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Hey folks, it's stay off my operating table with Dr. Philip Ovadia. And we've got something I know I say this all the time, Phil, something a little different, but this is different. Our guest today is somebody about whom I have tried to find information and failed. Now usually I like to read up on our guests and kind of have an idea where they come from and what they're about and maybe why they're here. And the only thing I've been able to find out about this guy is a, he barely has any social media presence at all, and b he's an ER nurse. That's it. So tell us why is, why did you invite Darius Sharpe to be on the show? And then we'll get into whatever he is here, whatever he is here to talk about. Yeah, well, I would put Darius in the category of one of the people that I am just fortunate to have come to known. And he's not really out there necessarily as a public figure. But he is, I can guarantee you this is gonna be a very interesting conversation. He's one of those just deep thinkers and I think has some unique perspectives to bring to the metabolic health space. He does occasionally come out of the shadows. He had a recent talk at Dave Feldman's COSI conference that we're gonna talk about. And I think I also spoken at COSI maybe a year or two ago as well. But like I said, I'm just, I, I'm just consider myself fortunate to have gotten to know Darius over the past couple of years, and wanted to bring his story and his like I said, some interesting perspectives that he's developed on metabolic health out to the world. So, with that, Darius why don't you introduce yourself talk a little bit about what got you interested in metabolic health. Talk a little bit about what you do within healthcare. We mentioned already that you are a, a nurse in the emergency room, and then we'll go from there. All right. Thanks Phil. Thanks, Jack. I don't like talking about myself much, but I am, like you said in the shadows, really, I I don't have much of a social media presence. I actually got into this whole space because I ended up on Dave Feldman's lean Mass Hyper Responder Facebook group. Oh. After I, yeah, after I saw that my LDL was quite high and I also had the, the. The low triglycerides and high HELI was like, oh, I fit this thing. And I had kind of started dabbling in, in the space and, you know, watching some YouTube videos and, and finding Dave's blog online, the cholesterol code. And I was like, oh, well let me check this out. And I joined the Facebook group and have been on that since 2019. So Dave Felman actually knows me mostly from that because I posted a ton. I've done a ton of personal experi experiments and done a boatload of lab tests. Like he has actually for his his own your labs company that he, he owns. I am the most frequent user according to him. Huh. Yeah. So, so do you get frequent flyer points there? I really wish, not so much, but you know what, I'm, I'm very happy to support that business. As for me, my background. I have I started out in actually working on ambulance 9 1 1. I was an EMT, started at age 18, worked for a few years, became a paramedic at age 21. Worked as a paramedic for 13 years and then became a nurse. Now I've been an ER nurse for eight years. I'm 42. Always been very fit, healthy and active, so I never really had any health issues for myself. But I did notice very early on in my career, like the same things over and over again with all the patients that I saw. So on the end, I remember asking this again, I was probably 19, and I remember asking this with my paramedic partners. I'm like, why don't we prescribe. Like diets to patients. Like I see the same, the same exact things over and over. I see. They're all obese, they all have heart disease, they all have diabetes. They're on all of the same medications. I, I, I can, you can practically copy and paste the medication list. Metformin, lisinopril losartan, metoprolol Lipitor, you know, it, you can just rattle 'em off. It's all the same medications. Hydrochlorothiazide, they're all taking the same things. They all have the same problems. I'm like, well, why don't we fix the problems rather than medicate these people? Of course, I never gotta Good answer on that one. But you know, the further I've gotten my, gotten in my career, the more apparent that it's all the same stuff affecting people and they're all coming in, they're all calling 9 1 1 for the ultimate resulting problems of the illness that they've accumulated over the years. Yeah. For my own personal medical history, I, again, I've always been fit. I've never been overweight. I've always exercised. I've, I've ran track in high school. I have had a gym membership since I was 18. But I did, I do have not the best family history. I, all of my biological grandparents were dead by the time I was 21. My grandma, my maternal side died of an MI at 20, at 62. Just dropped dead Christmas morning. My grandpa on that side died in his, I think, early seventies. My grandparents on my biological dad's side died when they were, I think in their mid seventies. They all had strokes and heart attacks, and all of my di, every single one of 'em had diabetes. Actually, my grandmom, my mom's side had type one. So I was, you know, I've always thought to myself, okay. I need to pay attention to my health because I don't have the best genetics and I need to make sure that I'm always lean and fit and active. Early on that just meant, hey, don't eat too much and make sure you're exercising. So I didn't really pay attention to carbs or anything like that. I had the benefit of remember I started working at age 18 as an eem, as an EMT. Most people I work with were in their mid twenties, so I had the benefit of watching them over the few years I worked with them. And you hit that like mid to late twenties and you just start putting on the pounds. And I remember seeing that and going, holy crap, I need to control my eating.'cause back then I was like, you know, I would get the extra large Jamba juice and a burrito and just pound those down. You know, you could just eat as many colors as you want at that age. And I remember thinking, you know what, that's gonna catch up to me. I better pair back my eating at this point. And so that's kind of what I did. Again, I'm, I managed to always stay lean and fit. But later on, after I started nursing school, actually had a couple, couple interesting things happen to me. When I was in nursing school. I was we had our day that we learned how to use glucometer, which is kind of funny 'cause I've been using it for years. But we had to check our own blood sugar. Everybody around the table did. And I didn't, I didn't do this on myself. I did it a couple times in the ambulance just for kind of, just for fun. And it was always like in the eighties, but this time I checked it and it was about an hour and a half after I had con had the smoothie that I made every single morning before school. And everybody around the table was like in eighties and nineties. Healthy smoothie, I'm guessing, right? Actually, you know. Yeah. It was frozen strawberries, frozen blueberries, frozen bananas, whole milk, peanut butter and protein powder. Yep. I didn't add any sugar to it. I didn't even add any juice, but when I checked my blood sugar, it was 1 26 and everybody else. But that in context, put that in context for those of us who are not medical professionals. Yeah, it's so, normally blood sugar should sit in between 70 and a hundred milligrams per deciliter. If you're fasted. Ideally you would consume something and your blood sugar would go up and by the two hour mark, be back down into that normal range. After eating, in my case, this is about an hour and a half, almost, almost two hours from consuming that smoothie. And I was still sitting at 1 26, which. And, you know, is much higher than I would like it to be. The definitions of hyperglycemia kind of vary depending on which source you look at. I think universally over one 40 is definitely considered hyperglycemia over 1 25. For some people they say that's actually hyperglycemia. But safe to say, my glucose was elevated and especially in the context of looking around the table at everybody else, and theirs was in the, theirs were in the, you know, seventies, eighties, and nineties. So when I saw that, I was like, huh, that's interesting. I kept going through nursing school. I just plowed my way through. Didn't think much about the whole health aspect. Prior to that, I was good about like trying to eat more whole foods at home, generally cutting down on on sugar at home. But I didn't pay attention to like macros. I didn't