Live Like a Girl with Dr. Mindy Pelz - The Secrets To Overcoming Insulin Resistance - Dr. Benjamin Bikman

Episode Date: August 9, 2021

// R E A D Y • S E T • R E S E T This episode is all about overcoming insulin resistance, accelerating weight loss, and the most significant signs of insulin resistance. Benjamin Bikman earned his Ph.D. in Bioenergetics and was a postdoctoral fellow with the Duke-National University of Singapore in metabolic disorders.  Currently, his professional focus as a scientist and professor (Brigham Young University) is to understand better the role of elevated insulin in regulating obesity and diabetes, including the relevance of ketones in mitochondrial function. Outside lab, Dr. Bikman is a devoted husband and father and enjoys nothing more than traveling and adventuring with his wife and three children. In this podcast, we cover: Why a majority of people are not metabolically flexible How to truly know if you are insulin resistant Ways to overcome insulin resistance Why only twelve percent of Americans are metabolically fit Which is worse: sugars or bad fats? // R E S O U R C E S  M E N T I O N E D Feel the impact of Organifi - use code PELZ for a discount on all products!  Fast Training Week Low Carb Shakes- Get Hlth Book: Why We Get Sick Book: Good Calories, Bad Calories // M O R E  O N  D R.  B E N  B I K M A N Instagram Twitter // F O L L O W Instagram | @dr.mindypelz & @theresetterpodcast Facebook | /drmindypelz & /theresetterpodcast Youtube | /drmindypelz Please note the following medical disclaimer: By listening to this podcast you understand that this video is for educational purposes only. It is not intended to substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your doctor with any questions you may have regarding your health or medical condition.  

Insulin matters. If I can look back at my career and say, I have helped people understand the clinical relevance of insulin resistance, then I will finish, I will retire very, very happy. I am a woman on a mission that is dedicated to teaching you just how powerful your body was built to be. I like to do that by bringing you the latest science, the greatest thought leaders, and applicable steps that help you tap into your own internal healing power. The purpose of this podcast is to give you the power back and help you believe in yourself again. My name is Dr. Mindy Pels and I want to thank you for spending part of your day with me. Okay, resetters, have I got a podcast for you? So my next guest is Dr. Ben Bickman and I just got done interviewing him and this is

the episode that those of you who have been trying to lose weight, you've been trying to overcome insulin resistance. You're trying to figure out what foods to eat, how long to fast. You want hacks to accelerate weight loss. Dr. Ben Bickman, he's going to bring it to you, and he does it in such a clear way. This is really one of the most enjoyable conversations I've had with this podcast. Let me give you a little bit of a background on him as you're listening to him so you know who you're talking to because you're going to hear that he has a love for science. He is a professor at BYU in Utah, and his specialty is insulin resistance. He is a scientist, he's a professor, he's an author.

His book is Why We Get Sick, which is a phenomenal book if you haven't listened to it. And he is so good at explaining what happens to our body when we get spikes in insulin and how we can keep insulin down. So on this episode, everything you wanted to know about insulin resistance, we unpack. We went through the microbiomes effect. One of the things I wanted to know was if we took a round of antibiotics, did that make us gain weight immediately following that round of antibiotics? He answers that. I wanted to know, what about if I drink water from a plastic water bottle?

We've all heard that BPA plastics can cause us to be insulin resistant and hold on to weight. What did you think of that? He answered that. I also wanted to know, is insulin resistant, or are we only insulin resistant when we are obese or have too much extra weight or what are other signs of that? And I'll wait to hear this conversation. He had a very interesting point about how we can make sure or know if we're insulin resistant.

I mean, the list went on and on and on. One of my favorite episodes, and those of you that are looking to lose weight, Here's my gift to you, Dr. Ben Bickman. Insulin resistance is literally a topic my brain has been obsessing on for several years. But I feel like the last year, it was really brought to light when we started seeing statistics that only 12% of Americans were metabolically fit. So I just want to start by throwing that out at you and saying, why are only 12% of Americans? and I know we have a worldwide audience, but why are only 12% of us metabolically fit?

Yeah, yeah. So that eye-opening study was based on looking at how well people did in the metrics of the metabolic syndrome. So they looked at waist circumference, blood pressure, blood glucose, and blood lipids just to maybe lump those together. And they found that only 12% of U.S. adults were good in all of those aspects. And in contrast, 88% failed one or multiple of them. So it's pretty sobering. And I like that you noted the international aspect to your audience. I have a great appreciation for this problem worldwide. And so far as my actual career as a scientist, in a way, started in Singapore,

tucked away in Southeast Asia where I did what's called a postdoctoral fellowship with Duke Medical School there, with the explicit purpose of understanding. the metabolic disorders that are becoming so prevalent in Southeast Asia. I've given talks on this topic throughout that part of the world and the Middle East, which actually has worse, worse statistics than we do. So as much as we think the problem's bad here, it's even worse in some other countries. So that certainly gives us the scope of the problem. But I might even add that this unique moment in time where people are more mindful of their immune function, then it makes insulin resistance even more relevant, where we know that in the midst of this

current fear of a particular virus, those who have poor metabolic health are substantially orders of magnitude more likely to suffer problems from an infection. So now more than ever, not to mention the growing Alzheimer's disease and certain metabolic-related cancers and heart disease, those are all relevant. and always have been, even immune system and our ability to fight off to successfully defend against a viral infection, that makes this topic all the more relevant. It does. And yet, why are we, you know, people like you and me are bringing it to light, but I have sat around for the last year in awe while we had everybody quarantined inside

that the education on insulin resistance stopped. That is, that it, that cannot. continue. Why is that? Is it a lack of media attention? Is it big pharma, big food? Like, why aren't we bringing this to light for people? Yeah. Yeah. So in you asking that, I realized I didn't quite answer a part of your previous question, which was how did we get to where we are? And very, very briefly, it's because of what we eat. It's what we eat and how frequently we eat it. And we can get into those details later. But that really is at the heart of the problem. The food we eat is the culprit or the cure. And then in the context of the current concerns with immune health, I can only speculate. I can speak on how we get to the problem very, very authoritatively as a research scientist.

