Vit D3 & T2DM, Statins only if confirmed plaque & the glycocalyx – It's where it's at!

so I came live a little bit early to try to make sure we cleaned up some of the visual problems that we have hey John good to see you already David can you guys see me pretty well and can you hear me 147 degrees west guess what I'm going to talk about tonight Thanks okay great 147 degrees west you're in Alaska right and I'm gonna be I'm gonna talk a little bit about the glycocalyx you got me interested in that with that question okay so by the way I I apologize for the hat and the and the t-shirt I keep trying to juggle my workout schedule and the YouTube live schedule and I worked out this afternoon hoping I'd be done and and showered and ready for the for the life tonight and unfortunately I cut it too close I wasn't able to get a shower so I got a sweaty head so I want to go ahead it's six o'clock I'll go ahead and start covering some items wanted to cover three items as I said the glycocalyx but I'll do that last first I want to just mention a couple of research signals one is on el LDL and a soft black versus hard plaque it was a viewer sent in a statement saying he was very confused totally confused he didn't know which way was up anymore because somebody came out and said no hard plaque is actually a greater risk than soft plaque he showed me the citation I looked it up it's a conference it's a paper being presented at a conference by someone at Intermountain health I have no doubt I mean I don't distrust the the the researcher but every study has its flaws and again a paper that's presented at a conference is not that well reviewed third-party reviewed or judged so I'm not too worried about something that comes out that seems weird until I see a pattern of it three four times in the literature it was a very interesting quote in the article though he said you know one thing we may find though is that we shouldn't give statins just on high a high LDL duh I've been doing that for years I don't give statins unless or don't recommend them unless you have plaque he did have a good point and again I would love to see the standards of medicine start to change to where we actually look to see if someone has plaque before we start recommending you know heavy guns like like statins and aspirin and things like that so again first message is don't overreact to a research signal and the term signal is just a informal term saying it's a finding that someone had in one of their studies that's all it's not a pattern it's not something that is it all conclusive yet now the second signal that we saw I did a I did a couple of videos I did a video on the other one as well those these are all videos that will be coming out over the next month or so that was the DVD study D as in the letter D or vitamin D to is in the numeral and D is in type 2 diabetes this was in the New England Journal now there are very few places that are if a if an article makes it through the New England Journal it has been refereed pretty hard this was an interesting study what it found was they were looking at this whole issue of this vitamin D d3 decrease the probability of going into type 2 diabetes and this study found that it did not it was a relatively small study it wasn't huge I think it was like a couple hundred people but it was also a rent so you know a lot of weak spots but a couple of strong spots it's the first randomized clinical trial we've seen in this area everything we've seen up till now looking at vitamin d3 and prevention for type two diabetes was an observational or environmental study meaning you saw a bunch of people out in the world you notice the people that were taking vitamin d3 maybe didn't have diabetes as often so you said well maybe that's preventing it that could be a gazillion thinks doing a randomized clinical trial is a much stronger study so here's the big question am I giving up on vitamin d3 not at all not at all I'm continuing to take it I'm continuing to recommend it and here are a couple of reasons even though it was in the New England Journal it at the end of the day it wasn't really that earth-shattering a study number one it didn't rule out a minor impact it was a fairly weak Association we're talking about supplements here let's remember our priorities you cannot supplement your way out of a bad lifestyle so if if your BMI is 29 and a half or 33 I don't care how much vitamin d3 here you take you're not going to reverse all of the you know the fat mass and the hormonal problems that that increased fat mass is causing he was the second reason the second major weakness to this study they didn't look at people that were totally pre disease state what they looked at was people that were all insulin-resistant so in other words they already had this insulin resistance disease process going on people like me people like over half of us after we get a 60 and then they look to see if they decrease the probability of them going on to type 2 diabetes now that's important especially if you're one of us people who already has an slow resistance but how important is it mmm again I'm not stopping my d3 so here's one other question about that point that whole that whole study design implies that you're okay when you have insulin resistance you're just having a problem once you get full-blown diabetes nothing can be further from the truth you already have the disease process going on you're already forming plaque you're already creating risk for a heart attack stroke dementia blindness kidney disease so you know again admittedly blindness and kidney disease are much more likely to happen once you get into that full-blown diabetic state but still they happen prior to it and again the the major killers are the heart attack stroke and and dementia all of which happened with insulin resistance alone you do not have to get full-blown diabetes so the study was helpful in terms of us getting our head around okay just how important it is one final weakness on that study they didn't look at anybody with a vitamin D level less than 20 they didn't have anybody with a vitamin D level less than 20 so you could debate whether that's a weakness