In this episode of Solving Healthcare, Dr. Robert Cywes, an obesity medicine specialist, discusses the importance of addressing metabolic health to prevent and reverse disease. He shares his journey of emotional eating and highlights the role of sugar in metabolic diseases. Dr. Cywes emphasizes the value of continuous glucose monitoring, individualized patient care, and the need for sustainable lifestyle changes. He also challenges the current healthcare system’s focus on treatment over prevention and explores how maternal nutrition can impact conditions like autism spectrum disorder.
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Speaker 1 (00:00):
The views expressed in the following program are those of
the participants and do not necessarily reflect the views of
Saga nine sixty am or its management.
Speaker 2 (00:11):
Turn my music, ha ha ha, Sure I do. I'm
from the street, swere to foot. Welcome back onecast Nation.
You got a special episode with my man's doctor, Robert Stribes.
He is a BORD certified general surgeon and pediatric surgeon.
(00:38):
He is a bariatric surgeon as well. He specializes in
obesity medicine and he's very passionate, very loyal, throwing down
free education on how to reverse metabolic disease. And we
get into all things metabolic health, folks, strategies to help
you get healthy again. And one of the key messages
(01:02):
here that we talk about is creating that environment, creating
healthy alternatives, but always having that lens of it's got
to be a sustainable approach, folks. It's got to be
something that you can do for a sustainable period of
time and really get for you to be able to
achieve your goals. And it's nice to be able to
talk to a fellow fellow clinician that sees patients, because honestly,
(01:29):
it's nice that somebody could fully appreciate the uphill battle
that we're dealing with here when you know about eighty
seven percent of the population in the US are metabolically
and healthy. So I think you guys are going to
really enjoy this episode. So without further ado, let's do this.
Folks go to Robert Sives. Welcome to the show.
Speaker 3 (01:48):
Well, thank you very much. I appreciate that. And you know,
just to start with obesities yesterday, we have come so
far from the entry point into metabolic health was through
the large literally and figuratively gate of obesity, but it's
become so much more. There's not a disease that you
treat or deal with as a critical care specialist, not
(02:11):
a disease that I deal with as a surgeon as
a metabolic physician that isn't touched by metabolic health. So,
whether that's obesity, where it's diabetes with its insident resistance,
we have to take as good physicians when you're treating
patients the background of metabolic health into consideration. And so yes,
(02:32):
obesity might be the primary index issue, but there's so
many other issues that we as clinicians have to take
into account. When you imagine managing patients from psychiatry to
inground toenails and everything in between. So yes, obesity is
a piece of it, but it's so much bigger and
(02:53):
greater than that, if that makes sense.
Speaker 2 (02:54):
Oh absolutely, And I love the fact that you highlighted
this because this, I mean, I was new to this
space relative to most like I came onto it during
COVID when we were seeing the metabolic health being a
key metric for poor outcomes. But these new these new
evidence for metabolic health linking to such things as mental
(03:20):
health has been so enlightening. So maybe we'll take a
step back, doctor Robin. And what got you into this
in the first place.
Speaker 3 (03:30):
Well, there's there's really three parts to it. The first
part was a personal story of very rapid weight gain.
I'm blaming Canada for that. I was doing my PhD
in Toronto, Oh my goodness. And you know when there
is a second cup in the base in the lobby
of your hospital, as there was in mind Sinai Hospital
(03:50):
when I was working there in Toronto, you know, up
and down to the lab and back up to down
to the Bavarian I passed Starbucks at just second cup
all the time, and it was the big brand muffin,
the big thing of coke. Then went to the University
of Michigan. There's a Wendy is right there between the
er and the or, you know, and you got free
access to these things. So I gained weight very rapidly.
(04:13):
I'm very obisogenic. Some people gain weight very easily. Some
people can walk past the same doughnut not gain weight,
but their blood sugars go up tremendously. We can explore
that that is genetically predetermined. But I gained over one
hundred pounds very very rapidly, and it concerned me. So
there was a personal journey, and I realized that personally
the problem wasn't calories. The problem was a shift away
(04:38):
from primarily eating food for the nutritional value toward eating
and drinking primarily to manage emotional tension, anxiety, stress, depression, anger, fear, frustration, exhaustion.
This was my cigarette and I realized that eating and drinking,
particularly carbohydrates, but snacking, the behavior pattern was primarily a
(05:00):
substance abuse problem, not a weight or a calorie problem.
So that was the first part. In those days in
the early nineties, late eighties, early nineties, everybody was focused
very heavily on lipophobion. Fat fat fat fat, fat, fat
is bad for you. We weren't eating eggs because of cholesterol,
all that kind of thing. And I was doing my
PhD again in Toronto, and one of the models we
(05:21):
were looking at in the liver was we wanted to
create inflammation in the liver so that we could study
strategies to reduce inflammation. And so we knew that fat
caused fat and cholesterol were terrible. They would cause all
kinds of inflammation. So we created a model where we
infused fatten, cholesterol, and protein into and nothing happened. Nothing happened.
The livery just said, cool, I'm here, I'm doing my job.
(05:44):
Nothing happened, nothing fazed me. Then when we started to
add sugar in within three hours, I could kill a
liver with a glucose insulin clamp. And contrary to what
the world was telling me, we proved that the problem
was sugar in elevated blood, sugar that was affecting the vasculature,
not fat, not protein, not anything else. And we then
(06:07):
used a sugar based model an insulin clamp to create
an injury, which we then found different ways of resolving
whether it was platelets with aspirin, culture, scene and other
medications for white cells. So at a time when everybody
was blaming fat, we started to realize this wasn't a
fat problem, this was a sugar problem. So there was
(06:29):
that connection to myself. I wasn't eating fat when I
gained hundred pounds. I was eating crystal meth or sugar
and starch.
Speaker 2 (06:36):
And then the.
Speaker 3 (06:36):
Third component as a surgeon, especially during my pediatric surgery,
One of my first patients as a young practitioner was
a fourteen year old kid who weighed three hundred and
fifty pounds. But he came in with a cute write
up a quadryt abdominal pain, had gallstones and straightforward operation.
Well obesiently made it more difficult, but we took out
(06:56):
his gall bladder and we got gall stones. We got
an obst fourteen year old. He shouldn't have time, We
shouldn't have cursed dog gallstones. But when I went back
to see the patient afterwards and I was looking what
he was eating, it wasn't fat. There was some fat there,
but the majority of what he's eating, ninety percent of
what he is eating and drinking the mountain dew, the
(07:17):
French fries. It was all carbohydrates, and so that that
constellation of things the personal story we're doing in the lab.
What I was seeing in my patients, my abst patients,
young kids, was that the problem with sugar and starch,
and I started to look more and more at some
of the diseases caused by sugar and starch, both from
(07:38):
a substance abuse psychology perspective, cardiovascular pcos, obesity, diabetes, and
the connection was there that you cannot have any of
those diseases without going through the gateway of insulin resistance.
Even type one diabetes, which everyone thinks is a lack
of insulin, well, you become resistant to your own insulin
(08:00):
you're injecting. So the complications of type two diabetes, the
core mobilities, are primarily Type two complications related to insulin resistance,
not related to the lack of insulin. So it became
very evident to me. But the problem is, I think
you faced as well. And this is what I'd love
to know from your site, is it conflicts one hundred
(08:22):
percent with everything retort and everything that they that they
tell us and with the entire management of all of
our patients. I'll give you an example in the ICU,
if you've got a patient who's not eating for a while,
what do you do? You put them on TPN. One
of the foundations of TPN Doug Wilmore, nineteen seventy, Pittsburgh,
(08:43):
is to use somewhere between twenty and twenty five percent
dextros in that infusion. So our sickest patients are getting
this massive glucose infusion, and then what do we do
when their blood shigar through the if we add insulin
and we expect them to get better, So we're creating
diabetes in insulin dependent diabetes in our sickest patients and
(09:03):
then wondering why they're not getting better faster.
Speaker 2 (09:06):
Oh, and we also give them and like we know
it's pro inflammatory and like to be to be hyperglycemic
as we see it, and we're literally if you look
at any hospital and what is landing on our patients plates, Okay,
like even the diabetic meals, it's high in carblohydrates. And
(09:29):
and it's exactly as you said, Rob, like if we're
if we're somebody who was not eating, give them some
sugar water, give them some TPN or even then in
my world too, the intro feeds high in carblo hydrates,
and and there was a recent actual study I don't
know if it came across your desk on feeding patients
(09:50):
with a ketogenic diet and just having less inflammatory markers,
less insulin. There's a bunch of surrogate markers, nothing, no
heart outcomes. But still it was just another reminder that
what is our goal with the way we're approaching our
patients exactly right?
Speaker 3 (10:08):
And I think you know, in my own practice as
a surgeon, I don't have a huge number of patients
in the ICUs and things, but apart from kids under
the age of two, in the last fifteen years, I've
never ever added dextros, never added dextros to TPN. And
because the liver, even the sickest of livers, makes its
(10:28):
own sugar, I've never had a problem. But I've also
not had patients on insulin because we were feeding them sugar.
The other issue, just while we're speaking about TPN is,
of course everybody's afraid of saturated fat. So TPN is
made of absolute garbage. It's all poly unsaturated fatty acids.
Speaker 4 (10:45):
It's soy based, and I mean even the quality of
the lipids in the TPN we're giving the people is
also basically seed oil, so we're giving them a double hit.
Speaker 3 (10:56):
But it's the best we can do right now. But
certainly you don't need to add glucose to TPN to
be able to keep somebody alive and thriving. You're absolutely right.
But the question is how do you navigate the healthcare
system given what you know to be true, what you've
proven to yourself to be true, and yet there's a
(11:17):
box call best practices? How do you navigate that? We'll
be right back with doctor Rob.
Speaker 1 (11:37):
Stream us live at SAGA nine six am dot C.
Speaker 2 (11:40):
A welcome back to Solve and Healthare Radio featuring Doctor Rob. Yeah,
(12:02):
it's a it's a good question, and honestly, I haven't
really navigated it. It's it's a pretty it's a pretty
strong force when it comes to trying to trying to
adjust the sales of the approach to how we eat.
And my approach has been similar to you, is to
(12:23):
just empower the patients. Empower people to realize, like food
is medicine and it could affect your outcome, and thinking
about how we were you're putting your body and think
of how it will affect your overall health. But as
in patience, I've given up. I won't lie like I've
given up. We did a review, uh presenting. We did
(12:48):
a paper a low carb low carb approach to intensive
care patients, and you know, it was mostly deriving studies
that have used lower carb or ketogenic approaches for for
other patient populations and showing that there's been some positive signals.