But why lifestyle and overall and metabolic health continues to be overlooked, I can only assume there's just competing interests and not to sound too cynical. But giving dietary advice doesn't make money. And I'm enough of a capitalist to appreciate companies and the desire to out-compete another company and make money. I'm not saying, I don't mean for this to be interpreted incorrectly. Money can be a wonderful motivation, but it can also be a terrible motivation or motivation for all the wrong reasons. So I think the ongoing refusal to acknowledge metabolic health in the context of a viral epidemic can only, I can only assume there's just competing interests and there's no money to be made by telling people that they need to watch their diet. Yeah. So on the food,

and I agree with you. I really do. And I think it breaks my heart. And this is why I love doing podcasts with people like you so we can bring this to light. But do you think on the topic of food that we're in a situation where it's a little bit like if you put a, a frog in boiling water, it will jump out. But if you put a frog in cold water and gradually raise the heat, it will die. I feel like that's what's happening to our food. Everything has changed about our food. Chemicals are our food. Fats are different, but humans haven't figured it out. Do you feel like that's what's going on? Yeah, absolutely. I think that we have been, like every organism, humans have an ability to adapt to their environment within reason,

like every organism. It's always within reason. Just like the frog can't immediately adapt to the boiling water, it would be lethal, of course. But within reason, the small, in this case, you know, the small degradations or the small degrees of change, we can adapt. I think what we've done within the last couple generations is something that is totally unique in the history of humans and human nutrition, which is now for the first time we're getting very high fat and high carbohydrate foods. That doesn't exist in nature, really with one exception, which is milk, where you know, like you imagine mom, mother mammal giving a perfect food to baby mammal and milk happens to be high in all three macronutrients, fat, carbohydrate protein. That means it's a perfect cocktail for growth.

But for those of us that are grown, you don't get fat and protein, fat and carbohydrate at high levels together. And I mentioned protein. What we've done is, of course, strip away the protein because protein is very satiating. So it doesn't make sense for a food manufacturer to want to keep the protein in there because that's bad for business because then someone doesn't want to eat as much. And protein is expensive. Yeah. And so they can peel that protein off and do something else with it.

Well, then that's just another way to make more money. So protein and, sorry, carbohydrate and fat in nature would never come at a high level without some protein. But that's what we've put ourselves in, where we're eating foods from bags and boxes. with barcodes. And that essentially means we're getting high fat, high carb, low protein foods. And tragically, it's the worst kind of carbs, which is refined sugars and starches and the worst kinds of fats, which are refined seed oils. This is a total, a total departure from an ancestral way of eating that we've put ourselves in in very little time. Yeah. And so what I'm hearing from a lot of

the public, this is why I love fasting so much, is because this is our food industry, but if I want to eat better food, I'm going to be willing to pay more, which is horrible onto itself. And so the way I've looked at this for a long time is that the only way out is to get people to start skipping meals and to start fasting so that we can learn how to not put as much of this food in. Do you see another way for us to change the, the, the, the, that exact scenario that you just talked about? In the context of food, and there are other inputs that affect insulin resistance and metabolic health, but food is the biggest, no question, of all the levers we're trying

to manipulate to get healthier, a bunch of there, a bunch of them there, some of them are slippery, the food we eat is absolutely firm. We can change that immediately. We can push it up or push it down based on what we're eating. I am a fan of fasting. I like the nuance or the context that you bring in, which is if you're eating better and that's more real food and more real food costs more expensive, costs more than fake food, well then combine that with fasting because you just need less of that real food. I think that's an intelligent view. And maybe we defend it. I would defend it as a kind of nutrient biochemist by saying by eating real food, you're getting so much more nutrition. It's so much more nutrient dense that you can

metabolically afford to fast because you've gotten everything you needed in such a condensed or dense nutrient or you know food stuff that you physically metabolically it's no problem if you now go 12 hours or 16 hours because you are nourished and that's it's in such stark contrast to where most people find themselves which is they are overfed yet miss or undernourished and I kind of refer to that as as like a misnourishment where they get plet plenty of energy, plenty of calorie, which a human needs to survive, of course. We have to have energy. Thankfully, we store a lot of it in our fat cells.

But then you also need all of the other stuff that ought to come with nutrition as we're eating. So that's one benefit of intermittent fasting, no doubt. To me, as a metabolic and a fat cell scientist, I just have to emphasize that one of the best ways to improve insulin sensitivity is to lower your insulin. And there's no question fasting is the most, most effective, rapid way of lowering insulin. When you simply stop eating or drinking energy and calories, insulin has no choice but to start to come down. So as we look at a kind of microscopic level, you see, I don't mean literally, but maybe in a small time frame, when someone goes to bed, they're not eating now for the first time in a long time.

insulin can finally start to come down because it takes several hours after eating for insulin to come down. During that period where insulin is at its low or fasting state, the body's becoming more insulin sensitive and the body starts going into a more fat-burning state because low insulin means higher fat-burning. Well, if you can fast through that period or somehow prolong it, either by fasting through breakfast or fasting through dinner by just starting the insulin drop earlier, whatever way you do that on either end of the day, you've simply prolonged the period of low insulin, which means you're enhancing an insulin sensitizing state or allowing insulin to do its job a little better

and stay at lower levels. But the tragedy is that someone has eaten a big dinner and an evening snack and their insulin takes a long time to come down. Well, right around the time it's coming down, they're waking up. And wouldn't you know it, they're ending their fast. They're breaking their fast with a starchy, sugary breakfast. It's bagels or cinnamon rolls or toast or cereal or orange juice. And that spikes insulin 10 times over where it had been. And it takes three hours to come down. And right around then they're having their mid-morning snack and then lunch and then afternoon snack. And every waking moment is spent in a state of elevated insulin. That's a wonderful way to never burn fat for fuel. And it's a terrible way to make sure your body is

becoming more and more insulin resistant at every moment of the day. So would you say that the most important meal to skip then would be breakfast? That is a great question. In fact, Mindy, I'm not going to let you pin me down to that. But that's, that is the, that's probably the easiest way to do it. Yes. For the reasons I mentioned, which is you've been sleeping and it's already low, so just keep it low. And it's easiest because insulin is breakfast, rather, is one of the less social meals we have. And that really matters. So for me, well, not even me, there is a study that looked at cutting breakfast or cutting dinner. Cutting dinner yielded more significant metabolic benefits than cutting breakfast did. So that's the objective data. However, it's tricky to fast through dinner because

that is the social meal. I'm a, I'm a husband and I'm a father, and that matters more to me than keeping a six-pack in my mid-40s. So even though I know, as a metabolic scientist, fasting through dinner is going to actually yield greater metabolic dividends than fasting through breakfast. I just can't fast through dinner. It doesn't work. I'm sitting at home with my life and kids, and so it doesn't work. Breakfast, in contrast, no, it doesn't upset a family dynamic at all if I fast through breakfast. Even though I'm with my family, virtually every breakfast. Daddy is in charge of breakfast. That's kind of the family dynamic. I'm there. I'm making crapes. I'm making egg muffins for the kid, whatever it may be.

