And then he found out maybe not so, that he was actually pre-diabetic and this was in his 20 so pretty young for that to happen and that set him on this course of becoming a bio hacker which he'll define for us because that has a lot of different terms. But basically he learned how to use nutrition to heal himself and then tried to use that as a doctor to heal others and that's a fascinating journey that he's had.
So I hope you appreciate his story and along the way we'll pick up some tips about how we can incorporate his lessons into our lives to make things easier and what it means to be a bio hacker, what that means for nutrition and for sun exposure and when that can go a little too far.
So I think that's really important to keep in reference that a lot of the things we see in terms of bio hacking are expensive and of questionable utility so John is going to help us figure some of that out and figure out how to evaluate that. So it's a great discussion. We also talk about families and kids which is near and dear to my heart so I hope you enjoy this discussion with Dr. John Lemanski.
Dr. John Lemanski welcome to the DietDoctor podcast. Thanks so much for joining me today.
And so the question to me was as a medical students I think I know everything, you know, I am young, I am healthy, I'm doing all the right things that I've been told and yet these labs are not showing or not reflecting that. And that was pretty scary, was pretty eye-opening to me at the time. So I wanted to see why is this... is it genetic, is it dietary, am I exercising too much?
Which could be a possibility and really got led down the path of no, it's actually what I'm eating. That's driving most of these lab abnormalities. And it was beyond just the lab abnormalities, it was also how I felt. And so I'm sure you can remember back when you're a medical student, but you're always tired and you think, "It's because I'm studying all the time."
But then I never got better and it was a question of how can I be so exhausted all-time and yet, you know, I'm young, healthy and fit and it must be an answer to that question.
But, you know, very little protein so I was more kind of a pescatarian, not too much protein and essentially no fat. If I was eating fat it was from olive oil, olives and things like that, but otherwise I was pretty much avoiding that.
I was a biochemistry major in college and so going back to the biochemistry and understanding how we are actually processing the macronutrients, what's the process that's actually happening, Atkins seemed to be a little bit more in the line of I think this is going to be healthier, which is based on simple biochemistry. I didn't like so much the amount of protein that I was consuming based on that.
If you remember I went from pescatarian, really like 30 g of protein maybe a day, so pretty low on the protein, pretty high on the exercise, so that probably was not a good combination. But going to much higher levels of protein I didn't feel as good. And then just kind of researching, going to pub med, going to library at the time, you know, Google wasn't a big search engine like it is now and looking at the research studies that were out there at the time about keto it just made more sense from a physiological level.
So I started kind of transitioning into more of a ketogenic, low-carb I would say initially because I still do like vegetables. And then as time has progressed and now we have ways of really measuring blood ketones, breath ketones, glucose much easier, I've got kind of transitioned into going into ketosis quite exclusively and then maybe coming out once in a while, but doing more of a low-carb. So it's a process I think like most people experienced, it's not get it right the first time.
So I figured, go to the worst state in the country where it's a problem that is I think worse than just the statistics would show. And it is devastating in the south and now really in the rest of the country, but one of the main factors in terms of risk factors for most things is age. So if a 20-year-old comes in complaining of chest pain, you're not going to run to the cath lab with that patient.
Now for a 50-year-old you might think a little bit more in terms of doing that. In the south we would see MIs in people in their 20s and 30s, people on dialysis, people who would have cardiomyopathy with EF of 10%. Maybe obviously genetics is an issue, but really no other factor that we can look at and say, "This is what's driving this." So that experience was eye-opening in the sense that I saw the worst possible outcome of everything that you and I are discussing at a very young age.
And so we're in a situation there where we talk about healthcare for everybody, should we not have Obama care, should we have some new form of healthcare, but the question that I think is never raised is how we're going to manage chronic medical diseases, which are starting at such a young age and trying to maintain health and happiness for those people. So that experience I think was eye-opening in many ways.
So you get into this question of is that a futility of care? Is there a better option? Is there a way to maybe prevent these things from happening? And should the focus be on that? And for me it was kind of a no-brainer at that point. I felt like I could make more of a difference by preventing what I was seeing in the hospital than necessarily just treating it after the fact.
So keto or low-carb I'd say is ubiquitous for the patient population that I take care of initially. And to stress by... based on how metabolically sick they are. And so I think Gary Taubes put the slide up yesterday about this sensitivity to insulin, everybody has a threshold in terms of how many carbs they can consume before they really kind of push the insulin level back up. Same thing happens with the patients that I take care of, it's really figuring out first what is their threshold. So are they metabolically sick? Do they have diabetes? Which a lot do. Do they have insulin resistance? A lot do.
Do they have high blood pressure? So do they have risk factors that need to be addressed more aggressively initially, then they'll be ketogenic to begin with. And then eventually it's a question of can you transition back into more of a low-carb? Because I don't think everybody needs to be in strict ketosis all the time. But I think it's an extremely powerful tool to be used for specific situations.