But honestly, I don't know if you've had some success,
(13:10):
but just because and obviously in the intensive care unit
there's a ton of fish to fry. Like you see
a lot of people you're more focused on the ventilation
and what have you. But I'll be one hundred percent
honest with you, Rob, like that is a battle that
I have been nowhere close to winning. How about yourself?
Speaker 3 (13:28):
And that's to say, you know, I've I'm older, so
I'm not employed and I've chosen to do that. Has
that harmed me? Absolutely? It has. The entire shift of
healthcare is towards employment. But if you're employed by an employer,
you fall under the box of standard guidelines, of best
practice guidelines, and I've chosen to practice outside of that,
(13:50):
and I'm doing actually, fortunately pretty well but that is
exactly the challenge. And I get very apprehensive every time
I go into a hospital because I've got this conflict
of my hippocratic oath that says do best for the
patient and then the system that says this is what
you have to do to so called do best for
the patient. And there's a direct conflict, and that is
(14:11):
an ethical dilemma for me that is massive. And I've
circumvented that by trying to keep patients out of the hospital.
Working out of Surgy Center is changed my type of
practice more seeing patients in the metabolic health space now.
But you're absolutely right. I mean, the fastest way to
get diabetes is to be admitted to a hospital for
a week and eat their food.
Speaker 2 (14:32):
But it is we see and we do see it
like it's obviously there's a food and there's the fact
that they're acutely ill. Sometimes it's some medication, but we
do often unmask some metabolic syndrome when patient's land in hospital.
Speaker 3 (14:48):
Well, I'll give you, I'll give you something that just
you know, if you go into an ICU, go into
a hospital, you're going to get monitored for everything. You're
getting monitors slapped on you lines placed in your vessel.
Everything's being monitored. We have this wonderful simple technology called
a CGM, a continuous glucose monitor, which is a very
(15:09):
very similar. You can put it on a newonate. They're
tiny and it tells you a blood shugar reading every
five minutes. We will do blood gases on people all
the time. We do all these other BMPs and potassiums
and those are important, but we don't monitor. We don't
slap a CGM on them.
Speaker 2 (15:26):
Why not?
Speaker 3 (15:30):
But we're two decades behind on that or a decade behind.
You can now as of this week in the US.
I don't know about Canada, but in the US, you
can buy a CGM called Stello. My video from last
night it talks about this. You can buy it over
the counter without a doctor's prescription, so Stello Stlo. It's
basically the DEXCOMG seven that is an over the counter CGM.
(15:54):
It's a fifteen day CGM and it was released on
Monday by Dexcom. You can go to the website and
sign up for it. My video talked about this. But
if the late public has access to this, why is
this not something we put on everybody when they get
transported into the hospital or into an ICU. I'll tell
you why not is because unfortunately, it conflicts directly with
(16:19):
everything we're doing. So if you're a diabetic patient, you
put estello on and it says, okay, I ate my
mashed potatoes and my blood sugar went through the roof
and now I have to use insulin. But if it
didn't eat my mashed potatoes, my blood sugar didn't go up.
It conflicts directly with the narrative that they're promoting in
the hospital. I'll give you another very simple example. All
(16:41):
of my patients know and ask for something called a
currently arctic helsium score. Doctors will put everybody that they
can find on a statin okay, but they will never
ever order a CAC score. In my opinion, it is
malpractice to put somebody on a staaten without knowing what
(17:02):
their CAC score is, because if your CAC score is
zero like mine, and my cholesterol is very high, you're
putting me on a very toxic drug called a staaten
with a lot of negative side effects for a disease
I don't have, and even when work, it don't work.
Why are we not testing because if my cholesterol. If
(17:22):
my total cholesterol is three ten and my C and
my LDL is two forty, which was the last reading.
Your belief is as a doctor, you must have cardiovascular disease.
That's why you need to take the staaten. But then
I come with a CAC score that's a goose egg.
Now this conflict.
Speaker 2 (17:39):
Yeah, And just just for folks to understand cecs, it's
like a calcium score, which is you do like a
CT scan and I'll assess whether you've got you got
calcified vessels or risk of and it will give you
a sense of what you're I forget the timeline five
to ten year.
Speaker 3 (17:57):
Yeah, but it tells us how much pluck there is
in your blood and your heart blood vessels.
Speaker 2 (18:02):
And you'm zero. It's like your risk of an event
in the next I forget. It's like five to ten
years is almost negligible. It's like almost zero.
Speaker 3 (18:12):
I will tell you my risk of getting pregnant is
higher than my risk of it. So and no double
one way to find out exactly right. No doctor has
prescribed me both control yet. I mean, it seems ludicrous,
but it isn't It isn't it. The same thing is
that there is, just the risk is so low. Not
(18:34):
only that, there are other reasons, there are other ways
even if you even if you are at risk for
a heart attack of a stroke, they're much more effective medications.
We can get into that in a little bit, but
really what we're talking about as physicians is the frustration
of not wanting to know, and that is a concern
for me. So we don't want to know what your
blood sugars are, so we're not going to use technology
that's inexpensive and readily available. We don't want to know
(18:57):
what your risk of a heart attack or a stroke
is because we want to put you on a staten
And let's face it, last year there were more heart
attacks and strokes in the US than ever before twenty
twenty three, and forty eight percent of Americans were on
statins or cholesterol lowering agents PSK nines. So surely if
statin's worked, you'd have a lower risk of heart attacks
with strokes. Again, these are narratives that we conveniently ignore
(19:20):
because we don't want to change or even question the
way we currently practice healthcare.
Speaker 2 (19:25):
Yeah, it is a lot, I must say, because of
the pandemic. My eyes have been open and you can't.
You can't ignore some of this. And I know our
research group we're looking to incorporate continuous glucose monitors to
proagnosticate patient outcomes, which I think I'll be shocked if
(19:47):
there's not a correlation because we see it all the
time patients. It's one of the early signs that they're
going to become sicker. In fact, is their blood sugar
becomes disregulated. But yeah, I think this is a this
is a very promising sign. But Rob, I want to
get a good feel of like your practice now. So
you went you mentioned the kind of three phases that
(20:08):
led you into addressing of metabolic health and having a
metabolic health practice, But what does it look like now
on a data day and how you impacting your patients?
Speaker 3 (20:21):
Well, you know, just a little bit of history. So yes,
my gateway into this into the metabolic space was through obesity.
I became very interested in pediatric and adult obesity. But
as we discovered more about obesity, we discovered two things.
First of all, that people with insilent resistance behave in
two separate ways. Some become more dibisogenic, their blood sugars
(20:42):
go up and they tend to have cardiovascular disease, but
they don't necessarily become enormous. There may be a little overweight,
but their primary issue is mild mildly elevated insulin levels,
but very elevated blood sugar levels. And the challenge there
is once they become resistant, once they get blockage of
insulin effectiveness, they produce a little bit of extra insulin,
(21:07):
but it can't clear the sugar, so the sugar builds up,
and those people get primarily damage in their blood vessels
and in the space between the blood vessels and the
cells called the interstitial space. So they're getting heart disease,
they're getting neuropathy, nerve disease, they're getting ligament and tendon injuries. Genetically,
another group of people can produce very very high levels
(21:27):
of insulin, but they have fairly normal blood sugar levels,
maybe mildly elevated. Those people have perpetually very high levels
of insulin, and they can shove sugar into their cells
very easily, no matter how resistant they are, and the
cells convert that sugar to fat, so those people gain
weight very easily. They don't suffer the vascular injuries of
(21:49):
the diabetic group or the dibisogenetic group because their blood
sugars are fairly normal until very late and they crossover. However,
those people under insulin is a very important quarterback hormone
and for those folks, high levels of insulin correlate with cancer,
autoimmune disease, Alzheimer's, polycystic ovarian syndrome in females or infertility pcos,
(22:12):
low testosterone in men, and weight bearing joint disease. So
while I started with obesity, I recognized that insulin resistance
goes two different ways. So my practice now has branched
out to still treating insulin resistance, diagnosing and treating insulin resistance,
but now I can look at people with heart disease,
cardiovascular disease which is high blood pressure, a rhythmias, and
(22:33):
plot disease. I look at people with interstitial disease, neuropathy, diabetes,
ligament and joint injuries. I can then look at people
with cancer, with mental health issues, with infertility, polycystic goverarian syndrome,
gestational diabetes, autism, spectrum disorder. All of these are through
(22:53):
the eye of the needle of hyperglycemia hyperinsulinemia. So my
practice is now branched out and giving me a degree
of expertise to manage, at least from a reversal perspective,
so many of those other diseases, and we become more
and more confident. Look, I don't specifically treat cancer, but
I can certainly help a cancer person to reduce their contribution,
(23:19):
their ongoing contribution to their cancer from their diet. So
I'm never going to be naive to say I can.
I can get rid of a cancer necessarily unless I
wear my surgeon's hat. But cancers don't like a don't
like deep keytosis typically, so at least the patient can
bring that to the table and they're healthier as they
(23:40):
deal with radiation, chemotherapy, surgery and reduce the rate of
cancer progression.
Speaker 2 (23:46):
We'll be right back with Doctor Rob.
Speaker 5 (23:48):
Out of a night into the water, we pushed from shore,
breaking in and still.
Speaker 1 (24:04):
No radio, No problem. Stream is live on Sagay ninety
sixty AM, dot c A.
Speaker 2 (24:12):
Run AM Jewels Fast Run and rNam Jewels Fast Run and.
Speaker 3 (24:17):
The Slow Moll.
Speaker 2 (24:20):
Welcome back to solve the healthcare radio feature in Doctor Rob,
What do we do before if someone lands to see us?
Because if you come, if you land here with whatever
it might be, cardiovascular events, stroke, often you're not coming
out the same person, So what can we do to
prevent you from doing that? And I'm curious. I'm curious,
(24:42):
for example, when when you have the the Kenyons as
an example, the patients that look like they're in the
best of shape and doing all these amazing thing marathon running,
and they get that high risk c AC score. Is
there other signals that would be pointing towards you to
say like, hey.
Speaker 3 (25:05):
Yeah, there are other signals, But by the time we
get to the signals, it's kind of a little bit
too late. So what you've got to have is a
high index of suspicion. And that's really what it's about,
you know, is that And a lot of my testing
up front reveals disease that sometimes even I didn't expect
to see, but we test for it because it's not there.
(25:25):
I got a very dirty letter from ETNA a little
while ago saying you do way too many tests for
vitamin D. But you know what, one of the commerce
deficiency we see is low vitamin D levels. And are
you going to intervene when somebody's forty years old with
a low vitamin D A woman, or are you going
to intervene after the hip fracture from osteoporosis. It's that,
(25:48):
you know, we live in a world where so many
of the disease, these diseases can be prevented if we
intervene earlier, and the cost equation to insurances is so
much lower. It's much better to let's say, have a
stent placed if you've got to tight stonosis with a
positive nukemed before you've had the heart attack. Then have
them spend a week in the ICU and get their
(26:08):
stend so they're cabbage done after they've had the heart attack,
then go to cardiac rehab.
