Low Carb in the Clinic: Treating Obesity & Diabetes with Diet & Lifestyle · #128 ft. Dr. Andy Phung


– [Announcer] Welcome to the HVMN podcast. What do we do with our bodies today, becomes the foundation
of who we are tomorrow. This is Health Via Modern Nutrition. In this episode we welcome Dr. Andy Phung. Geoff, take it away. – Dr. Andy Phung. Really good to have you
on the HVMN podcast. – Oh Geoff, it’s amazing. – No, it’s always fun
and positive to discuss with like-minded also unlike-minded folks that are interested in
human performance, health, and helping people just live better lives. So I think it’s always a
productive conversation, and I know that you’ve
been on other podcasts, and it came up on Zill,
our producer’s radar in terms of how you articulate it and then some of the ideas
that you have so excited to dive in and cover some ground here. But for folks who don’t
know your background, can we get a quick survey on your formal training, your experience as a medical practitioner and what
your focus is for today? – Sure, I’m a medical doctor. I’m in North Carolina, Raleigh area. Before going to medical school, I was in the Navy for three years and went to college in Madison. Then did residency,
both certified in family medicine, graduated in residency in 2010 and started practicing medicine. And then throughout that whole time my grandmother was diagnosed and treated with type 2 diabetes, eventually ended on insulin injection and
she had Alzheimer’s also. And then in the back of my mind I’m like, hey this family history
of diabetes here it goes inside the family. It travels in the family, you’re not overweight
but you certainly carry like 15-20 pounds over. Make sure you do something. And so we are very well trained into, hey if you wanna lose weight, just eat a little bit less and exercise a little bit more. And then so the seven years, I try to do what everyone been told, eat less, move more, eat in moderation. Then in 2016 I was diagnosed with prediabetes, A1C at
5.8 and I am like ‘5″8 and then we had 170 pounds. My BMI goes like 26.5 and
then most people would say, which finger of the left
arm do you want a BMI of 26 because that’s what I want. And I’m like, no, my BMI
is 26 I’m pre-diabetic and I’m exercising and I’m eating right. And then it’s not working. So that’s when I came across
a video by Dr. Jason Phung saying, hey you can reverse diabetes. And then in the back my mind I was like, wait, wait, time out. I just graduated quote,
unquote brand new doctor. Everything is up to today. Check out my certificate. It’s still stamp saying
I’m board certified. Hey, what’s going on here? How come he said you can reverse diabetes? But what we’ve been told is the chronic progressive disease and here I am staring with prediabetes in the
face, one under traditional medicines that you’re doing. Then someone else that no you’re not. Then so I started my
journey back was like, okay, maybe I need to listen to him to see what he has to say. And then, eventually it ended
up on the topic of insulin. Then in my mind was like, we all know insulin will make anyone obese if you give yourself the shot. If you have diabetes long enough, we all end up on insulin and once you’re on insulin you get
more and more overweight. – Right, it’s a very strong
point, an anabolic hormone. So sometimes bodybuilders for example, be taking
insulin to help gain mass. – Yes. But in the back my mind
was like, wait Andy, you’re not on insulin. What’s wrong with you then? When he came across the
topic of the three Macros, you know Carb, protein and fat, and the difference in the
amount of insulin that each food group releases. And then that was when
the connection was made that because I am ethnically
Asian and you’re Chinese. Then we eat a lot of rice, we eat lots of noodles and we
have lots of those sweet tea. They don’t call it sweet tea, they say like, sweet sugar juice. I was like, oh no wonder
I can’t lose the weight because of all the sweet
and sugary stuff that I eat. And then that’s when my journey started. – Almost every one of us I think that are sensible and thoughtful, have this point where, am
I turning into a charlatan? Am I turning into pseudoscience? I think probably all of us had that moment where it’s like, okay, I am veering off of traditional medical consensus, right? I mean, there’s very credible, repeatable professors who
talk about a mixed diet, and you’re making sure
you have the carbohydrate, and all of this stuff, and obviously you come from
that training and background. You’re a formal MD board certified. What was your thought process as you’re looking at
kinda these trajectories, it could stick with the
status quo and wasn’t working for you personally, or did
you feel like you’re being a real scientist and
actually looking at data and questioning the dogma? Can you walk us through
that thought process? – When I look back, I was like, okay, I understand insulin, I understand carbohydrate
drives insulin, so I said, but does it really work? What I had to do was I have
to put myself on it first. I have to say, okay, you’re
not going to eat rice anymore. You’re going to go home and have your veg, and have your meat and then. you know, if you’re not hungry, don’t eat. So within three months
I dropped like 25 pounds and I went back and
checked my A1C it’s 5.4. And then, so now I was like, okay. But in the meantime I’ve
been learning more and more. So after three months I
started questioning myself. I’m like, Andy doing the day job, you write people pills and a shot and awe to treat their type 2 diabetes, hypertension and everything in between. And here is something that works for you. What should you do? I was at a crossbow of like, maybe I should not say anything. Maybe I should just continue to ride the medicine because it’s so much easy. It’s really easy. If your blood pressure is high already and you on one medicine,
we either increase the dose or we add another one. If your diabetes is high, it’s easy. Everyone sees high, we eat or if you’re on three medicine, or already we can add insulin. So it’s really, really easy
from that point of view. But then I was like, look, but they’re getting worse. They are getting fatter by the day, their blood pressure get worse by the day. I started really slowly
just with type 2 diabetes, just with people who are obese trying to push low-carb and say hey, I understand that I
wrote you insulin before. I understand I wrote you
diabetic medicine before, but man I learned something new here. Would you like to start on this? I think I can help you. And then one person, they go on they start losing weight and now it’s you and another patient and another patient
and another patient. They’re like, wow this is amazing. And while you’re doing all this, I think once you go in,
you’re not coming out one, you do check out one rabbit
hole and you go in another one. And the next one was like, what? Obesity or the standard American diet will also the try ADHD because it’s a metabolic
instant resistance syndrome of the brain and low-carb in to being fast and go also fix that too. It just one thing after the next. So the journey is really, really amazing. But at the same time it’s a lot of work that we have to do. We see patients, we get like
20 minutes per patient at most. And if you spend all that time talking, who’s going to and when are
you gonna do the documentation? So you bring the work home, which is sad but that’s
what you have to do. – I think that sounds very interesting trajectory and matches
