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Food as Medicine with Dr. Dustyn Williams

Episode 29 · 23 June 2025 · 1 hr 9 min

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Food as Medicine: Dr. Dustyn Williams on Moving to the Right, One Step at a Time

Food as medicine doesn't mean perfection. Internal medicine physician Dr. Dustyn Williams joins Dr. John Oberg and Randy Lorensen to explain his "move to the right" approach: one better choice at a time.

Dr. Williams lays out a simple spectrum, from heavily processed food on the left to whole foods on the right. He explains why the goal isn't to get all the way right, just to keep moving that way. He shares a patient story about peanut M&M's, explains why the word "diet" can backfire, and covers how calories and ketosis work.

The three talk through continuous glucose monitors and what the numbers mean, whether steps count as exercise, and why the best activity is the one you'll actually do. Questions about BMI, red meat and cholesterol come up too, along with how Precina works alongside patients and their medications.

For a practical start, he shows how to read an ingredient list, compares real sugar with artificial sweeteners, and talks about oils and how food is preserved. He closes with small, sustainable changes, moving more, and starting strength training safely.

Food as Medicine Basics: Ingredient Labels, Glucose and Moving More

What you'll discover:

  • The "move to the right" approach to eating better
  • Why the word "diet" can work against you
  • What a continuous glucose monitor can and can't tell you
  • Do steps count as exercise?
  • How to read an ingredient list in a few seconds
  • Small, sustainable changes, and starting strength training safely

This episode is for educational purposes only and isn't medical advice.

Timestamps

  • [00:00] Welcome Dr. Dustyn Williams
  • [00:55] What "food as medicine" means
  • [02:40] The food spectrum, from left to right
  • [04:27] A patient who loved peanut M&M's, and the potato example
  • [06:11] "Move to the right," one step at a time
  • [08:48] You don't have to be all the way right all the time
  • [09:41] Intermittent fasting, and the word "diet"
  • [13:10] Calories, and how ketosis works
  • [16:40] Extreme cuts, and finding balance
  • [18:30] Blood sugar and continuous glucose monitors
  • [22:52] Glucose ranges and what to watch
  • [25:34] Expert plans, and starting insulin
  • [27:20] Exercise: whatever activity you'll actually do
  • [28:15] Do steps count?
  • [31:45] Walking desks and low-intensity activity
  • [33:29] BMI, red meat and cholesterol questions
  • [38:52] When you think you're doing it right but aren't
  • [41:30] Moving to the right with medication
  • [45:03] Food-as-medicine success stories
  • [48:33] How to read an ingredient list
  • [52:05] Real sugar versus artificial sweeteners
  • [54:43] Fats, oils and food preservation
  • [59:08] Seed oils and inflammation
  • [1:01:48] How Precina works with patients
  • [1:02:40] Small, sustainable changes, and moving more
  • [1:04:26] Starting strength training safely
  • [1:08:50] Randy's workouts, and wrap-up

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About Dr. Dustyn Williams

Dr. Dustyn Williams is an internal medicine physician and Chief Medical Officer of Precina. He also helps write medical school curriculum.

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Meet the hosts: Randy Lorensen · Dr. John Oberg · Anthony Marino

Transcript

A full transcript is below. It was generated automatically from the episode audio, so expect some spelling errors in names and terms.

[00:02] the health space today and we have a special guest, Dr. Dustin Williams, Doctor of Internal Medicine. why settle for less? Uh today we are here with Dr. John Oberg as always and also with Dr. Dustin Williams and we're going to be talking about food as medicine. So let's uh John, we brought this topic up. Why did we even decide we wanted to cover this topic? Right. It's it's certainly part of the five Fs. It's part of fitness and part of that is health and food. But can you go a little deeper into why we're covering this topic? Yeah. I mean, so this is like a lot of my life's work right now with Dustin. We've been partners in a medical practice now for years. And so we're trying to help people who have metabolic syndrome that no one knows what that term means outside of medicine. Few people talk about it. It's not well organized as a concept in the industry of medicine. Is that is that fair to say? I think well it has a definition but we are redefining it. We are bringing a new spin to an old thing, right? Like we've repackaged, repurposed it and can show people how we can treat food fitness that disease and keep people from getting it first place. So let's you say nobody knows what it means metabolic syndrome. Let's tell listeners what does it mean? Yeah, I shouldn't say no one knows. It's it's illdefined and there's lots of debate about it and we're trying to end the debate and say like just like there's um you know infectious disease or other subsp specialties of medicine like here is a way to treat a set of things and this set of things includes type two diabetes it includes some cardiovascular disease Dustin jump in if you want to be more specific hypertension diabetes obesity dysipidemia yeah and then it also then then you can take those same treatment protocols and treat other things that aren't necessarily metabolic syndrome but things like some pulmonary diseases is COPD, asthma, you can use similar treatment methods and get similar clinical results. And what we're finding is that we're seeing clinical results that are far far far far better than what we've seen in decades past. So you've talked to me a little bit about the concept is moving to the right. So Dustin, what what does that mean when when you say moving to the right when we're talking about food is medicine?

[02:11] Sure thing. So um I teach a class called food is medicine. It's a for medical students but um in it you pick a diagnosis and I teach you how to prevent or treat that disease using food as medicine of course in addition to regular medicines. When I was doing uh the research um back then the they I realized that everyone was saying the same thing even though they were using different words. Societies are better about it now. You can treat all chronic metabolic disease with the same treatment. Food is medicine. So I coined the phrase move to the right. What does that mean? Usually I'm on screen with the patient when I do this. So I'm going to do it as though I am right off the off to my left off offscreen. You can't see my hand. These are bad foods. Trans fats, those cause cancer. Can't get them anymore. Then there are things that you know are bad for diabetes. The simple sugars, the vitamin waters, the colas, the juices, candies, um, and processed food. If it's white, don't eat it. Fast food. It is fast. It's not food. Hand comes on screen from off left. Food becomes food when you get to fatty mammals. That's pork and beef. Food becomes not from a bad food source when you get to lean birds. There's chicken, poultry, turkey. Food becomes a from a good food source when you get to eggs, fish, and low-fat dairy. Low-fat dairy means liquid at room temperature and skimmed. Cheese does not count. Food comes from the best food sources when you get to plants. Nuts, seeds, legumes.

[03:35] You don't need the skeletal muscle of an animal in order to get your protein. And which plants? Whichever ones you like, as long as you get them in their plant form and move to the right doesn't like like juicing it doesn't count. Uh it if you squeeze it is not as good as the whole food. Juicing it not as good as squeezing. Yeah. Right. So move to the right doesn't mean all the way to the right all at once. That doesn't that doesn't work. Like that's actually what we try to avoid doing. Right. No big changes. In in other words, people are not going to go from junk food, fast food all the way to the right, right? That's just not a realistic for most people. Yeah. Most people aren't going to become vegan ever, right? And that's not that's not the point. The point is to find where there are things that are in your routine day that are to the left that can be replaced with things to the right. We have a guy in our practice who came in who loved peanut M&M's. It turns out what he actually liked about them was the peanuts. So, he just stopped eating candy and started eating peanuts and he lost 50 pounds. And another guy um was told he can't have blueberries.

[04:41] His favorite fruit was blueberries. I was like, "You can have as many blueberries as you want as long as you get them as a blueberry." He also lost 50 pounds, right? What was he getting them as? Was he getting them like blueberry cereal or I mean, what do you mean as long as you get them as a blueberry? Well, no. So, um if the So, if you get a plant out of the ground or from Whole Foods, right, that's a whole food. If you take that plant and you process it and you buy it in a bag at the grocery store, right? Like it's not like as long as you get it as a whole blueberry, right? Right. You can do whatever you want to it. A blueberry isn't isn't the same thing. Right. So the bag at the the bag at the grocery store, can I assume it's because of sugars or preservatives or what what's the problem with that one? That's basically it, right? So you take but the example is the potato. You take a potato out of the ground. As long as you don't add butter and sour cream coming from the cow, that potato, though it does have a bunch of carbs in it, aren't bad carbs. it's coming from a good food source because it has other micronutrients. It's got fiber. You're not going to absorb all the sugar. You take that same potato, you pass it through the food industry, and you buy it in an aluminum foil bag as a potato chip. All of a sudden, you've taken all the nutrients out and it just left the carbs. You're basically drinking a Coke only in potato chip form. And the way you know that is by looking at the back of the packaging. If it says ingredients colon whole grain and you're eating a potato chip, that's just as good as eating the potato. If it says anything else, it's been processed. The nutrients have been extracted and more than likely simple sugars have been added in various ways. I think that in in the real thing we talk about behaviorally, Randy, is like how do you get from where you are and just move the job isn't to get all the way to the right. The job is to move to the right.