Some people sort of miss some of the lifestyle they had before and want to find a happy medium. So what do you use in your practice to decide is somebody "ready" for that and how do you follow them? Do you do oral glucose tolerance tests? Is it based on their insulin levels A1c? What kind of tools do you use?
So the first thing before we even talk about how to transition I would say a good way to kind of keep people in this situation where they want to stay in ketosis or they want to be restrictive is making it applicable to their cultural situation. So for instance in the south, you know, barbecue, drinking will be a big kind of social gathering factor, so trying to figure out how do you actually make low-carb keto accessible to people who want to stay in those situations? And there's tricks you can use.
But let's say just from a clinical perspective if somebody wants to transition from keto to low-carb, a couple of things I'll look at. So I don't really like the oral glucose tolerance test. I do like it in combination with the insulin test. So I think that gives you a lot more information. So doing a fasting insulin, doing the glucose tolerance test, doing the insulin test to see... number one is fasting insulin suppressed in general.
But number two, what is the response? So if they're still having an exaggerated response then their threshold of carbohydrate intake will probably be much lower than somebody who has a normal physiological response. So obviously using metrics like HbA1c is important, blood pressure measurements, high-sensitivity CRP, things like that, but the main ones I would say are have they reached their goal in terms of what they're trying to accomplish? Do they have an abnormal response to that test? What is their fasting insulin?
So I tell people, "Weigh yourself initially and then don't weigh yourself for a month." Inevitably I find that most people come to keto because they want to lose weight, that's the number one driving factor and it makes sense.
But most people as they transition and they start noticing things are getting better, so their joints don't heard, they don't have headaches, they are not frequently hungry, they are sharper, more cognitively sharp, inevitably that becomes really the driving factor I think for most people to want to stay or at least kind of transition in and out.
But in terms of answering a question, you know, everybody has a weight goal that they want to get to. I use body fat percentage as a better metric and I try to encourage the people I take care of to use that as their metric. You know, how is your visceral fat responding to what we're doing, how is the body fat percentage responding.
And so if we get down to the goal body fat percentage, visceral fat is gone, lab markers are back to normal, then yeah, I think it's a very reasonable question to say, let's try some different things, let's expand your carbohydrate. I think Andreas showed very nicely that in a ketogenic community we also have given carbohydrates a bad name and they're not necessarily bad. Obviously highly processed ones are going to be detrimental to our health, but incorporating healthy vegetables I think is a perfect way to transition.
So initially I think my approach is change your diet, so change it from what you're eating to low-carb, to keto, get adapted, get fat adapted, actually make the enzymes that you need and then start incorporating some other factors, like time restricted feeding, intermittent fasting, longer-term fast, because I think that's an extremely powerful way of suppressing insulin.
Plus I think there's a lot of people who will reach a threshold where they just cannot break through that kind of plateau. And incorporating something like the intermittent fasting tends to help tremendously.
That makes sense that you'll be able to deplete your glycogen storage to some degree, start beta-oxidation. So people use weight as metric but that's the reason, is you are actually going to the underlying cause and addressing it. And for most people I think it's pretty simple to do an intermittent fast, especially if you do it, you know, early dinner, late breakfast... It makes perfect sense for most people to be able to do that.
I want to have dinner with the kids and the family, dinner is a social outing, but it seems like our circadian rhythm would say the other way. We should have the breakfast and skip the dinner. So how do you balance that with your patients?
For me I do it this way where I eat dinner and then during the day I don't eat much. And I do it because I want to have dinner with the children. So I think in the big scheme in terms of all the different things that you will do to improve your health, if the timing of your main meal is really the deciding factor, then I think we've probably gone overboard.
So I would say, and I know I'm kind of hedging on this question, but I would say if it's going to allow you to do it and dinner is the best way because you want to have family interaction, then I would do it that way. If you don't have a- let's say you're single or you have a girlfriend or you don't have this kind of idea that you have to eat dinner as a family, then yeah, I think eating in the morning is perfectly fine.
So I find it for me because I'm fasting most of the night, you know, I have high ketone levels, I feel very, very sharp when I wake up. I know it sounds monotone but this is me being sharp. But this is me awaken, so for me it works well in that sense and a lot of people that I work with they are also pretty active in the morning and so it works well for them too.
And those are the ones that I focus on. You and I as clinicians will talk to our patients about diet and exercise, but I don't think we necessarily- and I don't speak for you, but we don't necessarily go into depth in terms of what that means. So we'll just say, kind of blanket statement, okay make sure you do that and exercise, but what does that actually mean?
What are some of the simple cost-effective really lifestyle modifications that you can do which actually from a bio hacking standpoint impact your health tremendously, probably even more so than maybe some of the more extreme forms of bio hacking. And I don't have anything against certain techniques like hyperbaric oxygen chambers and sort of other kind of more advanced bio hacking techniques that are being used but the question really becomes, how can you apply those to the majority of people?