a lot of the experiences I’ve had speaking with MDs
and medical practitioners as they go through the personal journey, through their training
and then through working with patients and seeing
how the interventions affected their patients. And I think the end goal for all of us is that we want our patients
and people in society to be healthier. And I think you just see the experiment in your face as opposed
to from a textbook. But I think why I am
excited and optimistic is that I think the dogma is shifting. I think you see a lot more randomized controlled trials backing the observations on the clinic side. So I think you see the
Virta Health studies showing that ketogenic, low-carb diets are very
potent for controlling type 2 diabetes. I think the data, and the research is going to emerge even more. So I don’t think this is like, hey we’re just talking pseudoscience. This is well documented, and I think there’s a very quickly
growing corpus of data justifying and providing evidence for some of these new
interventional suggestions and recommendations. And I think just within
the last few months you had ADA update their
nutrition guidelines incorporate low-carbohydrate and ketogenic diets as part
of a nutritional adjunct. I think we’re starting
to see the world change. – We are seeing change. Sometimes you wonder
like why is it so slow? I’ve been doing this for
almost three years now and then people are
still coming by and say, “Hey Dr. Phung, you’re
the first one to tell me “that the carbohydrate in
our food is not helpful.” And I’m like, what do you mean? I hear it every day? I hear it on Twitter, I
hear on Facebook groups, but how come we don’t get
in the mainstream media? And I’m not really sure who is pushing the agenda for instance,
with Virta and their study. You don’t see giant news
world or organizations coming out and say, “Hey look, “we can put type 2 diabetes in remission at two years at 60%” Do you hear that? I don’t see that broadcast coming out. – Yeah, it’s only on nutritional
Twitter or same thing. I mean that’s, we can talk about that where that’s a
little cluster of craziness in of itself. But yeah, it’s not very well known. And I think if a pill
who was able to resolve diabetes are that 6% rate, that would be a blockbuster drug, which is I think a very interesting comp in terms of the level of
publicity or knowledge of something that this is that profound. – It is, the idea is that we in America are so sick as a society. I don’t remember the study, but it came out of UNC,
a school of medicine, 88% of adults in America
have metabolic syndrome. What does that mean? Yeah 12% of Americans are metabolically healthy and then when you look around, you start seeing people who might not be
overweight, look very badly, but they have these potbellies that is waiting to happen. – Yeah. It might be helpful for
our listeners actually, because I think we’ve talked
about metabolic syndrome. What are the key quantitative
markers that diagnose one? That’s fine. Metabolic Syndrome. – Yeah, so metabolic syndrome, it comes in five things. First is we call them central obesity, carrying too much weight
in the middle of the body, followed by elevated blood pressure and then impaired fasting glucose first thing in the morning and high triglyceride and low HDO. If you have three out of five,
you have metabolic syndrome. But it’s not necessarily to have all three or all three of the five
have metabolic syndrome. If you just have one of the five, you can have towards that two of five, three of five and it will come and it will come very slowly and
because it comes so slow that people will see, I
just carry a little bit extra weight in the middle. I should be okay. And next thing you know, your triglycerides start
going up and then it, it’s just one add on to the next. And we know what drives
metabolic syndrome, which is insulin and then we fixed the insulin problem actually known as hyperinsulinemia or insulin resistance. It depends on who you
talk with and if you fix that with low-carb and
intermittent fasting it literally fix the root cause of metabolic syndrome and
then you don’t have to deal with a lot of other
problems that comes with it. – Obviously in the
low-carb community we talk about insulin as a terrible thing, and we can talk about that. I think people that are
aware and know about ketogenic low-carb lifestyles have probably heard about
wanting to produce insulin load. It might be refreshing to talk about why you’d want some insulin or what would be useful load insulin. For example, to gain mass and for the athletic performance perhaps, you’d want healthy acute loads of insulin to be able to be anabolic
and grow mass and recover. Can we break down the good uses
or the good roles of insulin versus some of the environmental variables that make insulin harmful? Right, I think that’s
like an interesting thing to just tease into until
a little bit more deeply, if one has a first level understanding that I think most people in our
audience have at this point. – Insulin is a growth hormone, it lets the body grow,
it lets the body build. The thing is that you must have insulin for you to survive, if you
don’t have insulin you will die. You cannot metabolize food and then you will die and
so that is type 1 diabetes. If you have type 1 diabetes where you have zero insulin, you will die. And so to keep type 1 diabetes alive, we do have to give them insulin like exogenous injectable insulin. – What was the predicted lifespan? I mean I’m not super, I’m not very deep on the literature there but
people would not make it past teens or twenties right? People would just waste away. – Yeah, if you don’t have insulin, you literally you will
waste away before 19, 21. But since then we had
insulin and when insulin came out we say, look, we
have a cure for diabetes. Now everybody can just go on insulin. But type 2 diabetes, they
actually have too much insulin. That’s the different between too much and too little. So where we want is we
want the sweet spot. People say, “Well what is
the sweet spot for insulin?” Generally less than five. So a fasting insulin
should be less than five. And then if you check most
people’s fasting insulin, it will be high than five. So that’s a sweet spot for you. – And I think what you said is
actually not obvious, right? Same as type 2 diabetes is a disease of too much insulin is
actually would be controversial in some circles because
the treatment of choice is more insulin. So I think that’s actually a subtle point. And I would say that
probably like the more subtle definition, at
least in some circles would be type 2 diabetes is a problem of too much sugar, which you would control with adding exogenous insulin. I think that is the core
question in the bait between the two camps. If you were to isolate
one line in the sand. – When people have type 2 diabetes, when their sugar are very
high at the tail-end of it, is that they actually
don’t have high insulin, sorry, type 2 diabetes
when you give insulin at the tail-end of type 2 diabetes, it’s because the insulin
that the body is making, the pancreas is making
the body stop responding to the insulin. So you if were to measure type
2 diabetics insulin level, unless they have it for so long, they literally killed a pancreas, they will still make insulin, and you can check the C-peptide level and that will still be there. So the question is,
well if they are making insulin then why doesn’t
that insulin work? Why do I have to give them more insulin– – For the same response.
