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 00:21
Welcome to the OneMedicine Podcast. I'm Rob Lutz, your host and the editorial director of Today's Practitioner. Today, we're joined by Dr. Jacob Teitelbaum, and we'll be discussing diabetes and metabolic syndrome, metabolic health in general, and how to address these challenges with your patients. Dr. T. was my first guest, so it's a real pleasure to have you on the show with us again. Welcome back to the podcast, Dr. T. Before we get started, can you share a little bit about your background for those--I don't think there are probably too many people out there who don't know you, but just a little bit about your background, and then we'll dive into the topic.

Jacob Teitelbaum 00:59
Well, thank you, Rob. It's great to be with you all again today. By way of background, I've been an MD for about 50 years now. You know people ask, "What's a nice Jewish doctor like you doing in holistic medicine?" I got into it the way so many of you did. I came down with a disease that modern medicine had no clue what to do. I had post-viral chronic fatigue syndrome back in 1975. Knocked me out of medical school; left me homeless. And of course, when they couldn't figure out why this problem persisted, they said, "Oh, it must be a depressed med student," all that kind of stuff. So my focus has been on the metabolic syndromes, on how to optimize energy as one facet, how to address pain relief, effective treatment for CFS and fibromyalgia. I would note, if it's okay Rob, that for those of you interested, let me give you my email address, so if you have questions, some stuff you talk about today, my personal email is fatigue ( F, A, T, I, G, U, E) doc (D, O, C), @gmail.com. Feel free to email me for Long COVID, fibromyalgia, neuropathy, pain information sheets, and even information sheets on the diabetes and metabolic syndrome we'll talk about today. I know we cover a lot of territory, and this way it's just all--these are all free.

Rob Lutz 02:15
Yeah, and I'll make sure that your contact information is in the show notes, so if someone wasn't able to write it down quick enough, it will definitely be in the show notes for them to link right back to your email. Great. So how common is diabetes and metabolic syndrome? Why is this an issue?

Jacob Teitelbaum 02:30
It's important to know the historic context. Right now, we're looking at 1/3 of Americans having diabetes or prediabetes, and that's extending down even into children, which is mindboggling. Having--since we only live 100 years or less, we think, well, it's always been this way, but it hasn't. Wonderful research done by medical anthropologists out of Harvard showed that diabetes was, at least adult diabetes was, exceedingly rare until the Western diet was introduced. This is a disease of Western civilization, along with so many others, which means it is optional.

Rob Lutz 03:13
That's great. So you mentioned it's really not something that--it hasn't been as common until recently, the last 100 years or so. Is that primarily related to lifestyle, dietary, you know, what's the difference? What caused it would you say?

Jacob Teitelbaum 03:27
Number one, the American diet, obviously, the standard American diet--S-A-D, good acronym for it. We're getting about 140 pounds of sugar per person added to the diet in food processing each year. That's 18% of calories, another 18% from white flour. Meanwhile, fiber levels in the diet have decreased considerably, so sugar absorption spikes during the day. All of this triggers insulin resistance. We're also seeing the diet being highly inflammatory, especially with these ultra-processed foods, which a recent study, a meta-analysis of almost a quarter of a million people, showed that ultra-processed foods are responsible for about, well over, 120,000 US deaths a year. It's the sixth leading cause of death in the United States. Low exercise, obesity, and the inflammation drives obesity, the advice to avoid sunshine--there's so many different things that trigger metabolic syndrome and insulin resistance, that every one of the things that I mentioned are all treatable.

Rob Lutz 04:36
So changing your lifestyle, changing your diet, would be a start. You know, maybe if we could back up before we get into your recommendations on what we could do for patients. What are some of the things that happen to someone that, as they start to eat more poorly and their blood sugar starts to rise, insulin resistance, what are some things that they might start to see over a period of time, some symptoms that they might experience would you say?

Jacob Teitelbaum 04:57
Well, initially what they're gonna see is weight gain. They may start to have some fatigue also with it. They may see their cholesterol start to go up. Their blood pressure may start to go up. These are all symptoms of the same insulin resistance problem. But when they're starting to get that spare tire around the waist, it's time for them to start looking. Unfortunately, the symptoms they're going to get are mostly late.

Rob Lutz 05:24
Are mostly what? Sorry.

Jacob Teitelbaum 05:24
Later, after the disease has been wreaking its destruction. For example, high blood pressure is called the silent killer, and insulin resistance is the main cause of high blood pressure. Let's talk about some other things today, too. High blood pressure has very little to do with salt intake. Let me take a moment just to give it 30 seconds on high blood pressure.

Rob Lutz 05:25
Sure.

Jacob Teitelbaum 05:29
If you take salt intake from the highest amount you can eat to the lowest amount you can tolerate, you'll drop blood pressure readings on the order of one to three millimeter. It's really pretty negligible. And the rise is one millimeter in most, three millimeters. And it's just not sustainable for people. It is not thought like--so salt is a small player. That's a myth that's persistent. The main thing is potassium deficiency. Hypertension and incidence of insulin resistance is low potassium intake. You won't see it on the blood test, because it's intracellular, where you don't see it. So drink some tomato juice, some V8 juice. Eat an avocado or banana each day. Simple things to raise potassium, along with what we'll talk about today, will lower blood pressure far more effectively.

