From the Heart with Dr. Kosmicki

Hello, ladies and gents Robert Sykes keto, Savage.com to never get special. Guest dr. Kuzma Kion the lion. He is a cardiologist and he's also a type 1 diabetic. So we dive deep into the Weeds

on proper heart health. We talk about lipids, we talk about CAC scans, we talk about all kinds of things as it pertains to improving the health of your heart and cardiovascular system, but we also talked about nutrition quite a bit in how his type one diagnosis, which didn't come to him to his 44 years old, kind of has shaped his nutrition. He's also a A runner, he's run a few marathons. He ran the New York City marathon. So I wanted to kind of pick his brain as to how being a type one

diabetic. Has impacted his nutrition for the Run specifically, but just every day to day life, so thoroughly into the conversation, I've got no doubt that you will take something from it. So without further Ado, sit back relax and do the podcast with doctor because Mickey And we are live doctor, Cosmic, how are you? Sir, good. How are you? I'm doing.

Wonderful. Well. So before we started recording, and we had to kind of figure out how we know each other through a, the different connections people have had on the podcast that lived close to people that work for me and then we finally figured it out but you have an interesting story. Nonetheless, your dad was type 1 diabetic and then you were diagnosed later in life and now

your cardiologist did that. Did that knowledge that how did the whole cardiologist Park under beta did having Add had that diagnosis and kind of seeing that unfold motivates you to go the route of getting this knowledge. Yeah, you know, I, you know, I was I did well in school and then went to college and I was kind of, I was studying physics

and ends biology. And then ultimately decided I wanted to go to med school and some of it was I mean I had growing up like my dad was was very sick and was around a lot of doctors. And so, you know, I saw that how how that field could be very rewarding. Being and and mean a lot to families and stuff and to the patients. And and so ultimately, I decided that that's the route I wanted to go and kind of led to

Cardiology just. I always liked the physiology of the heart and the cardiovascular system and then, but I also like doing procedures, I like doing things with my hands. I like figuring things out and so I do Interventional Cardiology, so that allows me to do procedures, I put in transcatheter aortic. Valves, I do pf0 closures, so those are more structural Hearts things and then take care of people that come in with heart attacks.

I Rush In And and put in stents to open up the arteries that are are blocked. So but then I also get a see patients in clinic and treat them. You know medically and establish relationships with them that way. So don't you got. You actually just had an echocardiogram about a month ago. Now few members of my family have a bicuspid so they wanted to see from a genetic standpoint. If that had passed down to me so I had to go in for echocardiogram and I do not have a bicuspid. Well good?

Yeah that's yeah, that is one of the one of the most common congenital heart abnormalities. So yeah, what is that? I mean, just shoot that. I got you, I'm ask yourself this question for the family. A have a do have that? Is that like a big risk? Is it something they need to, you know, mitigate later in life have that and fixed or what is typical there? Yeah, you know, it's so there someone with a bicuspid aortic valve.

So they ordered valve is normally three leaflets but some people are born with two and it's more likely to become stenotic or narrowing, but it also can develop. It also can become incompetent and leak. And so one of those two Ooh things. So knowing that allows a person to you know, to follow with regular Echoes. If they do have that bicuspid aortic valve and you know, get it treated before it would lead to heart failure or other problems.

And so so it is recommended because it does run in families. It is recommended all first degree relatives, get screened, kind of chat with Echo. That makes a lot of sense when you work in the clinic. What are, what are the general? No demographic that you're working with. Like what are the most common denominator problems that you're seeing face on a day-to-day basis?

Yeah, you know, I mean we see most commonly, I mean, we see coronary artery disease so that's someone that's, you know, has someone that's had either a heart attack or has had a stent or open heart bypass surgery. We see those very commonly we see atrial fibrillation, which is an irregular heart rhythm.

So those patients are at increased risk of stroke and can have symptoms from from the atrial fibrillation and Then, you know, we see a lot of high blood pressure, high cholesterol, you know, I don't know what percentage, but I mean, a high percentage of Americans, let alone you get a Cardiology clinic have metabolic syndrome or Frank diabetes. You know, most commonly type 2. Are you seeing this? I would imagine you're getting a variety of patients coming in,

is there? They don't want to generalize obviously, but I would assume that a lot of these people are, you know, with metabolic syndrome, specifically are likely overweight and not paying much money into their nutrition.

That's a, you know, I mean, it's kind of a generalization, but yes, I mean General lot of them, you know, maybe are trying to do the right thing, but maybe don't have the best advice or knowledge and and so a lot of them do have metabolic syndrome with, you know, lipids that show high triglycerides, low HDL.

Obesity or overweight. Yes. From a heart health standpoint like, is there like some like certain tests that you recommend getting done proactively just to kind of keep people in the loop as to what they need to be looking out for as opposed to waiting until it's you know after they've had the stroke or after they've had the heart attack. Yeah, so we do commonly, you know, there are several other than just you know knowing your cholesterol knowing your blood pressure regular exercise.