– The same response. So, because the insulin had been so high, the receptors throughout the cells in the body like the muscle, the liver and all that,
will literally downgrade, remove the insulin receptor, so you can send as much insulin out, but there’s no receptors to bind to it. You can’t trigger the biological process where you can let the sugar go in. – It makes so much sense
from a first principle systems or engineering approach, right? It’s just like because
we have more and more baseline insulin, your body
builds resistance to insulin. It builds up resistance. The caffeine, stimulants, virtually any exotic just compound. There are some resistances build up and insulin is no special, no different. And you have less and less of an adaptive response given the same level of signal. And I think that’s the flywheel that, it makes so much sense from
an engineer’s point of view. That’s from my point of view is this, that’s how you would design a system. And maybe I just don’t
have those bad habits in terms of just accepting that. – No, because we’ll pretend right? If the body said, well I’m going to listen to insulin all the time and
insulin is an anabolic steroid. Anabolic meaning you’re going
to get bigger and bigger. So if you have more insulin, you can get really, really, really big. And then if you think about in the why, if you get so, so big, you get eaten, some something will come and eat you. So because there’s actually
a protective mechanism, but what happens is that, I tell people the joke is that we’re not in the wild anymore. We don’t sleep under the bushes anymore. And then because the way we eat, we have lots of lots of carbohydrate and we just don’t eat three
carbohydrate meals a day. When I was growing up, I would eat three
carbohydrate meals a day, and you say, where’s my snack? It’s not there. So while you’re not eating, your insulin can come
down because continued high insulin actually
dries insulin resistance. But you said, well what’s
wrong with the Americans? But like, well, because we eat three giant carbohydrate meals a day and then between those meals we have giant carbohydrates
snacks throughout the day. So literally, you have these high insulin then like 16-18 hours
a day and the body say, look I can’t let all these insulins, it tells me to get bigger and bigger because we’ll be in trouble. As far as if I’m still in the wild. – But I think the good news is that you can make pretty
acute changes that are pretty impactful on these bowel markers. I need to look like my exact blood work. But I think when I was
doing an experiment, I was doing a normal diet and then a hard ketogenic fasted protocol. I believe my insulin
was generally healthy, so it wasn’t super high, maybe it was probably around five, and then I was able to drop
it to like one or two units after three, four, five, I think it’s about a six week
ketogenic diet fasting period, which is the good news, right? That body’s adaptive, and
you can shift pretty quickly. I think luckily if I probably didn’t have years and years of abusing my system of carbohydrate to get
to the point that it might take longer to correct, but I was decently
surprised to see how quick some of these interventions could work. – Generally speaking, if
we restrict carbohydrates, the body will start burning fat within like two three days slowly and then the speed picks
up by about 10 days. But usually within three weeks of carbohydrate restriction, your insulin will be really, really low and then you’ll be burning fat. And so people like,
well what’s the problem? Why can’t the insulin be high? And I’ll be burning fat too. The answer is you can’t– – They’re opposing forces, literally. – That’s right. So, if the insulin is high, it’s like, look you need to lay down fat. The key goes if you’re laying down fat, you ain’t going to burn any fat. And then so that’s why we have kept, the insulin really low for people who are overweight or have
metabolic syndrome for them to burn off, especially the visceral fat. The fact that– – Maybe let’s go one level deeper. So insulin (murmurs) like policies and you have the opposing hormone glucagon that releases glucose and supports that fatty acid metabolism. And I think what you’re describing is that literally insulin
is the signal that your body perceives that at halts life policies. – Yes, so for instance, if someone who comes to see
me and they are overweight and then I’m like, okay,
so your overweight, then we need to get
you to lose the weight. In order to lose the weight, we have to low your basal insulin level. And then, the only way to
lower your basal insulin level is stop the carbohydrate because carbohydrate relative
to protein and fat drive begins then the highest. So first it’s get your
carbohydrate down to get your insulin down. And once your insulin down your body will start that burning fat. So people say, that’s all I need to do. I said not exactly, it’s for
people I watch the problem? Can I eat low-carbohydrate meal 24/7 and lose this fatness? I said, there’s no way
you’re going to lose that fatness because even though when the insulin is down,
you’re going to burn fat, you’re gonna burn the exogenous or the fat you just eating before the body will burn the store body fat. So technically speaking,
they are really no food you can eat to lose weight, you really have to stop eating, so that’s called intermittent fasting, and in America we eat 18 hours, 16, 18 hours during the day, so that’s why we are not
burning any fat at all. – I think that’s a good point. And I think this might be a little bit in the weeds and this is
a traditional Twitter land where to give people that might not be following
the discussion as closely. There’s this big, I would say one school of thought that’s more
calories in, calories out, and then is more one of the
carbohydrate insulin model, which is based on insulin as
one of the primary mediators of weight gain and weight loss, and I think what you
described as quite nice, which that it’s really both. You need a control,
your hormonal response, and you also need to control
your calorie count as well. I think, I would say that most scientists I talked to from by
those camps also agree, but I think there’s that academic, very, very technical differences where they’re arguing
what is more important than the other, and I think
there’s some rationale of why you be wanna having a hierarchy of what is a more important driver. For example, I think folks
on the ketogenic school, say that, you have suppressed appetite with the ketogenic and that would lead to lower caloric consumption, which resolves the calorie
in, calorie out model. But I think that is overly technical and might not be actually practical, which I think you’re saying is that reduce the carb intake but
also don’t like just eat pounds of fat as well. I mean you also have a little
bit of a chloric deficit. – Calorie in, calories out make it really, really easy to tell the patient. So if the patient is overweight or obese, all you have to do is eat a
little bit less of what you eat, and then if you burn a little
bit more of what you store, you lose weight. – That has failed. – And the catch is it does work, but it only works temporary and because it works and
when it stopped working then the doctors that are
looking at the patient say, “Hey, you dropped at 50 pounds. “What’s going on now? “You’re gaining it back.” “Are you slacking again?” – Yeah, you’re lying to me. They don’t trust the patient, right? – No. – Yeah, so I think it’s
having both, right? You need also the hormonal response to the insulin control as well. – If we eat the standard American diet, the insulin is quite high. If we just reduce the
portion of that we eat, yes, the insulin is lower, but it’s not going to get
to three to four, okay? And you can’t get it to three, four, and then because you can’t get this low, because the other function of insulin, is that insulin actually determines our basal metabolic rate. What it really means is insulin determines how much food, energy the
body’s going to use to burn. And then so, if you reducing the food that you eat and then you
try to increase the amount of exercise you do and
the insulin is still high, your body’s going to say, look, what food is
coming in is not meeting the caloric expenditure,
so I’m going to lower my basal metabolic rate. So instead of burning about 2000 calories, you’re not going to burn 2000
calories six months later. – Yeah, I think that’s a
good way to articulate it. You’re giving your body
very conflicting signals that wouldn’t necessarily be received in a more national food
environment, right? It’s like a very weird
artificial state to have high insulin response
with a caloric deficit. It’s very opposite signals. – It’s confusing the body, and it doesn’t work in the, it’s called a free living environment. So if you live in a house where you buy your own food versus
if you live in the lab where they control your food. So if we all live in cages, yes, you can restrict calorie, and it works, but we don’t live in cages. We have like what, 320 million of us. Not all of us are in prison, so that’s why it doesn’t work. – I think for the 88% of Americans that have metabolic syndrome, I think the general guideline
of reducing insulin load through reducing carbohydrate
is very, very sensible. It’s like a very easy
understandable first step to resolve some of those health risks. And fasting is basically
a more restrictive version of not eating
carbohydrates, right? Just eating nothing.