[06:21] Like take one step to the right. So wherever you are, if you want to be healthier, just move one step that direction. It doesn't mean get to the end. It means get to something sustainable that is right of where you are. Does that make sense? So if somebody's eating McDonald's or they're eating whatever fast food, if they just buy real beef and make their own hamburger, that's a step to the right. It's a step in the right direction. And you know, if you move from like a a white bread hamburger bun to a whole grain hamburger bun, that's not ideal, but it is one step better, right? And then if you move from like a whole grain hamburger bun to lettuce wrapped, one step better. Hamburger to chicken burger, one step better. Like I And you know, I will say this, I eat hamburgers and not chicken burgers. My son eats chicken burgers. Like that's it's it's not about perfection all the time, right? I think that's that's the important part. Well, I like this because it's I think it's reasonable for most people. It's not asking them. I I think sometimes whether diets or whatever you want to call them, it's it's such a big lifestyle change that it's impractical for the average person.

[07:31] Look, I I I there's a couple doctors that I follow, Mark Heyman and Peter Aia, and I I have like immense professional respect for these guys, and I try to do the things they're talking about because I've moved to the right, and I want to move further to the right, and they're really far to the right for diet, really far to the right for exercise, really far to the right for medical care. Like, they're really, really good at health span. like they're really great at the optimization. Some of the patients we deal with are 300 400 lb. They've been working on their disease for 25 30 years uncontrolled like like to talk to them about spending six hours a day doing anything. I'm I'm being hyperbolic because men and don't tell you to do that. They're really reasonable for people that are healthy and want to get healthier, but we're dealing with people that are unhealthy and want to get less unhealthy before they can worry about being, you know, 100 years old. So, so I think it's just a different message for meeting people where they are. Um, I I feel like Dr. Heyman and are meeting me where I am, but our job is to meet our patients right where they are, which is sometimes a little bit different. Yeah.

[08:33] Yeah. Okay. And it is like this, as you said, like you go to the fast food, get a hamburger, to the right is make the hamburger yourself, right? And we tell people, well, if you're if you have a choice between beef and fish at a restaurant, choose the fish unless you're at a steakhouse because that's what you're there for. Go ahead and have a steak. It's not about trying to be all the way to the right all the time. It's just generally make deliberate choices when you have the opportunity to pick the better thing. So, somebody's grocery shopping. The advice I've always heard is stay on the outside of the grocery store. Is that is that as good of advice as it sounds? I don't know. I don't go to the grocery store. Yeah. Yeah. Yes, that's the answer. Because on the outside of the grocery store is the whole food, right? On the inside of the grocery store is the packaged and frozen food. And so generally speaking, stay to the outside of the outside of the store. You and this is something Dustin and I, you know, we've debated because there's like there's the behavioral health, my world, and the medical health, Dustin's world. And so we oftentimes debate things like what about diets and fasting and and my position, and we can have this debate on the air. I think people would appreciate this. My position is like intermittent fasting is amazing for the people for whom it works, right? Dustin would tell you that intermittent fasting Well, I'll let you speak for yourself. Yeah. It doesn't matter. Just you shouldn't do it. Just be move to the right is more important. Yeah, but but at the end of the day, I'm I'm I'm a habit and behavioral based guy. So So if intermittent fasting is the thing that works for me and that's what I'm it's good for me in this season, like I'm all for it. Intermittent fasting does work for John, right? Intermittent fasting does not work for my wife. So So she definitely shouldn't do it. I should use it to the extent that it's helping with my behaviors, but at the end of the day, it's find the behavior that helps you get to the right. Right. And it's and it's not instead of right. like correct like you do have to move to the right.

[10:18] If then you then layer on top of that moving to the right with your intermittent fasting because it works for you. Great. But don't start there, right? Move to the right first. Well, yeah. Intermittent fasting with Captain Crunch is not really a healthy a healthy healthy answer, right? It's just not a great answer for that. And and that's that I think that's our approach to dieting kind of broadly is that if if we say that the word diet implies um restriction of something that's nonsustainable, then I think we're both kind of like anti-diet. What we're looking for is like sustainable habit change. And that and that's what we found in our practice is that we get people healthy and then we keep them healthy for a very long period of time. And once you start moving to the right, you lose the taste or the actually the tolerance for foods to the to the left. Like I used to drink Coke all the time after doing that nutrition class. I was like, "This isn't that hard. I'm just going to not do that." Now, if I have a regular Coke, it tastes like syrup to me because it's so much sugar. Like my taste buds have accommodated to a lower sodium, lower glucose, lower fructose environment. Like you get used to eating the way you are. And so when you start moving, right, it's like, "Oh, I'm not I didn't make that much change, but you did." because you're moving right and the further right you get the you don't even know about how bad the left is going to taste until you stumble upon it again you're like gh and blueberries taste great when you're when you're moving to the right they do yeah which is awesome but when the other thing that we talk about sometimes is like there are some people like there's things like um eating for your blood type where people have said like this blood type does great with this and this blood and and to me like I think that's a debate we could get into and have a really long lengthy debate I think the place that I try to land with our practice is, hey, if that's what it takes to get you to move to the right, then that's the thing we're going to help you. Like, if that's the if that's the mental model that helps you, we're going to use that mental model for you. Because I don't know that the science is strong enough on on the blood eating for your blood type, I haven't I haven't dug into it to take like a firm firm firm position, but at the end of the day, like if that's the lever that I can use, you know, with you to help you move to the right, then we should do that. And that I think medically you're you've signed up for this. We didn't we didn't start the conversation there, but I think it was where we landed. Right. Exactly. Because your blood type doesn't matter, right?

[12:30] For the food that you eat, there's no way there's no way it could correlate whatsoever. But I don't say that to the patient. Causal. It could be correlated. We don't know. H probably not, right? Probably not. But if the patient has offered that to us as the thing that is going to get them to follow us to the right, why take that from them, right? Meet them where they are. don't necessarily condone what they're what they're saying and and and and don't take it away from me either. So, so, so let's let's talk about for a second like calorie counting, okay? Because I think I think, you know, for me, one of the things I did along my journey is I wanted to be at least aware of the calories I was taking in. And it wasn't because I was like I had to have a calorie number, but I knew that like, you know, 2,300 calories a day wasn't going to be as helpful for me as 1500 calories a day. Healthy calories, of course. I mean it's not Well, you just said it right. So the number doesn't matter. The source matters more. Well, but doesn't matter at all or doesn't matter as much? Doesn't matter as much. It's not as all right because it it's not just calories in, calories out, but calories in does matter, right? Like your your body has to process all the calories that come in. You absorb it. Your body cells metabolism have to deal with it. Yeah.

[13:35] If you have less calories coming in, there's less to use and then you're going to use more of your stores, right? So like that's true. I think like ketosis is one of the examples I've heard and I don't know if this is right so you can correct me here but like ketosis is where you're having like non sugars you're you're mostly eating proteins right and your body goes into a different type of energy utilization but if you have so much protein at some point you can actually knock yourself out of ketosis because you have so many calories. Is that accurate? So ketosis is about um insulin versus glucon. insulin dominant state is after you eat, your blood glucose goes up. Your pancreas senses that and sends out insulin. That tells your liver to say, "Hey, we're fed. Stop feeding people and store that energy." So, the liver switches into a store glucose as fats and glycogen and sends the fats off to the fat cells all over the body. In the glucagon dominant state or the fasting state, um the liver is the source of nutrition. So, it is going to do gluconneogenesis. It's going to make sugar. It's going to use the glycogen that it's stored in itself and then it's going to call those triglycerides back from the fat cells and it's going to burn them down to acetil coa. So it's going to use the the fats as energy and then it's going to assemble them as ketones. So ketones are the other way the liver feeds the rest of the body.