pay attention to carbohydrates versus, versus fats. I always made sure I ate plenty of protein 'cause I was big into like, you know, lifting weights and working out. By the time I ended nursing school, I had put on a couple of pounds because the very last semester I was stressed out. I was working two jobs. I actually had just ended a long-term relationship and I remember going to Costco and buying the five pound bucket of Tollhouse chocolate chip cookie dough. Oh my god. And eating that over about about three weeks. Oh dear Lord. Yes, I know. That's, that's deep depression there. That was but it was delicious. Depression. Delicious depression. Okay. But this is not medical advice. People. Yes. Don't do this. So by the time I finished that semester, I remember I was, I was about 1 92, which for me was, was big as I'd ever been. I, nobody would look at me and think I was fat, though I was still very muscular, still working out. But I definitely knew, I like kind, I gained a little more weight than I wanted to. I tend to be better off, like in the 1 75 to 180 range. So once I finally had some kind of more bandwidth to look at other things, this is, this is the end of 2017. Someone had had recommended max Luga Vere's book, genius Foods. And so that was actually my first, you might not know this one, but I don't, that was actually my first step into the world of like low carb, ketogenic whole food. Type eating. Again, prior to this I had pared down like added sugars and gotten rid of like added artificial colors and flavors at home. I'd already kind of been doing that over the years, but this is the first book that really kind of introduced the idea of just whole foods. Keep your carbohydrates and your glycemic carbs low. And and so I started following that and again, it was kind of like a, not necessarily ketogenic diet, but definitely low carb, probably in the 50 to a hundred grams carbs range net. And I dropped the weight. I dropped 20 pounds in like, heck, two months, just weights fell off. I was like, oh, well this is good. So I, how old were you? How old were you at that time? So I would've been probably about 35. Oh, 35 at the time. So I'm 42. Okay. Had, yeah, that was, yeah, right about that time I was 35. So I had continued eating that way. I had practiced some fasting and I was feeling pretty good. Well, I was still, even though I was eating better at home, I was still very liberal with myself when I went out and I would still have some soda and some bread and pasta, whatever.'cause again, I lost the weight and I was feeling good and fit well about a year after that. So this would've been like January of 2018, I believe. Yeah. 20. No, actually, January of 2019, I had decided I got off a shift. I worked 12 hours.

I got off shift at 11: 13:08

00 PM and my commute home was an hour. So I was like, you know, I have a hankering for some In-N-Out burger, which anybody from California is very familiar with. So I decided, you know what, I'm going full bore. I'm getting the root beer, I'm getting the burger with the bun. I'm getting fries and ketchup. Meanwhile, this is like this, this meal I'm describing to you is ubiquitous in America, right? Oh yeah. Everybody eats this all the time. Well, I got off work, went over to the, to, to the restaurant, got it from the, you know, the drive through, sat in the parking lot, ate it, started my drive home. 10 minutes in I'm feeling like garbage and I'm like, man, I feel awful right now. I'm like, I wonder what my blood sugar is. And at this point I'd already bought a glucometer, commer. So I and I, I get home. It's exactly an hour later, I've been sitting in a car the whole time. Right? So this is a perfect, like one hour postprandial glucose check. Well, when I check my glucose, it comes back at 2 53, which is very high. Yep. You actually, you essentially just diagnosed yourself with diabetes. Yes. When I looked at it, I was like, holy crap. I mean, if, if a patient walks into my ER and their glucose is in the two fifties, I'd be like, what the heck did you eat before you walked in here? You're diabetic, you're not taking care of yourself. What are you doing? But I was like, wow, this is, this is me we're talking about. And that number blew my mind, but it also really piqued my interest. I'm like, well, what happens if I reduce the carbohydrates? And would you actually permit me to share my screen? Sure. Hang on just a sec. All right, so if you can see that. So it was actually 2 51 was the, was the glucose. Wow. So it actually really peaked my, let's, for the folks who are listening, I'm gonna just why don't you describe what your four different images are here, as well as showing them. Yeah. So, on the upper left there, that was actually initial reading, it was 2 51 was actual, was the number, again, extremely high for someone who's not diabetic. He was fit and active, but it, I was like, well, what happens if I reduce the carbohydrates in this meal? So the obvious one I got rid of first was the root beer just had water. So if you look in the upper right, I had the In-N-Out burger. I had two hamburger patties on it with the bun fries and ketchup. But I had water that time, check my glucose. One hour later I did this, like I did, it took like a month. I was like, let me do this experiment. I got off work at the exact same time, January 23rd and the next one is March 2nd. Exactly. Gotcha. Okay. I decided to do the I at first I was like, holy crap, I'm gonna stay away from this food. And so a month, you know, went by. Then I thought, this is kind of interesting what happens if I reduce the carbohydrates? And so I was, got rid of the soda. This is my very first like experiment that I ever did on myself. Right. I got rid of the soda and I got home. Sugar was 2 0 4, still very high. I was like, okay, well I still don't like that. Well, let me get rid of the. Bun, I'll just do a lettuce wrap burger. So I did lettuce wrap, burger, two patties, fries with ketchup and water. I get home glucose is 1 42. Definitely a lot better, but still higher than I would like. By this time I'm like, okay, I am actually reducing the amount of calories I still need to feel like I'm satiated. So I had two burgers, two patties each, but both of'em were lettuce wrapped. I didn't have any fries. I just had water, got home and glucose was one 13 post meal. And I'm like, that's the range where I need to be. And it kind of very, it really, really opened my eyes to the idea that, wow at least for me, this is the way I should be eating. Because if there is one thing that is ubiquitous with the sick patients I see in the er, it is that number on the upper left there actually those, those two numbers at the, on the top. High glucose, hyperglycemia, glucose, I see it all the time. And the worse your glucose is, the sicker you are as a patient. Phil, jump in here real quick and comment.'cause Darius ran some, some experiments on himself and then did a little pattern recognition with the patients he sees. In extreme circumstances in an emergency room, when you're looking at patients they're, they've obviously got a serious condition, but at that point it's chronic. It's not necessarily acute. A comment on, on what Darius just showed us. Yeah. Well, you know, so the first thing I'll do is give a shout out to Darius, right? Because I gotta tell you I was a EMT you know, when I was in college at that same age, right? And I was one of Darius's partners, right? Who he was watching, getting fatter and fatter.'cause you know, we just you eat a lot of fast food, you're working overnight shifts, all of that stuff, right? Very unhealthy lifestyle. And then, quite frankly, I went through, you know, college, medical school, early part of my career, right? And I saw the same things that Darius is describing, you know, as a heart surgeon, right? Every patient literally on my table, same deal. And it took me quite a while to, wake up to this, right? And as people know from my story, it really took, when I kind of looked in the mirror, all of a sudden I'm like. You're pre-diabetic, you're morbidly obese, you're gonna be on the table. And, you know, I started coming across low carb and, and of course that's what got me woke me up to this. Now that I know, yes. I see it. Every one of my patients without fail, that ends up on my table for, you know, atherosclerotic heart disease. They are all insulin resistant. If we look for it the right way, most of them spike their blood sugars. Right. You, you know, a lot of 'em will come and, you know, they'll say, well, I'm not diabetic. Right? But after the operation, they're in the ICU and their blood sugars are two 50. Right. And