it’s related to thyroid and adrenal hormones. Not to be confused with type S, this is where the adrenal dysfunction is the primary thing. It’s not that there’s chronic stress or there’s something that we can pinpoint there that we can handle, it’s actually the hormone imbalance itself. Hypothyroidism is oftentimes at the root of this, but we see adrenal dysfunction as well, and other things. There are a few other things that can show up like mitochondrial dysfunction and toxins as we mentioned, but those are the main four subtypes that we classify. And when we sort of look at a new client, we’ll sort of think about those four as we create a care plan for them.

Dr. Weitz:            I can see how those could be really useful. We are a little bit short on time. I’d like to make the last question about which nutritional supplements can be beneficial as part of an adjunct to your care for patients with diabetes or prediabetes.

Dr. Mowll:           Yeah, great question. And I break supplements into two categories. So we look at nutrient based supplements and botanical, herb based supplements. The nutrient based supplements are things that we would normally find in our food, things like omega-3 oils, vitamin D, chromium, zinc and so forth. And then magnesium. And then there are herbal or botanical based supplements, which are things like cinnamon, berberine, turmeric, curcumin and others. For me, the nutrient based supplements are kind of a cornerstone. We want to eat a good diet, we want to use food as medicine, and then sometimes we can supplement to sort of fill in the gaps. Most people I think need and can benefit from some omega-3 support. We just don’t get those healthy omega-3 in our diet as much as we should. And there’s risk with fish today, even though I recommend eating fish.

So good omega-3 supplementation I think is important. Somewhere between one and six grams of combined DHA and EPA per day. And you can check the label, the bottles. If the bottle doesn’t tell you how much EPA and DHA there is in the fish oil, then don’t use it. Make sure it tells you how much is in there and then add those two up. EPA plus DHA, DHA, excuse me, and those should add up to a thousand or more per day. And there are certain ways of tweaking that depending on what we’re trying to accomplish. I also recommend vitamin D for most of our clients. You can check, obviously vitamin D, 25 hydroxy on a blood test, it should be around 40 to 70, maybe a little higher is okay, and if it’s not at least up in that range, then supplement with some vitamin D3. Typically we’re doing 5,000, I use per day, sometimes up to 10, and sometimes as little as 2, but somewhere in that range, I think is really helpful. For people with diabetes, there’s a clear connection between vitamin D and insulin sensitivity and blood sugar regulation.

Dr. Weitz:            Use vitamin K with the vitamin D?

Dr. Mowll:           Yeah, especially if we get up into the higher doses, I think it’s important to do some K2 in particular. You can get vitamin K1 through a lot of foods, but vitamin K2 is hard to find. If we’re up over 5,000 units of D, we’ll definitely add in some vitamin K2 as well.  I like chromium. Chromium is important for glucose regulation and glucose tolerance.  Most people don’t get enough chromium in their diet, so you can supplement anywhere between 200 micrograms up to a thousand micrograms, if you’re trying to really make an impact on your blood sugar of chromium per day, I think that can be helpful.

Dr. Weitz:            And in which form?

Dr. Mowll:           Yeah, either picolinate or polynicotinate. Both of those have good research behind them and seem to be effective.

Dr. Weitz:            And do you like vanadium as well?

Dr. Mowll:           Vanadium is a little trickier. It’s a metal salt and it can be toxic at certain levels, so I use that one short term. I’ll use maybe 20 milligrams of vanadium short term. I think it’s milligrams, milligrams or micrograms. I can’t remember, but we’ll use that one more short term. I’ve seen supplements with 50, 100, I think it’s milligrams of vanadium and that …

Dr. Weitz:            Yeah, I think it’s milligrams.

Dr. Mowll:           Yeah. That, I think there’s some caution there. So I’d be a little bit careful with pushing the vanadium up too high, but vanadium sort of has insulin like effects on the cells, and there are some studies that show vanadium supplementation can sort of act as insulin and help to reduce blood sugar. I’ll use vanadium more in people who don’t make enough insulin and it can be helpful in some cases. Magnesium, really important for many, many reasons. Good blood sugar health is one of them. And then on the herb front, berberine can be really effective. Berberine is a alkaloid compound found in golden seal and other flowers. It acts in several different ways to improve glucose utilization and insulin sensitivity. And it’s one of the most effective compounds we have. Cinnamon can be good as well, especially if you’re eating carbohydrate and you want to lessen the impact of carbohydrate on your blood sugar system, taking some cinnamon at meal time can be really helpful.

Dr. Weitz:            Berberine is kind of a natural form of metformin and can also be used synergistically with metformin, correct?

Dr. Mowll:           Has many of the same mechanisms of action as metformin, yeah, absolutely. Metformin does not derive from berberine. It’s a different chemical structure altogether, but they do have similar mechanisms of action.

Dr. Weitz:            Yeah. And they can actually be used concurrently, right?

Dr. Mowll:           It can, yeah. You have to be a little bit careful. Usually what we’ll do is sort of balance, like if somebody is maxed out on metformin, we’re not going to max them out on berberine also, but oftentimes we’ll do like a little transition where we’ll work with their doctor to back down on metformin and increase the berberine and that can help them, it can be less of a stress on the kidneys and less stress on the gastrointestinal system.  Metformin is really hard on the GI track, it depletes vitamin B-12, it interferes with vitamin B-12 absorption and interferes with the production of coenzyme Q10, so I don’t like to see people maxed out on metformin for too long if we can help it, even though it’s a pretty safe drug.  If we can help to replace some of that with berberine or something else, it can be helpful.

Dr. Weitz:            Great. Any other herbs?

Dr. Mowll:           Well, I like green drinks and I like chlorella.  Chlorella is a, basically an algae that’s pretty high in iron. It has some protein. By weight, it’s high in protein, and it’s very detoxifying.  It’s very energizing, it’s got a lot of chlorophyll.  I like to do some chlorella and I love to do green drinks, which is like basically powdered vegetable and fruit extracts. Usually they’re very low carbohydrate, very low calorie and can give you a nice burst of energy. And I actually like to use those as sort of a multi, because they … It’s kind of plant medicine. It’s got all sorts of vitamins, minerals, nutrients, phytochemicals that we don’t even, necessarily haven’t even identified yet and certainly haven’t put into pills. I like to use food as medicine whenever possible and a green drink is a great way to do that.

Dr. Weitz:            That’s great. Awesome. I think we’ll wrap there. Can you tell our listeners how to get a hold of you and find out about your programs?

Dr. Mowll:           Yeah, so probably the best way, I have my own podcast called Mastering Blood Sugar. I’d love to have you on there doc, maybe sometime here in the future, but Mastering Blood Sugar, you can check out Apple, we’ll be starting … Or iTunes, we’ll be starting our next season here relatively soon, and for other information, just go to drmowll.com, that’s D-R-M-O-W-L-L.com. I have a resource on my website called the blood sugar manifesto, which is free to download and it’s basically got all my best advice in there, some information about supplements, diet, exercise, stress management, sleep management, all those things are included. If you want to get some good free information, go to drmowll.com and download that blood sugar manifesto.

Dr. Weitz:            This has been a great podcast doc. I got a lot of good information. I have a ton of additional question, so if you’re up to it, maybe we could do a part two at some point in the future.

Dr. Mowll:           Yeah, I would love to do that. Maybe a little bit of a deeper dive. It’d be great.

Dr. Weitz:            That’d be awesome. Thank you so much.

Dr. Mowll:           Okay, doc, thanks for having me on.