or a strength the bottom line is you're not going to find many people in the US with a vitamin D level less than 20 that's rickets kind of level are osteomalacia kind of level osteo meaning bone Malaysia it's a it's a bone problem if you're not going to find people in the u.s. except people with significant other types of risk like elderly and some other risks then the question is how significant a weakness is that it's not a big weakness but again it wasn't an earth-shaking study so a couple of signals study findings out there in the in the blogosphere digisphere stratosphere that thought I'd give you an update on and then we'll talk we'll uh we'll deal with a few questions and then we'll go in and talk about glycocalyx and the capsule and the slime layer so URI along hi doc I was wondering if the use of catheters could damage the glycocalyx well I'm sure that if you're putting a catheter in the in the artery wall of course it's going to do some immediate damage to the glycocalyx the question is for hey what are you doing the catheter for and B you know how long-term a damage is that but again that's a good question maybe a question more for when we get into that discussion Laura to Dillingham good morning loretta you must be in I don't know the Philippines are somewhere Joey boombox hello Joey good to see ya hello for M from Aberdeen where's that Washington Carolyn I like the cap in the t-shirt it becomes you doc oh well thank you very much that's as you may have noticed that's South Carolina that's on the South Carolina flag and I was born in South Carolina and we have a home down in on Kiawah Island I love the place Tom Bell the mad scientist marketer love your videos just got an angiogram and they found several blocked arteries in my heart including one that is 100% making your content very in caps V ery interesting I bet thank you so much for sharing that Tom and our prayers go out to you as you as you deal with this Loretta Dillingham I believe vitamin d3 is just one ingredient in the anti-inflammatory mix I do too and again something the the jury's still out on I am NOT I'm not stopping my vitamin d3 and nuts up and recommendations on it and I'm not stopping recommendations regarding levels another sort of questionable component they accepted the standard level saying that 20 to 40 would were normal levels and above 40 were risk levels I thought that even the standards groups had changed that by this point but maybe not so let's see unless we've got any hello from Scotland Oh Aberdeen Scotland Richard Petty thank you Richard hello to you too let's see if we can pull up a couple of pictures on the glycocalyx what is the glycocalyx well if you look at a well bacteria have glycocalyx sees as well and I'm going to be fixing this problem with the light a Tom excuse me no a fellow named Richard LAN who's done a lot of this kind of production work for some really big names like Johnny Carson is helping me get out of my high school level of production and get into a little bit better I'm not going to do his level of production but anyway this is a capillary cut sideways this is the flow and this is the inside wall you know we've talked about the intima layer many many times and it being a single-celled layer but what we haven't about and what 147 degrees west reminded me we should do is the glycocalyx this glycocalyx let's break them down break the word down just like we always do glyco meaning sugar calyx meaning skeleton or sponge kind of layer those are some of those glycocalyx fibers sticking out into the to the the lumen or the hole that this flows in now what's interesting about that well that actually may be where a lot of the action happens you know if we've talked many times about blood sugar and LDL sip slipping through the endothelium and getting stuck into the media layer of the artery well guess what if you damage this glycocalyx by the way that glycocalyx also has a mucous layer this is a drawing of it hmm there we go that's a drawing of it that you can hopefully you can recognize that that's a red blood cell flowing in the in the blood flow and this is the glycocalyx here and it's sort of what we color pertinacious like glycoprotein kind of it's like snot pardon the imagery but that's exactly what it is if there's a capsule layer and a and a slime layer and the flow actually happens up here think of a think of a river in a marshland there the flow actually got may go pretty fast in the middle of the river but once you get further out towards the edges where the marsh is it slows further and further now think about it though I mean the marsh this is just like the marsh in the the real biological activities happen right there in that marsh where the flow is slowed down there's all the baby fish there the snails that the you know the crabs the the animals are eating the plants the plants so same thing here all of those biochemical processes the transfer of blood sugar from the blood into the cell wall again happens right here the insulin receptors all of the other types of hormonal receptors all are there inside the cell wall our cell membrane and they have these fibrous projections glycoprotein projections sticking out into the area now guess what happens when you damage that glycoprotein that like glycocalyx area here images of damaged like a protein area well one thing that happens is that LDL starts slipping through that that intimate layer and getting lodged in the the muscle layer of the cap of the artery and capillary walls another thing that happens is these things normally these hairs detect the flow the shear of the flow going through the through their artery when it increases they stimulate arginine and some other things to come together to form what nitric oxide so that increased flow causes increased nitric oxide activity you still have the mechanism for creating nitric oxide in the in the artery wall when the glycocalyx is damaged but you don't get that nitric oxide development because the shortened clipped glycocalyx hairs excuse me can no longer sense the increased flow so one other thing that happens these white cells are routinely just traveling along these the capillary