The Kick Sugar Coach Podcast
The Kick Sugar Coach Podcast
Dr. Brian Lenzkes: Why Your 'Normal' Blood Sugar Might Be a Metabolic Time Bomb
Have you ever wondered why some people exercise religiously and follow all the right diets but still struggle with weight and metabolic health? Dr. Brian Lenzkes, ten-time recipient of San Diego's "Best Doctor" award, reveals the missing pieces in our understanding of metabolic health that might be sabotaging your efforts.
Dr. Lenzkes opens up about his personal journey through metabolic dysfunction despite being a practicing physician with all the "right" knowledge. When his blood sugar reached pre-diabetic levels despite regular exercise and following conventional dietary guidance, he knew something fundamental was missing from mainstream medicine's approach.
The breakthrough came from an unexpected source—an elderly patient who lost 40 pounds through intermittent fasting. This led Dr. Lenzkes down a path that transformed his medical practice, helping patients come off diabetes medications completely and reverse conditions he once believed were permanent.
In this conversation, Dr. Lenzkes delivers several shocking revelations. First, the blood sugar tests your doctor runs might be missing the most important marker of metabolic health—insulin levels. He explains how high insulin can silently damage your body for years before blood sugar numbers ever change. Second, he explains why muscle mass might be the single most important factor for longevity, even more significant than avoiding smoking or drinking. Finally, he demonstrates through patient stories how stress, poor sleep, and even arguments with loved ones can spike blood sugar more dramatically than eating cookies.
Whether you're struggling with weight loss plateaus, puzzling blood sugar readings, or just want to understand why conventional medical wisdom keeps failing so many people, Dr. Lenzkes offers practical insights that bridge traditional medicine with cutting-edge lifestyle approaches. His message is ultimately one of hope—that with the right understanding of how our bodies actually work, many of the metabolic conditions considered "chronic" might actually be reversible.
Ready to discover what might be missing in your health journey? Listen now to understand the surprising connections between stress, muscle, insulin resistance, and lasting health.
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Welcome everybody today to an interview with Dr Brian Lenskies. He's an internal medicine physician with over 20 years of clinical experience. He had for many, many years oh, he still does actually have a clinic in San Diego, and for 10 years in a row. He won't boast about this, but I'll do it 10 years in a row. He was voted best doctor in San Diego 10 years straight. He recently, because I haven't talked to Brian in a few years and I'm like what's new and good. Well, it turns out he now has a clinic in Arizona. It's called Arizona Medical. Sorry, arizona Metabolic Health Clinic.
FLORENCE:And that's just kind of up and coming, but he works virtually, so you don't have to be in Arizona to take advantage of his expertise.
FLORENCE:Through his own journey of working with obesity and having a family with diabetes, a predisposition to diabetes and early coronary disease, dr Lenski's as a doctor realized I need to do. I need to do something different than just the usual standard protocol around this, which is probably pharmaceutical or that I need to look at my own lifestyle and then, in the course of discovering wow, that's seriously powerful medicine, he started to turn his practice into a more lifestyle medicine focused one, and when he started to do that, he started to deprescribe medications and also started to experience the real joy of being a doctor like truly watching people reverse metabolic health symptoms, get off diabetes medications, lose weight, feel good all the things that we turn to our doctors for outcome those kinds of outcomes. And he now is able to experience that and his clients can experience that with him as well. Two things about Dr Lensk, as you might know is that he has not one but two podcasts, so he's a co-host of the Low Carb MD podcast with Dr Tro right.
DR LENZKES:Yes, that's right.
FLORENCE:And he also has another one. So that's very focused on lifestyle medicine, sort of nutritional intervention the sugar, the junk food, the processed foods, all those kinds of things and how they you know, dropping our junk food and high refined carbohydrate consumption makes a difference. But his other podcast is called life's best medicine and that's all about how. That's a piece of it. But there's a whole other realm of things that we need to look at to live joyously alive and not just vibrantly healthy. So you could check those both out. He's had over 10 million downloads on his low carb IUS sorry, low carb MD podcast so wildly popular, incredibly, incredibly skilled as a clinician, like decades of experience working with people frontline. So I'm going to we're going to pick his brain today on his both his low carb side thing, md part, and also maybe what are some other things we need to consider as we all try and feel less stressed and happier in our lives. Welcome, dr Lenskis.
DR LENZKES:Florence. Thank you so much, gosh. I don't even have to say anything. You got her all covered. Yeah, no, great Thanks. Thanks, and I love your work you're doing with it the kick sugar summit and how important that is to help get people on track. It's pretty amazing. So appreciate all you do.
FLORENCE:Thank you. Yeah, I think over the years I mean, when I first started this 10 plus years ago, I was really quite narrowly focused on just the white added sugars, the junks. I just saw them as being incredibly damaging. And now, you know, the further I walk this path, the more I realize oh my gosh, it's just one of many seed oils and et cetera, et cetera. But yeah, it's still a piece that's highly over-consumed by people. Most of them have no idea that there may be an addiction in play. So, yeah, I carry on, I keep doing this work. So do you want to tell us a little bit about your own sort of journey of like realizing your own health wasn't where you wanted it to be and having to make your own lifestyle changes?
DR LENZKES:Yeah, for me it was. It was just a long road. In my entire, all my mom's side of the family, Everyone's obese diabetic. You know they would eat whatever they want and shoot more insulin and take their statin drug and eat cookies every night and drink beers, and you know from Ohio in a rural area, and so I just watched all my family members dropping like flies and you know I was in in going into medicine.
DR LENZKES:And then I'm practicing medicine. I'm like, okay, I'm practicing the ADA's recommended diet. I'm, you know, eating like green shakes or drinking green shakes, trying to lose weight. My sugars are getting worse. My sugar average got up to 5.9, which is in the pre-diabetic range, and even though I worked out five or six days a week, I'm gaining weight. I'm like, how can this possibly be?
DR LENZKES:And then I started looking at these different factors and one of my patients actually came in and he lost 40 pounds and he's in his late 60s, early 70s and I'm like, well, first thing I think is either I have diabetes or cancer. People don't just lose 40 pounds. And I said what are you doing? He said I'm doing the thing called the fast diet. He goes, you're not going to like it. I said what is it? And he said, well, basically he was fasting two days a week, so say Tuesdays and Thursdays. He was eating 500 calories, no carbohydrates those days. And so he's explaining it to me and from a Western medical perspective, I'm trying to grasp why he's losing weight. Because I say, well, okay, so two days a week you're doing that. The other five days he's saying whatever I want, I go, so beer and pizza and cookies. And he goes, yeah, whatever I want. And you lost 40 pounds doing that. I'm like this works. So I started researching and I come across Jason Fung, who's one of the greatest minds in medicine and in medicine, and I'm watching this video, waiting for him to say, oh, by the way, it's going to be 1995. And then you know, we'll send you this product.
DR LENZKES:And it was really just talking about intermittent fasting, cutting out processed food, watching the sugar and insulin resistance. And once I got that concept, I started doing it myself and said, okay, I'll just cut out, because at that point I was eating melba toast and, you know, rice crackers with a little peanut butter, and then the only guy to shove something down at lunch, when I was really busy because I was in a 18 hour a day practice, basically working, not sleeping, and all these other factors that are involved. And so once I made those changes, I started losing weight. Then my patients asked me what I was doing, you know, and and at that point Professor Noakes was going on trial and all these bad side it was really risky to talk about it. So I said, well, here's what I'm doing. I'm not recommending it for you, but here's what I'm doing.
DR LENZKES:And once I started, really I went to a low carb USA conference and I saw all these doctors talking about the benefits that were happening with their patients and I thought, well, if patients want to try it, I'll work with them, and if it doesn't work, I'll switch to something else.
DR LENZKES:And in six months I had 11 patients take themselves off of insulin, right, I had never seen this in the 16 years before that. And then all of a sudden, people are coming off insulin and I used to think it was crazy Once you're on insulin you don't come off. But now we see it routinely, right, it's become reality. So that's kind of my story in a nutshell of, you know, always struggling with weight since a kid, struggling with weight since a kid, and you know, and I figured my metabolism would just screwed up because I played football and I was. I'm only five foot eight, so I had to play football at 200 pounds and I would wrestle at 160. So I would lose 40 pounds between seasons and just run and spit and do whatever you had to do to to get that weight off, and that's not a good thing. The more times we do that, that yo-yo, the harder it gets every time, you know it gets every time, you know, incredible.
