OneMedicine Podcast

Rob Lutz 00:00
Hello and welcome to the OneMedicine Podcast with Today's Practitioner. In each episode, we share the expertise of a respected thought leader. Some you'll know, and others you'll probably meet for the first time. We cover topics important to you, always with a focus on improving the health outcomes of the patients you treat, while expanding your understanding of the many healing modalities being used today.

Rob Lutz 00:25
Hi. Welcome to the OneMedicine Podcast. I'm your host, Rob Lutz, and with me today is Chris Meletis, licensed naturopath, who has been on the show a number of times. And today, we're going to talk about my personal cardiometabolic journey. And both Chris and I turned 60 this year, and so there's some similarities there, but Chris, can you just quickly introduce yourself, share a little bit about your background, and then we'll just jump right into this?

Dr. Chris Meletis 00:50
Well, certainly. Thank you, Rob, and thanks for having me as always. And thank you to the whole audience for listening to us talk about a really important topic, heart disease and just heart wellness. And we'll probably get to the heart of the matter--pun intended--as we talk today. I've been a naturopathic physician for 33 years here in Oregon. I can write prescriptions here in Oregon for all kinds of cardiovascular meds, blood pressure meds, and of course, all the statins, so forth and so on. But of course, we know in functional medicine, we've tried to identify the cause of a problem. Why is something high? What can I do about it with diet and lifestyle? And there's a time and place for Western medicine, there's no question about it, but really looking at the foundational side of heart health, I mean, our heart beats 60,000 times a day, plus plus, maybe 100,000 times a day. It's 60,000 miles of blood vessels, and it's like, "Wow. What have we done for our heart lately?" I guess that's what we'll talk about today. What are our road signs along the journey of heart health, I mean?

Rob Lutz 01:47
Yeah.

Dr. Chris Meletis 01:47
There's mile markers on a highway.

Rob Lutz 01:48
Exactly. So to kind of maybe set the stage on how I got here, as I mentioned, I turned 60 this year. And about a year ago, I did a podcast with Dr. Mark Houston, and we really dove into the topic of cardiometabolic health. And one of the takeaways for me from that conversation with him was the importance of advanced lipid testing. And you know, some of the standard testing doesn't quite go deep enough. And to be honest, I was really expecting stellar results across the board. I eat pretty healthy. I exercise quite a bit. I've been in the functional medicine, integrative medicine space for a long time, and you know, I felt like I was doing things the right way. In December, I had my test done, and some of the results that came back were disappointing for me personally, and one was my LP(a) was at 230, and I think 70 is about the upper limit that is considered healthy. My total cholesterol was 216. 190 is the target or lower. LDL-C was 133, target of about 70 or lower. ApoB was 110 as opposed to 90. The other things that came up is my glucose was a little bit higher than it had been in previous tests, and then I also ended up getting a calcium scan, and that came in at about 62, so the results weren't stellar. And because I've got a little bit of a history with heart disease--my father had open-heart surgery when he was 75 and mitral valve prolapse, and anyway, he was quite clogged, apparently, despite living a pretty healthy lifestyle and good diet as well. Working in the industry, I've got contacts with a lot of really great brands. I chose to purchase the products because I wanted to report on my personal journey, not only the products that I'm taking, more about the ingredients we'll focus on, but also the lifestyle changes that I thought would be helpful. And so we'll talk a little bit about that and my personal challenges of adapting my lifestyle in a way that I think probably most practitioners like yourself, Chris, would be advising to a patient. That in fact is much more challenging than I thought. You know, I would--my weight had gotten up to about 170. I think a healthy weight for me is below 160. And I've lost about half of that at this point, but it's difficult, you know. For me, I found it very difficult to continue to lose weight. Anyway, Chris, that's kind of my basic--you and I have talked a little bit about this in the last couple of weeks. But any initial thoughts, you know, kind of what I've--and also my blood pressure is slightly high, so it's somewhere between hypertensive 1 and 2. So that's another area that I'm looking to, you know, improve those numbers as well. Any initial thoughts?

Dr. Chris Meletis 04:31
I know when you shared the results with me, I said "Cool." And then I asked, "Well, what about this number? And what about that number?" And you said, "Well, I--those weren't measured for me." So hopefully we'll talk about things like apolipoprotein B and myeloperoxidase and LP-PLA2 and TMAO and SDMA and ADMA, all these alphabet soup words. There's these things, which also are markers. And coincidentally, I'm turning 60 this year, and I'm going like--so I finally, after 20 years of not really looking under the hood like I do for my patients, I ran all those tests on myself. I'm like, "Oh, my oxidized LDL is just a tinge high, 10 points too high, but not terrible." And I said, "Yeah, I'm talking about vegetables and fruit. It's berry season. I'm a berry farmer. I grow berries in my yard." And so it's like, so teasing out those little markers, and the ADMA is a reflection of possibly nitric oxide levels. SDMA: how's your kidneys? It's cleared by your kidneys. So I think your--the calcium score you have tells us the calcification levels. It doesn't tell us potentially soft plaques. But that's a really good number you have, so I feel, you know, largely reassured by that. But I definitely would love to see those other numbers as you're doing your supplement and wellness journey, your weight. I know you're a big exerciser. Maybe you can tell the audience, listeners, I mean, how intense your exercise is. I think you and a bicycle might all go into one word.