– It’s like nothing. – But I think probably a larger percentage of our audience are metabolically healthy and are looking to optimize. I’m curious in terms of your experience, whether personally or your clients, are you mainly dealing with folks with metabolic issues or
just general health issues? Or do you have also have
some insight into people that are more on the healthy
side looking to optimize? – I don’t have too many
people on the healthy side, but I can talk about myself. So, what happened was that, after I dropped like 20 some pounds, start hearing more and
then I knew that hey, exercise doesn’t help you lose weight but exercise can help you
build your muscle strength. And then so I started taking up exercise and then so, I’m actually
kind of proud of myself. I can do like 20 pull
ups on a monkey bar now and I couldn’t do before. – So even when you’re
in the, in the Navy yet, it’s like, I think I remember I looked at this actually very recently, 23 pull-ups for a man is considered 100%, or 100 out of 100 score on
the Marine Corps fitness test. – But the Navy was like,
I left the Navy in 1999. You know what I mean? Now it’s 20 years later I can do a 20. – I mean how much were you doing for your fitness test in the Navy? – We didn’t do pull-up back then, but from what I know
is that if you wanna be a Navy SEALs candidate,
all you have to do, is do like, six pull ups, that’s it. I would like, (murmurs)– – I mean, in knowing a
little bit about community, obviously six is kind of like, the minute of the men to
even qualify to like even do a pre-fitness screen of
the pre-fitness screen. Obviously the folks in special operations are doing much more than six poll ups. – I think in the health part
is that I talk more about autophagy or intermittent
fasting is a promotion of health, because when we eat, whether
we are eating carbohydrate, we eat protein, we eat fat or
a mixture of all the foods. When food goes in, it actually
stresses out the body too. Think of the blood vessels and the vein and everything else as a row. Now we’re going to put
all this food depending on what will you call it in the row, and you have to incorporate
that food some way, you have to put it somewhere, whether it’s amino acid
or fatty acid or glucose, you have to put it somewhere. So the key goes is
that, well then how does intermittent fasting help you? Because if you’re not putting anything in the row that there’s no food. But the key goes that in the blood, the body always need about five grams of glucose for the brain,
for the red blood cells, and for the kidney to be alive, because they are obligate
glucose users, but not the brain, the brain will need about
20% of it as glucose, the other ADC, and can
come from fat or ketones. So the key goals is like this, so well how does fasting help me then? So what happens when you’re not eating? The body will say, hey, I
need some glucose here’s, but my glycogen is gone, so what happened is that the bodies start going and tearing or
breaking down the damage or the protein that
would have been in excess to clean up the area and
then turn those proteins back into amino acid and turned those the amino acid back into glucose called
the nova-gluconeogenesis to keep the glucose levels stable. But the next time when you eat then you can say, hey look,
the area that was damaged, I removed most of that junk, I turned into sugar, I
burned it off already, so now I can repair that area. So that is like autophagy or cell repair, it goes by many names, and when you repair an
area that is damaged, now you’re actually fixing the problem. So that would be like, so
in the performance part, then I would say we do need some fasting because when with fast and we
get the insulin really low, we can repair the damage area and when we feed again
we can repair that area. – I think that’s, I
would say a relatively, I think active area of research. How would one incorporate fasting for performance use case, because I think it’s
very nuanced to prescribe a ketogenic diet for
a performance athlete. There’s a huge role of
carbohydrates as a fuel, and I think there are
different schools of thought, well with like you know
Volek and Phinnie’s work with ketogenics for some
assets of performance, but I think it’s by no means as strong of a case as something of a fascinating ketogenic for type 2 diabetes. I think that is a very,
very a clear story, a very, very clear mechanism, I think from a performance perspective, I think that’s like a
really an interesting new area of research, and I think I would just wanna make sure that the low-carb world isn’t overstate its claims on the performance
side of the field, because for a lot of performance athletes, you’re not optimizing for longevity. I mean the activities they’re
doing are very, very tough. It’s so like it’s orthogonal
I think that the end points, is a very different process that optimized for how many eaters that you’re a quote unquote healthy, versus I wanna win an Olympic gold medal, what can I do to like
push my body to super hard for the next two years to
get me to get me there? And those are very two different goals. – No, they have very different, even if you’re trying to
win the Olympic gold medal, but the key goals is that
if you want to do like, I wouldn’t say like ketogenic diet, but at least like low-carb, right? If you reduced the amount of carbs you eat or no sugar gel that you use, this is going to have
take time for your body to ramp up fat burning. So if you say, look, tomorrow I’m going to an athlete,
but when they get up, like, in two weeks, I wanna
go out and win a gold medal had been caught bloating forever, fon’t do it because it’s not gonna work. And then it’s going to take months to at least get some fat adapted. And then they’re also talking something, carb loading strategies. Sometimes you might need learn it here and you might need a little
bit there to get optimized. So now, I mean the carb is not all bad but the key goes it’s, but those athletes, generally speaking they
are insulin sensitive because they are very young. But what I’m talking
to my patients that no, they are not trying to win gold medals. They are hauling like 50 pounds, a hundred pounds too much. And so it’s really not for them. These carb loading stuff
is really not for them, it’s for these people who are very young. – Use it as a tool for the right place on the right time, which
I think is best practice as we work with different athletes and different groups in
terms of how you can use exogenous ketone something that we’re very deeply involved with
or exogenous carbohydrates, like sugar gels and all that stuff. That might be interesting segue. I’m curious in terms of, have you had any experience with exogenous ketones? Obviously we talked a lot
about endogenous ketosis, or essentially what I mean by that, is essentially we’re talking
about low-carbohydrate, low insulin states and
as a side effect of that, you’re oftentimes inducing ketosis in doing that in the natural
physiological process through ketogenesis. I think that’s a very
interesting area of research, how ketones themselves
could be an interesting signaling metabolite
for different pathways. So ca you either go
down that route or talk about exogenous ketones
and if you’ve experienced or thoughts in that route. – I haven’t had any clinic experience with the exogenous ketones, it was tempted to say
because there was a lady who has dementia, a lady with dementia
came with her husband, and obviously with metabolic
syndrome, but no diabetes, again, you don’t have to have
diabetes to have dementia, it’s on the incident-resistant spectrum. So I knew that if I can
get her carbohydrate lower, she will basically start burning fat, and when you burning
fat is that fatty acid do not cross the blood brain
barrier or very difficult. So what happens to the liver will convert that fatty
acid back into ketone, and ketone bodies are more soluble, then you can cross the
blood brain barrier. So they said, “Well, why
are you trying to do that?” Because from what we know from at least the direction of what
we know about dementia is that it is an energy crisis, there is not enough energy
going into the brain. And then people are like, wait, what do you mean there’s
not enough energy? They eat all this food and
look, they are overweight, how come they don’t have energy? It’s because of the years and years of high carbohydrate diet,
the blood brain barrier has down regulate the
receptors for insulin. So insulin can no longer go to the brain. Well if insulin cannot go to
the brain, then what happens? Insulin is an anabolic steroid, insulin help things grow. Well if you don’t have
insulin in the brain, how you going to grow neurons, how you going to go grow connections? You can’t, and so if you can’t grow that, then your brain going to shrink. And so, that’s what dementia
is, it’s a shrinking brain. (murmurs) But how can
the sugar not go there? This sugar can, but if you don’t have any