Rob Lutz 06:36
I kind of relate something to myself. I'm going to turn 60 soon. I did a podcast with Dr. Mark Houston, last year, and we talked about cardiometabolic Health. And I felt I was a pretty healthy guy. You know, I ride my bike a fair amount. I eat pretty healthy. I'm not a big drinker. My blood work has always been pretty good, and he suggested I do a little bit more advanced blood work. So my blood pressure is slightly high. My LP(a), which I had never really knew much about until the podcast, is very high. It's at 230. My cholesterol is slightly high, but not terrible. You know, just all these things are just slightly above where the ideal number is, according to, you know, mainstream medicine, I suppose. Even my glucose is a little bit high. And so I'm thinking I must be kind of on that road with some metabolic dysfunction, possibly, but with all those things happening. So this is--I find this interesting, and it makes me think there are probably a lot of patients out there that are somewhere on this continuum, and they're not quite there, so what could they be doing to correct this? But really, I'd like to know, what can we recommend for patients that are insulin resistant, having serious metabolic health, or even have diabetes? I think that's where I'd really like to go with this. So what are some of the key lifestyle issues that can reverse this? I mean, you talked about, it's optional. Diabetes is optional. Tell me a little bit more about what you're thinking there.

Jacob Teitelbaum 07:58
Number one, diet. This does not mean giving up everything you enjoy. Rob, we have this Puritan point of view in this country, which is horrible. You know we talked about in old England, if you're a robber or a hooker or whatever, they sent you to Australia, and if you're a Puritan who said, "BLAH! BLAH! BLAH! BAD!" they put you on a boat and sent you to America. And I think Australians are much more fun. You know, we have this concept that anything that feels good is bad for you, which is utterly insane. Things that feel good are usually good for you, unless the food processors have messed with them. So, for the diet, keep most of the things you enjoy, but cut out the sugar. Stevia is--I use, I have a sweet tooth. I want the book "A Complete Guide to Beating Sugar Addiction." I like my sweets, and I will get my sugar-free chocolate, and I will get--I use stevia. I am, like, wanting coffee that tastes like an ice cream sundae with no sugar in it. So you can have your pleasure in ways that are healthy. Cut out excess sugar. Instead of the fruit juices, you know, where, well if you have a 16-ounce orange juice, that's 12 spoons of sugar, eat an orange or two instead. You know, it's just common sense. Number two, it's just like the lectures I used to give. Every year, I'd lecture to third graders on nutrition, back when I lived on Chesapeake Bay, and the basic thing is, "Look at the ingredients. If you can't read it, don't eat it." So if it looks on it, and it says farm, you know, eggs, and those are the ingredients, and you can read them, and they're like basic whole foods, good. But if you're getting to a bunch of hydroxylated blah blah, and it looks like this chemical soup: If you can't read it, don't eat it. Put back on the shelf. As I mentioned, the recent meta-analysis showed that eating these ultra-processed foods caused more deaths than diabetes and Alzheimer's.

Rob Lutz 09:55
That's incredible.

Jacob Teitelbaum 09:57
It is, and finally it's being addressed. So, common sense and diet. You like butter? I love butter. I think when people say the secret of life is butter, I mean, you know, these foods--

Rob Lutz 10:08
Butter or bacon, yeah.

Jacob Teitelbaum 10:10
Butter, bacon, eggs. Eggs are healthy. Eggs are a healthy food. So have a pleasurable diet, but cut out the stuff that's just not recognizable as food when you look at the ingredients.

Rob Lutz 10:23
So eat more for nutrition, not so much just for recreation, but at times, enjoy yourself. Yeah.

Jacob Teitelbaum 10:29
No! Eat for fun and have joy of it, but look at what you put in your mouth and make sure it's actually food, not junk. Number two, the advice to avoid sunshine is insane. We are going to look back, and I said, "Geez, Mom took me to a museum of natural history when I was about five, and they have the skull with a hole cut in it." And I said, "Ancient Aztecs would cut holes in the skulls to let out evil spirits from sick people." Like, I take my mom's dress. I said, "Mommy, mommy, were they crazy?" And she looked at me, and she said, "Yes." And I can see in 100 years, we'll have a museum of modern medical--of old medical--history, and they're going to show the doctor saying, "Pall Mall cigarettes," as part of the advertisements and, "Don't breastfeed. It's barbaric." And another doctor will say, "Avoid sunshine." And the little boys will be tightening up their mommy's dress, saying, "Mommy, mommy, were they crazy?" And Mom will be going, "Yes, dear." So sunshine is healthy. Low sunshine contributes to excess inflammation and low vitamin D, and is a major risk factor for diabetes. So avoid--

Rob Lutz 11:41
Low vitamin D is a risk factor. Yeah.

Jacob Teitelbaum 11:44
Yeah, which is--and sunshine is the vitamin D.

Rob Lutz 11:44
Yeah.

