The Dr. Hyman Show - The Truth About Alcohol, Caffeine, and Sugar and Your Health

Episode Date: March 11, 2024

View the Show Notes For This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal The trio of alcohol, caffeine, and sugar are often the centerpiece of social engagements and times of emotional distress. While consuming them from time to time may be okay, overindulging in them can be a recipe for a disaster, leading to inflammation, insulin resistance, disrupted sleep, and more. In today’s episode, I talk with Dr. Elizabeth Boham, Dr. Todd LePine, and Dr. Robert Lustig about how the foods we love can often have negative consequences when overconsumed. This episode is brought to you by Rupa Health, AG1, and Essentia. Streamline your lab orders with Rupa Health. Access more than 3,000 specialty lab tests and register for a FREE live demo at RupaHealth.com. Get your daily serving of vitamins, minerals, adaptogens, and more with AG1. Head to DrinkAG1.com/Hyman and get a year's worth of D3 and 5 Travel Packs for FREE with your first order. Receive an extra $100 off your mattress purchase! Go to myessentia.com/drmarkhyman to get this great deal.

Coming up on this episode of The Doctor's Pharmacy. Having one and a half to two ounces of hard alcohol every day for two weeks, you can start to see signs of fatty liver. When somebody has fatty liver because of alcohol and you take them off of alcohol, you can see resolution of fatty liver within four to six weeks. Hey everyone, it's Dr. Mark. As functional medicine practitioners, we need to get to the heart of root causes behind our patients' health concerns. And let's face it, ordering labs to get the data can be an administrative nightmare. Luckily, Rupa Health is here with the solution.

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Hi, this is Lauren Feehan, one of the producers of the Doctors Pharmacy podcast. Substances like alcohol, caffeine, and sugar are often part of social gatherings, yet when consumed regularly, they may affect your liver, energy production, metabolic health, and more. In today's episode, we feature conversations from the doctor's pharmacy about how alcohol, caffeine, and sugar affect our bodies acutely and over time. Dr. Hyman speaks with Dr. Elizabeth Boehm about how alcohol and sugar contribute to fatty liver. Then he talks about how different people respond differently to caffeine. Next, he speaks with Dr. Todd Lapine about how caffeine affects ATP or our energy production. And finally, with Dr. Todd Lapine about how caffeine affects ATP or our energy production. And finally,

with Dr. Robert Lustig about what sugar is and why we all need to minimize it for the sake of our total body health. Let's dive in. Why is fatty liver a problem? I mean, so my liver is a little fatty who cares, like, why is it an issue for people? Why do we care to fix it? Other than the fact that you can get cirrhosis and die from liver failure. That's not a common thing. I mean, other than that. But that's a late stage thing. The other problems are not late stage and they happen to a lot of people and they're unrecognized as related to fatty liver. Right. I mean, they can happen quickly. Fatty liver can develop quickly. They know that within two weeks of heavy drinking,

having one and a half to two ounces of hard alcohol every day for two weeks, you can start to see signs of fatty liver, which is, you know, it can develop very quickly. What's great to also understand within a lot of this research is that it can resolve quickly. So when somebody has fatty liver because of alcohol, and you take them off of alcohol, that you can see resolution of fatty liver within four to six weeks. So it can progress, unfortunately, quickly if we're not taking care of ourselves. And then it also regresses when we start to make some shifts. And, you know, as you were mentioning, we're seeing this huge rise in fatty liver, not only because of alcohol, but because of how high blood sugar, high levels of insulin, toxins like glyphosate and all the other toxins

you mentioned, medications that people are taking, all are putting stress on our liver and making it so then our liver can't do what it needs to do to detoxify. So it becomes this vicious cycle of we're inundated with toxins that are impacting our liver, but then the liver can't work as well. And so then we can't get rid of the toxins that we're inundated with. So it becomes a vicious cycle of having issues with our detoxification system in our body. And as we've spoken about before, the liver is such a critical organ within the body's natural ability to detoxify and handle all the toxins we're exposed to. Maybe we weren't put together to handle all of these toxins, unfortunately, that we're exposed to, but we do have this ability to handle toxins and we want to take care of our body so we can handle