insulin, you can’t incorporate it. Then, so people like, well,
so how does ketone help them? So because ketone does
not need insulin to open the door at the blood brain barrier. So now you switch the fuel source. So if you switched the fuel source, now the brain will say, look, there are ketones
around that I can use. So now you no longer in fuel crisis, so people would actually get better. So, in her case, I try,
but the family was like, Oh, you know Dr. Phung she’s too far gone. I’m like, what do you mean? And they, I’m like, well she was talking with you guys last year. I think it might not be 100%
but I think we can help. But the family wasn’t buying. But I did get somebody else who was having early cognitive decline basically before dementia and he had prediabetes, A1C at 5.8 and then a central obesity, high triglycerides, low HDL. And I said, “You know what? “I think I know why your
brain is not working well. “I think its instant
resistance of the brain, “because of your body
habits and the way you eat. “Let’s get your weight
down by the right way. “Not Calorie restriction,
but carbohydrate restriction, “to get your insulin down.” And guess what? Before we started the
low-carb intermittent fasting, he needed two chaperones to
come with him to the visit, because he would go off because
he wasn’t himself anymore, but after losing 40 pounds, he’s driving himself to the practice, he doesn’t need chaperone anymore. And people are like, what’s the point? The point is he’s like 63, how long you gonna live with this problem, if you don’t fix the root cause of it, the key goals, if you
don’t fix the root cause, the next thing you’ll know, is that he’ll go to a nursing home, and then there might be
wet flow, he will trip, now he going to break his hip, and exemplar case (murmurs). It’s going to be suffering, it’s terrible. – It’s a bad place to be if
people sort of have given up on you being a functional
member of society, right? Okay, we’re going to park you on the side and wait for you to die. And equals one case, one single case study. But in the community, and I
think just our customer base, so listeners, I think you hear a lot of these stories and
hopefully we can do randomized controlled trials to really assess this in a formal more rigorous way. But I think exactly, I think what you articulated makes a lot of sense
in terms of a mechanism or describing a mechanism,
that make sense, right? Yeah I have a insulin
resistance is the brain, there’s an energy deficit in neurons, and that might be
prohibiting neurogenesis, or you’re not allowing
the neurons to recover and heal and fix them, repair themselves because of energy deficits, and can you rescue that function with an alternate fuels source, right? I think that’s an active area of research that I know is ongoing today. – And with n equals one
at least for that person, he said, “Look, it’s 100%.” So for him, he literally went a lottery in his brain for his brain
and so how many of doctors would be willing to say, “Hey I think we can do
something about this.” Because most of us are still stuck in, hey
you need to eat less, you need to move more, because you’re overweight
and you’re losing your mind. – Yeah, what is standard of
care for early onset dementia? Is it just like, you’re screwed? Because all the neurological
programs for pharmaceuticals don’t really work, right? – They don’t. So this is what they say. Well, so they will give
you something called a Mini-Mental Status Examination, I think with like either
25 or 30 questions, I think is, but anyway,
it’s a questionnaire test, and then see how well you do on it. And then if you don’t do well and say, well now you either have
mild, either your normal, mild, moderate, or
severe cognitive decline. Then, the flow sheet will be, well if that is the case
we’ll make sure a few things are not causing your
(murmurs) copper to decline. So they if said, well
we’ll checked your TSH, most of it is time it normal. Make sure you check on your RPR, make sure don’t they don’t have syphilis because that will ask (murmurs). You know, they tried to
look for these zebras and in the in front of them
as if they just checked insulin level, I promise them it’s high. It will be more than 4.5 or five, and then if that is the
case, then you go wait, everything is normal
but my insulin is high. Then, people are like, well doctor, what drug can I take
to get my insulin down? And I’m like, I’m sorry
that no drug to take to get your insulin down, there’s lifestyles you can
do to get the insulin down. So we as a society are very nearsighted or at least trying to say, hey, give me a pill to fix whatever I have because there’s only one solution. It’s the pill or nothing., and unfortunately it is
not, these pills don’t work, and then people just go down hill, and when they go down hill, they said, “Well Dr. Phung, don’t you know “that there’s no hope for them, “so why do you even bother with them?” Which is really sad. – I think that’s nicely articulated. I think my increasing concern or question with a lot of these spot drugs, is that the more you dive
into the complex systems of how everything interconnects, there’s so much targets for
potential pharmaceuticals, and so much side effects
that are not targeting, and it’s like very, very complicated, and it seems naive for humans to say, hey, we’re going to target
this one specific drug target, and we think that’s the only thing that’s going to hit, and we understand all the
myriad metabolic pathways that one target hits. It’s very complicated. I think there are people smarter than me, that probably understand
that very, very well, but I would still say that I think they would be arrogant to
claim that they understand the 100% downstream effects of any specific drug and
how it hits that target and understand all the side effect targets that it might be hitting as well. – There are always two things, you know there’s the risks and the benefit and then so with a lot of these drugs that you hear in the market,
all you hear are benefits, if you turn on six o’clock news, I don’t watch it anymore, but sometimes you do to channel surfing, you go by, you say, hey, talk to (murmurs) about this. I’m like don’t talk to me, because I don’t wanna hear about it. The key goals is that when they get to the side effects, they
just read the darn thing, you know, take like half of the commercial just to read the side effects. And I’m like, so you are
expecting like a family doctor, like I am that have 20 minute patients, seeing about 18 to 20 patients a day, to come home to research
on this drug for you. Come on. And then so it literally
next to impossible. So as doctors, what do we do? We just listened to these
organizations before this, the ADA, well they look, if
your patient is diabetic, just eat whole grain, get
fresh fruit, eat lean meat. Oh, that’s what they should be on. And then it doesn’t work. Then, when it doesn’t work, then they say, “Well look, it is a progressive
disease and that’s why.” You just, you’re doing the best you can. But the key goals as doctors, we just don’t have enough time to do a lot of these deep dives ourselves. And so we listen to all
these organizations, but unfortunately a lot of the guideline that comes out from these organizations, I don’t wanna say it
sounds like conspiracy, but a lot of people who sit on there, they get a lot of funding from industries that sometimes like, are you really there to write a guideline for all of us? Or are you there to write a
guideline for the industry? And to me it seems like
it’s for the industry. – Yeah, I’m not a conspiracy
theorist person myself, but I think it is important to realize that folks in academia,
folks everywhere have biases, I have biases. I think it’s more obvious of what my biases might or might not be, but I think t needs to
be clearer that you see a lot of professors at very,
very repeatable institutions and you look at their
conflicts and disclaimer page, it’s like boom, they literally involved with 25 companies. It’s like, whoa, this person has a lot of their hands in a lot of different money pockets. So not to say that you
cannot be high integrity and besides driven with conflicts, but I think it’s important to realize that we’re all humans. There is that natural
tendency for prejudice or ambition, or impact
that is important digest as you look at the guidelines. And I think that interest in the course of history guidelines, I’ve never had a really good
track record, unfortunately. It just like the guidelines have changed every 10 years and maybe
our best practice today will change in 10 years. I think I’m humble enough to realize that if there is better
science and better evidence of how I should be changing my diet for end points I care
about, then I will change. And it doesn’t sound like, well either of us are
dogmatically religiously tied to low-carb ketogenic diets per se, but I think he evidence,
the body of evidence suggests that this is the right track given the entire