Speaker 5 (26:12):
Go.
Speaker 3 (26:13):
It's a crazy way of doing things. Why not help
somebody to lose weight before they need a new replacement
rather than have them lose weight because they're getting a
near replacement. You see. I mean, those are the equations
that we're doing. So so many of these disease that
we've cause to ourselves are reversible or manageable so that
(26:34):
you don't need that intervention. Well, when people are prescribed
blood pressure medication, it usually is forever, but a lot
of my I mean I do more deep prescription of
blood pressure medication not because I just like to de prescribed,
but because the patient no longer needs to be on
blood pressure medication. We get them to monitor their pressures
and as the pressures come down, we've got an algorithm
(26:56):
for deep prescription. Well, now you've saved the insurance company
three or four lifetime's worth of blood pressure medication.
Speaker 2 (27:05):
And I'm curious in your practice, Like we all like,
there's a lot of approaches to reversing metabolic disease. You'll
have some people that are We've kind of alluded to
this before on social media. They it's got to be
key to or it's got to be carnivore, it's got
to be xyz. What's your apperson look like from a
(27:28):
lifestyle modification approach to to your patients.
Speaker 3 (27:33):
Well, I think there are a It's such a good
question because anybody can lose weight, anybody can do anything
for a little while. It's irrelevant. All of my patients
on the obesity side are experts at failing weight loss programs.
They've all lost weight. And I'll tell you where We're
see this in ridiculously excessive amount. All the people on
(27:55):
GLP ones. Now everybody's using ozempic to lose weight, they
feel one for for a year or so, and then
they come off the medication and boom there they gain
all that weight back. So one of the fundamentals of
my practice is to focus not on how quickly you
can lose weight, but addressing the behavior and changing the
(28:16):
behavioral strategies that resulted in the obesity in the first place.
So the important things for me are sustainability and removal
of certain behaviors and replacement with others. You know, AA
alcoholics anonymous doesn't get anybody to quit drinking. You have
to do that yourself. AA is there to help you
(28:38):
to rebuild your life to replace the role that alcohol
had in it. And that's kind of the way we
practice I call myself carb addiction doc. We help people
to remove carbohydrates to change their snacking behavior, but replace
it with other things that they do so that it
is both nutritionally and from a mental health emotion management perspective,
(28:58):
sustainable until they die. And the behavior patterns the strategies
that we create are toward that sustainability. So the eating
what you're eating is just a very tiny fraction. Why
why do I need to eat this right now? Why
do I want that ice cream? What else can I do?
All of those strategies are there in the equation, So
(29:21):
we work very heavily towards sustainability and slow, steady behavioral change.
You don't want to be the rabbit, you want to
be the tortoise, and that is very, very important. I think,
just to allude to the GLP ones, if you look
at the step trials which are done with Ozempeg, they
saw in the first year seventeen to twenty percent body
(29:41):
weight loss. Beautiful what body weight lost. And I do
like the glp ones, but those are people who are
outsourcing their weight loss, like any diet, to the medication,
to the diet, without changing any behavior. And then when
they stop the medication, the statics are statistics are that
ninety six percent of people at forty eight weeks in
(30:02):
the step forward trial after stopping the medication regained back
seventy five plus percent of the weight that they lost
within forty eight not even a year. And the reason
for that is because they never understood and nobody told
them what behaviors to address while they were losing their weight.
Speaker 2 (30:20):
Yeah, and I'm curious to hear rob some of the
practical strategies that you suggest. You have that drive to
want to eat that ice cream, and you ask yourself, yes,
is this emotional or whatnot? But what what do you
suggest to your patients that they can modify this approach?
Speaker 3 (30:46):
Well, okay, so I want to ask you the question.
I'll pretend you the patient. So what is the only
thing an alcoholic should do?
Speaker 2 (30:54):
Not drink?
Speaker 3 (30:55):
No, don't drink alcohol. Nobody tells an alcoholic what they
should drink. But as you alluded to a little bit ago,
everybody loves to tell fat people what they should eat.
And that's crazy if you see it through the lens
of substance abuse. Let's focus just on the sugar and starch.
I don't care what you eat. You can be more vegetarian,
more carnivore. What I care about is not eating carbohydrates.
(31:17):
Changing that relationship, and you don't have to change it
all at once. You can slowly change it. Let's get
rid of If rice is your thing, let's leave rice
to the end. Let's get rid of the fruit. Let's
get rid of some of the ice cream. Let's get
rid of some of the other things. And we do
that slowly and progressively, so that idiot is sustainable, So
we focus heavily on the sugar in the starch. The
rest of the food is less relevant as long as
(31:40):
we can formulate a diet that is more complete than
not in terms of nutrients. The second part is the
pattern of eating A snack is always, always, always an
emotional event, it's never a nutritional event. So both you
and I throughout this conversation have been sipping on something
that has nothing to do with hydration. That is a cigarette.
(32:01):
In other words, that's something you're doing just to give
your brain a little break so you can refocus. I
call that a bridge. My coffee is bridging me across
the moment where I need that little brain relaxation so
I can refocus. But when I was fat, this was
a cocaine eminem's. So instead of a cigarette, you put
gum in your pocket. So we teach them to develop
(32:24):
that relationship, that positive relationship with something to drink in
lieu of having a snack. And then the more pre
emptive you are about your eating, So when you come
home at night and you're exhausted and you don't know
what you're going to eat, you're much much more prone
to being a victim of your emotional need in the
moment and eating a bunch of crap and justifying it
(32:45):
because you're exhausted and stressed. But if you knew last
night what you were going to eat tonight, and you
make a decision about it, if you're empowered by that decision,
and if you're empowered by that decision, number one, you're
less likely to be a victim of itinerant opportunistic snacks.
And secondly, you're most likely going to execute on something
(33:06):
that has nutritional value without the emotional override. So I
knew last night that I was going to eat Roby
steak tonight.
Speaker 2 (33:12):
That's gold. Let's call you know, And.
Speaker 3 (33:14):
There it is, And I'm empowered by that. I'm looking
forward to that. And when you make comments like that,
it's like, yeah, because I feel good about that. The
other thing, also is what's important about addiction management is
you've always it's about your own personal choice. When you
tell somebody you can't have this, you're not allowed to
do that. That's a diet that's deprivational. If I feel
deprived of something, it's just a question of time before.
Speaker 2 (33:35):
I do do it.
Speaker 3 (33:37):
I can eat ice cream anytime I want to. I
have chosen not to eat ice cream again. I'm empowered
by my own decision to.
Speaker 2 (33:46):
Not do that.
Speaker 3 (33:46):
That's disgusting. How could anyone eat ice cream? Says the
guy that twenty years ago lived on ice cream and
pizza and other things. So empowerment is the watchword, not deprivation.
And diets ask you to controller relationship you can't control.
In addiction, we recognize I can't control it. So the
other little phrase that I use is proximity is your
(34:07):
biggest enemy. Okay, don't have cigarettes in your pocket and
say you're going to quit smoking. Don't have ice cream
in the fridge and say you're not going to eat it.
Distance is your best friend. If you don't have it there,
you might get upset. But the ice cream isn't there,
but you less likely you get in your car and
drive down to the store at eleven o'clock at night
to go and get it. There's at least an interface
(34:28):
you could still do that. But proximity is your enemy.
Distance is your friend. So those are all things that
we help patients to understand. And even if you say
I'm never going to eat pasta again, well, then why
the devil is the pasta in the house. You know,
it's all of those little things. But the way that
addicts convince themselves that right now, this is okay to
(34:50):
have is incredibly complex, and we have to help people
to understand their mechanism of justification validation because nobody, nobody,
nobody gets this right. The first time we make mistakes,
we struggle. And you know what, the only time you
fail is when you quit what you want to do.
(35:10):
Nelson Mandela. One of his famous quotes is it doesn't
matter how often you get down, get knocked down. As
long as you get up one more time beyond what
you were knocked down, you're going to be successful. That's
a paraphrase of what he said. It's it's on all
my slide shows, and that is just something that's stuck
with me. My entire life is that get up, get up,
learn from your mistakes, don't beat yourself up because of them,
(35:31):
but don't make them again.
Speaker 2 (35:32):
We'll be right back with doctor Rob.
Speaker 3 (35:33):
You must it's better if you get job and roll
up there. What's how we roll up there? I take
that's older thing, hope that it's so nerds. I take
the sip for that. Yet I want to be. I
take the hit of that they can't stop.
Speaker 1 (35:46):
Rebally, what's the streamers live at SAGA nine sixty am
dot c A.
Speaker 3 (35:58):
Yeah, well wrapped the balious job by.
Speaker 2 (36:01):
Listening to Solven Healthcare Radio to Doctor K featuring doctor
Rob felt Fast, my friend. I love that so much.
I'm them have a similar mantra. But yeah, this is
this is pure gold. I think this is something many
people think about intuitively, but proximity barriers don't keep the ship,
(36:23):
don't keep the food that is going to be the
devil in your house. And I also like that tip
of replacing what you might snack on with something to
drink that that is actually quite genius. And so one
thing I want to maybe as we kind of wind
down here, Rob is you and I have both clinicians.
(36:48):
We we walk the walk. We we preach metabolic health,
and we do it in our own lives. We try
and bring it to our patient's attention and so forth.
What do we got to do to level this up
to the next level? Because really, if you think about it,
(37:09):
eighty seven percent of the US is metabolically unhealthy and
I don't see this significantly moving and we're all in
our own spaces, trying to do our best and to
try and move the needle. But I'm curious what's keeping
you motivated? Do you see this needle changing? What do
(37:29):
we need to do at scale?
Speaker 3 (37:30):
You think, right, And I don't think that at scale
we are going to make a difference. And I know
that sounds awful. I know it sounds pesstimistic, but it's
one on one, it's one person at a time.
Speaker 2 (37:41):
I'll tell you why.
Speaker 3 (37:43):
You know, in the nineteen fifties and sixties, the tobacco
companies were very good at camouflaging the harm of smoking.
But there's nobody that doesn't know that smoking is really bad.
And yet we still sell cigarettes at a societal level
at huge cost. Now it's okay cigarettes, but it's vaping.
There's really not much difference we can argue that one.