we're pumping insulin into them to get their blood sugar back down. And you know, it, it's it, it isn't. That unusual that patients discover that they are diabetic when they're, you know, in the hospital for their heart attack and their subsequent heart surgery. Like that's the first time that it's been revealed to them. But they've been diabetic for a long time now. What's interesting about Darius, right? You know, that blood sugar of two 50, right? If you have a postprandial blood sugar of two 50 you're diagnosed as diabetic, right? But Darius isn't diabetic. Like Darius said, he's in good shape. He's pretty muscular. I don't know if you know what your A1C was at that time, Darius, but I know what it is now, right? And you're not diabetic yet. You know, one of the things you've been kind of talking about is you still, if you eat these carbohydrates, you get very high blood sugars. And that kind of brings us to, you know, an interesting conversation about we talk a lot about insulin resistance and how important it is not to be insulin resistant. But even if you're not overtly insulin resistant, there may still be some trouble brewing under the hood. Exactly. I spoke recently at the collaborative science conference that Dave Feldman put on in Vegas. And my talk actually was about this specific thing is postprandial hyperglycemia. Now most people think, oh, you know what I, I just realized prandial. Postprandial after eating. That's, that's, that's something that after, yeah, after eating. Thank you. Yes. Sorry. You know, I, I throw around terms like a lot of times and I forget that people often don't know what I'm talking about. So please feel free to stop me or just even for the listeners. Oh, I, I never hesitate to do that. Yes. Thank you. My talk was specifically on this idea of acutely high glucose, even if it is not chronically high, is damaging in all kinds of different ways. Chiefly among them is it increases oxidative stress enormously. It also causes acute clotting, like we can actually measure elevated d dimer and elevated prothrombin fragments, which is actually literally clotting in the blood happening in the moment. Post the moment you are hyperglycemic. Whoa, whoa, whoa. Did I hear that right? You can detect the blood being more prone to clot, not just more prone to clotting, actual clotting. So we have the moment the blood sugar tips over into that danger zone, Into that hyperglycemic range. Now where that exactly happens is not entirely clear. So in the studies, they usually are looking at glucose over 180 in the 200 range, but obviously I'm hitting that easily. And anybody who is diabetic and anybody who's pre-diabetic can easily hit that. If they're eating, if they're consuming, like really rapidly absorbed hyper, glycemic carbohydrates it's the, it, it's it's tiny clotting, right? It's not necessarily a big giant clot, but it definitely increases your. Likelihood of having a larger clot, I cannot tell you how many times, especially stroke patients come in and they are acutely hyperglycemic. Their glucose is in the 200, 304 hundreds very, very frequently. Now, can I say for sure that they ate something and they had a giant glucose spike and therefore the stroke happened? No, I can't say that, but there's all these things that point in the same direction, right? Diabetes is the single biggest risk factor, bar none for heart disease and for cardiovascular disease, for cardiovascular events. And the, you know, the, that's funny. The number two and three are what's called lipoprotein insulin resistance score and the metabolic syndrome. Now, the thing that I see and Phil talks about as well, the most common things that I see. In these sick patients, these acutely sick patients, is they almost universally have metabolic syndrome and metabolic syndrome for those people don't know, is a kind of a constellation of factors. We look at what's called central obesity. So it's actually a measurement of your waist circumference over, I believe it's over 35 inches for men and over 40 inches for women. Correct me if I'm wrong, Phil. Yep. Yep, that's correct. 40 inches for, for men. 35 inches for women. Yeah, that's right. That's right. And then hypertension, elevated blood glucose, so that's a fasting glucose of over a hundred or an A1C in the, in the pre-diabetic range, low tri or high triglycerides. So that's the technical cutoff, I believe is one 40 milligrams per deciliter. And for, and HDL low, HDL. And for women, I think it's under 40 for women. Under 50 for men. Again. Again, yeah. Under 50 for women under 40 for men. Yeah. And one 50 on the triglycerides. Yeah. Okay. So yeah in general, and you know, those, those numbers are always a little fudgy because there's always a room for error in the lab value that you get. So if you get a man who's whose HDL is 42, they're still like, that's still way too low. That general, when you have metabolic syndrome, you are insulin resistant. So again, that would also, it would coincide with the or be congruent with the LPIR score. So if you have metabolic syndrome, you would see an a high lipoprotein insulin resistance score in these people. Anybody who has insulin resistance. If they're consuming glycemic carbs, they're having large glucose spikes, like it's just happening. You put a, you slap a CGM on them and you'll see it happen. And I'm fortunately now seeing lots of patients come in diabetic patients at least who have CGMs. And it's fascinating to look at them.'cause I'll have them show it to me. I'm like, Hey, lemme see your, lemme see your data. And sadly, a lot of 'em never actually look at it until I point it out to them. And the interesting thing is you'll see their glucose actually kind of hangs around in the, you know, maybe high nineties, low one hundreds, maybe one teens, that's their baseline. But when they eat, not even a lot of food, like just a little bit of toast, their glucose will shoot into the 300 range. It'll eventually come back down and area under the curve matters. But that acute spike. It causes tons of oxidative stress, again, causes acute clotting. It causes, and a big thing it causes is LDL glycation and oxidation. It causes a decrease in what's called flow mediated dilation. That's, so that's the ability of your arteries to expand, to increase blood flow or increase demand. So in other words, your arteries are stiffer, they're not expanding like they should, and which leads to higher blood pressure. And we know high blood pressure leads to all kinds of other problems, right? And this, again, all this happens acutely within the first hour or two of glucose being elevated and things like the prothrombin fragments and the D dimer, they'll stay elevated for 24 hours after the exposure. One of the I just wanna highlight something that Darius said there that may have been a little lost.'cause he was using the technical terms but he mentioned LDL glycation and, and oxidation, right? And what that means is that those cholesterol particles, you know, that everyone's always worried about the LDL cholesterol. They're getting damaged by the blood sugar. And this is one of the important things of understanding again, a lot of what I talk about, you know, why high cholesterol may be problematic in some situations and may not be problematic in other situations. And it also points to the fact that even if you have what's considered to be a, normal or a low, cholesterol level, LDL cholesterol level, you still might be causing problems if you have sugar constantly damaging those particles. Because that's really what you see when you look at the plaque. It's not the normal healthy LDL particles, it's these damaged oxidized glycated LDL particles that are involved in the plaque forming. This is subtle but important. Okay? So one of the things that I talk about in my talk at COSI. Was about the fact that LDL, when you look at population studies, it associates with heart disease, right? The higher your LDL is, the more likely you have cardiovascular disease, but it's still, it's like a weak association. It's consistent. It's always there, but it's, it's not, it's doesn't have the hazard ratio that say like diabetes or metabolic syndrome do, or hypertension for exa for that matter. I think this is, I think the reason this is, and this is just my hair brainin theory, is that when you look at the population, at least the US adult population, 60% of US adults are diabetic or pre-diabetic. And when you look at the C, the current CGM studies that they're doing, that they started doing. There's another 10% of the adult population that is not either diabetic or pre-diabetic, yet they still have giant