And my kids eat more carbs than I do. It's no problem to them. If I'm not eating breakfast, I'm sipping on a cup of tea or something. It doesn't matter to them. The breakfast morning is so busy. People are coming and going. It doesn't upset a social dynamic in my home. And even more the case with lunch when I'm at work all the time. If I, so I, my, well, I don't want to get off topic. So, you know, best bang for your buck would be fasting through dinner, but that is hard to do. So I'd hate for someone to take it to leave our conversation and say, all right, Ben said fasting through dinner, I'm going to fast through dinner and only do it once successfully and

never do it again. Well said. And so the fasting through breakfast is the easiest way to do it, even if, even if it's not quite as high dividend as fasting through dinner, it's still going to be wonderful. So if that's the one that someone can do, then do it. And yet, if you're listening to this, maybe you don't have a family or you're like, I want to do whatever I can to lose weight. What I hear you say is then you're going to want to fast through dinner. Yep, absolutely. And why is that? Is it just a, you're going into bed without food in your stomach? Yes, cortisol surge? Yeah, yes. That's a great point.

there could absolutely be this more pronounced flux or shift in hormones. Maybe when you're eating a lot right before you're going to bed, now it just takes the body a lot longer to clear it because your metabolic rate has slowed. Energy demands is just much down, much, much further down. I actually think it's because of a permissive effect that comes in the evening. I know for me personally, after dinner, evening is the witching hour. That is when I'm at my weakest when it comes to temptations and indulgences. I would look at something in the morning around breakfast and not even have a speck of temptation

to eat that. It is totally unappealing. But if I put that same thing in the evening, oh my goodness, it'll take a Herculean discipline on my part not to indulge. And so if I have just decided I eat a big, heavy, hearty lunch and then I'm done until breakfast the next day, well, then you're done. There's just no getting around it. but if I've eaten dinner and I can still eat and I'm kind of roaming the house, then I just start snacking. And that's the challenge for me where if I, because I don't fast through dinner, I really try to have a very big lunch.

And so because I've found, not that everyone would feel this way, but if I only eat one meal a day and it's dinner as my only meal, then I almost always overindulge at dinner and I almost always end up. snacking on stuff after dinner and go to bed full and uncomfortable and sleep poorly, and it sets me off for another round of trying to do that again. So I, more and more, as I'm learning more about my own habits, and again, this might be helpful to some, I try to have a big lunch. And so when I come home for dinner, I'm already a little full. And then it just makes eating a small amount of dinner so much easier. And it makes stopping after dinner so much easier than otherwise. But if I have that kind of hunger pressure growing throughout the day and it kind of

crests at dinner time, then usually I don't do it well. And so as much as I'm a fan of condensing an eating window and one meal a day in theory, for me, it doesn't work out that well because if I'm only going to eat one meal a day, it's most certainly going to be dinner with my family. And then it just sets me up to fail. So I'd rather fast through breakfast, have a really big lunch, and then a very modest dinner. So it's almost it's almost like I'm kind of coming down for my lunch and it just keeps coming down through dinner because it's so modest. And then I just flatline early in the evening with my insulin. I love that. And actually, I've done that on, I like to vary my eating styles all the time in my fasting lengths. And I, so what you're saying I actually did today.

And I like that because when you get home, you're not like, okay, I'm going to break my fast. Get me the food. What do you mean? Dinner's not on the table. Like there is an emotional and response to your meal at night that you don't typically have in the middle of the day. Yep. But I have to be very strategic at the meal I put together for lunch so that I don't crash. My energy doesn't crash. Do you find that? And if so, what meal do you put together?

For sure. Yeah, for sure. I noticed that that mid-afternoon is the hardest for me, where I start to get the most tired and my productivity would tend to go down. I just simply nip that in the butt by not eating. carbs for lunch. I'm very, very strict at lunch. And that was a study published by David Ludwig's group at Harvard last year where he looked at energy availability. So basically, how much nutrient is in the blood after a high carb meal versus a low carb meal? And it was significantly lower in the wake of the

high carb meal. And that might be why people get hungrier, sooner after a high carb meal, because you've cleared the blood of all the nutrients. Insulin spikes up and it lowers. glucose, lowers fats, lowers ketones. Now the brain is thinking, wait a minute, we're getting low on energy. We need to eat. At the same time, the brain might be giving us a sense of fatigue because it's sensing the lower energy and thinking, oh, wait, energy's a little low. We need to kind of tamp down our brain metabolic rate, which would be manifest as a fatigue or a tiredness. So I eat a big lunch and I just make sure that it's a lot of protein and a lot of fat and very little or very smart about my starches. And that kind of reflects my three nutritional principles in general.

What would be, give me an example of would you do like a big chef salad? Yeah, yeah. So, yeah, some examples, I'm not a big salad guy, but I'd be totally in favor of it. It's just that I don't really have the patience to make it on my own and bring it. That's not in my wheelhouse. And there's no convenient place nearby. So lunches for me is a mix of leftovers from the night before. Like today, it was a bunch of taco meat, just hamburger from the night before that I just mixed with avocado and sour cream. And then I just kind of ate it by the spoonful, you know, so a pretty ugly, miserable little dinner lunch, but delicious and very nourishing. Other times, it's, I go to this little hot dog joint near campus and I get two big hot dogs on a plate

with a bunch of mustard and sourcrow. And I eat that, no bun. And then other times when I, when I, really need it to be convenient, then I will take a shake. And not to sound like a shill, but a couple of my brothers made a low-carb meal replacement shake just for this purpose, which is when you're low-carb, it's sometimes hard to have super convenient foods. And if anyone wants to learn more about it, I won't say any more than that, but go to a website called Get Health. And Health is spelled H-L-T-H-H, no vowels in Health, but GetHealth.com. And you can learn more about the shake and see my blog posts. Yeah, we'll put it. We'll put it in the notes, because I actually think shakes can be really horrible or they can be really beneficial.