(38:03):
So at a societal level, we are never from a
health perspective, going to beat the economics and the power
play that is the sale of drugs. You're never going
to beat the cartels from Mexico bringing or wherever it is,
bring drugs into our country, both countries. You're never going
to beat the food industry in terms of what they're
(38:25):
promoting the manufactured food processing company. You're never going to
beat the tobacco companies, but one on one we can
make our own empowering decisions. So I take one patient
on at a time, and my success is through the
success of my patients and through the people that come
out the other side saying, Wow, I'm feeling great, I'm
looking good, and they pass on that message. This is
(38:47):
about grassroots activation activism. It's not going to happen in
medical schools for a long time. It's not going to
happen in the hallways of government, as much as I
wish it would, and I'm not saying we shouldn't try,
but this is going to happen at the kitchen table,
from person to person. When I've got a mom conquering
(39:09):
her diabetes and changing the way the family eats, when
I've got I just had one yesterday where I've got
a young child changing where their parents eat. All of
those things, that's the influence. It's a grassroots campaign. But
I think as physicians, one of the problems that we
have is cognitive dissonance. We are locked into a way
(39:29):
of thinking and more and more our thinking, and it
was a purposeful thing done in the nineteen nineteen nineties
at universities where we switched from physiology to epidemiology. And
we have to as physicians go back to understanding disease process.
If we keep using outcome metrics, but the question that
(39:50):
was asked and answered by the outcome metric was wrong,
We're down all kinds of abnormal paths. I'll give you
an example. I can prove to you on outcome metrics
that alcohol that water makes people drunk if you conveniently
ignore the fact that it has whiskey in it. And
I mean it's a bizarre example, but when you say
(40:12):
red meat causes diabetes, you're ignoring the fact that it's
pepperoni on pizza and lasagne that was included in the
foods that were counted as red meat. So getting away
from epidemiology and outcome metrics and using those kind of
so called pure review papers because you know as well
as I do, that we choose the peers that are
going to review the papers, which is crazy. You're basically
(40:35):
selecting a group of people that are going to prove
your paper. So this whole thing of autonomy and independence
doesn't exist in healthcare. So as physicians we have to
open our eyes and look at our patients, and it's
so obvious what we see. If you see this enormous
child fourteen years old, ninety percent of what they're eating
is sugar. Don't blame fat, it's all of those things.
(40:58):
You know, if you have to use insulin to correct
blood sugar, why are you giving the person extra sugar?
All of those things make a difference, and we as
physicians have to keep asking those questions. That's how we're
going to change as individuals. But also we need to
foster a dialogue at the grassroots level about how is
(41:19):
this happening? And that I think is something that we
can do as a society. Whereas the powers that be
have too much of an alternative, ulterior vested interest, there's
no incentive for them to change. In fact, quite the opposite.
I'll tell you one other thing. The biggest problem for
me is the ethical barrier that I don't sell anything.
(41:41):
I have nothing to sell, so I can't make money
by selling stuff. I can't promote my message by selling stuff.
I don't have widgets and stuff I can sell. The
people that market stuff you turn on any TV, they're
selling something. They're selling a pill. They're selling a product.
I've got life. I've got hard work that I sell.
I don't have anything easy to sell.
Speaker 6 (42:03):
I've got to mount I've got what I sell every
day in my office is a very very tool mountain
that I ask my patients to climb and those that
embark on that, one step at a time get to
the other side.
Speaker 3 (42:15):
But I don't sell magic.
Speaker 2 (42:16):
Mm hmm. It's so true. Like and as you as
you mentioned a lot of these success stories, they come
from a lens of sustainability and tortoise, not the rabbit.
You need to have that patience, and it's it's hard.
And you know when you said the I mean I
(42:37):
will I'm going to go on record and I don't.
I don't know fully if what I'm going to say
is true. But I still have hope though, I really
still have hope. Just I see in the next generation
of physicians too, that seem to care a little bit
more about this stuff, start to ask a little bit
more questions, think about root cause and really thinking of
(43:00):
about how we're gonna how are you going to change
trajectory for our patients and and so are we going
to cure metabolic syndrome or are we gonna significantly change
a needle. I don't. I don't think it's gonna be
anytime soon, but I certainly hope it's that there will
(43:20):
be a tide. And to what impact, I'm not sure,
but I just something's gotta something's gotta change. And the
other point, too, rob that I'm hoping will be a
trigger is the other areas of health, whether it's the cancer,
whether it's a mental health, PCOS, fertility. This is where
(43:41):
I'm wondering more of a push towards trying to remedy
folkses metabolic syndrome. Maybe we'll see more of a push,
But that's I'm notorious for being an optimist, so I uh,
I'll put that little uh asterisks on there.
Speaker 3 (44:01):
Yeah, And you know, I am very optimistic for each
patient that here's our message, because they're empowered by the
ability to change slowly and it's not about outcome metrics.
It's not about losing one hundred pounds. It's about having
a good day and then adding another good day. So
I'm empowered, very optimistic about each individual patient. But as
(44:23):
I've gotten older, I become more jaundiced and pessimistic. About
societal society pivoting quick enough, and it will eventually, but
not in my lifetime. You know, I'll give you another
just I know we've got to go. But just for me,
the most tragic, tragic of all the obesity diabetes, there's
at least a recognition there that that is self induced.
(44:46):
The thing that bothers me the most and the most
tragic thing for me, and I've got a bias toward
pediatrics is autism spectrum disorder. And we are spending billions
of dollars trying to find some gene trying to find
some genetic association. If there was a genetic association to
ordism spectrum disorder, the billions and billions of dollars we
were spent would have shown that it is so obvious,
(45:09):
so so obvious when you step back from this, that
ortism spectrum disorder is a structural brain abnormality caused by
a substrate deficit, the substrate deficit being fat and too
much sugar in too little fat.
Speaker 2 (45:25):
Now diet.
Speaker 3 (45:25):
Ordism spectrum disorder has gone from one in one hundred
one in fifteen thousand in nineteen seventy to one in
twenty last year, and it is a substrate problem and
those children didn't choose this. They didn't choose this, and
it's going to impact on them and our society for
the next seventy to eighty years. And that is a
place where we can potentially intervene. But the problem is
(45:49):
it's so emotive. When we talk about it, even just
me saying this, there'll be a lot of pushback. How
can you say that because we're emotional, we feel guilt.
But as we take pregnancy gestational diabetes. In my home
country of South Africa, eighty percent of women pregnant women
have gestational diabetes. I mean, just think about those numbers
and how it impacts not just one generation but the
(46:11):
next eighty to one hundred years of people. That's where
I think we can have an impact is educating and
working with gynecologists, obstetricians and young people who are getting
pregnant because they care about their babies. There's very few
mothers who won't stop drinking alcohol, who won't stop smoking
when they're pregnant. Why don't we push on this as well?
Speaker 2 (46:35):
Wow, I know we're up against it, But like when
it comes to the substrate deficiency and too much sugar
with the with artism is that are you saying that
the host like the mother, like during the pregnancy or
is that or during a post like when is the exposure.
Speaker 3 (46:58):
Yeah, it's a long time exposure. So just simply put,
the human brain begins to develop it around five to
six weeks suggestation before most women know they're pregnant. Human
brain develops. Structural development continues through the first five years
of life. So if the mother is eating a high
carbohydrate diet, and remember insulin has to go across to
(47:19):
the blood bread across to the brain, brain starts develop
it five to six weeks. Insulin only gets produced by
the baby's pancreas at fifteen to sixteen weeks, so depending
on the mother's on what the mother's eating and drinking.
If the mother is hyperglycemic or hyperinsulin emic, the brain
the structure of the brain doesn't develop adequately. The brain
itself is primarily made of fat. About sixty five percent
(47:41):
of the gray matter is fat, about seventy seventy five
percent of the white matter is fat. If you don't
have adequate ketosis, if you have adequate fat for the brain,
the structure of the brain doesn't develop properly, and autism
spectrum disorder is a white matter structural abnormality. The grain
matter is okay, the white matter doesn't develop autism spectrum disorder.
(48:03):
And this is what's bizarre, is a clinical behavioral diagnosis
with the average DIAGNOSI is made of eight years of age.
You can do an MRI on a baby's brain at
three months and diagnose the structural abnormality that is consistent
with ASD. So where as a society you have to
shift that and say, okay, these babies, no matter what
you think of fat, need more fat. As a substrate.
(48:25):
You look at breast milk. Breast milk hat is the
only substance. It's the only substance that is dominant in
saturated fat. Even meat that we eat is not saturated
it's there's a lot of saturated fat in it, but
the dominant is probably unsaturated fat. But milk is that? Why? Why?
Because our brains need it? And what do we do
(48:46):
when we feed baby's formula? We feed them soy, We
feed them crack that isn't saturated fat, And as soon
as they come off the breast, they're eating cheerios and
goldfish and all kinds of carbohydrates and we drop their
fact radically low. So if we can make one impact
on those pregnant mothers to say, you know what, you're
(49:07):
gonna get rid of smoking. You're gonna get rid of No,
you're not, you're gonna smoke, You're not going to smoke.
Most likely, you're not going to smoke. You're not going
to take alcohol if you're pregnant. A lot of mothers
won't even use coffee when they're pregnant, which hasn't ever
been proven to be a problem. Okay, why don't we
add sugar and starch to that? Why don't we add
a higher amount of fact. They're going to take their
pre natal vitamins, they're going to take their DHA, they're
(49:28):
going to take the iron. Why don't we add some
fat to that equation? And I think that is an
emotive starting point where we can impact on people preventively.
Everybody else, every patient that we see has to reverse disease.
But if you start at birth, if you start at
the fetal level, you are now creating a state of
(49:52):
health that you don't have to reverse. Does that make sense?
Speaker 2 (49:57):
Oh? Yeah, absolutely? Good ties directly to the prevendor side.
Fascinating stuff. I feel like I have a lot to read, Robert,
But thank you so much for joining us on the show.
This has been so eye opening, and I know our
our listeners are going to really appreciate. Where can people
(50:19):
learn more about you?
Speaker 3 (50:21):
If you want to get in touch from a clinical perspective,
We've got a phone, you can WhatsApp, you can call,
you can text five six one five one seven zero
six four to two. But if you just want information,
I've got a YouTube channel. It's called carb Addiction Doc.
I've got a ton of videos on there, folks.
Speaker 2 (50:40):
The page is awesome, full of content, over two hundred
thousand subscribers. If I'm not mistaken, it's it's it's a hit. Robert.
Thank you so much for joining. This has been an
absolute gem. This has been long overdue. We've got to
do it again. I really appreciate and I love what
you do. I appreciate so much what you do. Oh
I would lusture if I could, my friend. Thank you
(51:02):
so much for listening to Solving Healthcare Radio with Doctor
K featuring the one and only Doctor Rob talk Wilson. Heece.