glucose spikes when exposed to glycemic carbs. That would be someone who's like, who's like me? My A1C actually does sit in the, in the pre-diabetic range. I think that's entirely because I'm just so dang sensitive that whenever I expose myself and a lot over the past couple years, I've been doing a ton of glucose experiments and sitting my glucose super high. It's still, it's, you know, basically causing a ton of glycation that lingers. So we have, up to 70% of US adults that are regularly experiencing hyperglycemia every single day. Well, if LDL gets di, gets damaged by hyperglycemia, cation, oxidation, then of course it's gonna associate with heart disease. It's getting damage in everybody, but it's also why we see, and you know, there's these people out there who think like the lower you get LDL, you know, you're gonna, you're gonna make cardiovascular disease a orphan disease. That's frankly idiotic. As long as diabetes exists, you're gonna have heart disease. Full stop. I don't care how low you get your LDL yeah, because you're going to be causing all kinds of endothelial damage or damage to the inside of your blood vessels. Thank you. From the from the high glucose, and you're gonna be damaging your LDL particles. I see patients all the time that are on statins that have normal LDL levels that are still getting strokes and heart attacks because their glucose is not under control. What does it say? Yeah. And that's really the, you know, takeaway message here to people. Right. And of course, it's one that we've talked a lot about that, controlling your cholesterol, whether we think it's helpful or not. And, you know, again, there's debate on that, but it's clearly not enough because, that approach hasn't been working for the, you know, even though it's been our focus for the past 50 years plus heart disease is not getting better ultimately. And what Darius sees and what I see on a daily basis is people with well-controlled cholesterol that are still coming in with heart disease and you know, stroke and other cardiovascular diseases and until we address. The blood sugar, the insulin resistance that leads to the higher blood sugar. Those, and of course the food that they're eating that's leading to the high blood sugar. We're, we're, we're not gonna really be able to make the headway against this. So, maybe let's pivot a little bit. Talk about, you know, your life as in the er, right? And now you're seeing these patients and now you understand this. And, you know, the ER is a challenging environment. You're obviously just seeing these patients for short periods of time. But you know, how do you then address that with that patient that's coming in you know, and it's their fourth time they're there in the past two months, you know, with their high blood sugar or, some effect of that. How do you start to address this now with the patients? You know, it's. Interesting. So I have, you know, my bias obviously is that I get the sickest of the sick patients. That's who I see all the time. And unfortunately I don't get to do any follow up, right? So it's like I have this kind of short window of time to, to talk to this patient if it's a, you know, if it's a situation that I feel like I can help. And I have, fair amount of respect around the er. With, in terms of like a lot of the doctors and nurses and stuff, everybody knows that I'm really into health and fitness and nutrition. Sometimes I'll actually send me in to talk to a patient about this stuff. And it's actually, I, I really consider it a blessing. This is actually really why I don't do so much social media stuff, because I, I like my job, I love my job. I get to take somebody who is having an acute problem and. And you know, for example, like a non-healing foot wound for example. That's a really, that's actually a great example because I can take a patient like that and go look in their chart and go, wow, I'm looking back in your chart here, and I can see that your A1C was 14 just recently. And I can see over the years that your glucose has gotten worse and worse and worse. What are you eating? And in some cases I find out that people are, say, drinking a couple of liters of Coke a day. And I have, you know, obviously I have to, you know, hit, I gotta be very careful about what I, what I say here in terms of hipaa. So I can't, you know, talk about specific cases. But I have had patients that came back for other reasons and talked to me and said, Hey, you helped me. Heel foot wound that I had because I didn't realize I was doing this to my glucose, and they were able to, you know, change their diet up. I can tell, you know, I can give them certain tips like, Hey, if you're drinking soda, knock the soda off. At least switch to like Coke zero or something. I'm not very bullish on sweeteners, especially for patients who are diabetic and they are addicted to sweets. It, it, it really becomes about harm reduction for those patients. I'm like, okay, if you're drinking soda every day, there's no way that I am in five minutes going to convince you to just start drinking water. Hey, switch to Coke Zero or diet, anything else that doesn't raise your blood sugar super high. I've had for example, the one I, the example I gave earlier with the continuous glucose monitors that people are starting to show up with, I can teach them, Hey, look, I can tell you. All the things that you should and shouldn't be eating, but this device right here is going to tell you the truth. You eat something and you watch it. If your glucose shoots up, you avoid that food or you minimized the heck out of it. I've had a lot of patients who even on their own kind of saw me and go, Hey, you look like you're fit. Can you help me out? I've been getting fatter and sicker over the years. What can I do to reverse this? You know, in that moment that somebody's actually experiencing an acute card cardiac problem or something related to their hypertension or their diabetes or their obesity I'm able to. Counsel those patients and point them to some resources. I can point them to Phil, I can point them to diet doctor, I can point them to all kinds of different resources. I don't specifically say that everyone should do keto or low carb, but you know, I am on very, very safe ground to tell all these people, Hey, don't eat anything that spiked the heck outta your glucose. I really think that at those moments, these patients are much more receptive to this information because they can now see the ultimate result of their lifestyle habits. It's very hard to, and I, I think everybody's done this with their own families, where they see somebody's, they're eating a junk diet and they obviously don't look particularly healthy. They're overweight. They, you know, you can tell they have low energy and you try, Hey. You can feel so much better if you just started eating this way. You started just moving a little bit and you just cannot get people to do, to change. I had a teacher, this is kind of an aside, but I had a teacher one time that you would always put, it was my eighth grade science teacher. He'd always put a quote on the board and one day he puts this quote on the board that says never underestimate the ability to change yourself. That's very kind of vanilla. I think we all kind of understand that and agree with it, but the next day I only remember that one because the next day he put on the board, never o never overestimate your ability to change others. And that one stuck with me because even with these patients that I see that are very sick, in some cases, just they're heading down the path of an early death. YI can't change everybody and I can't make everybody realize that they have a different path ahead of them. But there are those that are receptive and I try to be very attuned to those who are because I do think in that moment I have the ability to affect that person's life in a positive way. And I have seen the results. And again, I've had a handful of patients come back for other unrelated reasons and found me and like, Hey, you helped me out. And that's really, really rewarding. I've actually recently we've had several patients come in, in their thirties and forties with cardiac events and I'm actually thinking about putting together like a case series and since I'll, you know, since I can work within the hospital system, actually have access to patients, I. And gather some of their data.'cause the things that I see over and over again especially is, or especially the metabolic syndrome criteria, I see that over and over and over again. In particular the low HDL high triglycerides that is almost ubiquitous. Yep. Like that one more than