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Description
This is the fourth program in the 2018 Cupertino Library Foundation Wellness program series!
Dr. Ronesh Sinha, an expert on diabetes, cholesterol and heart disease prevention, has been seeing a local surge in the amount of individuals with cholesterol and heart disease issues at an early age. Our modern lifestyle habits are a primary cause. Dr. Sinha focuses on some of the following areas in his talk:
Cutting Edge: Latest science behind cholesterol and heart disease
Quantify You: Important labs and metrics to assess your own risk
Prescription Foods: Nutritional approaches that lower cholesterol and heart disease risk
Exercise Science: Time-efficient exercises and movements to improve heart health and lower risk
Sleep/Stress: The role of sleep and stress in heart disease and some simple tools and apps to help you find balance
Resources: High-tech tools and resources to help optimize health will be shared.
Recorded September 23, 2018 at the Cupertino Community Hall.
B
Thank
you
and
welcome.
Everyone
I
think
it's
Sunday
afternoon
after
a
good
lunch,
but
hopefully
dr.
Ron
will
keep
you
really
busy
and
he
is
planning
to
do
some
exercise
for
you
and
he
will
make
you
to
do
some
exercise
right,
dr.,
absolutely
so
that
you
won't
feel
sleepy
by
the
way.
My
name
is
gopal
'gopal
camera
pan
I
serve
as
in
the
in
the
board
of
Cupertino
library
foundation,
and
that
this
is
one
of
those
serious
wellness
series,
one
of
the
program's.
B
We
bring
it
to
the
community,
mainly
just
to
bring
an
awareness
so
that
you
can
go
into
practice
and
to
bring
the
really
the
best
health
to
our
life
like
education
and
wellness.
Both
goes
together,
because
if
you
don't
get
educated
properly
or
bring
awareness
on
what
we
do,
I
think
we
take
it
for
granted
and
with
the
busy
life.
We
forget
very
basic
things
and
I
personally,
listen
to
dr.
B
ranson
her,
like
seven
years
back
when
I
was
at
Oracle,
where
he
comes
and
used
to
come
and
teach
us
and
tell
us
what
all
these
different
programs
so
I
am
personally
a
beneficiary
of
his
lectures
and
listening
to
it
and
put
together
and
so
I
don't
take
any
medication
and
cholesterol
levels
have
gone
to
a
better
level
and
definitely
helped
so
that's
one
other
reasons.
I
said
ik
I
need
to
go
and
somehow
pull
dr.
B
Ron
again
bring
him
here
so
that
he
can
share
his
experience,
not
just
to
you
all
and
since
it
is
going
to
be
it
isn't
being
recorded,
it
will
be
available
on
the
site
for
the
rest
of
the
community
to
see
it
to
it.
Please
share
that
information,
not
just
our
own
community
member
anybody.
You
think
that
your
friends
and
family
that
this
is
such
a
great
information
which
they
need
to
be
aware
of
it.
So
with
that
or
really
welcome
dr.
C
E
A
pleasure
to
be
here
I've
seen
a
lot
of
people
that
I've
seen
at
other
events
and
if
you're
familiar
with
my
talks,
already
I'll
warn
you
that
this
is
gonna,
be
a
rollercoaster
ride.
There's
gonna
be
a
lot
of
information.
Hopefully
I
will
keep
you
awake
during
the
talk,
but
but
the
good
news
is
they
are
recording
it.
So
I
keep
my
lectures.
E
So
I
was
typically
taught
with
case
studies
that
a
typical
heart
disease-
patient
is
somebody
you
know,
typically
a
Caucasian
who's
above
age,
65
or
70,
who
eats
a
lot
of
red
meat
and
smokes
a
lot
of
cigarettes.
So
that's
where
the
vision
we
were
sort
of
taught
in
medical
school
and
then
all
of
a
sudden
I
got
here
and
my
practice,
which
is
right
next
door
to
Oracle
I
started
seeing
a
totally
different
face.
I've
started
seeing
people
that
look
like
this
okay,
so
much
younger
several
decades
younger
than
what
I
learned.
E
Many
of
them
were
not
eating
red
meat,
they're.
Reading
foods.
Like
this,
you
know
Asian
sort
of
East,
Asian,
pan
Asian
type
foods.
Many
of
them
were
vegetarian.
They
won't
really
sit
a
smoking
cigarette.
It's
oftentimes,
the
cigarettes
were
not
their
addiction,
it
was
more
a
digital
addiction,
so
so
very
different
version.
E
So
definitely
I
still
saw
the
former
in
my
practice,
but
I
was
seeing
a
lot
of
this
sort
of
risk
to
people
of
different
ethnic
backgrounds,
early
onset
heart
disease
and
different
risk
factors,
and
then
what
I've
learned
about
in
medical
training
so
I
want
to
start
off
with
a
case
study
because
I
think
these
really
hit
home.
This
is
not
really
a
true
person
but
I'm
just
identifying
some
data.
Just
to
give
you
a
little
bit
of
a
idea
of
the
types
of
case
studies
I
see.
E
So
let's
call
this
gentleman
Sam
he's
a
38
year
old
software
engineer.
He
it's
a
vegetarian
died.
He
has
a
body
mass
index
which
is
a
composite
of
your
weight
and
height
of
24.
He's
got
a
normal
blood
pressure
and
blood
sugar
he's
got
a
total
cholesterol
level
of
about
190,
so
you
might
be
familiar
with
total
cholesterol.
E
We'll
talk
about
it
in
detail,
but
often
you'd
think
that
a
total
cholesterol
of
less
than
200
is
fine,
and
then
he
visits
to
gym
two
to
three
times
a
week,
but
his
otherwise
sedentary
and
work
stress
is
high.
Can
anybody
relate
to
this
sort
of
a
composite?
Does
it
sound
familiar
to
people
I
see
a
lot
of
head
nods
there
right.
So
what
happened
to
Sam
is
at
3:00
a.m.
on
a
Sunday
morning.
He
was
woken
up
by
progressive
chest
discomfort.
E
He
thought
he
was
having
acidity
bloating,
maybe
I
ate
too
late,
so
we
took
an
antacid
and
he
didn't
have
any
relief.
Thank
God
he's
married
because
men
are
in
denial,
but
the
wife
knew
what
was
going
on,
so
she
called
911
right
away
and
it
was
rushed
in
the
emergency
room
and
he
was
diagnosed
with
a
massive
heart
attack
due
to
a
blockage
in
a
major
artery
of
his
heart.
E
So
this
is
what
we
see
day
in
and
day
out,
but
what
I've
really
been
struck
by
over
the
last
decade
is
the
escalation
and
the
rates
of
heart
disease
I'm,
seeing
that
diversity
of
Ages
and
ethnic
groups
that
I'm
seeing
so
I
think
the
key
way
to
motivate
you
today
is
to
teach
you
what
exactly
is
happening
inside
your
body
when
heart
disease
and
chronic
disease
strikes,
because
I
can't
motivate
my
patients
unless
they
understand.
What's
happening
in
their
body,
so
I'm
gonna
spend
a
lot
of
time.
E
Teaching
you
what's
happening
and
then
the
lifestyle
information
will
make
much
more
sense.
So
this
basically
is
a
busy
slide
and
it
shows
two
major
processes
which
we're
gonna
learn
about
today.
The
first
is
inflammation:
it's
on
your
left
side
and
the
one
on
the
right
is
insulin,
resistance
and
all
the
little
thing
that
you
see
I,
don't
know
if
you
can
really
see
all
the
conditions
around
there.
Almost
every
chronic
health
condition
is
linked
to
some
combination
of
insulin,
resistance
and
inflammation.
E
We're
talking
about
heart
disease
today,
but
all
the
risk
factors
we're
going
to
talk
about
influence
cancer,
diabetes,
Alzheimer's
disease,
I,
give
a
separate
talk
on
brain
health
and
Alzheimer's.
Alzheimer's
epidemic
is
out
of
control
right
now,
and
many
of
the
processes
that
cause
heart
disease
actually
cause
Alzheimer's
disease
as
well
too.
So
this
talk
will
definitely
help
protect
your
heart
and
your
brain.
Now
the
first
process
is
inflammation.
What
is
inflammation?
E
Okay,
so
if
I
sprained
my
ankle
right
now,
you'd
see
my
ankle
would
swell
up
and
turn
purple
and
red
and
that's
actually
a
protective
mechanism.
If
you
injure
yourself
and
your
ankle
gets
swollen
in
red,
that's
going
to
prevent
you
from
moving
in
different
directions.
It's
going
to
keep
your
ankle
stable,
so
that
is
visible
external
inflammation.
But
when
you
develop
chronic
health
conditions
like
autoimmune,
disease,
cancer,
heart
disease,
etc,
there
is
invisible
internal
inflammation
taking
place,
and
it
basically
looks
like
this.
E
The
same
immune
system
that
protects
you
against
infection
becomes
overactive
on
a
regular
chronic
basis
because
of
your
lifestyle
and
all
these
little
cells
that
you
see,
they
start
attacking
your
own
blood
vessels
and
that's
really
what
leads
to
the
plaque
formation.
So
in
the
old
days,
we
just
think
that
heart
is
a
disease.
Was
a
disease
of
plumbing
right,
you
think
of
your
arteries
as
being
pipes
and
basically
it's
accumulating
with
all
the
foods
that
you've
been
eating
a
lot
of
fatty
foods
and
then
it
gets
blocked
off,
but
actually
heart
disease.
E
Most
heart
disease
is
due
to
less
than
50%
blockage
of
that
pipe.
Most
heart
disease
is
due
to
very
small
plaque,
so
barely
occlude
that
actual
blood
vessel.
So
what
happens
is
when
your
immune
system
over
reacts?
It
causes
that
small
plaque
to
rupture,
and
then
it
erupts
like
a
volcano
when
actually
blocks
up
the
blood
vessel.
So
it's
really
a
completely
different
situation
than
what
we'd
anticipated
during
medical
training.
E
So
this
is
a
signature
slide
I'm
going
to
spend
some
time
on
this,
but
this
will
teach
you
what
really
happens
in
most
cases
of
heart
disease
and
how
your
diet
and
food
is
indicated
in
this.
So
basically,
at
the
center
of
the
diagram,
you
see
a
car
I
call
this
carbohydrate
car,
okay,
I'm,
going
to
teach
you
what
insulin
resistance
means,
because
this
is
really
a
fundamental
process
that
leads
to
most
of
these
conditions.
So
let's
say:
we've
got
that
carbohydrate
car
in
the
middle
we've
got
three
parking
lots
in
the
body.
E
You
got
your
muscle
at
the
left,
the
liver
in
the
bottom
in
the
fat
parking
lot
on
the
right.
Every
time
we
weed
carbohydrates,
excessive
amounts.
We
want
the
glucose
to
actually
go
to
our
muscle
parking
lot,
because
our
muscle
can
burn
the
glucose
for
energy.
That's
the
ideal
destination
the
way
the
cards
get
inside.
The
muscle
is
by
using
a
parking
pass
called
insulin.
Okay,
so
diabetic
settings
inject
insulin
for
their
blood
sugar.
It's
pushing
the
glucose
from
the
carbs
inside
the
muscle,
so
it
can
use
it
for
energy.
E
Now,
here's
the
problem
in
most
situations,
what
we're
seeing
now
in
our
modern
civilization,
this
epidemic
insulin
resistance,
is
our
body's,
producing
the
insulin,
parking
paths,
but
the
muscle
saying
sorry
I'm
not
going
to
respond
to
the
signal
I'm
not
going
to
let
the
glucose
in
so
when
that
happens,
you
have
all
this
overflow
traffic
and
that
overflow
trap
that
goes
in
different
directions.
You
might
go
to
the
fat
parking
lot,
especially
the
belly
fat.
It
might
go
to
the
liver
and
the
liver
converts.
E
Those
carbohydrates
into
dangerous
cholesterol,
particles
called
triglycerides
and
how
that
overflow
traffic
is
distributed
varies
in
each
person's
body.
So,
for
example,
I'll
give
you
an
example.
A
lot
of
times
I
see
couples
in
my
clinic.
Ok,
so
I'll
see
you
often
maybe
a
slender
male
and
then
the
wife
might
be
twenty
thirty
pounds
overweight.
It
can
go
the
other
way
too.
E
So
I
don't
want
to
make
any
generalizations
here,
but
but
usually
what
I
explained
to
them
based
on
that
composite
is
that
in
the
case
of
the
slender
male
what's
happening,
is
he
doesn't
have
much
carb
traffic
he's
got
some
carb
trap
that
going
towards
fat
storage
a
lot
of
it's
going
to
the
liver
to
make
triglycerides?
That's
why
I
see
a
lot
of
slender
people
of
all
ethnic
backgrounds,
but
especially
Asians
and
Indians,
who
don't
have
much
body
fat,
but
they
have
very
high
triglycerides
and
fatty
liver.
E
So,
despite
them
not
looking
very
unhealthy,
they're
very
unhealthy
based
on
their
lipid
profile
and
a
lot
of
the
women,
especially
before
menopause
a
lot
of
the
carbs
go
towards
fat
storage
in
them
not
much
to
liverish,
although
their
body
weights
heavier
the
cholesterol,
doesn't
look
as
bad
so
as
much
as
they
are
very
jealous
of
their
husband's
body.
Type
I
tell
them
right
now,
at
the
rate,
we're
going
you're
gonna
way,
outlive
your
slender
husband,
okay.
So
so
really
you
have
to
understand
how
that
traffic's
distributed
and
our
fundamental
goal.
E
When
we
talk
about
lifestyle
changes,
is
we
want
to
reroute
traffic?
We
want
to
get
the
carbohydrate
car
moving
back
towards
muscle
and
away
from
these
other
dangerous
sites.
That's
essentially
what
we're
going
to
talk
about
now,
the
process
of
atherosclerosis.
That
is,
the
process
where
plaque
formation
begins
the
plaque
that
can
cause
heart
attacks
and
strokes,
and
one
of
the
things
I'm
going
to
talk
about
at
the
end
of
this
talk
also
is
this
is
a
process
it
starts
in
childhood.
Okay,
this
is
a
fundamental
thing.
You
have
to
understand.
E
Plaque
formation
starts
in
the
first
decade
of
life.
It
doesn't
start
all
of
a
sudden.
Your
50s
and
60s
I
mean
things
can
accelerate
that,
but
a
lot
of
what
we
do
in
our
childhood
and
teenagers
can
lay
the
foundation
for
plaque
formation
and
when
I
talk
about
children's
health
a
little
bit
towards
the
end.
Hopefully
I
can
motivate
everyone
to
sort
of
make
multi-generational
changes
to
reduce
the
risk
of
heart
disease.
As
we
talk
about
heart
disease
risk.
These
are
the
five
worldwide
factors
are
a
link
to
over
80%
of
heart
disease.
E
It's
abnormal
cholesterol,
it's
high
blood
pressure,
it's
diabetes,
it's
obesity
and
smoking
and
when
we
assess
heart
disease
risk,
these
are
the
categories
of
risks
that
I
look
at
I.
Look
at
your
biometrics,
I'll
teach
you
what
your
numbers
mean.