I remember seeing you when Spaghetti Strappy Snapsack helds up
by your back.
Speaker 3 (51:15):
When I've seen it, I was like, damn, girls, do
you have a man buddy?
Speaker 1 (51:19):
No radio, no problem. Stream is live on Saga ninety
sixty am dot c a
The views expressed in the following program are those of
the participants and do not necessarily reflect the views of
Saga nine sixty am or its management.
Speaker 2 (00:11):
Turn my music, ha ha ha, Sure I do. I'm
from the street, swere to foot. Welcome back onecast Nation.
You got a special episode with my man's doctor, Robert Stribes.
He is a BORD certified general surgeon and pediatric surgeon.
(00:38):
He is a bariatric surgeon as well. He specializes in
obesity medicine and he's very passionate, very loyal, throwing down
free education on how to reverse metabolic disease. And we
get into all things metabolic health, folks, strategies to help
you get healthy again. And one of the key messages
(01:02):
here that we talk about is creating that environment, creating
healthy alternatives, but always having that lens of it's got
to be a sustainable approach, folks. It's got to be
something that you can do for a sustainable period of
time and really get for you to be able to
achieve your goals. And it's nice to be able to
talk to a fellow fellow clinician that sees patients, because honestly,
(01:29):
it's nice that somebody could fully appreciate the uphill battle
that we're dealing with here when you know about eighty
seven percent of the population in the US are metabolically
and healthy. So I think you guys are going to
really enjoy this episode. So without further ado, let's do this.
Folks go to Robert Sives. Welcome to the show.
Speaker 3 (01:48):
Well, thank you very much. I appreciate that. And you know,
just to start with obesities yesterday, we have come so
far from the entry point into metabolic health was through
the large literally and figuratively gate of obesity, but it's
become so much more. There's not a disease that you
treat or deal with as a critical care specialist, not
(02:11):
a disease that I deal with as a surgeon as
a metabolic physician that isn't touched by metabolic health. So,
whether that's obesity, where it's diabetes with its insident resistance,
we have to take as good physicians when you're treating
patients the background of metabolic health into consideration. And so yes,
(02:32):
obesity might be the primary index issue, but there's so
many other issues that we as clinicians have to take
into account. When you imagine managing patients from psychiatry to
inground toenails and everything in between. So yes, obesity is
a piece of it, but it's so much bigger and
(02:53):
greater than that, if that makes sense.
Speaker 2 (02:54):
Oh absolutely, And I love the fact that you highlighted
this because this, I mean, I was new to this
space relative to most like I came onto it during
COVID when we were seeing the metabolic health being a
key metric for poor outcomes. But these new these new
evidence for metabolic health linking to such things as mental
(03:20):
health has been so enlightening. So maybe we'll take a
step back, doctor Robin. And what got you into this
in the first place.
Speaker 3 (03:30):
Well, there's there's really three parts to it. The first
part was a personal story of very rapid weight gain.
I'm blaming Canada for that. I was doing my PhD
in Toronto, Oh my goodness. And you know when there
is a second cup in the base in the lobby
of your hospital, as there was in mind Sinai Hospital
(03:50):
when I was working there in Toronto, you know, up
and down to the lab and back up to down
to the Bavarian I passed Starbucks at just second cup
all the time, and it was the big brand muffin,
the big thing of coke. Then went to the University
of Michigan. There's a Wendy is right there between the
er and the or, you know, and you got free
access to these things. So I gained weight very rapidly.
(04:13):
I'm very obisogenic. Some people gain weight very easily. Some
people can walk past the same doughnut not gain weight,
but their blood sugars go up tremendously. We can explore
that that is genetically predetermined. But I gained over one
hundred pounds very very rapidly, and it concerned me. So
there was a personal journey, and I realized that personally
the problem wasn't calories. The problem was a shift away
(04:38):
from primarily eating food for the nutritional value toward eating
and drinking primarily to manage emotional tension, anxiety, stress, depression, anger, fear, frustration, exhaustion.
This was my cigarette and I realized that eating and drinking,
particularly carbohydrates, but snacking, the behavior pattern was primarily a
(05:00):
substance abuse problem, not a weight or a calorie problem.
So that was the first part. In those days in
the early nineties, late eighties, early nineties, everybody was focused
very heavily on lipophobion. Fat fat fat fat, fat, fat
is bad for you. We weren't eating eggs because of cholesterol,
all that kind of thing. And I was doing my
PhD again in Toronto, and one of the models we
(05:21):
were looking at in the liver was we wanted to
create inflammation in the liver so that we could study
strategies to reduce inflammation. And so we knew that fat
caused fat and cholesterol were terrible. They would cause all
kinds of inflammation. So we created a model where we
infused fatten, cholesterol, and protein into and nothing happened. Nothing happened.
The livery just said, cool, I'm here, I'm doing my job.
(05:44):
Nothing happened, nothing fazed me. Then when we started to
add sugar in within three hours, I could kill a
liver with a glucose insulin clamp. And contrary to what
the world was telling me, we proved that the problem
was sugar in elevated blood, sugar that was affecting the vasculature,
not fat, not protein, not anything else. And we then
(06:07):
used a sugar based model an insulin clamp to create
an injury, which we then found different ways of resolving
whether it was platelets with aspirin, culture, scene and other
medications for white cells. So at a time when everybody
was blaming fat, we started to realize this wasn't a
fat problem, this was a sugar problem. So there was
(06:29):
that connection to myself. I wasn't eating fat when I
gained hundred pounds. I was eating crystal meth or sugar
and starch.
Speaker 2 (06:36):
And then the.
Speaker 3 (06:36):
Third component as a surgeon, especially during my pediatric surgery,
One of my first patients as a young practitioner was
a fourteen year old kid who weighed three hundred and
fifty pounds. But he came in with a cute write
up a quadryt abdominal pain, had gallstones and straightforward operation.
Well obesiently made it more difficult, but we took out
(06:56):
his gall bladder and we got gall stones. We got
an obst fourteen year old. He shouldn't have time, We
shouldn't have cursed dog gallstones. But when I went back
to see the patient afterwards and I was looking what
he was eating, it wasn't fat. There was some fat there,
but the majority of what he's eating, ninety percent of
what he is eating and drinking the mountain dew, the
(07:17):
French fries. It was all carbohydrates, and so that that
constellation of things the personal story we're doing in the lab.
What I was seeing in my patients, my abst patients,
young kids, was that the problem with sugar and starch,
and I started to look more and more at some
of the diseases caused by sugar and starch, both from
(07:38):
a substance abuse psychology perspective, cardiovascular pcos, obesity, diabetes, and
the connection was there that you cannot have any of
those diseases without going through the gateway of insulin resistance.
Even type one diabetes, which everyone thinks is a lack
of insulin, well, you become resistant to your own insulin
(08:00):
you're injecting. So the complications of type two diabetes, the
core mobilities, are primarily Type two complications related to insulin resistance,
not related to the lack of insulin. So it became
very evident to me. But the problem is, I think
you faced as well. And this is what I'd love
to know from your site, is it conflicts one hundred
(08:22):
percent with everything retort and everything that they that they
tell us and with the entire management of all of
our patients. I'll give you an example in the ICU,
if you've got a patient who's not eating for a while,
what do you do? You put them on TPN. One
of the foundations of TPN Doug Wilmore, nineteen seventy, Pittsburgh,
(08:43):
is to use somewhere between twenty and twenty five percent
dextros in that infusion. So our sickest patients are getting
this massive glucose infusion, and then what do we do
when their blood shigar through the if we add insulin
and we expect them to get better, So we're creating
diabetes in insulin dependent diabetes in our sickest patients and
(09:03):
then wondering why they're not getting better faster.
Speaker 2 (09:06):
Oh, and we also give them and like we know
it's pro inflammatory and like to be to be hyperglycemic
as we see it, and we're literally if you look
at any hospital and what is landing on our patients plates, Okay,
like even the diabetic meals, it's high in carblohydrates. And
(09:29):
and it's exactly as you said, Rob, like if we're
if we're somebody who was not eating, give them some
sugar water, give them some TPN or even then in
my world too, the intro feeds high in carblo hydrates,
and and there was a recent actual study I don't
know if it came across your desk on feeding patients
(09:50):
with a ketogenic diet and just having less inflammatory markers,
less insulin. There's a bunch of surrogate markers, nothing, no
heart outcomes. But still it was just another reminder that
what is our goal with the way we're approaching our
patients exactly right?
Speaker 3 (10:08):
And I think you know, in my own practice as
a surgeon, I don't have a huge number of patients
in the ICUs and things, but apart from kids under
the age of two, in the last fifteen years, I've
never ever added dextros, never added dextros to TPN. And
because the liver, even the sickest of livers, makes its
(10:28):
own sugar, I've never had a problem. But I've also
not had patients on insulin because we were feeding them sugar.
The other issue, just while we're speaking about TPN is,
of course everybody's afraid of saturated fat. So TPN is
made of absolute garbage. It's all poly unsaturated fatty acids.
Speaker 4 (10:45):
It's soy based, and I mean even the quality of
the lipids in the TPN we're giving the people is
also basically seed oil, so we're giving them a double hit.
Speaker 3 (10:56):
But it's the best we can do right now. But
certainly you don't need to add glucose to TPN to
be able to keep somebody alive and thriving. You're absolutely right.
But the question is how do you navigate the healthcare
system given what you know to be true, what you've
proven to yourself to be true, and yet there's a
(11:17):
box call best practices? How do you navigate that? We'll
be right back with doctor Rob.
Speaker 1 (11:37):
Stream us live at SAGA nine six am dot C.
Speaker 2 (11:40):
A welcome back to Solve and Healthare Radio featuring Doctor Rob. Yeah,
(12:02):
it's a it's a good question, and honestly, I haven't
really navigated it. It's it's a pretty it's a pretty
strong force when it comes to trying to trying to
adjust the sales of the approach to how we eat.
And my approach has been similar to you, is to
(12:23):
just empower the patients. Empower people to realize, like food
is medicine and it could affect your outcome, and thinking
about how we were you're putting your body and think
of how it will affect your overall health. But as
in patience, I've given up. I won't lie like I've
given up. We did a review, uh presenting. We did
(12:48):
a paper a low carb low carb approach to intensive
care patients, and you know, it was mostly deriving studies
that have used lower carb or ketogenic approaches for for
other patient populations and showing that there's been some positive signals.
But honestly, I don't know if you've had some success,
(13:10):
but just because and obviously in the intensive care unit
there's a ton of fish to fry. Like you see
a lot of people you're more focused on the ventilation
and what have you. But I'll be one hundred percent
honest with you, Rob, like that is a battle that
I have been nowhere close to winning. How about yourself?