and artery wall areas when they come to an area that is the glycocalyx has been denuded cut short like this they stop and what happens when white cells stop well if it's a polymorphonuclear side it starts releasing myeloperoxidase if it's a oh I'm blanking on the name I'm a senior moment if it's not a T cell my plasma cell and that plasma cell if it's the other type of white cells they start releasing LP PLA two foam cells you know there's three three or four different names that when they come to they'll form what's called a foam cell and they'll start releasing plaque – you remember what MP MP O'Malley peroxidase in plaque – are those are two of the biochemical tests we have for inflammation the other two tests being HSC are CRP c-reactive protein which is a protein made by the liver in reaction to inflammatory processes a lot of people the people that do look at cardiovascular inflammation tend to focus on CRP alone the problem with CRP is it's way too nonspecific sprained ankle a cut or even a flu shot today gives you over a 50% probability of having a positive CRP two or three days from now so if you have more interest in this inflammation process you've got a whole course on it we're continuing to improve that course and again if you think our our services are too expensive you know to see me individually it is very expensive we won't go into that but we've got this service that's free this these free videos we've also got the courses that we're developing and they're going to be about 30 bucks apiece the inflammation course is already ready so a lot of very interesting things happen in that glycocalyx area thank you again 147 degrees west for bringing this up I'll be doing I've done a one video on it and planned to do a few more so let's go back and talk about some question I'm getting a lot of questions tonight Erland FR a great question I've wondered that too oh and that I guess the question is in blood is blood pressure really associated with insulin resistance so that if IR is corrected blood pressure may normalize here's the bottom line on on that crave that is a good question here's the bottom line we're not still where the science is still not totally clear on what causes insulin resistance or what causes high blood pressure we do know that both of them are very much related my development is very typical to what you see with a lot of patients what we first noticed with me was that first ii started developing some increase in my blood pressure then a couple of years later i started demonstrating insulin resistance that's often what happens however sometimes you you get it the other way where you can pick up insulin resistance first now there is a theory and I think there's a lot of good science to support it they would say this high blood pressure is most often associated with a GE and we don't mean aging getting old although that's true we're talking about advanced glycation end-products you remember we discussed that a few times advanced glycation end-products what is that the key word here is glycation and and the root word for glycation is glucose so here's what happens when glucose is floating around in the blood at too high a level it will bind to proteins now if that sounds geeky to you wait a minute you've heard of it many many times hemoglobin a1c what do you think hemoglobin a1c is it's glycated hemoglobin that's actually another name for hemoglobin a1c and what what the reason hemoglobin a1c works and tells us your average glucose for a three-month period is this your typical red blood cell lasts for three months a red blood cell is basically a sac it's not really a cell it's a sack a corpuscle that's just full of hemoglobin yeah so that's that protein and now we can start to estimate how your what your levels of blood sugar have been through the three-month period that a typical red cell lasts by looking at that our level of hemoglobin a1c now why don't we just use that to look at your to look to see if you have insulin resistance well that's actually what most doctors do unfortunately that can be 20% off so guess what let's look at 20% let's say your hemoglobin a1c is 5.0 at a 20% variation that could be 5 plus 0.5 plus 0.5 it could be all the way up to 6 or it could be as low as 4 the difference is between 6 or and for our dramatic 4 is like super person Superman in terms of glucose management and 6 is some would say well it's clearly pre-diabetic some would say diabetic so that's why hemoglobin a1c is not sufficient it doesn't work now let me go back it sounds like I went out down one bunny trail after another after another you remember the original question was high blood pressure and the association between insulin resistance and high blood pressure so if you go back and you remember the statement high blood pressure is most often probably associated in the beginning started from a GE those advanced glycation end-products like broken up hemoglobin a1c and other proteins that glucose is bound to get they clog up the filter mechanism of the kidney not the exact filter itself it's a it's a portion of the kidney that's next to the filter that controls blood flow and blood volume so as it begins to get clogged up the kidney senses that wait a minute we're not getting enough volume here so the blood pressure must be to loaves so I'm going to increase the volume well if you continue to in you've got a mechanism inside your kidneys continuing to increase the volume within the same space that's going to increase the pressure so again as I said the bottom line on on the research and all that is it's still pretty murky but if you begin to see it in that way that helps you begin to understand gosh that may be one of the major reasons why the linkage between high blood pressure and insulin resistance is so important Craig Larsen Craig Idaho what about Houma I our blood tests for IR versus OG TT or craft insulin tests huh my R is really good it's just even more diff I don't even mention it in the insulin resistance course and here's why it's really more of it I mean you could use it it's a little bit more technical it's a little bit more academic and it's really more something for research