When
you
go
to
get
the
doctor's
office,
then
you
get
the
lab
tests
back,
there's
specific
things
that
you
have
to
look
at
that
are
very
different
than
what
you
normally
think.
So
I'll
teach
you
how
to
do
that.
E
The
second
thing
is
genes,
so
nowadays
we
are
in
the
era
where,
where
we
can
check
people's
genetic
information,
but
right
now
just
to
keep
things
simple.
We
assess
genes
by
just
assessing
your
family
history
and
then
the
third
thing
is
we
assess
your
lifestyle
risk,
you
know
stress
physical
activity,
etc.
So
let's
talk
about
cholesterol
first.
So
when
we
talk
about
cholesterol,
so
this
is
an
image
from
the
book
that
I
want
you
to
understand
so
you're.
Looking
at
these
two
boats,
so
I
want
to
start
off
and
talk
about
LDL
cholesterol.
E
The
type
a
boats
are
larger,
LDL
particles,
that
type
B
or
small
ones,
and
you
would
think
that
the
large
ones
would
be
more
dangerous,
but
it's
actually
the
small
Type
B
particles
that
are
the
ones
that
are
more
dangerous,
they're
the.
If
your
body
has
more
type
B
LDL
particles,
those
boats
tend
to
anchor
into
the
blood
vessel
wall,
so
I'm
showing
you,
if
you
think
of
the
inner
lining
of
the
blood
vessel
wall
I,
show
that
layer
right
here.
E
If
you
were
to
take
like
a
tube
and
open
it
up,
let's
think
of,
like
a
toilet
paper
roll
you
open
that
up
and
that
inner
lining
is
where
the
damage
happens.
So
type
B
particles
tend
to
stick
the
bend
at
the
old
cell
layer
and
cause
more
damage
versus
type.
A
and
I'll
teach
you
how
to
figure
out
what
type
you
had,
even
without
doing
advanced
lab
tests.
The
reason
those
small
particles
are
so
dangerous
is
there
kind
of
like
a
pack
of
let's
say,
mischievous
teenagers.
E
When
they
hang
out
inside
the
blood
vessel,
the
small
particles,
they
tend
to
not
flow
through
the
pipe
very
much
they
tend
to
stick
to
the
blood
vessel
walls.
So
when
you
have
more
type
B
LDLs,
they
will
stick
to
that
wall,
much
more
avidly
than
the
type
a
they're
also
more
susceptible
to
damage.
These
are
like
little
hand,
grenades
when
they
attach
to
the
blood
vessel
wall
they
can
oxidize,
which
is
a
process
that
causes
the
particles
to
become
unstable,
and
they
also
attach
to
glucose
molecules.
So,
basically,
remember
small
is
tied.
E
E
If
there's
one
thing
you
should
take
away
from
this
talk
is
know
your
triglyceride
numbers
and,
if
they're
elevated
fix
them
as
soon
as
you
can,
because
triglycerides
are
the
number
one
cholesterol
risk
factor
I
see
in
the
clinic
today.
Triglycerides
are
basically
a
storage
form
of
fat,
so
when
we
gain
body,
fat
or
fat
cells
actually
get
filled
up
with
triglyceride
particles,
when
your
blood
has
elevated
levels
of
triglycerides,
that's
a
sign
that
you
have
insulin
resistance.
You've
got
the
carbohydrate
traffic
problem
to
some
degree.
E
It's
also
an
early
trigger
for
plaque
formation,
atherosclerosis
and
then
here's
the
most
important
part
in
our
cholesterol
section
here
is
it
leads
when
you
have
high
triglycerides,
it
leads
to
the
formation
of
more
of
the
small
type
B
LDL
particles,
the
dangerous,
sticky
particles,
okay.
So
this
is
a
bit
of
a
complicated
graph,
but
I
just
want
to
show
you
just
to
make
the
point
that
as
your
triglycerides
go
up,
so
that's
x-axis
right
here
is
your
triglyceride
levels.
Go
up
that
green
graph
is
dropping
your
LDL
particle
number
goes
down.
E
This
shows
that
inverse
proportion,
basically
as
triglycerides
go
up.
Ldl
particle
size
goes
down,
so
even
without
so
there's
a
specific
way.
You
can
check
your
LDL
particle
size.
There
advanced
tests
that
you
can
do,
but
you
don't
always
have
to
do
them.
If
you
looked
at
your
triglyceride
number,
if
it's
above
150
and
especially
above
200,
you're
almost
guaranteed
to
have
more
type
B
particles
above
100
150,
you
might
have
intermediate
risk,
but
really,
when
you
get
up
above
150
to
200,
you
start
generating
more
of
those
particles.
E
Now
healthy
cholesterol,
HDL
the
job
of
healthy,
healthy
cholesterol.
Is
it
removes
some
of
that
cholesterol
away
from
the
blood
vessel
lining,
so
the
more
we
can
elevate,
HDL
cholesterol,
we'll
talk
about
how
to
do
that.
That
can
help
basically
reduce
some
of
the
heart
disease
risk.
It
also
lowers
inflammation.
It
keeps
the
blood
thin,
so
it
doesn't
clot
in
the
blood
it
keeps
the
blood
vessels
less
stiff
and
again.
This
is
why
I
obsess
over
triglycerides
high
triglycerides
pushdown
HDL.
E
So
if
you
look
at
your
lab
panels
over
time,
you'll
see
that
they
tend
to
be
inversely
proportional.
If
you
get
enough
lipids
done,
you'll
see
the
higher
tribus
or
heads
are
the
more
it
pushes
HDL
down
lower.
So
the
easiest
way
to
fix
it
is
to
lower
triglycerides
over
time.
The
HDL
should
float
up
so
to
make
it
easier.
Let's
put
some
of
these
principles
into
practice:
let's
look
at
Sam's
cholesterol
results.
E
What
let
his
heart
disease,
and
often
if
you
don't
I
wish
I
could
say
that
all
doctors
are
trained
to
interpret
cholesterol
panels
like
this,
but
unfortunately
they're
not.
This
is
a
typical
type
of
profile
where
his
doctor
told
him
that
your
numbers
looked
okay
and
he
had
a
massive,
almost
life-ending
heart
attack.
So
it's
going
to
be
your
job
to
interpret
these
numbers
properly,
because
your
doctor
may
not
know
this.
So
basically,
look
at
the
test
results.
The
total
cholesterol
is
190.
E
Okay,
target
level
I
put
not
important,
because
some
people
with
a
really
good
cholesterol
levels
are
above
200
because
they
have
such
high
levels
of
HDL
cholesterol
right.
So
that's
why
total
cholesterol
is
not
very
useful.
The
LDL,
the
bad
cholesterol
108
was
his
number,
and
most
doctors
would
say
less
than
130
or
less
than
100
is
okay,
but
I
kind
of
put
that
you
know
I'm
not
really
as
concerned
about
LDO.
E
Let's
come
down
to
the
other
numbers,
the
HDL
32,
so
normally
it
should
be
greater
than
40
in
males
greater
than
50
in
females,
but
his
was
32
triglycerides
250,
the
cutoff,
typically
on
most
labs,
is
less
than
150.
Less
than
100
is
ideal.
If
we
can
aim
for
100
the
particle
size
shifts
and
the
ratios
get
better.
This
is
important.
Different
health
care
systems
use
different
cut-offs.
Most
will
use
150
I'm
aware
of
a
medical
system
in
the
Bay
Area
that
uses
a
cut-off
of
500.
E
So
if
you
have
300
400,
you
might
be
told
by
your
doctor
that
it's
normal
it's
crazy.
I've
had
patients
come
from
India
telling
me
as
long
as
it's
below
700.
Don't
worry,
you
know
they
see
so
many
patients
they're,
like
oh,
my
god,
okay
as
long
as
it,
but
most
heart
disease
is
happening
in
the
150s
180s
to
hundreds
between
2
to
300.
So
in
this
case
it
was
250.
Now
here
are
the
really
important
ratios.
Probably
some
of
the
most
important
information
from
this
talk
is
TC
2,
HT
or
ratio.
E
That's
your
total
cholesterol,
divided
by
your
HDL.
So
you
take
this
total
cholesterol.
You
divide
it
by
the
HDL
ratio,
is
5.9
should
be
less
than
4.0.
Most
lab
reports
do
report
that
number.
The
number
they
don't
tend
to
report
is
de
triglyceride
to
HDL
ratio.
Be
sure
you
calculate
that
on
your
lipid
profile,
take
your
triglycerides
divide
it
by
the
healthy
cholesterol
and
see
what
you
get
in
his
case
is
number
7.8
far
above
the
3.0
cutoff,
so
those
ratios
are
lifesavers.
E
If
you
look
at
absolute
numbers,
you
might
think
he's
not
really
high
risk.
When
you
look
at
the
ratios,
you
realize
that
he
was
a
ticking
time
bomb,
so
this
is
really
critical.
So
be
sure
you
understand
these
numbers,
so
the
problem
with
our
current
approach
is
70%
of
heart
attack
patients.
Today,
based
on
a
huge
UCLA
study,
they
have
normal
cholesterol
levels.
Their
total
cholesterol
looks
fine
because
they
look
like
this.
Guy
total
cholesterol
is
less
than
200.
Llv
looks
pretty
good,
but
they're
still
coming
in
with
heart
disease.
E
That's
why
it's
so
important
for
you
to
understand
what
these
numbers
mean.
Like
I
said
the
LDL
can
be
misleading.
You
can
have
a
low
LDL
and
still
be
very
high-risk,
there's
not
enough
emphasis
on
triglycerides
and
most
people
don't
know
how
to
raise
the
H
he'll
effectively.
The
other
problem
with
today's
approach
to
is
what
happens
when
you
see
your
doctor.
You
have
high
cholesterol,
most
likely
if
you're
they're
gonna
put
you
on
a
statin.
E
Like
lipitor
studies
have
shown
the
minute
you
put
somebody
on
cholesterol,
drug
on
average,
they
gain
8
to
10
pounds
within
3
months.
Why
is
that?
Because
they're
like
hallelujah
and
now
can
eat
whatever
the
hell
I
want
right.
My
cholesterol
went
down
70
points,
I'm
gonna
go
party
how
many
or
whatever
that
guy
want
right.
That's
a
problem,
so
you
see
weight
gain
so
cholesterol,
drugs.
What
they
do
is
cholesterol.
Drugs
are
very
important,
I'm,
not
undermining
them,
and
the
right
patients
are
important,
but
you
have
to
also
know
what
they
also
don't.
E
Do
they
don't
reduce
visceral
fat,
they
don't
lower
inflammation
in
the
body
they
lower
inflammation,
maybe
a
little
bit.
They
can
lead
to
worse
insulin,
resistance
over
time,
there's
a
definite
link
between
statin
medications
in
increased
diabetes
risk.
So
definitely
in
high-risk
people
it's
important,
but
don't
think
because
your
numbers
are
better
on
a
statin
that
you're
bullet-proofed.
If
anything,
you
have
to
be
more
careful
about
your
sugar,
carb
and
physical
activity,
because
over
time
you
might
develop
another
complication.
E
So
how
do
you
deal
with
this
problem
with
the
high
triglycerides
in
low
HDL?
We'll
dig
deep
into
this,
but
a
few
key
things
that
when
I
sort
of
give
you
off
the
top
is
that
we
have
to
cut
added
sugar
as
much
as
we
possibly
can
we
want
to
remove
some
of
the
excess,
carbohydrates
and
I'll
tell
you
how
to
do
that.
It
is
a
carb
driven
process
that
triglycerides
as
much
as
triglycerides
are
called
blood
fats.
It's
a
carb,
driven
process.
E
So
that's
why
a
typical
low
fat
diet,
radition
aliy
in
typical
indian
vegetarian
diets
that
are
very
carb
heavy.
Those
are
the
patients
that
have
some
of
the
highest
triglycerides
I,
see
in
the
clinic
they're
wondering
how
did
I
develop
heart
disease
I,
don't
touch
key
I,
don't
touch
butter,
I,
don't
need
fat,
but
I
have
heart.
Disease
I've
got
triglycerides
above
400
because
it
is
a
predominantly
carb
driven
process.
That's
the
main
thing:
I'm
telling
you
that
increasing
physical
activity,
we'll
talk,
we'll
talk
about
structurally.
E
How
we
can
do
this
and
typical
types
of
diets,
a
real
key
to
keep
in
mind
what
about
LDL
levels
I
put
if
they
need
improvement,
because
sometimes
people
are
told
you
have
an
LD
of
130.
We
need
to
bring
up
down
140,
but
all
their
other
numbers
are
fine.
They
don't
necessarily
need
to
be
brought
down,
but
if
you
do
have
elevated
LDL
the
ways
we
do
it
is.
We
want
to
increase
natural
fiber
in
the
diet.
Fiber
is
an
LDL
lower
I
put
mostly
through
vegetables.
I'm,
not
anti
fruit.
E
E
Well,
that's
why
I
said
if
you're
overweight
be
careful
of
excess
intakes
of
fiber
foods
that
have
a
lot
of
carbohydrates,
like
oats,
wheat
sand,
grains,
emphasize
healthier
fats,
which
is
key,
we'll
talk
about
that
activity
and
exercise,
and
there
are
supplements
called
plant
sterols
which
are
very
safe
to
take.
You
can
find
it
at
Target.
You
can
find
it
at
Costco.
If
you
have
a
stubbornly
high
LDL,
you
can
take
plant
sterols
supplements,
it's
a
type
of
plant
cholesterol
that
can
bring
down
LDL.
E
The
next
risk
factor
is
blood
pressure,
so
how
high
is
too
high?
So
just
so,
you
understand
what
these
numbers
mean:
a
perfectly
normal
blood
pressure,
where
there's
no
increased
risk
of
heart
attack
and
stroke
is
115
one
one,
five
over
75
now
for
every
20
points
that
top
number
goes
up
in
ten
points,
the
bottom,
no,
the
number
goes
up:
you're,
basically
incrementally
doubling
risk
of
heart
attack
and
stroke.
E
So
that's
why,
if
you
go
up
to
135
over
85,
that's
two
times
at
risk
and
going
all
the
way
up
to
scale
it
gradually,
it
has
a
doubling
effect,
so
anything
above
120
over
80,
which
is
a
common
number,
already
elevates
your
risk.
So
you
have
to
really
be
aware
of
that.
So,
if
you
ever
have
any
high
blood
pressure,
be
sure
you
monitor
it,
I
know
you
might
be
checking
in
the
doctor's
office
or
Walgreens,
but
get
a
home
blood
pressure
cuff
and
check
it
at
different
times
of
the
day.
E
So
you
see
where
your
average
number
is.
Your
cuff
should
be
large
enough
one
of
the
common
false
elevations
of
blood
pressures.
If
people
get
a
cup,
that's
too
tight.
I've
noticed
this
with
one
of
my
relatives.
They
were
wearing
a
cuff
that
was
way
too
tight
and
I
was
falsely
elevating
their
blood
pressure.
The
minute
we
got
a
normal
cuff,
the
number
was
actually
fine,
so
make
sure
the
cuff
you
dare
on
the
side
of
the
cup
being
a
little
bit
on
the
larger
side
and
then
share
your
home
recordings
with
your
doctor.