LDL.'cause I see LDL it might be moderately high, maybe it'll been like the, mid one hundreds mid to upper one hundreds at worst. Very, very rarely do I see anything over 200, even in the sickest of patients. But that, that low HDL high triglycerides, I see that over and over again. And I would love to do this case series because we could identify these people. And every one of these people I look at their history, have the chance to go back in the chart. At most they've had like an EKG or a stress test. None of them have had cardiac imaging. None of them have even been diagnosed with metabolic syndrome, even though it's, it's clear in their chart that they have it. And I'm like, well, if, if this condition is so highly associated with heart disease, why aren't we identifying it in these patients? And why aren't we intervening earlier, at least with, with diagnostic imaging of some sort. But, at again, at we're at best, I see stress tests on these patients, which is like, you know, basically waving your hand over a, over a crystal ball in terms of how effective it is identifying people with you know, with future heart conditions. Like if you're at the point of having EKG changes with a, on a treadmill, you are way far down that path. Yeah. You know, it's amazing to think about, you know, CGMs, right? You know, they, they, they cost nothing essentially, right? They're, they're$50 each retail. You know, if a hospital wanted to buy, you know, 10,000 of these, right? They'd probably get 'em for 10 bucks a pop or something, right? These patients come into the er, right? And each time they come into the er, it's costing thousands and thousands of dollars, you know, let alone, even if they don't get admitted, could you imagine if we just, you know, on the way out of the door of the er, you got a $10 CGM slapped on your arm and, you know, you get the app and it just like simple direction. If you eat something or drink something and your blood sugar goes above this level, don't eat that or drink that anymore. And what, you know, a powerful impact that would have on people's behavior. And yet, it's it is it is not even considered unfortunately, as we see all the time. Yeah. You know, I, I really, I'm a big fan of these, of any sort of dynamic measurement what you're eating in that moment and what it does to you, because it really does have so much more of an impact when you could see it happen in real time. I do wanna pivot a little bit though to my own health here. And part of my the talk that I had was actually about my own heart disease. Oh, geez. Now. Yeah. This is the thing, the I'm very fit and active and healthy and lean. Nobody would look at me and think heart disease. But I did get a at a few years back, actually in summer of 23, I got a coronary artery calcium scan and it came back at 44, which for my age was actually, puts me in the pretty high percentile. Like I shouldn't have any calcium at my age, but I do, and this is where, there are a lot of people in the low carbon space that will be like, you know, LDL doesn't matter at all. LDL isn't an issue. You shouldn't, don't be concerned about it. I, I completely disagree with that. I think it's contextual and in my case, my LDL has always been high. The lowest I ever had, lowest reading I ever had was 1 79. And that was when I was 24. That's already in like the 95th percentile or something I think for LDL. And then when I went low carb, it went even higher. Now it's typically in the low three hundreds since I know for a fact that I tend to be, and I, it's more of a genetic thing. And I've dug into this a bit. I'll just leave, I'll leave the mechanistic behind. I'll just say genetically I'm very prone to hyperglycemia. I think that I do my or my heart disease comes from the fact that I have had these very high glucose spikes combined with high LDL over the years. Now my heart disease, I've, I've checked it a couple times. I've actually had a coronary CT angiogram, which actually they ingest, they inject contrast and they could see a soft plaque in there. And I do indeed have soft plaque. I don't have any, what's called low attenuation plaque or low density plaque. That's the stuff that's really, really highly likely to rupture. So I don't have any of that. But I do have mixed soft and calcified plaque completely asymptomatic. Mind you, I do, you know, spartan races and defi challenges and marathons and half marathons. I work out very frequently. I don't have any chest pain or anything like that. Which is, you know, I think it's a big signal that a lot of people should pay attention to, obviously. But when I did, I've done a couple of carotid intimate media thickness ultrasounds. And in both. I have both cases. I have no idea what that is, but it's an ultrasound of your carotid arteries that go, you know, from your heart to your brain. And you can see plaque or thickening of those arteries, which means there's athero sclerosis happening. It's like a proxy for coronary artery disease basically. And I've had a a couple of those tests and I had some regression over about a year and a half of my carotid intimate media thickness. And in my coronary CT angio, I had roughly, it was a tiny bit of progression, but it's basically within the margin of errors, like, well within the margin of error. So it really was essentially just the same reading. I think. People who are completely dismissive of LDL are wrong. But I think, on the other, on the flip side, people who are, you know, are the people who wanna drive your LDL down to zero are also wrong if they're, especially if they're doing that at the exclusion of other factors that are in play. What, what's the guy's name? Simon one of the low kind of plant-based influencers. He had a look, his name up real quick. I'm familiar. Simon Hill or Simon Hill. That's right. Yeah. He had had a coronary CT angio also, and he, his LDL is in the seventies. He's plant-based. He is low fat. Yet he actually had basically the same amount of plaque that I do. And he, you know, his plan is basically to drive LD down LDL down even more. And instead of, I mean, I, it sounds like he's doing that at the exclusion of looking at anything else. Like, Hey, are you checking your glucose? Are you checking other factors? Are there inflammatory issues? Are there oxidative stress issues? Are you having some sort of autoimmune problem? He kind of just leaves it up to, you know, he kind of throws out genetics like his, I guess his dad and his grandpa had heart attacks in their forties. And genetics obviously plays a factor, but genetics genetics are what, cause the mechanisms that produce the issues. Right. And I think those mechanisms need to be addressed. In my case, my genetics aren't good in terms of glucose metabolism. So the glucose, for me, my glucose metabolism hyperglycemia are a result of my genetics, but the mechanism is still there and I'm able to control that mechanism now because I have the information. What do you what, what do you think the role might be of your athletic activities? Right. So we do have some data that points to a high level athletic pursuits, endurance type, activities seem to correlate with. Higher than expected rates of heart disease in those people, right? Because otherwise those people, you wouldn't think at heart disease. They're, healthy and lean and, and all of that. You know, in a story like yours, right, where you're showing some plaque at an earlier age and, you know, that's, that's raising some concern. And you know, you mentioned yes, you have this high LDL but yes, you've also, demonstrated in the past that you were having high blood sugars. Maybe you didn't know about it at times. And then, you know, one of the situations where people sometimes see their blood sugar spiking up, we talked about after you eat food, right? But there are other people that they exercise and their blood sugar goes up and, you know, do you think that that is potentially harmful in that same sort of context? Yes potentially. So for myself I I'm not training like a lot of these guys who are out there, you know, just, really, really training at high intensities. And that's where we tend to see the higher calcium levels particular are these guys that have, you know, that are just really burning the candle at both ends in terms of their training volume and their training intensity especially. So when they look at studies for people who are athletes, they see that it's the training intensity in specific that tends to associate with the higher coronary artery calcium levels. So for me, do I have, do some high intensity training? Yes. Here and there for sure. But it's usually pretty