the toxins that we are exposed to. And so it's really important that we take care of our liver. And so what's considered normal for alcohol intake? For men, it's less than 10 drinks a week. And for women, it's less than five drinks a week. And so we know that problems with the liver can occur when we're drinking too much. So we see problems when people are binge drinking or consuming more than 14 drinks a week for men or more than seven drinks a week for women. So I think it's important we also talk to our patients about what is moderation with alcohol? How do we take care of our liver, both from all aspects of nutrition and lifestyle? So there was also an interesting study came out recently looking at cancer and alcohol and showing that there's a dramatic increased prevalence of cancer. Even a little bit of alcohol may actually increase the risk of cancer.

So it's not just fatty liver, but it was a Japanese study with 63,000 adults where they looked at people who were drinking alcohol and it was a Japanese study with 63,000 adults where they looked at people who were drinking alcohol, and it was a concern. But that aside, besides just the overload on your liver, besides just the stress on your liver's ability to deal with all the normal toxins we have to deal with, what happens when you have a fatty liver is it drives inflammation in the body. And it's linked to heart disease, to cancer, to diabetes, to even dementia, and all sorts of things that we don't think necessarily related to a fatty liver. So fatty liver is sort of an early warning sign and clue that there's something wrong in your body and it's causing a risk, an increased, dramatically increased risk of all these other problems. With that said, how do we know if we have fatty liver? You know, one of the first ways we find out is

with general blood work. So if you do a metabolic panel, comprehensive metabolic panel on a patient, and we look at these markers like the AST and the ALT, and if they're elevated, either high end of normal or elevated above the normal range, you know, that's something we really have to be thinking about is, is this fatty liver? Should we go on and do an ultrasound of the liver to see if we are seeing some fat deposition in the liver? And so that's one of the ways we start to see it most frequently with our patients. Yeah, absolutely. And so there's other tests you can use, which I've had personally, just because I've started biohacking,

kind of like to check everything. But you can do an MRI and look at liver fat. And it should be less than 2%. And many people have very, very high liver fat. I thankfully have less than 2%. You can also, they're actually also doing fiber scans, which look at the fibrous content, the fiber, sorry, the scar tissue from the fatty liver, and they can use ultrasound scans. And those are good for measuring the degree.

They can do liver biopsies. And I think, you know, what we see is really in functional medicine, a roadmap for healing the liver in ways that just doesn't exist with traditional medicine or conventional medicine. So talk about what are the ways that, you know, in addition to the testing we talked about, we'll look at insulin resistance, we'll look at the particle size, we'll look at inflammation, we'll look at a lot of things that traditional doctor wouldn't look at. What are the beginning things we do from a dietary lifestyle and supplement perspective to reverse fatty liver? I mean, one of the first things we do, right, is of course we get a good detailed history from our patients and try to get a sense of what's going on for them, get an understanding of their timeline

of their health. And that can help us find out what may be driving health problems in that person. So if there is some concerns about fatty liver, you want to get a sense of what their toxic load has been in their lifetime. What is their weight? What is their nutrition? What are they eating? And what is their microbiome like? And so we can really evaluate all of that and get a sense of how best to help this patient, that individual patient improve. Because we know that for some people, it may be more focusing on toxic load. For somebody else, it may be focusing more on alcohol intake. For somebody else, it may be more they're eating way too many carbohydrates,

refined sugars, soda, coffee drinks, muffins, and not exercising enough and that whole metabolic syndrome process. So we want to really help focus the treatment plan on that individual patient. And I think that's what's so special about functional medicine is it's really looking for that underlying root cause for that underlying patient so that they can reach their optimal health. And we know that problems with the liver and fatty liver impact our immune system and how well we fight off infections. It impacts how we can digest food, metabolize food. It impacts our nutritional state in our body. So there's so many reasons why we really want to look deeper here. Absolutely. And I think in addition to the dietary stuff and getting rid of the