Rob Lutz 05:56
Yeah. So yeah, I do exercise quite a bit. Cycling is my passion, particularly in the summertime, and so I typically ride over 4,000 miles a year. And last week, I got on my first long ride of the year, really long ride, and felt great. But apparently it's not enough. You know that, just the exercise wasn't enough. And the other tests that you mentioned, just as a follow up to that, I am having my testing done again here in the next couple of weeks, just to see how I've done over the last seven months or so with some of the lifestyle changes and the supplementation. And part of the story was my practitioner, even though she works at a holistic wellness clinic, she looked at the numbers and she recommended I get on a statin. And I'm not saying I'm opposed to doing that if I have to, and that was something that Dr. Houston said as well. You know, it could be a good way to bring down numbers quickly. But I chose to go the direction of using red yeast rice, berberine, garlic, and a few other ingredients in a formula, so I'll be interested to see how that starts to pan out for me. The other things that I looked at was endothelial health, so something to boost my nitric oxide. I'm taking Ubiquinol for one, taking zinc. I'm taking a pretty high dose of omegas with a CoQ10 in there. I'm taking magnesium and vitamin D, because my vitamin D levels typically aren't that high. So those are just kind of the supplements. Those are easy to have compliance with for me. I can, you know, take a lot of supplements. I exercise quite a bit, so it just really, I wondered why my numbers weren't better. And so it'll be very interesting. I'm gonna have these tests done again in the next couple of weeks, and I'll share those results either on another podcast or in an article, blog post, on Today's Practitioner. But let's maybe dig into some of these tests that, you know, other patients might be, you know, looking to have done to get some more insights into their own cardiometabolic health. And what--if you could talk about, what do you recommend? What do you look for? And then maybe, how do you treat those patients? How--what do you recommend?

Dr. Chris Meletis 08:03
Well, certainly. And you mentioned your blood sugar, and I describe everything, and most of us functional medicine providers believe this mantra, which is, if you understand a material, an area of focus, well enough, you can translate science into English. And so, for example, you mentioned glucose. Well, glucose is a Polaroid moment. It's a moment in time, whereas your A1C is two to three to maybe four months of how long your red blood cells are living. It varies from person to person. And like, your A1C was really quite good, and a blip of a Polaroid moment with your glucose is like, okay, is that adrenaline? Was it a bad blood draw? How was your commute over to the blood draw station? Lots of other factors. And so, of course, starting even before we get to the lipid side of things, glycation, so diabetes, metabolic syndrome. I give this simple example of, you don't want to have caramel corn as your cells in your body. And so what you want to do is have fresh-air, non-GMO, air-popped popcorn. Now say that represents a healthy cell just for the sake of conversation. You add a little bit of sugar, so that's metabolic syndrome. Well, you got kettlecorn, little bit of sugar on it, but not too much. Then you get to caramel corn, and it's really sugar, and that's glycation. So glycation worsens all your lipid numbers. So glucose, so sugar, and then fats, both of them need to be addressed simultaneously. So luckily, your A1C was really quite good, as I would expect, with your athleticism and your very conscientious eating. And so then the question is, what does the standard doctor, the conventional doctor, do? And I wrote an article that's in Today's Practitioner, that we're still using 1950s mindset. At the average, you're going for your physical to your regular conventional provider. She or he will do a total cholesterol, an HDL, an LDL, and a triglyceride, and getting anything more than that, it will be a miracle, and the waters have parted. And now functional medicine-wise, some are measured, but like your provider did oxidized LDL and apolipoprotein A. So for me and my clinical practice, I do a lot more. In fact, the local draw station at Quest Diagnostics--and I do not work for them, disclaimer--but they work for me most of the time, but they love to lose my lab orders. So I would send my patients, I said, "Print it and bring it in with you." But I'm known as like, "Oh my goodness, you're one of Dr. Meletis's patients," because 15 to maybe 18 tubes of blood are drawn on my patients, usually on their annual check, because I'm measuring the total cholesterol. I'm measuring, of course, testosterone or hormones, which also have to do with--estrogen and testosterone have to do with yourmitochondria, has to do also with some of your lipid numbers. Your lipid numbers can actually go up when you have either menopause or andropause, male menopause. And so it's kind of interesting. But I like to measure lipoprotein A and apolipoprotein B. And lipoprotein A is largely genetic. You do it once, generally you know what that number is, and you can move it a little bit with maybe some hormone replacement therapy or maybe a little bit of niacin. And of course, I love using the sustained-release niacin with a meal. Because I've had more than one of my patients--I tell them during the visit. So imagine you're my patient. "Well, Rob, I'm gonna put you on niacin," which by the way, before statin drugs arrived on the marketplace, was a therapeutic intervention, and conventional medicine was niacin, and it was a flushing niacin. But it's like, "Wow, niacin!" Okay, well yeah, you want to measure your liver enzymes, make sure your liver is handling the niacin. But it's like, hmm okay, so I have a patient. They take it, I say, "Take sustained release, and take it with a meal," and then they get all red and prickly, and they think they're dying. That's the niacin flush. And then, I've had more than one patient go to the ER, like, "Oh my goodness," but by the time they're driving over there, it's abated. That part doesn't usually last so long. But niacin is a great tool for those that aren't wanting to do a statin drug or red yeast rice, and so that's a consideration. But I can go through my big list here, but maybe just I'll add it throughout--a smattering of it. But I think the one I will tease people with is myeloperoxidase. It's a marker that looks for oxidative stress and cardiovascular risk, and it is elevated when you have increased neutrophils, increased inflammation in the body, and it contributes to oxidation of LDL. And LDL, of course, we think of it as a bad cholesterol, and I think--make sure I loop around to this in our conversation--but not all LDL is created equal. Not only are there oxidized LDLs, but what size is your LDL? You have large bad guys, or good bad guys, small bad guys. And you say, "Well, I'd rather have a small." No, do you know, should I have a large LDL? So same quantity, but the size though. So you have 120 points. 120 points, do you want them to be big or small? It matters, but the average provider is not doing that. So you get an LDL. It looks okay, but if they're all small, oh my goodness, your risk for heart disease is going up dramatically, even with the same number, whereas your large, fluffy LDLs, they don't get stuck in the nooks and crannies. And I give the example of a blueberry and an apple in a refrigerator. I pull a blueberry out, I pull an apple out, and something startles me. I drop the blueberry, I drop the apple, but which one gets stuck underneath the refrigerator? The blueberry, that's how you remember little LDL is the one that's a problem, because it gets stuck, whereas the apple doesn't.