[14:53] First glucose for everybody and then ketones for all cells that have a The ketosis is a marker of starvation glucagon dominant state and you are the liver is making ketones. So in that state you are calling all resources from the the systemic cells back to the liver. Aipocites fat cells do that with Skeletal muscle cells do that by sending protein. All of it gets turned into some fuel source either glucose or ketones. forget where I was going with this, but uh supposed to answer your question, but but this is it, right? So, what we're trying to like there are people that say you want to kind of like teeter between ketosis and not ketosis. And again, my point is like if that's working for you, great. I I I know some people that like I can think of one friend in particular where ketosis has worked for them for a very long period of time and their partner tried ketosis and it didn't work for them at all. And so, for for understandable reasons, their body thought they were starving. That's right. And so and so again, if if ketosis is working for someone, thumbs up. If it's working for a period of time or a long period of time like that, I think that's like I can live with that.

[16:06] But the thing I would tell people is that like if if I'm eating really whole food, but I'm having 6,000 calories a day and I'm burning 1500 calories a day, you're going to gain weight, right? So So it's, so it's so it's it's it's not as simple as calories in, calories out. It's not as simple as whole food only. There there are a couple of variables that need to get monitored here. Sure. Well, the only thing that ketosis is actually good for is a bodybuilder who needs to cut right before a show or a photo shoot. And Arnold used to talk about this all the time, right? So, you you do that for like two weeks. You get off water weight and you lose like the last little bit of fat that you can and right after the photo shoot, you consume 10,000 calories because that's two weeks sucked and it's good for a very temporizing thing. Yeah. Right. Then it is it but counting the calories if it could be a distraction, right? Could could could be because what matters more is what's below the calorie count, which is the ingredient list. If you spend your time looking at labels and you choose to to look at the ingredient list and then you don't deliberately take in large volumes of food multiple times per day, you're not going to get all those calories. If you spend all your time counting the calories, you might end up adding them up to a really high number because you're eating the wrong foods.

[17:20] And so you get double you get double whammy. Eating fewer calories but consuming worse food sources is worse than consuming good food sources with slightly more calories, right? And so it's a balance. Like that's the thing we're trying to balance. And I think this is where the we have part of our practice is meet them where they are and find the plan for them. It's the expert plan with the person they're going to use. The plan's got to be not just a good plan, but it's got to be one that someone's excited about eating their food, right? And so that that's where I think like we got into this big debate about constant glucose monitors. And I think this might be the only debate that I won. So Dustin, tell us about constant glucose monitors. Continuous glucose monitors, CGMs, right? They continuous, not constant. Sorry. Continuous glucose monitor medical device, not behavioral device are things that you Exactly. This is that's why you win the argument, right? So I you wear it all the time and that gives you the ability to use your cell phone to go beep beep and detect what your blood sugar is. People use them the wrong way, right? When you when a person without diabetes consumes a meal, their glucose is going to go up. Their pancreas is going to respond by sending insulin and bring the glucose back down.

[18:35] If you have a glucose monitor, you can see that happen. But if you have a normal pancreas, you're not going to go out of range. You can watch it go up or down. And people are like, "Well, I need to know how my body responds." Like, do you really need a CGM to know that that cookie is bad for you and it's going to make your blood sugar go up more than that piece of lettuce? Do you really need the CGM? But, and the answer is yes. Yes, some people do. That's right. Like, like the visual is actually a way to take in that information where it hits home better. And the reality is that having that information, that data driven, it's it's and here's the here's the part where it's problematic. When someone doesn't use medical professionals and help them understand what's happening, people freak out. They're like, "I started working out and my blood sugar went up or downed or whatever." Yeah. But but it's like if you don't have diabetes, it can go up or down depending on what you're doing. Yeah. But but but if you're if you're working out and you have not eaten that morning, it would make sense that your body is going to actually put blood sugar into your blood so that you can consume it. Right. Right. And then it's going to come back down as you consume it. But I didn't eat my blood sugar. That's correct. That's how the energy stores work in your body, right? For for the non-medical doctor here. So So, okay, let me let me try and simplify this. What you're saying, I think what I hear is if you don't have diabetes, you probably don't want to use you don't want to continuously monitor this. There's no medically there's no reason to, but right this is this is why he wins the argument. There's medically no reason to do it. Your body is going to maintain itself in homeostasis.

[20:04] You're going to be in normal range whether you eat or don't. You're going to stay in healthy range. nothing useful about go nothing medically useful about that but there is data that's useful there are people that want to watch it and so like I I was so I wore one when I didn't need one I was like okay what what's the benefit here and what I found was that if someone's like well pineapple probably spikes your blood sugar I ate pineapple and saw that it didn't do bad things for me and someone said well you know rice probably spikes your blood like I ate rice and guess what it did it spiked my blood like spiked my blood sugar. And so for me, what it did is like, okay, this is going to help me understand what specific sensitivities I have. And then it also was a an alarm for me because you can set alarms for how things are going. So it was just it was like a little bit of a a little bit of a technological help for me so that I could actually monitor my own habits and get data behind it. So there was no medical reason to do it, but there was great behavioral reinforcement to do it. And that to me from a more broad if you're looking at kind of what's the clinical outcome we're looking for which is a medical clinical outcome and there's a behavioral reason to have the data for some people sometimes not all people all the time. Yeah I get it. Look I would I would compare this to I have an Aura sleep ring which I've actually not been wearing lately because the battery is really just it's old. I need a new one.

[21:27] But wearing that when I do and I get a score, it gifies it, but it makes me aware of what's going on. It's a way of tracking it. And then there's just benefits to the gamify and wanting my score to be higher than the next day or better. And gamification is another reason too that you can actually make a good good example of like ways to improve your habits is gamification. And and that's the like essence it's the only reason that I won the argument is because we're trying to change a habit for long-term sustainability. And and you know this, you know, I think I think there are people that say, "I want to be a carnivore. I want the Mediterranean." And and my take is whatever works in that season to help you get the habits you need for that season. There are some people that'll pick one set of habits and it'll work for 10 years. There are other people that are going to need to change their habits every year. Sure. Like as long as you're understanding that you want to be leaning and moving to the right for diet and I'd say the same thing is true for exercise, too, right? We we and so let's talk about moving to the right. You said it though, right? It's like so some people need the CGM because it helps them. Yeah. Right. But not in exclusion of doing other things, right? You still have to move right and move and move more. And as long as you're doing those things and this is helping you do it, this is the catalyst for that, right? Yeah. Before we leave CGMs real quick, can we talk just I mean listeners may understand that like when you're a CGM we're in a CGM and your blood sugars in occasionally in the typically you want your blood sugar to be under 100 when you're fasting after you've slept and you want to be under 140 after you've eaten right so the range is like under you know you might be as low as 70 or even 60 if if you're not a diabet diabetic but so 70 to 140 would be considered a normal range and some people without diabetes you might range into you know, not over 140. Not over 140, but sometimes like as low as 50.

[23:15] Yeah. Right. The um normal really want to be like 70 to 120, right? But like the normal range is bigger than that. That's right. And if you deliberately have 300 grams of glucose and check your sugar an hour afterwards, maybe get over 140. Right. Right. But that's an absurd amount of glucose. You wouldn't do that. Right. And so and so let's talk about like how accurate and precise these devices are because we deal with patients that are sometimes 300 400 like have real problems and so the as you get closer to 100 you get less well it's actually I'm talking about something else right so the best sample the best measure of what your blood glucose is would be an arterial sample and that's ridiculous because that's difficult to get next is Venus and so when you get a blood draw the glucose that comes up on your labs is the most accurate at that time the blood was drawn that that's the person where you go and you get your blood drawn by a professional right when you stick your finger you get a capillary reading and that's lags behind the venus reading right because that like you have to squeeze it out there's alcohol you're not directly sampling blood cgms how how when you say it's it's lagging how far behind Venus um pretty close so it's the CGMs are the problem cgms are in subcutaneous fat they're not even in blood vessels right so like you're talking 30 minutes to hours behind and so when you use a CGM as a diabetic, it's not necessarily the the number itself or the precision of the number. It's more the trajectory which is useful, right? So, if you see your blood sugar precipitously dropping like 200 in 20 minutes, you should probably have some sugar because you're going to keep going down, right? And then what the value is right now isn't the value of your blood sugar, right? It is an estimate thereof. So, if you see your blood sugar going up or down, you know, you can intervene on it, but it is inaccurate at all levels. and lagging behind by an hour or more. And so as you get down to smaller and smaller numbers, the precision remains imprecise.