environmental toxins that we can, sort of decreasing our overall toxic load, and we've talked about this in other podcasts, like the Environmental Working Group's Guide to How to Reduce Your Exposure to Toxins in Food and Household Cleaning Products and Personal Care Products. But there's also a lot we can do from a dietary perspective to upregulate those pathways in the liver that boost glutathione, all the brassica family, the onions and garlic, all the spices that we can use in the even herbs that can be very helpful, like milk thistle and others to help improve the liver function. And then there's a whole bunch of nutrients that the liver needs to function. And in fact, you know, you and I were both trained in traditional medicine and we worked in the emergency rooms and, you know, people come with a total overdose.

We give them this, quote, drug called mucamist, right? Which is actually N-acetylcysteine. It's a supplement you can go over the counter. And what it does is it boosts glutathione and helps the liver to regenerate glutathione, which is what's depleted often with fatty liver and internal liver damage from overdose. And so there's a lot of things you can do to boost glutathione. You can take glutathione, you can take initial cysteine, lipoic acid, milk thistle, curcumin. And we use a lot of herbs. We use also the B vitamins, zinc, selenium, amino acids,

and we do a lot of things to help the liver heal. And what's amazing is when you use this cocktail of substances, things like milk thistle, lipoic acid, you know, N-acetylcysteine, glutathione, and so forth, livers will come back. And it's striking to see the drop in liver function tests, the improvement in fatty liver content. And I encourage people to really think about, one, checking to see if they have it. Two, thinking about how to actually upregulate your lifestyle so that you can protect your liver and live a liver-healthy lifestyle. There's a lot of variation in how people metabolize caffeine. So there's fast and slow metabolizers. There's people that can have a cup of espresso and go to sleep and be fine. Other people have one cup of coffee in the morning and they're bouncing off the walls and have palpitations and panic attacks and

anxiety so it really depends on the individual and what your metabolic pathways are and we measure those through genetics so we can actually look at that but the the the truth is that it's just it's worth an experiment for yourself to see how you feel now if most people can tolerate a cup of coffee or two in the morning and that's fine i probably wouldn't have one after the morning cup. I certainly wouldn't have one in the afternoon and definitely not in the evening. Now, you may be one of those super fast metabolizer, doesn't bother you, you're fine, you like to have an espresso after dinner, go ahead, but know your body, because ultimately can catch up with you. So I encourage people to try to just limit their caffeine a cup a day, but also to go on a caffeine holiday and see how they feel,

because it might actually give them way more energy. Coffee blocks adenosine receptors. And you were talking earlier about ATP. So the fuel of our body is ATP, adenosine triphosphate. So there's three phosphate groups attached to this molecule. And as we go throughout the day, ATP gets degraded into ADP, which is two phosphate molecules, and then to adenosine monophosphate, and then to just plain old adenosine. As our bodies, and the more you exercise, guess what? The better you sleep. The reason for that is our body has a buildup of

adenosine. So as our bodies go throughout the day, we're active, physically active. So it's good to get more adenosine. Great. The adenosine will slowly build up, and in certain parts of the brain, that triggers the sleep mechanism. Well, guess what? If you look at the structural molecule, the caffeine fits into the adenosine receptor, so that's why it prevents us from feeling tired.