Rob Lutz 13:42
Makes sense. You know, you mentioned testosterone. Talk to me a little bit about that, because, you know, my free testosterone is not ideal, so that might be something that could be having some impact here. Is that fair to say?

Dr. Chris Meletis 13:56
Yes, especially with the lipoprotein A, and also it's cardiovascular health. So if we look at a crossfitter and we say, "Well, look at how buff and toned they are." Well, that's that anabolic effect. Well, also what we need to do is you have your heart. It beats 100,000 times a day. It needs, of course, to have testosterone for good cardiac function, not too much. And as we chat today, I'll date the date, because Hulk Hogan passed away today, on the news and 71 years young. But of course, I'm not saying he did, but lots of professional wrestlers and strength athletes use anabolic steroids. So you need to have enough, but not too much, because you don't want to be muscle-bound from a heart perspective, but you need to have that. So heart health and contractions and all of this, and higher testosterone levels for male or a female, all things being equal, within the normal reference range, not supraphysiological. Also nitric oxide production. And I think that when you were mentioning your supplements, I don't know whether you mentioned you're also taking a nitric oxide support product as well.

Dr. Chris Meletis 15:01
And I think that's absolutely critical, and I will be very intrigued when you get your blood work back. What is your ADMA, which is a molecule that actually can compete with nitric oxide production, or your SDMA? So these are both going to give us a little look at not just what your salivary nitric oxide levels are, which is a very common way people will measure nitric oxide, put a little saliva on the--

Rob Lutz 15:03
Yeah, I've got those.

Rob Lutz 15:03
Yeah. I am.

Dr. Chris Meletis 15:13
Yep, but I want to know when the rubber hits the road, what is your ADMA and your SDMA? Simple blood tests. And these are all things I do for my patients, and when I got my tests back, which like I said, I finally did the same thing I do for my patients, it's like, "Wow. Okay, that's better than I thought." But your number on something which I talked about, glucose, but the other big thing that everybody forgets about that's, unless they're into functional medicine--so we got the glucose and the glycation, or caramel corn, kettlecorn example, but the other one is C-reactive protein. I've always had a higher CRP. Your CRP, as I recall, is pretty good, and we've all heard the term inflammaging. So that accelerates the aging process, and also the 60,000 miles of blood vessels that permeate our body, well, if you have inflammation, that's going to cause more problems. And my inflammation level is still high, so I'm taking a special VESIsorb delivery omega to lower that inflammatory marker, because when I was a young guy, before I became a naturopathic physician, I was in conventional medical school, a common medical school, and did the basic science program. I was going through my rotations, met a gentleman that double dared me to check out naturopathic medicine, and I pivoted. But I previously ate tuna fish every day of my life. I was on a student budget, so I had tuna fish, tuna fish, tuna fish. It was back in the 80s, when we weren't really thinking mercury. And so I've kind of avoided the fish products, because it's like, "Wow, what organic ocean am I going to get my organic fish from? Not!"

Rob Lutz 16:59
Right.