E
Now,
what
are
the
contributing
factors
now?
Unlike
cholesterol,
cholesterol,
we
can
reverse
almost
most
cases
with
lifestyle
changes,
blood
pressure
we
can,
but
genetic
factors
do
tend
to
play
a
role
with
blood
pressure.
So
family
history
is
a
factor
stress
and
sleep
I
put
at
the
top,
because
these
are
the
two
that
people
neglect.
Everybody
focuses
on
salt
and
the
diet
I
got
to
lose
more
weight.
Those
are
all
important.
Salt
is
becoming
less
important.
I
did
a
very
detailed
blog
post
on
the
connection
between
salt
and
blood
pressure
and
you'd.
E
Be
surprised
to
find
that
the
link
is
not
as
strong
to
think
so.
Salt
really
is
if
it's
coming
from
processed
packaged
foods,
that
has
an
impact,
but
if
you're,
making
stir-fry
vegetables
and
healthy
foods
and
you're
adding
salt
to
that,
that's
probably
not
going
to
have
much
of
a
blood
pressure
elevating
effect,
but
here
in
Silicon
Valley,
when
people
are
not
able
to
manage
their
blood
pressure,
we're
piling
on
more
meds,
it
is
de-stress
and
sleep
that
is
often
the
most
important
factor.
E
E
That's
always
the
one
they're
afraid
of
what's
go
to
bed
early,
no
way
just
maybe
exercise
more,
but
those
are
the
two
that
have
a
huge
impact:
excess
weight,
especially
the
belly
fat
inactivity
for
spending
a
lot
of
prolong
time
sitting
and
then,
like
I,
said
sodium
coming
from
processed
foods,
not
necessarily
a
salt
shaker,
but
if
you're
eating
a
lot
of
packaged
processed
foods
and
you're
not
getting
enough
potassium.
So
the
balance
of
sodium
to
potassium
controls,
how
stiff
those
blood
vessels
are.
You
don't
have
to
measure
through
a
blood
test.
E
If
you
just
limit
your
processed
foods,
your
sodium
ratio
is
going
to
go
down
and
if
you
eat
more
plant-based
foods,
think
potassium
Peas
for
potassium
peas,
for
plants,
nuts,
seeds
and
vegetables
will
elevate
that
and
by
switching
that
ratio
just
through
dietary
changes.
The
blood
pressure
over
time
can
come
down
and
then
be
careful
with
alcohol
for
some
people,
they're
very
alcohol,
sensitive,
even
a
glass
of
wine
for
most
people,
blasted
wines,
not
an
issue
we'll
talk
about
alcohol
later.
There's
some
really
compelling
studies.
E
It
just
came
out
last
month,
but
for
some
people
they
are
very
alcohol.
Sensitive
and
I.
Tell
them
just
hold
off
on
the
alcohol
for
two
to
three
weeks:
check
your
blood
pressures
at
home
and
see
what
happens
if
nothing
happens,
there's
no
net
effect.
You
can
probably
add
it
back,
but
just
keep
in
mind
some
people.
It
can
be
very
sensitive
to
the
impact
of
alcohol,
okay,
so
managing
blood
pressure.
Some
items
to
check
out
in
my
book
I
focus
a
lot
in
chapter
3.
This
blog
post
is
very
popular
I.
E
Give
people
6
steps
very
unique
steps,
not
the
usual
steps,
where
I'm
actually
hoping
that
I
help
them
lower
blood
pressure
through
through
natural
lifestyle
changes.
So
that's
a
blog
post.
You
can
check
out
on
my
blog
now.
Let's
talk
about
insulin
resistance.
This
is
our
carbohydrate
traffic
problem.
How
can
we
fix
this?
But
before
we
can
fix
it,
how
do
we
measure
it?
How
do
we
know
we
have
a
traffic
problem
in
the
first
place,
you
checked
your
fasting
blood
sugar.
E
If
your
fasting
blood
sugar
in
the
morning
after
10
to
12
hour
fast,
is
consistently
100
or
above
that's
a
sign
of
pre-diabetes,
so
that
can
be
an
early
sign
of
insulin
resistance
if
it's
above
125,
126
and
above
that
defines
diabetes.
Now,
if
you
have
borderline
sugars
or
family
history,
you
should
ask
your
doctor
to
get
a
test
called
the
a1c.
The
a1c
is
a
composite
score.
The
problem
with
just
one
blood
glucose
number:
it's
just
one
data
point
in
time.
E
You
might
be
a
little
bit
elevated
in
the
morning,
but
you
might
be
okay
throughout
the
day.
So
then
that's
not
as
much
of
a
concern,
but
the
a1c.
It
tells
you
your
average
sugar
for
the
last
three
months
lasts
two
to
three
months,
so
that's
a
number
that
we
should
get
if
we
have
any
issues
with
insulin,
resistance
in
the
family
or
if
your
Sugar's
have
been
high
and
then
coming
back
to
this
high
triglycerides
and
low
HDL.
This
is
the
key
that
is
an
early
sign
of
insulin
resistance.
E
Now,
a
lot
of
doctors
define
insulin
resistance
at
carbohydrate
problem.
They
wait
for
the
sugar
to
go
up
and
I.
Tell
them
don't
wait
for
the
sugar
to
go
up.
If
you
have
high
triglycerides,
you
have
pre
pre-diabetes
by
the
time
your
sugar
starts
going
up
already.
Your
body
is
losing
the
capacity
to
use
sugar
for
energy.
If
you
can
get
it
checked
at
the
high
triglyceride
stage
in
yourself
or
in
your
kids,
you'll
find
out
that
we're
seeing
tons
of
kids
now
with
high
triglycerides.
E
That's
when
you
immediately
want
to
fix
it,
because
that
will
preserve
that
pancreatic
function,
so
won't
lead
to
type
2
ty
B's
diabetes
later
on.
How
do
you
improve
it
kind
of
similar
to
the
triglyceride
slide?
Again,
we
want
to
reduce
the
added
sugars
and
excess
carbs
increasing
muscle.
Okay,
when
you
add
more
strong
muscles
to
your
body,
they
can
burn
sugar
more
effectively.
So
that's
one
key
thing,
because
many
of
us,
when
we
exercise
might
be
focused
more
on
cardio
and
cardio,
is
absolutely
important
for
your
heart.
E
But
if
you've
got
that
carbohydrate
traffic
problem,
you
want
to
make
sure
you
amplify
that
muscle,
because
it
will
burn
sugars
more
effectively,
which
means
it's
going
to
take
more
carbs
from
your
diet,
towards
muscle
and
away
from
fat
and
away
from
liver,
increasing
your
baseline
activity.
Steps
we'll
talk
about
that
during
exercise,
adding
some
cardio
a
few
times
a
week
and
then
again
the
stress
and
sleep
factors
can
actually
elevate
sugar.
So
one
example
we'll
give.
E
You
is
I,
have
some
patients
in
my
clinic
now
that
we're
continuous
glucose
monitors
24/7
their
glucose
being
reported
out
to
an
app
on
their
phone,
and
many
of
them
have
fixed
everything
from
their
diet
and
exercise
standpoint,
but
they
still
have
elevated
morning,
sugars
and
I've
told
them
even
before
they
got
the
monitor.
That
is
probably
your
bedtime
in
your
stress
levels
and
they
don't
believe
it,
but
the
minute
they
start
tracking
their
data
24/7.
E
They
are
shocked,
then,
when
they
go
to
bed
one
hour
earlier,
when
they
shot
their
device
off
and
do
something
mindful
or
read
a
fiction
book
that
over
time
their
sugar
gets
better.
And
why
is
that?
So
let
me
explain
to
you
why
that
happens,
why
does
nighttime
stress
in
digital
stimulation
raise
morning
blood
sugar?
Let's
go
back
to
evolutionary
times,
okay,
so
if
we
were
out
in
the
savanna
and
we
had
to
go
to
bed
at
night,
nighttime
is
a
vulnerable
time
you
might
get
attacked
by
predators.
E
During
that
time,
your
body
is
on
high
alert.
So
what
happens?
Is
your
body
produces
stress
hormone
and
it
activates
your
liver
to
produce
a
slow
pulse
of
sugar
during
the
night
time?
Because
if
you
get
attacked,
you
need
that
sugar
to
run
the
heck
out
of
that.
You
know
your
hut
and
get
away
from
danger.
E
Often
we'll
never
see
that
morning,
sugar
improve.
So
just
keep
that
in
mind.
So
now,
let's
talk
about
body
fat,
our
favorite
topic,
okay.
So
this
is
a
way
explain:
body
fat
to
people.
There's
two
types
of
body,
fat
and
I
showed
I,
don't
know
if
I
should
use
a
jelly
doughnut.
This
may
not
be
sending
the
right
message:
I'm,
not
telling
you
to
eat
the
jelly
doughnut.
This
is
a
model
of
what
body
fat
looks
like
so
there's
two
compartments
of
body
fat.
E
The
outer
fat
is
a
subcutaneous
body
fat,
that's
divisible,
body
fat
that
usually
contributes
to
more
of
our
mass
weight.
The
inner
fat
is
de
Visser,
alors,
inflammatory
fat.
That's
to
jelly
inside
the
red
jelly
inside
that
visceral
fat
is
what
contributes
to
increased
heart
attack,
heart
disease,
stroke,
cancer
risk
now
look
at
the
ethnic
distribution.
This
is
one
of
the
reasons
why
certain
ethnic
groups
like
Asians
and
Indians,
can
be
at
higher
risk
at
lower
body
weights
in
chuckle
Caucasian
body.
The
ratio
of
jelly
to
donut
is
about
even
it's
about
one
to
one.
E
Maybe
in
african-americans
they
tend
have
less
of
the
inflammatory
fat
and
more
of
that
outer
crust.
So
they
can
become
very
overweight
without
developing
glucose
issues,
but
their
heart
disease
comes
because
african-americans
have
a
disproportionately
higher
rate
of
high
blood
pressure,
so
they
get
kidney
disease
and
heart
disease
from
high
blood
pressure.
But
look
at
the
Asian
diagram
here,
a
tremendous
amount
of
jelly,
which
you
can't
necessarily
see
it's
in
the
triglycerides
in
your
blood,
it's
in
your
liver
and
just
a
thin
rim.
Basically
that's
subcutaneous
fat.
E
E
But
that's
a
pulsatile
thing
that's
during
times
of
feast,
famine
whatever,
but
if
you
chronically
have
that
elevated
visceral
fat,
then
that
can
lead
to
more
heart
disease
risk.
So
let's
look
at
what
this
looks
like
okay,
so
these
are
two
famous
obesity,
researchers
and
I
just
want
to
make
the
point.
This
is
a
British
doctor.
This
is
an
Indian
researcher
and
they
partnered
on
a
lot
of
interesting
studies.
But
what
I
wanted
to
show
you
here
is
their
body.
Mass
indexes
are
identical.
This
is
the
height
weight
composite
score.
E
E
I
eat
a
typical.
You
know
in
didn't
diet
and
the
only
exercise
I
get
is
stepping
off
the
elevator.
I
never
take
the
stairs,
even
though
he
does
all
this
research
is
basically
pushing
the
buttons
on
the
elevator
is
the
only
exercise
he
gets
so
so,
but
you
know
again,
culturally
a
lot
of
people
that
see
people
like
this.
You
think
that
wow,
this
guy
needs
to
eat
more
right.
This
is
the
guy
that
the
mother-in-law
the
spouse
is
like.
This
guy
needs
to
gain
weight
right.
Another
point
of
conflict
in
the
clinic
is
pay.
E
That's
why
it's
really
key
that
we
keep
that
visceral
fat
down
one
very
popular
resource
on
our
palliative
medical
foundation,
page
that
I
built
several
years
ago,
is
an
Asian,
adjusted
body
mass
index
calculator
and
also
waist-to-hip
ratio
calculator.
So
this
is
a
good
resource
for
you
to
know
because
there's
different
body
mass
index
cut-offs
for
different
ethnic
groups.
So
that's
a
good
resource
for
you
to
check
out
now.
I
want
to
make
a
quick
point
about
smoking.
Okay,
hopefully
most
of
us
in
this
room
are
not
smoking.
E
It
is
the
strongest
reversible
risk
factor
for
heart
disease.
It
can
increase
LDL
and
triglycerides
and
lower
the
healthy
cholesterol
increases
blood.
Clot
and
you
guys
might
know
this
already
smoking.
We
think
of
as
lung
cancer.
Profound
impact
on
heart
attack
risk,
but
here's
the
part
that
I
think
might
raise
some
eyebrows.
Even
one
cigarette
a
day
daily
is
deadly
I
go
give
a
lot
of
corporate
toxin.
E
I
still
still
see
people
out
in
the
parking
lot
in
the
smoking
areas,
and
they
tell
me
I'm
a
social
smoker,
just
two
scotch
and
a
cigarette
on
the
weekends.
But
this
study
done
in
2018.
Just
let's
spend
some
time
on
this
because
I'm
sure
all
of
you
might
know
somebody
or
might
be
somebody
that
smokes
1
to
2
cigarettes
a
week.
E
It
showed
that
males
who
smoked
one
cigarette
daily,
they
have
a
46%,
greater
heart
disease
risk
and
a
25%
greater
risk
than
non-smokers,
females,
57%,
higher
heart
disease
risk
and
31%
greater
risk,
and
you
might
think
that
smoking
one
cigarette
daily
has
you
know
one
twentieth,
the
risk
of
somebody,
smoking
20
cigarettes,
but
it's
actually
half
the
risk
right,
so
that
one
cigarette
has
a
huge
problem.
Now,
if
you're
smoking,
one
cigarette
on
top
of
having
increased
belly
fat,
high,
triglycerides,
huge
problem,
okay,
so
you're
just
compounding
all
those
risks
together.
E
So
I
tell
people
social
smoking
is
deadly
smoking
quit
at
100%.
There's
no
amount,
that's
healthy
at
all
for
cigarettes
now
advanced
test,
so
you
might
have
gotten
the
standard
blood
tests
by
your
doctor.
There
are
some
additional
tests
that
can
be
useful.
There's
a
blood
test
called
the
HSC
reactive
protein.
It
can
test
your
body
for
inflammation.
So
many
of
my
patients
that
have
high
cholesterol,
they
might
have
other
risk
factors
for
heart
disease,
we're
not
sure
if
they
need
cholesterol.
E
Medication
I
might
check
a
C
reactive
protein
to
say
that
if
they
have
high
inflammation
levels,
I
mentioned
that
you
can
do
an
advanced
lipid
profile
in
some
cases
to
break
down
the
size
patterns.
There's
a
test
called
ALP.
A
little-a
I
want
to
talk
about
that
in
a
second
and
the
heart's
again
I'm
going
to
talk
about
these
are
advanced
parameters.
What
is
LP
little-a,
so
this
is
a
really
important
cholesterol
particle.
It's
like
an
LDL
cholesterol
particle,
but
it's
even
more
dangerous.
E
What
it
does
do
is
it
sticks
to
the
blood
vessel
wall
and
it
causes
tremendous
inflammation,
damage
and
blood
clotting
and
when
you,
if
any
of
you
have
a
family
member,
that's
had
early
heart
disease
like
a
sibling
or
a
parent.