Getting good sleep. But as far as like preventive things we do, you know, do coronary artery calcium scores. And so that's a CAT scan that can be done through the heart. And then it adds up the calcium which calcium is a marker of cholesterol buildup and the higher the score, the more atherosclerosis or more coronary artery disease that is present.

And so that can that can provide I'd you know, several things that can help with medications that can help patient awareness as far as that they do have coronary artery disease and help somewhat with motivation of making those Lifestyle Changes. This, this is a, this is way outside my wheelhouse.

So, I'm glad I've got you on here, but when it comes to people in the nutritional space, especially the keto carnivore space, you know, they are oftentimes consuming more lipids and one of the common things that that they get, you know, asked frequently is you know what? That doing your last four numbers aren't in that.

Just going to clog your arteries and result in a heart attack and a lot of people will see it as an initial increase in the lipid profile, then oftentimes, that levels out. But some people they don't see that leveling out. They'll notice elevated LDL for quite some time if those individuals have that elevated LDL but they go and get a CAT scan and there is zero calcification. Should that put them at ease or where should they go next? Yeah, that's a, you know, that's a the lean mass.

Hyper responders are a very interesting group. And, you know, I think that having a, you know, if you get the calcium score done in, you're too young. I mean, you can have salt, what's called Soft plaque, which means that cholesterol, that hasn't calcified. And so, it's not 100%. And then which I guess in medicine, no test is 100%. And so, but It's reassuring.

But I would say it's very unchartered territory and you know, day Feldman is doing further studies there on these lean that lean mass hyper responders. And so I think that's a that's an area that will be explored more I think as a general rule it's really I mean you do think. I mean, people just have the perception that, you know, you start eating some more fat and and everybody's cholesterol.

I was high, but it's really the most people we see, we see really significant improvements in their lipids, and so so that is the the minority of patients that, that that happens to, or people that go on a ketogenic type of diet.

Yeah, when people go and get a general wellness check, they're typically just getting the basic lipid profile, total cholesterol HDL, LDL and Triggs like it for their Seeing, you know, relatively low triglycerides and, you know, a reasonable HDL like they're probably don't have too much, you know, cause for concern, like if they start to see highly elevated numbers and then go get a particle size test.

But if generally speaking, if they have really low Triggs, they're probably fine in that regard, right? Yeah, I mean, that's, it's interesting. I mean, I, you know, I probably see more of a biased result. I would, Say generally, people with high HDL and low triglycerides, have a lower prevalence of coronary artery disease. However, I do see patients like that come in with heart attack. So, I mean nothing.

Nothing is 100%, as we know in medicine, but, but generally, those patient that is a healthier profile and healthier person. And so overall they probably are at lower risk but Again it's all individualized to that person. Yeah. Is there like a specific LDL perimeter in which you kind of start to raise your eyebrows? Because a lot of like the one of the range is the healthy range. Is that are cited and provided in these lab panels.

You know like the like elevated LDL, I don't even want to know what it starts at, but like anything over like 150 is considered elevated LDL, right? Yeah, I mean really above 130 and, you know, they've really lowered it to above 100 and if you have, you know, someone that's had a heart attack or or has had bypass or has had stints, you know, you would like it 70 or even lower. The problem is, is that, you

know, that's a very, I guess. It's a very myopic View and that there's more, you know, we see people with very low ldls come With with heart attacks. But the thing that you, you know, I would say most commonly would be the, you know, the person that has a low LDL but their triglycerides are 200 in their HDL is low and they have those other signs of metabolic syndrome. So, so it's very individualized, I think, you know, I've learned a tremendous amount.

I mean, we, I think traditional medicine. We it's easiest. And, and, and, you know, we're Overwhelmed with patients and so. So a lot of times doctors just focus on one number. However, you you quickly as you as you know about this, you realize that it's not just this just that one number. You've got to look at look at everything together and take that that individual person and and decide, you know, how high a risk are they and what benefit would they have, what what

should their lipids look like? So yeah, for sure, what about statins. You know, a lot of people, I know, have been pushed towards Stanton's by their primary care, doctors by the cardiologist, and I don't know, like, all the time, like, I'm not a cardiologist obviously, so I don't know what they're looking at in order to have the preliminary data to recommend these statins. But is there a gamut of tests that are being done prior to

that recommendation? Or is it just simply a lipid, a simple lipid profile and they're kind of pushing towards Tetons and if so, what are the pros and cons of Statins and hash people kind of way that out. Yeah. You're getting into controversial areas - that's not nice. I'm just truly, you know,

curious and don't know. Yeah, no. I mean, I you so, so I know a lot of a lot of people in the low carb and ketogenic realm are, you know, very anti Statin and, you know, overall anti medicine which a lot of them don't need medicine because they're extremely metabolically healthy and overall, Overall healthy. You know as far as people getting started on statins, I think the way I approach it is if someone has had a heart attack or has had a has had a stent has these things.