[25:09] So but the range that you can be imprecise by goes down. And so you have less certainty of what your number is. So CGMs are not good to know exactly what's happening right now in your body. They are useful to detect trends. Yeah. And so so when we have people that are using insulin for example, we generally prefer um a finger stick to a CGM. But there are reasons we would use a CGM instead. And that's where again the expert plan. It's like what's the best outcome for the patient. That's really the most important thing is what's the what's really the best outcome for the patient. So yeah, I don't want to stick my finger. I'm not going to ask you to stick your finger, right? I'm going to use the CGM. Okay. As long as you use the pre-meal blood glucose to that to choose how much insulin you're going to give yourself, okay? Don't watch the blood glucose climb after a meal, freak out and take extra. We know it's going to go up. So, as long as they use the CGM the right way, detecting trends and are smart about using the glucose readings in order to intercede premeal glucoses only, CGMs can be beneficial.

[26:15] Yeah. And and this is one of the reasons we get so engaged with people particularly in the first 90 days of their work with us. Like we're not seeing them, you know, every couple weeks. We're in some cases talking to patients daily to help walk them through particularly if it's their first time on insulin. I mean that, you know, things where they're nervous about it. We really want to hold their hand. So diet versus exercise, we talk about this all the time. What's more important for for health and fitness? If you're kind of new to the health and fitness game, you're not already kind of all the way to the right. Do you start with diet or do you start with exercise? Yes, you start with whatever the patient's willing to start with. Yeah. Right. So, um and and when we say exercise, by the way, we don't really say exercise. We say movement. Yeah. Well, I do say the the ADA recommends 150 minutes of moderate intensity aerobic activity per week. And then I follow it up with what does that mean? Walking on a flat surface, right? So, there's no target heart rate. You don't have to sweat. There's no zones. It's just movement. The movement has to be in intervals of 10 minutes or longer. I don't know why that is, but there's lots of evidence that it's true. And the target is to get to 150 minutes a week. What activity you do is whatever activity you have available to you that you're willing to do that you like doing and that's appropriate for your climate. I'm not going to have someone walk outside in Austin right now when it's 110 degrees, right? I'm going to tell them to wait for the evening or go to the gym and use an exercise bike or whatever they want.

[27:36] But it has to be free movement. And in golf doesn't count to be fair. like walk like it's like if you're walking it's got you walking for 10 minutes 10 minutes or more which by the way that might work golf might work for me because I might search for a ball for 10 minutes before I can find it that may actually work for me but for most like golf doesn't it's got to be continuous movement continuous movement now it's if you playing you know nine holes of golf every day you're going to be moving more than if you were watching TV for that time right so it's not bad I just tell people it doesn't count steps don't count and that that pisses people off because like they got that little thing on their foot and we've had a patient who was a um a delivery service and she she was getting 12 to 15,000 steps cuz she was walking from the truck to the the place she was delivering every day. I was like steps don't count and she started doing like 15 minutes of jazz exercise with her daughter and all of a sudden she lost a bunch of weight. Right? So it is um it is the movement and continuous movement. Now, if you move harder, right, you do highintensity aerobic activity, you are sprinting and sweating. You can cut the time in half, right? But most people don't go from, huh, I wonder if I should get healthier to high intensity aerobic exercise.

[28:43] That's not realistic. Instead, moderate intensity aerobic activity is walking. Yes. And the way it plays out sometimes for us just pragmatically is, hey, how far is it to walk to your mailbox? And for, you know, someone who's outside the front door, then we've got to get them to walk to the front curb. And then how many rounds do they have to do to make that 10 minutes? you know, in some cases. And so I think there's like a and and the the thing is it's like just a little, right? Like it's it's just a little is what it takes to get get better. So hold on. I want to go back to So you're saying somebody that delivers packages and they park, they walk 30 seconds, 30 seconds back. Those steps just What do you mean they don't they don't matter at all? They don't matter as much. They they don't seem to matter at all is what I'm hearing. Right. They so they I mean again it's like the golf thing right they they they obviously are better than not moving right like that so they have to be but this woman was seeing no results and she was doing that for years then she started doing 15 minutes in addition 15 minutes of jazz exercise her size with her daughter every morning and all the pounds came off right so they are it's not like they're unhealthy right you should do more steps but in terms of losing weight and being healthy from a chronic metabolic disease perspective they don't count so So getting off the couch, going to the bathroom or going to the fridge to get snacks doesn't count. Definitely. That's what I'm hearing. I mean, unless your fridge is really far away, like five minutes there, five minutes back, and then what are you eating? If you're eating carrot sticks, I'm Yeah. So So at least 10. So let me ask you this. So, I I work at home a lot and I will take sometimes just and I'll just go walk around in the yard and I've never really thought about it for 10 minutes, but just putting around in the yard and moving stuff and I don't know, just doing whatever. If I do that for 15 or 20 minutes, that has that has benefit.

[30:33] Um, so if you're putting around, that's the like that's the key thing there. Are you walking around, bending over, picking up stuff, leaning against the fence, not moving? Yeah, I might be walking around picking up sticks. The armadillos dig holes. I'm filling those in. I'm just kind of Sometimes I'm doing it while I'm on a phone call or something like that as I walk around the yard. That is probably going to be low intensity aerobic activity, right? Rather than moderate, right? So you um usually moderate activity uh is defined by intent. You're you're intending to do it. Um walking around the neighborhood like looking at stuff, right? That probably counts. Um, but when you do moderate intensity aerobic activity for this purpose, you're usually not doing something else. Now, I say that, but I do it while playing. I have an elliptical stepper at home and I I play a video game while I'm on for my 30 to 30 to 60 minutes, right? So, the playing the video game is irrelevant because my attention is on that, but my legs are doing the exercise and it's also my resistance is up also up to 20, right? So, I am it is effortful work for me to do and the intent is the exercise and if I lose at the video game, it doesn't matter. So, um, aimlessly doing stuff is better than sitting on the couch, right?

[31:41] But to get the benefit, you need to do deliberate movement. I love I love that, right? The video game while you do it. I do similar. I bought a a treadmill that I have at my desk, a standing desk where I can sometimes I walk for 10 or 20 minutes. Sometimes I walk for two hours on that thing while I'm while I'm working. So, that that's been really beneficial for me, I think. Yeah, that's one of the things that we recommend people do, right? Like if especially if you work at home, they the things that fit underneath the desk, they don't go very fast, right? And you're not trying to like go running on on you're meant to be standing and moving, right? And if you get good at it, I can't do it whenever I do it. Like I I I shift and I miss my keys. So I can't do it if I'm typing. Yeah. Right. But if I'm And I can't do it if I'm on a call because the bobbing and the weaving it makes everybody uncomfortable. Right. But if I'm watching a video, I'm learning something new, I get on one on the next room, right? um be using that to stay moving even if it's not moving a lot. That generally doesn't add to the 150 minutes cuz it's usually low intensity, but it's still better than sitting down. Right. Yeah. I I found that to be really beneficial.