If
you've
had
a
parent
or
a
sibling
that
had
heart
disease,
males
less
than
age,
55
females
less
than
65,
there's
a
good
chance.
You
have
an
elevated,
LP
little-a.
You
should
ask
your
doctor
to
get
a
check.
E
It's
very
overlooked
and
not
often
checked
enough,
but
when
that
is
elevated,
it's
significantly
compounds
heart
disease
risk
and
it's
actually
the
the
Association
it's
10
to
20%
of
the
population.
It's
even
higher
in
certain
groups
like
Asian
Indians
Asians,
have
the
highest
incidence
of
elevated
LP,
little-a,
so
being
Asian.
Indian
alone
is
probably
a
risk
factor,
but
if
you
have
a
family
history,
you
should
absolutely
get
that
checked
now,
quick
point
about
heart
scans.
This
is
a
test.
I,
sometimes
check.
E
If
you
are
at
high
risk
for
heart
disease,
it's
something
you
may
want
to
know
about,
or
talk
to
your
doctor
about
in
the
old
days.
The
only
way
we
can
look
at
your
arteries
Baidu
is
by
doing
an
angiogram,
but
there
is
a
test
called
an
EB
CT,
it's
a
heart
scanner
and
you
can
look
for
calcium
inside
the
arteries
of
the
blood
vessels
and
that
calcium
is
an
actual
surrogate
marker
for
plaque
formation.
I've
caught
some
early
heart
disease
in
patients
that
actually
had
a
positive
plaque
score
and
thank
God.
E
We
checked
it
because
otherwise
we
would
have
just
been
waiting
for
the
heart
attack
to
happen.
So
a
positive,
calcium
score
is
an
indicator
of
heart
attack
risk.
We
don't
check
it
in
everyone.
There
is
some
radiation
involved.
We
usually
tend
to
check
it
in
people
that
have
intermediate
to
high
risk,
we're
not
sure
if
they
need
to
go
on
a
statin
medication,
but
this
is
a
test
that
can
be
done,
so
you
can
discuss
it
with
your
doctor.
So
now,
let's
get
to
how
do
we
reduce
these
risks?
E
So,
let's
come
back
to
my
traffic
diagram.
Remember
what
I
said
our
goal
for
everyone
in
the
room
is
we
want
to
get
more
glucose
and
carbohydrate
traffic
going
to
the
muscle
parking
lot.
So
how
do
we
do
that?
A
few
different
ways?
The
first
thing
is,
we
have
to
lower
the
amount
of
carbohydrate
traffic
going
to
the
muscle.
So
let
me
make
a
really
key
point
for
you
here.
This
is
really
important
for
nutrition.
Your
muscle
parking
lot
has
a
fundamental
disadvantage.
It
has
limited
parking
space,
especially
if
you're,
not
a
bodybuilder.
E
All
of
our
muscle
parking
lots
have
fixed
a
limited
parking
space.
Our
fat
parking
lot,
unlimited
space,
open
24/7.
That's
why
we
can
gain
hundreds
of
pounds
of
extra
body
fat
right,
our
liver.
It
can
take
on
a
lot
of
traffic
and
convert
it
into
fatty,
liver
and
it
can
convert
it
to
blood
triglycerides.
Now
here's
the
issue,
let's
say
today,
you
ate
pretty
healthy.
You
didn't
need
too
many
extra
carbohydrates.
You
went
to
bed
at
night,
okay,
so
you
probably
filled
your
pardon.
E
What
most
of
us
are
filling
or
overfill
in
our
parking
lot
and
on
a
daily
basis,
then
you
wake
up
the
next
morning.
Do
you
think
your
parking
lot
is
empty
the
next
morning?
There's
no
reset
button
overnight.
It's
still
full!
So
if
you
wake
up
in
the
morning
with
a
full
muscle
parking
lot
and
you
have
one
innocent
slice
of
whole
wheat
toast,
maybe
a
bowl
of
oatmeal
there's
no
place
for
that
oatmeal
to
go.
It's
not
going
to
go
inside
there.
E
It's
gonna
go
towards
fat
storage,
triglyceride
production
or
it's
gonna
stay
in
your
bloodstream.
So
when
people
ask
me
is
oatmeal
good
or
bad,
it
all
depends
on
context
if
you've
been
physically
active
and
the
oatmeal
is
going
to
be
part
of
a
carbohydrate
restrained
eating
plan.
It's
not
a
problem,
but
if
you
ate
like
crazy,
we
went
to
the
buffet
and
you
know
for
your
Saturday
and
then
you
wake
up
and
you're
having
oatmeal.
That
oatmeal
is
gonna,
be
the
straw
that
breaks
the
camel's
brackets.
E
It's
gonna
lead
to
high
triglycerides,
a
body,
fat,
storage,
fatty,
liver
and
all
that,
so
your
goal
is
not
only
to
lower
the
amount
of
carbohydrate
traffic.
You
need
to
clear
parking
space
on
a
regular
basis,
and
what
that
translates
into
is
your
muscles
have
to
be
active
on
a
regular
basis.
Any
time
you
engage
muscles
into
exercise,
it's
burning
energy
in
its
clearing
parking
space.
So
then
more
carbohydrates
can
go
in
and
the
types
of
activities
that
do
it.
Yeah
walking
all
these
things.
E
But
if
you
want
to
rapidly
clear
a
lot
of
space,
do
something
that
tires
out
your
legs
go
for
a
hike.
You
know
do
intervals,
go
on
the
elliptical
machine
and
turn
up
the
resistance.
Anything
that
produces
leg
fatigue
is
rapidly
actually
clearing
parking
space
interval
training
does
it
an
interval,
doesn't
mean
if
you're,
not
somebody
that
can
run.
Even
my
mom
I
tell
her
when
she
goes
for
a
walk,
walk,
fast,
slow,
fast,
slow,
walk
for
10
minutes
to
get
your
heart
rate
up,
but
then
alternate.
E
If
you
have
hills,
go
up
and
down
hills,
anything
that
produces
alternating
intensity
or
leg
fatigue
will
clear
more
parking
space
and
then
you
can
enjoy
some
not
unlimited
amounts,
but
some
carbohydrates
after
that.
So
that's
what
you're
trying
to
do
and
then
adequate
stress
in
sleep
when
sleep
and
stress
are
not
controlled.
Often
the
body
will
not
let
go
of
fat,
it's
not
going
to.
Let
go
it's
going
to
hold
on
to
it
and
up
and
it
can
drive
less
carbs
to
muscle
and
bring
more
towards
fat.
So
that's
another
thing.
That's
often
overlooked.
E
Okay,
so
now
that
we
know
this,
let's
do
a
couple
things
here
so
now
that
we
understand
insulin,
resistance
and
inflammation,
which
meal
do,
you
think,
might
contribute
to
higher
insulin
levels
and
inflammation.
The
one
on
the
left
is
vegetarian.
Right
you've
got
a
nice
Indian
flat
plate.
There,
you've
got
all
those
beautiful
round,
you
know
carbohydrate
bombs
and
you've
got
the
rice
and
you've
got
all
this
wonderful
thing.
We
always
include
this
decorative
tomato
and
on
one
cucumber,
it
says
decorated.
E
We
don't
actually
eat
that
it
just
adds
color
to
the
plate,
but
then
the
rest
of
the
meal
looks
like
that
or
you
know
a
vegetarian
Asian
noodle
dish.
Compare
that
to
maybe
something
that's
got
more
protein
less
charges
and
more
colorful
vegetables
right,
so
I
think
we
know
which
ones
gonna
trigger
more
insulin,
issues
and
more
inflammation,
and
so
this
is
a
sample
plate
and
applying
to
this
to
one
culture.
E
But
you
can
apply
this
to
any
culture
really,
but
usually
what
I
tell
people
is
one
critical
number
for
you
follow
again,
let's
get
back
to
the
foundation
here.
We
want
to
lower
insulin
resistance.
We
don't
want
to
form
type
B
particles.
The
easiest
way
to
do
that
is
to
change
the
way
you
eat.
So
what
I
tell
people
is
if
you're
gonna
track
a
number
use
like
MyFitnessPal
or
fad
secret,
or
some
sort
of
nutrition
app
and
just
pay
attention
to
how
many
grams
of
carb
am
I
eating
each
day.
E
More
specifically,
I
have
my
patients
check
how
many
grams
of
net
carbs,
which
is
your
grams
of
carb,
two
fiber
and
typically
on
a
daily
basis,
if
you're
eating
the
average
sedentary
worker
here
in
Silicon
Valley,
if
you're
eating
more
than
100
to
150
grams
per
day,
your
triglycerides,
your
numbers
are
gonna,
go
up
most
likely?
Okay.
So
now,
let's
look
at
this
snapshot
from
my
book.
Is
this
person
that's
having
one
piece
of
flatbread
one
cup
of
cook
lentils
and
a
potato
based
curry
and
that
one
meal
it
sounds
so
innocent?
E
There's
ninety
four
grams:
that's
how
much
how
much
I
eat
on
an
entire
day!
That's
one
meal
right
there
right!
So
that's
how
it
adds
up.
So
my
typical
Asian.
This
is
Indian
Asians
or
you
know
even
my
non
Asian
patients,
often
they're
eating
300,
400
plus
grams
of
net
carbs,
a
and
they're,
not
clearing
parking
space.
So
all
this
excess
carbohydrate
is
causing
fatty,
liver,
triglyceride
and
the
type
B
from
particles.
So
this
slide
tells
you
how
to
calculate
net
carbohydrates.
E
This
is
a
mnemonic
that
I
use
for
a
lot
of
my
indian
patients,
but
you
can
apply
to
anybody.
I
call
it
carbs.
The
C
stands
for
chapati
and
in
Indian
that's
flatbread,
so
you
can
call
that
tortillas
or
bread.
The
a
is
aloo,
which
means
potato,
which
are
starchy
vegetables.
The
AR
is
rice,
okay,
so
rice
and
grains,
the
B
is
beans
and
the
S
is
sugar.
Now
people
I
made
this
very
clear
in
the
book
that
we're
not
gonna
eliminate
these
food.
E
These
are
staple
far
at
the
parts
of
our
diet,
but
you
need
to
mix
and
match
your
portfolio
properly.
You
can't
spend
it
all
on
eating
carbs
in
one
meal
right.
So
maybe
I'll
have
a
little
bit
of
this
curry.
With
a
little
bit
of
lentil,
then
I
have
some
vegetables,
but
I'm
not
gonna
have
rice
flat
breads,
and
you
know
all
this
together
because
then
in
one
meal,
like
you
saw
with
Smita,
your
numbers
are
way
above
the
charts.
E
So
that's
what
we're
really
trying
to
optimize
you've
heard
this
before,
but
really
we
need
to
add
more
color
to
your
plate,
often
by
patients.
I
haven't
take
pictures
of
the
things
that
they
eat
and
it
looks
like
a
black-and-white
photo.
Everything
is
gray
and
brown.
You
know
it's.
Why
Brown
you
don't
see
bright
colors
at
all,
so
I
tell
people
each
of
these
different
colors
has
a
different
for
your
body.
Can
lower
cancer
risk?
It
can
protect
your
brain,
so
really
that's
saying
eat
the
rainbow
is
really
important.
E
Like
I
said,
if
you
have
sugar
issues
eating
more
vegetables
and
fruit,
you
know
snacking
on
vegetable
snacks,
mini-com
cucumbers.
All
these
things
can
have
incredible
benefits
in
terms
of
lower
cancer
or
heart
disease
risk,
and
this
has
really
been
a
fundamental
strategy
and
I'm
so
happy.
When
I
wrote,
the
book
I
was
teaching
people
how
to
make
Kali
rice.
Kali
rice
is
one
of
the
most
important
things
you
can
do
and
now
they
sell
it.
You
don't
have
to
use
a
food
processor,
a
shredder.
E
You
can
find
Kali
rice
at
Costco
at
Trader,
Joe's
and
the
reason
it
makes
such
a
huge
difference.
You
will
burn
more
abdominal
fat
eating,
Kali,
rice
and
doom
situps,
and
the
reason
for
that
is
because
Kali
rice
is
just
cauliflower,
that's
pulverized
and
shredded
into
rice.
Grains.
If
you
do
the
math,
the
typical
serving
of
rice
or
flat
breads
can
be
30
to
50
grams
of
carbohydrates.
But
if
you
filled
your
plate
with
Kali
rice,
it's
less
than
3
grams
and
it's
anti-cancer
nutrients
as
cruciferous
vegetables.
So
often
I
teach
my
patients.
E
How
do
you
make
your
vegetables?
Look
like
carbs?
Okay,
so
you
can
do
that
with
noodles
spaghetti
squash,
zucchini
pasta.
Even
if
you
love
rice,
I
tell
people
don't
just
eat
rice
plain
eat
it
like
an
Asian,
fried
rice
or
an
Indian
biryani,
where
you
use
60
to
70
percent,
less
rice,
but
mixed
vegetables,
not
two
seeds.
Paneer
shrimp
chicken-
whatever
you
want,
add
vegetables,
protein
and
fat
instead
of
just
eating
plain
white
rice,
it
changes
to
chemistry
of
what
the
glucose
does
to
your
body.
It
also
lowers
the
total
amount
of
carbohydrates.
E
So
these
are
some
real
key
things
to
do
in
terms
of
healthy
fat
intake.
Monounsaturated
fats
are
heart
healthy,
so
these
are
oils
that
come
from
olives,
avocado
oil,
nuts,
especially
almonds.
You
know
Brazil
nuts
cashews.
If
you
want
to
know
more
about
nuts
I
did
a
dedicated
blogpost
on
nuts.
It
teaches
you
everything
you
need
to
know
about
nuts
and
then
seeds
as
well
too,
and
then,
of
course,
to
play
an
avocado
itself.
These
are
excellent
sources
of
heart-healthy
fats.
E
Omega-3S
are
also
heart-healthy.
If
your
diet
allows
it,
we
want
to
get
it
from
Coldwater
fish,
but
nuts
and
green
leafy
vegetables
I
put
fish
oil
capsules
up
there
for
some
people
it
might
be
useful,
but
more
updated
studies
show
that
fish
oil
capsules
are
not
as
hard
protective
easy
as
we
used
to
think.
So.
If
we're
trying
to
lower
triglycerides
the
best
way
is
still
through
diet
and
not
by
taking
the
omega-3
capsules,
there
might
be
some
risks
with
mega
threes
in
certain
people
as
well.
E
Now
the
big
question:
what
about
saturated
fat
we
get
this
all
the
time
is
coconut
oil
good,
for
you
is
butter
good,
for
you
is
key
good
for
you.
It's
full
fat,
dairy
good
for
you
and
the
answer
isn't
black
or
white,
it
looks
like
it
depends.
Different
people
respond
differently
to
saturated
fat
in
their
diet.
If
you
use
it
like
the
usual
culinary
amounts
like
you're,
using
a
little
bit
of
coconut
oil
to
cook
a
little
bit
of
key
to
cook.
Most
people.