Speaker 3 (13:28):
And that's to say, you know, I've I'm older, so
I'm not employed and I've chosen to do that. Has
that harmed me? Absolutely? It has. The entire shift of
healthcare is towards employment. But if you're employed by an employer,
you fall under the box of standard guidelines, of best
practice guidelines, and I've chosen to practice outside of that,
(13:50):
and I'm doing actually, fortunately pretty well but that is
exactly the challenge. And I get very apprehensive every time
I go into a hospital because I've got this conflict
of my hippocratic oath that says do best for the
patient and then the system that says this is what
you have to do to so called do best for
the patient. And there's a direct conflict, and that is
(14:11):
an ethical dilemma for me that is massive. And I've
circumvented that by trying to keep patients out of the hospital.
Working out of Surgy Center is changed my type of
practice more seeing patients in the metabolic health space now.
But you're absolutely right. I mean, the fastest way to
get diabetes is to be admitted to a hospital for
a week and eat their food.
Speaker 2 (14:32):
But it is we see and we do see it
like it's obviously there's a food and there's the fact
that they're acutely ill. Sometimes it's some medication, but we
do often unmask some metabolic syndrome when patient's land in hospital.
Speaker 3 (14:48):
Well, I'll give you, I'll give you something that just
you know, if you go into an ICU, go into
a hospital, you're going to get monitored for everything. You're
getting monitors slapped on you lines placed in your vessel.
Everything's being monitored. We have this wonderful simple technology called
a CGM, a continuous glucose monitor, which is a very
(15:09):
very similar. You can put it on a newonate. They're
tiny and it tells you a blood shugar reading every
five minutes. We will do blood gases on people all
the time. We do all these other BMPs and potassiums
and those are important, but we don't monitor. We don't
slap a CGM on them.
Speaker 2 (15:26):
Why not?
Speaker 3 (15:30):
But we're two decades behind on that or a decade behind.
You can now as of this week in the US.
I don't know about Canada, but in the US, you
can buy a CGM called Stello. My video from last
night it talks about this. You can buy it over
the counter without a doctor's prescription, so Stello Stlo. It's
basically the DEXCOMG seven that is an over the counter CGM.
(15:54):
It's a fifteen day CGM and it was released on
Monday by Dexcom. You can go to the website and
sign up for it. My video talked about this. But
if the late public has access to this, why is
this not something we put on everybody when they get
transported into the hospital or into an ICU. I'll tell
you why not is because unfortunately, it conflicts directly with
(16:19):
everything we're doing. So if you're a diabetic patient, you
put estello on and it says, okay, I ate my
mashed potatoes and my blood sugar went through the roof
and now I have to use insulin. But if it
didn't eat my mashed potatoes, my blood sugar didn't go up.
It conflicts directly with the narrative that they're promoting in
the hospital. I'll give you another very simple example. All
(16:41):
of my patients know and ask for something called a
currently arctic helsium score. Doctors will put everybody that they
can find on a statin okay, but they will never
ever order a CAC score. In my opinion, it is
malpractice to put somebody on a staaten without knowing what
(17:02):
their CAC score is, because if your CAC score is
zero like mine, and my cholesterol is very high, you're
putting me on a very toxic drug called a staaten
with a lot of negative side effects for a disease
I don't have, and even when work, it don't work.
Why are we not testing because if my cholesterol. If
(17:22):
my total cholesterol is three ten and my C and
my LDL is two forty, which was the last reading.
Your belief is as a doctor, you must have cardiovascular disease.
That's why you need to take the staaten. But then
I come with a CAC score that's a goose egg.
Now this conflict.
Speaker 2 (17:39):
Yeah, And just just for folks to understand cecs, it's
like a calcium score, which is you do like a
CT scan and I'll assess whether you've got you got
calcified vessels or risk of and it will give you
a sense of what you're I forget the timeline five
to ten year.
Speaker 3 (17:57):
Yeah, but it tells us how much pluck there is
in your blood and your heart blood vessels.
Speaker 2 (18:02):
And you'm zero. It's like your risk of an event
in the next I forget. It's like five to ten
years is almost negligible. It's like almost zero.
Speaker 3 (18:12):
I will tell you my risk of getting pregnant is
higher than my risk of it. So and no double
one way to find out exactly right. No doctor has
prescribed me both control yet. I mean, it seems ludicrous,
but it isn't It isn't it. The same thing is
that there is, just the risk is so low. Not
(18:34):
only that, there are other reasons, there are other ways
even if you even if you are at risk for
a heart attack of a stroke, they're much more effective medications.
We can get into that in a little bit, but
really what we're talking about as physicians is the frustration
of not wanting to know, and that is a concern
for me. So we don't want to know what your
blood sugars are, so we're not going to use technology
that's inexpensive and readily available. We don't want to know
(18:57):
what your risk of a heart attack or a stroke
is because we want to put you on a staten
And let's face it, last year there were more heart
attacks and strokes in the US than ever before twenty
twenty three, and forty eight percent of Americans were on
statins or cholesterol lowering agents PSK nines. So surely if
statin's worked, you'd have a lower risk of heart attacks
with strokes. Again, these are narratives that we conveniently ignore
(19:20):
because we don't want to change or even question the
way we currently practice healthcare.
Speaker 2 (19:25):
Yeah, it is a lot, I must say, because of
the pandemic. My eyes have been open and you can't.
You can't ignore some of this. And I know our
research group we're looking to incorporate continuous glucose monitors to
proagnosticate patient outcomes, which I think I'll be shocked if
(19:47):
there's not a correlation because we see it all the
time patients. It's one of the early signs that they're
going to become sicker. In fact, is their blood sugar
becomes disregulated. But yeah, I think this is a this
is a very promising sign. But Rob, I want to
get a good feel of like your practice now. So
you went you mentioned the kind of three phases that
(20:08):
led you into addressing of metabolic health and having a
metabolic health practice, But what does it look like now
on a data day and how you impacting your patients?
Speaker 3 (20:21):
Well, you know, just a little bit of history. So yes,
my gateway into this into the metabolic space was through obesity.
I became very interested in pediatric and adult obesity. But
as we discovered more about obesity, we discovered two things.
First of all, that people with insilent resistance behave in
two separate ways. Some become more dibisogenic, their blood sugars
(20:42):
go up and they tend to have cardiovascular disease, but
they don't necessarily become enormous. There may be a little overweight,
but their primary issue is mild mildly elevated insulin levels,
but very elevated blood sugar levels. And the challenge there
is once they become resistant, once they get blockage of
insulin effectiveness, they produce a little bit of extra insulin,
(21:07):
but it can't clear the sugar, so the sugar builds up,
and those people get primarily damage in their blood vessels
and in the space between the blood vessels and the
cells called the interstitial space. So they're getting heart disease,
they're getting neuropathy, nerve disease, they're getting ligament and tendon injuries. Genetically,
another group of people can produce very very high levels
(21:27):
of insulin, but they have fairly normal blood sugar levels,
maybe mildly elevated. Those people have perpetually very high levels
of insulin, and they can shove sugar into their cells
very easily, no matter how resistant they are, and the
cells convert that sugar to fat, so those people gain
weight very easily. They don't suffer the vascular injuries of
(21:49):
the diabetic group or the dibisogenetic group because their blood
sugars are fairly normal until very late and they crossover. However,
those people under insulin is a very important quarterback hormone
and for those folks, high levels of insulin correlate with cancer,
autoimmune disease, Alzheimer's, polycystic ovarian syndrome in females or infertility pcos,
(22:12):
low testosterone in men, and weight bearing joint disease. So
while I started with obesity, I recognized that insulin resistance
goes two different ways. So my practice now has branched
out to still treating insulin resistance, diagnosing and treating insulin resistance,
but now I can look at people with heart disease,
cardiovascular disease which is high blood pressure, a rhythmias, and
(22:33):
plot disease. I look at people with interstitial disease, neuropathy, diabetes,
ligament and joint injuries. I can then look at people
with cancer, with mental health issues, with infertility, polycystic goverarian syndrome,
gestational diabetes, autism, spectrum disorder. All of these are through
(22:53):
the eye of the needle of hyperglycemia hyperinsulinemia. So my
practice is now branched out and giving me a degree
of expertise to manage, at least from a reversal perspective,
so many of those other diseases, and we become more
and more confident. Look, I don't specifically treat cancer, but
I can certainly help a cancer person to reduce their contribution,
(23:19):
their ongoing contribution to their cancer from their diet. So
I'm never going to be naive to say I can.
I can get rid of a cancer necessarily unless I
wear my surgeon's hat. But cancers don't like a don't
like deep keytosis typically, so at least the patient can
bring that to the table and they're healthier as they
(23:40):
deal with radiation, chemotherapy, surgery and reduce the rate of
cancer progression.
Speaker 2 (23:46):
We'll be right back with Doctor Rob.
Speaker 5 (23:48):
Out of a night into the water, we pushed from shore,
breaking in and still.
Speaker 1 (24:04):
No radio, No problem. Stream is live on Sagay ninety
sixty AM, dot c A.
Speaker 2 (24:12):
Run AM Jewels Fast Run and rNam Jewels Fast Run and.
Speaker 3 (24:17):
The Slow Moll.
Speaker 2 (24:20):
Welcome back to solve the healthcare radio feature in Doctor Rob,
What do we do before if someone lands to see us?
Because if you come, if you land here with whatever
it might be, cardiovascular events, stroke, often you're not coming
out the same person, So what can we do to
prevent you from doing that? And I'm curious. I'm curious,
(24:42):
for example, when when you have the the Kenyons as
an example, the patients that look like they're in the
best of shape and doing all these amazing thing marathon running,
and they get that high risk c AC score. Is
there other signals that would be pointing towards you to
say like, hey.
Speaker 3 (25:05):
Yeah, there are other signals, But by the time we
get to the signals, it's kind of a little bit
too late. So what you've got to have is a
high index of suspicion. And that's really what it's about,
you know, is that And a lot of my testing
up front reveals disease that sometimes even I didn't expect
to see, but we test for it because it's not there.
(25:25):
I got a very dirty letter from ETNA a little
while ago saying you do way too many tests for
vitamin D. But you know what, one of the commerce
deficiency we see is low vitamin D levels. And are
you going to intervene when somebody's forty years old with
a low vitamin D A woman, or are you going
to intervene after the hip fracture from osteoporosis. It's that,
(25:48):
you know, we live in a world where so many
of the disease, these diseases can be prevented if we
intervene earlier, and the cost equation to insurances is so
much lower. It's much better to let's say, have a
stent placed if you've got to tight stonosis with a
positive nukemed before you've had the heart attack. Then have
them spend a week in the ICU and get their
(26:08):
stend so they're cabbage done after they've had the heart attack,
then go to cardiac rehab.