Okay, so I just got this new espresso machine. Is there anybody in the market for a new espresso machine? How about decaf? Is that okay? Yeah. So that's, but you know, again, you know, caffeine can definitely, and actually, there's actually some interesting thing with coffee intake. Epidemiologically, you know, a couple of cups of coffee actually have preventive effects for Alzheimer's and Parkinson's. So it's not, it's not all bad. Not all bad and the one the one thing one thing i will dose and the timing the dose and the timing like like anything and and the other thing that's really i think important with coffee

is to make sure it's organic because that's one of those highly sprayed uh things like strawberries you don't want to eat yeah they're unless organic coffee is one of those things you just don't touch it unless it's organic very important yeah. And there's some great companies out there that do this. Purity Coffee is a great one. I encourage you to go check that out. Hey, everyone. It's Dr. Mark. Sleep is the foundation of wellness and happiness.

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We all were trained and I was trained because I'm old now. I was trained in the era when it was fat that was the boogeyman. Fat was going to make you fat. Fat was going to cause heart disease and strokes. Fat was going to make you sick and fat. The truth is that it's not fat, it's sugar. And that I've written about a lot in the blood sugar solution, in the 10-day detox diet, in food, what the heck should I eat, in the vegan diet. I mean, there's plenty out there about this sugar issue from my perspective. And the biology of sugar is fascinating because historically, we only consumed about 22 teaspoons a year if we were lucky and

found maybe some honey or we had a lot of berries, we get a little rush of sugar. Or maybe we're like the Nepalese honey hunters, where they had to literally climb a tree 100 feet high with a smoking bush to get the honey out of the tree. Imagine if you had to climb a tree with a smoking bush 100 feet to get a cookie, right? But now we are living in a sea of sugar and flour. The average American eats about 152 pounds of sugar per year, per person, 133 pounds of flour per year, per person. And we'll get into why flour may be worse than sugar. I'm talking about wheat flour, whole wheat flour, regular flour, any kind of flour, and why that is causing havoc in our biology. So you ask the question, what does it do when we consume this with sugar?

Well, if you're consuming a berry here, a little bit of honey there, not a problem. Our bodies are designed for starvation. So whenever we got to see a lot of calories or a lot of starch or a lot of sugar, the body knew exactly what to do to get through the winter. It would store those calories in your belly and it would put on a lot of belly fat.

And this is what bears do. I mean, I was in Alaska, I remember with my daughter kayaking a few years ago and we went to Adamanty Island, which has the highest concentration of grizzly bears. And they were fishing for salmon. You could go to this one little spot. You could stand there used to humans and they were fishing for salmon and they would eat the salmon all day long and they wouldn't really gain that much weight. And then the summer they'd go up in the mountains and they would eat the berries and they eat like literally hundreds of pounds of berries and they would eat the berries. And they'd eat literally hundreds of pounds of berries, and they would gain 500 pounds. Then they would go to sleep all winter.

And basically, they would become diabetic and hypertensive and overweight, but then they would just live off that all winter. The problem is we just keep eating all winter. We don't have winter. We basically just eat all winter. And so we're consuming massive amounts of calories in the form of starch and sugar that are driving this ancient pathway to store belly fat. Now, why is belly fat bad? Well, it turns out that belly fat is the fat around your organs. It's the visceral fat. It's the fat that coats your liver, your kidneys, your intestines,

all this fat. It's not the subcutaneous fat or the fat on your butt or your thighs. It's the belly fat. And that fat is so active. It's not just there holding up your pants. It produces all kinds of molecules. One of them we've heard about, which are called cytokines. You might have heard of the cytokine storm. Why is about 80% of the deaths caused or occur of COVID in people who are overweight or obese? Because they are literally a firestorm waiting to happen. Their fat cells make cytokines, particularly one called interleukin-6. And this is fuel for the fire, not just for COVID, but for all chronic disease, high blood pressure, heart disease, cancer, dementia, kidney disease. All these chronic illnesses are the result of

this belly fat, of this visceral fat, which is producing hormones, neurotransmitters, inflammatory molecules. And it literally, when you get the fat in those cells, in your belly fat cells, because of the way the body works with high insulin levels, the insulin lets the sugar and the fuel into the fat cells, but it doesn't let it out. So it's like a one-way turnstile on the subway. All the calories get in, but they don't get out. So basically you shut down what we call a lipolysis, which is fat burning. So by eating sugar, you literally shut down your ability to burn the fat off your body. Second, and I don't just mean the fat you eat, the fat off your body.