So whenever somebody creates a good shake, that is an awesome. Yeah, and we're just sort of a shake-obsessed culture for various reasons. One, they can taste very good. And two, they're just so convenient. Very convenient. And so depending on what my day is, now, I don't think anything's a replacement for real good, hearty food. That always ought to be the priority.

But the fact is sometimes it just doesn't work. And the more you go low carb, the more you don't have convenient foods. And you can't just rip open the backs of the box or the bag of junk that you were about to eat for lunch. You know, real food doesn't come often that way. So for those that find it to be a little, they're time pressed and they can't have planned their meal out or don't have time to hit the hot dog shop or the hot dog joint. Well, then I think a shake is always a pretty good option. Well said. What do you think is worse?

you think sugar is worse, or do you think the bad fats are worse? Oh, my goodness. This, of course, you know, you being who you are, you know the debate that's raging on this topic, most especially on social media. You know, so here, you know, I can't, I don't want to answer that definitively, but maybe let me just talk through it for just a minute and put some context here. Maybe that'll lead me to a conclusion. So we are, I mean, the people who attack, so I do tend to fall on the insulin side of things. I think chronically elevated insulin is so clearly pathogenic, creating insulin resistance and all the problems that come from, that come from it, that it's very hard for me to say that refined starches and sugars aren't important. I have to just tip that way, simply because my scientific

expertise is so strong that I know the data so well that I just have to say that. However, I acknowledge that there is robust data suggesting that high levels of linoleic acid consumption are also very pathogenic. I just don't do those kinds of studies myself and I'm not as familiar with the research. So I have to fall on the refined carb side. But in the end, I think we're splitting hairs because the fact is we're getting both. I think if you remove one and the other, or if you remove one, you've essentially removed the other. Because when people are getting high refined starches, they're getting them from processed foods that are high refined oils. When someone's getting high refined oils, it's not that they're drinking a bottle of soybean oil.

They're getting the foods that the soybean oil has been cooked in, which is always going to be a refined starch or sugar. So in reality, we get them together and there's really no pulling them apart. but if I had to pick one just because I'm so much more familiar with the science that I would have to just say, well, the refined starches are going to be a huge problem. No, well said, you're the insulin resistance specialist Tarynx off. That's right. I'm the carb insulin. Yeah, I love it.

And you know what I always tell people is if I came into your house and I swapped out all your oils, I just poured the good oils and the bad oil bottles, you probably wouldn't even notice a difference in taste. So I do feel like some people are very insulin resistant. If they can't get that sugar craving under control, if we just start by swapping out their fats, we at least have a door in. Yeah, in fact, but even then, Mindy, I think it's genius. The moment we say that, though, we're also immediately forcing them to toss out all the refined foods they're eating, which is such a culprit. Because if we're just talking about replacing their cooking oils, which would be huge, it would be huge.

because it's not like these people are getting their carbs because they're making cake at home. You know, they're eating, they're getting their treats from these stores. And so there's, in reality, there's just no pulling the two apart. But I like your sentiment. If we could just say, you know what, just use that olive oil or use that coconut oil instead. Yeah, but they're not baking, cooking at home. You know, they're eating. Most of that stuff is coming from outside the home anyway.

Yeah. How would somebody know? one thing I've realized in just interacting with so many people is that we only look at insulin resistance if we have an obesity issue or we're struggling to lose weight or we've been given a, you know, a diabetes diagnosis. But there are a lot of other signs that we are insulin resistant. To help our listeners understand, like, what are some of the other signs? Like one time somebody brought to my attention and I was like, oh, I had never even thought about this. If you can't go without food, you're metabolically unflexible, that those mitochondria are struggling.

And that could be a precursor to you being insulin resistant. That might be the first sign. How do you feel on that? Yeah, yeah, that's great. I love that you're bringing this up. And by way of context, you know, if we're saying 88% of all adults in the U.S. have some form of insulin resistance, well, then there isn't, there is a gap there because only about, you know, 60% are overweight or obese.

So you have a portion of the population that don't fall into the overweight or obese category by current standards, but yet still would be failing some aspects of metabolic health. So how do we explain those to? Or what might be the less obvious signs of insulin resistance to your point rather than just, I have too much fat that I'm jiggling or pinching? One, that's a great one. If someone can't fast for 12 hours, that's a terrible sign. and in a way probably reflects insulin resistance and chronically elevated insulin, which always comes with insulin resistance. And if insulin is high, good luck burning fat for fuel. And that creates a problem with the person who's fasting because if your insulin is high because you're insulin resistant, even when you're fasting, it's still going to be higher than ideal.

And when insulin is high, you are in glucose or sugar burning mode. And the body runs out of sugar very quickly. And so if you can't go 12 hours with, and you're an adult as a fast, that's a problem. You need to wean yourself off of that starch and sugar and help your body learn to burn fat better. And then it's nourished and it senses it has energy because you're using your own fat for energy, which after all is why it's there. That can only happen when insulin is down. But beyond the context of fasting for or not.

being able to fast as a sign of insulin resistance. Others would be high blood pressure. It is almost a guarantee if someone has high blood pressure that it is caused by insulin resistance. That is the overwhelmingly most common. And then other less very noticeable to the individual and more subtle would be infertility. Irrectile dysfunction in men. There was a manuscript published a couple years ago that the title of it is unforgettable. And it's something like, I just said it was unforgettable, but I'll get it wrong a little bit. I clearly forgot. I clearly forgot the precise words here, but it was something like in its being memorable. It was something like is erectile dysfunction the earliest manifestation of insulin resistance.

And in a man, that is a reflection of the problem that's happening at blood vessels in insulin resistance, which is that there is no, there's insufficient vasodilation. And good luck getting an erection if you can't have blood vessels that dilate. That has to happen. And in women, the most common infertility is PCOS, polycystic ovary syndrome. And that is at its core, a metabolic problem, insulin resistance. Now, this really plays in well to this immediate topic, which is you can have women with PCOS who don't meet the metrics of insulin resistance. They are lean and they look healthy.

Even in those women, they have much. higher level of insulin resistance at their fat cells than women who have the same body weight but who don't have PCOS. So even there, when they look like they're metabolically healthy, when you actually scratch beneath the surface, you find that they do in fact have insulin resistance. It's just subtle. It's not clinically evident, but with a little further scientific scrutiny, you detect it at the level of where insulin resistance actually starts, which I believe is at the fat cell. These seemingly lean healthy women with PCOS have insulin resistance at its origin, which is at the fat cell. And that's very likely what's contributing to the polycystic ovary syndrome.