I mean we there's very good evidence on secondary prevention and taking statins, you do most people, we can use, you know, started a low dose and then get them to make. Style changes improve those other things. And with just, you know, a small dose of Statin, they'll their, their cholesterol and everything will look look within normal limits, or what we would like it to, to be okay. You do have patients that have side effects from, from the

statins. And so, you know, we do have alternative medicines to help them Reach, reach goal. And we know that that improves reduces the risk of recurrent, M eyes and And for secondary prevention, there is mortality benefit where you get controversial as in primary prevention. I mean, there is, there is a reduction in events as far as heart attacks and strokes.

But the mortality, it's been much more difficult to show a mortality benefit with with statins and so I kind of I mean, I don't know, I kind of stay out of that. I try to give I mean if I have a patient come in, You know we can you can put their numbers into a calculator, you can say you know here's your 10 year risk and you know here's what it would be as

if you took a medicine. If you took a Statin medication or if you didn't these are you know if we can change these other numbers if we can improve your your HDL triglycerides. I mean we can lower your risk that way too. So I would imagine is probably similar to like, you know, taking on exotic just hormones for some.

Like you, you wouldn't want to go that route until you've done the the underlying, you know, basic groundwork from a lifestyle standpoint regards to improving Sleep Quality, reducing stress, you know, exercising proven nutrition, you know, because that's going to have a pretty tremendous impact on hormonal levels prior to going the round of Exile, just hormones. Probably the same would hold true with sentence. I would imagine.

Yeah, yeah. I mean they're, you know, I think that, you know, there's lots of issues with the American Health System and you know, doctors are overwhelmed, MIT primary physicians, everybody's overwhelmed. So but the first step is always lifestyle factors to to improve someone's risk. Yeah, totally. What are some of the are there? Very many documented, known negative side effects to Statin use because it seems like I've seen varying points of discussion on that I've seen.

Some that suggests there are no documented negative effects. I've seen some that say that it's going to lead to Alzheimer's or dementia. Like I don't know where the actual data sits on then. Yeah you know the data would say it's probably not you know there's not those those side effects as far as mental or dementia, there's you know, liver liver abnormalities are very uncommon. And so there's not a lot of document.

I mean, the biggest thing that people worry about are the muscle aches or exercise tolerance, and, you know, there's been studies that have shown that, you know, it really. It's really just the matter of taking a pill. So when they gave people Placebo, so they were randomized to either taking a Statin taking Placebo, or taking, no, pill, and the people that That had the least amount of side effects

were the ones, taking no pill. As far as them taking Statin or Placebo. The side effects were very aware that essentially the same. And so it's just that fact of having to take a pill, probably a lot of it that that can lead to some of that, that side effects.

But in, you know, Anna even though that says in a randomized study, there's not not those significant effects and a totally, I mean, you see patients, That very much, you know, have real symptoms on the medication, so you have to, you know, just be extra extra cognizant of that and be able to, you know, best be able to take them and lower their long-term risk. And those real symptoms are typically manifested in that muscle taking phenomena.

A lot of it. Yeah, decrease exercise tolerance and muscle aches are the most common that, that Die here. Yes. So in your personal life like you would probably not go the route of a low dose that will stand from a prophylactic standpoint. Yeah, I mean, not not currently, I guess, you know, I think that if you, if you have a calcium score of 0and coronary artery calcium score of 0and your, you know, your metabolically Healthy.

I think it's going to be my opinion is that it would be hard to show a benefit of of a Statin in that group. Can't you what about blood pressure? Like a lot of people, you know, they have a history of heart failure. They'll go to checking blood pressure on a daily basis, to kind of mitigate to just simply have awareness that there. What would you recommend in that regard? I guess that's like a good daily Hammer that people that have a history of high blood pressure

should get into. And then what would you recommend as ways to improve upon that? Yeah, you know, the the trick is always getting accurate blood pressure assessment and so you know, really doing doing home. Blood pressure monitoring as is important and make sure that the patient does it correctly, you know they should rest for 5

minutes. Take be in a calm seated position, take their blood pressure you know rest a few more minutes and repeat it because lots of times that second or even third one will be a little bit lower. You know probably some of the worst blood pressures are where we rush them into Clinic, the patient's running behind and then we grab them and put them in a room and ask them a bunch of questions as we're trying to take their blood pressure.