The second is it slows your metabolism. Third, it actually creates inflammation. Fourth, it drives horrible hormonal changes in men and women that make basically men into women and women into men. You get men with men boobs, and you get women with facial hair and hair loss on their head because of the changes in the hormones that happen from the visceral fat. And then you get shrinkage of your brain and the hippocampus goes down. So the memory center goes down. That's why we're calling Alzheimer's type 3 diabetes. And if that weren't bad enough, it also fuels cancer cells. Cancer loves sugar. So basically, you're fueling every disease that is resulting from sugar that causes chronic disease.

Heart disease, cancer, diabetes, Alzheimer's, all the things that we see as we age. High blood pressure, kidney disease, and more. And when we sort of take a step back and we look at, wow, why are we seeing in America major advances in science and the most money by a factor of two or three or four that other countries spend on healthcare? And we're seeing worse and worse and worse results. I mean, the US has the worst COVID outcomes. Why? Because we're the sixth population.

Why? Because we eat too much sugar and flour. And so people really need to understand that this is something that is within their grasp to fix, and that sugar is not only harmful in the sense of the volumes of sugar we're eating and the consequences, but it's also highly addictive. And we'll get into talking about that. So in short, when you eat starch and sugar, it turns on all the mechanisms of your body for disease and death. Sugar, dietary sugar, the sweet stuff you put in your coffee, you know, the crystals,

is two molecules in one. It's called sucrose, but it is two molecules. One is called glucose. One is called fructose. Now, glucose is the energy of life. Every cell on the planet burns glucose for energy. Glucose is so important that if you don't consume it, your body makes it. Makes it out of proteins.

It makes it out of fats. So you will always have a serum glucose level. The Inuit, who basically didn't have any carbohydrate because they didn't have any fields to grow any carbohydrate, they ate whale blubber. They still had a serum glucose level because glucose is that important. But it's not important to eat because you can make it. Now, fructose, that sweet molecule in sugar, is a different animal entirely. There is no biochemical reaction in any vertebrate that requires dietary fructose. It is completely vestib is completely all animal life.

Now, it just so happens it's sweet. It just so happens we like it a lot. It just so happens it's addictive, but it is actually metabolized like fat, but it is completely unnecessary. Now, glucose will stimulate insulin release. And that's not good because insulin release will drive energy into fat cells and increase weight gain. And that's what Dave Ludwig is talking about. And he's right.

And he's right. I'm not saying he's wrong. He's right. But fructose, because it gets stuck in the liver and causes that liver fat, you get insulin resistance. Two different phenomena, two different things. One's called insulin secretion, insulin release. The other one's called insulin resistance. They are not the same. Insulin release will cause weight gain. Insulin resistance will cause heart disease, diabetes, Alzheimer's, cancer, and virtually all of the other chronic metabolic diseases that are chewing through our entire healthcare system. Insulin resistance is the bad guy. Insulin secretion is basically what we're talking about when we're talking about

the scale. Insulin resistance is what we're talking about when we're talking about the scale. Insulin resistance is what we're talking about in the doctor's office. But eventually, though, if you have enough of the restoring starches, even if you don't have refined sugars, you will see an increase in insulin resistance because you introduce more and more insulin and the cells become resistant. So it's sort of related, but I get your point. Fructose really has a unique effect on the body. We had Richard Johnson on the podcast who talked a lot about the dangers of fructose. And David Perlmutter talked about what he called drop acid, meaning uric acid in this role as a real accelerator of insulin resistance and chronic illness. So I agree with you, Robert.