Yeah. And we've, you know, there's another breakdown in how we measure health is we think a number on the scale or BMI gets tossed around a lot as that's the measurement for health. I can't tell you how many women in our community have struggled to get pregnant. They told their BMI was high, we show them how to fast according to their hormonal cycle and within a month they're pregnant without even dropping any weight. That's awesome. Yep, that's right. Yep, that's right. And that is a reflection just like you said where insulin resistance is not something that's so manifest on the scale. It often is, but that doesn't mean it always is, even more of the case with different ethnicities that I like to joke that if you want to be really fat, you want to be

Caucasian because Caucasians appear to be able to be the fattest and yet retain some form of health. But when I was doing my postdoctoral work in Singapore, talk about a difference of body fat and body type. If you compare, if I had two guys, two men, one of Chinese ethnicity in Singapore, one of, say, European or Northern European or Caucasian ethnicity in Singapore, same environment, same diet, same culture in a way. even eating the same food has a different response. But the Chinese guy, he's starting to experience substantial metabolic problems at a very mild body fat level. So he just looks a little overweight and he's already suffering the metabolic health that would take the white guy, the Caucasian guy, obese levels to get to.

So there's massive ethnic differences on how the body stores fat and how pathological or pathogenic it is in kind of starting or contributing to this progression of insulin resistance to diabetes, hypertension, Alzheimer's, infertility, and so on. Oh, that's fascinating. I'd never heard that before. That's fascinating. How much does the microbiome play in it? If I've been on a round of 20 antibiotics and now all of a sudden I can't lose weight, did I just kill all those bacteria to help me manage my blood sugar? Yeah. So you, that's what a great question. And it's certainly I know a topic of interest. And you start, you frame that. in a nice way for me to answer because I can start with the easiest part of it and then confess

the challenge. So at the easy end, we know in humans that after doses of high, high strength antibiotics, they gain weight. It is exceptionally consistent finding across multiple different types of antibiotics. So there's no doubt the microbiome matters when it comes to our metabolic health. But that is for me where the certainty ends. Because now when the conversation turns into trying to manipulate certain types of bacteria, trying to promote the growth of some and the death of others and certain foods or habits to change the microbiome, everything we do will change the microbiome. It changes so much.

And so for me, I don't like that. That's too shaky ground for me as a scientist. So while there are some scientists undoubtedly who can navigate those shaky waters, very well. I like to stay in the still waters of known metabolism in nutrient biochemistry. So I just can't speak to that very well. But in general, I'm a little cautious when it comes to the microbiome and how well we understand it and how we ought to change it. One, it matters. I say that with absolute certainty based on the human evidence that we do have. but then two, how we can change it in a way to work for us, that I just don't know as well and

don't know. I don't know how much is known. The information on fasting right now that's coming out, I've been looking at the trends on science behind fasting for about four years now. And I find it really interesting that the current research that's coming out is showing that the most dramatic change is happening at the microbiome level. And when you fast, you're making that specific change. Like there was a study that just came out April 2021 where they took two groups of people and they put them on the dash diet. But they decided with one group, they would fast them for five days, put them on like a soup liquid diet before they went on the dash diet. And what they found is when they went into the diet, they got a better result. And they speculated the change was

because of a change in the microbiome. So I agree with you that there's the sensitivity of the microbiome is high and it can be influenced one positive or negative. But I also think it has so much to do with how we're regulating blood sugar. And we just love to kill every bacteria we can find in our culture. Yeah. Yeah. So I think there's that's all. I'm thrilled to hear that.

I do think bacteria matter. I love that bacteria are able to take these beneficial bacteria are able to take fiber, like soluble fiber, not insoluble fiber. They're able to take soluble fiber and metabolize it into short chain fatty acids that then feed other bacteria and feed the human body. We get to pull those short chain fats in and talk about metabolic magic. Those little short chain fats, boy, they're minute. They're diminutive, but they punch up above their weight class where they are known to induce

mitochondrial biogenesis. They are known to enhance insulin sensitivity and improve glucose tolerance. So to more rapidly lower glucose after. the consumption of a starchy, sugary meal. So in that sense, I'm a great defender of the microbiome because they do what we can't. But again, it is an encouragement to focus on soluble fiber, the fiber that comes from fruits and vegetables and not as much hold not as much regard for insoluble fiber, which is neither a fuel for us nor the bacteria. They just comes through us as bulk. and that's what we'd be more getting from grains.

So, yeah, I do think there's something, there's some metabolic leverage we can have when it comes to soluble fiber. In addition to not giving us a sense of satiety and not providing direct calorie, you know, we're not digesting it, but the good bacteria are digesting it. So then are we missing out on that necessary fiber for those bacteria if we hop on something like the carnivore diet? Oh, my goodness. I'm just going to go after all.

Yeah, you're trying to get me in trouble with like every camp. I'm going to offend everyone today. Yeah, so this is where it, the fact is, there's no question that going on a carnivore diet would change the microbiome. But there's also no question that the metabolic dividends are massive on a carnivore diet. I mean, I have personally seen, I have to say this as an anecdote, because there just isn't a lot of evidence out yet. I'm optimistic more will start to come as this is gaining steam. But the metabolic improvements in people that go on a carnivore diet are absolutely mind-blowing. It is just, it is shocking how quickly these people start cutting medications and feel better and look better and move better. I've never seen anything comparable, to be frank.

So despite the view I just mentioned, which is the role of soluble fiber in promoting or feeding healthy bacteria as a prebiased. I have to then say, but it's clearly not essential. Because when someone's adopting a carnivore diet, they aren't putting that fiber in their system. There's no question they still have a healthy gut microbiome. I don't think there should be any question. Stool studies, a limited amount of evidence suggests that the microbiome are very much there, but they change profile, which makes sense. I would then just say the microbiome is still there, the gut bacteria are still there.

they have changed in their population of who's dominant and who's not. Clearly, the bacteria that don't need fiber to live are thriving, and that doesn't mean they're bad because these are people who have just profound improvements in their health. So once, and all of this is, in fact, part of what brings me to my conclusion that we just should be very careful in making conclusions about bacteria and how much we understand and how much we understand of the individual roles of these bacteria, that despite me already saying repeatedly good and bad bacteria, we don't really know how that balance really works.