limited. I'm, at most time I'm doing kind of zone two. Running or like on an air bike or doing some lifting sessions or maybe some, some calisthenics. And occasionally I'll do some 30 minute, one hour high intensity sessions, you know, once a week or something like that. So I'm not, I'm not training at the intensity and volume level to where I think that's actually a problem for me. But you are right that when you do, when you are putting out high intensity and high intensity effort, and I'm going to show you this here. So this is what's called a defi challenge. It's actually the shirt I'm wearing right now. And it's a, a basically a, an event where you run for a few miles or it's a, it's a 5K plus. An a station. So it's like you run 500 meters, do a station, 500 meters, do a station. And so you can see during the event, my heart rate is like I average at 1 79 for the whole whatever, 45 minutes. Yeah. For this event. So I'm, you know, I'm cooking pretty hard and you can see right here what my glucose did. It shot up to 1 79. Actually, I think maybe even a little bit, maybe about 180. During that event, I did not eat. That was me fasted. So that is purely from the glycogen dump during that effort. That so now is that the same as eat as drinking a soda and having my glucose shoot up? I don't know. I, I, I can't say whether or not that that is. Those are equal. When you exercise, you do increase your, you real anti, you know, real quick, we just need to point out for our listeners who are not looking at it he's got his, he's got, was that a CGM that was reporting that? Yeah. Okay. He's got continuous glucose monitor and during his exercise completely fasted his his glucose shot up to 1 79. Now what's concerning, you know what, what's concerning about this Darius right? Is, is this is what happens to your glucose, right? You were fasted. I'm guessing you were kind of on your usual low-ish carb diet at the time, right? Mm-hmm. Yes. What many athletes are doing during these events, right, is they're, they're literally mainlining glucose, right? They're using the gel, the goo, whatever it is, right? To keep their energy up with sugar. And you know, you just wonder what some of their CGMs might look like during you know, during something like this. Yeah. I'm really curious. You know, I haven't seen much data on that. This is a pretty short event, so this isn't something that people would normally fuel during, but you know, during like a half marathon or a marathon, you definitely see people pounding down gels and carb bloating prior to the event and things like that. Yeah. Yeah. Now is this as, again, is this as bad as drinking soda? I don't know, because when you exercise, you do increase your your antioxidative capacity, your glutathione goes up. So. Is it the same? I don't know. I have done a ton of, a ton of different experiments though with high intensity training and fasted versus fed. And if I feed, like say if I do something like what's called a keto brick, which is a thousand calorie bar shout out to Rob Sykes, by the way. It's a thousand calorie bar that is mostly like just fat. It's, I think 80% of the calories from it are fat. If I have one of those, like a couple of hours before Intensity City workout, it completely flattens my glucose spike. I don't get the giant g glycogen released. I think primarily just because when you eat something like that, you have a ton of energetic substrate as a fat floating around your system to use, to utilize. So your body doesn't go, well, I I need all this glycogen right now. It just goes, oh, well there's all kinds of stuff floating around you. I'll just use that. So, so what's your experience with the a thousand calories worth of, of fat in your system doing these kind of workout rather than doing it fasted? How's it feel? Does it feel any different? It, it, it's hard to say, I mean, because, I, how your workout feels could be your mood, the weather, how you slept yeah, I realize it's all subjective, but yes. So in general I feel pretty good when I have one of those a couple hours before. If I eat it too close though, then I start getting the GI issues and I don't feel as good. So that, that's really, as long as it's timed right, I think I generally feel better and more energetic as long as I, it's far enough out from the actual event. Interestingly, I've actually recently did a, and Phil, you'll like this, I did a I called it a keto or a fat bomb experiment where I consumed two of these keto breaks at one time and I measured labs just before, and then at 30 minutes, one hour, two hour, three hours, and four hours and watch what my lipids did over that time. And this might be too nerdy for this podcast, but No, no, no, no. We get super nerdy. I'm just the one who goes, I have no idea what that means. So, But I'm, so far I'm hanging with you. Okay. Well, I mean, maybe I'll go ahead and, and share it for, yeah, so some of the nerds that really want to take a look at this so again, I ate one of these things right here. This is a keto brick, mostly cocoa butter. Some calories. Yep. 1000 calories. So I ate two of these at one time. So whi which is impressive enough in and of itself. I was gonna say, yeah, that, that's, I struggled, I struggled to get a whole keto brick down at one setting. These are dense, yes, they are dense. Yeah. But awesome. So that's that's a, you know, that's 112 grams of saturated fat. That's what, 176 grams of, of total fat. This is a, it's pretty heavy. Yeah. And so I ate one of those and I was like, okay, well what's my glucose and fat and lipids and stuff do Now I've done tons of experiments like this all the time, mainly with, with glucose in my CGM. For example, I did, this is a experiment that I did with orange juice. This is completely. Fresh squeeze orange juice off. I picked the orange juice off of a friend's tree as organic as you can get. Squeeze the orange juice myself. And I saw my glucose do this up to 210 and verified with my finger stick. So I, again, I liked these really dynamic things. I repeated that in and out burger experiment where I had the soda and the burger. And the fries. This is what I saw. Incredibly high glucose. I love these dynamic experiments. Now the fat is different. Oh, one more I'll share real quick 'cause this one's very, very entertaining. I had a bowl of plain shredded wheat, shredded wheat, plain shredded wheat, no added sugar, and I saw my glucose hit 2 27. Wait, you ate a bowl of shredded wheat. I ate a bowl. I mean, it was with and with non-fat milk. By the way, the sacrifice Darius makes for science. That there folks is your heart healthy, shredded wheat. It was painful. I'll bet. But yeah, that's what happened to me. It was a giant glucose spike, no sugar, just non-fat milk and plain shredded wheated. That's the heart. Healthy, you know, lots of fiber. Yeah. You know, even just a single, this is a interesting experiment. Single banana, empty stomach that went from 1 0 8 to 1 79. And that was just what, 30 minutes later. So listeners, he's, he's showing us screenshots of his his glucose monitor. Yeah. One man on an empty stomach took you in less than 30 minutes. Yeah. 25 minutes to shoot up to 1 79. Now again, this is me, this is my own biology, right? Other people don't necessarily have this. I, part of my talk actually was that my another buddy of mine eats junk and I mean pizza and McDonald's, hamburgers and french fries with, and polishes it off with three pints of great value ice cream. And his glucose barely budges it like kits into maybe one 20, maybe one 30. His biology. Let's see what happened with the keto bricks. Yeah, with the keto brick, glucose was completely flat right here. So obviously that's the case'cause it doesn't have much, doesn't have many carbs in it. I did see ketones go up. During the experiment starting out here, ke 0.6, my ketones are always actually pretty low. They don't ever go all that high. I won't go into that much here, but in general, people who are, especially lean, mass, hyper responders who are lean often don't see very high ketones. My glucose kind of went up a little tiny bit. But ketones did go up during that whole experiment. But here's a more interesting thing. Now here are my lipids. This is, if anybody's watching this on the phone, it's gonna be hard to see, but my computer, it's you should be able to see, see it somewhere. I'm also going to change it so that there we go. Alright, so we are, describe what we're looking at here. So these are the labs that I did during this quote unquote fat bomb experiment that I did, where I had these two keto bricks on the first set of labs here. Can you see my arrow? Yep. January 2nd, 2026. Yep. That was a first. That was a, just kind of a, a comparison. So this is what my, my labs kind of tend to look like. My ins insulin's a little bit higher than it tends to be. I think I was eating a little extra at that time. But my LPIR score is zero. My what's called the NMR Lipid Profile, NMR Lipo Profile, it's a proprietary test that LabCorp actually does. And I use own your labs to order this stuff. So shout out to own your labs and Dave and Shaban. Here are my lipids. You can see my total cholesterol is very high at four 20 at 4 28 LDLC 3 23. 