everything that we’ve seen. – That’s right. You have to look at the
totality of the evidence to judge it for yourself. And then the totality of
evidence is quite why. And then because of the time constraint that we have in the big medical systems, we just don’t have a lot
of time to learn ourselves. And because you can’t learn it yourself, then you just have to follow
what the big organization has to say. And unfortunately, sometimes it’s just not the right thing, and it might be the right thing, but the results might be very small, and if the result’s small,
but then something is vigor, then why are they not
saying something about that? It’s hard to say. So people will accuse the low-carb people, we are all conspiracy theorists saying the government is there to harm us, the organization is here to harm us. But if he goes that
there is a lot of money exchanging hands at the
expense of the patient. The 88% of the Americans are being robbed, I would say, if they are not being told that the low-carb is
actually what would be better for them, than the
understand American diet. – Before we went on live, we were talking a little
bit about the insurance pay or payee structure
and how you recently moved from a medical group to
more of a private practice, and not as fancy for
say, a concierge doctor, but more in that style for folks who know what concierge doctors are. And I think you would agree with this, correct me if you’re wrong,
but drugs have their role, drugs are important
for a lot of use cases, (murmurs) they don’t take drugs when they’re presented properly, but I think it goes back to your point, I think a lot of lifestyles
intervention changes are so impactful because that’s something you do every single day where a drug is like one spot change
you do for like four weeks. And I think sounds like one of the things that I’m curious to get your thoughts on is in the traditional
billing insurance system, doctors get paid for writing or encoding to an insurance code, right? You can build insurance company, because you diagnose this, and you build this, or you
can prescribe this drug, and boom, you get paid X amount of dollars for that and then, and there’s no code for low-carb diet, right? – It is called nutritional counseling. It’s kinda funny because
nutritional counseling takes a long time. So when I found out that,
hey, can you use low-carb to help people with
diabetes and weight problem and things like that. I went and talked to the company, the medical system and say, Hey, I would like to do a group teaching. I would want everybody to come in. I want you to introduce the
concept of low-carb to them, and then I would like them
come on a specific half day, and I will just lay
down the science, like, insulin, insulin resistance, what it does, and here’s how we’re gonna fix it for you, because 20 minutes, you don’t
have time to explain all that. So we got there and I talked to them. They said, “Yes, Dr. Phung,
we’re going to pay you.” I’m like, “How much?” They say, “We’re gonna
pay your $20 per patient.” And I’m like, if I book six patients for the morning of
Thursday, we’ll make it up, and then they pay me $20 per patients, so I’d make $120 for the whole morning, so how am I supposed to pay my nurses, how am I supposed to keep my build up? How am I supposed to pay
my malpractice insurance? There’s no way you can do that. – What would you get paid if you’re prescribing
metformin or insulin? – So it’s called ENMCO. So evaluation and management code. And so, if you come in like the first time with three chronic problems,
but if you establish and care, it’s going to run you two, $300, by just writing the matters. If you have diabetes, here’s metformin, you’ve had high blood pressure,
here’s your lisinopril. If you have cholesterol, yes,
here’s your lipitor for you. And all you have to do is
like the patient came in, 50 year old came in with diabetes, high blood pressure, cholesterol,
blood pressure looks good, no need to change medicine. A1C little bit high. Let’s start metformin and then
because the patient diabetic, let’s start them on the stand
to prevent heart disease. You can do that in like seven minutes. – And then you get paid 200,
300 bucks in seven minutes. – Yes. Then, so you crank it
out you every 15 minutes because you’d take seven
minutes to see the patient, write them a prescription, send the prescription to the pharmacy, and then you go to the next one. And the other sad thing
goes like this too. So after you see the patient for diabetes, high blood pressure, cholesterol, you write them the medicine and at the end they said, well my throat hurts too. Can you look into to it too? Then, now we’ll do either do a strep test or flu tests, whatever the case. But since you’re done most
of it already, you say, oh, what the heck go,
I’m just going to submit the 99213 and then we send in the bill, it doesn’t go into the
insurance right away, it goes to this place called scrubbing. So they actually, literally hire people to look at your chart to
make sure you can up code, to say, look, do you know that Dr. Phung actually added this sore throat in, and he didn’t bill for it, and now we can actually
going to charge you $400? And you’re like, do they get $400, the answer is no, they don’t get $400, it’s all based on percentage. It’s like we’re North Carolina, so we have Blue Cross Blue Shield. So if you’re a Blue Cross
Blue Shield patient, if you’re a client, then you pay Blue Cross
Blue Shield Premium, then Blue Cross Blue
Shield pays the doctors whatever they charge you. But there’s between Blue Cross
Blue Shield and your doctor, or your medical system. So, the more people you
have in the medical system, the more the medical system and said Blue Cross Blue Shield, we have a lot of doctors here, all of them are under our roof. What percent are you willing
to pay Blue Cross Blue Shield? They say, oh, we’ll pay you 30%, and the medical system said, no, we have lots of doctor. We want 35 and then, but the key goals is that because it’s a percentage wise, but the key goals, when
you submit that $400, you only get like, 35% of that $400, but if you don’t have
insurance, guess what, they’re going to shaft you with $400 bill. And they said, well that’s
what we charge you for. So it’s all a game. It’s all game. – And then the medical group, again, like they’re incentivize
to scrub and code properly. – Code up, properly
meaning up, not down, okay? Let’s just be honest here. – That’s wow, because I think every
person in that system probably wants good for the end patient. But the incentive structure, the money is forced in one direction. That’s rough, right? Then it’s like, okay,
you take your morning, talk to six people, and
you get paid 120 bucks, or you can crank out seven
of these, make 3000 bucks. And it’s like, man. – So because of that,
because of time constraints, and not just beside the money, but they also have this thing
called quality measures. So what the medical system will talk to Blue Cross Blue Shield and
say, “Hey, you know what?” “We’re doing very good
without patients management.” They said, “Well, how can you do that? “How can you prove to us?” So the hospital system will say, look, we have so many diabetic, look at how good their A1C is, buy pills. Look at how many hypertensive
patients we have, also buy pills, look at
their cholesterol level, it’s awesome. Look, a lot of your clients that are seen by our physicians network,
their numbers look awesome. So instead of 35% you need to pay us 40%, but key goals, that’s just a shell game. I just said, what do you
mean by Shell game, right? So, for diabetes per se, so we’ll use that as an example. So, if an average sugar more than nine, if it’s 9.1, it’s considered uncontrolled. So, the key goals, is that
every day the computer system will go through and say
is the patient diabetic, and the answer’s yes, and if A1C is more than 9.1, they say, “Well, Dr.
Phung you are a bad doctor “because the A1C 9.1.” I’m like, okay, so I need to get under nine then, yes, so now you get it to seven,
so the next time the computer said, oh, Dr. Phung, awesome. You know, that A1C was
nine, now it’s seven, so you’re doing a good job. So we’re going to go to
tell Blue Cross Blue Shield, you’ve done an awesome
job with the diabetes now. So Blue Cross Blue Shield we’ll pay you, pay us more money, so
we’ll pay you more money. The key goals, it doesn’t work like that. Their key goals, they’re
gonna push insulin. So what happens when
you jack up the insulin, the patient’s getting fatter,
but the A1C comes down, right? Versus if you get them to
change their food habit, doing low-carb internment fasting, they’re going to lose the weight. They probably wouldn’t need their blood pressure medicine anymore. Their cholesterol
function, probably improve, and then now they A1C is seven. So if you just look at the plain number, of A1C at seven on drugs versus
A1C of seven not on drugs– – Completely different.