FLORENCE:And was it hard within your medical practice to start to share some of the lifestyle interventions that make a difference and help people to reverse metabolic syndrome?
DR LENZKES:The irony of when you introduced me is that I was thinking about, while you were talking, you know, getting one of the top doctors in San Diego for 10 years in a row. And then, when I started doing real medicine and cutting down on medicines and deprescribing and preventing diabetes, and now I'm no longer one of the top doctors because it was so outside the paradigm, people looked at me. The other doctors initially were saying, like what's he talking about? Like telling people, you know, more fat and eat less carbohydrates where we need it for exercise and all these other things. But once they started seeing the outcomes, you know it really made a huge difference. And plus, I left the big system. So when you're not part of the big system, where you're in people's eyes all the time, then then you don't get voted for those kinds of things. So I don't.
DR LENZKES:I never really held that as a. I mean, it was an honor because I knew my peers respected me. But to all of a sudden say, okay, I'm not going to fuck this guy because he's outside of just giving everyone drugs. Right, he changed how he's doing things and so it's a hard thing, you know, because so many doctors are trained in the paradigm and it's hard to shift gears and step back and say, wait, is what I'm doing working? Because what we're seeing is every time the patient came back, we throw another drug at them, and throw another drug at them, and another drug until we got the numbers we wanted, but the patient's dying.
DR LENZKES:So at some point when you start realizing, okay, we can treat patients better and if they're invested, we can do miracles, the problem is the doctor has to be invested and has to believe what they're doing and the patient has to buy in and be willing to say I'm going to make some changes, because what we were doing before is what got us to where we were right. Even though I thought I was doing everything right, it wasn't working. So I had to change the gears and go okay, let me try with this nutty patient who lost 40 pounds, is doing and see what happens right. And then you start understanding medicine and physiology and what. The more you look at, it becomes very common. I mean very common sense.
FLORENCE:Totally, totally. It's incredible how simple some of these lifestyle changes are and how powerful. So when you first took the risk of saying to your patients hey, so for me, here's what I've been doing. It's a simple little lifestyle thing. I don't know. If you'd like to try it, try it, let me know how it goes. How did patients receive that?
DR LENZKES:I think it really depends. Right now I have a lot of success in my practice because I left the big system. Because when you're an HMO doctor and you have 2,000 patients in your practice and those patients are just like, they didn't select you necessarily, they got stuck with you based on you know what, what their company, what their insurance was. So a lot of people just they just said, you know what, just give me the drug and I don't want to give a piece of beer and whatever I'm doing every night, so I'll just take the drug to get my sugars better. But you realize that drug is not going to make the sugars disappear, it's just dubbing it into your tissues, into your fat cells, into your kidneys, into your eyes, into your heart.
DR LENZKES:And so when you start seeing the amputations and you know, and there's a, there's a concept you know in in, for instance, in the African American community, where they say well, my uncle is fine, he went on insulin, then he died and he got amputation. All this stuff happened. Well, part of it is that they they didn't go on insulin until the last stage, once all the damage was done. But also insulin in itself, high dose insulin, insulin resistance, causes peripheral vascular disease, cardiac disease, you know, renal disease, eye disease, all these things, and that's why diabetics are set up for all these huge, huge catastrophes. In medicine, you know, the number one cause of amputation, dialysis, you name it across the board is diabetes. So until we take that serious and know how to manage it, we're going to be in a lot of trouble as a society.
FLORENCE:You know, from a medical perspective, that was your answer was interesting because I always just thought, if doctors just sat down and look their patients in the eye and say, here's my prescription, here's where we're going to start, as long as it was safe to do so, we're going to just start with some simple lifestyle interventions. Okay, here's what I recommend I want you to do get more sleep, you know. Get some. Get some exercise, get out into nature. I'd like to see you, you know, eliminate the processed junk foods. This is my RX, that's my medical prescription. Job Drop the junk. I always kind of thought that because doctors are almost like gods to some extent, you know that, that that we've underestimated what patients would say. I thought they would say okay, doc, my doc says I can't eat sugar, I'm going to, I'm not going to eat sugar, everybody Cause, my doc says. But I've never asked a doctor to see if that was actually a theory. My theory was right.
DR LENZKES:Well, your theory is right, but here's the reality. We're in, right. It's like some of the big HMO plans in California, the doctor has 12 minutes with the patient. How are you going to talk about life, stress, sleep, you know, alcohol, divorce, all these things and sugar and all this stuff? So it's easier. They'll say, okay, you have high sugars, here's a pill to bring your sugars down, instead of saying why are your sugars high? Right? So in medicine, like this was, was was so ironic to me just having this when I first started doing these things, because clearly the nutritionists at the hospital were against low carb, cutting out processed food and sugar and stuff.
DR LENZKES:The diabetic diet was a low fat diet, right. So people go in the hospital. They put them on a low fat by definition. What does that? Do? You have to give them more sugar, so they're having oatmeal and cereal and toast and all this stuff, orange juice with every meal and soda and you go. But it's low fat, but these people's sugars will go up. So how do they die? Like when you're going to give someone insulin, they would say, okay, with each meal, how many carbs are you eating? And this is how much insulin we give you to cover the carbs. Well, once we just not give you the carbs, how much insulin do I have to give you? None, because you're not taking in carbs. So if you're eating protein and meat, and you know, unless you're type one diabetic, so we'll give it. So it's yeah.
DR LENZKES:I've had these crazy conversations with endocrinologists when they say it's dangerous what you're doing and I say why? Well, because their insulin is going to make their sugars go low. Then don't give them the insulin, that's what they'll need, it right. And so that's what we're seeing is that even in the hospital they'll take and I've seen it magically appear over all these years is my patient would go in, that's managed on, you know, metformin and a couple other medicines that you know with their diabetes is under control. But by the time they leave the hospital they're on insulin, because in the hospital they don't give those meds, they just put you on insulin. Then they give you a bunch of carbohydrates, they shoot you with insulin every time and they wonder why your sugar is going high.
DR LENZKES:So the stories I've seen, and it's it defies logic. So I've had some patients go in and they put them in and maybe they're not eating or something and they they put them on sugar water in their veins and then they call me and say how come the patient's sugar is so high, so stop giving them sugar? You're giving them sugar in their veins. They can't even enjoy it, they're not even tasting it, but that sugar is making their sugars crazy. Then you're giving them insulin. They're bringing their sugars back down. That's like saying I'm allergic to peanuts. Here I'll give you peanuts and I'll give you prednisone for the allergic reaction. You just don't give them peanuts Right. So when you think a little kid will understand these concepts, but doctors who've been around for 50 years can't get that concept right. And it's amazing.
FLORENCE:Right, right, it seems insane. It's kind of like you know, my head hurts. Well, stop banging against the wall. Just stop banging it against the wall.
DR LENZKES:And then, yeah, if your son's in all the time and you go, my son is killing me, he's bothering me. Have you got all the sun? I can just keep the lotions for for your allergic to poison oak, but you're going poison oak every day. Right, you have to avoid the thing that's causing the problem and I think in medicine we've lost that root cause of understanding and then talking to the patient. Like you and I, before we started recording, talked about addiction being a part of this, and stress and the family, what we've learned and modeling, what our parents did and all these things. And you know, once we can step back and start realizing this, it's a huge thing and for me, the reason I was burning out and working 18 hour days is, I could tell by the labs, high insulin is, of all, the stuff that worries me is high insulin level right, and we could talk about that more, but that's insulin resistance, meaning you're making more and more insulin trying to get that sugar into your tissues. That are full, right, if we. But the problem is when your insulin is really high, your pancreas at some point burns out and says I can't keep up anymore. You keep eating sugar, you keep eating these things and it stops making insulin. And then all of a sudden your sugars go crazy high and there you got diabetes and you're in the hospital. So the sad part is really no one should get type 2 diabetes. We have a 10-year warning because the insulin creeps up and up and up and then it gets to a maximum where it can't make anymore and then, boom, it drops. And so that's what's frustrating is pre-diabetes. We can prevent it.