Speaker 5 (26:12):
Go.
Speaker 3 (26:13):
It's a crazy way of doing things. Why not help
somebody to lose weight before they need a new replacement
rather than have them lose weight because they're getting a
near replacement. You see. I mean, those are the equations
that we're doing. So so many of these disease that
we've cause to ourselves are reversible or manageable so that
(26:34):
you don't need that intervention. Well, when people are prescribed
blood pressure medication, it usually is forever, but a lot
of my I mean I do more deep prescription of
blood pressure medication not because I just like to de prescribed,
but because the patient no longer needs to be on
blood pressure medication. We get them to monitor their pressures
and as the pressures come down, we've got an algorithm
(26:56):
for deep prescription. Well, now you've saved the insurance company
three or four lifetime's worth of blood pressure medication.
Speaker 2 (27:05):
And I'm curious in your practice, Like we all like,
there's a lot of approaches to reversing metabolic disease. You'll
have some people that are We've kind of alluded to
this before on social media. They it's got to be
key to or it's got to be carnivore, it's got
to be xyz. What's your apperson look like from a
(27:28):
lifestyle modification approach to to your patients.
Speaker 3 (27:33):
Well, I think there are a It's such a good
question because anybody can lose weight, anybody can do anything
for a little while. It's irrelevant. All of my patients
on the obesity side are experts at failing weight loss programs.
They've all lost weight. And I'll tell you where We're
see this in ridiculously excessive amount. All the people on
(27:55):
GLP ones. Now everybody's using ozempic to lose weight, they
feel one for for a year or so, and then
they come off the medication and boom there they gain
all that weight back. So one of the fundamentals of
my practice is to focus not on how quickly you
can lose weight, but addressing the behavior and changing the
(28:16):
behavioral strategies that resulted in the obesity in the first place.
So the important things for me are sustainability and removal
of certain behaviors and replacement with others. You know, AA
alcoholics anonymous doesn't get anybody to quit drinking. You have
to do that yourself. AA is there to help you
(28:38):
to rebuild your life to replace the role that alcohol
had in it. And that's kind of the way we
practice I call myself carb addiction doc. We help people
to remove carbohydrates to change their snacking behavior, but replace
it with other things that they do so that it
is both nutritionally and from a mental health emotion management perspective,
(28:58):
sustainable until they die. And the behavior patterns the strategies
that we create are toward that sustainability. So the eating
what you're eating is just a very tiny fraction. Why
why do I need to eat this right now? Why
do I want that ice cream? What else can I do?
All of those strategies are there in the equation, So
(29:21):
we work very heavily towards sustainability and slow, steady behavioral change.
You don't want to be the rabbit, you want to
be the tortoise, and that is very, very important. I think,
just to allude to the GLP ones, if you look
at the step trials which are done with Ozempeg, they
saw in the first year seventeen to twenty percent body
(29:41):
weight loss. Beautiful what body weight lost. And I do
like the glp ones, but those are people who are
outsourcing their weight loss, like any diet, to the medication,
to the diet, without changing any behavior. And then when
they stop the medication, the statics are statistics are that
ninety six percent of people at forty eight weeks in
(30:02):
the step forward trial after stopping the medication regained back
seventy five plus percent of the weight that they lost
within forty eight not even a year. And the reason
for that is because they never understood and nobody told
them what behaviors to address while they were losing their weight.
Speaker 2 (30:20):
Yeah, and I'm curious to hear rob some of the
practical strategies that you suggest. You have that drive to
want to eat that ice cream, and you ask yourself, yes,
is this emotional or whatnot? But what what do you
suggest to your patients that they can modify this approach?
Speaker 3 (30:46):
Well, okay, so I want to ask you the question.
I'll pretend you the patient. So what is the only
thing an alcoholic should do?
Speaker 2 (30:54):
Not drink?
Speaker 3 (30:55):
No, don't drink alcohol. Nobody tells an alcoholic what they
should drink. But as you alluded to a little bit ago,
everybody loves to tell fat people what they should eat.
And that's crazy if you see it through the lens
of substance abuse. Let's focus just on the sugar and starch.
I don't care what you eat. You can be more vegetarian,
more carnivore. What I care about is not eating carbohydrates.
(31:17):
Changing that relationship, and you don't have to change it
all at once. You can slowly change it. Let's get
rid of If rice is your thing, let's leave rice
to the end. Let's get rid of the fruit. Let's
get rid of some of the ice cream. Let's get
rid of some of the other things. And we do
that slowly and progressively, so that idiot is sustainable, So
we focus heavily on the sugar in the starch. The
rest of the food is less relevant as long as
(31:40):
we can formulate a diet that is more complete than
not in terms of nutrients. The second part is the
pattern of eating A snack is always, always, always an
emotional event, it's never a nutritional event. So both you
and I throughout this conversation have been sipping on something
that has nothing to do with hydration. That is a cigarette.
(32:01):
In other words, that's something you're doing just to give
your brain a little break so you can refocus. I
call that a bridge. My coffee is bridging me across
the moment where I need that little brain relaxation so
I can refocus. But when I was fat, this was
a cocaine eminem's. So instead of a cigarette, you put
gum in your pocket. So we teach them to develop
(32:24):
that relationship, that positive relationship with something to drink in
lieu of having a snack. And then the more pre
emptive you are about your eating, So when you come
home at night and you're exhausted and you don't know
what you're going to eat, you're much much more prone
to being a victim of your emotional need in the
moment and eating a bunch of crap and justifying it
(32:45):
because you're exhausted and stressed. But if you knew last
night what you were going to eat tonight, and you
make a decision about it, if you're empowered by that decision,
and if you're empowered by that decision, number one, you're
less likely to be a victim of itinerant opportunistic snacks.
And secondly, you're most likely going to execute on something
(33:06):
that has nutritional value without the emotional override. So I
knew last night that I was going to eat Roby
steak tonight.
Speaker 2 (33:12):
That's gold. Let's call you know, And.
Speaker 3 (33:14):
There it is, And I'm empowered by that. I'm looking
forward to that. And when you make comments like that,
it's like, yeah, because I feel good about that. The
other thing, also is what's important about addiction management is
you've always it's about your own personal choice. When you
tell somebody you can't have this, you're not allowed to
do that. That's a diet that's deprivational. If I feel
deprived of something, it's just a question of time before.
Speaker 2 (33:35):
I do do it.
Speaker 3 (33:37):
I can eat ice cream anytime I want to. I
have chosen not to eat ice cream again. I'm empowered
by my own decision to.
Speaker 2 (33:46):
Not do that.
Speaker 3 (33:46):
That's disgusting. How could anyone eat ice cream? Says the
guy that twenty years ago lived on ice cream and
pizza and other things. So empowerment is the watchword, not deprivation.
And diets ask you to controller relationship you can't control.
In addiction, we recognize I can't control it. So the
other little phrase that I use is proximity is your
(34:07):
biggest enemy. Okay, don't have cigarettes in your pocket and
say you're going to quit smoking. Don't have ice cream
in the fridge and say you're not going to eat it.
Distance is your best friend. If you don't have it there,
you might get upset. But the ice cream isn't there,
but you less likely you get in your car and
drive down to the store at eleven o'clock at night
to go and get it. There's at least an interface
(34:28):
you could still do that. But proximity is your enemy.
Distance is your friend. So those are all things that
we help patients to understand. And even if you say
I'm never going to eat pasta again, well, then why
the devil is the pasta in the house. You know,
it's all of those little things. But the way that
addicts convince themselves that right now, this is okay to
(34:50):
have is incredibly complex, and we have to help people
to understand their mechanism of justification validation because nobody, nobody,
nobody gets this right. The first time we make mistakes,
we struggle. And you know what, the only time you
fail is when you quit what you want to do.
(35:10):
Nelson Mandela. One of his famous quotes is it doesn't
matter how often you get down, get knocked down. As
long as you get up one more time beyond what
you were knocked down, you're going to be successful. That's
a paraphrase of what he said. It's it's on all
my slide shows, and that is just something that's stuck
with me. My entire life is that get up, get up,
learn from your mistakes, don't beat yourself up because of them,
(35:31):
but don't make them again.
Speaker 2 (35:32):
We'll be right back with doctor Rob.
Speaker 3 (35:33):
You must it's better if you get job and roll
up there. What's how we roll up there? I take
that's older thing, hope that it's so nerds. I take
the sip for that. Yet I want to be. I
take the hit of that they can't stop.
Speaker 1 (35:46):
Rebally, what's the streamers live at SAGA nine sixty am
dot c A.
Speaker 3 (35:58):
Yeah, well wrapped the balious job by.
Speaker 2 (36:01):
Listening to Solven Healthcare Radio to Doctor K featuring doctor
Rob felt Fast, my friend. I love that so much.
I'm them have a similar mantra. But yeah, this is
this is pure gold. I think this is something many
people think about intuitively, but proximity barriers don't keep the ship,
(36:23):
don't keep the food that is going to be the
devil in your house. And I also like that tip
of replacing what you might snack on with something to
drink that that is actually quite genius. And so one
thing I want to maybe as we kind of wind
down here, Rob is you and I have both clinicians.
(36:48):
We we walk the walk. We we preach metabolic health,
and we do it in our own lives. We try
and bring it to our patient's attention and so forth.
What do we got to do to level this up
to the next level? Because really, if you think about it,
(37:09):
eighty seven percent of the US is metabolically unhealthy and
I don't see this significantly moving and we're all in
our own spaces, trying to do our best and to
try and move the needle. But I'm curious what's keeping
you motivated? Do you see this needle changing? What do
(37:29):
we need to do at scale?
Speaker 3 (37:30):
You think, right, And I don't think that at scale
we are going to make a difference. And I know
that sounds awful. I know it sounds pesstimistic, but it's
one on one, it's one person at a time.
Speaker 2 (37:41):
I'll tell you why.
Speaker 3 (37:43):
You know, in the nineteen fifties and sixties, the tobacco
companies were very good at camouflaging the harm of smoking.
But there's nobody that doesn't know that smoking is really bad.
And yet we still sell cigarettes at a societal level
at huge cost. Now it's okay cigarettes, but it's vaping.
There's really not much difference we can argue that one.