[32:42] And they're much cheaper listeners than you would think they were. I I thought they'd be a lot when you look, like you said, the ones that go under the desk really are max out at $500. And there's there's plenty that are in like the 100 to 200 range. Like you don't need it to go that fast, right? That's one and a half miles an hour is considered fast walking under a desk. 1 m an hour pretty reasonable. So it's it's pretty slow moving if you want to really slow it down. Yeah. I I used to Well, I still have I've got a little mini trampoline that I used to jump on a lot. But John I would make John sick when we'd be on have to take like he wouldn't I wouldn't even really realize I was jumping. I would but all of a sudden he'd be like, "Can you stop jumping, please?" Yeah. Or just turn your camera off. Either way, it's good. Yeah. I So I think maybe this might be a good place to take a break and then we'll come back. I do want to get into some of the measurements that people think are really important and when they're, you know, what to use them for, what not to use them for, and I think that would be a helpful thing, Dustin, again, like BMI and that kind of stuff. And Sure. Yeah. Talk about hypertension and and some of the work we do there. All right, let's take a break. Great. Cool. All right, listeners, welcome back. Uh, we are still here with the two doctors, uh, John John Oberg and Dustin Williams. Dustin, before the break, we talked a little bit about meat and moving and where it is on the spectrum and what do you would you tell people that you know the carnivore diet I think has become very popular you know and there's always a big debate carnivore versus vegan or whatever and and and there's a lot much of a debate but yeah and whether it's but but there's a lot of people that that's what they're doing. So what are you tracking there? Why is why do you think red meat is bad and even getting into cholesterol? Let's let's talk about that a little bit. Um so it's basically the evidence, right? So I heard two things there. Um what do you tell somebody who's doing it wrong who thinks they're doing it right? And why is red meat bad?

[34:27] Right? So listen, let's I just want to reframe that. Red meat's not bad. It's just not all the way to the right. Like red meat is better than some things, worse than others. It's not bad. No, that's it's pretty bad. Right. Red meat's like almost fast food, right? And red meat in particular. And the reason killing me well. Sorry. It's not It's not my belief. No, I mean literally killing me. Yeah. It's not my belief. It's just true. Right. So, there's good data that um people who eat red meat have higher LDL cholesterols than those who don't. Um and those who don't eat red meat but do eat fish have a higher LDL cholesterol than people who eat just plants. Right. Wait back to English. LDL uh is the quote bad cholesterol. It's actually the only cholesterol that matters. It's low density. Yeah. Low density. Um I don't want to say this. So the liver sends out cholesterol. All cells need it, right? It send they sends it out as a very low density lipoprotein VLDL. In the periphery that thing gets cleaved and triglycerides, cholesterols are taken up by the peripheral cells.

[35:29] They say, "Thank you very much. I need this." Eventually the that thing is going to go back to the liver as LDL. The the liver can choose what am I going to make cholesterol packets? What am I going to make VLDLDLs with? It prefers to take things from the diet. This comes as kyomicrons. Basically the same thing as a VLDL only only strictly from the diet. So if you eat cholesterol and fats, the liver is going to use that cholesterol and fat instead of other alternative sources. If it doesn't have dietary stuff coming in, it can choose to make new cholesterol, synthesize it itself. The last thing it likes to use is the LDL coming back from the periphery. LDL is essentially the reservoir form of cholesterol. That's because when we didn't have an abundance of calories, we didn't always eating that VLDL just came back around and the liver say, "Thanks, hey, come back in. I need you." The problem with it is that LDL leads to atherosclerosis, blockages of arteries. It is the LDL particle that gets deposited in in the endo behind the endothelium that leads to the plaque. So if you have more circulating LDL, you're more likely to end up with accelerated atherosclerosis. Plaque plaque, right?

[36:42] The the liver doesn't want to use LDL because it leaves the LDL in circulation as the reservoir. But if the the liver picked up the LDL, it wouldn't have the opportunity to end up in the end under the endothelium. So the goal I forgot where we're going now. Damn it. You're good. No, you're great. So So we're just about HDL and LDL, right? And so you're talking about like why we want the is you said LDL is the only thing that matters, right? HDL is not good cholesterol. LDL is not bad cholesterol. LDL just happens to be the circulating form that ends up in aththeroscllerotic plaques. And you get more of that when you eat red meat. Correct. Yeah. Right. That's where you're going. And that's exactly right. So the red meat has um unsaturated fats. The consumption of unsaturated fats increases the LDL cholesterol. It does. If you have unsaturated fats, I'll eat either poly or mono mufas or pufas unsaturated fats which are found in plants. Your LDL comes down. We have unsaturated fats. That's what our liver makes. And it just happens to be. It may be coincidence.

[37:46] There may be something behind it, but it doesn't matter because it's true. If we eat saturated fats, our LDL cholesterol goes up. More LDL cholesterol and circulating the blood, more to end up in an athoscllerotic plaque. And and so I I think one of the things Dustin and I have talked about over the years is like there there's all these, you know, truisms and evidence and there's you're always going to find one person to say, well, for me it's whatever and like we'll do the blood work, right? like that that's and and for that person. And so if that person if it is different for them, we're going to meet them where they are. If it's the same for that person, we're still going to meet them where they are. It's just that there's there's like kind of early indicators, easy indicators, right? Like it's really easy to figure out what someone's blood sugar is if you stick their finger, right? There's other things like BMI that we've talked about, not on this show yet, but like BMI is only important if you're a weightlifter, right? Like that's it's not a marker of health, but it is a marker of unhealth. For the listener, BMI means body mass index. It's a ratio of how tall and how much you weigh. Now, um to answer the second question, what do I tell the person who's doing it wrong but thinks they're doing it right?

[38:56] I educate them, let them come to their own conclusion, and then pass them off. Right? So, I see patients only for the first intake. Right? So, I'm the one who gives the information. and I get the necessary information to build out their chart to build the treatment plan and then I pass them down the line. And for the regulators in the payer industry doesn't mean once ever. He means once a year. Like I just want to make sure like we do see patients once a year for treatment planning. That's that's the way it works. Right. Right. So that's a good point. Thank you. So I just for the storytelling for the storytelling I see them once. The idea is that I get them to commit to something and what what what that something is is always dependent on that person. um if they are a carnivore diet and they're telling me that that's what they're going to do. I'm not going to try to fight them on the first visit, I'm gonna find a thing that they're willing to do and then hand them down the line. So eventually they're going to stop doing the wrong thing because they're going to see benefit from working with us. They're going to get better. They're going to feel better. They're going to trust us. They're going to say, "Fine, everything you've told me so far has been true. I'm going to give up the carnivore diet." That happens maybe in phase five or year two. It's okay. So people who don't who hear what I'm saying and say, "No, you're wrong."

[40:06] I'm right. You're wrong. But you can keep doing whatever you want because it's your choice. Especially if you're doing other things that are healthy. If you want to be a whole carnivore diet, but you're drinking lots of water and you're exercising 300 minutes a week, keep eating the meat as long as you're doing the right thing. Otherwise, and then from a behavioral perspective, we're we're now studying things that have been learned in a hostage negotiation to see if there's things we can do to help people make better decisions faster in still clinically appropriate ways because, you know, when you enter someone when you enter into like a mental health behavior, uh, a mental health relationship with someone, there's things that are, you know, clinically appropriate and clinically not appropriate. And so we're actually studying the different kind of fields of psychology to see if there's things we can learn that would help patients um you know move to the right more more quickly for their own benefit by their own choice but by their own like we we have a you know a really kind of candid set of conversations with our clinicians about helping the patient take agency for their own well-being. So that's important.

[41:09] So whatever I mean look the big takeaway I keep hearing over and over. I I I really I like this concept a lot of of the move to the right whether it's food to just be one tick healthier whether it's exercise or medicine or Yeah. or medicine. Well, let's go into medicine. This is the easy one. What medicine? Well, you move to the right with medicine, right? So it's like move to the right with medicine. Like let's just use insulin. Like move to the right with insulin means more insulin, more insulin. more insulin stabilized, less medicine, less insulin and less insulin because you get healthy, right? So, as you move to the right, it's like get you onto the right prescription first and foremost, which then means generally speaking, giving them more and more and more insulin until we get control, stabilize them at control, fix diet and exercise, then you're able to use less and less and less insulin and eventually get them off of insulin or replace insulin with other drugs, you know, GLP1s, whatever. But I mean moving to the right in medicine is about titrating the right amount of medicine, right? Sure. Yeah. We we jump from healthy for everybody to healthy for diabetes. Right. Right. So moving to the right is good for everyone, right? Not just people with with chronic metabolic disease. It's it's a way to prevent a chronic metabolic disease if you have a chronic metabolic disease.