DR LENZKES:So I would have a patient that I knew was going to get diabetes. I go look, we got to change what you're doing. Your insulin's through the roof, your A1C's starting to go up, you're going to get diabetes and the medical system frustrating. And so I would see all these patients that just were mismanaged for all their now all of a sudden they have to be on insulin. They have no choice, just because they burn out their pancreas and they were on bad drugs and so it's a. It was a huge paradigm shift for me, because we think meds are going to fix everything. So I would schedule those, really those patients I knew were going to get diabetes, and I would spend an hour with them and work through lunch, but then I would have to do all my phone callbacks and all that at the end of the day and I'm getting home at eight or nine at night. So you start realizing and 90% of those patients really didn't it wasn't going to sink in.
DR LENZKES:And so we started the podcast, the low carb MD podcast, and I'm telling you we would go to conferences and people would thank me and say that you saved my life and I came up insulin, all these and I was like I'm more effective on a podcast and I'm face-to-face with my patients. I could reach way more people here, like on this, the kick-sitting summit, right, we can reach so many more people than the 12 or 20 people I reach a day that are just going to be repeating and if they're not an audience that wants to hear, it's incredible the power of the mind. And really we just had that conversation today with Tro and Jessica Reynolds, who's a health coach. It's like until someone's ready, you can't really help them. If you're not ready to quit drinking, you can go to all the counseling in the world until you go. Yeah, I need to make a change.
DR LENZKES:Or whether it's carbohydrates or whether it's pornography or whatever it is like you pick your poison. Whatever it is, people listening will know what their poison is and do you go. Yeah, this is not good, it's affecting my life. I got to make a change, right, because if I tell you you got to make a change, you're not going to really listen so much unless you realize it's a problem. And and you know, there's different schools of thought on that and some people for instance, someone could be smoking three packs a day and they'll go look, george Burns lived to be 100. But that's one person. What about everyone else who's been a disaster case? And I think the other thing of community is really important is that you can see that other people came off insulin why can't I? And you can start believing and having hope that you can make a change, and that's a huge part of this.
FLORENCE:One thing. That's this might be a bit of a cheeky question. So when I interview my whole food plant-based doctors, they'll say hey, listen, a high fat diet, especially saturated fat, can actually contribute to type two, type two diabetes. And they'll say here's all the science. I've looked at it. It's in peer reviewed medical journals. Uh, I don't know, I'm not a doctor, but I'm like okay, interesting. I have clients and I know people working in this space who, after years and years and years of being on the low carbs sort of carnivores, sort of keto path eventually have noticed that they seem to still have insulin resistance, because if they have even so much as a teaspoon of something with a carbohydrate in it, their blood sugar will shoot up into diabetic ranges and hang out there for a very long time. So I know two people in my life right now and their weight loss has stalled. So we're scratching our head going okay, wait a minute, is there something to that? What is your thoughts?
DR LENZKES:Yeah, I think that's a great question. That's a great observation, because the reality is this, and Ben Bookman and some of the great scientists have really discussed this problem so if I'm low carb and don't eat sugar all the time, right, what happens? My body says, look, I don't need to make that much insulin. That's kind of our goal is to decrease the insulin because you don't need it all the time. If you're not eating a bunch of sugar, your body goes okay, I can send some of the guys home that are making insulin. So when you go and you haven't had sugar for six months or whatever, then you go and have donuts and cake. Yes, you're going to get a bigger response.
DR LENZKES:But that is not insulin resistance. It's that your body's just not making a ton of insulin, right, so it takes like. If you do that same thing for two or three days, your sugars, it controls it very quickly again because they call in all the factory workers to make insulin because you need it. So that is not insulin resistance. That is that your body just doesn't make as much insulin as it used to. So if I used to have a ton of insulin, now all of a sudden I don't need that much, right, it takes a couple of days. So if they do those same studies and they wait a day or two of eating carbohydrates, the body adapts very quickly to that. So you will see the sugar go up. But when I'm looking at a continuous glucose monitor and I see the sugars go up, I'm not really caring about the sugar going up.
DR LENZKES:Necessarily I'm wondering what the insulin response to that sugar load is right. So, for instance, if I'm fasting all day and I go for a sprint at the end of the day my sugars go crazy high. They go to 160. Is that dangerous? No, your body's doing what it's supposed to do. Your body's saying look, I'm going to kick out extra sugar from your fat stores and then you can burn that right. So I know there's vegan doctors out there and you look at it and you go okay, if I'm looking for longevity, right. If longevity is my goal, I think all of us want to have a good, healthy, long life as much as possible. So if I'm vegan, what happens to my muscle mass? Generally, it drops, right. The biggest indicator of longevity is muscle mass. So if you're not exercising, you could do and this is why I did Life's Best Medicine podcast.
DR LENZKES:You could do low carb perfectly, but you're stressed all day, you're mad at your husband or wife, you're in conflict, you're not sleeping, you're stressed out. Guess what? Your sugars go up. You've been eating perfectly. So all these things are different factors. You can't just change one thing, and that's why I always laugh when they say, well, it's, the Mediterranean diet is the way to go. Yeah, but the people in the Mediterranean are not living in this stressful inner city life, right, they're not getting their cars broken into. They're living in a community and they go. Yeah, I feel like working today. Let's go. You want to go play golf? Right? I mean, it's a totally different lifestyle. So you can't divorce the nutrition part of it from everything else. Right, because I see it all the time with continuous glucose monitors. If you come in stressed, not sleeping, you're fighting.
DR LENZKES:I'm telling you that I've seen some of the funniest things, where one of my patients is doing great and all of a sudden on Wednesday, her sugars go crazy at five o'clock in the afternoon. I go what did you eat? She goes I didn't even eat. What happened? My husband and I got into an argument about you know, he moved all his dad's stuff into my garage and I can't get my car in the garage anymore and she goes. We looked at her sugar and was like oh my gosh.
DR LENZKES:So people who are in this stress, sympathetic, overload all the time, and I think that's a huge topic. We're missing is if you're not finding and that's why I did Life's Best Medicine, because all of us have to figure out what's life's best medicine for you and then do it. If it's making you enjoy from that, if it's going to church, if it's thing is, you can yes, you can do a vegan diet and control your sugars. The problem is I've had tons of vegans with full-blown diabetes because they're eating quinoa rice and what happens? Your pancreas has to make insulin all the time to get rid of that right, and they do have an argument. If you're eating a super high-fat diet, you fill the fat stores stores, and I've seen it where you can fill your fat stores up so much that any carbohydrate you have, what do you store it? Your fat stores are all full right and so it's staying in the bloodstream and you see it longer. So so if you're changing from a high carb and replacing that with more fat, sugars, generally get better when I see that right, but you could go on a high protein diet and raise your sugars initially if you're metabolically sick.
DR LENZKES:So the goal is to get ourselves metabolically healthy, and if you're metabolically healthy you'll probably get away with a lot more than people who are metabolically sick. So, and that's why it's so funny that people in the low carb community like Tro he'll get into a fight with this guy named Lane Norton, because Lane Norton says he's a big muscle guy and he goes. My guys eat donuts all the time and they're fine. Yeah, but they have all muscle and no visceral fat. They're totally metabolically healthy. Yeah, they can get away with it. But my 300-pound sedentary job person who doesn't exercise can't get away with that. It's not going to work right. So I think it's really individualized and some people are going to go more the keto, the carnivore keto roll. Some people are getting more of the plant-based. Okay, if it works for you, I don't care. If you're metabolically healthy, you have tons of people like you can add in way more carbs and you could go to extremes on both sides for sure, no question about it.
FLORENCE:So yeah, yeah, I was going to say and I think there is something to be said for this extreme that there are people that are eating. They're like I eat all the fat I want. Not necessarily right, like it's possible, and I hadn't. I didn't think about the fact that if you're overeating fat for your body, your fats, you still have weight to lose. There's still weight to lose and your fat cells are full. Well, they can't be full because they were fuller at some point. If you've lost a hundred to 150 pounds, I'm assuming there's still storage in those fat cells.