– Completely different. But in the eyes of the
quote, quality measure, it’s the same thing, and it’s not. The one who was on drugs, we’re going to end up having
a heart attack, a stroke, losing the kidney, going to go blind and going
to get their foot cut off. And then they going to say, look, we’re doing the best
that we can for your client. And that’s why it is a progressive
disease, and it is not. And then people are
like, how come it’s not? Because I have put people’s
diabetes in remission, I’ve been doing for three years. So the people are, well,
Dr. Phung the patient came to see you yesterday. (murmurs) Was nine and
today we’re doing an audit, and now it’s like, it’s still high. So you are a bad doctor. I’m like, you barely
give me any time to get the A1C down, so I can’t be judged. And they said, “Well, no, because we have
to submit the homework “to Blue Cross Blue Shield tomorrow.” And then because if it’s not
down your are bad doctor, it’s just so nearsighted. – Damn, that’s rough. ‘Cause yeah, I can drop your
gullet glucose like a laugh, I just jack you with insulin
or jack you with metformin, but that’s a bandaid. Like I can not get them manipulate your biomarkers pretty
crazily with anything, right? – Yes, yes, it’s sad. But sorry with (murmurs),
color about that. – No, no, I think that’s like
super interesting information. I mean, I’ve seen some
of the structural issues, but I think, this is the first time I’ve heard some of the
actual specific details where you think a lot of our listeners would appreciate because I
think it’s kind of a black box, honestly for most Americans. You just don’t know how insurance that your company provides. Does you pay some premium, which again, most companies
will cover the premium, so you don’t even know. It’s like you’re really paying for this. And then doctors kind of do some stuff, and you get some tests,
then it seems kind of find, so doctors are usually
nice and then you get an insurance bill, and it’s like, I guess this works. And then you see politicians talking about Obamacare, medicare
for all, it’s like, those sound good, I don’t know how this relates to me. So I think hearing this in
terms of the gory details, of I didn’t know that
medical groups negotiate as kind of a union, or a
block for the percentage to reimbursement rate for
Blue Cross and Anthem, which we have that in California as well. It’s kind of interesting. And then I guess you get bonuses if you just hitting metrics, right? – Yeah, they do. – And it just sounds like this metrics are very, very gamable right? If I wanna play maximize the hypothetical Dr. Jeffrey’s cash book. All right, I’m going to
just go for these clients, that have these things
and figure out the most highest billable insurance code to have the easiest biomarkers to manipulate and just bang them out every 10 minutes. – That’s how a lot of
places work is this up code, whatever you do and then see the patient as frequent as possible
because the more you see, the more you make. – Are doctors cynical? I mean, do see this game? I mean I’m sure there are some doctors who are more on the sociopathic
side, which is like, Hey, I’m very smart, I go on through medical school. There’s this weird game, and it’s a pretty crazy system. And this is me just talking to you. If I wanna be an exploitive person in that system, all
right, let me just look through the insurance coding books, see what is the highest reimbursable, lowest time thing and
just I’m the world expert at doing this procedure and boom, just start racking up money. Are people that cynical or
they’re trying be to as positive as possible within a weird game. – On average, I would
say majority of doctors are not there to make money. I mean I wasn’t there to make money, I was there to help patients. I went to medical school, because I want to truly help patients. But after you go to medical school, is that a lot of things
that you are taught are just medications. You’re taught medication, you’re taught procedures, you’re taught surgery and
that’s what you taught, and then they barely brush, I don’t remember, obviously they never talk about
insulin resistance for sure. – It’s four hours of
nutritional lecture, right? I think that’s something that people tell medical school folk. – This is the nutrition they teach you, they said look, carbohydrate
has four calories, protein has four calories, fat has nine calories
and because it’s calories make us fat so we should
eat the high calorie foods. So what high calorie food,
animal fat, animal foods. So don’t eat that. And then so what do you eat? So now three foods,
carbohydrate, protein and fat. If you don’t eat the fat, you have to eat the carbohydrate. They said well, if we
have to eat the carb, then you have to eat whole grain, and people were like, well, is whole grain
better than white bread? The answer’s yes it is slightly
better than the white bread. But if you look at, so that’s
called glycaemic index, how fast that sugar turns into, is how fast that food turns to sugar in your bloodstream is very fast, if you eat that white bread, but that whole grain bread is still going to turn into sugar,
that insulin’s gonna come out, and then people were like, well, but they don’t think in that. They just said, well,
you know, empty calories, eat less calories, and then you said, well,
I’m not eating the fat. I’m eating less fat,
I’m eating more carbs, I’m eating whole grain. But now you’re jacking up your insulin. That’s why it’s a balance. Now you need to exercise, to get rid of that actual calorie. So, on average you have
to run 20 frequent miles to lose 3,500 calories. And it’s like really, really, really far and no one
runs 20 miles to lose a pound of 3,500 calories and by the time, even if you do, and even live
on the standard American diet, you’re going to be super hungry. You’re going to eat more and then eat all the junk food and now
your insulin goes back up, and now your weight goes back up, and they will blame you for, hey, you didn’t exercise
to lose the weight. You say, look, I run 20 miles
to lose my 3,500 calories, and they say, well, you
didn’t run far enough. I’m like, it’s just beyond myself. – We need more doctors like yourself, and then just changing the culture. I think that’s ultimately more of the politician’s side,
but I think it’s like it’s a super complicated
system and we just need more educated people, right? I think if individuals feel more empowered to understand their health
and take a little bit more responsibility, I
think that’s the main thing I wanna encourage people to do. When I was in my early twenties, you just don’t think about your health. Like, you just gave up your sovereignty of your body and your
health to some doctor, which I think you need to trust people, but ultimately you own your own body, you own your own health and
you need to just be more educated about that so you can have a more productive conversation with that said, doctor that you trust. I think that has to be
the model for the future where it turns more and
more into a conversation amongst interested parties together, rather than you are a
rat and I’m going to feed you stuff and you’ll listen to me. I don’t think that’s model is acceptable in modern society given the influx of information and just
the level of discourse. I think that model that
might’ve worked in the 1800s, where there’s a such a different level of education and class between people. We’re American, this is just
not like the upper class and lower class, and you
used to follow orders, That doesn’t exist anymore. – If you really look at
the meaning of doctors, we’re actually teachers, we’re teaching our
patients how to be healthy. So has the other doctors
being a bad teacher? We would say no, they
haven’t been a bad teacher. The toolbox they have is a low-fat diet, a exercise diet and a prescription diet, prescription toolbox. That’s all they got. And that’s all your
teachers are trained in. What else do you expect
them to do for you? So if they already tell you everything they need to tell you, I would say, hey, you’re a good teacher. But the key goals, they don’t have enough
tools in the toolbox. And the biggest tool in the toolbox is how to fix insulin
and insulin resistance. And unfortunately we’re
not taught in that. And then because we’re not taught in that, now we have to learn all on our own, oh, you get sick like me. Then figuring it out yourself and you get really upset about what you were taught where it’s just like half truths, and now learn the whole truth. Then so yeah– – Keep pushing the good fight here. So I’m curious as we wrap up here, what is your personal routines now? Obviously dealing with
a lot more exercise, what is the hit-list for you? – So right now, I’m opening up my clinic, it’ll open up on October 1st. We’re signing up patients now. There’s price transparency. What you pay is what we do in
the office, no extra costs. So we don’t bill insurance. And then, so I’m getting the website up, I’m getting the scales in, I’m like that actually do fat analysis, like present fat analysis
that we get all of that in. Then I don’t eat breakfast, I wake up. I don’t eat, I brush my
teeth and then I do my thing. And then sometimes I don’t eat lunch. So I eat one meal a day. People are like, “Dr.