I think, you know, it's so amazing to me that the single biggest driver of our exorbitant healthcare costs, of our declining health globally, of all of our chronic diseases, heart disease, cancer, diabetes, dementia, even depression, and more are driven by insulin resistance. And yet it's something we learn almost nothing about in medical school. My daughter now is in second year medical school. I think she had like an hour on it. And it wasn't really in the context of what's really driving it. And it's like if you treat that, you treat so many of these chronic illnesses.

And it's one of the drivers of all aging. I just finished my book on longevity called Young Forever. And basically, if you look at the science of this, the science of insulin resistance is really the science of chronic disease and the science of aging and the science of death. Couldn't agree more. In fact, insulin resistance is the sentinel problem in all of these chronic metabolic diseases because insulin resistance is a manifestation of mitochondrial dysfunction mitochondria are little energy burning factories inside each of our cells

and when our mitochondria work efficiently we are healthy and our blood glucoses do not vary very much and our weight stays stable and we feel good and we can sleep well and all is right with the world. And as soon as our mitochondria don't work well, all hell breaks loose and we get all of these chronic diseases and we feel like crap, et cetera, et cetera. And we end up starting to having to take medicines in order to try to make our mitochondria work better, except guess what? We don't have a medicine to make our mitochondria work better because no medicine can actually get to where the problem is. Okay. But it's foodable, not druggable, right?

Right. So that's the whole point is what's wrong with the mitochondria and how do you fix it that's basically what this whole story is about and to be honest with you mark that's what functional medicine is about okay whether for sure whether they taught you that or not that's where we are no it's it's for sure. Frigging mitochondria. All right. Absolutely. So what's poisoning them? That's the big question in all of medicine.

Before we get into the – I want to get deep into mitochondria and all this. I just want to kind of back up a little bit because we said a lot of stuff, and I want to make sure people get it. So I want to talk about how we diagnose insulin resistance and, and, and you have in your book, a way to self-diagnose because it's really important because your doctors are missing 90% of it. They don't get taught how to diagnose it. They don't, because there's no simple drug for it. So there's no drug for it. Why test for it? Right. And, and you talk, you just talked about a few major things that are a little bit confusing. One is you can be metabolically normal obese, meaning you're overweight but metabolically normal.

And I think that's a small number of people. You can be metabolically obese and normal weight like the people from India and China. They can be on their BMI, their body mass index normal, but they're still diabetic, right? And that's dangerous. In fact, I've seen some studies that that may be more dangerous than being overweight and metabolically unhealthy. And then there's the, obviously the overweight, the metabolically obese and obese, obese patients. So there's these different categories. Some of it's genetic, some of it's, you know, has a lot of variations, but you kind of can't know until you test. So explain to us how we can understand what's going on in our bodies. How do we test for this

phenomenon that's driving all these diseases for which we're taking so many medications that aren't really working? They're just managing the disease and they're not actually treating the problem. They're treating the symptoms. Totally. The problem, of course, is that your doctor has access to all of this and you don't. And you need to, and they need to,

but they don't understand it, which maybe you can teach your doctor what to do. How would that be, all you audience out there? Okay. I love that. All right. Sometimes doctors are a little, you know, shall we say provincial and they don't necessarily, you know, listen to their patients, but they really should. If they listen to their patients, they'd be much better doctors. All right. Number one, you look at your waist. Now your waist is a conglomeration of many things, but primarily

visceral fat and liver fat. That's what determines your waist circumference. If you are a male and your waist is 40 inches or greater, the chances are you have visceral and or liver fat. And that probably means you have insulin resistance and you have mitochondrial dysfunction if you are a female and your waist is 35 inches or greater same thing now that's the cheap way unfortunately it's sensitive but not specific so there are other things that can you know cause you problems as well like ascites and other things. But, you know, we're not going to. Pregnancy. Pregnancy.

Yeah, pregnancy. Thank you. Yes. Okay. So, which of course is insulin resistance also, you know, but that's for another day. Then you start getting into the lab tests. Okay. What lab tests do you need to get?