E
We
don't
see
elevated
inflammation,
we
don't
see
elevated
cholesterol
levels,
but
there
are
some
specific
genes
that
I
put
up
here.
Some
people
that
have
these
genetic
you
know
markers
they
have
very
significant
elevations
in
their
cholesterol,
from
eating
even
a
little
bit
of
ghee
or
butter
or
coconut
oil.
So
the
main
thing
I
tell
people
I,
don't
check
these
genetic
tests,
I
tell
people
any
time.
We
make
a
dietary
change.
E
Let's
check
your
baseline
cholesterol
and
then
let's
recheck
it
two
months
later,
if
they're
eating
a
lot
more
eggs
a
little
bit
more
butter,
etc.
Then
we
recheck
it
if
the
numbers
didn't
change,
much
and
they're,
looking
better,
which
they
most
often
do.
If
they're
eating
all
the
other
right
foods.
I
don't
worry
about
it,
they
can
enjoy
it
in
moderation,
but
some
people
are
really
sensitive.
E
Even
small
amounts
can
cause
more
of
an
issue,
but
what
I
would
tell
you
is,
regardless
of
that,
you
do
need
to
diversify
your
fat
intake
some
people
because
of
all
the
press
behind
coconut
oil
and
ghee,
or
eating
primarily
saturated
fat,
but
I
tell
them
that
as
much
as
in
many
people,
he
and
coconut
oil
may
not
raise
heart
disease
risk.
It
has
not
been
proven
to
be
heart.
Protective.
The
oils
that
are
heart
protective
are
the
mono
unsaturated
oils.
E
So
when
you're
cooking
and
eating
fats,
you
should
basically
diversify
so
add
some
of
the
monounsaturated
fats
use
the
olive
oil
use
some
Omega
threes.
Naturally
from
foods
you
can
add
a
little
bit
of
the
saturated
fat
high
quality.
In
addition
to
that,
but
be
sure
to
get
rid
of
the
really
bad
fats
that
are
served
in
snack
foods
and
restaurant
foods,
that's
one
of
the
issues
when
you
guys
go
to
a
restaurant.
E
If
you're
eating
out
a
lot,
many
people
are
like
yeah
when
I
ordered
or
because
I'm
too
busy
to
cook
I,
always
get
the
low
carb
stuff,
just
like
you
told
me,
but
what
they
don't
realize,
even
when
they
go
to
the
Indian
buffet
they're
like
I'm,
not
gonna,
eat
the
rice.
I'll
have
the
salad
I'll
have
the
meat
whatever,
but
what
they
don't
realize
is
the
oils
that
they
use
in
the
restaurants
are
more
damaging
than
the
carbs.
E
The
oils
that
they
use
are
usually
omega
sixes,
which
are
inflammatory
and
they
don't
tend
to
typically
clean
up
the
pots
every
time
they
cook
they
recycle
the
same
oil
over
and
over
getting
back
to
inflammation
those
cause
direct
inflammation
in
the
body
I'm,
not
banning
restaurants.
You
should
go
out
and
joy
yourself
have
your
Sunday
dinner,
but
for
people
that
think
they're
eating
a
low-carb
on
a
daily
basis,
because
all
their
dinners
are
coming
from.
E
Restaurants
or
lunches
you're
trading,
one
problem
for
another-
yes,
your
carbs
might
be
low,
but
your
inflammatory
oils
and
fats
are
extremely
high
and
there's
rarely
any
place
in
the
barrier
that
I
know.
Even
when
I
go
to
corporate
cafeterias,
they've
got
wonderful
food
there
they're
usually
using
the
wrong
oils.
So
that's
why
I
just
choose
to
bring
my
food
if
I
can,
because
you
know
I'd
rather
not
eat
the
inflammatory
oxidative
byproducts,
so
a
healthy
plate
is
typically
I
tell
people
for
most
patients
half
the
plate.
E
You
really
want
it
filled
with
vegetables
multicolored
a
corner,
but
is
gonna,
be
your
protein,
the
healthy
fats
in
the
middle
and
then
starches
in
this
corner
and
I
dial
this
up
and
down
based
on
my
activity
levels
if
I
went
for
a
big
hike
or
I,
did
a
workout
then,
and
do
some
leg
fatigue.
I
can
be
more
liberal.
With
my
starch
intake
I
can
up
dial
that,
to
maybe
you
know,
20
25
percent,
or
so
you
know,
I
can
go
higher
on
that.
E
If
I
did
a
lot
of
weight,
lifting
I
need
to
build
stronger
muscle.
The
protein
can
actually
go
up.
Maybe
I
can
eat
slightly
increased
portions
of
chicken
and
meat
if
I'm
sedentary
I
look
at
my
Fitbit.
My
Apple
watch
I
hardly
got
any
steps.
I
didn't
walk
all
day.
I've
got
to
really
keep
the
carbs
under
control,
it's
proportional
to
my
daily
activity
levels.
E
So
most
common
question
I
get
is
how
do
I
get
more
protein
in
the
diet
so
to
address
that
I
did
very
detailed
post
one
specifically
for
vegetarians,
but
it's
also
applicable
to
non
vegetarians,
but
it
teaches
you
how
to
get
pro
more
protein
into
your
diet
in
a
healthy
way
and
that
can
really
have
a
lot
of
health
promoting
benefit
alcohol.
Here's
the
big
question:
this
is
where
I
get
nervous,
because
my
father-in-law
is
in
the
front
row.
Okay
right!
E
This
is:
we've
talked
about
this
a
lot
so,
okay,
so
so
August
2018
Lancet
is
one
of
the
most
prestigious
medical
journals
and
it's
a
study
and
basically
what
it
did
was
it
looked
at
alcohol
use
and
disease
burden,
not
just
heart
disease,
but
every
acute
and
chronic
condition.
Cancer
Alzheimer
is
everything
accidental
death
and
they
looked
at
it
from
1990
to
2016.
E
Most
of
the
studies
out
there,
but
on
alcohol
and
heart
disease
are
poorly
designed,
they're,
not
they're,
not
statistically
powered
properly.
So
this
one
was
a
very
detailed
analysis
and
doing
this
analysis
I
wanted
to
ask
you
guys:
let's
take
some
guesses
out
there,
how
many
drinks
per
day
were
associated
with
absolutely
no
increased
risk
of
disease?
What
was
the
right
amount
to
drink
to
improve
health?
Oh
my
god,
you
guys
are
impressive:
a
plus
zero.
E
That
was
such
a
sad
thing,
but
what
they
said
was
even
though
a
small
protective
effect
for
heart
disease
was
found.
It
was
counteracted
by
the
risk
of
cancer,
injuries
and
communicable
disease,
but
you
don't
have
to
which
I'll
call
away.
Let
me
provide
a
little
more
context
here.
Okay,
so
here's
the
situation
with
alcohol-
and
this
can
be
applicable
to
a
lot
of
different
types
of
studies,
context
matters.
What
they
found
in
these
studies
is
typically
people
that
are
drinking
in
moderation.
Let's
say
one
to
two
glasses
of
wine
every
day
without
going
overboard.
E
What
types
of
people
are
those
usually
usually
they
come
from
a
higher
socioeconomic
profile?
Usually
that
better,
you
know,
incomes
are
educated,
they're
literate,
they
have
better
access
to
health
insurance.
So
it's
not
necessarily
that
the
alcohol
is
really
protecting
them.
It's
just
that
they
come
from
a
socio-economic
background
where
they've
got
everything
else
working
in
their
favor
right.
So
that's
really
what
we're
fine
and
we
call
it
the
healthy
user
effect
that's
different
than
somebody.
That's
not
drinking
moderately,
that's
abusing
alcohol,
so
really
alcohol.
E
The
issue
is
what
context
are
you
having
it
an
irregular
basis
in
a
healthy
environment
in
a
social
way
and
not
overindulging?
That
may
not
have
any
increased
risk.
You
might
have
some
protective
benefit.
That
protection
is
probably
the
fact
that
you're,
a
social
person
that
enjoys
life-
that's
more
important,
that's
what's
actually
inside
the
wineglass
itself
versus
somebody.
Who's,
self-medicating
and
I.
E
Ask
this
in
the
clinic
I'm,
like
I,
can
tell
some
of
my
patients
they're
suffering
they're
unhappy
with
their
job,
with
their
spouse
with
their
life,
and
they
have
to
have
two
three
scotches
and
it's
not
like
the
Scotch
is
increasing
their
heart
disease
risk
it's
to
life
around
it.
It's
what's
motivating
the
Scotch
and
the
beer
and
the
wine.
So
if
you
think
of
it
that
way-
and
you
provide
that
context-
then
you
can
understand.
So
that's
why
I
tell
people
never
start
drinking
for
health
benefit.
E
It
doesn't
do
it
there's
a
million
other
things
you
can
do,
but
don't
start
drinking
to
protect
your
health.
It's
really
more,
this
kind
of
subtle
Association
that
explains
a
lot
of
differences
in
alcohol
intake
sitting
time.
Okay
feel
free
to
stand
up
any
time,
but
we
are
finding
that
increased
sitting.
Time
increases
death.
E
You
might
have
heard
this
in
the
news,
but
the
one
thing
I
want
to
mention
to
you,
which
is
really
important,
is
most
of
the
studies
show
that
even
people
that
exercise
30
to
45
minutes
a
day
if
they're
spending
time
doing
prolonged
sitting,
it
still
increases
their
heart
disease
and
diabetes.
Risk
and
I
see
this
often
in
the
clinic
people
go
to
the
gym
in
the
morning.
They
work
out,
and
then
they
sit
for
eight
or
nine
hours
because
they
think
they
already
did
their
activity
right.
I
see
some
people
knocking
like
all
right.
E
So
so
that's
the
problem
is
you
have
to
interrupt
prolong
sitting
when
you
sit
for
more
than
30
to
40
minutes
at
a
time
your
body
produces
hormones
that
store
more
abdominal
fat
that
raise
your
blood
sugar,
so
I
actually
tell
patients
I'm
happy
you're
going
to
the
gym,
but
I
want
to
find
out
what
you're
doing
for
sitting
and
standing.
That's
the
foundation
of
physical
activity
do
use
a
stand
up
workstation.
How
many
steps
are
you
getting
if
those
are
sound,
then,
of
course
you
want
to
layer
on
some
activity.
E
On
top
of
that,
but
don't
use
one
as
a
substitute
for
the
other,
that's
the
most
important
thing.
So
now
we
have
all
types
of
devices,
but
now
it's
funny,
because
when
these
things
first
came
out,
people
really
use
them
and
paid
attention,
but
most
people
don't
use
them
anymore.
They
just
use
them
as
a
timepiece.
E
Nobody
knows
how
many
steps
are
taking
anymore,
but
we
really
need
to
use
them
in
the
right
way
and
what
I
tell
people
is
try
to
aim
for
hourly
steps
and
try
to
get
at
least
4000
steps
by
1:00
p.m.
the
reason.
I
say
that
is
because
some
people
do
all
their
walking
in
the
morning
or
they
back-loaded
in
the
evening.
But
if
you
get
enough
steps
by
1:00
p.m.
it's,
ensuring
at
least
that
your
physical,
you
know
walking
steps
are
distributed
evenly
throughout
the
day.
E
The
newer
generation,
fitbit's,
watches
they've
got
the
stand
up
reminder
those
are
really
important
features.
Even
if
you
stand
up
for
a
few
minutes
or
get
a
few
steps
in
you
just
want
to
interrupt
that
prolong
sitting.
The
increased
inflammation
happens
from
prolonged
sitting
as
well.
Okay,
so
remember,
we
need
better
parking
spaces.
Muscle
parking
lots.
Okay,
the
stronger
our
muscle
parking
lots.
E
We
can
indulge
in
a
little
bit
of
extra
carbs
and
the
ways
we
can
do
that
I
tell
people
you
know
as
much
as
maybe
you
come
from
a
country
where
you
didn't
do
these
crazy
boot
camp
exercises.
Our
bodies
are
designed
to
do
these
types
of
activities.
You
know
so
lifts
taking
any
sort
of
weight
and
lifting
it
using
your
whole
body.
So
the
legs
are
strong.
You're
using
your
core
squatting
is
a
very
Asian
India.
E
It's
a
very
you
know
typical
position
that
a
lot
of
us
have
lost
out
on
because
we're
sitting
in
chairs,
but
it
does
restore
hip
mobility.
It
engages
the
legs,
then
suitcase
carries
and
farmer
walks
are
basically
carrying
weights
around
these
things
really
engaged
the
whole
body
and
I
really
reckon
my
patients
that
are
above
age,
forty
fifty
they
do
these
because
I
tell
people.
E
What's
the
point
of
doing
all
these
complex
movements
that
they
do
in
boot,
camp,
where
you're
jumping
off
a
plank
and
doing
all
this
crazy
stuff
I,
don't
want
to
make
sure
that
when
I'm
older,
that
I
don't
have
to
ask
somebody
to
carry
my
bags,
I
want
to
be
able
to
load
my
own
bags
in
the
overhead
compartment.
So
that's
why
this
is
important.
I
want
to
be
able
to
carry
things
with
no
issues
at
all
with
proper
balance.
E
Right
I
want
to
be
able
to
do
this
sort
of
motion,
because
that
translates
into
everyday
life
into
quality
of
life.
That's
what
we're
really
looking
for,
so
for
exercise.
Questions
I
did
a
very
detailed,
two-part
blog
post.
The
reference
is
up
there,
but
I
teach
people
how
to
exercise
in
the
safest
way
possible.
I
see
a
lot
of
people
in
Silicon.
Valley
they've
got
a
corporate
boot
camp.
They
sign
up
for
a
class,
they
feel
really
good,
but
then
they
get
injured
they
blow
out
their
Achilles.
E
E
So
really,
if
you're
somebody
who's
high
risk,
you
should
actually
see
your
doctor
and
you
should
get
medically
cleared
oftentimes.
These
patients
have
to
get
a
stress
test
before
they
participate
in
these
sorts
of
intense
activities,
CrossFit
whatever
you're
doing
otherwise.
Walking
light
to
moderate
exercise
is
fine,
but
if
you're
gonna
do
something
really
intense
and
you
might
have
risk
factors
make
sure
you
get
those
checked
out
really
important.
E
Now,
what
about
stress
I
mentioned
stress
so
I
want
to
explain
to
you
how
stress
scientifically
causes
heart
disease,
so
this
is
something
from
a
dedicated
stress.
Talk
that
I
do
so
so
basically,
I
want
to
show
you
what
happened
to
our
ancestors
versus
what's
happening
to
us
now.
So
I
tell
people
basically
when
it
comes
to
your
blood
vessels.
Okay,
when
our
primitive
hunter-gatherer
ancestors
were
under
stress,
their
blood
vessels
would
tighten,
and
that
was
a
good
thing.
E
You
know
why,
because
if
they
got
cut,
they
stepped
on
a
sharp
object
and
they
started
bleeding.
You
want
the
blood
vessels
to
tighten,
so
you
don't
bleed
to
death,
but
in
somebody
who's
just
sitting
at
work,
stressing
out
all
day
and
their
blood
vessels
say
stiff.
They
get
high
blood
pressure
from
that
right,
so
something
that
was
adaptive
has
become
maladaptive.