Jacob Teitelbaum 11:45
Sun vitamin. So avoid sunburn, not sunshine. Go for walks outside as the exercise. Meanwhile, keep your weight at a reasonable level. And when you have a high-protein, low-carb diet, it's easier to not gain weight. For those of you who do hormone replacement therapy, low testosterone in men or high testosterone in women both cause insulin resistance. So as the testosterone level, and again, I'm preaching to the choir here. The medical definition of low on a blood test is usually two standard deviations, and that means you have to be in the lowest 2% of population. And normal shoe sizes, and this is an example I give patients, people who I treat, so they can understand--a normal range for shoe sizes is size 5 to 13. So if I come in with my size 12 foot in a size 6 shoe, the doctor will say it's normal.

Rob Lutz 12:43
Mm hm. Uncomfortable, but normal. Yeah. right.

Jacob Teitelbaum 12:46
Yeah, insane. An income of $8,100 a year is poverty, but medically normal. So for testosterone, if the level is under 500 on the blood level, I will consider bioidentical testosterone, or other measures naturally that people may want to do to raise testosterone. But the low testosterone in men, you see, as men go through man-opause, they'll start to develop metabolic syndrome. That's a symptom of low testosterone.

Rob Lutz 13:09
And when does that usually happen would you say? What's kind of the range?

Jacob Teitelbaum 13:16
55-ish.

Rob Lutz 13:16
Mm hm. And what kind of symptoms would a patient or a doctor see in someone who comes in? How are they presenting? What are they going to say?

Jacob Teitelbaum 13:25
Tired, low motivation, maybe a bit depressed, putting on a spare tire around their abdomen, difficulty with sexual function, loss of libido, low testosterone.

Rob Lutz 13:26
Okay, yeah.

Jacob Teitelbaum 13:29
In women, it will present as polycystic ovarian syndrome when they have high testosterone. And that's what drives the insulin resistance, drives PCOS. That's a whole 'nother topic.

Rob Lutz 13:50
So as a practitioner, and you have a male patient come in, who's, let's say, 56 years old, has some of those symptoms, do you test their testosterone? Or what's the level where you're saying to yourself, "I need to do something for this patient. I need to supplement."

Jacob Teitelbaum 14:06
if it's under 500 and they have symptoms, because some people, a size six shoe is normal.

Rob Lutz 14:12
Right.

Jacob Teitelbaum 14:12
Some people a 350 level on the testosterone is normal. But if they have these other symptoms, suggesting that it's not adequate for the body, in the younger male, I will use a medicine called clomiphene to stimulate their own or I will just use a bioidentical testosterone. The pellets are preferred over the cream, and the cream is much preferred over the injections or the oral. I don't recommend those other two forms. Cream is good. Pellets are better.

Rob Lutz 14:42
So back just a little bit to insulin resistance. What's the mechanism that's causing that? You talked about diet, but what--could you talk to me a little bit about what is actually kind of happening behind the scenes.

Jacob Teitelbaum 14:53
Many things are driving it. One of the key things is that the constant excess presentation of sugar to the cells. Sugar is like gasoline for a car, and the cells are like the motor, and you have a certain amount that gets--you have furnaces in the cells that burn sugar for energy, and insulin is the key that opens the furnace door, so the sugar goes in, gets burned for energy, and that works very well when you're having steady, low levels of sugar. Well, what happens when sugar levels go too high? It starts to gum up the furnace. And the furnace will say, do not accept delivery of the sugar. It becomes deaf to the insulin. That's no, you're not opening the furnace door and letting more of that junk in here. So it does it to the point that the cells are starving for energy, because--and the body then drives up insulin. It becomes a vicious cycle. What are some of the things that drive up insulin resistance and high sugar? Well, the 140 pounds of sugar per person per year. Increased inflammation. Inflammation drives insulin resistance by many mechanisms. It does so in the muscles. It does so in the fat cells. It's a major kind of an issue. So cutting down inflammation, which is really easy naturally--we'll talk about that as we talk about the treatment--makes a big difference for so many things in our health. And then lack of exercise. The burning of the sugar tends to help maintain the control, so it doesn't just build up in the bloodstream. And again, Vitamin D is critical.

Rob Lutz 16:21
Mm hm. With all this sugar, that's not--it just gets converted to fat. Is that what's happening?

Jacob Teitelbaum 16:30
Well, insulin is kind of like the traffic cop. When the insulin is working, it takes your sugar, it takes the calories, directs it into the mitochondrial furnaces to be burned for energy. And then you eat, you get energy. You don't get fat. But what happens when the furnaces say, you know, Return to Sender, that they're not accepting it. Then the traffic cop, the insulin, has to send all that sugar into fat. Gotta do something with it. That's why you start getting the weight.

Rob Lutz 17:05
That makes sense. Well, do you want to talk a little bit about, I know you have a protocol that you've used with success for patients. You want to talk a little bit about what's in that protocol and how you came up with it, or, you know, what's the results that you've seen?