[42:18] It's about optimizing the medications that go after the underlying pathophysiology. In diabetes, it's about undoing the insulin resistance. Right. Right. And so then then that is the case. Right. If you need to use insulins up front to get rapid control, you prevent the complications of hypoglycemia. But if you're doing that with insulin, you're only exacerbating the problem. More insulin be gets more insulin resistance. But you need control first while you get the right drug started. And then as the insulin resistance is combed with diet, exercise, and the right meds, the amount of insulin that you have to inject comes down or eventually off. Yeah. Yeah. So, so right medicine, when I think about it as a non- physician, I think about like right medicine, right amount, you know, and we have to manage the side effects, right? And then get people off the wrong medicines. Like we had one patient that came out of the hospital and had four hypoglycemic events in five days. Super dangerous, right? But but when you look at it from the outside, it's understandable as to why the problem existed. It just needed to get fixed fast. We had another patient who was on $1,000 a month paid out of pocket hormone replacement therapy that was timed inappropriately for their life.

[43:28] And instead of having the consequence that the patient thought they had intended and the doctor maybe thought they intended, they were actually increasing their cancer risk as they were getting no benefit from the replacement therapy. And so there was like a a financial treatment burden, a medical treatment burden for a clinically worse outcome. So that would be moving to the left. That's not what we want to see happen. So, so really when we talk about medicine, what we want to do is we want to make sure we get them the right medicine, manage the side effects to eventually get to a place where in every place that's appropriate, get them down titrating. So, less medicine or in a perfect world, no medicine where the food becomes the medicine. Is that that's right. Okay. Now, it's not possible for everybody, right? Like there's some people who are far enough along in their disease, we're not going to completely reverse it, right? That's not if you have a disease, you can't reverse it. It's some people that have progressed so far that they're only going to manage it. That means they're going to be on medicines for the rest of their life, but at the same time, we control the disease. We prevent the complications and the That's right. No, you got it. And I think in in addition to that too, it's like, you know, there people ask us all the time about GLP1s for weight loss and they're like, "Well, you're going to be on the rest of your life." And the answer is, "Well, maybe, but we think, we don't know, we think there's a way that you can come off of a GLP-1 and then go back onto it if you hit a point where it's clinically appropriate." And then but again, there's such a new drug.

[44:46] I don't I don't know that we actually know the answer to that, but that's our best view of the future. Oh, that's what we do, right? When patients hit their weight goal, come down or off. Yeah. If they go back up because they they've redeveloped bad habits or whatever and they need the help coming back down, we can intercede early. Yeah. Right. But there's nothing that says you need to be on the drugs for for life. Yeah. Let's give give some examples of using food as medicine. Let's hear some success stories. Well, the two earlier, right? The guys that were eating peanut M&M's went to eating peanuts. We had went to blueberries. So, we've had um Were you part of the ice cream to ice cream story? Was that me or was that I know I was on the phone with a patient, but were were you the I think that No, I think that No, that might have been all you. Okay. So, yeah, we had a guy that was um he had he had some things going on with um kind of early stage dementia and he was only willing to eat ice cream and he drank chocolate milk for drinks and that was the only way he took calories in. And we changed the type of ice cream he was eating and his normal kind of uh morning blood sugar went down by a 100 points within seven days just by changing the ice cream because we went to ice cream that was I'm going to say the words and Dustin doesn't want to be it was healthier. Move to the right.

[45:54] It was it was on a relative basis it was a healthier type of ice cream. Um and then that gave him the confidence to say okay I'm willing to look at other changes but I mean that I mean but that's that's where the start starting place. We had one woman who it was change the coffee creamer and that you know and so it really is getting deep deep deep into the daily little habits and choices that you know can be well ingrained. Well, we actually had a proforma that uh assumed we were going to have patients for an extended period of time because we had never seen an intervention that was so successful. Everybody who enters the practice who follows it lose drops their A1C from 12 to six in 6 months. Right. They lose 50 pounds or faster or f Yeah. like they lose 50 pounds in 3 months. Like everybody just it's the success is like repeated over and over and over again. It's not like one good example that that that shines the rest. It's and there's no silver bullet. There's no like do this meal plan. It's look at what you like, what do you eat, what do you do, choose things that are more choose the ingredients that are further to the right. And so individualized planning, right? And every everybody has their own move to the right story. And most of our patients come off the meds. the definitely the insulins and then even some of the the the non-insulin medications which we presume you have to have have to be on for life but their sugar is so well controlled they don't need them so we see that not irregularly but commonly yeah I think the we talk about that if you have like a drug that can drop your A1C your hemoglobin A1C by one percentage point in 12 months you generally have a billion dollar drug like that's really successful and so we commonly see A1C drops of 1% up to like per month and over a series of months when people are very sick like we've seen some people that have dropped their A1C by five points in 3 months. That would be an uncommon outcome by the way.

[47:43] That's that's pretty fast. But we have seen people that have dropped actual hemoglobin A1C 5 percentage points over a three-month period. An actual A1C matters, right? So that we are not using estimated A1C's based on the current blood glucose. It is a blood draw. And this is relevant because an A1C gives you a 90day average, right? So to drop 5% in 3 months means that you went way further than that because you're still using the blood from three months ago, right? You still have red blood cells that have been glycated with that with with sugar. And so the measurement is going to be the 90day average and they dropped five. So that that that actually is reflective of an even better change we haven't detected yet. By the way, when you guys say we, you're talking about Sedera to to the Pino or um old company wrong company. Yes. Um, so you're talking about procina. Yes. Yeah. It's our medical practice. Yeah. Yes. Just to be clear where we're going. So Justin, let's dumb this down a little bit for listeners. Let's say we got somebody out there that just they're going through life. They're busy, right?

[48:44] They got a family, they got kids, they're working, and they just want to move to the right. They just they they but they don't know where to start, right? So you gave them the spectrum at the beginning, but the average person, what are the one, two, three, four things that they could just like what's the highest impact thing that they can start with? The the first thing is usually grains, right? Bread, uh whether it be hamburger buns or loaf of whatever. Um because most people have them, right? Pastas, right? So, anything that like you think of as a carby food, particularly grains, the one thing you can do to make a huge change is the next time you go shopping, turn the package over. Don't look at the numbers. Doesn't matter. Look down to where it says ingredients colon. If the words after the colon are whole grain or whole and the name of a grain, that's okay to have. If it's anything else, it's been processed and you don't know by how much, put it back down. What what are the other things they should be looking for there that maybe not with bread or whole grains, but what what else should they be avoiding there? Um, anything that's been packaged, right? That's it's the um going after whole foods rather than processed foods. And it's very difficult to know what's been processed by the way it looks, right? There is a hamburger bun brand at Whole Foods, HB, sorry. Um, and there they have a whole grain version and a might as well be Wonderbread version. They both are dark brown. They've got oats and barley on top. If you use your eyes, they are indistinguishable. I went back to the burger thing again because that such a a telling story. The way you know that something is more to the right is by knowing that it hasn't been processed.

[50:23] And you know that by getting it as a whole food, freshly slaughtered, freshly cut. And then in between is really hard because how much something has been processed is not exposed to you. So you could be eating something that's absolutely terrible or just just slightly to the left and you don't know. So it becomes more about finding things you know that are definitively to the right to replace things that you know that are definitively to the left and not try to change everything about your diet. And and I think you know like better whole grain than than processed grains for me better lettuce wrapped than bun like that you know like that's just it it but again I recognize that not everyone's ready for the lettuce wrap burger and that's okay and it it's not there's no silver bullet. There's no like there's not four things I can tell you. It's like what do you have in your day that you could definitively replace the sentence? So you have to like analyze your day. And it's not like oh I'm not going to ever have beef, right? It's the when you have the opportunity to choose beef or fish, choose the fish, right? Unless you're unless you're at a steak restaurant. Yeah. Or or choose it instead of red meat five days a week, have red meat four days a week. like that like small like oftenimes we come to someone comes to us and they're ready to make big sweeping change and we actually encourage them to make a smaller change instead because it's more sustainable and and that's really important. So even when people have like the they're ready for the grand gesture.