(38:03):
So at a societal level, we are never from a
health perspective, going to beat the economics and the power
play that is the sale of drugs. You're never going
to beat the cartels from Mexico bringing or wherever it is,
bring drugs into our country, both countries. You're never going
to beat the food industry in terms of what they're
(38:25):
promoting the manufactured food processing company. You're never going to
beat the tobacco companies, but one on one we can
make our own empowering decisions. So I take one patient
on at a time, and my success is through the
success of my patients and through the people that come
out the other side saying, Wow, I'm feeling great, I'm
looking good, and they pass on that message. This is
(38:47):
about grassroots activation activism. It's not going to happen in
medical schools for a long time. It's not going to
happen in the hallways of government, as much as I
wish it would, and I'm not saying we shouldn't try,
but this is going to happen at the kitchen table,
from person to person. When I've got a mom conquering
(39:09):
her diabetes and changing the way the family eats, when
I've got I just had one yesterday where I've got
a young child changing where their parents eat. All of
those things, that's the influence. It's a grassroots campaign. But
I think as physicians, one of the problems that we
have is cognitive dissonance. We are locked into a way
(39:29):
of thinking and more and more our thinking, and it
was a purposeful thing done in the nineteen nineteen nineties
at universities where we switched from physiology to epidemiology. And
we have to as physicians go back to understanding disease process.
If we keep using outcome metrics, but the question that
(39:50):
was asked and answered by the outcome metric was wrong,
We're down all kinds of abnormal paths. I'll give you
an example. I can prove to you on outcome metrics
that alcohol that water makes people drunk if you conveniently
ignore the fact that it has whiskey in it. And
I mean it's a bizarre example, but when you say
(40:12):
red meat causes diabetes, you're ignoring the fact that it's
pepperoni on pizza and lasagne that was included in the
foods that were counted as red meat. So getting away
from epidemiology and outcome metrics and using those kind of
so called pure review papers because you know as well
as I do, that we choose the peers that are
going to review the papers, which is crazy. You're basically
(40:35):
selecting a group of people that are going to prove
your paper. So this whole thing of autonomy and independence
doesn't exist in healthcare. So as physicians we have to
open our eyes and look at our patients, and it's
so obvious what we see. If you see this enormous
child fourteen years old, ninety percent of what they're eating
is sugar. Don't blame fat, it's all of those things.
(40:58):
You know, if you have to use insulin to correct
blood sugar, why are you giving the person extra sugar?
All of those things make a difference, and we as
physicians have to keep asking those questions. That's how we're
going to change as individuals. But also we need to
foster a dialogue at the grassroots level about how is
(41:19):
this happening? And that I think is something that we
can do as a society. Whereas the powers that be
have too much of an alternative, ulterior vested interest, there's
no incentive for them to change. In fact, quite the opposite.
I'll tell you one other thing. The biggest problem for
me is the ethical barrier that I don't sell anything.
(41:41):
I have nothing to sell, so I can't make money
by selling stuff. I can't promote my message by selling stuff.
I don't have widgets and stuff I can sell. The
people that market stuff you turn on any TV, they're
selling something. They're selling a pill. They're selling a product.
I've got life. I've got hard work that I sell.
I don't have anything easy to sell.
Speaker 6 (42:03):
I've got to mount I've got what I sell every
day in my office is a very very tool mountain
that I ask my patients to climb and those that
embark on that, one step at a time get to
the other side.
Speaker 3 (42:15):
But I don't sell magic.
Speaker 2 (42:16):
Mm hmm. It's so true. Like and as you as
you mentioned a lot of these success stories, they come
from a lens of sustainability and tortoise, not the rabbit.
You need to have that patience, and it's it's hard.
And you know when you said the I mean I
(42:37):
will I'm going to go on record and I don't.
I don't know fully if what I'm going to say
is true. But I still have hope though, I really
still have hope. Just I see in the next generation
of physicians too, that seem to care a little bit
more about this stuff, start to ask a little bit
more questions, think about root cause and really thinking of
(43:00):
about how we're gonna how are you going to change
trajectory for our patients and and so are we going
to cure metabolic syndrome or are we gonna significantly change
a needle. I don't. I don't think it's gonna be
anytime soon, but I certainly hope it's that there will
(43:20):
be a tide. And to what impact, I'm not sure,
but I just something's gotta something's gotta change. And the
other point, too, rob that I'm hoping will be a
trigger is the other areas of health, whether it's the cancer,
whether it's a mental health, PCOS, fertility. This is where
(43:41):
I'm wondering more of a push towards trying to remedy
folkses metabolic syndrome. Maybe we'll see more of a push,
But that's I'm notorious for being an optimist, so I uh,
I'll put that little uh asterisks on there.
Speaker 3 (44:01):
Yeah, And you know, I am very optimistic for each
patient that here's our message, because they're empowered by the
ability to change slowly and it's not about outcome metrics.
It's not about losing one hundred pounds. It's about having
a good day and then adding another good day. So
I'm empowered, very optimistic about each individual patient. But as
(44:23):
I've gotten older, I become more jaundiced and pessimistic. About
societal society pivoting quick enough, and it will eventually, but
not in my lifetime. You know, I'll give you another
just I know we've got to go. But just for me,
the most tragic, tragic of all the obesity diabetes, there's
at least a recognition there that that is self induced.
(44:46):
The thing that bothers me the most and the most
tragic thing for me, and I've got a bias toward
pediatrics is autism spectrum disorder. And we are spending billions
of dollars trying to find some gene trying to find
some genetic association. If there was a genetic association to
ordism spectrum disorder, the billions and billions of dollars we
were spent would have shown that it is so obvious,
(45:09):
so so obvious when you step back from this, that
ortism spectrum disorder is a structural brain abnormality caused by
a substrate deficit, the substrate deficit being fat and too
much sugar in too little fat.
Speaker 2 (45:25):
Now diet.
Speaker 3 (45:25):
Ordism spectrum disorder has gone from one in one hundred
one in fifteen thousand in nineteen seventy to one in
twenty last year, and it is a substrate problem and
those children didn't choose this. They didn't choose this, and
it's going to impact on them and our society for
the next seventy to eighty years. And that is a
place where we can potentially intervene. But the problem is
(45:49):
it's so emotive. When we talk about it, even just
me saying this, there'll be a lot of pushback. How
can you say that because we're emotional, we feel guilt.
But as we take pregnancy gestational diabetes. In my home
country of South Africa, eighty percent of women pregnant women
have gestational diabetes. I mean, just think about those numbers
and how it impacts not just one generation but the
(46:11):
next eighty to one hundred years of people. That's where
I think we can have an impact is educating and
working with gynecologists, obstetricians and young people who are getting
pregnant because they care about their babies. There's very few
mothers who won't stop drinking alcohol, who won't stop smoking
when they're pregnant. Why don't we push on this as well?
Speaker 2 (46:35):
Wow, I know we're up against it, But like when
it comes to the substrate deficiency and too much sugar
with the with artism is that are you saying that
the host like the mother, like during the pregnancy or
is that or during a post like when is the exposure.
Speaker 3 (46:58):
Yeah, it's a long time exposure. So just simply put,
the human brain begins to develop it around five to
six weeks suggestation before most women know they're pregnant. Human
brain develops. Structural development continues through the first five years
of life. So if the mother is eating a high
carbohydrate diet, and remember insulin has to go across to
(47:19):
the blood bread across to the brain, brain starts develop
it five to six weeks. Insulin only gets produced by
the baby's pancreas at fifteen to sixteen weeks, so depending
on the mother's on what the mother's eating and drinking.
If the mother is hyperglycemic or hyperinsulin emic, the brain
the structure of the brain doesn't develop adequately. The brain
itself is primarily made of fat. About sixty five percent
(47:41):
of the gray matter is fat, about seventy seventy five
percent of the white matter is fat. If you don't
have adequate ketosis, if you have adequate fat for the brain,
the structure of the brain doesn't develop properly, and autism
spectrum disorder is a white matter structural abnormality. The grain
matter is okay, the white matter doesn't develop autism spectrum disorder.
(48:03):
And this is what's bizarre, is a clinical behavioral diagnosis
with the average DIAGNOSI is made of eight years of age.
You can do an MRI on a baby's brain at
three months and diagnose the structural abnormality that is consistent
with ASD. So where as a society you have to
shift that and say, okay, these babies, no matter what
you think of fat, need more fat. As a substrate.
(48:25):
You look at breast milk. Breast milk hat is the
only substance. It's the only substance that is dominant in
saturated fat. Even meat that we eat is not saturated
it's there's a lot of saturated fat in it, but
the dominant is probably unsaturated fat. But milk is that? Why? Why?
Because our brains need it? And what do we do
(48:46):
when we feed baby's formula? We feed them soy, We
feed them crack that isn't saturated fat, And as soon
as they come off the breast, they're eating cheerios and
goldfish and all kinds of carbohydrates and we drop their
fact radically low. So if we can make one impact
on those pregnant mothers to say, you know what, you're
(49:07):
gonna get rid of smoking. You're gonna get rid of No,
you're not, you're gonna smoke, You're not going to smoke.
Most likely, you're not going to smoke. You're not going
to take alcohol if you're pregnant. A lot of mothers
won't even use coffee when they're pregnant, which hasn't ever
been proven to be a problem. Okay, why don't we
add sugar and starch to that? Why don't we add
a higher amount of fact. They're going to take their
pre natal vitamins, they're going to take their DHA, they're
(49:28):
going to take the iron. Why don't we add some
fat to that equation? And I think that is an
emotive starting point where we can impact on people preventively.
Everybody else, every patient that we see has to reverse disease.
But if you start at birth, if you start at
the fetal level, you are now creating a state of
(49:52):
health that you don't have to reverse. Does that make sense?
Speaker 2 (49:57):
Oh? Yeah, absolutely? Good ties directly to the prevendor side.
Fascinating stuff. I feel like I have a lot to read, Robert,
But thank you so much for joining us on the show.
This has been so eye opening, and I know our
our listeners are going to really appreciate. Where can people
(50:19):
learn more about you?
Speaker 3 (50:21):
If you want to get in touch from a clinical perspective,
We've got a phone, you can WhatsApp, you can call,
you can text five six one five one seven zero
six four to two. But if you just want information,
I've got a YouTube channel. It's called carb Addiction Doc.
I've got a ton of videos on there, folks.
Speaker 2 (50:40):
The page is awesome, full of content, over two hundred
thousand subscribers. If I'm not mistaken, it's it's it's a hit. Robert.
Thank you so much for joining. This has been an
absolute gem. This has been long overdue. We've got to
do it again. I really appreciate and I love what
you do. I appreciate so much what you do. Oh
I would lusture if I could, my friend. Thank you
(51:02):
so much for listening to Solving Healthcare Radio with Doctor
K featuring the one and only Doctor Rob talk Wilson. Heece.
I remember seeing you when Spaghetti Strappy Snapsack helds up
by your back.
Speaker 3 (51:15):
When I've seen it, I was like, damn, girls, do
you have a man buddy?
Speaker 1 (51:19):
No radio, no problem. Stream is live on Saga ninety
sixty am dot c a
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