DR LENZKES:Well, you know, and that's the thing is, when you've lost weight and you plateau out, one of the big things is if you've, by definition right. If you lose weight, it means you're eating less than you're burning, right? I mean, basically, that's what we're saying. So, okay, if you're losing weight, at some point your body goes, oh, your body wants to survive. So if you lose weight too quickly, your body's saying, oh, something's wrong, let's slow down thyroid function, let's slow down this function. Right, mental function gets slower.
DR LENZKES:But if you're doing that and you lose muscle mass, right, that's your metabolic rate. Is your muscle mass basically right? You lose muscle mass when you lose weight a lot of times, plus, you think about it. You're not carrying around 50 pounds on your back anymore. You walk around with these weights on your back and then you take them off. You think, oh, my gosh, everything's easy at that point. So, yeah, you don't bring as many calories when you lose weight.
DR LENZKES:If you want to slow metabolic rate, lose weight, that's just the reality. And let's say, putting on muscle mass at the same time, right? So that's why, you know, we don't have to get too much into the weeds. But some of these newer drugs, like Ozempic classes. You know 40 to 60% of the weight loss is muscle mass. If you want to have a disaster as you get older, lose muscle mass. It's clear by the data that losing muscle mass is the worst thing you could possibly do. So if you have the choice of losing 10 pounds of muscle, or putting on 10 pounds of muscle and gaining 10 pounds, or losing 10 pounds of fat, right, you're going to be way better off putting on 10 pounds of muscle because that's metabolically active tissue and that makes you metabolically healthier and you don't need as much insulin. Those muscles, if you're exercising, will take that sugar out of your bloodstream or out of your liver or out of your fat stores.
DR LENZKES:Without insulin it's very insulin independent, right. But if your fat stores are full, you're spiking up that insulin. It's so high and then it's not effective anymore and that's what people really don't understand. You want that insulin. So if I can get my insulin as low as I can, as long as my sugars are controlled, that's great. But I saw someone. They go look, isn't this great news? My insulin is at four. Like you know, less than 10 is healthy, like super metabolically healthy. Their insulin will be less than five, but their A1C three-month sugar average is around 5.2 or something. But this guy's A1C was 8.6 and his insulin is a full I go. You're in trouble. This is the worst case scenario because you can't mount an insulin response to get rid of that sugar. You can't make more insulin than what you're making or otherwise your body the thing is that's off right. So that's where there's a lot of confusion over metabolic health Interesting.
FLORENCE:What you're saying is that he's already peaked his insulin production. It's now on that sort of dangerous slope down to not being able to produce enough at all and burning out pancreas cells.
DR LENZKES:Yeah, there's a great diagram that I've looked at because I was confused by this when I first started out. But Ben Bickman and his lab did great research showing your insulin goes up and up and up for 10 years and then, all of a sudden, what happens? It drops. And when that drops, what happens? Your sugar starts going up. As the sugar goes higher and higher, it's more toxic to the pancreas, so your pancreas can't make more insulin, so your sugar is super high and this is where you get diabetic ketoacidosis, right, you end up in the hospital because you can't make enough insulin to shut the sugar down. Plus, the other big problem is there's something called glucagon, which is the other counter regulatory hormone to insulin. So if insulin's high, glucagon goes low, what does glucagon do? When you lower your insulin down, glucagon goes up to release sugar into your bloodstream, right? So if someone's fasting, for instance, if you're sleeping overnight, your insulin is the lowest it's going to be in the morning. So anyone who's listening and who's probably doing a low carb diet, they're going to see that their sugars are higher in the morning and they get worried about that. What do I do? Well, it's not a problem. It's because your insulin is so low that the sugar is going up. Right, because your body is saying I don't need insulin, I don't need to store sugar right now because I haven't had anything for the last eight or 10 hours, right, hopefully. So as soon as you eat your cereal for breakfast with some honey on it, boom, your sugars go up. And when your sugar goes up, insulin goes up to get rid of that extra sugar. Right, so having when you you want glucagon to say, oh, sugar's going low. So when you're fasting or when you're sleeping, the reason your sugar doesn't go to zero is because glucagon is doing the job it's supposed to do is raising the sugars up, and where's it getting it from your to do is raising the sugars up and where's it getting it? From your fat stores, your liver, wherever you backed up, right, so it's really. It's really.
DR LENZKES:But if your insulin is high all the time? This is why it makes sense. When you think about it, you say how can someone be 450 pounds? Right, why do we store fat for future energy? So we have extra energy. Right, we have to get energy out of it. It can't stay in the circulation, so we put in the fat stores. So if you don't eat for a while. What happens? Your body says, oh, I'll just release that sugar I just stored. It's a balancing act, but people just aren't good. So if your insulin is super high at 50 and you don't eat all day and you're going to try to eat salad, guess what? Your insulin blocks you from getting to your fat stores. So you're starving. So if you can lower your insulin down now, you can get to your fat stores and run on that. So that's why most of us just can't run on our fat stores very efficiently. Hopefully that makes sense.
FLORENCE:It did. I think so. So two things are coming to striking me. One is that for many, many, many of us, we have A1Cs below 5'4", 5'5", 5'6". Right, we seem like we're safe. We'll go. Your blood sugars are good. No, four, five, five, five, six. Right, we seem like we're safe. We'll go. Got your blood sugars are good, you're no problem. But they're better. Doctors aren't testing for insulin. So if we have a strong pancreas and we were making lots of insulin and it's coming in and keeping our blood sugars though, we look like we're metabolically healthy, oh, I'm good, I got a clean bill of health. I'm not even pre-diabetic, everything's good. But we have no idea if, if we actually have really high insulin levels because it's not being tested for it, that are that are, that are making it seem as if we have good metabolic health but it's masking the fact that we have very we're at high risk because the insulin is the problem.
DR LENZKES:Yeah, it's a huge problem from you. Look at cardiovascular risk high insulin level was like a 700 increased risk of cardiovascular disease, right, because insulin is the marker and that's the problem and that's why it's so frustrating that no one checks it. Check it, then you know. If your insulin is normal and your A1C is normal, you can go have all your fruit and do what you want to do. If your insulin is super low and your A1C is super high, that's a problem. You can't make enough insulin. So what we see is in the Asian community and Indian community, uh, that people can be 140 pounds and have type two diabetes. It's not about obese. That's where it's been. So when I first saw this, I thought how can this possibly be? But you outstrip your uncle's ability to make insulin, then you're in trouble, right? So, no matter what I have as an example, I have a guy who was a CEO of a big corporation in San Diego came to me and his dad has diabetes. His brother had a heart attack at a young age and he's from India, super brilliant guy, and anyways, I'm looking at his labs like you're in trouble, like you don't realize it, but he was vegetarian, but he was eating naan bread, mango with the honey sauce on it, and all this like tons of carbohydrates. He goes, yeah, but my A1C is 5.2. I said, yeah, but my A1C is 5.2. I said, yeah, but your insulin is 38. It should be less than 5. That means your pancreas is at maximum output right now. So you got to cut your carbohydrates. That's the only way out. And so he goes come on doc. And I go look, I want to see you in, have diabetes on on your. When you want to get life insurance, everything's forget. Diabetes is the worst diet, one of the worst diagnoses you can have for long-term care life insurance, because they know you're going to be a disaster. So he's like oh, my God, okay, what am I going to do? Okay, let's put you on a low car I got it Isn't an ethical reason. You don't eat meat or eggs and things. He goes, no, I just thought it was bad for my heart. I go let's get this as soon as I'm in control, then we'll worry about that. So within three months his A1C went to 5.1. His insulin came down to 14. It was still elevated, but it's way better than being 38, and his A1C dropped that much in three months. And so he said, okay, I got it, now I'm good.