And so that's not always the most accurate accurate way of getting it. But we, you know, we do know that. I mean blood pressure is a very important one of the very important cardiovascular risk factors. And so people aren't going to feel better with normal blood pressure. You can have side effects or complications when your blood pressure is very high. But I mean, you can have have mild to moderate hypertension for years and years and not have

any real symptoms. That's why I guess it's called the silent killer is that it? It won't make people feel better. So, but being aware and cognizant of what, the blood pressure is getting those accurate readings and then You know making lifestyle changes and if it's still high, you know, taking some some low dose medications can can help is there a particular blood pressure cuff that you recommend just for the average day-to-day

person use? You know, I don't I should probably research that but I just, you know, usually the pharmacies will have some different ones. They recommend. I know that you can go on and I haven't taken the time to do this. There is a, I believe there's a website. Site that you can look at the accuracy of different ones that that are available on in the market, but I haven't researched that extensively. And what kind of range are? You typically want people to strive for when it comes to

their blood pressure readings? Yeah, I mean you know, we like it less than 130 over 80 120 over 80 is considered normal or lower, you know, but having it on average less than 130 over 80 is certainly a reasonable blood pressure goal because that kind of shaped your opinion on individuals caffeine intake, sodium intake throughout the day as far as like what you've seen how that's impacted their their blood pressure readings. Yeah, I think, you know yeah, the blood pressure.

I mean it will fluctuate throughout the day and and I think this is always a topic, you know, someone doesn't didn't sleep well, the night before they were, you know, having a lot of stress those things. So I think that it's a, you know, getting those those accurate readings and then Yeah. May you know, just getting more readings as probably a better than having less readings of the blood pressure. Yeah, totally. Totally, what about nutrition is

talking about nutrition. So you said your father had type 1 diabetes. He was born with it, right? Yeah. So he was he was about 10 when he was diagnosed, okay? And I believe it was around age of 10. And so, I mean he lost a bunch

of weight. I mean, that's a stage where you're growing a lot and And he became became ill and lost a bunch of weight and then eventually was or, you know, shortly after that was diagnosed with type 1, diabetes and started on insulin at that point, you know, they didn't have, we didn't even have glucometers. He tested his blood sugar with urine strips. And you know, as long as you didn't detect glucose in the urine, they thought your blood sugar was was Okay, and so, so

that's how he started. And then ultimately, he, he had many complications from it. And so, he, after undergoing to kidney transplants, he went blind had a leg amputated, he passed away at age. 32 mean, it cannot even imagine. You think event could have likely been avoided? Had we known what we know now about attrition. And, and Dosing insulin and just mitigating that risk.

Yeah, I mean, I think that I, you know, it was, you know, he probably, I mean, you know, I don't know how much could have been mitigated. I think that a lot of it, if if, if the knowledge had been there, you know, he probably could have lived a very, very long life and done well and so but I think he, you know, followed what they knew at the time And, you know, just like just like now, I mean, I see people come in that that

have poorly controlled diabetes. That, you know, they're one of the lucky ones that they don't seem to develop the complications, but he was one that was, you know, at the time was okay control. But despite doing that, you know, had had a every complication. Mmm. And then you get that nose to what age Yes, I was diagnosed at age 44.

So, you know, I really thought, you know, the at that time, you know, they had told us that, you know, there wasn't really a lot of increased risk for, for my brother and I to develop it.

And after I got past like age to age, 20, I was really, I was kind of, like, well I made it, I thought there's very low likelihood that I would get diagnosed with type 1 and so So I you know, I never really thought about it again until until that spring of 2018 and I was trying to run more and I just was feeling horrible, my muscles were hurting, I just felt my energy was terrible and then over a matter of like two or three weeks I just, I was getting up to use a restroom at

night which I never did. And I No new some. Oh, I knew something was wrong, but I, you know, in denial obviously. Until one day after Clinic, I'd had a really rough week and I just, I was at my son's baseball game and it was 100 degrees and I was dehydrated, I couldn't drink enough water, which were all signs that. My blood sugar was just really high. And so, I did a finger stick after everybody left clinic and My blood sugar is like 284, I think was the number and so I

knew things were not good. Then was it like when you went and you get an official diagnosis, was that scary having seen your dad, go through all that and then being diagnosed, you know, at 44 or did you feel like you had those tools at your disposal to kind of mitigate that rest risk and not let it cost you too much sleep at night? Oh yeah, I know. I mean I was, you know, I was devastated. I didn't. I was like, how am I going to work?

How am I going to, you know, do go about normal life, you know, even you know, I was like I can't be having highs and lows and trying to rush to the hospital to take care of someone with a heart attack and those things. So, Um yeah, I mean I really I would say, you know, going through med school and step I, you know, you don't get a lot of nutrition training at all very little.

You learn about the diseases that you never see these rare deficiencies and and whatever else but as far as like basic nutrition so I would say I didn't really really no. I mean I was very uncertain. And what what did like, how did you learn about nutrition? Or how did that become, like a stepping stone for you? What is your nutrition look like now with you? Having the type one diagnosis. Yeah. So I so it's really, really

interesting. So, Father's day was right after I got diagnosed in June, and my mom wrote In My Father's Day card. She said, I've heard of this guy, dr. Bernstein, In maybe you should look into this and I'm kind of thinking, you know, well I've gone to med school, I've done all this. I mean, who's this? You know who's this guy? Dr. Bernstein and, and so kind of looked a little bit and then I also heard the name Keith Runyan.