3 23. But you see my triglyceride HGL ratio is actually very good. It's well under one 0.56 HGLC 1 0 1. Triglycerides 57. And this is an important measure right here. VLDL is really important. A lot of people don't realize, but and generally you want that under 10. Going down the column here, you'll see insulin 7.1 a little higher than typically for me. Glucose is 98. My glucose tends to hang out in the like mid to high nineties all the time. Home IR 1.7 A1C. Now here's the thing about me. My A1C is always in the pre-diabetic range. It has never once been lower than that. I think maybe, I think actually one time I had like 5.5 but it never gets down to like, you know, the low fives. Interesting. Yeah. There's a lot of questions as to why that is.'cause when I do control my glucose, well it still stays there. So some people say it's longer red blood cell. Lifespan. I'm not sure I entirely buy that, but in any case, that is what my A1C sits at. Uric acid's always low for me, fructosamine ISS in a normal level. Okay, Phil, this is what's called Phil comment on this. If this was your patient, you're looking at it, what are you seeing? Yeah, so, when I look at his baseline here in January, right, he is got very low triglycerides high HDL cholesterol. He's very insulin sensitive by all of these different measures. And, you know, he's got good sizes of his cholesterol particles, his LDL particles specifically. One of the numbers we look at there are the small LDL particles. These are like the most damaging, form of LDL. And they're below the lowest limit of detection on this test. So, you know, he's got a very healthy looking profile here. You know, the A1C being high, a little interesting insulin, you know, maybe a little higher than some people would say ideal. But and low inflammation is the other thing that I notice here. He's got an H-S-C-R-P of 0.15, so very low. And then he eats the keto bricks. And so the, the morning of the keto bricks, right? Seven 30 there, your, yeah. Similar numbers. Yep. This is actually an interesting point I do wanna make. Yeah, I, I was looking at that. So now we're looking at the day he ate the keto bricks. Yes. So at 7 38, that's couple months after, after taking his baseline here. Yep. So, actually this, this column at 7 38 was prior to the keto break. Okay. This was the initial lab test. And this is a, I wanna point out a very, very interesting thing here. For Phil especially, do you see my small LDLP? Yeah. Difference 10.6. That's the highest I've ever seen it. I do notice that I do sometimes get little bumps in, in small LDLP and it's almost always during active fat loss. Mm-hmm. So at this time I, I was in a bit of a deficit. I don't think I intended to be, but I ended up being so for sure. And I do see UGIC, me triglycerides go up as well. In this case not so much, but I will see a bump in small LDP and this case, it was actually pretty dang high. Ultimately, it didn't affect my LPIR score was still pretty low. So I was still, again, insulin sensitive. But just continuing on that track there. As the hours went on, you can see my small elderly LP. It dropped a huge amount. It's 10 86 at 7 38 in the morning. Mm-hmm. At 10 o'clock in the morning, it's dropped to six 30 and a little less than two hours after that, before noon. So in less than four and a half hours, it's back down below the measurable level. Exactly. This, yeah, so this is a very, very interesting thing, and I was talking to Dave Feldman about this as well. This is one of the numbers just for context, the small ld, the so small LDLP is, that's the really dangerous situation. Theoretically, yes. Those along. Yeah. Those are the form of LDL particles that are most what we call atherogenic. They, they are the most it most likely to be involved in plaque formation is how I usually explain this to people. And yeah, it's fascinating to see, right. First of all, it's just fascinating to see between your January 2nd and your, you know, February 27th, right. That dramatic a change, and then within four hours after eating keto bricks, right. You know, to see them plummet like that. Mm-hmm. And this probably has to do with. So during this four hours, right, your body is trying to process all of this fat that you just ate. And so it doesn't surprise me to see your triglycerides go up, right?'cause that's how your body's going to kind of, you know, initially transport that fat. And you know what, what is interesting, right? So your LDL comes down your HDL comes down a little bit but your LDL went from three 15 down to two 50 eight that says. So, yeah, definitely dropped. And I had my LDLP with that as well. And your LDLP went down and the small particles dropped dramatically. Right? So what does that tell us? You were, you were basically pumping out more large particles and all of those small particles that had been floating around in your blood basically got reabsorbed into your liver real quick.'cause you're trying to, you're trying to recycle your LDL particles to now transport this fat around, uh mm-hmm. And the triglycerides, you know, in the LDL, but it's pretty interesting. And then your insulin, you know, goes up a decent amount, went from 6.3 to 18.4, but your blood sugar doesn't change. Right. So, like you said, I mean, keto bricks are fairly low carb, but they're not zero carb. And so your body was kind of dealing with that carbohydrate load. Uh. And you know, at least temporarily you were becoming more insulin resistant. The LPIR goes up and the homa IR calculation goes up. Very fascinating experiment, I'll say. So, yeah, I do wanna point out a couple things here. I, the, something that I've seen a lot in the LMHR Facebook group is that a lot of people are, will see their small LDLP go up during active fat loss. I'm not entirely sure what mechanistically is happening here. But one thing that we do know for sure is when your insulin goes up, that does shut down. It does shut down lipolysis. Right, So in this case, this actually makes sense, is that my small LDLP, if my small LDLP is elevated because I was actively losing fat weight, it does make sense that it drops down to, to back practically nothing when my insulin goes up acutely because I'm not actually seeing any lipolysis happening. So I know I, I'm, I'm gonna need Dom Tino to some, somebody to explain this mechanistically to me. But I think it was super fascinating to see. And again, this was the highest L small LELP I've ever seen. It's almost always well under 90 'cause I'm usually weight stable. I do wanna point out, so something that a lot of people will say, and even Ben Bickman will say this, saturated fat does cause a little bit of insulin resistance, so when you look at my insulin, it goes up. It's never hyper insulin you make, right? I'm not, I'm not going over, I'm not even going over 20, barely over 20. Micro I use per milliliter. But like, it does stay elevated for quite a long time because there's just so much energetic substrate and my body has something to do something with it. And insulin is how it's, you know, managing those all that excess substrate floating around. Unfortunately what most people are doing is they're not eating, exclusively saturated fat or exclusively carbohydrates. And when you eat like exclusively carbohydrates, this is a, I'll show you this really quick. I did another experiment where I did a, what's called a craft test and I consumed glucose beverage and checked my insulin and glucose levels over the, over the, couple hours. You can see my glucose. This is on, I tried it on both a one week of a strict ketogenic diet and one week of a high carb diet to see how, what the difference was. And at the end of the keto week, I had a higher glucose spike and a higher insulin spike. Because the higher glucose goes, the more insulin you're kicking out to deal with it. Now compare this, look at the insulin peak here. For my keto week. It's looks like it's somewhere around 90, maybe high eighties. Compare that with the keto brick, which was 2000 calories, but barely any carbs. Insulin, barely touched 20. But