from a day to day patient production getting the right answer so a patient can interact and decide what to do next you've got some really good methods I mean you've got insulin resistance I mean you've got to OG TT we've these days we've actually even finally been able to negotiate with quest labs to add an insulin test with each of a two sometimes even three our OG TT so then you have not only the blood sugar level in response to that challenge but you also have the insulin level which adds in the critical piece if you can't get them that way through the National Labs and we have we weren't able to for many years then you use something like a craft insulin survey so it's obvious Craig that you know a lot about this space is a ketone another question from Craig is a keto like diet the only or the best way to aid insulin resistance and what about low carb vegan actually you don't have to do keto full-blown to to and you know I I'm stating that as fact all of these are debatable points and there's science both ways but here's the thing you can do look are vegan I have demonstrated that many times in my own diets and manage your blood sugar the one thing that we do know is that as your blood sugar continues to rock it up past 120 140 180 you're burning your arteries you're burning back glycocalyx that we talked about you're burning that slime layer you're burning your capillaries ability to transfer metabolic products back and forth and signaling back and forth between cell and bloodstream you don't have to be quito to do that you just need to not let the blood sugar continue to spend hour after hour up over 120 if that sounds is repetitive it's because I see patients all day every day and that's what we're again we're still surrounded with as a population i'll saving and this is repetitive to you but it's the truth the cdc is very conservative about this statement they say what 80 million americans have instant resistance and i think that's way low by maybe a factor of two and even they will say and ninety percent of it have no clue so if we could just get people to start using continuous glucose monitoring and start looking to see how often their blood sugar is going up over sorry i'm going to show you i'm not just doodling with my phone i want to show you something I'm sorry well I hope this will be worth it especially for those of you who haven't seen it before so on your iPhone you can download a little app called freestyle Libre link let me show you what that app will do that's my blood sugar values over the recent past past few hours I had a gap but I rant my button ran out what do I mean by button and see that the dead value is it's 80 to 120 I think that was when I agreed to go have some pizza with Jeffrey to break my fast the other day I had a I usually do a 2 day water fast this is the button so that button stays in my arm for 14 days and I'm not full-blown diabetic I'm nowhere near it my last my last hemoglobin a1c was what 5.4 something like that the highest I've ever had was 5.7 and so here what you do is you can click on that and it says ready to scan you as you saw it has a Bluetooth technology it's scanned it and it said it's 112 it's it spiked up to about 125 when I worked out that's one of the things you'll find if you start watching your blood sugar level on a continuous basis working out can actually cause a temporary spike but back to the point very very few people that I run into even know about this process it just became available over the past year 18 months and very few people know anything about the dangers associated with blood sugar so and again if you look at the if you look at the the literature out there this is pre continuous glucose monitoring if you look at the science out there it would indicate that over half of us by the time or age 60 have insulin resistance that's a conservative number coming from general looking only it hema globin a1c and fasting glucose the CDC would say you know maybe it's thirty to fifty percent there was a study a year and a half two years ago from la UCLA School of Public Health in California it was way over 50% 500 way over half of adults starting at age 30 not starting at age 60 had insulin resistance so you know it's just a huge problem that we don't know about speaking of which none of those studies took advantage of continuous glucose monitoring and what you you would imagine what you'd expect to see is exactly what's happening people that were everybody including their dot and the scientists though these are totally but healthy subjects they have no problems with this they're having once you start doing looking at healthy groups with these monitors even healthy grapes are getting spikes up into the 180-200 stuff like that so we've got a lot to learn in terms of blood sugar values and unfortunately the vast majority of us are just totally clueless in this area so thank you for listening to my diatribe and your patience 147° West are you going to do an unboxing of the crack craft insulin test hey that's a great idea I still have an unboxed one in my in my room I don't have it close by but I'll do that maybe next week for the for the YouTube live event or a video not sure I'm not going to do I don't plan on doing all the sticking it's a blood stick test whereas if you get a GTT at at a reference lab they'll just they'll do one draw here and in some ways a little bit simpler you can do the craft insulin survey at home but it's you're doing a lot of sticks and putting blood spots on on pieces of paper Hancock if berberine can help protect the glycocalyx scene one small study is it likely that metformin might have the same mechanism it's very possible you know we think we know what's going on with metformin but we don't there are at least two other possible mechanisms for metformin there's clearly evidence that metformin stops the liver or slows down the livers production of it's not glycolysis what's the word I'm looking for oh gosh another senior moment somebody help me out what when you put all of the glucose molecules together you get blank in the liver ah anyhow metformin slows that process down when the liver does do that it's spewing