I'd seen his book came up when you Google stop and so I actually got hit Keith runyon's book first. Can't remember the name of the book he had out at that time, but he's has another one subsequently, but but I started reading that and it was very eye-opening just how he he was a nephrologist. And, you know, spent I don't

know. 10 plus years of, you know, having highs and lows and just not being able to control his diabetes, following the Ada recommendations and, and how he went on a low carb or ketogenic type diet and how he how he did. Has done so so much better with that and he was didn't hire man and and all these things. So then I get dr. Bernstein's book next? And I read that from front to back and just find it very

amazing. And during this time so my wife who is very, very supportive and she orders a cookbook and Ada cookbook off Amazon, or I suppose, and so we start. She's, she's trying to, you know, follow recommendations and give me all the exact carbohydrates and everything in these foods. And these recipes are coming from the Ada cookbook. And, and like, it's really hard.

Like, I figure out within, you know, weeks, I'm like my blood sugar just shoots up, despite the, you know, doing what they tell me to do and what these recipes say are Nam and and this is really hard and I mean, I guess I would say that even made me question more like how am I going to continue to work when you know blood sugar all the sudden is high and then it's low and and you're trying to inject more insulin to cover it and so

quickly probably within. So I was diagnosed the beginning of June And I think I don't remember the exact day but I came home after reading dr. Runyon's book ever reading Bernstein's book? I basically came home and said, I'm just going to eat 30 carbs a day or less and see what

happens. And my wife was very supportive and and so since then we've kind of adjusted, you know, I do my and right now is just a lot of protein and some vegetables, a lot of eggs and just a little bit of, I'll have some berries for fruit just for something sweet. Usually, at the end of a meal or something, I'll grab a few raspberries. If I want something sweet. And then I've been able to, you know, essentially normalize my blood sugar's and So, I found that it's, it's amazing.

I don't have to worry about with that. I don't have to worry about going low. I mean, I can be called for an emergency and I'm very confident long with I guess. My Dexcom that. I wear all the time. I'm very confident I can take care of patients and there's no no issues with with my blood

sugar's. And so, since I was diagnosed, I've and two marathons continue to exercise, you know, most days of the week and Do you do you do very much a dietary fat or is it pretty much just the protein, the vegetables, and the occasional Bears? Yeah, I do. I add a little bit of fat. I just, I think I eat the fat that comes along with the protein in the, you know, meat or fish or chicken. I don't do a lot of added fat, but a little bit, I'll put I in put a little bit of geeky.

Sometimes in my coffee in the morning, or Two times just like half a tablespoon or something and blend that in there, just to provide a little, a few extra calories and and stuff. So I you I was monitoring my ketones and other things. And I've really gotten away from that. I just kind of go with how I how I feel. I don't know if I don't notice as big a difference. I guess if I'm technically like ketogenic or if I'm Just low

carb. I'm probably just because I'm I eat such a small amount of carbs that I probably am mostly mostly ketogenic but I really have not been monitoring that at all. Do you thin Jack much insulin do I do? Yeah I mean I take her seba and then take short acting or medium acting regular or novalog and One before meals. So, yeah, I do. I do have to take insulin.

Yes, I don't you know, I essentially have very minimal insulin production myself so probably significantly less insulin than you were having to take when you were doing the Ada recipe book recommendations. Yeah, definitely I mean, it's about, you know, about half of what I was taking initially and so so it's Much less. Yes, it's interesting. I've got a few clients that are type 1 diabetics.

One of, which is also a runner and he'll inject, you know, kind of around his workouts depending on what his blood sugar's doing around some of his meals. But it's like, if I was a diabetic, I can't imagine not at least trying a low-carb.

Can you drink that? I mean, I would think from a, you know, a risk mitigation just simplification of Lifestyle standpoint, like that would be 100% the way to go, I think, but you don't really see a whole lot of Of recommendations towards a ketogenic a low-carb diet, in these, you know, diabetes organization and Association websites or content because there's not really much push towards that at all.

Yeah, there's not. I mean, you know, so most of the most people we see are type 2. And, you know, though the guidelines have said that the most evidence is for a low-carb diet. And and so there there is some shift and I do see a lot more patients.

Now coming in that, that, you know, are aware of that and and in are Added a, as far as type 1, I think the sis, they're still very, very hesitant to recommend a low-carb diet and so, that's where I mean, I think that I just, you know, I like to tell people, you know, I can, you know, if, if anybody, you know, I can do it other people, giving them the information.

I mean, just so that they know that this is possible that You don't have to, you know, be battling these highs and lows and so you get into and I try to stay, you know, out of a lot of this controversy. But you know, a lot of the type one and, you know, I've only, I've only been dealing with this for, you know, five years now. So I, you know, I don't know. Maybe I'd feel differently if I had had it from the age of 4 10. And now I was, you know, in my upper TS and had dealt with it

the whole time. But I mean people they kick people out of some of these dipole. Diabetes groups if they if they say anything about low-carb and and and so I think the I'm not really sure like where that where that bitterness comes from I guess I just I like to you know, give people the information and let them know that it's it's possible, you know. I just Out a patient that came in she was came in and she was 44 years, old was diabetic and just not doing well.