DR LENZKES:A year later I see him. His A1C is 7.8. He went back to his old ways, right. He went back. He thought it was cured. I go, you're not cured man. So now this guy's A1C and, mind you, he weighs about 148 pounds. He's not a fat guy, right, and so he has zero muscle mass. So I said, the biggest thing that we do is get you on a good protein source and working out. Biggest thing that we do is get you on a good protein source and working out. So now he works out his. His waist had dropped eight inches, his A1C is in the four range and his insulin is in the, you know, three to five range. So he took, he made those changes and now he's doing great. So, yeah, you can't tell by. I mean that's. It's so frustrating because all the time I have patients tell me that their doctor said they're fine because their A1C is okay. But what's your insulin? If I don't know your insulin, I don't know that you're okay. That's a huge marker and it costs $12.95 to check.
FLORENCE:Well, 95. So tell us a bit more about that, and I know most of the audience will be in the States. I'm technically up in Canada, so is this something we can order through Amazon? Tell us more about how we can check our insulin, so is this something we can?
DR LENZKES:order through Amazon. Tell us more about how we can check our insulin. Well, there's certain places there's one called Own your Own Labs that you can get through LabCorp, and I use an Ulta lab test through Quest as their cash pay and it costs about $12.95. So I have a lot of patients. Their primary care is with a big, huge HMO. That HMO will not check a fasting insulin and I haven't offered, because I've had patients out of their system come to me because there are options.
DR LENZKES:If someone has diabetes, they go okay, you can go on a liquid diet or you can get bypass surgery. That's it, that's your options. Or vegan diet, those are your options. Like, well, if you lose muscle mass, is that going to help your insulin sensitivity? No, it's going to make it worse.
DR LENZKES:So people come to me. I help them. They get their sugars under control. They come up on their meds. I send them back to their doctor at this big HMO and the doctor didn't even notice. They go okay, okay, we'll just keep doing what we're doing. Then I'm not saying you lost 58 pounds and you're off your insulin. What happened so? But I even talked to one of the doctors over there and I said hey, I'll come talk to you guys for free. I'll just come and help you guys because you could help a lot of people Look how many.
DR LENZKES:They have a lot of lives that they take care of and they said, no, we're not interested, we're not going to check that lab for $12 and 95 cents. It seems. It's mind blowing, like we're medicine where we always talk and not HMO is actually. They always talk about preventive care. Preventive care we're doing, you're not doing preventive care, because if you checking your fasting insulin level, which is a cheap test to do, it's ridiculous. It should be a part of every physical exam, you know, and any physical for sure.
FLORENCE:Yes, it's almost more meaningful than the A1C actually.
DR LENZKES:I mean, I have to see both because I can't tell you because I can look at your insulin. If your insulin is super low, you have to know what your A1C is to see. If that's a process. I can't walk into a room and see if your thermostat's working. It depends what the temperature is outside. Right, so it should be. But if it's super hot in your house and your air condition is not turning off, turning on, you say something's wrong. Or if it's really cold and your air condition isn't running full speed, it's like why is it running full speed? It's cold in here, it shouldn't be. Have given people right Because they're saying we're going to keep your sugar high all the time, why it doesn't make sense, right? So all those things I think we're coming around, we're getting, the science is unimpeachable at this point.
DR LENZKES:You know, we have so much data. It's not just someone's opinion. We see it over and over and over again. So you know, I think whatever works for you, good, go for it right. But we all agree, whether you're vegan or you're a carnivore, we all agree to cut out the processed foods, the addictive processed foods, and we're going to do better. Right, everyone agrees on that. But we argue with all the minutia rather than going okay, let's all agree with this at least.
FLORENCE:Right, yeah, I so agree with that. I so agree that I don't. I'm not in the diet wars. I don't actually care what whole foods you're eating. Um, you can figure out which ones work for you. But there's something to be said for the, this muscle mass piece, that if you're vegan and you're exercising, you're probably going to be fine If you're low carb and not exercising.
FLORENCE:you know that, that that isn't necessarily going to protect you, because if we're not keeping strong and building the muscles that uptake the sugar without the insulin and keep our metabolism high. I also heard this, and I don't even know if this is true. I had heard somewhere that the muscles are like batteries they they hold charge. They hold energetic charge that they can help keep our bodies energized. I don't know.
DR LENZKES:Yeah, and it's a sink for sugar. Right, because people don't realize this. But your muscles when you put sugar in your muscles, it stores this glycogen. Your muscles are not releasing that back. So if your sugars go low, your muscles don't say, oh, let's just reverse that sugar and drop it into the bloodstream to keep the blood sugars. It doesn't, it's committed. But if it's sitting in your muscle all the time and you don't burn it, you don't exercise it, what happens? There's nowhere to put it If you empty it all the time.
FLORENCE:With exercise, your body goes.
DR LENZKES:Oh I'll just keep putting sugar in the muscle it wants to put it. So, really, if you look at the science, insulin resistance happens in the muscles even before it happens in the fat tissue and happens in whatever else. So if you keep your muscles insulin sensitive, you're going to do way better. But most of us who are insulin resistant which 90-something percent of us are then you have to really start working at putting on muscle mass right. Start working at putting on muscle mass right, because the other thing that I learned over the last few years which is unbelievably fascinating to me is that if you have a ton of visceral fat fat around your organs, around the internal organs, that's that. So we first start in the subcutaneous fat. Once that fills up, then we go to the visceral fat. Once that fills up, then we have diabetes. But visceral fat, believe it or not, inhibits muscle mass. So once you start getting out of shape and sitting on the couch, it's hard to put muscle on. So even if you start exercising, it's hard to burn that visceral fat. So it's like it inhibits it.
DR LENZKES:So if you think about it because I was really so I have a guy. He's amazing. I just saw him this week and he, when he first came to me, he was 320 pounds. In a month and a half he was 316 pounds. So he lost four pounds in a month and a half. Right, and he's so happy and I'm like, four pounds, that's ridiculous. His wife at the same time lost 38 pounds and she started at 170 or something. So I'm like how can this possibly be? So I'm looking at him and he goes Doc, I'm telling you, the scale's not right because I'm losing my clothes are falling off me. My His shirt used to like, if you look at the first picture, all these bands were stretched out. Now they're all together. And so we measure him. He lost eight inches off his waist. I go how can you lose eight inches and lose four pounds? It doesn't make sense.
DR LENZKES:Well, based on what we're seeing and Dr Sean O'Mara is doing some work on this area is that you put on muscle mass. When you lose visceral fat, you put on muscle mass automatically. Even without exercising, your muscle mass starts going up. So it's like a bear hibernating, right, if the bear is going to hibernate, there's no benefit to having a bunch of muscle If you think bad times are coming. This is why stress is such a factor. So if I'm stressed all day, I'm telling my body and my brain something bad's coming.
DR LENZKES:Store fat, raise the cortisol, break down muscle. Which cortisol does? It breaks down muscle and puts on fat tissue. Because then you can hibernate, like if you're Arnold Schwarzenegger bear and you have no visceral fat. You can't sleep very long. You're gonna have to wake up to go kill something and eat in the middle of the winter and die in the sleeping. Right, you want to be sleeping. So let's get rid of your muscle. Put on fat. So when we're stressed out, that's what we do. We put on fat weight and we and and we lose, lose muscle. Not a good combination for long-term survival.
FLORENCE:How incredibly depressing that, the fact that, okay, great, I'm starting to turn my life around. I have a lot of belly fat, I have a lot of visceral fat, clearly, but now that's working against me. Building the muscle. That's part of the solution, Like. So how do how do we get this visceral fat dealt with you?
DR LENZKES:have to do both. Yeah, you're right, you have to do both. You have to lose the visceral fat and you have to exercise. So exercise might help you lose the visceral fat because muscle inhibits visceral fat. So you put on more muscle mass. That's why the muscle guys go. I can eat cookies and donuts yeah, it's just going to your muscle.
DR LENZKES:And you have no visceral fat, okay, who cares? It doesn't matter. But if you have a think of it as a snowman, if you keep putting snow on the snowman, it gets bigger and bigger. If you keep eating all you want, right, and if you're trying to burn that snowman with a little match, it's going to take forever to melt it. But once you have a blowtorch of muscle, you just melt that thing really quickly. That's why some people go on a low carb diet and they lose weight like crazy. And other people it takes a while Because if you have no muscle mass, like, your metabolic rate is so low. So people in the low carb community, when I first came on, you know eight years ago now it was hilarious that so many people said exercise doesn't matter, all you do is eat fat and you're going to lose weight.