We know that bacteria are good based on the antibiotic data we have from humans, but whether it's harmful if we're not getting fiber, now these bacteria are starving. Well, clearly there's still a bunch of other bacteria that are working wonderfully because these people are ridiculously healthy. Yeah, yeah. Is it possible that as humans were not meant to all go on the same diet? I think that's absolutely, that's almost a cop out for me to agree with because then, you know, then it just says everyone's different, so it might not work for you. But I think it is,

I think there's safety in that view. While I do think I'm bold in saying that I think everyone would benefit on a diet that is lower in refined starches, you know, whether it's really low carb or still, like even someone could say, I'm going to go on a vegetarian, I cannot in any way really condone vegan diet. I just think that's too antithetical to human survival. But if someone were vegetarian, primarily, you know, whole food plant based, but they're getting the essential nutrients they need from animal based foods, then there's no doubt. They're going to be so healthy. they're going to be super healthy and thrive. There may be other people who have an inherent iron deficiency

where that wouldn't work for them. They just need more heem iron from beef. And so the very low levels. Like this is on my, that one is a low hanging fruit for me because I'm a university professor. And every semester I have young women, only young women who come to me and complain about being tired and they don't have their iron dose correct.

And they're always vegan. Yes. And so I look at that and think the vegan diet isn't working for you. Not to, I don't mean to offend people. I really don't. Where someone listening is a staunch vegan and they're going to contact me and say, you know, screw you. I've never felt better. You know, that's great, good for you. I'm glad. But when you need to be supplementing, when you need to be supplementing, it does suggest that what you're eating isn't adequate. it. And so, you know, for these young women who are, they're experiencing, of course, very frequent

menstrual cycles and their college-aged kids, so they're very physically active for the most part, that, to me, doesn't work. And I just want to just put my hands on their shoulders and just say, eat some beef. You know, don't worry. So, yeah, I do think different diets absolutely can work for different people. And it can, in fact, cover a massive spectrum, kind of whole food plant-based, vegetarian diet, I think can work wonderfully for some people. And then a pure carnivore diet can also work wonderfully. What I would say they all have in common is that they have cut back on their refined starches and sugars and their refined oils. That's what would be common across this whole spectrum and why I think it could work. Yeah. Yeah. And I think that this is my point in asking you,

if you think that there's one diet for every human, we tend to look at our friends and go, oh, they went on the carnivore diet. They lost a bunch of weight. I'm going to go on it. That's going to be right for me. And what I'm trying to educate my audience on is that there is a unique path that's right for you. And it may look different. It may look than anybody else.

And I would agree with you. But every amazing diet should not have refined flowers in it and sugars and it should not have bad oils. Yep. So I would say I kind of, I presented the case as a kind of nutrient biochemist sort of physiologist, which is, you know, in the case of the. undergraduate who's not getting enough iron, eat more iron. And that's a part of the adaptability of a diet. We're not, you know, neither you nor I is advocating or advocating one single diet. It really is

take these principles and then find a way to make it work. But what goes into that also is the cultural differences that if we were to tell someone who comes from India, you've got to go on a carnivore diet. Good luck. That won't work. Interesting. Yeah. You know, I mean, that is a culture. that generally is a heavily vegetarian, heavily plant-based, and culturally, it just might not work. And so there are those incangibles of the culture, macroscopic or microscopic, you know, in a country, and a whole ethnicity, or just within a family, that it might not work for someone to go too far to the extremes. So, biochemically, we can defend someone adapting the diet. But even culturally, we need to be sympathetic and mindful of the fact that some,

food, some dietary changes just won't work with some micro or macroscopic cultures. Yeah, well said, well said. And again, this is why I want to elevate people's thought and stop trying to fit everybody into the same box. Talk to me a little bit about toxins. So the term Obesogens has really been thrown around. And one thing I'd love to know from you, is it true if I put a toxic lotion on my skin? Is that making me insulin resistant? Yeah, yeah. Yeah. So there are chemicals, Obesogens, as you call them, and I agree, that's a great name, that are uniquely fattening all things equal. Now, the evidence starts to fall apart in humans because there's no causal or mechanistic evidence proving that this happens in humans. So we have correlations in humans that fit well with the causal evidence that we have from animals, from lab animals, where we know chemicals,

that come from plastics and detergents and even certain lotions, perhaps, they are capable of making lab animals fatter than what the calorie load suggests they should be. So there's something uniquely fattening about some of these chemicals. And again, pesticides and detergents and plastics are really the big culprits, and then maybe to a lesser degree certain lotions. But that would be a far, far lesser degree. In humans, we do find that people who are, have, who have more fat do have higher circulating levels of these chemicals in their blood. So we find the correlation. That's just correlation. We don't know the causality in humans, but we do know the causality in rodents, which kind of gives us some confidence that what we see as correlation probably reflects actual causality. So these are

molecules that can be uniquely, unique fertilizers to the fat cell and promote the growth of fat cells, all calories equal. And these are things like diethylstylbestrol, these are things like bisphenol A, even BPA is a known obesity in lab animals and correlates very tightly with human obesity. So these are, these are chemicals that are all around, and many, many dozens more that I can't even think of at the moment. They are all around us. but it is a strong encouragement, especially for kids, especially for kids who are really setting the tone for how many fat cells they're going to have for the rest of their lives. Because we basically set our number of fat cells when we finish puberty, which is late teens

and girls and early 20s and boys. People think puberty ends much earlier than it actually does. But nevertheless, that's typically where we've set the number of fat cells we're going to have for the rest of our adult life until our 70s and 80s. when we actually start to lose some, which sounds better than it is. But these Obesagins can, in the youth, the fear for me as a father is that I want to make sure I give my kid the best possible start that when they leave our home as adults, even metabolically, I'm putting them on the right path.

And so I do deliberately, I'm very mindful of them drinking too much water from malleable plastic bottles. Because those squishable plastic bottles that we're all buying our water from the grocery store are going to be very high in BPA. All the more, if they've been heated up in any way, if they're warm and sitting in your car, then you're leaching even more of those chemicals into the water. So we ought to be really as much as we can where our kids are taking water bottles with them and everybody does these days.

Let it be metal or glass, certainly as the best options. And then if it's got to be plastic, just try to get the better plastics. And I don't remember the exact numbers, but you can just check the BPA levels. and all plastic bottles look on the bottom and it'll tell you the number and you can look that number up online. But I think like plastics three and six, I think were the best, but I can't remember. But if it's BPA free, at least you're removing the elephant in the room. Yeah. Yeah, we always say get glass because I guess they're, you know, the way they're looking at the other BPAs now is that they're toxic as well. On the on the topic of you have all the fat cells, you're going to get all the fat cells for your life in your teenage years.