[51:47] It's like hey that's great and if if we get there that's awesome woohoo let's do the let's commit to the thing we know we can do and then if we go further that's great. So, okay, I hear you that, you know, but you said the carbs. I guess the other thing is sugar. We're hearing more and more about sugar now. I mean, that's a big one. And what's your feeling on real sugar versus all the fake sugars? I mean, the fake sugars are worse because they're more processed. Is that fair to say? That's going to be the answer, right? So, um, if you have a potato, which is very starchy, there's no such thing as a glycemic index. You can use that to communicate with patients, but it's not a real thing, right? So if you have a whole food, you can have a very carboheavy food, but because it's coming as a whole food, you're not going to absorb it all, right? So it's not all pure glucose, which your intestines are optimized to absorb. High fructose corn syrup is terrible for you both because it gets absorbed instantly and it doesn't trigger the mechanisms that control glucose stuff, right? So you're getting both the calories and not getting the satisfaction. the cells aren't happy about it and like you're overburdening your body with with sugar that doesn't help regulate glucose. So all the all the attack, none of the defense, right? Exactly. Right. So and if as you get to simple sugars, which is usually mean high fructose corn syrup, sugar added to beverages, right? Like if you go make sugar from cane, you're not going to get the white sugar you get in a jar, right? If you're adding the white sugar, if it's white, it's processed. If it's white, don't eat it. Right? So, if you have sugar that you add to something, imagine what some a manufacturer is going to do. They're going to add three times as much. Oh my god. I had sugarcane for the first time.

[53:26] My friend's kid was like two years old and had a had raw sugar cane and they cut it in half and offered me some to suck on cuz it was great. And I bit into it and I knew I was in so much trouble because it was so much less sweet than sugar. Like so much less. Like I had never had it before and you know decades into my adult life. And and I I but I I was like, "Oh my gosh, I am in so much trouble." like it is not nearly as sweet as sugar any sugar I've ever had. In order to get this sweet sugar out of sugar cane, you have to process it and concentrate and concentrate and concentrate and concentrate. Yeah. So, what about seed oils? This is the one and we've mentioned this earlier, but the you know, I don't at least me, I hadn't heard anything about seed oils till a couple years ago and and my wife Julie came home and she was like, "Oh god, it's the new smoking and it's it's d like there's this I mean, do you again processed? I assume that's correct. you the seed oils are also on the devil end of things. Um I don't know if explic explicitly you're talking about but I'm going to answer a different question. Um fats aren't bad, right? There's no macronutrients unless you're a competitive athlete, right? There's doesn't matter what your ratio of protein to fat to carbs is, right?

[54:33] Instead, it matters food source. Good fats come from plants. Good fats are unsaturated. Unsaturated fats mean they can't stack close together in their in their natural form. So at room temperature, they're liquids. So if you have a fat, an oil, and it is uh the actual plant oil, maybe the seed oil is something else, right? But if you've got a plant oil, it is a healthy fat to have. If it is solid at room temperature, don't eat it. Butter is bad because it's solid at room temperature. You have to heat it up. Bacon grease is bad, right? It's it's liquid when you cook the bacon, but then it congeals when you don't and you stop cooking it. So if it's if we're talking about plant oils, they're good because they are unsaturated. They come from plants. If there's something special about the processed these seed oils, then that might be something different. Okay. All right. What about during the break you were talking about the beef and and I think this is an interesting thing for people that they haven't thought about. You were talking about the beef that's at the grocery store and what do they do to keep it fresh, right? So, do you want to go back into that a little bit? Yeah. Well, so my point is that you don't know what they've done, right? If you kill a deer and butcher it yourself, you know exactly what went into the processing.

[55:47] Probably nothing except skinning, right? But in order to get it from wherever the animal was to the consumer in a state that hasn't rotted, there has to be something along the way, right? There's some pres preservation now. And it's and you could do it in a whole food way if you freeze it, for example, right? that that's expensive and not everyone's going to do that when there's a cheaper option. So there it is likely unless it's been butchered in the back of the grocery store that there's been some level of processing. If you go farm this is why farm to table is so important. If you go farm to table there's no processing and so that that type of red meat is definitely better than a chicken that's been processed. Right. Right. So it's the extent of processing and not just the food source but in at the grocery store they have to make sure that it doesn't go bad. They don't waste the material. So, they're going to do something to make it last longer so they can sell it to you. Yeah. I I think of that of a lot of things. You mentioned coffee creamer earlier and I always think, you know, I used to put use coffee creamer and then one day I just I don't know. I thought, "Oh, this has been sitting out on this counter for I don't know how long and it hasn't gone bad." There you go. And it's got dairy in it. How the hell much preservatives are in here for that to happen? Right.

[57:01] And but I'd never really thought about it till I don't know what made me think about it that in that instant. But you hit on something, right? So the um the best food is whole food and whole food goes bad quick, right? So you have to shop frequently and often and you lose the convenience of having it on your countertop forever. Well, we we buy so I eat a lot of beef. We we buy beef a half a beef at a time directly from the farmer, right? And it's processed. And while I'm not watching every step, I'm pretty confident that it's a grass-fed, grass-finished, you know, they're not adding, they're not pumping it full of and yeah, you know, hormones and that's actually cheaper than going to the grocery store, but we also we go to the farmers market and things and again, I think, but that's expensive. Yeah. Now we're back to like the like the that whole comment we started with Mark Heyman and Peter Aia like you're that's so far to the right already and that's just not reasonable for the vast majority of the country which is where we're coming from which is like yeah yes you should do all that amazing high five that's great and not many people have the resources to store half a cow until they can eat through all of it or go to the grocery store twice a week or like that's that's called treatment burden right like the so for us like what's the burden of doing all these things and so we've got to find a plan that doesn't have an overwhelming amount of burden.

[58:19] Yeah. Like and so like for you, you can do that financially. Most people cannot do that financially, right? We have we have patients in our practice that are choosing between food and medicine some weeks, right? And so how do you lower that treatment burden? So we're aggressively finding a plan that they can use, but that aggressive planning means lowering cost, lowering energy. And and I'd pick something else, right? Like if you told me that that was you, I'd be like, "Okay, let's let's not talk about red meat again. Let's talk about something else that is way to the left that that needs correction, right? But I'm also speaking I'm not only speaking to Pcina patients here, right? I mean, our listeners are going to vary throughout the economic spectrum. 100%. I think I think that Heymania, they do a great job of like I think if you want to understand what the far right looks like, I think and it do a really marvelous job of explaining the even even further right than we do. And and like it's why that's why I have such a high level of respect for what they're doing. For sure. Yeah. seed oils. Back to Can we go back to seed oils for half a second? Sure. So, there's a lot of debate about seed oils right now. So, I think the debate's hot and raging. One of the one of the points in the debate is about inflammation. And you and I have talked recently about inflammation versus swelling and what the like medical difference is. I think it's worth talking about because while it's true that um sugar may cause a lot of swelling and water retention and things in the cells, that's different medically than inflammation, which is new information for me. Right? So inflammation is defined by the presence of immune cells, right? You have your immune system has to say that is a foreign invader dispatching the the troops, right? Um true acute inflammation is neutrfils trying to fagotitize a bacterium or a foreign particle. But you can also have lymphosytes, right? But the pre the point is that actual inflammation pathologically hisystologically means the presence of immune cells in a biopsy. And so sugar may actually cause something that looks like inflammation in the sense that it's swelling but may may not clinically be inflammation.