Jacob Teitelbaum 17:19
I came up with it, because I'm a science geek. I read the literature for fun. I know that the universe loves me, because the most beautiful girl in the world, at least to me, had a thing for science geeks, instead of people who do sports and all the other stuff. So yeah, I will read dozens of studies a day, not uncommonly, and I know how to tear them apart. Yes, with most research, if I look at study and I look at the conclusion, that tells me who paid for the study, how to tear the data apart to see what actually is happening in the study. So let me start with a quick explanation. Most of you are familiar with this. Some may not be. In measuring blood sugar for diabetes and screening, the most helpful test, I think, is called a glycosylated hemoglobin. It has many names--hemoglobin A1c--but the glycosylated hemoglobin is a key. It averages the sugar over a period of time, so you get an idea of what's happening over time. Most people are around 5.4. If I checked the two of us, we would probably be 5.4, you know, maybe 5.5, and anything over 6.5 is diabetes. Anything over 8.5 is poorly controlled diabetes. They kind of go from there. So most of the people coming in to see you, if they have somebody else who has diagnosed the diabetes, they'll have that glycosylated hemoglobin number, so you'll see what they're on. Using a mix of four natural compounds, the research shows that over one year, these four compounds will decrease that number by 2.7, so if I have somebody who's pooly controlled at 8.8%, I keep them on these four really easy things. After one year, they'll be down under 6.5%, which means they're non-diabetic at that point. All of these play well with medication, Metformin. Everybody has their own point of view with it. My point of view is that Metformin is a perfectly good medication. The main problem is it will cause vitamin B12 deficiency, even with normal tests, and then people develop nerve pain, and the doctor will say, "Well, that's just the diabetic neuropathy." No, that may be, but it's also often from B12 deficiency from the Metformin. So if they're coming in, I don't try to get them off the Metformin. I do put them on a multivitamin or on something that has B12, at least 100 micrograms of, I think, B12. So that's just as a little aside, but here's the recipe. So if you have a piece of paper and a pen, write it down, or you can email me for it. First thing I do is I use an herb Hintonia latiflora called that's available in the United States as Sucontral D in the practitioner lines. S, U, C, O, N, T, R, A, L, capital D. It's one twice a day. It starts working in three to four months, and continues increasing in effectiveness over a year. At the one-year mark, it decreased the glycosylated hemoglobin average by about 0.9% or 1% basically, which is quite dramatic. It's very safe, very well-tolerated. Two excellent mechanisms of action: it has a polyphenolic called coutareagenin that increases insulin sensitivity directly, and it slows sugar absorption in the gut. So it works very nicely. Many, many studies on it.

Rob Lutz 20:48
But it takes a few months to really see some benefit.

Jacob Teitelbaum 20:54
It takes three months to lower it about 0.3%. About at 11 months, it's down, it decreases up to the 1.0%, which is awesome.

Rob Lutz 21:05
But does it have any other positive impacts besides the blood sugar, or?

Jacob Teitelbaum 21:09
Well, most things that improve insulin sensitivity help the whole metabolic syndrome process.

Rob Lutz 21:15
Got it, yeah.

Jacob Teitelbaum 21:16
Which is high blood pressure, high cholesterol. But it's studied, what it's been studied for is diabetes. And the head of the Diabetes Association, the International Diabetes Association, came out saying that he recommends it on all his patients with diabetes. It's just really, really good. But if you're talking about side benefits because, here's the thing: in medicine, we talk about pharmaceuticals, and unless you're taking pharmaceutical advertising, then you're talking about the side effects, you know. If you're taking pharmaceutical advertising side effects, well, you know--anyway, that's another topic that I won't talk about today. But the nice thing about natural remedies is the side benefits. So let's take a look at the second piece of that four-part thing for lowering our blood sugar, berberine. Berberine is a wonderful herb, and in addition to lowering blood sugar, also after one year, on the order of 1% for the glycosylated hemoglobin, the--it lowers cholesterol, lowers high blood pressure, because it's helping insulin sensitivity. If you're taking the regular berberine, then you're looking at about 500 milligrams three times a day. It can cause upset stomach, and that's a problem, but you, and the compliance of three times a day is a little iffy sometimes. But what it does do is it kills harmful bacteria and other organisms in the gut. So if I were traveling to India, for example, and I needed to take something to keep from getting cholera, I'm going to take the berberine. If I have all kinds of dysbiotic issues, I'm going to take the berberine. So in somebody who has dysbiotic issues, including Candida, or fungal overgrowth, which you can't tell on the test-- there's plenty of tests; I wouldn't give a nickel for any of them--but if they're having gas, bloating, diarrhea, constipation, nasal congestion, sinusitis, that's Candida. No testing needed. The berberine can help that. It's probiotic.

Rob Lutz 23:13
You mentioned the amount they should be taking per day for this. What, can you say that again?

Jacob Teitelbaum 23:18
In the studies using regular Berberine, it's 500 milligrams three times a day.

Rob Lutz 23:23
Okay.

Jacob Teitelbaum 23:23
But again, people get stomach upset sometimes with that. If you're looking for the diabetes, you don't need to be killing the gut stuff. You can get--there's this very high-absorption one that has something called GammaSorb with gamma cyclodextrin. It's a natural compound that--this is, as a clinician, it's really important to be aware of this compound, because it dramatically cuts down the dosing and cost. We did one study using a regimen of energy for people with chronic fatigue, fibromyalgia, Long COVID, and they increased energy at an average of 60%, but we used two--one that had the GammaSorb in it, and it decreased the dose needed by 75%. I mean it just, so if you want to make compliance easier, there is an ultra-high--it's called Berberine Ultra Absorption. It's made by EuroMedica. 250 milligrams twice a day is required.