DR LENZKES:And it's not true, it's not true and I can tell you story after story. One that really interested me along these lines is I had a guy who was very interested. I'm looking at his history and he had all of his weight charts and everything over the years. I'm like this is the craziest thing. Every winter you lose weight and the summer you gain a ton of weight. Everyone else does the opposite. We all gain weight in the winter and lose it in the summer. Right, because we want to look good in our swimsuits. I say you're the opposite of everyone I've ever seen in my life. I go why do you? Why do you think you gained so much weight? He would gain 40 pounds in the summer. No, he's less active in the winter time. So that's what I said. And he said well, I ride my bike. I ride, like you know, I've been mild at a time, ride my bike in the summer. I was like, okay, you should be losing weight in the summer.
DR LENZKES:Then he was carb loading like crazy to exercise. He probably got to eat all these carbs and he became very insulin resistant. So he got out and it's amazing when you see the tracings I get talked to him. I go look just one time for me try this. Let's let's eat a low carb diet for a while and then next time you go on your a hundred mile race, don't eat and let's see what your sugars do. You have a CGM on. We'll monitor you the whole time.
DR LENZKES:And I happened to be speaking at a conference that morning when he was riding the bike and he had a huge sugar spike at the beginning and then it came back down and normalized and it was flat and nice the rest of the time. And I said what was that? And then an hour in his sugars went way up, not down, don't way up. And I go oh, did you, did you carb load at all? And he said I didn't eat he's, I just had electrolytes. And I'm like, why did the sugars go up at this point? And this point he said that's when I was going up a huge hill, so his body was releasing sugar for him to burn. Who cares? That's what I mean. Not all sugar spikes are bad, it's just why it's happening. So what he was doing is when he did that and this is why exercise is so important.
DR LENZKES:The other thing people don't talk about when he was putting that max demand on his body, his insulin dropped down. Because why would you want to store energy when you need it? Why would you put money in the bank when you need it right now? If I owe you money, I'm not putting all my money in the bank today. Right, I'm going to hold on to it. So he lowered his insulin so he could release sugar like crazy.
DR LENZKES:And then, as soon as he was done with that huge demand, his insulin went back up to get rid of that extra sugar that was floating around, put it back in the storage and said your muscles don't need it anymore because you're going downhill. You can relax, right, but stress and all these other factors will do the same thing as this exercise will do. So that's why it's so amazing. And once he realized, oh, I don't have to eat sugar all the time and I can exercise and his friends were all looking. I'm like how come you're not drinking Gatorade like we are? He said I feel great, right, yeah, but you have to be able to get to that point. That's why, when your insulin is super high, you can't get to your energy store. So you have to lower that insulin to get to the fat stores, otherwise it's like you're a diesel truck, but you're running on the little tank on the front instead of plugging into that huge tank of fuel that you have on your backside right.
FLORENCE:And I do know people whose insulin is still quite elevated, even though they're carnivore, low carb, you know, doing everything right for a long time, but their weight's stuck and their insulin is still a bit high and, interestingly, one of the people I'm thinking of is their thyroid markers are just slightly hypo right Even though they're all the other, other than that they're like really, really doing well and I'm wondering if it's because there isn't enough exercise, muscle mass building, to do that last bit of the job of getting that insulin low enough.
DR LENZKES:Yeah, there's so many factors involved, like you know. Usually we look at it and go, okay, what are our options? What do we have to fix? One is stress is the one people don't think about. You're stressed all the time and even less. That's that rate that that cortisol first of all breaks down muscle tissue to make sugar, but also blocks thyroid function, cause it's telling you why do you want to burn energy, like if I think David and doom is coming in the next three months. I'm going to conserve as much energy as I can. So mental functioning goes down and it can go to another extreme.
DR LENZKES:I've seen it where I've seen people that are super thin, fit, all muscle, no fat, right, and they're super low carb and they go and do a CrossFit for two hours a day and they zero carbs and their LDL cholesterol goes through the roof and their sugars go through the roof 300, 300, 400. Why Cortisol? So I was like that, saying this person was a doctor, she was 96 pounds. I said look chill on the exercise a little bit. Just do normal exercise, go for walks, do lightweights, do your little spin class or whatever you're going to do, liberalize your carbs a bit. And she goes. Oh my gosh, look at my sugars. You're going to tell me to eat more carbs. I go, yeah, that's what we're going to do. And so she liberalized her carbohydrates, decreased her exercise. Your sugar is totally normalized, right? Because her body was freaking out.
DR LENZKES:And what happens when you have no energy? Your body goes. I got to make energy. What I'm going to do break down muscles. So you're exercising and you're breaking down your muscle because your body's saying you don't have any energy to put muscle mass. So things like that that you go. It's how our body's really there to make us survive.
DR LENZKES:So if you go to one extreme or the other, your body doesn't like it. And even if you lose weight, your body goes. Wait a minute, this isn't where you're. So there's a set point of our weight. So I know I'll sit at a certain weight for a long time. It's hard. I got to work below that weight and even if you have terrible food, you just get stuck at that weight. It seems like you know. So it happens and it takes a lot.
DR LENZKES:Of fact, she needed bioidentical hormones. My hormone specialist got her on a little thing and she called me and goes I'm upset. I've gained 10 pounds and I feel flabby around my middle and she was doing really well. So I said come on in and we'll do a body composition on her. She put on 10 pounds of muscle and her visceral fat dropped significantly. So what happened?
DR LENZKES:The body, when you stop making estrogen, progesterone, you start stringing as visceral fat. That's why post-menopausal women have an increased cardiovascular risk compared to when they're younger. So people can, and I'm telling you I have people that are 300 pounds, 350 pounds, and metabolically they're healthy because they have tons of fat storage subcutaneously right. So their visceral fat's normal. It's normal.
DR LENZKES:You see, you can't judge a book by the cover. You can't look at that and go, that patient's sick, this person's not. You can't, I can't. But I can see if you have a ton of muscle mass, most. I have never seen an exception yet where someone has a ton of muscle mass and they have a ton of visceral fat right, because the muscle mass inhibits visceral fat. Visceral fat inhibits muscle mass. So they go, they, they, they fight against each other. So it just tells you the importance. And this is why, initially, when they told me muscle mass was the most important factor for longevity, even smoking and drinking and all that stuff, muscle mass was the most important, and the reason is it's going to make that means you're metabolically healthy, right, and so it's an amazing thing.
FLORENCE:How do we test for visceral fat, like, is it, what can I? And so it's an amazing thing. How do we?
DR LENZKES:test for visceral fat. What kind of test does that involve? I use something called a CICA machine and the CICA it looks at body composition, muscle mass, visceral fat, subcutaneous fat, and we can tell where we're at and we monitor that with time. And then there's DEXA scans people use and there's in-body. There's a lot of different ones you can do, but it's really using bioimpedance to look at muscle mass. And what's interesting that I learned because at first I was like this is not good, because I had people that were doing low carb and they were losing muscle mass for the first two months and then and their visceral fat was coming down too. But they're losing muscle mass and boom, then their muscle mass goes away and they're lifting weights for the first time.
DR LENZKES:I'm like how can I be lifting weights and they're doing it doesn't make sense. They're eating tons of protein. Everything is like where it should be and it turns out the bioimpedance gets fooled because our muscles, like you said earlier, you store fat in your muscle, right? So if you start losing weight, you lose fat in your muscle, so your muscle mass goes down. It's like going from a ribeye steak with a bunch of fat marbling to a filet. Who cares, you're healthier, it doesn't matter. So that's the thing is. I'm telling you that is a huge thing, because if you put a hamburger on the grill and you cook it, all the fat, the protein doesn't fall out. The fat falls out and the hamburger was big when you put it on there and then it shrinks. Why the fat'sically healthy and the numbers prove that. That's why all the way in the insulin. So I have someone's insulin come in at. You know 58 and I've seen as high as 110, you know is that 58 and they dropped to 20. I don't care about weight loss, I don't care about any of that. You're getting healthier, it doesn't matter, right, and you can work on stress and sleep and all these other things we're talking about, finding your peace. But where's insulin? So you could, like we talked about, you can eat a perfect ketogenic diet or a vegan diet or a perfect carnivore diet and not get benefits because you're stress, intense and not sleeping and worried about the kids and worried about this. And so I've always said and this is why I started looking at this stuff how can I be? My middle-aged real estate agent, who's always busy, doesn't lose weight and they can't get their sugars under control. But while I'm talking to them like this, they take four calls and go hold on, doc, let me get back. I have to send this email right now, like everything's urgent, like they don't have this piece, so sometimes just taking a breath.