when I consumed pure glucose as a beverage, which actually is only like, I think 400, 400 calories, I'm getting a much higher insulin spike. Now think about it, most people are eating a McDonald's meal, right? So when I ate that or make or Inn out meal that, a good example, when I ate that meal, which has a lot of fat and carbs in it, I'm getting a giant glucose and insulin spike and any fat in that meal is keeping my insulin elevated for a long time. That's where we get people who are end up chronically hyperemic. Because they never let it, they never let their insulin come back down after consuming a meal like that. They end up going on and eating something else or eating some snack in between. And so the glucose and the insulin are constantly staying high. Coming back to, yeah, that, that combination of, you know, right, and, and this is a lot of why we thought, saturated fat was so bad for our health was because, most of the time people in those studies were not eating isolated, saturated fat. They were eating saturated fat, combined with carbohydrates. And, you know, clearly I, I don't think you would define anyone no matter what nutritional camp they're in that would disagree that the combination of saturated fat and refined carbohydrates is probably the worst thing that we can eat. And that's the standard American diet essentially. Yeah. That it, it truly is. Again, like I was saying, that that type of meal, burgers, fries, m soda is ubiquitous in America. Yeah. Last thing here, uh, I checked inflammation markers during this experiment as well with the keto break experiment. H-S-C-R-P stayed flat, didn't budge actually I think I forgot to put the last two in here, but it was the same. I checked what's called L PPL A two activity, which is showing inflammation in the arteries. And in this case it, if anything, it dropped or, basically within the margin of error. And, but I did see what's called the sedimentation rate, erythrocyte, erythrocyte sedimentation rate go up a couple hours into the experiment. So I thought that was pretty interesting. I dunno if you can see that, Phil. Yeah you know, you know, eating is an inflammatory action, right? I checked you know, renal labs all stayed the same liver enzymes, interestingly you know, the, they were all completely the same except for the, the bilirubin dropped to like unreadable undetectable levels, which I thought was interesting. Free fatty acids did go up. They roughly doubled or doubled. And I thought this was a fascinating thing bit too. My testosterone dropped quite by quite a bit, went from 7 0 4 to 4 52. I'm not really sure. Again, mechanistic of what's going on there. It could just be, I don't know, in such a fed state, my body's like, Hey, you need to just chill out. What else about this Can I say, oh, you know, one, one last bit. When, whenever anybody says to, like, you only need to check LP little a once in your life. I, I think it's ridiculous. You can see right here on these two, these two readings up towards the top here. I had a a 20 point difference in my readings there. It does go up and down depending on what you're doing. I've had to go up to like the one fifties after a trip where I was like consuming all of the carbs and seeing gigantic glucose spikes. I've seen it drop down into the sixties when I was super, super, super strict. That is a measure that I think people should get checked more often. It doesn't necessarily need to be, you know, every few months, but, you know, once a year or so. What else? Awesome experiments that you've been doing. Like I said, I think you're bringing a lot of a lot of interesting data. You're raising a lot of interesting questions within the community, and really glad that we were able to get you on and and be talking about this. Where, where, where does this kind of lead to you, you know, for you? What are you what do you see kind of in the future as to what you might be able to do around all of this? You know, I, I always struggle with that question myself because I do value my personal time, you know, just hanging out with my wife and my, I have an eight month old daughter you know, those take a lot of my time and a full-time job and a dog that needs attention too, and a house that has stuff, stuff that needs, always needs to get done. You know. I, I struggle with deciding if I wanna do more YouTube videos or, more podcasts or anything like that, because those are just also time consuming. Ultimately, I like to just kind of dabble in this space, talk to people like you who are extremely knowledgeable. Learn what I can and apply what I've learned to my own practice with the patients that I see in the er because I, I feel like I can actually on the ground help real people that I see in front of me that are suffering and being able to do that, that is, pays way more dividends than just being able to, you know, you know, pop off a couple of videos on YouTube. And ultimately, I, I tried to gather the information so that I can then help other people. In real time in my real life. And, you know, maybe again, like I, I was thinking I wanna do some more stuff in and around the medical system that I already work for. Maybe I can, you know, get them to eliminate juice in the hospital, for example. Which I can't tell you how many times my diabetic patients have five boxes of juices next to them when I walk into their room. Or just to get them to, you know, start looking, start doing more earlier diagnostic imaging for cardiovascular disease. So I, you know, I think I want to affect the areas that I can, that I closer to rather than, you know, do a whole bunch of stuff in the nutritional, metabolic health space. That's why, again, I, I've kept a low profile this whole time. Yeah. But I love what you brought here. This was really, really cool. And I love the subtlety and the nuance and the context, the lack of black and white proclamations, that all of this is always bad and all of this is always good. It's good to, to look at real life experiments. I am utterly fascinated that there's a human being who actually ate a bowl of shredded wheat and didn't end up in the emergency room by himself. And likewise the same human being ate two keto bricks. That oughta put you in the record books all by itself. I've heard of people eating four of those, so, good Lord. Alright Darius, thanks for, thanks for joining us. I'll let folks know that you've got an Instagram account, which I guess is probably the, the, the most, active thing available for you, but, but really your job here, I think is to just demonstrate how to be a citizen scientist and how to take responsibility for your own health. You know? That's a huge part of it. So many people I see, and especially all my patients, they just kind of float through life and don't even think about the things that they're doing to their bodies. They're not, you know, I've, I've always been kind of a nerd about it. I've always read, ingredient labels. At least, the very least, I started doing that from the moment I first started shopping for myself. But most people don't even think about the things that they're putting into their mouth. They go, oh, this tastes good. I'm going to eat it. It, we, I, I always say that we, in this space, we're always talking about keto versus vegan versus carnivore, versus plant-based, versus high fat, low carb, high carb, low fat. The vast, vast, vast majority of the people are not trying to decide between, you know, those diets. They're trying to decide between McDonald's versus KFC versus Pizza Hut. Yep. And that's, that's the people I wanna reach. Those are the people I'm trying to reach. Those are the patients that I see that have never once even considered the fact that the things that they're eating are contributing to their poor health. And my whole goal is to make them see that and so that they can then do something about it. Yep. That's good. Awesome. Thanks guys. Be the change You wanna see something like that? That's good. Well, our guest today has been Darius Sharp. Who is a an ER nurse and a citizen scientist who does his own biohacking share this episode with the folks in your life who need to hear it and you'll know who you are and who they are. And I'll make sure that we post Darius's contact info in the show notes. It's Murse underscore Darius, is that right? Yeah. Murse with M as in Mary as in man, nurse, as in ah, that I was trying to figure out why was it an M. Okay. A Alright. Me, Darius at Instagram. Well, for Dr. Philip Ovadia, I'm Jack Heald. This has been stay off my operating table. We're glad you're here. Come back and see us next time. We'll talk to y'all soon.