Rob Lutz 24:21
Okay.

Jacob Teitelbaum 24:22
And that just makes it really easy, for example.

Rob Lutz 24:24
Is it a different delivery system or a different form? What's the difference?

Jacob Teitelbaum 24:29
GammaSorb is a molecule, and it's kind of like a bucket. It grabs these, kind of, components, and it's both lipophilic and hydrophilic. It basically has a part that can pass through water and a part that passes through oil. So if it hits a door, because most things are one or the other, and if they hit stuff--if it's water soluble, and it hits a lipid, it stops. Well, this one just turns around and goes back in the other way. So it dramatically enhances absorption, totally natural, totally safe, and benign. It's wonderful.

Rob Lutz 25:02
You don't have to take as much.

Jacob Teitelbaum 25:04
Nowhere near as much.

Rob Lutz 25:05
Yeah.

Jacob Teitelbaum 25:07
It's not expensive. It's safe, and it cuts--I don't like people taking handfuls of pills all day. This cuts pill counts down dramatically.

Rob Lutz 25:14
Yeah.

Jacob Teitelbaum 25:15
So like say, for the regimen seeing energy, which increased energy 60% in our study, half a tablet a day was equal to two capsules using the GammaSorb form. That's what I take myself if I need some energy. Once, if I'm on a show, and I just--so it's the Berberine Ultra Absorption, 250 milligrams twice a day. The next thing would be CuroPro, which is a high-absorption curcumin. Curcumin is wonderful. And as I mentioned, mega-science geek, the number of studies I went through is a lot, and for about 20 years, there are all these studies on curcumin and turmeric, and it was, "Oh, my God! This is amazing." But when you look at the dosing needed, unless you're in India eating a curry diet, there's just no way you could get these 16,000 milligrams a day and stuff. It just was not doable. Then somebody discovered that if you take the turmeric oil called turmerone, add it back in to the curcumin, you increase the absorption almost 700%, sevenfold. Suddenly, all these thousands of studies became usable. That was one of those, "Ta da!" You know, the angels open--I was like, yeah, yeah. So we talked about how inflammation drives metabolic syndrome, and the American diet is really very, very inflammatory. Full of white flour, loss of omega-3s, grass-fed beef, decreased vitamin D from sunshine avoidance, all these things. We are, have inflammation on overdrive in this country. One of the simplest, most powerful natural ways bring down inflammation is with the high-dose, high-absorption curcumin. I feel healthy as a horse, but I take the CuraPro, 750 milligrams a day, the high-absorption curcumin, becausing I just can't justify not taking it. The anti-cancer preventing, effects, the anti-pain effects--it probably decreases Alzheimer's and dementia risk, decreases metabolic syndrome. It brings down the glycosylated hemoglobin after, probably quicker than a year, 0.4%. So you know, you're looking at Sucontral D will bring it down 1%, Berberine Ultra would bring it down 1%, 0.4% for the CuraPro, one each morning. And the CuraPro, that's just like a side benefit. There's all these other benefits. And then melatonin for sleep. I will take a 10 milligram sustained-release melatonin, and that brings it down another 0,4%.

Rob Lutz 27:54
And is it the melatonin that's reducing it or your improved sleep that's having that impact, yeah?

Jacob Teitelbaum 28:00
The studies just show, in repeated studies, that the blood sugar goes down in diabetics who take it, and it's just 0.38% to 0.4%.

Rob Lutz 28:10
So you know, these different products that we're talking about, you mentioned, each one has a certain percentage of impact on your blood sugar. Do they work together synergistically? Is there--

Jacob Teitelbaum 28:23
Beautifully.

Rob Lutz 28:23
Yeah, okay. Can you talk a little bit--and that's, I find that really interesting, because a lot of times you'd think, "Oh, if it brought it down 1% here and 1% there, is it going to really add all those up together, or is it going to do something more, or is it going to do less?"

Jacob Teitelbaum 28:37
They're synergistic, because the mechanisms vary. So when you have something working through the same mechanism, you're less likely to get additive synergy. When you're coming from different mechanisms, then you'll tend to see that be additive. And I'm going to add all four of these. And again, I may just start with the Sucontral D or the berberine. That may be all they need. I'm not anxious to get them off the Metformin, but the Sucontral D has the vitamin B12 in it, as one more thing that kind of takes care of that problem, because as I mentioned, Metformin will cause B12 deficiency, regardless of the test results. And the Sucontral D takes care of that as well. But if you want them off the Metformin, again, Metformin decreases the glycosylated hemoglobin 1 to 2%, depending on the dose you're using. So any one or two of these can replace the Metformin. But for me, I have no problem combining all these together.

Rob Lutz 29:38
And then eventually you'll be able to get the patient off of the drug and maybe keep--would this be something that this patient needs to take forever at this point or?

Jacob Teitelbaum 29:46
Just until they correct their lifestyle.