Had a heart attack in November and, you know, she was trying, you know, she probably wasn't as good as she as she could have been, but she was trying to, but she was eating, you know, a lot of grains in a lot of sugars and and stuff in her, A1C was 10 and a half. So that's like an average blood sugar, you know, of close to hate 280 to 300. And and she just, I just saw her back the other day and she's just, she is down 25 pounds per A1C.

Now is down below 6, she feels great, she's exercising. And, and you know, that is where it's really like if I had walked in and told her, you need to eat a low-fat diet. You know, I could see her still struggling now, you know, for five months later and and still be at very high risk of recurrent heart attacks and strokes. So she's not a ketogenic diet, she's doing a essentially a ketogenic diet. I don't know if she's monitoring but she's like, she's doing basically 30 grams of carbs a

day. Yeah. And she's been able to cut her insulin. And I think, by over 2/3 or 3/4, she's cut her insulin down. So What? So that's what I try to do, just individually with my patients is you know the ones most of them are type 2 but the ones I have that are type 1, I just try to point them towards, you know, the some information on low carb and and what's available yeah. What do you feel like via like amongst your peer group especially them like the realm

of traditional Western medicine. Do you feel like that the notion of a ketogenic diet is starting to gain more acceptance? Or do you feel like there's still quite a bit of pushback

there? Yeah, I think locally I've went and spoken to all the primary doctors and so I think they understand where I'm coming from, you know, I'm sure some of them still, you know, think I'm kind of nuts for the way I do things and and stuff and you always, you have to be careful because patient, you know, people people only hear certain things you say. Say and and so, you know, you always have to be take it with a grain of salt.

When you hear, you know what, what someone is saying about about you and the community or or whatever. But I think all the locally here, we've, we've had very good luck. We have some diabetes Educators that are on board with low carb and they're, they're doing awesome. And and so It's still just, you know, it's a battle just because of the food supply, let alone the food supply when people go home.

But I mean, we feed them terrible food in the hospital and and then they, you know, they go home and, you know, their family, maybe not is not supportive and so, it's a, it's a real battle. Yeah, the the availability of

foods that are just not great. Food has got to be like the people that are struggling with this and they're trying to learn all this information in, like they would be much more likely to adhere to it if they just simply had good quality foods their fingertips, but you just, you must have to seek out these foods. Like, they don't just come natural. Like, it's in the school, it's in the hospital. It's in every day to day life.

Like, it's much more of a challenge to actually find a good for than it is to not find good food. Yeah, and I mean we see I mean the nursing homes are really bad to and meals-on-wheels where they deliver, you know, the food to which is a great program. I don't need to discourage, but they're regulated by, you know, the government, and the nutritional guidelines and, and those things. And it's, it's a, it's not always the best for that, that

individual person. So, Yeah, it's a challenge for sure, it's an uphill challenge, but I think, I don't know. I feel like I've been I've been seeing a lot more talk of just this holistic approach to health and I don't think the conversation around quoting nutrition is likely going to come from the top down per se. But I think, if more people start showcasing, what's worked well for them?

Or they know somebody in their family that been able to reverse their type 2 diabetes, or improve their type 1, diabetes. These are lose a bunch of weight or improve their their lipid markers like that that spreads like wildfire. Yes it does. I mean that's what I mean. So many people is becoming much more more acceptable and and you do have to always, I tell patients now, even that, you

know, you as it's become more. As you, as you said, more aware more mainstream, maybe not mainstream, but more more awareness of it. Have to be careful because I tell people if you go into the grocery store and buy every food that says keto friendly on it, you're probably not eating real food that that point in that, you know, it's so the the food companies are also marketing to it, but hopefully, they can continue to improve the quality of products of food and and

things. But hopefully would you expect us on Sorry, I missed that. When's your next marathon. You have one in the pipeline? No, I don't have one in the pipeline right now. I had kind of thought about doing one this year but I've kind of been battling a heel injury and so my mileage has been pretty low and so I may wait till I don't know, I may wait till next year or I may do like an endurance bicycle ride, which I thought, I like to bike also. So I've been doing some more

cycling. We Running quite a bit prior to your type, one diagnosis. Or is that mostly post-diagnosis? Yeah. You know, I was always a, I would run.