What
about
high
blood
sugar?
E
We
talked
about
this
a
little
bit
earlier,
but
high
blood
sugar
provides
energy
to
the
body,
so
you
can
flee
or
fight
danger,
but
unfortunately
chronically
high
blood
sugar
and
somebody
who's
just
inactive
all
day.
That
leads
to
conditions
like
insulin,
resistance,
pre-diabetes
and
diabetes
belly
fat.
How
can
belly
fat
be
adaptive?
Well,
if
you
live
in
a
feast,
famine,
Society
I
tell
people
during
times
of
famine,
your
belly
fats
like
your
Tupperware,
it
stores
calories,
and
you
can
use
that
fat
for
energy.
E
So
you
don't
starve
to
death
during
times
of
famine,
but
I
tell
people
we
now
live
what
what
happens
in
the
winter.
We
don't
famine,
we
feast
even
more,
we
never
empty
our
Tupperware.
We
keep
filling
gut
Tupperware.
Our
body
has
to
find
places
to
shove,
it
the
liver,
the
body
fat
whatever,
but
that's
where
it
has
become
completely
maladaptive
and
then
inflammation
actually
interesting.
We
talked
about
this
already.
It
triggers
immune
system
to
defend
the
body.
So
that's
good.
E
If
you're
out
in
an
environment
where
you're
exposed
to
all
types
of
infections,
but
like
we
talked
about
on
a
chronic
basis,
it
can
lead
to
plaque
formation
and
other
chronic
health
issues.
So
this
is
related
to
this
I
wanted
to
show
that
this
to
you
I
know
it's
a
very
busy
looking
slide,
but
I
did
just
want
to
indicate.
In
the
last
column,
there
is
on
the
last
row,
the
HS
or
the
C
reactive
protein.
E
This
guy
had
very
high
C
reactive
protein
above
10,
and
he
dropped
it
down
to
3.6
through
diet
and
lifestyle
changes,
and
then
he
dropped
it
from
3.6
to
a
perfect
level
of
0.6
and
the
only
change
he
made
was
he
started
meditating.
So
this
is
numerical
evidence
and
I've
seen
this
in
my
patients,
who
are
sleeping
better
and
they
start
meditating,
their
inflammatory
markers
often
go
down.
So
that
just
shows
you
because
I
don't
know
for
a
lot
of
us.
E
Meditation
mindfulness
is
a
black
box,
but
there
is
biochemical
evidence
that
it
can
actually
impact
your
immune
system
in
a
way
that
can
lower
inflammation.
So
keep
that
in
mind.
This
is
my
own
data.
Now
we
can
really
look
at
what
my
numbers
look
like.
Why
am
I
so
passionate
about
this,
because
you
can
see
back
in
2009
now
that
you
know
how
to
read
these
numbers?
My
HDL
cholesterol
was
28.
Now,
look
at
my
total
cholesterol
on
the
left
column
154.
So
a
lot
of
doctors
might
look
at
that
and
go
doctor.
E
Sinha,
your
cholesterol
looks
good,
it's
less
200,
150
fourth-grade,
don't
worry!
My
triglycerides
were
314
okay
and
then
my
LDL
came
back
at
85
all
right.
So
look
at
my
ratio.
My
ratio
is
11
point
2.
What
should
my
ratio
be?
Do
you
guys
remember
lesson
3
right
lesson
3.0.
So
I
was
11
point
2,
but
a
lot
of
people
that
don't
know
this.
They
would
say
that
you
know
what
the
most
important
number
is:
your
total
and
your
LDL
cholesterol.
E
So
again
my
LD
looks
really
good,
but
I
know
based
on
my
triglycerides,
remember:
I
said
when
your
triglycerides
are
above
150
or
200.
You
are
almost
assuredly
making
those
dangerous
type.
B
particles
I
knew
that
already
because
I
checked
my
LDL
size
and
it
come
back.
B
is
bad
right
and
the
problem
is:
when
you
have
B
particles,
they
make
your
LDL
look
good,
they
trick
you
and
they
trick
your
doctor.
Your
doctor
will
look
and
say
you
look
good.
Your
triglycerides
are
200,
your
LD
is
100.
E
Don't
worry,
you
should
worry
in
fact,
it's
so
predictable
that
in
many
of
my
patients,
when
they
fix
your
diet
and
they
improved
their
numbers,
I
said
expect
that
your
LDL
might
go
up
and
that's
exactly
what
happened
to
me.
So
after
an
I'll
show
you
how
I
change
my
diet
after
I
change
my
diet.
Over
time,
you
can
see
that
my
triglycerides
dropped
from
314
to
74
HDL,
naturally
went
up,
I
told
you
they're
inversely
proportional.
My
ratio
dropped
to
1.6,
but
look
at
my
total
cholesterol.
It
went
up,
30
points
and
untrained.
E
I
would
say
well
you're
eating
too
much
ghee
or
butter.
What
happened,
but
that's
because
my
HDL,
my
healthy
cholesterol,
went
up.
My
sighs
pattern
went
from
a
B
to
an
A
right,
everybody
in
the
room
likes
it
when
their
B's
go
to
an
A
right.
We
all
like
straight
A's,
so
b2
an
a
so
I
had
the
larger
particle
my
LDL
went
up,
but
in
a
healthy
way,
cuz,
when
your
LDL
gets
larger
in
size.
Often
the
LDL
will
go
up
as
a
number,
so
this
is
really
important.
E
Stuff
you're
not
going
to
get
this
for
most
doctors,
but
the
ratios.
Everything
went
in
the
right
direction
and
for
me
again,
I'm
using
an
app
I
was
checking
my
car
because
at
that
time,
when
I
had
314
I
exercised
a
lot,
I
was
eating.
Steel-Cut
oats
bananas
I
was
eating
whole
wheat,
stuff
I
was
eating
salads
everything,
but
when
I
calculated
my
net
carbs
look
at
my
breakfast
Trader
Joe's
steel-cut
oats
in
a
banana,
it
came
out
to
be
47
grams
of
net
carbs.
E
I
know
from
tracking
my
numbers
when
I
get
above
100
or
150.
It
goes
up.
The
tribalist
rods
go
up,
so
in
one
meal,
I
was
getting
almost
50
grams.
Now,
if
I
were
to
eat
something
like
a
Mediterranean,
omelet
veggies
she's,
whatever
it's
got
more
fat
more
calories,
but
the
carb
substitution
is
three
right,
so
a
significant
reduction
there.
So
that
gives
you
an
idea
of
how
calories
really
in
many
cases,
don't
matter
it's
a
composition
of
the
foods
itself
that
are
really
critical,
okay,
so
real
quickly.
E
This
case
study
I,
wanted
to
bring
up
because
I
know
we're
all
concerned
about
an
outer
own
health,
but
our
kids
and
everything-
but
this
is
somebody
I
saw
several
months
ago.
So
this
is
a
32
year
old
entrepreneur
who
came
to
see
me
with
his
parents
after
having
a
massive
heart
attack
during
the
high-intensity
exercise
class
32
year
old
entrepreneur
he's
extremely
successful,
very
fit
he's
a
former
collegiate
athlete.
He
eats
a
pretty
unhealthy
diet.
E
High
stress
his
parents
are
very
concerned
because
he's
a
workaholic
who
gets
very
little
sleep
and
doesn't
know
how
to
relax.
So
how
and
when
did
his
heart
disease
begin?
So
we
had
a
very
in-depth
conversation
and
I
won't
forget
this
conversation
because
it's
been
repeated
many
times
before,
but
we
talked
about
the
fact
that
the
parents
were
getting
very
frustrated
with
him
because
he
couldn't
control
his
life,
and
you
know
they
said
that
they
just
he
doesn't
listen
to
us.
We
tell
him
you
need
to
rest
more.
E
You
need
to
make
so
much
money,
just
relax
and
chill
out,
but
then
you
know
I
asked
him
a
question
asked
him:
what
were
you
guys
like
when
you
were
his
parents
when
he
was
younger
right?
What
what
was
happening
then-
and
it's
important
point
to
ask
because
a
lot
of
us
when
we're
parents
were
caught
in
the
rat
race.
We
see
what's
happening
around
us.
My
kids
got
to
do
this.
We
got
to
do
that.
You
know
they
need
to
do
this
act
a,
but
they
got
to
go
to
Stanford.
E
They
have
to
be
an
entrepreneur.
You
get
con
that
rat
race,
but
then,
as
a
grandparent,
you
have
a
different
perspective.
How
many
grandparents
are
out
there
raise
your
hand
now
keep
your
hands
up
if
you
feel
like?
Maybe
your
kids
are
pushing
their
kids
a
little
bit
too
hard.
Well,
it's
awesome.
It's
okay,
yeah
and
that's
what
happens
right.
You
lose
that
perspective
and
the
issue
is
a
lot
of
times.
E
You're
gonna
reflect
back
and
think
that
maybe
it
wasn't
worth
it
to
have
them
do
so
much
and
just
go,
because
now
the
parents
can
slow
him
down
he's
on
he's
on
a
train
where
he
can't
slow
down
at
all
and
it
took
a
massive
heart
attack
and
even
still
I'm
working
with
this
patient.
It's
very
tough
to
slow
him
down.
E
So
so
that's
why
I
want
to
be
fair,
that
what
is
the
greatest
risk
factor
for
heart
disease
and
the
greatest
risk
factor
is
actually
age
and
for
a
lot
of
people
what's
happening
in
modern
civilization.
Now
is
the
risk
factors
the
high
triglycerides
and
those
risks
are
starting
in
nine
10
year,
old,
kids
and
teenagers.
So
by
the
time
they're
30
35,
their
blood
vessels
have
been
exposed
to
chronic
stress,
high
triglycerides
and
sugar
for
15-20
years.
That's
why
we're
seeing
heart
disease
happening
earlier?
Think
about
our
kids.
Now
right,
they
don't
play
anymore.
E
All
the
parks
they're
like
they
have
cobwebs
everywhere,
cuz
nobody's
playing
on
the
playground
structures.
Nobody
rides
their
bikes
unless
they're
riding
their
bike
to
math
class
or
to
school
right
and
because
of
that,
every
generation
of
kids
is
gonna,
face
heart
disease,
obesity,
chronic
disease
much
earlier
and
we're
seeing
that
pattern
happen
already
remember
I
told
you.
The
process
starts
in
childhood:
okay,
the
triglyceride
to
HDL
ratio.
E
This
pediatric
Journal
showed
that
when
your
tribe
booster
at
the
HDL
ratio
is
high
in
kids,
my
wife's
a
pediatrician,
you
used
to
see
this
all
the
time
and
kids
that
already
predicts
increased
stiff
arteries
later
in
life.
So
this
is
starting
very
early
on
okay,
so
I
tell
people
we
have
to
redefine
our
kids
report
cards,
we're
focusing
on
the
left
side,
but
many
of
our
kids
when
it
comes
to
exercise
diet.
You
know
socialization
outdoor
play,
they're,
not
passing
the
marks,
and
a
lot
of
that
is
on
us.
E
You
know
it's
our
responsibility,
they
don't
know
any
better.
We
have
to
instill
those
habits
and
get
them
started
early,
so
they
don't
end
up
like
the
30
role
executive.
Who
want
paper,
looks
great
he's
the
one
you're
gonna
put
on
a
pedestal
and
say
you
work
hard
and
you
can
be
like
him,
but
I
see
him
in
the
clinic.
I
know
what
is
a
marriage
is
like
I
know.
E
You
know
we
never
taught
them
how
to
eat
healthy,
so
they're
not
going
to
learn
it
in
their
20s
and
30s,
and
often
this
is
going
to
happen
before
we
actually
make
that
realization.
Okay,
stand
out
question
of
the
day.
What
factor
is
a
greater
health
risks
in
obesity
is
as
dangerous
as
smoking,
15
cigarettes
a
day
and
raises
heart
attack
and
stroke
risk
by
30%
and
no
cheating.
If
you
came
to
my
prior
talks,
can
anybody
guess
what
that
risk
factor
is?
E
That's
a
really
good
guess.
That's
the
one
I
would
guess.
Yes,
stress
really
close,
so
it's
actually
loneliness
okay.
This
is
turning
out.
It's
been
shown
over
and
over
I
didn't
believe
it
at
first,
but
now
that
it
looked
at
the
data,
loneliness
is
turning
out
to
be
one
of
the
most
profound
risk
factors
for
heart,
disease
for
cancer
and
I
was
trying
to
understand
what
the
science
is.
There's
actually
a
couple
of
genes
that
are
linked
to
loneliness.
E
So
when
we
perceive
our
lives
as
being
lonely,
we
see
this
a
lot
in
our
community
here
as
we
age.
We
start
to
see
this
kids
are
out
of
the
house
for
immigrants
that
are
coming
from
large,
extended
families
and
now
they're
living
a
nuclear
family
life.
We
have
this
perception
of
feeling
alone
and
again
coming
back
to
evolution.
Whenever
we
feel
alone,
we
feel
like
we're
in
danger,
there's
a
specific
gene,
a
special
that
becomes
activated
with
loneliness
and
it
causes
your
immune
system
to
start
overreacting.
E
So
this
is
really
important
again,
as
we
think
of
our
kids.
Are
they
socializing
enough
or
they
completely
absorbed
in
activities
that
are
disconnecting
them
from
their
friends
as
we
age?
Are
we
still
you
know,
keeping
our
connections
and
staying
social
there's
now
hard
hard
science
and
look
how
profound
it's
as
bad
as
these
other
risk
factors,
and
that's
why
there
are
some
communities.
E
You
can
look
at
some
ethnic
populations
where
their
lifestyle
risks
are
not
very
good,
their
diets,
not
good,
but
because
they
have
sense
of
community
their
heart
disease
risks
are
actually
very
low.
It's
incredible.
So
that
is
has
a
really
big
factor.
This
is
another
post
I
prefer
e
to.
This
is
one
of
the
most
popular
posts,
I've
written
in
a
long
time.
It's
it
was
written
in
the
end
of
June.
It's
called
this
single
thought
process
can
ruin
your
health
and
it
gets
to
the
funder.
E
You
know
underlying
sort
of
psychology
of
why
we
end
up
with
a
lot
of
health
issues.
A
lot
of
people
reach
out
to
me
and
said
this
really
made
a
big
difference
in
their
life
sort
of
understanding
this
process,
so
just
some
posts
for
you
there.
This
is
my
blog,
where
you
can
pick
up
more
information.
My
book
I've
got
a
queue
for
you
to
look
at
in
the
back,
but
you
can't
find
my
book
on
Amazon.
E
We've
been
designing
a
lot
of
wellness
programs
nattu
for
people
who
want
to
learn
more
about
their
health
I
work
with
the
company
too.
That
actually
does
personalized
profiling
that
can
actually
customize
your
diet
based
on
your
metabolic
risk,
and
they
actually
work
out
of
here,
and
it
can
do
profiling
in
India
as
well
too
and
I
even
worked
with
the
same
company
that
does
low-carb
anti
inflammatory
flatbreads.
So
we
know
we
can't
live
without
our
flatbread,
so
this
is
a
company.