sugar back out into the blood so that's mechanism number one for metformin mechanism number two for metformin might have to do with the gut biome we know that metformin has an impact on the gut biome in fact 20% or more of people that start taking metformin will have gas they'll have maybe some diarrhea and there's it but most of them get over it within a few weeks in other words the metformin is changing that gut biome so that's another mechanism as you've just mentioned there's a possible mechanism that maybe it's impacting the glycocalyx Cheryl McDuff listening from New Zealand with interest thank you for joining us from there I've got I've got a couple of patients in New Zealand and I am dying to come out there someday it looks like it's beautiful when I was at Hopkins at you know preventive medicine residents can be kind of weird sometimes and they just travel all over the world do a lot of public health type of activities and New Zealand was a favourite trip for those guys I actually had a couple of job offers to go work at the what's now the the the of the National Institutes of Health in Canberra and my lovely wife and bride Janice nixed that and she's regretted it ever since and I regretted it when she did and I regretted listening to her but another story personal issue from a different time thank you how is the button attached to your arm Oh oh gosh I just did something weird to this okay the button is simply attached by you know what that's another maybe demonstration I could do on a video or a live event it's got a little spring-loaded mechanism you put the spring-loaded mechanism on there you trip the button and it goes pop then it's got it's a tiny wire that's about that long maybe half an inch long and you don't feel it go in so everybody that says you know what I don't like doing finger sticks from my blood you don't because I you know I don't like doing that sticking you do not feel this go in and it just stays in there for 14 days and then then you just simply peel it off so quincy st it seems like having seems like keeping having your a1c in the low fours greatly decreased your risk of high blood oh yes oh yes if you if you keep your a one-seed down you're gonna you're going to significantly decrease your risk of developing high blood pressure now you can get it from other other ways other sources other mechanisms but you've just taken a major mechanism off the table if you can keep your blood blood sugar down 147 degrees west from alaska that would be awesome as a video I know I would like I would like to know what is in the box okay well good I will uh I'll put that down Lucianne P bergamot plus Berg amine a good combo I think so I think so Bobek gun Jovian hi duck I watched your video on a fib you know what we're we're in the midst of of indexing and play listing updates for the videos there's what 550 videos out there and another what 40 or 50 what we call in the can they're recorded they're sitting on YouTube they're waiting to be released one of the biggest things that I hear over and over and over again is I can't find your video on this or I wish you'd do a video on that the reason your comment brought that up by Bach is that as we were doing this I found that I've got like two dozen videos on atrial fib atrial fib and weight loss atrial fib and exercise exercising through your atrial fibrillation exercises atrial fib and diet atrial fib and genetics so anyhow we've got a lot of videos and we're making progress on getting them indexed and set up where you can you can find them the a trophy but can you go over the pathophysiology of atrial fib causing stroke by up to 80% what are your what if you reflect frickin a vitro Philco stroke I have not seen anyway that's a really interesting let me let me repeat the question physiology of atrial fib and stroke increasing the risk of stroke now that like many other things is full of theory and not quite ready for primetime in terms of actual hard repeatable evidence so here's the two things the two potential ways one is you know is it associated with plaque and your question is is spot on in terms of differentiating that mechanism is it plaque or is it is it a clot that forms in that quivering atrium because when you've got atrial fib instead of having the fit the atrium do like this and push all that blood out that atria is just doing like this and the theory and I and I think for several reasons this is probably going to end up holding it out to be true when we are finally able to prove it is that you're forming tiny clots in here when you're never completely and totally empty the atrium those tiny clots are breaking up showering clots up into places like your your brain now the question is can you have a stroke and not have plaque so in other words is plant causing the stroke or is a clot in your atrium causing the stroke and again there's some soft evidence in terms that that's very well researched that would lean towards more of the clot side it doesn't appear to be completely dependent on on plaque you do tend to see a high correlation with plaque but there's there's some some it's there because the same things that cause stroke like insulin resistance also cause atrial fib so there's a lot of overlapping comorbidities and risk factors there I'm probably going to end up just stumbling around if I go further in that conversation I hope I hope that was helpful gluconeogenesis Thank You Marilyn Harris the when I had that senior moment a few minutes ago and I couldn't remember what it is that's built up in the liver and then broken down to increased sugar in the blood glycogen and gluconeogenesis or gleich gluconeogenesis is usually where the liver is breaking down taking glucose off each little bead of glucose off of that long chain of glycogen spewing it out into the blood and increasing the blood now metformin does slow down that process thank you again Marilyn Harris and 147° West said the same thing gluconeogenesis the button measures interstitial glucose is it generally about five to ten minutes behind the blood sugar glucose yes but it does not get insulin not sure what I understand a comment about it does not get insulin but