I ran several half marathons, I never really thought I could run a marathon and just because usually, after halves I was, I was really hurting and and, and probably not just didn't think I think that was really in my bucket to be able to do however, then after I kind of it, it provided running was was something I would do intermittently, but not religiously and then it really, after being diagnosed, it was just really an an outlet to, to be able to run and be able to

think and And figure out what I would do. And so, I felt great running. So the marathons were awesome. The first one was New York City. And, and so, it was the most incredible experience. Yeah. Running like, I've got a deep respect for people that do long distances because it really become a certainly love technique involved with it. It's certainly a lot of conditioning involved, but so much of it just simply the mindset component of running long distances, being in paying,

as a, when you were. In a marathon like you're in pain. There's not really any ways to sidestep that. Like, it hurts, like it's, you're thirsty, you're tired. You're hungry. Your feet are killing you yet. You still put one foot in front of the other. So, there's a definite exercise and just the overall mentality towards it, which I appreciate.

Yes, it was. It's been an amazing experience and I really, really have enjoyed doing that the training was fun, it, you know, it's a lot of time which, you know, when you, when you work full time plus, and, and have family. It's really know. It's hard to harder to do, but but but my family was very supportive. part of, and And allowed me to do that. What do you do?

Nutritionally speaking? Like you know in preparation for a marathon and then throughout the Run itself I could you doing like are you eating throughout the Run? Are you doing like a big load of food the night prior? Like how do you structure that with your diabetes? Yeah, so so mostly I the marathon while they were different. So for New York City it, I didn't start till like late morning. I think it was 11 or so, but you have to get over across onto to

the starting line. Like we left around 5:00 a.m. so I I had a big breakfast of eggs and bacon and sausage before leaving I took my regular long-acting insulin and then carried short-acting insulin with me. And and then essentially, I did not eat anything until about mile 20 and I had one nut butter. And, and that was about it till I was done.

Nice. So I did take in and I had salt tablets, I can't remember what kind I use then, but some type of salt tablet I could drop in because, every course every aid station has Gatorade and all this sugar-laden drink. So I would just grab water and then put some salt in it. So was your it was your blood sugar going pretty low. Oh, throughout that run. Vo, it actually stayed.

You know, I think because of the you know there's there's a million things that increase blood sugar and only one thing that decreases it which is the insulin. But you know, I probably if I remember, right, my blood sugar which so mostly my goal is to keep my blood sugar between 70 and 120. And most of the times I try to keep it in double digits. So I want to be, you know, Somewhere below 100 when I'm exercising it goes up.

I mean that's you know it'll it'll go up a little bit usually if I really am doing something very high intensity it'll go up more but I would say before the marathon I started if I remember

right? I was probably like 120 130 and then really my blood sugar stayed very stable and I think when I finished I was probably like 90-something, never really had problems with it going low, which I think was just a matter of being very, I did all my most of my runs all all fasting or fasted and so in the morning typically and so I think I was just very fat adapted so I Do not have problems with my blood sugar dropping from running. It's interesting.

Yeah, I've been one marathon and I didn't, I didn't eat anything either. I didn't they didn't have a big meal the night prior and I fasted throughout the day and I never really noticed any, you know, - shift in energy. Like I never felt like I was going to Bonk or anything like that but it all these, these endurance Runners. So typically had like a big carb up with spaghetti or something the night before they'll have their Goose throughout the race.

But but it's interesting to talk to people that don't do any of that stuff and seem to have it pretty, even kill energy level throughout the entirety of it. Yeah, yeah. No, I think that. I mean, I think obviously with with having diabetes, I think having better blood sugar's if probably more advantageous. I mean, could I have done something better? Maybe I don't know if you know, there is some this product called you can, that's like a

super starch. Ouch, I've used that a little bit and since the marathon and it it doesn't seem to affect my blood sugar. I'm not sure that it really like provides me any more energy though, I'm not convinced that, that it necessarily help me either. So I don't know. There could be there could be other things to do to optimize, like, I guess time and an energy. But I mean, I really felt It

very good. And I did not feel that I was, you know, I think I ran it in 351 and I felt that was excellent for for, for my age and experience level and everything. So what kind of this Mason little random but what kind of shoes do you typically run in? Yeah, Brooks mostly but I ran like a Nike.

I ran the marathon in Nikes at the time, so but I train a lot in Brooks, I've run in Brooks as well, and I've switched off since which that all my Footwear, to this zero, drop kind of like the ultra Footwear. But like, zero, drop wide toe box, shoot like let my foot be more natural, I guess. And I haven't run any significant distance since that switch but I feel like my feet have just significantly.

Strengthened And because like, for me when I'm there, I'm running distances, my my feet are what, give out on me first. I might my energy levels seem totally fine, but my feet are just not ready for that constant beating, but I feel like a lot. It's because I've used to heavily cushioned shoes or too much arch support. That's just not let my foot. Do what? It naturally wants to do. Yeah. So I kind of I've tried do.

Yeah. So I try to do workouts and do core work and and do walking all And xero shoes. And so they're basically as close to Barefoot, I guess as you can get. And so I think that does help strengthen the feet. I just I haven't been able to change my or I guess haven't taken the time or willingness to change to actually run in a Barefoot shoe, but I know Ultra has has Or of a zero drop shoe, but with some cushion to, but, but the Nike, I don't know, they were very, they're very springy.