The most important lab test for determining insulin resistance is a fasting insulin. Now, doctors don't draw fasting insulins. I think it's the single most important lab test to draw, but they don't draw it. Why don't they draw it? Because the American Diabetes Association told them not to draw it. Now, why is it that I'm saying that this is the most important test that you have to run? And the Diabetes Association is saying, don't bother. How come we are so completely diametrically opposite? The answer is because I'm right and

they're wrong. Now, here's why. I agree. By the way, I've been measuring this test for 30 years. Me too. And it's just astounding to me how important it is and how nobody tests for it who's in the conventional medicine. That's right. So here's why the ADA says don't draw it. Two reasons, and they're both wrong and specious. Number one, they say, well, lab tests around the country for fasting insulin are not standardized. Yeah. Now, that is true.

That is true. I don't argue that. And the reason is because cheap tests, cheap insulin tests, do not distinguish between the insulin molecule and its precursor, the pro-insulin molecule. Now, pro-insulin is a pro-hormone, meaning it's before you get the active hormone. It's bigger. And the pancreas, the beta cells in the pancreas make this thing called pro-insulin. And then there's an enzyme that cleaves the C-peptide piece off, and then you release the insulin. Now, when you're sick, when you're insulin resistant, your pancreas doesn't have time. Okay. And that may actually even be a problem that you have a problem with that enzyme. And that enzyme is called PC1 or pro-hormone convertase 1.

Now, you may, if you're sick, release both. You may release both pro-insulin and insulin. And so pro-insulin gets picked up in the insulin assay. So indeed, insulin assays around the country are not standardized. So the American Diabetes Association is right about that. But so what? If it's high, you got a problem. Okay. And they basically don't understand that. And that's, so that's, that's specious issue number one. Specious issue number two, they say insulin levels don't correlate with obesity. That is also true. They correlate with metabolic health. And heart disease and cancer and dementia. Exactly. Okay. And we just told you that there are thin, sick people. Okay. So they're not registering on the scale, but then they don't know that they're sick. Yeah. So this is exactly why we need to be drawing fasting insulins is to figure that out.

Yeah. So fasting insulin. And by the way, you know, the other, the other thing I do, I would just say, it's going to add my two cents because i've been doing this for a long time too and i started measuring not just uh fasting insulin but i measured a glucose tolerance test with insulin almost on every patient who i thought even smelled that they could have had metabolic syndrome and it was fascinating to see the data on this you'd see people with like blood sugars that were perfect like i had this one woman like like a big apple her fasting blood sugar was like 90 after the 275 gram glucose which is like you know two coca-cola worth of sugar her blood sugar went to like 110 never even went into glucose intolerance but her fasting insulin was like 50 and it went to like 200 one in two hours. So I found that very helpful. And

fasting insulin is probably the second stage. The first stage is a post-prandial insulin that goes up, right? Yes, exactly right. So in fact, we did oral glucose tolerance tests with simultaneous insulin levels on kids, published this back in the early 2000s, where we, this is where we realized where we had these two problems. One's called insulin hypersecretion, and those kids are fat, but healthy. And this thing called insulin resistance, and those kids were fat and sick. And so even though they are both insulin problems, they are for different reasons and different things in our diet cause each of them. Insulin hypersecretion can be genetic.

Insulin resistance usually is not, but it's very, very liver fat specific and very much dietary fixable. So we learned quite a bit by doing that. I don't need to do that anymore. And I'm retired anyway, so I'm not seeing patients. But the point is, I can figure out from the other lab tests what's going on. So I don't have to do it. Exactly.

Me too. Actually, when I was in residency training, I had a pulmonologist who was one of my preceptors. And he taught us to read x-rays. And he goes, well, this is this, this is that. And then he goes, and this is the Aunt Millie sign. I'm like, well, what do you mean? What's the Aunt Millie sign? Well, it walks like Aunt Millie.