[1:00:11] Right. It's definitely not actual inflammation. Yeah. And um the the seed oil thing pro-inflammatory it may be um rooted in in one myth which is um you know omega-3s omega 6 which which omega mega one looks like the proin one's pro-inflammatory because it looks like another inflammatory cyto. Not true. The like the omega-3s are good. They can be used to treat familial hyper triglyceridemia. That's the stuff you find in salmon, right? Yeah. And and it it does not help treat LDL cholesterol. Adding omega-3s on top of a bad diet, on top of eating saturated fats doesn't make you better. Stopping the bad fats is what makes what actually matters. And that thing um the pro inflammation thing comes from um like the category I forget what it's called like the class of the fatty acid that it is it looks like another one that might be inflammatory or be involved in inflammation and because it has like the same group number people erroneously ti tether them together and turns out no relation whatsoever. Yeah.

[1:01:19] Sorry, I didn't mean to jump us off there, but that's I think as as listeners, I want to be able to like when I talk to my doctor, like I want to know the difference. And so that's that was helpful new information for me What other I mean, what other big takeaways do you want a listener to have about food as medicine? Like what maybe maybe it's a question we should ask that we haven't asked. I mean, more plants, fewer processed foods. I mean, that's really what it's about. And participate in the process, right? Most patients want to know how to participate in the process better. And so, you know, we do that really deliberately at Pcina. It doesn't take our medical practice for a patient to get involved with their doctor and say, "Hey, here's what I want to do to move to the right and, you know, be really active in their own health journey and to be vigilant, right? Like you're not there's no answer. No one has the all the solutions. There's no silver bullet. There's no recipe book, right? It is about being vigilant about your the things that you use to make food. And also that's another thing. Make your food. Don't buy it. Okay. In other words, cook it yourself. That's right.

[1:02:21] Right. The closer to raw you get something, the more you know it hasn't been processed. And anything you do to it is not going to be anywhere close to what the food industry does to process food that lasts a long time. Right. So buy stuff that's raw. Cook it yourself. Grow it yourself. Okay. I love that. That's my questions. John, you got you got anything tied? Put a bow on it. Look, I I think this is about like small sustainable stuff. Like that's, you know, make make small decisions and and be an active participant in your own healthcare. Like that's the that's really the the bottom line. All right. Do we want to do anything on move more? I mean, yes. Go. Yeah. I mean, move more. What does what does move to the right mean in movement? Do we did we do this already? No, we we talked about moving. We didn't get we did not get into flexibility like mobility. We didn't get into balance. We didn't get into strength. Yeah. We talked about two and a half hours of you know of movement. Right. So that that that is the that is where you begin to to treat the chronic metabolic disease. You give the same left right like so moving 150 minutes a week is like in the frame not moving at all sitting on your couches outside the frame to the left. Well so um I'd see this actually more as a timebased journey right the thing that we got to get people to do is move more.

[1:03:37] what that looks like, it doesn't matter, right? Move more. But as you begin to lose weight, just like the the story about the the ketosis, if you only exercise and don't do resistance training, your body is going to consume muscle in order to get the glucose. The liver is going to make food for everybody taking all nutrients at protein alike. So in order to maintain yourself, especially in the aging population, to maintain strength and balance, you have to do resistance training in addition. But it's it's first move more, do the aerobic activity that gets you on in the healthy direction. You're using the calories, you're coming losing the fat. You will also lose muscle. So as you get moving more, you then need to also do resistance training. Resistance training shouldn't come first. It should be move more resistance training and then as you age, balance, posture, stuff like that becomes important, too. So, where would you if somebody's starting out, right, moving more, they can go walk resistance training? I think some people are intimidated. What would you tell somebody that's just never done it? They they picture Arnold Schwarzenegger at Gold's Gym and you know that that's in it's too much for him. So, where would the one little step to the right for somebody just starting out? There's a couple of answers to that, right? It's going to depend on them, right? So, um you you can get a three pound or five pound dumbbell, right? something that just that doesn't weigh anything that anyone could pick up and start doing stuff. You're not going to hurt yourself, but you got to get trained on how to do it right. And so, um, a trainer, go to a gym and see if they've got, you know, a special offer where they can show you the ropes, right? Find somebody who knows what they're doing. What you shouldn't do is go from never having done a deadlift before to doing 400 lbs. If you don't know don't know what a deadlift is, don't do one. Yeah. I mean there and there's lots of things people can learn that are like body weight exercises with things around the house where they can be trained to do that with like anything from a community health worker and you but there's lots of professionals that can help with that but I think body weight exercises can lead to things like you know there's Tabata training which is super high intensity 8 minutes that is not day one like that is pretty far to the right for training right and um yeah so I think wherever you are take the one next step so you're thinking about not falling falling as you age.

[1:05:55] Not falling means balance. Not falling means mobility in your, you know, muscles and joints. And then it means um strength. And so those are the and and a really like a great trainer can do all those in one movement, which was, you know, really nice. But I recognize that learn learning the right movements matters, right? So the answer to the question is if you really don't know what to do at all, go learn from somebody. Don't look at the internet. Don't try to do stuff that you see people doing because you don't know how to do it. If you do already know how to do it, do the thing you know how to do and go ahead and go back to it, right? But if you really don't know, you need to get educated and the internet is a bad place to do that, right? You should get trained by a professional who knows how how to do the movements the right way, can teach you how to do it right, do it wrong so you don't end up hurting yourself. Yeah. I see so many people at the gym with terrible form and I just think, "Oh my god, you're you're stressing your back, you're stressing this, and well, making sure you do things like using the opposite muscles, right?" Like, you know, when you train one side of your body, you need to train the other two so you don't have later, you know, worse posture later. Like there's there's a lot of little things that people will help out with. And I think Randy means like just people like doing stupid movements, right? So like you you can't learn from just anybody.

[1:07:00] You really got to learn from a professional. There is a right way to do resistance training and most people do it wrong. Right. I see people, you know, the one I always see there's a I don't know, but you know, they sit and they pull some kind of a back exercise, but they're, you know, when their back's supposed to be straight, I watch them and they're just they're hing they're doing all the pulling with their back, not their lat muscles and they're just go to the gym and watch. I mean, 80 90% of the people that use that machine, it's they're doing most of the lifting with their back so they can do heavy weights, right? And and that's actually that's a good takeaway, right? Weight isn't the goal, right? Like how much you can lift isn't the the well I mean it could be a target, but it really is about engaging the muscles, giving them something to hypertrophy from. You don't have to do max weight. There's no target weight. You do the exercise correctly until you feel it in your muscles. Once you feel it, then you know you've you've exercised them. And if you've done it right, you've exercised only the ones you're supposed to, not exercising your back when you're supposed to be exercising your shoulders. Right. Right. So, yeah. And I I think the big one for me, too, and this has been challenging as I've gotten older. It used to be playing football and basketball and doing things that I enjoyed that were fun, right? And we've talked about this, John. Now, I go to the gym and I lift and I've made it bearable because I listen to podcasts. So, you should listen to Tales of Abundance while you go to the gym and and do this. But I listen to podcasts. And by the way, feel free to listen twice. Yes. And uh and so I'm I take my mind off it, but just sitting and lifting weights is incredibly boring for me. I have I have someone I meet at the gym so that I know they're going to be there and I know they're expecting me. And so I have to game it that way where I actually have someone that goes to the gym with me.

[1:08:43] Yeah. And so I think I think doing things in community can be great not just for the gym, but can also be great for community. I I don't go to a gym. I don't lift weights. I do almost all aerobic exercise until I go to Aruba because then I've got my partner Meredith who she and I go to the gym together and then I come back from Aruba all jacked up. Okay. Community community is a really important long-term part of this. We we'll come back and do that episode next time. But I think community is a really important part. So my big takeaway is go to Aruba more often because you get traffic. That's take away. Tales of Bunnings.comtravel partners which doesn't really exist but it could. That's right. That's right. All right. Well, I think this has been fantastic, Dustin, and a lot to think about here. I know for myself, hopefully for listeners, um any anything place you want to send people? Christina.com. Okay, brina.com. So, learn more about your health. There we go. So, thank you listeners, as always. Um you know, find us on social media, download wherever you get podcasts, give us a thumbs up, give us feedback, uh tell your friends, tell your family. Thank you for listening and everybody have a fantastic day. Thanks, Randy.