Rob Lutz 29:51
So these different products will help bring down those levels. The important thing is for them to make these changes in their lifestyle, but then at some point they maintain those lifestyle changes, and they don't have to continue to take these different things. That's the ultimate goal, yeah?

Jacob Teitelbaum 30:05
Well, no. The ultimate goal is control the blood sugar and help them have a great life. If they can't lose weight and they can't make the changes, then at least they can take these things and that'll give their body what they need to adapt and to thrive despite those issues. You know, I always prefer a healthy diet and common sense. And again, I will rant against people who say, "A healthy diet means giving up everything you enjoy!" Anyway, I--just to digress for a moment, can you imagine a universe where there was some god or goddess or creator or evolution, any of these, creating a system where things that are enjoyable are bad for you. What?! Why?!

Rob Lutz 30:45
Right.

Jacob Teitelbaum 30:45
Or other industries.

Rob Lutz 30:45
Yeah.

Rob Lutz 30:45
Right.

Jacob Teitelbaum 30:45
Evolution is going to say things that feel good help you survive. A benevolent parental or other kind of God or nature or goddess or whatever, you know, unless there's, he's an evil mother, making it, "Hey, everything good for you is bad." It's like, "I don't want to be about that system." No. Things that feel good are usually good for you, until the food processors get hold of them.

Jacob Teitelbaum 31:06
And try to addict you.

Rob Lutz 31:13
They figured out what your body--influence your body so that you're eating more of this food. And they formulate and develop those foods in that way to turn on and turn off whatever, so that you're tempted to continue to eat this stuff that isn't good for you, even though it feels good. You enjoy it. You probably feel like crap after you eat a lot of it, but that's the difference.

Jacob Teitelbaum 31:32
Yes. So again, all these things you've been taught about, "If it's good to you, it's bad." BZZZT! Please stop doing that to the people you treat. It's really unhealthy. Life is meant to be enjoyed. It's meant to feel good.

Rob Lutz 31:47
Agreed. So anything else around metabolic health and diabetes? Because I would also like to talk a bit about hypertension, because I think there's that connection you mentioned before, but I don't want to skip to that until I feel like--have you, is there anything else you want to share?

Jacob Teitelbaum 32:04
I think this, you know, the lifestyle, the four-part thing, just letting people give it a year to see the full effect, and that, I think what you talked about, most diabetes will go away. It can be effectively treated. It's not rocket science. And the research is good research that's not behind it. People ask about the GLP1c, some new type medications. My experience in 50 years in medicine is, except for Metformin, every diabetes medicines just comes out. While it's under patent, the media is going, "The horns of the angels in heaven are coming out." And I look at the research that's hidden. And I know we discussed it. There's all these toxicities and side effects. And then the exclusive patent runs out on the new medicine. Then the media is free to talk about all the toxicity, so they can bury the old medicine that's now cheap and make space for the new wonder, patentable one. And wash, rinse, repeat. This is this kind of ongoing cycle.

Jacob Teitelbaum 33:05
So I tend to be skeptical of semaglutide. And having said that, I think it's a good medication. It's obscenely and absurdly expensive.

Rob Lutz 33:09
Yeah.

Rob Lutz 33:15
Right.

Jacob Teitelbaum 33:16
But it is available through the compounding pharmacies at a much more reasonable price. But, so with that one I prefer what I've talked about here. A lot of people need to lose a lot of weight. It's--

Rob Lutz 33:30
It works.

Jacob Teitelbaum 33:31
So far, yeah.

Rob Lutz 33:32
Yeah. And then hopefully they can get their weight down, and then, you know, not fall into that trap where, "I'll just keep taking this drug and keep my lifestyle the way that it was." Right?

Jacob Teitelbaum 33:43
Yeah. Again.

Rob Lutz 33:44
And that's the temptation in this society these days. It's, "I want to take a pill. I want the easy way out." And they aren't willing to make some of those changes.

Jacob Teitelbaum 33:52
And again, when you're talking to the person in front of you, let them know pleasure is good. And I know I'm repeating myself. I'm not looking for you to give up your pleasure. I'm looking to guide you how to get even more pleasure, but in a way that's healthy.

Rob Lutz 34:05
Mm hm. Makes sense.

Jacob Teitelbaum 34:05
You know to remove the high blood pressure.

Rob Lutz 34:07
Yeah.

Jacob Teitelbaum 34:07
We can talk about cholesterol, if you like also.

Rob Lutz 34:11
Yeah. I'd love that. So okay, so we've talked about, you know, metabolic syndrome that is likely causing some of these other cardiovascular challenges. How is that happening? And then how do you approach that?

Jacob Teitelbaum 34:24
Okay, so the metabolic syndrome is the mix of high blood pressure, high cholesterol, weight gain around the abdomen, and the prediabetes, the diabetes. All of that comes from insulin resistance. So these are all wisps of smoke from the same fire. Doctors will treat them like they're unrelated conditions, which is absurd. For the high blood pressure, again first of all, they keep trying to make them--and we talked about the normal range is two standard deviations. And the 95% of the middle is defined as normal, through sizes of 5 or 6 to 13 is normal. But when you have an expensive medication, suddenly the normal range disappears. Nobody's normal.