Does that mean if I was an overweight 17-year-old and I've been overweight ever since and now I'm 35 and I want to lose weight? And what's happening when I'm trying to reduce my weight down? Are those fat cells disappearing or are they just shrinking? They're just shrinking. So what happens is, yeah, so we set the number of fast cells we have prior to the end of puberty. So transitioning into adulthood. And if someone is overweight and then they start to lose. weight in their 30s, 40s, 50s, they're shrinking those fat cells. They're not killing them.

That doesn't happen. We don't start destroying the fat cells. Fat cells have a natural life. I've heard some chuckleheads, even professors say who should know better. Fat cells are immortal. That's just ridiculous. They're not immortal. A fat cell has a life of about 10 years. But throughout adulthood, when one fat cell dies, as it has lived, it's 10 years, it typically will just move into a a new fat cell that's been created. So we have this capacity to replace one for one. That actually, we start to lose that in our older age, 70s and 80s, and that sounds like it's a good thing, but let me make sure I answered your question. So you just shrink the fat cells. You don't cut the number back. Now, in older age, what's so interesting about the loss of those fat cells then

is that if someone's continuing to eat the same way they were before they start losing their fat cells, all that means is the remaining fat cells start to get bigger and bigger and bigger because what was once a fat amount that was being held in five fat cells has now been whittled down to say two fat cells, but there's still all the calories and all the insulin telling the body to store fat. It just puts an increasing pressure on the remaining fat cells to store more. And that's the worst way to store fat. When you have individual fat cells getting very, very fat or what's called hypertrophic, those are the fat cells that become very insulin resistant. And that's probably part of the reason why as we age, we start to have much more insulin

resistance. It's just because even if the person doesn't look like they're storing any more fat than they were before, those remaining fat cells are all more hypertrophic. And that is more pathogenic when it comes to insulin resistance. How do you get around that? Yeah. So it is a stronger push as we age to just make sure we're keeping our insulin in check. Because if insulin is low, you cannot have fat cells grow. And in contrast, you have no choice, but for the fat cells to start shrinking. So all the more anyone listening, getting into their 70s and 80s, control your insulin, those simple rules, well, I have four simple rules, control carbs, prioritize protein, don't fear fat and fast. If you're doing those four things, you're doing

everything you can. And I would maybe just say be physically active. I was going to say, where's exercise? Yeah, where's exercise? Yeah, well, it's not as much as people think. In fact, there was a study just published about a month ago or so that took overweight type two diabetics and put them into two groups. One was a group of vigorous weekly exercise, coached multiple times a week, high intensity exercise. The other group was just a low carb diet, like basically following the strategies I just mentioned. And they had significantly greater fat loss, significantly greater glucose and insulin control, just by going on the low carb diet, no exercise intervention at all.

Now, again, I'm a huge defender of exercise. Let me be clear. But when it comes to just maximizing your metabolic benefit, changing your diet will yield significantly greater returns on your investment than trying to exercise. You can't out exercise a bad diet. Yeah. It's cliche, I know, but it's true. Well, but you know, I'm 51 and when I went into my 40s, I started to do more fasting.

And as I started to drop weight and enjoy my body more, I stopped exercising as much. And then I started to think to myself, why am I exercising? And then I realized, oh, I'm exercising for brain health. That's what I'm exercising for. And it was a beautiful switch because then I totally looked at my exercise different. I wasn't trying to run marathons to keep my weight where I wanted it to be. Yeah, good for you. I'm very quick to say your reasons are slightly different than mine, but they certainly align.

Eat smart to be lean and metabolically healthy and exercise to be strong. I exercise. Well, one, one, my ego. You know, I'm involved in my early 20s and I got to give my wife a reason to come home to me every day or to let me in the house. I still want her to be interested in me physically. So I want to be, I want to look healthy. But two, I want to be a healthy grandpa. Even though that is 10 years or more down the road, I really really.

want to be the kind of grandpa who can go skiing with his grandkid, where I can get on the ground and wrestle with my grandkids and get right up and throw them up into the air and play with them and play on the playground. A healthy diet will certainly help with that, but to just be physically strong enough to pick up my grandkids, you have to be challenging your muscle to do that. So my reasons aren't necessarily staying lean and metabolically healthy. It's just I want to stay physically capable. Yeah, I love that. I love that. Well, gosh, I feel like I can stay here for like three hours and pepper every question i've ever had about insulin resistance to you those are the only questions i can answer just so everybody don't ask me anything about your car or plumbing

or house building if it's insulin and metabolic health well you know unfortunately i'm like probably in the same boat as you i spend about 70% of my day thinking about metabolic health so uh so we you know we could have a lot of good conversations together so but let me finish up i have five rapid fire questions for you that I'm actually really, now that I've chatted with you for an hour, I'm very intrigued how you're going to answer these. No, I'll start off with an easy one. I'm going to give you an easy one first. Okay, what is the one book? We're starting a book club with our podcast that changed your life that you feel everybody should read. Okay. Okay. So I'm not going to say my book. Yeah, you can. And actually say your book. But I won't. I won't because I actually do want to answer that.

I'm just, just a shameless plug. Everybody get my book. Yeah. It's called Why We Get Sick. Why We Get Sick, which is a phenomenal title. And it's all about a lot of the stuff we've been talking about. What is insulin resistance? Why does it matter?

Where does it come from and what to do about it? Now, separate from that, if I were to mention a book strictly within the realm of biomedical science, because I have other favorites and other genres that are not relevant at all, I would say good calories, bad calories by Gary Taubbs. was an absolute revelation to me. And in a way, I credit his book for allowing, for giving me the courage to step on the path that I already kind of suspected was there

based on my own research with insulin and feeding in the animal studies we were doing. I think his book is absolutely wonderful. It's encyclopedics, so you have to roll up your sleeves, but good calories, bad calories by getting carbs. Great. Oh, I love it. Okay. Now for a more difficult question, if you were the surgeon general, the U.S. Surgeon General right now,

and you saw the bad that 40% of Americans have two or more chronic disease, 60% have one, and that's moving worldwide, what would you implement to end chronic disease in our country? Yeah, yeah. So that would, there's no simple answer, but I would, I would, this is maybe, I might regret saying this at another point, but I'd, remove the the food label that indicates calories. Well said. In part because we miscategorized protein. I don't think protein should be given a caloric value whatsoever.