Dr. Chris Meletis 16:59
And so now I've actually started saying I'm gonna work on my omega-3/fatty acid balance, because, of course, you can do a blood test at a standard lab or a functional medicine lab. The Omega 3-6-9 ratio and arachidonic acid also says, how fluid am I? And do I have, as the word says, essential fatty acids in the right proportion or am I proinflammatory? So you also got the good A1C, you got the good calcium score, you got the good CRP, and A1C. So you got lots of good things, but still fine-tuning. So I give the example to my patients. You're on the FM dial, my friend. Just a little bit of static, but you are still listening to your favorite song, Billy Joel today. You're Billy Joel today. And it's like, okay, so you got Billy Joel on the radio, but I wanted greater fidelity, and I need it tuned in. So for you, luckily, it's a tuning thing. For some people it's a, "Okay, I'm on AM dial, and I'm all the way right-justified, and then all I've got is static." And I meet those patients where they're at too. But I applaud you for taking the proverbial bull by the horns and tackling it, because--

Rob Lutz 18:06
Well, yeah. It's interesting. I read somewhere recently that there are two distinct points in your life where the significant aging happens. One, I think, is in your mid-40s, and the other is when you're 60. And I can say for sure this year I feel like the warranty's up or something, you know, it just, and I want to--I'm looking for lifelong fitness. I want to be able to do the things I love to do, you know. I want to be healthy for my grandchildren and and all those things. And so I know it's not just supplementation. I've also read that, you know, getting in the gym, so more resistance training is good. So I've been doing some of that as well. But, yeah, the supplement part is easy enough and, but it's not just that, you know. It is lifestyle changes. And again, I think about how hard it is for me to make some of these lifestyle changes, even though they might be kind of tweaks here and there. But, you know, as simple as, I like an IPA in the evening and, but it impacts my sleep. I track that, and I see that I don't sleep as well, and I feel much fresher and better if I don't. So that's something that I, you know, try not to have any beer on the weekdays type of thing. But do you have any advice? So when you're talking to a patient, and yes, of course, if they can remember to take the supplements that you've prescribed to them, but it's the lifestyle changes that I think can be more challenging, whether it's your diet, because you've got 60 years of eating a certain way, things that you like. How do you approach that with your patient for compliance?

Dr. Chris Meletis 19:32
Well, what I tell my patients is hopefully they have a date with their toothbrush twice a day, morning and evening, at the very least. So I said, keep all the important pills with your toothbrush. So in the evening, I have my pills that I take in the evening when I go to bed, but then I have in the morning, I have a glycocalyx-supporting product, which will support the inner lining of the blood vessels above the endothelium. I have lumbrokinase, which is originally derived from earthworms, which breaks up clots. So that's good. I'm taking a chelating product in the morning, and I also have my cholesterol-null red yeast rice product, which I take in the morning. And then at night, I take other things, so I kind of separate them. But yeah, one of the ways to do it is, anything that's really important to you, put it with your toothbrush. So I have morning pile toothbrush, evening pile toothbrush. Brush my teeth in the middle of the day, I get a break from that. So that's kind of the toothbrush. And then, of course, during the middle of the day, I take my omegas and so forth. But you mentioned something very interesting. So I've mentioned how glucose levels and metabolic syndrome, and diabetes is a risk factor, and then the other aspect is I mentioned C-reactive protein and inflammatory markers is a risk factor, so those deal with autoimmune disease or chronic ailments or joint issues. We want to keep track of that CRP, apparently like cardio-CRP, along with CRP. But the other thing is, you mentioned IPAs. I had a patient, healthcare provider, very successful woman, and I said, and she was thin and fit and, you know, was well put together in terms of her professional, you know, presentation. But I said, "Yeah, I'd like to get a home sleep study on you." She says, "Why would I want to do that?" I said, "Well, just because you have all these other symptoms. You've got lots of stress in your life." And so she, being a healthcare provider, said, "Okay, I'm not going to be clever on this." I didn't know what she was doing. So she normally enjoyed two glasses of wine before she went to bed to kind of wind down. It was her treat to herself. After all, we've been sold that alcohol is good for you, like a glass of wine, blah, blah, blah. And so she did one night of a home sleep study with her two glasses of wine, and then one night with no wine. She was four times worse with her sleep apnea, 4x times worse with her sleep apnea, when she drank her two glasses, and I joked with her, because I had good rapport. I said, like, "These are, like, the Big Gulp wine?" She said, "No, no, they're just really glasses of wine." And I said, "And then, no wine." So of course, an IPA or, once again, wine or something else relaxes our airway and relaxes things, and we see, of course, those people that get in an accident and they were under the influence of a lot of alcohol, they're very relaxed. Well, it relaxes your airway, and they often end up not being as injured as a person that was not consuming alcohol. So alcohol and sleep apnea, so the hierarchy of things, you can change your diet. You can make sure you stay hydrated, so you don't increase your chance for clots. You can be sure, if you're sedentary, that you get up out of your chair every half hour and/or sooner, and just get up and move circulation so you're not pooling for deep vein thrombi, blood clots. But the other thing is home sleep apnea test. So food, you can live weeks without food, generally. Water, about three days. Air, a few moments. And so I tell everybody, "Get a home sleep study. It's $189. You can order it yourself. You don't even need a healthcare provider." And my healthcare provider friends like the fact that they don't need a healthcare provider, because that way they don't have to go through insurance. They don't have to bother a friend. They just order it online. They deliver it to the house. They sleep with their favorite pet and significant other, and on their pillow with nobody watching. And then they get the results, and it's reviewed by sleep medicine doctors. Even the Department of Transportation approved this home study. And I'm not affiliated with the company I'm mentioning. It's like, "Wow." It's like, "Wow, hierarchy. Air. We never talk about air." And after all, what is our heart pumping? Oxygen and nutrients. Making sure we're oxygenated is very, very important. So, home testing.