there's a thing called the choo-choo effect the to to effect describes when it you know when a train is going up a hill and it takes longer to show a value and then it comes back down it's pulling a long train that's what they're talking about with the fact that this is really an interstitial fluid not inside a vessel so therefore it's actually the the package inserts will tell you that it tends to be more like 20 minutes behind your blood 15 to 20 minutes behind your blood in terms of showing a spike and if you actually use this and correlate it with finger sticks you'll see that's fairly accurate Quincy Street besides I are what other mechanisms cause high blood pressure well cortisol can cause high blood pressure you know they they talk about stress they say that you know people go back and forth on whether or not stress is a real a real issue and stress is a real issue glucocorticoids also caused us to hold hold salt glucocorticoids are the things that cortisol cortisol and other things that cause us to retain salt which increases our blood pressure pheochromocytoma that's or multiple endocrine adenoma ptosis pardon me for all of those confusing words all they mean is little tumors in the in the adrenal glands and those little tumors in the adrenal glands are basically a little tumor that just it's like fight or flight and it's on steroids pardon the pun that was from Quincy St Joe Isaac why don't you take a pcsk9 inhibitor well Joe why should I take a pcsk9 inhibitor he'll do is not really a significant risk for me and it's actually not a significant risk for a lot of my patients now I know there are some talking about signals in the literature there are some signals that lowering your LDL does help and there's no question that it does but here's the question in the if your glycocalyx is healthy if your endothelium is healthy how much do you really need to lower your your LDL now we may get to a point where we've got enough research out there which would say yeah we want to get everybody's LDL down to 30 I'll be surprised if we get there and I can't remember what my LDL is right now I think it's between 80 and 100 it's just never been something that's caused me a problem the things that have caused me problems were low HDL and again more than anything else and resistance Richard Morris hi dr. brewer can you explain the role of cortisol in diabetes you know I met an endocrinologist one time now he was a lot of other guys would say he was out there but it was the interesting unique theory and I did a video on it see if he can find it in those 100 550 videos it's like a needle in a haystack but his theory was that stress caused insulin resistance and his point was constant stress all day every day you're firing that your cortisol and your body just gets stuck in a rut and that is what's causes insulin resistance you know what you're pointing out is something that I didn't mention before about cortisol cortisol will increase your blood pressure by causing you to retain salt it also causes insulin resistance in other words it wants to keep your blood sugar high so very very good point thanks for bringing it up okay Bjorn to fly I now have something borderline between insulin resistance and normal glucose response is measured by og LT I'm not familiar with og LT but I'm going to assume that you mean og TT is it is it wise to take metformin you know what I've got several videos on a study called the tame study targeting aging with metformin and it's some what they the idea behind the tame study is basically to put metformin in the water if you've heard that term it's to give it to everybody over age 65 I have to tell you I'm comfortable with almost anybody that wants to take it I'm very comfortable writing the script for it another side to that and that sounds like a weird statement but there are two things there's number one the question benefit which I'll get into in a minute the other is the question about risk you'll see sites and still Mayo website says you've got risk of lactic acidosis with metformin no you don't there have been to have met the meta-analyses studies again now having a senior moment on on what the name of those two cochrane analyses and look them up see OCH re any cochrane analyses on metformin and both of them showed you don't even get metformin i mean you don't even get like the gas of doses which is still not a huge deal if you did you don't get that with metformin either so very very little risk other than some diarrhea and gas but here where's the benefit come in the benefit comes in with if you begin to look at this whole picture that we were painting earlier about we're awash in a sea we're sort of like that analogy of frogs boiling slowly and instead of in heat it's in insulin resistance it's in a in sugar too much sugar in our bloodstream and to a large extent that's that creates a lot of the essence of aging high blood pressure through a through advanced glycation end products creates plaque creates you know damages are the glycocalyx which therefore leaves creates the plaque in some inflammation because the white cells are congregating and releasing enzymes so maybe I went too far down a bunny hole there but the tape study is saying let's just put it in the water I would say don't wait to your age 65 take it at age 60 or if you have any any inkling at all of insulin resistance take it earlier one other point I'll make I get I get beat up a lot on the on the comment section about pumping or pushing drugs or being paid by big farm I'm not paid by big farm at all don't do that but here's the point and I do say this all the time you can't out supplement you can't simplement your way out of a bad lifestyle and you can't medicate your way out of a bad lifestyle so yes go ahead and I would recommend taking metformin I'm pretty liberal about about writing for it but more the studies have already been done is that there's actually one in New England Journal gosh maybe a decade ago which paired up metformin versus minimal lifestyle changes minimal increases in exercise minimal decrease in in food intake and the lifestyle changes were three times more effective so just a plug and reminder