We never use it as energy in all but the most extreme metabolic circumstances. Protein's a building block. And it is given rise to the fear of fat that persists. And fat is not what we need to be fearing, at least in its ancestral version from fruits and animals. We should be eating those abundantly with no regard. on the calorie number because if our hormones are in check, then the body knows what to do with extra energy. So there are other things I'd say, but maybe that's the easiest one. Remove the

calorie value that we give to foods. Yeah. Oh, I love that. I love that. Maybe replace it with like a carb warning or or in a seed oil warning. Yeah. Well, I mean, most people don't even know how to read a label. So, but they know calories because that's what's been drilled in their head. And I think that's, that is a huge tragedy. The law. of thermodynamics should have never been applied to nutrition ever, full stop. Yeah. Agree, agree, agree. Okay, what's the one health habit you do every single day that you would never give up?

It is like your go-to. Oh, gosh. Well, I don't do this every day because I don't exercise on Sundays, but it would be, actually, no, let me change it. Sona. Sona. Every day? Or most days? Every day that I can, yeah, which is to say when I'm on campus.

And I live so close to campus that even on Saturdays on occasion my wife will give me the wink when she knows if I want to go sauna. So go just take a sauna really quick. So I'll go schvitz in the sauna for 15 or 20 minutes. But I mean, everything else I'd say would be obvious, but I'm such an advocate of the sauna. I feel so good when I'm in there and it's just quiet. It's kind of a meditative sort of time. Not that I'm praying or doing anything like that, but it's just a thoughtful time and it's quiet and you feel so good when I do. When I come out of there, and it's funny because when I used to go to the YMCA with my dad as a boy, I thought the sauna was the worst thing on the planet.

It was just torture. But now that I'm becoming my dad, I think it's the best place in the world. So every day that I can, I will sauna for 15 months. minutes or so. And there is very real benefits to come from that. Of course, ample evidence out of Scandinavian countries showing reduced risk of Alzheimer's, heart disease, diabetes, obesity. And there might be a lot of confounding variables there. I just do it because I feel so good when I come out. You know, I just interviewed a doctor who's a hormone, male hormone expert, and he talked about how, but he said for both women and men, we make testosterone out from our skin, from the

cells on our skin. So the more that you are sweating, you're opening up that circulation and it's improving testosterone levels. Genius. Isn't that crazy? Works for me. Amazing. I'll take it. Okay. The fourth question here for you. If you're listening to this and you're just, you're in the standard American diet, you're trying to figure out where to go from there. What's the one hack that you feel like is the most helpful? Maybe it's a hack nobody talks about much to manage blood sugar. Yeah, I would say change breakfast tomorrow. And you and I have already, we've covered so many great topics. I already talked about the tragedy of how we, insulin's been coming down overnight and we

immediately spike it 10 times with all this junk that we eat. Breakfast, unfortunately, has become almost a meal of nothing but dessert in the way we do it. So I would say change breakfast, change it tomorrow, either just drink a cup of coffee or tea or even water and fast through it. or eat something with protein and fat and essentially little to no carbohydrate, whether it's a smart omelet with some smart veggies in there, or it's just bacon and eggs,

or it's a smart, low-carb meal replacement shake, whatever it is, make sure it's heavy protein, heavy fat, and little to no carbs, certainly no refined carbs. That would be the easiest thing. Change breakfast, change it tomorrow. Yeah, and everybody could do that. It doesn't cost money. It doesn't take time.

I love it. Okay, last question. if you had one message for the world that you could get into everybody's brain, what would it be? Yeah. Yeah. So the bumper sticker would be insulin matters. And that is, that is, that's a big idea I know. And just to parse it down a little, that really is my professional goal that at the end of my career, if I can look back at my career and say, I have helped people understand the clinical relevance of insulin resistance, then I will finish. I will retire very, very happy. And all of this plays into what we've been talking about, which is insulin resistance is the single most prevalent problem on the world. It is the single most common health disorder to define problem a little better. It's the single most common health disorder worldwide. And in addition to its prevalence is the relevance, which is that virtually every chronic disease is in some way derivative or coming from.

insulin resistance. Whether the insulin resistance is directly causing it, like heart disease and hypertension and infertility, or whether it is exacerbating or accelerating it like breast or prostate cancers or Alzheimer's disease, insulin resistance is the come, it's really kind of the tree that all of these branches are coming from. So rather than someone opening their medicine cabinet and taking out their pill for their blood pressure, their pill for their infertility, their pill for their diabetes. My hope would be that after this kind of discussion, they would say, you know what, I just keep trimming the branches of this tree and the branches are always growing back. I'm just going to cut the tree down. That is what happens when we finally start taking control of our insulin

resistance. All of those problems that are just branches off one common trunk start to get better. I'm not saying they'll go away, but they will absolutely start to get better. And the best news of all is that we can do that just by changing the food we eat. You don't have to focus on drugs when you're improving insulin resistance. In fact, the best way to do it is changing food. The food we eat is either the culprit or the cure. We just need to let it be the latter. We need to start letting the food we eat work for us rather than against us. You need a mic drop on that one. That was awesome. I love that. Well, again, Ben, I could sit and chat with you forever. This was great. Hey, resetters, I just want to start off by saying thank you so much for all your wonderful reviews

and those of you that have left me comments on iTunes. I just greatly appreciate your thoughtfulness and how much you guys are enjoying these episodes. And it seems like you're enjoying them as much as I am enjoying doing them. One of the things that I've learned in just interacting with so many people is that we've really lost the art. of deep conversations. And for me, the Resetter podcast stands for having meaningful conversations with people who are thinking about health, about life, about mindset in a way that we may not be getting on social media or in mainstream media. And so I just want to say, give you guys a shout out and just say thank you for participating in this process with me. Because as much as I

absolutely love delivering the information to you. I love even more knowing that it's impacting your life. So please let us know if there's anything we can do to make this podcast more customized to you, to make it better. We are now officially in season two and we are working to bring you the best conversations that health influencers have, that mindset changers can give and to really deliver you something that you're not able to get anywhere else. So from the bottom of my heart, as I always say my YouTube, from the bottom of my heart, I am deeply appreciative of you. I am deeply grateful to be on this journey with you, and let's get healthy together.