Rob Lutz 35:05
Right.

Jacob Teitelbaum 35:06
Everybody should get statins, and give it to your pets, your hubcaps, and yeah, it's crazy. So you have to be a little skeptical of the testing. We're seeing the same thing with blood pressure. We're certainly treating blood pressure as critical. The medications are well worth it to keep the blood pressure under 160 over 90, but the attempt is to try to drive it to 120 over 80 or less, or 120 over 70 or less. It's often unhealthy, especially with people who are over 65, and they start getting falls and hip fractures, and they start getting TIAs, strokes, that cause decreased cognitive function. That's all ignored, because, "Low is good, dammit!" You know, no. Healthy is good, optimal is good, and what that is varies from person to person. So number one, 140 over 80, I'm a happy camper.

Rob Lutz 35:58
Okay, 140 over 80 is good enough. Right?

Jacob Teitelbaum 36:02
Good enough. It's plenty good enough for most people. There are times where there's exceptions, but--anyway, but that's plenty good enough. As I mentioned earlier, the salt was a very small player. What the studies show is that salt has a negligible effect, salt restriction, but salt substitutes have a sound effect on decreasing mortality. Why? Because salt substitutes are potassium.

Rob Lutz 36:27
Interesting.

Jacob Teitelbaum 36:28
It's a potassium supplement.

Rob Lutz 36:31
So are a lot of people deficient in potassium?

Jacob Teitelbaum 36:34
Yes. American diet is--

Rob Lutz 36:36
Right.

Rob Lutz 36:36
Why is that?

Jacob Teitelbaum 36:36
Because the American diet doesn't have it, and you can't really supplement it. Our government, and God bless them, in their wisdom made it illegal to put reasonable amounts, helpful amounts of potassium in a supplement. "Well, what if somebody with kidney failure takes it?" Thank you, sir. Everybody else will be deficient.

Jacob Teitelbaum 36:38
I guess.

Rob Lutz 36:44
Yeah.

Jacob Teitelbaum 36:48
But again, 500 of--as a very rough measure, 100 milligrams is like one milliequivalent. So if we're using milliequivalents, 10 to 20 milliequivalents a day is a really good supplementation level. So you're looking at a good mid. So one inch of banana would be about one milliequivalent, 500 milligrams of potassium in eight ounces of V8 or tomato juice. Half an avocado will have that much. So if you have a taste, see which ones you have a taste for, and start to include those in your diet.

Rob Lutz 37:33
Again, all sorts of other side benefits from doing that.

Jacob Teitelbaum 37:36
Yeah.

Rob Lutz 37:36
Eating a healthy whole food diet.

Jacob Teitelbaum 37:38
Healthy whole food diet. Tasty whole food diet. But again, it doesn't have to be can't--you know, I'll go out and have my pizza. You'll see me at Costco. My wife calls me a Costco-holic. She's right. And if you ever see a picture of me holding a Diet Coke and one of those big hot dogs, "Hi, I'm Jacob and I'm a Costco-holic." You know, most of the food I eat is gonna be really healthy, but it doesn't mean we can't, occasionally--

Rob Lutz 38:04
Exactly. Enjoy yourself. Do something fun. It's not gonna kill you.

Jacob Teitelbaum 38:08
Yeah. It's a matter of degree, not absolutes.

Rob Lutz 38:12
You know someone that's presenting with with hypertension, what are your recommendations for that patient?

Jacob Teitelbaum 38:17
Well, I will have them exercise, go for walks in the sunshine. I will start them on the blood pressure medications. If they want, they can take the berberine, and the Berberine Ultra Absorption is very good for that. There are other things I'm looking at. In two months, I'll have more data about some other things that may be very effective. But I will go with the ACE inhibitors, things along those lines. The medications are not bad for high blood pressure, and I'm not quick to get people off them. What I find is that if somebody has a very high blood pressure, it works much better to give them the medication, get their blood pressure down. And there's a nice one called Carditone, which is basically reserpine, an herbal, plus--I don't know the contents--I forget the company that makes that one. That's if you're looking for a natural option. But I do this. I will give them medications. I will bring their blood pressure down. I will keep the pressure down for a few months. I will do the lifestyle changes, and then they can wean the medication. Most things, I'm going to go the other way around. Diabetes. I'm going to start on lifestyle and then go to medications. Blood pressure is self-sustaining. Blood pressure starts to go too high, it becomes a vicious cycle where it keeps itself high. Easier to lower it through lifestyle, wean the medication.

Rob Lutz 39:34
And so if a patient was like 150 over 80, are you going to medicate for that?

Jacob Teitelbaum 39:38
No. No.

Jacob Teitelbaum 39:39
At what point do you think it's time to start considering medication?

Jacob Teitelbaum 39:43
165 over 95, I'm going to start the medication. 160 over 90, I'm going to give them lifestyle for three months. If it's still high, then I'm going to go ahead.

Rob Lutz 39:59
Gotta come back. Yeah. Okay. Anything else about hypertension that you want to share?