that yeah metformin probably is a good idea but it's not going to replace lifestyle for those of you who follow David Sinclair and some of the other longevity experts I'll just remind you that David Sinclair started taking metformin in his early fifties and I understand fully why if I'd known about it and at my early fifties I would have to Robert ostrich Oros trick I hope I'm pronouncing that right Esther please explain some time all of the parameters keto mojo measures and how they can help us ah that's a good question you know I only know of two of them the ketone level and it doesn't measure glucose as well maybe if you could give me a few more details of what you're looking for Lucianne p cardiovascular exercise increased cortisol – yeah it does now that's an interesting thing about it yeah as you know the human bodies like the human mind in order to change it needs to be stressed so then you get into that that whole delineation of you stress EU or Troost s stress versus damaging stress and so for example the high intensity intervals I just did and the cardia the resistance training I did we're stressing my body but I don't do them all day every day so overall they're gonna be they should be helpful I have enough rest in between so cardiovascular exercise will increase stress the question is you know it's a balance of how much wrist you give it Joe Isaac how can I increase my large HDL particles well it used to be one of the most famous quotes around that was drinking alcohol alcohol will increase HDL but you know we all know alcohol brings its own set of problems here's the thing when I look at it when people come to me they'll often if they haven't gotten my labs before they come in and most have by this point but if it's a sidewalk consult and they've got some of their own stuff they've almost always got it a cholesterol panel I will look at a cholesterol panel very quickly I don't focus too much on LDL I will you know I'll look at it but the first thing I look at is triglycerides / HDL and it's a tip-off to poor carb metabolism or insulin resistance you want it below 1 you under your triglycerides low and your HDL high and guess what when people go on these low carb diets they lose 30 pounds I saw a patient earlier today and another one yesterday both of them who had lost like 30 pounds as they did their triglyceride / HDL levels or a ratio went from two two-and-a-half down to less than one and there meanwhile their Hut HDL levels are going up from thirty thirty five forty fifth you know they're continuing to climb and that's what happens so why does that happen and why is it especially associated with insulin resistance well a couple of things go on insulin resistance means that your body is continuing to push out more and more insulin in order to get yourselves to pull that sugar into the into the cell so you've got instead of having a good low level of two or three these people people have basal insulin rates of ten twelve fifteen well insulin not only causes blood sugar to go into the cell it also stops the body from burning fats fats are triglycerides so if you've constantly got a high insulin level then your body's not going to be burning fats very well your triglycerides are going to be high now that same metabolism where you've got too many fats going on your HDL which usually pulls fats out of the artery wall and brings them back to the liver to be to be burned up your HDL gets overworked and you just don't have that many H deal around because they're getting overworked so long version but back to it gets once we go down all those bunny holes we get back to the point of you can have one of the first things I would focus on and the thing I see time and time and time again in terms of improving HDL is lowering the carbs in your diet so you stop stop some of that internal resistance process decrease that insulin Frank atkinson's oh excuse me rob to7 said David Sinclair turns 50 next week so there goes spouting in in a queue see he's not 50 yet and Robert answer this when did he start taking metformin cuz he's already on it and I guess part of your point is you know he's not even 50 and he's taking metformin and again I completely understand I'm probably sounding crazier and crazier I have nope I completely understand why a specialists in longevity his otherwise ostensibly healthy is taking that form in in his forties yeah G you should run the CDC actually I appreciate that when I was when I ran the program at Hopkins we got a lot of CDC people that would come up and train under us so got a little bit close there I'm I'll never make any of the politics though there's way too many politics in that job Billy the weasel yep triglyceride or HDL your l urial wong large HDL probably stay large if undamageable glucose low carb yep good point David Jones I think you may need to do your own evaluation of how metformin impacts your body I find for me keto that it greatly extends my workout recovery in other words it makes you it takes longer to recover that's a that's an interesting question because I've been taking metformin 500 twice a day for years for years maybe and I don't know if it was going to look hard but I changed a lot of things the biggest one was going low-carb I've greatly decreased my recovery period he used to it would be it would be 48 hours minimum to get through that dumb still late onset muscle soreness I just don't get it anymore and I don't know how much of its metformin I don't know how much of its low carb lifestyle broward person for someone with a low HDL in the 20s but all the other lipid levels good with taking prescription nice and nice man be worthwhile very well could niacin one of the is nice and is that it's one of the few things that impacts almost all of our lipid values hey guys again very interesting conversation very interesting questions your folks are bringing up we're getting along in the tooth it's it's 7 o'clock I am I've got some other stuff I need to do I certainly appreciate your interest and I'm going to have to run thanks so much for for your interest and for joining and the good questions now let me see if I can figure out how to turn this off