E
They've
got
their
breads
out
in
Indian
grocery
stores,
and
you
can
actually
subscribe
to
them
as
well,
but
they're
very
tasty
and
much
healthier
than
the
usual
stuff.
You
can
find
for
a
lot
of
people
that
complain
about
fatigue.
If
you
go
to
my
blog
I
have
a
free
ebook
there
that
has
information
on
fatigue.
People
throughout
Silicon
Valley
been
using
this
as
a
reference
and
with
that
I
loaded
you
with
a
lot
of
information,
so
we'll
open
it
up
to
questions.
D
E
E
E
E
You
know
in
terms
of
trying
to
keep
your
metabolism
up
by
eating
more
frequently
throughout
the
day
that
works
for
a
minority
of
people,
but
every
time
you're
putting
most
foods
in
your
mouth
you're,
causing
a
glucose
and
insulin
spike,
I'm,
actually
more
of
a
fan
of
keeping
more
space
between
the
meals.
So
one
popular
way
of
eating
is
intermittent
fasting
or
we
call
it
time
restricted
eating
where
you
do
all
your
eating
within
a
fixed
window,
and
then
you
allow
your
liver
and
body
to
fast
for
12
to
14
hours.
E
So,
for
example,
you
might
eat
everything
between
11
a.m.
to
7
p.m.
that's
eight
hours
and
then
for
16
hours.
That
gives
your
liver
time
to
cleanse
that
works
much
better.
What
I'm,
trying
to
reverse
insulin,
resistance
and
diabetes?
We
need
to
create
space
in
between
eating
episodes.
You
know
because
remember
my
parking
diagram
right
there
right.
E
One
of
our
goals
is,
we
need
to
keep
clearing
parking
space
and
we
have
to
keep
the
liver
cleanse
as
well
too,
and
one
of
the
ways
to
do
that
is
to
give
our
body
not
only
physical
activity
but
also
increase
space
and
the
way
you
can
incorporate
this
in
your
life.
You
don't
have
to
do
it
every
day,
but
typically
I.
Do
it
around
social
occasions
like
if
I
went
to
town
Saturday
night.
You
know
we
have
festivity
seasons
coming
up
and
let's
say
you
went
crazy
on
Saturday
night.
E
You
know
that
you've
loaded
your
liver
and
your
muscles.
So
then
sunday
is
a
great
time
dinner
man
fast
or
Monday.
If
you
did
it
all
weekend,
Monday
Tuesday
Wednesday,
my
lap
and
we'll
skip
breakfast.
If
you're
hungry,
do
the
lowest
carb
option
possible,
stay
physically,
active
and
then
maybe
eat
your
first
meal
around
11
or
12.
So
it's
a
good
way
to
detoxify
the
body
from
eating
episodes.
But
to
answer
your
question
I
think
it's
better
to
actually
spaced
out
and
not
eat
so
frequently,
because
that
causes
more
glucose
and
insulin.
Spikes.
E
F
D
F
E
Right
so
what
a
big
picture
I
want
to
say
about
diet
says
even
if
you're
eating
that
frequently,
if
you're
eating
the
right
types
of
foods,
it's
probably
in
okay.
So
let's
come
back
to
the
problem
with
insulin,
if
you
don't
have
any
signs
of
insulin,
resistance
and
your
body
weight,
everything's,
fine
and
you're
eating
that
pattern
and
you're
okay,
I'm
not
going
to
force
you
to
do
intermittent
fasting
for
some
people
having
three
meals
and
a
couple.
Snacks
might
work
fine.
E
But
in
today's
modern
day,
civilization
I
find
that
pattern
of
eating
is
leading
to
more
issues
because
we're
just
stop
burning
as
much
energy
on
a
regular
basis
and
our
foods
have
become
much
more
calorically
dense.
So
so
I'm
not
saying
it's
an
absolute
but
but
I
would
say
for
many
people
having
space
makes
a
lot
more
sense.
So
great.
G
E
I
have
an
app
it
tells
not
getting
enough
yeah
someday
there
will
be
probably
but
okay.
So
how
do
you
know
when
it's
empty
and
it's
ready
to
take
on
so
there
is
no
direct
way
to
know,
but
but
but
the
way
you
can
subjectively
tell
is
my
rough
rule
is,
if
you
do
any
sort
of
exercise
or
activity
that
induces
pretty,
you
know
palpable
leg
fatigue
you
know.
So
if
I
go
to
the
gym,
where
I
do
a
workout,
you
know
usually
it's
hard
for
me
to
walk
after
that.
E
E
It
doesn't
because
hunger
is
driven
by
so
many
other
factors.
Hunger
often
here
is
driven
by
stress.
That's
in
the
signal
to
our
brain.
It
has
nothing
to
do
with
our
legs.
Many
persons
are
sitting
all
day,
we're
not
even
using
our
legs
but
we're
eating
constantly
right.
So
there's
definitely
not
a
cent
of
leg
fatigue,
it's
more
just
we're
bored
or
were
stressed
or
there's
other
cues
to
that
so
yeah,
the
Meccan
of
the
human
body
mechanism.
It's
not
very
specific
at
sending
that
signal
out.
So
thank.
G
D
H
D
H
The
raw
vegetables,
okay,
the
first
part.
The
second
question
is
a
the
mole.
We
read
about
these
studies
that
come
out.
They
seem
to
contradict
the
previous
study
of
correct,
so
you
mentioned
about
the
coconut
oil
before
the
for
a
while
it
we
thought
that
was
the
worst
oil,
then
yeah,
although
they
are
the
best.
That's
a
helpful
yeah.
D
E
Okay
sure,
thank
you.
So
a
couple
things.
The
first
thing
on
the
vegetables
is
I.
Think
a
mixture
of
having
some
raw
and
cooked
vegetables
is
a
good
average
way
to
go.
Some
people
who
have
significant
digestive
issues
can't
break
down
and
process
food
if
they
have
a
lot
of
bloating
a
lot
of
acidity
and
things
raw
vegetables,
don't
agree
with
them
so
lightly.
Cooking
vegetables
is
fine.
It
can
help
your
body
digest
it.
I
just
tell
people
not
to
overcook
it
like
our
pressure
cook,
subkeys
and
Indian
curries,
where
there's
no
consistency
at
all.
E
You've
lost
pretty
much
all
the
nutrients,
so
you
want
to
cook
at
a
level
that
retains
texture
and
some
of
the
color
of
the
food.
That's
the
key
thing,
but
I
have
plenty
of
patients
that,
without
even
touching
salad,
they've
done
fine.
You
know
with
that.
So
so
it's
not
that
raw
foods
are
absolutely
necessary
raw
vegetables.
E
But
if
you
do
cook
it
lightly
is
key
you're
asking
a
much
bigger
question
about
the
coconut
oil
and
studies
and
and
literally
one
to
two
months
ago,
I
I
did
exactly
a
post
on
how
to
interpret
studies
properly.
For
the
exact
reason
you
brought
up,
because
nutrition
studies
are
notoriously
the
worst
Studies
on
the
way
they're
designed
because
most
of
them
are
based
on
food
frequency
questionnaire.
Is
they
take
a
population
of
people
and
they
say
what
did
you
eat
for
the
last
week?
E
Fill
this
out
and
then
there's
all
these
confounding
factors
that
makes
it
very
inaccurate.
So
what
I
would
tell
you
is
for
things
like
coconut
oil,
for
red
meat
for
all
these
numbers.
First
of
all,
know
your
own
numbers
and
health.
What's
your
body
weight?
What
are
your
metabolic
numbers?
What's
the
impact
of
that
food
on
your
body
and
then
the
last
thing
is
moderation.
If
you
read
a
headline
the
red
meats,
okay,
that
doesn't
mean
you're
gonna
be
eating
steak.
E
Every
day
you
still
have
to
keep
your
meat
portions
lower,
but
you'd
have
to
be
worried
about
just
the
limiting
and
completely
stuff
to
surround
it
with
the
ripe
food
same
with
coconut
oil.
The
pendulum
swings
back
and
forth
on
that
I've
seen
plenty
of
people
in
the
context
of
a
healthy
diet.
Do
phenomenal
inflammation
numbers
body
weight,
everything's
down,
I'm,
never
gonna,
take
coconut
oil
out
of
their
diet,
but
I
tell
them.
You
know,
mix
it
with
extra
virgin
olive
oil.
E
So
the
pendulum
like
I,
said
you're
gonna
see
different
headlines
every
week,
but
at
least
we
can
tell
you
that
these
foods,
if
you
try
them
on
your
body,
you
feel
good
and
your
numbers
look
good.
You
don't
have
to
worry.
Okay,
there's
some
foods
high
fructose
corn
syrup.
You
know
excess
sugar.
We
just
know
unanimously
that
you're
bad
for
our
body,
but
those
foods
I
think
you
just
have
to
test
on
your
own
you'll
go.
E
So
one
thing-
oh
yeah
sure,
but
but
but
I'll
tell
you.
The
coconut
oil
has
been
a
lot
around
a
lot
longer
than
lipitor.
Okay,
because
I'm
being
honest
and
telling
you
that
a
lot
of
my
patients
are
put
on
drugs
that
were
accelerated
through
the
pharmaceutical
pipeline
and
they've
been
only
on
the
market
for
like
3
to
5
years,
and
we
only
find
out
10
or
15
years
later
that
this
diabetes
drug
causes
pancreatic
cancer
right.
So
we're
always
taking
that
risk.
E
But
you
know
at
least
in
foods
that
we've
seen
I've
seen
my
grandmother
I've
seen.
You
know,
we've
seen
generations
of
people
thrive
and
do
well
and
I
think
the
problem
is
sometimes
we
hyper
focus
on
these
foods.
But,
like
that's,
why
I
kind
of
focus
on
big
picture
things
just
activity
stress,
loneliness
community?
A
lot
of
those
things
will
counteract
that
so
I
wouldn't
over
obsess
in
a
warrior
and
that's
the
problem
with
these
studies.
They
just
take
one
component
and
they
kind
of
exaggerate
that
so
so
I
think
you'll
be
fine.
D
I
J
I
E
Tough
I
have
a
handful
of
patients
that
are
cab
drivers
and
they
work
in
those
industries.
It's
really
hard
because
they
work
such
long
hours,
but
but
the
one
thing
I
have
a
couple.
Patients
that
did
really
well
and
the
one
thing
that
was
really
empowering
for
them
was
to
understand
that
if
they
change
the
nature
of
the
foods
that
they
eat,
they
can
make
a
lot
of
difference.
So,
to
give
you
an
example,
in
most
of
my
patients,
I
find
that
we
can
get
them
70,
80
percent
of
their
goal.
E
Just
through
food
changes,
they
don't
have
to
exercise.
A
whole
exercise
is
really
important,
but
you
know
just
sitting
down
with
this
particular
cab
driver
and
finding
out
which
places
he
was
stopping
to
eat
and
he
didn't
really
realize
the
impact
he
had.
Fatty,
liver
and
I
told
him
that
basically,
the
sugar
sweetened
beverages
you're
having
or
causing
that
you
know,
we
know
that
alcohol
causes
liver
disease,
but
so
does
you
know
so
do
frappuccinos
right
so
do
for
a
patina
and
sugar.
E
So
he
didn't
realize
that
link
so
providing
that
education
was
key
so
as
he
modified
the
diet
and
even
though
I
can't
get
him
to
you
know,
based
on
economics,
he's
eating
a
lot
of
fast
food.
I
did
say
that
you
know
what
all
places
they
do.
Lettuce
wrap
burgers
like.
Can
we
get
rid
of
the
fries
and
this
you
can
have
some
of
the
meat?
Did
you
know
if
you
added
some
tomatoes
or
had
a
salad
with
that
particular
food?
E
It's
going
to
do
better
and
it's
remarkable
how
much
better
they
feel
and
the
nice
thing
is
once
you
get
that
and
you
can
get
people
to
lose
like
eight
or
ten
pounds.
They
feel
a
little
bit
more
motivation
and
energy
and
all
of
a
sudden
they
might
be
getting
more
walking
steps
in.
So
that's
just
not
even
my
cat,
a
lot
of
my
patients
who
just
are
averse
to
exercising
they
feel
really
down.
I,
try
to
change
the
foods
and
subtle
ways
to
improve
their
mood
and
energy,
and
then
the
next
step
will
be.
E
E
Yeah
yeah
good
point,
so
so
I'll
tell
you
and
I'm
not
saying
so.
Let
me
clarify
I'm,
not
saying
you
should
do
like
fatiguing
exercises
every
day,
because,
obviously,
if
you,
if
today
you
did
a
really
intensive
leg,
workout
and
your
legs
are
fatigued.
Your
legs
are
gonna
need
rest
for
the
next
couple
days,
so
then
you're
gonna
be
doing
other
types
of
activities
bodyweight,
but
the
reason
I'm
emphasizing
legs.
So
much
is
a
few
reasons:
number
one
they're,
the
largest
storage,
carbohydrate
storage
containers
in
the
body.
E
So
when
the
legs
get
strong,
you
burn
a
lot
of
sugar
and
given
the
fact
that
we're
sitting
so
much
most
of
us
are
losing
a
lot
of
leg,
muscle,
okay,
so
that's
one
of
the
reasons
you
counteract
it.
The
second
thing
is:
if
you
look
at
the
root
cause
of
type
2
diabetes,
it
starts
at
the
muscle
and
if
you
look
at
scientific
animal
studies,
it
starts
with
the
leg
muscles,
and
one
of
my
theories
is
when
you
look
at
the
asian
body.
E
It
tends
to
be
typically
a
little
bit
of
a
potbelly
and
very
slender
limbs,
I.
Think
as
the
legs
get
stronger
and
I
see
that
my
practice
that
gets
better
I'm
gonna,
give
you
a
couple
of
other
reasons:
I
want
to
motivate
people
to
do
squats
and
lunges
is
they
did
a
study
that
looked
at
identical
twins
and
they
were
following
brain
health
over
several
years
and
they
look
at
every
factor.
E
Stress
diet,
nutrition,
plant
intake
and
they
found
that
the
factor
that
was
most
correlated
to
preserve
brain
health
was
leg
strength
which
is
unbelievable,
okay,
so
and
then,
finally,
in
terms
of
overall
aging
in
general,
if
you
want
to
be
the
most
independent,
the
one
factor
that
shows
all
the
time
is
leg
strength,
leg
strength
is
an
indicator
and
just
think
of
how
a
relative's
age
right,
I
think
about
my
parents
and
grandparents.
First
they
start
off
walking
confidently.
Then
they
walk
slower.
E
Then
they
walk
wider,
then
they're
using
a
cane
and
then
they're
in
a
wheelchair
and
then
they're
bed-bound,
it's
all
because
after
age
50
55,
you
lose
accelerated
leg.
Muscle
strength
goes
down
we're
facing
that
already
in
34
year-olds
who
are
sitting
at
the
desk
all
day.
But
if
there's
one
change
you
can
make
in
your
family
or
parents,
I've
taught
my
mom
all
the
leg.
She
can't
do
everything
I
can
but
I've
taught
I
do
two
modified
squats
things
that
can
really
preserve
leg
strength
is
a
game-changer
in
every
possible
way.