And, and my feet felt very good throughout the the race. And you mentioned that you're playing with the idea of doing like an ultra at some point in the future. Possibly. Yeah yeah. That would be exciting. I think the it's interesting to see how how popular the ultra runs have become as of late. So it's like the ultra Trail runs and some of these races are just like Bonkers. Like the the Moab 242 like 240 miles. I can't even fathom then. Yeah, no. Yeah, I don't think I'm gonna do

that. Okay, never say never that, maybe the next thing, but but like there's one my brother lives in Idaho and they have some races around there that are, you know, 50 case, or something like that. Or Nice, very cool, very cool. I'll definitely have to be following along to see how that that unfolds. What else is in the pipeline for what are you excited about going

forward? Yeah. You know, I yeah, I'm just busy with work and busy with family and stuff and I'm just I try and do you know, since the last couple years, I've been focusing more on on lifting and just kind of maintaining healthy lifestyle that way. I feel stronger. So I don't, like I said, I don't have a definite, you know, whether and do a marathon next or do an ultra race. Or do a long distance cycling

event. I'd like to do something like that but nothing really really big planned at this point. What's exciting? I always like talking with people that are doing things. I don't know Against the Grain so to speak. So I think it's awesome that you're doing these endurance events as a type 1 diabetic with the low carb, ketogenic diet. Because so many people you know, throw shade that direction say it can't be done.

I love toggle people that are obviously proven, otherwise, Yeah, I think it's you know I feel I honestly I don't know if I if I could have done this if I hadn't you know, been able, if I hadn't gone low-carb, if I hadn't been diagnosed with type 1 diabetes. I'm not sure.

I would have investigated all this and made these changes but I probably should have even if I hadn't been diagnosed because I feel like I've been able to do things athletically that, I That I wouldn't have been able to do before.

So yeah, it's never really liked a like, you wouldn't go out of your way to get a type one diagnosis, but I feel like any type of any type of diagnosis like this, that, that forces one to look a little deeper into what they're doing nutritionally speaking with their with their lifestyle and often times, just provides a catalyst for them to get healthy in a way that they wouldn't normally feel in cinema as to do, which I think is a

great way to go badly. That's it's only going to benefit you in the long run in that regard. Yeah, yeah. I'm Now, you know, you obviously wouldn't wouldn't wish it on anybody but you know, it has its made a dramatic change and that's where I mean, people, you know, people are very like you said, Throwing Shade at people, you know, they, you know, you get asked questions about, you know, how can you be so strict, how can you, you know, eat that way. And, and honestly, it's so I

don't know. It for me, it's so easy. I just find that You know, my mindset is is that, you know, life is short. Why would I want to spend any more time than I had to controlling my diabetes?

Yeah, by, you know, by doing this I can I can do whatever I can go exercise, I can go play with the kids, I can be called for a heart attack and I don't have to worry about you know that my blood sugar is running high or then it's going to shoot low and And and that allows me to, to enjoy each day and maximize maximize what I can do on a daily basis. Yeah. For like a lot of people they have a hard time you know, believing that it's sustainable.

They just assume that, you know, sacrificing the taste of cheesecake in a restaurant. Let me nothing could possibly be worse than that, right? But once you do it and you just recognize how your life benefits in so many other ways. Like you don't, Like you're missing out by not having that cheesecake because all that you have to gain far, far, far outweighs that temporary high. Yes, I totally agree. I love it, I love it. Well, dr. Cosmic he, where do people go to find out more about?

You don't know if you document any of this online or on social or can I put yourself out there? But I feel like they got a very interesting story. So anybody that wants to dive deeper into your, what were they go? Yeah, I mean, I guess if you Google my name, I did write about some of it. With my first marathon, it would be the Beyond type one. Probably in their website from their marathon in 2008 or 2019 New York City marathon.

Otherwise I'm on Twitter. I don't, you know, I kind of, I don't know, I don't do a lot of online stuff. I try to just More locally, help my patients and be able to you know give people inspiration to be able to improve their lives and in their health. But people can find me on Twitter I would probably I don't I'm not real active with posting information about myself just because I don't know. I find online. There's a lot of shade.

Our own online and you know for me kind of staying out of that and just focusing on what I can control. I think there's some serious wisdom there, feel like your stress levels are probably much lower by not spending more time on social and I think honestly like plugging more into your local community and focusing on that demographic first is, I'm honestly priority. So hats off to you there.

Thank you. Well, I will certainly linking out to that blog post that you've written and again, I really appreciate you taking the time to chat with me today. If there's ever anything I can do for you sir, in any way, just let me know. Alright, thank you. It was great talking with you, take care. Thank you. Well, I will certainly linking out to that blog post that you've written and again, I really appreciate you taking the time to chat with me today.

If there's ever anything I can do for you sir, in any way, just let me know. Alright, thank you. It was great talking with you, take care.