  1. D3 is involved in the expression of nearly 1,000 genes (of a total of about 20k to 25k genes)…. (Dr Rhonda Patrick)

  2. Nice hat…from SC

  3. Thank you for this presentation.

  4. Hey doc, got a niacin question. Does it need to be dosed multiple times during the day to be effective. Or just one large single dose is enough? I prefer I large dose 3grams pre bed. Thank you

  5. Hi Dr Brewer. I recently discovered you on youtube, and find your videos very educational. I am a physician as well, an ophthalmologist/retina specialist.

    My question is about carotid vs coronary artery plaque. Does the plaque in the carotid artery tend to calcify as the body tries to repair it as does the plaque in the coronary arteries? You mention in one of your videos that you reversed your carotid plaque. I would think that would not have happened had that plaque been calcified.
    Thank you!

  6. Your biomechanics and biochemistry knowledge is outstanding, and very evident in live sessions. Plus, your "senior moments" keep viewers riveted … just the right sprinkling of suspenseful pause 😂👍. Seriously, you're a humble man. Thank you.

    Veiwers had asked hypertension questions. You provided lots to research on that issue alone, as well as so many other topics to explore.

    I appreciate learning so much from your uploads. To improve the "searchability" algorithms, perhaps your YouTube expert can place an outline with timestamp hyperlinks in the description for quick click finds, or add it as one of your own "proxy" comment topics below. It's a lot of work, but may work well with longer videos that cover random veiwer questions.

    Thanks for reading all this if you made it this far. 😊

  7. Why with an increase of only 4000 IU would you expect more than the effect they showed?

  8. Hi Doc, talking of glycocalyx is it wise to avoid angiogram for patients with mild stable angina?

  9. Thank you so much, very informative.

  10. You appear to be really lean to be insuline resistant; something I don't typically see….via obsevation only.

  11. Side note… I remember reading somewhere that a significant number of African American women were sample during mid-winter Detroit…and a huge number had D levels at <10. My own 45 yr old son living in Montana was shocked to find out his was slightly lower than 10! I told him no wonder he was feeling lethargic! I wouldn’t be able to get out of bed in the morning!

  12. Great talk. I have a double VDR mutation (per promethease and nutrahacker) and when I got diagnosed my Vitamin D level was around 10. With 5000 IU a day I got it to 40 but it took a while. Now maintained on about 5000 3 x a week. Thank heaven no clinical osteomalacia!

  13. Hi Doc.. just now watching your replay I was out to dinner. I splurged and had some excellent lump crab meat over pasta… yes I know a bit too many carbs but I didn't go overboard..ha ha. I was also encouraging my dinner mates to check out your Channel and your approach keep up the good work!

  14. Hi doc. Is it possible to get your comment regarding converting metrics of some blood tests results and related discrepancies in TRIG/HDL ratios. Well, the test shows: TRIGLIC. 103 mg/dl and HDL 73mg/dl (makes ratio of T/H of 1.41). When converted into mmol/L metrics it is equivalent of: TRIG, 1.16 mmol/L and HDL 1.888mmol/L (makes ratio T/H of 0.62) . So the converted values give completely different ratios of TRIG/HDL comparing to mg/dl metrics. Why those 2 ratios are different ?

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