Rob Lutz 23:44
So is that what it's testing. It's looking at your blood oxygen level over the course of the night.

Dr. Chris Meletis 23:51
Yes.

Rob Lutz 23:52
Okay.

Dr. Chris Meletis 23:53
It measures how many times you stop breathing per hour, and it's called AHI, apnea-hypoapnea index. Insurance companies will allow you to stop breathing about five times an hour. Like, okay, this is a gentle show, okay.

Rob Lutz 24:07
Right.

Dr. Chris Meletis 24:08
We have four more in the next 60 minutes. Okay? And so, when I was first diagnosed, I'm 6' 1". At the time, I was 185 pounds, and I had 58 episodes an hour. Thin, tall, young, and it's like, "Hmm." And my oxygen levels went down, and the docs and providers listening will be astonished. It went down to 65% oxygen.

Rob Lutz 24:32
Wow.

Dr. Chris Meletis 24:32
That was my lowest. And it's like, "Hmm, wonder why my blood pressure was a little higher." So lots of men where you see a little bit more fatigue, a little higher blood pressure, could it be from a night of less-than-restful sleep and a little bit of anadrenaline jump as you're auto-suffocating? And for $189, think about in the greater scheme of things, it's like, "Wow. That's very affordable."

Rob Lutz 24:55
Yeah. What's the name of the group that does that test?

Dr. Chris Meletis 24:58
It's called Lofta, L, O, F, T, A, Lofta.

Rob Lutz 25:01
Okay, I'm gonna do that.

Dr. Chris Meletis 25:01
Yeah, and let me say, I'm not affiliated with it, but, boy, I should be, because I have sent so many of my patients and colleagues over there, and it's just a really great little test. And it's actually technology out of Israel that's now been adapted and adopted here in the United States. So it became very affordable. And they send you the device. You put it on. You go to bed. It's non-intrusive, and you wake up and, you know, they'll analyze your data for you. It's very, very nice.

Rob Lutz 25:33
Wow. That's very cool. You know, one of the other things that I've been doing in an effort to lose some weight, right now, I'm doing some intermittent fasting. What I tried at first was kind of a high-protein meal early, shortly after I woke up, and I was having the opposite effect. I think I was just eating too much, and so my weight wasn't going down. It actually went up a little bit. Now what I do is I stop eating definitely by 8pm at night, if not a little bit sooner, and then I don't have my first meal till 11 or 12 in the, you know, the next day. I think that, combined with actually exercising more again, you know, that's what has driven some of my weight loss. But I know there are other benefits, or at least, I've heard there are other benefits to intermittent fasting. What are your thoughts about that approach? And what does it do?

Dr. Chris Meletis 26:17
Yeah, and on one of our chats back and forth. what I suggested was looking at your growth hormone, your IGF-1, which you want to do first thing in the morning. And it's like, well, it can help your sirtuin levels and help--so sirtuin is that whole concept that calorie restriction helps with longevity. We've been sold the bill of goods in the westernized world, breakfast, lunch, and dinner. And you watch commercials, they'll even see fast food restaurants, "Come in for your fifth meal!" Like okay, well, I really didn't need three meals, let alone the fifth meal. And so that concept is in consideration, intermittent fasting gives your body a rest. And there's something in our body called zombie cells. And I said, when I first heard the term zombie cells, I said, "Well, that's a little cliche, okay. Well, what's that all about?" But if you actually were to go to PubMed and type in zombie cells, lo and behold, there's a couple articles that actually discuss zombie cells. What really zombie cells are is senescent cells. These are old cells. And when you do intermittent fasting, your autophagy and your mitophagy, for your mitochondria, and your autophagy for the rest of your cells, they actually go ahead and help replace some of these senescent cells. And now there's actually supplements out there also. We kind of go, and they're little what I call spurts. You take for two to four days once a month. These basically zombies killers, and they basically help the senescent cells leave your body. But otherwise they're stowaways. They're kind of like leeches on your legs going through a swamp. They're sucking away some of your energy, because they still take energy. They're burdensome. They can, of course, mutate. So the, back to why am I mentioning zombie cells? Well, because intermittent fasting is one of the many ways that can minimize that and give your body time to kind of clean up the mess.

Rob Lutz 28:04
What about, you know, metabolic syndrome, or avoiding falling to that level? Does it help to--intermittent fasting? Does that help with your blood sugar management?

Dr. Chris Meletis 28:15
It can. It can, if done well, like you said. If all of a sudden you are, and I'll give--the answer is, "Yes, it can." But now all of a sudden, I'm intermittent fasting. I've been doing 20-hour intermittent fasts.