Phung, you can do that?” I said, “Look, I haven’t
been eating breakfast “for the last three years.” On the weekend I might eat a late lunch with my kids, but that’s it. So I have two meals a day. I don’t snack because snacking
will dry up your insulin too. So I eat a low-carb meal, I do intermittent fasting, and about three times a week, I go to the park in the neighborhood, I do my monkey bar thing, like (murmurs) diamond does, to try to get some upper-muscle strength. – Calisthenics, have you
gotten to muscle-ups yet? – No, I haven’t, man, it’s hard. I mean it takes time to build
up that with mitochondrias. So that’s what I do and every
two, three pounds a week, I go and then I exercise,
and I let my body rest. And then when it’s resting, is that autophagy happening? I just tore some of that,
so now I’m not eating. The body will tear that
down and when I eat again, the body will put new amino
acid and then repair that area. So that longevity right there
is, and try to get my sleep in too, so that’s important. – Yeah, and you mentioned the beginning of the conversation that
a lot of Asian cuisine has is very grain-based and you know, personally growing up
with a lot of Asian food, I mean that’s some of my
favorite meals, right? Some fun noodles or ramen or
how do you deal with that? Obviously, we’re all humans, I think I would say unless
you have a very, very strict health concern, but if
you’re relatively healthy, like do you indulge or are you
very, very disciplined there? – We actually went up to dim sum over the weekend with my dad. I wasn’t like, hey, where’s
my shrimp wrap thing? I’m like, hey, I’m going to eat that. But the key goals is that we don’t go to
the restaurant everyday. We don’t go and eat this
high-carb food every day. So, and if you do go, you
don’t feel guilty about it, enjoy it. I just don’t eat that every day. And if you eat that every day, then you get into trouble. So, the key goals, is that, it’s kind of like fees on
carb and famine on carbs. So I do a lot of famine on carbs. So when I’m feasting I’m
not feeling guilty about it. But the key goals is that
the standard American diet, like feasting on carb every single day. And they said, well what’s the problem? That’s a problem right there. So I don’t feel guilty when I go out. I mean I eat, I don’t try
to be an asshole about, I’m not eating this, I’m
not eating that, I eat it, but I understand that, hey,
you put in this extra carb, it’s going to lay down your glycogens, and you need to fast, or
you need to exercise to burn your glycogen, but you can’t
exercise your muscle glycogen. So you really need to fast. So I basically landed one meal today, the next day, trying to
empty that glycogen now and trying to do some exercise to burn through that glycogen. So I’m not in the sugary
world all the time. – I see a very similar journey in myself, as well as lot of people in the community, where you go from not understanding the mechanistic approach
of what’s wrong to center of western diet and
they go super hardcore. Carbs are the worst thing ever. How dare you eat a cookie. I think I’m more like you now, where I have a very strong baseline, I’m disciplined around it, but I’m not judging people,
like you got to enjoy life, and it’s also gotta be sustainable. I think that’s why a combination of intermittent fasting
and low-carb is so potent, because if you have a
little bit of an extra carbohydrate meal, you
can reduce that load over time through intermittent fasting, or just reducing some carb
intake, or exercise, right? Use that carbohydrate, burn
through that muscle glycogen, through high intensity interval training or something, right? Or, just go on a longer bike ride. Obviously, you can’t just only do that, you also need to control the inputs. But I think you say it
really nice and I think it’s important for our listeners to hear, which is that I don’t think you and I are saying, hey,
you are a failure if you sneak in a little bowl of rice with your family on a weekend and it’s
like going out together. Because I know food is
a very important part of every culture. It’s a full understanding to incorporate this in
a nice integrated way where it’s not like this, thing where, yeah, you’re the asshole who’s just like not partaking socially, I don’t think that’s very sustainable, I think it’s very hard to maintain. – I mean, the key goals
that most of the time is that if you just watch
what you eat at home and be cognizant about what you eat out and don’t eat out if you don’t need to, I think that’s all you really need to do. But then you need to
understand a little bit about the science though, because if you don’t
understand the science then now, you’ll be like, wait, I’m doing what you ask me to do. I’m like, no, you need to
understand the science. Then, the key goals is that the science come through YouTube and the
science come through books, the science come through Twitter. And then unfortunately, those
are not big media channels that were people who will hear it. – Well said. So congrats on starting the clinic, exciting to see how that goes. I mean, obviously it’s
a big move and obviously a lot of work to standing
up something new. So where do people find your information? Where do people find the website? Where do people follow along? – I’m very active on Twitter
at the handle drandyphung.com. I have a website, my
website, www.drandyphung.com, you’ll find pricing information. It’s very transparent of what you will get from us and what you’ll pay us. Then, I just started a Facebook
low-carb support group, like three days ago, and I
have like almost 400 people asked to join, and it’s
actually a closed group, and I’m like, wow, people
are actually wanting to come. Then, the difference
between Twitter and Facebook that I learned, was that people
write a lot more on Facebook to go, look, this is what happened to me. I dropped like a hundred plus
pounds and this is awesome. You don’t see a lot of that on Twitter, I guess because Twitter
is very open and Facebook, especially with the closed
group, people feel more secure. And so, I’m there to support patients to their journey to better health. – Awesome. Yeah, let’s definitely stay in touch, and see how the world progress. I think you could probably, I’ve seen the world really change in terms of how people perceive
fasting low-carb diets over the last five years. And obviously, I think you’ve seen that very similar trajectory
where probably three years ago, it was insane, and now
it’s not that insane. We have documentaries and TV crews, and more, and more media, and all the these social network groups, where people are really
sharing positive results. So keep it up and keep
doing what you’re doing. – Oh, thank you. Fight a good fight. So I think we’ll get
there, either fast or slow. Ideally, we wanna get there fast or just because our population
just needs a lot of help. – Well said. All right. thanks so much, Andy. Talk to you soon.
– Thank you, Geoff.

3 thoughts on “Low Carb in the Clinic: Treating Obesity & Diabetes with Diet & Lifestyle · #128 ft. Dr. Andy Phung

  1. PreKure has a training program for medical practitioners and allied health care professionals who would like to develop their knowledge.

  2. Wow… the conversation got interesting… “game-able”… targeting and seeking the highest reimbursable customers … verses wanting to truly help patients …

Leave a Reply

Your email address will not be published. Required fields are marked *