DR LENZKES:And the other thing that we don't talk about enough and it's a huge factor is early childhood trauma. Right, going through this instability as a kid abusive family, alcoholic parents you go through it. Mental illness in the family, hugely correlated with obesity, diabetes and all these things why we're in this sympathetic overload all the time. So your body's telling you all the time you know what? So and I'm telling you, I have some people I'm like look, just breathe, just breathe.
DR LENZKES:Take two minutes in the morning and count your blessings, slow your stuff, because I see it all the time People go on vacation, their sugars get better and they lose weight, even though they're eating worse than they ever have, because that stress factors out right. So if I can give you one message, I think stress is the killer If we don't look at that, and that's why I said I'm going to migrate from California, where it's a lot more stressful, to being in the mountains and going for a hike with my dogs and my wife in the morning. I'm going for a mountain bike right after we're done here, so things like plus there's exercise.
DR LENZKES:Plus, you're out and you're seeing the trees and the lakes and the rivers. I'm up in the mountains here and it's such peace. I could just look at the sunset and all those things. So a lot of us who are driven, it's hard to slow down and downshift a little bit Because we feel like if you turn on YouTube and you look at these motivational speakers, all of them say don't stop, don't move. I mean just work, don't think, just keep going forward. Just like you got to slow down, Like the NASCAR racers slow down for the turns. They don't go full throttle, they go off there, they crash and burn. So I think that's a lot of it, Our burn. So I think that's a lot of it.
DR LENZKES:Our biggest when, when Tro and I talk about it, our biggest determinants of failure and lifestyle change are stress and lack of family support, lack of community, right, those things are so critical to help us get back on track. When we screw up a little bit, right, Don't eat one cookie and go. Okay, I'm just going to wait till January 1st and I'll start over again, Right, and it's only February a lot of months. So I think those little course corrections and really evaluating stress and sleep and all these other factors. What are your interpersonal relationships? Like you know, that makes a huge, huge, huge difference, because there's all the stress hormones. That's our battle is the stress hormones, insulin being one of them.
FLORENCE:And those NASCAR riders. They also pull over like going 180 miles an hour or whatever it is. They're just like going like that out of hell and they actually have to come to a screeching halt turn over while a team comes out and services the car.
DR LENZKES:Yeah, you're wasting all this time Like every second matters Like, come on, let's go, let's go, yeah, yeah totally. Yeah, absolutely.
FLORENCE:They have to shut everything down to go and do self-care. Well, car care, but in our case it's self-care yeah.
DR LENZKES:And some of my hardest patients are you know, it's the hardest thing. So many people are caregivers, and being a caregiver is one of the biggest risk factors for obesity, because you don't take care of yourself. I got to take care of my husband, I got to take care of my kids, I got to take care of my wife, and you never take care of yourself. And so sometimes you have to say, okay, oh, do my workout for 20 minutes. Right, if you could watch Judge Judy, you could probably go get a workout or you could work out while you're watching Judge Judy. I don't care Like, but it's not so many people, they don't have time, but you go, you really do. Right, we really do, I'm pretty busy and I have fine time for it. Right, you have to figure it out.
FLORENCE:Yeah, it reminds me of that expression that I absolutely love. Everyone should spend 20 minutes in nature just being calm and present and enjoying the nature, and if you're really busy, make it an hour.
DR LENZKES:Yeah, exactly right, yeah, exactly right. Yeah, if you can't slow down, I think that's a huge one, because I'm telling you, I have people. They just calm their nerves and there's some things I use to help, you know, just like meditation or relaxation, and you'll see their sugars just go straight down. If you have someone that's stressful you have a stressful boss all the time you're dealing with and your sugars are going crazy, you might as well eat donuts and cookies at that point, right, because your sugars are doing crazy stuff. I don't mean it that way, but I'm saying. It's the same effect, really. So people will say, yeah, I'm eating low carb all the time, but they're fighting with their husband every day or they're in a stressed situation and you're telling your body.
DR LENZKES:You know, and as a matter of fact, I'll just tell you, when I read this study, I was really amazed. I had to look at it again to make sure I was reading it right. So they took people and they put them on 1,000 calories a day, or 800 calories a day, and half of the people were sleep deprived. They were sleeping, you know, five or six hours or less a night. The other half, eating the same amount of calories, were eating were sleeping eight hours a night. Seven to eight hours a night. A vast majority of the weight loss in the. They both lost weight, but a vast majority of the people with the lowest sleep were losing muscle mass.
DR LENZKES:Oh God A vast majority of the people who are sleeping, we're losing fat mass, so so that that's one of those things you go sleep is important. I've been to conferences and docs have said, no, sleep doesn't matter.
FLORENCE:You have not looked at the science if you believe that. There's no doubt about it. That's just common sense. No one's going to argue that sleep is irrelevant. It's so, so relevant.
FLORENCE:I monitor my HRV from time to time and some of the things that I've noticed is that I will feel less stressed when I've had some higher carb periods and even when I've been in slips or relapses, and when I when I and I have had slips and relapses, I get myself back into. I get myself back into the good, the good junk sometimes. And when I've done that and I've followed what's happening with my, my perception of how stressed I am and what's actually showing up on my HRV data totally disconnected, my perception is that I'm calmer, I feel more positive, I feel more energized, I feel better. My subjective experience is that I'm less stressed. When I go and I got myself into that gluten-free bread or whatever it was that I went and got myself into and my HRV totally tanks. It goes up into the extreme stress. I'm like how is it that my body is stressed? My perception of it is that it's less stressed. So it's the case that stress drives up our blood sugars, but sugar stresses our bodies cellular.
DR LENZKES:Yeah, it's an interesting thing and I'll tell you probably why we feel this way and this is why we keep going back to those things. Part of it Is that first hit of carbohydrate when you eat sugar it helps with dopamine release and serotonin, and you do, but then you get resistance to that. So now you need more. That's why some people can have half a cookie and they go okay, I'm good. Other people need six cookies. They're going to eat the whole plate because they're trying to get their dopamine, because their dopamine is not working the way it should. So you need more and more, just like alcohol. If you drink a six pack every day, when you have one beer you're going to go okay, that's nothing, because you're used to six pack every day. But if you don't drink at all and you have one beer, you feel.
DR LENZKES:Iver cummins, who's a friend of mine, told me he goes. I was asking like what's that thing on your wrist? It was a whoop watch which is very similar to the or the ring, and so I had one. He goes, brian, he's really disappointing when you have it. I said why. He said every time you have a drink your hrv is going to be screwed up for at least a day and I said, come on, and it 100, true, right, unbelievable. So you're right that HRV is responding to the stress and so sugar is a stressor on the body. So physiologically, even though you feel better when you have that right, then physiologically there's, there's impact and that's great to have that HRV, because if you're like it'll tell you, don't work out today, right, you go, it's good to work out, yeah, but you've been working out way over to it. You got to listen to your HRV, yeah, but you've been working out way over. Today you got to listen to your HRV. Heart rate variability it makes a huge difference and that's a huge marker of sympathetic tone and parasympathetic tone. So if we could get our parasympathetic tone relaxing, you know, work out when you are, but then bring in that calm down. Even things like sauna and jacuzzi and cold plunges, that affects the HRV dramatically, it improves it, because you get a stress when you're in there, but then you get this calming effect afterwards, right.