Dr. Chris Meletis 28:26
I've lost a meaningful amount of weight. I've lost 35 pounds, that's since the beginning of the year, and it's caused some of my other numbers, which are like, "Okay, well, why is that?" And they are actually elevated in terms of enzymes in my body, because I lost too much weight too quickly. And I have a saying, "Don't die dieting." So if you lose a large amount of weight, and that's supporting phase one and phase two and phase three detox, then all of a sudden you're stirring up, like with a feather duster, yesterday and yesteryear's toxins, along with today's toxins. Does our body have the ability to handle that burden without supporting phase one, phase two, and phase three? Phase three, by the way, urinating, having the good bowel movements, sweating, all these other aspects of detoxification. Otherwise, we just stirred all this dust, and we're kind of like--was it Peanuts and that one gentleman that walked around always in a stir of dust. I can't remember his name.

Rob Lutz 28:26
Wow.

Rob Lutz 29:23
Pig-Pen.

Dr. Chris Meletis 29:24
Yeah, okay. There we are. So we're in a Pig-Pen phenomenon, and so we want to support, so I, you know, take a lot of things to support the phase one, two, and three. So whenever you're in major malady, but yeah, intermittent fasting works beautifully. Now, the question is, they say, as we get older, we shouldn't fast as long as I'm pushing it, with 20 hours of fasting. And the other thing with intermittent fasting, or any diet, is when our, the very popular now, GLP-1 meds. You know, inject yourself and lose weight, or go to a compounding pharmacy and do it sublingually, is we're causing sarcopenia, which is muscle loss.

Rob Lutz 30:00
Right.

Dr. Chris Meletis 30:01
And so, it's called the skinny fat. So like, "Wow, the scale looks good, but I've lost muscle mass." And muscle mass is active metabolic tissues, where your mitochondria is at. It's of course, helping with the browning of white fat to brown fat, which actually, this allows you to do beta oxidation and burn the fat. And then if you lose your muscle mass--so now, all of a sudden you say, "Wow. The scale's looking good!" But if you've lost your muscle mass, then your myokines and exerkines made by your muscle. Well, we used to think when I graduated in 1992, okay, muscle, weightlifting, moving, ambulatory, athletic, performance, onwards, but now we know the largest hormone organ in the body is actually our muscles. And so when we talk about that healthy aging process today, we're talking about heart disease. But also they say that our grip strength--like right now, if I said, measure your grip strength, my grip strength, it is actually an independent marker for overall wellness and longevity, all things being equal. So if you're got really weak grip strength, it's reflective of your overall strength generally. And of course, what's our biggest concern, other than heart disease and cancer, is taking a fall and a tumble. I have a good friend that's uncle's in a New York hospital right now, and he has a broken hip, and everybody's afraid. I don't want to take a tumble. So good, strong legs, so squats and things within your physical capacity without--you know, if you have a joint replacement, of course, work with your healthcare provider--but just really strong foundation, strong legs, strong hand grip, so all these things. So what this whole conversation is that intermittent fasting, yes, intermittent fasting is generally a great approach. But if you break that fast by going to a Hispanic-influenced restaurant with chips, do not start with the chips. It's gonna spike your insulin levels, like, that's, but they're making you wait. And don't start with a sugary drink. And so it's like, "Okay, I'm just waiting here for my protein. Just waiting here for my protein." And they're like, "Is everything okay, sir?" "No, I'm just waiting for my protein." Otherwise, you're in storage mode by the time you break your fast with a carbohydrate, just like it would be to go to an Italian restaurant; don't start with the bread. "But that's what they bring."

Rob Lutz 32:17
That's right. Exactly.

Dr. Chris Meletis 32:17
They've got some oil and vinegar. Yum, yum.

Rob Lutz 32:18
Yeah. I usually try to do kind of a high-protein, I try to do a high-protein lunch, you know, and so that's helpful. I mean, I feel good. I feel much more sharp in the mornings than if I were to have a sugary breakfast. I noticed that about myself years ago, I would love to eat pancakes or French toast, but, ah, I just go into a fog and want to take a nap afterwards.

Dr. Chris Meletis 32:35
Yeah. Amen, brother. Now for me, I actually break my fast with Amy's low-sodium vegetable soup, and it's 120 calories. It's not a huge sugar hit, and I'm feeling pretty good, but I can tell you, because I usually eat around four to five in the afternoon. And at four or five, I would not be the friendly dog or cat at the table, because I'd be like, "Okay, I'm hangry."

Rob Lutz 32:59
Yeah, exactly. Well, what else should we touch on here? So we've talked about different tests, and I've added some of those to my next round, so you know, we'll talk about those when I get that information back. Any other tests that you think we should be talking about? Or guidance for patients or practitioners around this whole cardiometabolic area?