Can you spend $40 a session in a cryo-chamber? Well, most people will say, "I can do it once, but I can't do that on a regular basis." So then what's the benefit of having that? And so I really define bio hacking as what are the things that you can do to improve your health, affect yourself from a metabolic standpoint positively and do it cost-effectively?
I haven't worked nights in- I don't remember when, I don't want to remember when, to see what's going be the metabolic impact. And so in five days I gained 7 pounds, not changing anything dietary, so maintained my normal fasting routine, just changed the timing, so there is an impact, so I was eating at night.
Fasting glucose was 15 points higher. So a part of that is probably because of the time of the eating and the sleep pattern was horrible. So sleep has a huge effect on our ability to be metabolically healthy. So simple things like that I think are extremely effective.
At that point I think getting your circadian rhythm as best as you can is extremely important.
So getting sun exposure during the day, making sure that when you're sleeping it's quality sleep that's being tracked, focusing on some of the other biohacks to really kind of help in terms of pushing the envelope in your favor, because you have this major kind of obstacle which is sleep, which is affecting your cortisol, which is affecting your hunger levels, which is also affecting your desire for craving carbohydrates. So it's extremely difficult I think for night shifters.
So what I have read it seems like 20 minutes of whole body exposure, not just like face, head, hands, but 20 minutes of whole body exposure seems to be like the minimum threshold that people should be shooting for, people like maximum benefit for minimal effort. So is that what you recommend too or you have a number in mind that you use?
So I wouldn't have the deep, the REM sleep at levels that I would want to get the restorative sleep. I would notice that my resting heart rate would take a lot longer to come down which makes sense. I would notice that the quality of sleep was not good. So changing timing of diet for me was based on sleep patterns and fasting glucose, but mostly sleep patterns. So I do think there is a balance because there is so much technology.
Which ones are going to be the most effective? In my opinion after nutrition I would say sleep is the second most important factor in people, whether or not that's science base or not, just my clinical experience, that's what I've noticed. So I think yes there is a cost associated with it, but the amount of feedback that you get to me is tremendous.
Now there's a lot of other gadgets out there I wouldn't spend a dime on. And so there is this balance of trying to figure out which ones are going to be useful versus which one are just going to be for fun to show you have a new gadget.
Kind of like you would use lab markers as a tool. You could run a plethora of labs that might impress people, but are you going to use those or are they going to be useful for you or is it just going to be an added cost? And so I think it's really weighing that balance based on your clinical experience what's going to benefit you.
So you've got to find that middle ground as well and the same for technological information with bio hacking our lifestyle.
And so same thing I think applies with the technology. I would rather spend money on something that I think is going to beneficially impact my health and it's going give me data to do that, but I wouldn't spend money on something that I think is just another gadget.
So again it gets into that next level of this isn't necessary for everybody, but does the science back up the investment? And some people could say yes, I am curious to get your opinion on that.
And the studies that look at cardiovascular health are in my opinion pretty impressive. Does that merit a $4000 or $5000 investment? Probably not for most people. Again going back to cost and cost being cost-effective, most people have a gym membership; whether they use it or not is a different story, but most gyms are going to have a sauna.
And you had asked me a question before we got online as far as biohacks and the way I look at it is number one, is it going to be effective? Number two, is it going to be safe? Are there going to be downsides as far as doing it? And then is it going to be applicable to people? I think when you look at sauna... is it effective? I think it's effective. I think in terms of a lot of people I work with really focusing on getting their fasting insulin as suppressed as possible. Sauna helps with that.
And then is it applicable? I think for most people if they use their gym membership, they can go to their gym sauna they don't have to have a huge cost expenditure for that and it helps to think for a lot of people who use it.
A lot of people I work with are interested in living longer but they also want to live longer and healthier, they don't want to be dealing with chronic diseases and so for those people implementing certain biohacks like that can help take them to the optimization of what they're looking for.
I think you can learn a lot about our country but also about people by being with them in different experiences, by learning what's driving their understanding of politics or religion or health. And showing how different parts of the country are going to experience a low-carb or ketogenic diet differently, based on resources, based on socioeconomic status, based on- culturally.
So obviously people in the South will have different cultural norms than people in the northeast and yet we can all do some version of low-carb or keto but a bit differently. And I want to show how that's possible and maybe educate more people along the way.
So it's definitely an experience but it's also a way to show other people who are dealing with children maybe how to actually transition them over to more of a low-carb version. I know that's a big struggle for many families, is they are low-carb, they've seen the benefits, but they transition their children and they don't have to be ketogenic, but maybe transition them over from the junk processed food... How do you do that? How do you do that when you travel? I think those are topics that are always being brought up.
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