Jacob Teitelbaum 39:59
Those are the main things. Again, one of the main, one of many benefits, in part, when you're protecting the blood vessels, you're also protecting the brain. The research is showing that the blood pressure control helps decrease dementia risk. But there's so much you can do to prevent dementia. Most dementia, I think, is preventable, and that's a whole 'nother show if you ever want to do that. But I'm going to just let the viewers know, if you email me at fatiguedoc@gmail.com, ask for the Alzheimer or dementia prevention information sheet. I'll throw that in there.

Rob Lutz 40:00
That's great

Jacob Teitelbaum 40:01
Again, if you have people with Long COVID or fibromyalgia, ask for that information sheet, mast cell activation syndrome, chronic fatigue, blah, blah, blah. Yeah.

Rob Lutz 40:22
Great. We also talked a little bit about maybe discussing high cholesterol, cholesterol numbers, in relation.

Jacob Teitelbaum 40:48
I find cholesterol very easy to address, because I don't stress it.

Rob Lutz 40:53
Okay.

Jacob Teitelbaum 40:56
You know to me, cholesterol is like a wisp of smoke off of a fire. Fire is insulin resistance, and you have a wisp of smoke called cholesterol, which I don't think has much effect. It's just a wisp of smoke. And you have the high blood pressure and diabetes, which have their own effects and problems that need to be treated. When I look at the statin data--now, I want to make a distinction. For primary prevention, people who have not had a heart attack or stroke, do not have angina, they just have a high cholesterol, my reading of the data is that in that group, which is most of them, is you lower heart-attack deaths about 2% with a statin. Now let me put that in perspective. If somebody takes one small square of chocolate a day, it's associated with about a 45% lower risk of heart-attack death. If somebody owns a cat, it's associated with a 30% lower risk of heart-attack death. If somebody takes a statin, 2%. Now they will torture the data, because what they do is they take people who have had heart attacks and strokes and angina who need to be on statins. This is lifesaving for that group, and they put just enough of those in these studies that they get statistical significance and can torture the data. So I'm not a fan of statins, unless somebody's had a heart attack, stroke, or actual angina. If they are on a statin, I don't have a preference one to the other, but I will make sure they're on coenzyme Q10. Again, I'll use one with GammaSorb. It's a chewable 100 milligrams that'll be equivalent to about 700 milligrams of CoQ10. EuroPharma has many of these. EuroPharma--I'm sorry, EuroMedica in the practitioner line. Wonderful, wonderful product. I don't take money from any of these companies, so I get to be very picky, and I get to be very mouthy about what I like, and what I don't like. So there's, they will have a CoQ10 that is high-absorption. They have several chewable CoQ10s, the 100 milligrams. Give that with the statin to prevent the toxicity. But the LP(a) test, it's kind of like a new, "Okay, but what's trendy? What new test can I find? Oh, well, I'll read how many whiskers are on my cat. That's going to help." Yeah, no. You know, use common sense. I don't chase cholesterols or the lipid fractions.

Rob Lutz 43:18
So you're more concerned with metabolic health, right? That's what I'm hearing.

Jacob Teitelbaum 43:18
That's what's causing the problem.

Rob Lutz 43:18
Yeah, yeah. Root cause.

Jacob Teitelbaum 43:18
I want to put out the fire. I don't want to chase wisps of smoke.

Rob Lutz 43:23
Yeah, right. So, you know, we talked about a number of different things, metabolic health, diabetes. You've provided, I think, some really great guidelines, and a protocol for helping practitioners address that with their patients. We've talked a little bit about the impact it can have on on heart health, cardiometabolic health. Is there anything else that you want to share? Any pearls of wisdom in this area?

Jacob Teitelbaum 43:49
I'm going to come back to what we started with. When your people you treat come in to you, and they've been given a diagnosis, we tend in medicine to make it a diagnosis cast in stone that only the doctor can treat. "No! You will listen! Please, there is nothing you can do." I can't take this kind of thing. We disempower people. You're letting them know that diabetes is optional. You can make it go away on your own. This is something that was rare. It's a disease of the modern lifestyle. It doesn't mean you have to give up what you enjoy. It means learning. It's like learning the price of things: what's expensive, what's not. And that you can make it go away. I will guide you in how to do that. It's a very different message than, "You are medicalized forever."

Rob Lutz 44:39
Right. You're doomed.

Jacob Teitelbaum 44:41
Yes.

Rob Lutz 44:41
Empowering the patient to make the changes that will eliminate a condition that is very dangerous, but it's in their power to do it, and they got there by the choices that they made, probably not realizing the impact of those choices. But educating them about changes they can make, they can take control of, and have an impact and improve their health. That's the recipe, right there.

Jacob Teitelbaum 45:02
Right there.

Rob Lutz 45:03
Yeah. Well, that's fantastic. Dr. Teitelbaum, thank you again so much for coming on the show, and very informative. I will include all the links, so folks can get in touch with you for more information about some of the things you talked about, both on this topic, but the others that you touched on briefly. So thank you again, and we'll have to chat about the next topic, because I always enjoy having you on the show. Thanks so much.

Jacob Teitelbaum 45:25
Aloha, everybody.

Rob Lutz 45:26
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.