Dr. Chris Meletis 33:18
Well, I think the one thing which, and I've learned this over the years. I love the analytics of laboratory tests, and I love data, and even on a simple CBC, complete blood count, we measure your white blood cells, we measure your red blood cells. But on the white blood cells, if there's elevated neutrophils, and assume it's not a bacterial infection, you can point towards some inflammation. So it's kind of a poor man's approach to, okay, well, it doesn't--it has so many neutrophils. It's not an infection. Might it be inflammatory? But then on top of that, we're looking for mean corpuscular volume, the size of your red blood cells. So we have 60,000 miles of blood vessels, give or take. Of those, 18,000 miles of those are capillaries. So you think of your nail bed, assuming your nails aren't in it wrong. But mine currently are not. You can actually squeeze that nail bed and see, how quickly does the perfusion come back? And the nail bed thing was a joke. I'll tie in a story in a moment on that one. And so it's like, hmm. So a red blood cell can range from 80 to 100 in terms of size and still be normal. If on the small side, you're microcytic, small size, small cells; macrocytic on the 98 to 100+. But now imagine I'm trying to fit into one of your bicycle outfits. I'm a larger person. I'm not as fit as you. It wouldn't fit very well. So actually, the size of those red blood cells that also is delivering oxygen to your heart, your tissues, to your brain. So something as simple as looking at the mean corpuscular volume, looking at, is there elevated neutrophils? So even in a standard blood test, you know, my body, I got pearls there. And then, the other thing is platelet count. We always want to see a person's platelet count right around 200, 225, 250, but the moment we start going into the 300s, that's thicker blood, and platelets actually cause clotting. So this ties into, I always love to measure fibrinogen for people as well. Fibrinogen is another risk factor for clotting, so fibrinogen, looking at platelet counts, and if a person has a higher platelet count, I usually ask them to focus on hydration. And if they still, with better hydration, still have a higher platelet count, that's when, of course, always talking to one's healthcare provider, and general information here, but you use nattokinase, seropeptase, or lumbrokinase to prevent that clotting factor. And that's important. You travel, you do road trips, you like to, you know, or just sit for a living. All those are really important considerations, is look at that fibrinogen. Look at the platelets. So there's just so many phenomenal pearls. And I tell everybody, go in for blood work very well-hydrated, because if you look at your blood work, it's nanograms or picograms, or milligrams per deciliter, or per liter per unit of fluidity. So if you and I were to have our blood drawn now, at this very moment, and then we both got an IV drip of hydration and had our blood redrawn right after the hydration, our numbers will be lower generally after the hydration because, of course, we're more dilute. So again, having eaten a normal diet, and well, of course, fasting, but the normal diet up to the night before, and your true hydration level, so you can actually measure a true number, not a facade of, "Well, this is me being good."

Dr. Chris Meletis 33:18
Right. And so how do you measure hydration? What's the method for that?

Dr. Chris Meletis 34:55
Obviously, if a person is very dehydrated, it's called tenting. You look at the back of your hand, you lift up your skin, you release it. Right now, I'm dehydrated. It doesn't--your skin should bounce back right away. But, I look at it from a laboratory perspective. I look at a UA, I want to look at the specific gravity, and you want your specific gravity to be on the lower side. So pure water, you'll say, 1.000, and if you're got a dehydrated state, your urine is not only noticably darker, but other elements do that too, but then you're 1.003 or 1.03, and then it's like, "Okay, well, then I'm underhydrated." And then I look at the platelets. Platelets and the UA give me a sense of where the hydration is at. You know, also, if it's really bad, you know, pruning fingers like that, when we take baths. Well, you get pruning fingers from that, or once again, it's called tenting. The skin should immediately bounce back, and it doesn't, and that's--but that's extreme, and I just dealt with that with a patient of mine that was traveling in Vegas over the weekend, and he got food poisoning, and he was vomiting every 20 minutes, and he was starting to feel like he was gonna pass out. So I said, "Okay, measure this. Are you tenting? Blah, blah, blah," until eventually, I just sent him off to get an IV.

Rob Lutz 37:59
Yeah, so I think I drink a fair amount of water. I use a Garmin scale to just track whether these things are accurate, but just to see trends. So it gives me my weight, calculates my BMI, which is just under 25. Percentage body fat is around 19 or so, and then has a hydration number. And according to that, I'm around 58, 59% I'm not sure exactly how that works. I think it's, electrical current goes through your feet or something like that.

Dr. Chris Meletis 38:28
Yeah. Your feet is, yes.

Rob Lutz 38:29
So I think those are probably okay numbers. What I do check is, before I go on a ride, especially if it's warm out or hot, I'll check my weight. And I know how much water I drink when I'm out there, and I try to drink. You know, every five to seven minutes I'll take a swig out of my water bottle, which has some electrolytes in it. But I came back from a, it was a five-hour ride this weekend, and I had probably four good-size water bottles. I still lost almost five pounds.

Dr. Chris Meletis 38:56
Yeah.

Rob Lutz 38:56
And so it did come back quickly, you know. I was able to drink that amount of water and it was fine, but, yeah, my urine was darker and I, but I felt much better after I drank a lot of water, that's for sure.

Dr. Chris Meletis 39:08
Well, and the beauty of hydration, and as, living in the functional medicine world, you're smart. A lot of people say "I just, I drink lots of water." and then we see their sodium levels are low, their potassium, because they're not replacing the electrolytes. And we're not pure water at our cellular level. We have sodium, we have potassium, we have magnesium, we have calcium, and so making sure we're rehydrating throughout the day with a nice electrolyte, sometimes is very important, and it also helps sharpen us. Now and this hydration, when we become dehydrated, we become more dull and brain fogged. We also are more toxic, and we're not having our blood flow as well, but electrical conductivity is the other part of our nervous system. We have our chemicals, our serotonin, our dopamine, acetylcholine, onwards, but then we have electroconductivity, much like a wire on a lamp, and it's delivering it to the bulb, and the bulb, of course, releases electricity, creates a chemical experience. Once again, that's the synapse. But, yeah, we need those electrolytes, and that's where, as an athlete, you probably have somewhere along the way underhydrated and you were like, "I got a cramp. I got a charley horse. I'm hitting the wall."