K
E
D
E
So
here's
the
situation
here-
okay,
sleep-
is
complex.
So,
first
of
all,
the
most
important
thing
about
sleep
is
not
the
quantity.
Necessarily
it's
the
quality.
If
we
get
enough
deep
phase,
there's
different
phases
to
sleep
deep
phase,
sleep
is
the
one
that
helps
us
live
longer,
feel
better,
more
refreshed.
It
regenerates
our
brain.
It
does
everything
now
here's
the
issue
with
deep
face
sleep.
It
happens
in
the
first
half
of
the
night.
E
So
if
somebody
tells
me
like
I
D,
eight
hours
of
sleep
I
went
to
bed
at
midnight
and
I
woke
up
at
8
a.m.
versus
somebody
that
went
to
bed
at
10
p.m.
right
and
got
up
at
6
a.m.
those
are
two
completely
different
animals
of
sleeps,
even
though
they're
eight
hours,
and
the
reason
is
because
one
of
the
key
hormones
it's
released
during
sleep
is
a
growth
hormone.
Growth
hormone
is
a
most
important
hormone
during
sleep.
E
It
helps
us
preserve
muscle,
it
reduces
calm,
Alzheimers
risk
everything
and
the
the
peak
spike
in
growth
hormone
happens
between
10:00
p.m.
to
2:00
a.m.
so
I'm
already
getting
my
pajamas
on
at
9
p.m.
I'm
like
ready
to
out
most
nights
at
10:00
between
10:00
and
10:30,
so
I
can
catch
that
natural
spike
because
after
1:00
2:00
a.m.
you'll
get
little
surges,
but
you'll
hardly
get
what
you
did
the
first
half
of
the
night.
E
So
my
I
tell
people
my
late
nights
for
my
early
mornings
if
I
have
to
get
work
done
or
do
anything
I'd
rather
get
to
bed
early
and
get
that
growth
hormone
in
and
get
up
at
5:00
4:30
sometimes
and
get
other
work
done.
So
that's
a
key
thing.
Your
question
about
naps.
Unfortunately,
usually
when
we
nap
it
doesn't
make
up
for
the
loss
of
deep
bass.
Sleep
most
of
us
are
getting
a
light
phase
sleep
during
the
nap
and
napster
refreshing,
I
love
naps.
E
Sometimes
they
just
energize
me
like
crazy,
so
I
think
they're
important.
But
it's
not
a
one-to-one.
Definitely
like
a
20-minute
nap
at
3
p.m.
is
not
the
same
as
you
sleeping
20
minutes
between
10:30
to
11:00
p.m.
totally
different
animal
altogether.
It's
bad
news,
I
wish.
Your
theory
was
right.
I,
like
your
theory
better,
so
I'd
rather
stay
up
late.
Thank.
D
E
Interesting
yeah,
so
it
all
has
to
do
with
wherever
you
live.
It
happens
to
do
with
the
timing
from
sundown,
okay,
so
so,
basically,
after
the
Sun,
it's
based
on
pretty
much
the
home
location
you're
at
so
you
have
to
equate
it
to
your
timezone,
where
you're
at
versus
you
know
an
alternate
time
zones.
Thank.
D
L
E
Traditional
health
care
system,
these
rotten
and
I'll
got
to
say
in
most
patients
I,
don't
necessarily
get
to
see
reactor
protein
I
get
it
when
I'm.
Faced
with
the
decision
in
somebody
with
insulin
resistance,
high
triglycerides
those
factors,
then
I
get
it
otherwise
I
agree:
it's
not
a
good
test
to
check
another
one,
because
sometimes
you
get
false
elevations.
It
can
be
for
different
reasons.
E
But
to
answer
your
question,
the
standard
guidelines
might
say
once
a
year
physicals,
but
you
know
really,
even
if
you're
in
your
30s
and
40s
and
your
numbers
look
great
like
you
have
no
signs
of
insulin
resistance
getting
checked
every
you
know
every
year
is
probably
fine
for
those
people.
Now,
if
you're,
seeing
upward
trend
lines
like
over
the
years,
you're
normal,
but
the
a1,
C's
or
the
glucose
is
going
up,
then
I'd
be
more
adamant
about
getting
it
every
six
months.
E
Every
four
months
or
something
like
that,
so
I
tend
to
use
more
frequent
intervals
in
people
that
look
like
they're,
strong
upward
trends.
It
motivates
someone
we
can
stay
on
top
of
that,
but
there
are
a
lot
of
doctors
they're
following
with
standard
guidelines,
and
they
don't
want
to
go
outside.
Of
that.
Insurance
may
not
cover
it.
You
do
have
the
power
by
the
way.
There
are
a
growing
number
of
labs,
including
labs
online,
where
you
can
actually
sell
order.
E
M
D
M
F
E
It's
great
I
love
my
this
is
why
I
love
working
in
Silicon
Valley,
because
they
get
questions
like
that
right.
So
you
know
what
happened
to.
Is
that
good
for
you
or
no?
No,
no,
but
you're,
actually
addressing
a
really
key
question
actually
did
a
blog
post
on
that
so
you're
basically
saying
the
the
type
of
diet
that
pretty
much
brings
carbs
down
to
that
level
is
known
as
the
ketogenic
diet
and
the
ketogenic
diet
is
being
scientifically
started
as
a
cancer
therapeutic.
E
E
Therapeutics
I
know
some
patients
that
have
tried
it
and
it
hasn't
necessarily
led
to
complete
remission
in
most
cases,
but
it
might
be
a
powerful
adjunct
to
make
chemotherapeutics
more
powerful
intermittent
fasting
and
some
eating
plan
that
can
lower
sugar
have
been
shown
to
reduce
recurrence
of
specific
cancers
and
breast
cancer
is
one
of
them.
There's
a
pretty
well
done,
study
that
showed
that
breast
cancer
recurrence
does
go
down
with
intermittent
fasting,
so
you're
right
with
the
concept.
E
J
I
E
So
there
are
specific
nutrients
in
dairy
fat,
anti
inflammatory
fats
that
can
keep
lower
sugar
in
kids.
They've
shown
three
studies,
one
of
them
a
Harvard
based
study,
the
kids,
a
drink
whole
milk
retain
a
better
body
weight
than
kids
that
drink
skim
milk,
just
because
of
the
abundant
nutrients
in
its
it's
more
satiating,
so
I'd
say
for
most
kids
and
adults.
The
data
is
looks
pretty
good
in
terms
of
the
health
effects
of
dairy
fat
and
it
does
help
people
moderate
intakes
of
other
foods
like
sugar.
E
Having
said
that,
some
people
are
dairy,
allergic
and
I,
don't
mean
just
the
easy
ones
that
you
can
test.
Some
people
have
inflammation
in
the
body
and
typically
dairy
allergies
can
be
eczema,
excess,
acne,
inflammatory
type
stuff.
So
then
it's
worth
doing
a
dairy
free,
but
for
most
people,
I
find
dairy
to
be
fine
in
the
Thank
You
thanks
yeah.
C
E
Looks
like
a
lot
of
those
vegetable
based
pastas
I
mean
it
looks
like
the
carb
load
in
that
is
less
you're
right.
It
is
more
processed
if
ingredients
to
show
that
it's
mostly
just
a
vegetable,
and
they
haven't
added
a
bunch
of
other
things
to
process
it.
It's
probably
fine
it.
It
does
tend
to
be
a
lower
glycemic,
so
yeah.
N
E
Is
I
mean
that's
what
I
do
in
my
clinic?
My
goal
is
to
reverse
diabetes,
but
what
I
would
say
is
you
have
to
be
pretty
motivated?
You
have
to
be
supervised.
You
have
to
be
ready
to
make
some
food
substitutions
some
of
our
generations
and
a
lot
of
our
relatives
in
India
there's
just
changes
that
are
very
difficult
to
make.
So
I
think
the
goal
and
a
lot
of
our
relatives
is.
Can
we
minimize
medications
to
eliminate
would
take
a
lot
of
motivation
and
ability?
E
If
they
have
that
motivation,
then
it's
possible,
but
I
would
say
the
goal
will
be
would
be
to
minimize
and
to
slow
down
the
progression
of
disease,
so
they
don't
require
insulin
and
things,
but
some
of
the
strategies
that
we
talked
about
in
terms
of
reducing
the
total
amount
of
carbohydrates.
Raising
that
awareness
a
lot
of
our
Indian
relatives
in
India
they,
for
example,
the
hub
toast
in
the
morning
for
breakfast
they
don't
have
any
protein
when
I
do
protein
intakes.
Most
of
us
are
very
deficient
in
the
amounts
of
proteins
we're
taking
in.
E
So
if
you
add
protein
to
their
diet,
that
alone
can
actually
mitigate
some
of
the
glucose
surges
from
that
so
there's
ways
you
can
manipulate
the
diet
and,
and
then,
if
you
see
the
sugar
levels
are
getting
better,
they
1c
is
dropping.
You
should
talk
to
the
doctor
about
whether
you
can
cut
back
because
some
doctors,
especially
they're
so
busy
they
don't
change
the
medication
list
unless
he
sort
of
proactively
asked
him.
What
can
I
do
to
do
that?
So?
Okay,
thank
you,
Thanks!
So
I
guess
it'll.
E
O
G
O
D
E
Absolutely
so
basically,
you're
talked
about.
If
you
have
plaque
already
all
these
things,
will
it
have
any
impact
or
you
sort
of
doomed
with
the
plaque
right?
So
so,
really
what
it
comes
down
to
I,
tell
people
and
you
think
of
that
plaque
as
being
an
earthquake
fault
or
a
volcano
okay,
and
what
happens
is
a
lot
of
these
dietary
and
lifestyle
changes.
E
We
talk
about
you,
we
don't
want
the
fault
to
become
active
or
we
don't
want
the
volcano
to
erupt
and
the
way
to
do
that
is
to
manage
the
stress,
the
lifestyle
and
all
of
these
things.
Now,
if
you
were
to
check,
for
example,
a
heart
scan
in
five
years
again,
you
might
show
the
exact
same
score
that
you
had
before.
You
might
have
the
same
amount
of
plaque,
but
you've
chemically
changed
the
plaque,
you've
stabilized
it,
so
it
doesn't
erupt.
E
So
it
has
a
dramatic
impact
and
that's
why
people
that
have
lifestyle
changes
after
their
first
heart
disease
event.
Yes,
the
actual
plaque
itself
may
not
disappear,
but
it's
a
completely
different
conformation,
where
it's
not
going
to
RuPt
as
readily,
and
that
can
add
decades
to
your
life.
So
that's
the
goal.
Now
with
the
newer
generation
scanners,
we
might
be
able
to
see
more
microscopic
changes
in
the
plaque
to
know
that.
Okay,
this
dietary
change
led
to
the
plaque
becoming
more
stable,
but
with
the
ones
that
are
more
widely
available.
E
It's
hard
to
get
that
nuance,
but,
for
example,
some
my
patient
with
plaque.
If
they're
belly
fat
went
down
there's
reactor
protein
got
better,
we
know
we're
stabilizing
their
plaque.
Their
risk
is
going
down,
even
though
we
don't
see
it
visibly
shrinking.
You
know,
at
an
aggressive
rate,
great
thank.
D
P
E
P
D
E
Sugar
yeah.
Is
it
a
good
question?
This
is
really
key,
so
this
is
the
problem,
so
you
guys
remember
when
they
had
the
low-fat
movement.
We
talked
about
that.
What
types
of
foods
did
they
create
right,
Entenmann's,
pastries
right
all
these
low
fat
things
I'd
had
a
lot
of
sugar
in
it
and
then
sugar
we're
not
now
we're
facing
a
whole
sugar
crisis.
E
So
the
big
point
is
now
with
the
low-carb
movement:
they've
created
a
whole
industry
of
foods
and
packaged
bars
that
are
low
carb
and
what
they're
using
is
they're
using
artificial
sweeteners,
other
types
of
foods
and
that
the
issues
with
these
types
of
foods,
if
you're
eating
the
wrong
type
of
carb,
is
yes,
it
might
be
the
same
amount
of
carbs,
but
it
can
feed
different
parts
of
your
body.
So
I'll
give
you
an
example.
E
If
you
have
30
grams
of
sugar,
when
you
have
30
grams
of
sugar,
let's
call
it
an
Indian,
sweet
and
Diwali
is
around
the
corner.
Okay,
we
have
that
all
of
that
subs
orbit
in
the
bloodstream,
pretty
much
everything's
in
the
blood
directly
goes
straight
shot.
What
if
we
had
an
apple?
Okay,
apples
got
some
glucose.
It's
got
some
fructose
when
we
eat
the
Apple,
because
the
apple
has
fiber
and
nutrients
when
it
gets
into
our
intestine.
Only
about
half
of
it
gets
absorbed
into
the
system.
E
The
other
half
actually
goes
directly
into
our
colon,
it's
encapsulated
by
the
fiber,
and
it
feeds
our
healthy
gut
bacteria.
It
actually
feeds
a
bacteria
that
can
actually
help
with
their
long-term
blood
sugar
control.
So
it's
very
different,
so
I'm
glad
you
brought
that
point
up,
because
now,
everybody's
so
and
I
maybe
contributed
because
I
have
people
such
focused
on
cards,
but
you
have
to
know
what
the
quality
of
that
carbohydrate
is
for
rice,
for
example,
you
know
as
much
as
you
can
manipulate
things
so
rice,
for
example.
E
If
you
were
to
cook
rice
and
then
you
cooled
it
and
you
reheated
it
the
more
times
you
cool
and
reheat
rice,
the
less
the
rice
will
be
absorbed
into
your
bloodstream.
Believe
it
or
not.
You
know
it's
interesting
things
like
that.
That's
why
the
way
Japanese
eat
rice
like
cold
sushi
rice
that
will
cause
your
glucose
to
go
up
less
than
just
having
hot
rice
out
of
a
cooker.
So
there
are
ways
you
can
manipulate
the
carbs.
Despite
what
the
you
know,
gram
to
gram
ratios
are
so
thank.
P
E
Mean
I
think
cardio
exercise
is
great,
but
remember
the
disclaimers
I
put
if
you're
doing
cardio
is
an
excuse
to
sit
all
day.
No,
if
you're
doing
the
type
of
cardio,
that's
not
necessarily
counteracting
the
prolonged
sitting
and
not
doing
enough
leg.
Strengthening
it
may
not
be
enough.
Cardio
is
great
but
again
based
on
your
profile
and
your
risk
factors,
you
might
have
to
do
more
aggressive
weight,
training,
I
think
for
most
people,
given
our
modern
work.
E
E
A
All
so
much
for
coming.
Thank
you
again
to
dr.
Vaughn
for
such
an
excellent
talk
this
afternoon.
If
you
can,
please
complete
your
surveys
and
return
them
to
us
at
the
back
table.
That
would
be
fantastic.
You
can
also
sign
up
for
Cupertino
library,
foundations,
email
list,
and
we
will
be
sure
to
send
you
the
link
to
the
recording
of
today's
talk
as
soon
as
it
becomes
available,
and
we
have
some
copies
of
your
book
as
well
back
there
that
you
can
take
a
look
at
as
well.
We
also
have
them
at
the
library.