It talks like Aunt Millie. It looks like Aunt Millie. So it must be Aunt Millie. Basically, if you look at the pattern, it's a pattern recognition. And if you look at the types of cholesterol, if you look at uric acid, if you look at, you know, all these other phenomena, hormones, you can tell so much about what's going on. So besides the insulin fasting level, what else should people be measuring besides their waste and their fasting insulin?

Right. So the next thing down the list is their ALT, alanine aminotransferase. Okay. Now, the problem with ALT is not... It's a liver test. It's a liver test. It's a test that tests for fatty liver. Okay. It's again, sensitive, not specific, but the problem with ALT is not the test. The problem with ALT is the interpretation. Yeah.

Now, when I, in 1976, when I entered medical school, the upper limit for ALT was 25. Today, you look at the lab slip, it's 50 or 50, 50. Yeah. So same test, but, you know, now double the upper limit of normal. How'd that happen? The answer is because everyone has fatty liver disease. That's right. Okay. The entire curve shifted to the right. And the way the lab determines normality is they do a whole bunch of tests on, you know, 10,000 or a hundred thousand people. Okay. And they get the mean and they get two standard deviations and they draw a line at those and say, okay, that's the upper limit of normal. Well, if the entire curve shifted, guess what? The upper limit shifts, but that doesn't mean it's normal. It just means that the patient didn't know they had a problem. Yeah. Well, it's sort of like if you were a Martian landing in American today, it would be normal to be overweight and obese because

that's what Americans are. It doesn't mean it's optimal. That's right. And so, in fact, an ALT upper limit is 25. If you're African American, an ALT upper limit is 20. So if you see an ALT above that, you got a problem. And you don't necessarily know why. And your doctor's looking at it and saying, well, you know, your ALT is 30, you know, it's below 40 or 50, you know, then no problem. And so your doctor's missing it. So that's the second test. And those are cheap. These are cheap tests. These are cheap tests. These are tests that are normally done on standard chem panels. The next test is uric acid, as David Perlmutter and Rick Johnson, you know, are espousing. Now, uric acid is the breakdown product of purines. So if you eat a lot of meat, you will get a higher uric acid. It's true.

All right. And of course, everybody with gout knows this. Benjamin Franklin knew this. He wrote an ode to his gout many years ago. But it turns out sugar also increases uric acid. Now, how can red meat cause increased uric acid and sugar increase uric acid? Red meat and sugar don't look alike. Well, in fact, in the liver, they do. And the reason is because

they both cause an increase in ATP being converted to ADP, ATP adenosine triphosphate being converted to ADP adenosine diphosphate, which then goes down the breakdown pathway to uric acid. So uric acid is a proxy for both red meat and for sugar. In our society, it's actually a proxy for sugar. Now, uric acid is bad for two reasons. One, it inhibits an enzyme in your blood vessels called endothelial nitric oxide synthase, or ENOS. This is your endogenous blood pressure lowerer, keeps your blood pressure down. And so when your uric acid rises, your blood pressure rises. And it is the reason why sugar is more important for hypertension than salt is. And we actually look at the data. Yes, thank God you're saying that. Salt restriction, sugar restriction actually causes a bigger decline in blood pressure than salt restriction does.

Yes, thank God. I mean, I've seen this over and over, that the cause of high blood pressure is not necessarily salt, it's sugar. And insulin resistance is driving the high blood pressure in the first place. Indeed, indeed. And insulin also prevents you from being able to excrete sodium. So the higher your insulin, the more sodium you hold on to at the kidney, which raises your blood pressure too. So by fixing the sugar, you're fixing the insulin resistance,

you're fixing the uric acid, and you're lowering your blood pressure virtually overnight. Thanks for listening today. If you love this podcast, please share it with your friends and family. We'd love to hear your comments and your questions, and please leave us a rating and review, and of course, subscribe wherever you get your podcasts.

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