Rob Lutz 40:17
Oh yeah. This was years ago, but I did a, it was a mountain bike race, and it was pretty warm, and I was just drinking water. I wasn't doing any kind of electrolytes, and on the second lap, I started to cramp up, and I never got to the point where the cramps went away. They had me eating potato chips and drinking pickle juice and all sorts of different things, but it never, never quite made it back. So I realize I have to get ahead of it, for me. You know, if I don't stay ahead, then it's hard to recover at that point.

Dr. Chris Meletis 40:44
Because we're talking about intracellular levels. And then your muscles are tight, and you have lactic acid buildup on top of it. And I give the example of a tight muscle like me making a fist, which I'm doing right now for the camera. And it's like, "Okay well, what color is the inside of my hand?" And you're gonna say, "Well, it's pink." It's like, "No. It's white. It's blanched out, because it doesn't have any circulation." So that's why you have to work through those knots, but once you're tight and those muscles are engorged, they're congested. It's like a traffic jam.

Rob Lutz 41:12
Yeah.

Dr. Chris Meletis 41:13
It's much harder to get those electrolytes in. And that's where, of course, you do the Epsom salt bath, you do a cold plunge, or you do something cooling to try to bring back some of that, get rid of some that congestion and get the minerals into the muscle.

Rob Lutz 41:26
Yeah. Well, anything else you want to share? Any other pearls around cardiometabolic health or patients?

Dr. Chris Meletis 41:33
You've covered it, and I would just finish on the provocative statement, "Size matters"--on HDL, on LDL, and making sure you're getting your particle size on your LDL and your HDL. Very important. It is the game changer, because all of a sudden, you have the wrong size of the good cholesterol--if I'm using that old, antiquated term--or the wrong size of the bad cholesterol. Numbers that appear to be okay are not okay, and then we need to pivot and move those. But I would just recap, you know, particle size, oxidized LDL, homocysteine, ADMA, SDMA. TMAO is another big one for those of us that are carnivores and not vegetarian. Too much carnitine can crank up TMAO and, or too much choline from eggs can increase TMAO. And so then if that's the case, you want to look at your gut flora, because like, we have a gut brain, a gut heart, and most--the misnomer, and I'm finished on this one, I promise--is we often vilify cholesterol. And it was Stephen Sinatra, integrated cardiologist. He's passed, sadly, a great loss for our community. He spoke about grounding, or earthing is what he called it, connecting with earth and nature and walking around barefoot and, but he also got that cellular phones, and even the old mobile phones we would have in our house on the different stations, can throw off cardiac rhythm. I lectured to 1,000 providers at a forum in Florida right after he did, so I got the benefit of listening to his entire lecture. But the other big thing is "Attitude of Gratitude"--you and I started before we saw podcasts--which is being mindful, less in distress. Be kumbaya. And is it that--no pun intended; not meant as a bad form here--but is it worth dying over? Do you want to road rage? Do you want to have a cardiac event? Or do you just let it, you know, water off a duck's back? And I think water off a duck's back is the better way, kind of like, you know, the martial arts is like, okay, their energy is their energy, and just let it pass you.

Rob Lutz 43:37
Yeah. Yeah, it's like one analogy someone made once that I that I liked was, you know, anger is like a hot potato. If you keep holding on to it, you're gonna burn yourself, but if you put it down, it's not gonna bother you anymore.

Dr. Chris Meletis 43:46
Now, stress is a big killer, and make sure you're getting your sleep. Your heart needs a rest, too. And you know, all this is very common-sense, functional medicine things. But luckily, you and I have taken the bull by the horn, and we've done our blood work. We know what to do. I'm going to also be remeasuring myself to see if I can improve my oxidized LDL. My homocysteine was 11. I'd rather see it around 7. And so I have a genetic MTHF polymorphism, so I know I haven't been taking my B vitamins as faithfully. They might have to get moved to the toothbrush, so I'll remember to take them.

Rob Lutz 44:23
Yeah. That's great. Well, Chris, thank you so much. I love having you on the show, and it's always very interesting chatting with you, and I hope, very informative, as I imagine it is for our listeners. So thanks so much, and good health to you. And I'm sure I'll have you back on the show sometime soon.

Dr. Chris Meletis 44:41
Thanks for what you--thanks for doing what you do. Rob. I appreciate you.

Rob Lutz 44:44
Yeah. Take care.

Rob Lutz 44:46
Thanks for listening to the OneMedicine Podcast. I hope you found today's episode interesting and came away with a few insights you can apply to your practice. If you're looking for the show notes, they can be found in the link below. If you want to go deeper on this topic or anything else, please visit todayspractitioner.com and consider registering for our weekly newsletter as well. Thanks again, and I hope you'll join us next time.