DR LENZKES:So stress is not the killer, it's the chronic stress, it's the continual stress, it's our mindset, and when we get that right then everything else gets better. And that's why in the last year I've really shifted gears, because I've seen there's people and it seems like these are the same people that go oh, I lost another couple of pounds. Oh, I wasn't. I didn't realize that, like, it's not a big deal. But other people weigh themselves six times a day and they're not getting the results and they're frustrated all the time. It's like you're defeating the purpose. Just trust the process and relax a little bit. Right, do what you can and don't worry about it. Don't worry about the outcome so much. All of us know we look at the scale and that number's not right. We're a loser and we have a bad day. We'll be upset Now it's down a little bit. You go oh my gosh, this is a great day, I'm happy. So, yeah, if you put on two pounds of muscle, don't worry about it. And there's always going to be shifts too.
FLORENCE:You're did yesterday, yeah, so here's how I would summarize this. That step job Number one at least my bias from the summit is is to start with the low hanging fruit of cleaning up your diet getting off the refined process carbohydrate, the junk that's, that's never going to serve you ever, ever, ever. No math, no amount of exercise. Even though there's some bodybuilders that can get away with some donuts, great for them.
FLORENCE:But, I would argue, give it time. There's going to be some sign that it's it's done, it's damaged because it just does. So get that out and then we need to sort of broaden the lens. All right, let's bring in self-care. Self-care is the future of healthcare. And let's look at my sleep. And am I exercising? Am I getting out into nature? Am I finding enough relaxation time to counterbalance the stress time, the mobilization time with it? Just do nothing, just sit in silence and quiet and don't read a book? Is there enough of that balance in my life? Am I having fun?
FLORENCE:There's such a correlation for people with who have disordered eating and their levels of of. Am I having fun? Am I doing things that feel fun? It's very low. It's totally. The more likelihood that you have a disordered eating, the more likely you will rate that your life is lacking fun, that there isn't this. Yeah, a lot, a lot of sympathetic push do run from one thing to the next, kind of energy which really does tie back to trauma and eventually the trauma piece is real for all of us. No one doesn't have trauma on some level, but some of us have states of hypervigilance that, until we're ready to look at it and deal with that. It's going to be the missing link and the missing piece, but eventually we make our way there.
DR LENZKES:Yeah, and stress affects gut health and gut health affects our digestion and all these things. And one thing I heard in the conference I really liked was name an animal that eats when it's stressed. So if my dog's stressed in a new environment, they're not. You can put their favorite food. They're not eating. They're going to make sure everything's okay. They're going to calm their nerves and then they'll. They'll eat when everything's calm Us.
DR LENZKES:We get stressed when we first thing we want to do is let's eat, like zebras aren't running away from a lion and saying I've got to stop and eat some grass on my way, right, and your brain right, to get nutrition and allow you to think see better, run away from this thing that's going to attack you. So if you're not, it's not. It's not putting it to your digestive system or your sexual organs either, right? So being stress intense, like having a new parent, like the sex drive goes away Cause you're like I'm trying to survive, this kid waking me up every hour and all you know, all that kind of stuff, so all those things are real and so I think we have to really take a look at that and not feel, you know, in our society me in particular, it took me a long time to slow down a little bit because I was working 18 hour days and then, when I wasn't working, I'm thinking okay, I got to catch up on my notes and I got to get ready for next week and I got. So it's like what kind of life is this? So that's why so many doctors are burning out. They have zero balance. They're always working, they're always under stress. You're going to see five more patients this week. You're going to have to. You know it's like, oh my gosh. So stepping out of that was like seriously life-saving. For me, the stress is the killer. And just being busy Even if you love what I love, and say, why don't I just extend that time and like, enjoy it a little bit more and not have 2000 pages, maybe cut down to 400, right? So you know all those kinds of things we have to look at and I think for all of us and I would say just in summary and closing, I think this is really important.
DR LENZKES:This is from Ben Bickman. He goes. Okay, I go, ben. Look, if I want to live a long life, this is when I was working 18 hour days and stressed all the time. I said what do I have to do? And he said, okay, brian, five things right. And this is what I would tell people. Number one don't work 18 hours and be stressed. All the time I was like there's only five? Yeah, what's? Number two Get enough sleep. And I was like, dan, I don't think I like your rules that much. I'm 0 for 2 and there's only three left.
DR LENZKES:Next exercise regularly. Right. Next, eat real food. Cut out the processed food, eat real food. Next, don't smoke or drink to excess. Right, and I have not found an exception to that.
DR LENZKES:I have never met a person yet, I've never had a patient that said you know, everything was going great when I was stressed out all the time, and then I started calming my nerves and everything got worse. Never. It's always gets worse when you're stressed out and tense and you're running around like a crazy person all the time. So I think if we can slow down and just, and also when you're sleep deprived and stressed, that's where you're gonna make bad food choices, because your cravings for sugar and all these bad and high fat and processed food goes way up. And I actually knew this in residency when I was sleep deprived.
DR LENZKES:I would watch everyone when we're out post-call, being up all night in the intensive care unit with all kinds of bad stuff happening all night and running around and putting tubes in people and stuff and lines. The next day I would be starving all day. I'm like, why am I hungry all day and everyone else was eating all day too. I'm like, why is that? So I'm like it's either sleep deprivation or stress is doing it. Guess what? All the studies show that's true and I told my wife I go, they're going to study this and they're going to prove this. But when people on night shift, they get like the night nurses getting more weight than the day nurses, anything just being sleep deprived, even shifting that sleep cycle, like IT people, whatever.
DR LENZKES:So focus on those things, those other things, because if you're frustrated, like you said, your insulin is still high, it's either stress, pain, not sleeping. There's other factors. It's not just what we're putting in our mouth, but what we're putting in our mouth is going to affect all those other things. So if we're eating the wrong things and we're wired because we're drinking caffeine at 10 at night and we can't sleep all night, then it's going to have downstream effects. So I love what you're doing. I think this is such a great thing, and especially to have people from all different walks and you can say, okay, if the vegan thing works for you, cool Arnavour works for you, cool, like, if it works for you, I don't care, I can tell you what religion to be of. Your religion is great for you, right?
FLORENCE:Right, totally, totally, totally. So your website is ArizonaMedicMetabolicHealthcom. Can you accept clients internationally? Can you accept clients internationally?
DR LENZKES:You know, right now, just because of legalities, I do San Diego. I mean California and Arizona. I'm limited to that. I was going to get licensed in a bunch of other states and if there's a demand I will. But I was thinking, if I'm not a good enough doctor to be busy in two states, then I got to find something else to do.
FLORENCE:Oh, my God.
DR LENZKES:But you know, but there's so many great and I think you know there there's so many great uh uh physicians out there who are like-minded and lowcarbusaorg. They have a listing of all kinds of doctors who are looking at lifestyle and stress and all these kinds of stuff. Trochalasian, my partner on the podcast, is licensed in all the States. Right, he wants to take over the world. I'm I just want my little corner.
DR LENZKES:I don't want to be too busy, I only want to have 300 patients that I can take good care of and not be overwhelmed and get back to the situation I was in. So but I love it. I love it. I do do consults. If people want to do a one-time consult to get their insulin or get on a continuous glucose monitor or just get their labs like a reasonable lab panel because it's cheap to do, a cash pay price. I I mean, if you have insurance you can go through that, but cash pay price for a good metabolic panel is like $85 or something. So it's a, it's a slam dunk to to really know where you stand and then you know things. Like we talked about the.
DR LENZKES:The GI map is a test you could look at the gut microbiome. That's super helpful for small intestinal bacterial overgrowth syndrome and all the kinds of other stuff that if things aren't working, then you have to look at those things. So your people with high insulin level that's another thing. Their metabolic system could be off if they're not absorbing nutrients right and they're hungry all the time. So looking at the gut is the next forefront of medicine and that's why cutting out sugar sugar feeds most of the bad stuff like candida and all the bad bacteria. You cut that out and you're way ahead of the game. Right, you're going to improve. I see it all the time. And stress and sleep and all these other factors. You know, inflammation of the brain is not a good thing.
FLORENCE:Amazing. Thank you so much for your your time today, your podcast, all your generosity Appreciate it.
DR LENZKES:Thanks for reaching out. It's an honor to be here and I love what you're doing and and everyone listening. You're going to have a huge benefit of hearing a lot of different perspectives and I think it's really important. Whatever little pieces you take out, that makes your life better. That's really important. Thank you so much. Thanks, lawrence.
