Informed dissent, the intersection of health care and politics with Dr.

Jeff Barkey, board certified primary care physician and Dr.

Mark McDonald, board certified child, adolescent, and adult psychiatrist.

All right.

We are here.

Welcome to another episode of Informed Descent.

Well, my co-host is missing tonight, Dr.

Mark McDonald.

He's on some tropical beach somewhere.

But the good news is I have a phenomenal guest, somebody who I have followed for many, many years, admired, and most importantly, clinically used his information to help patients.

And I'm talking about Dr.

Barry Sears.

Dr.

Sears, welcome to inform dissent.

Well, thank you very much.

It's a great pleasure being on your program.

You know, I I was trying to remember the first time that I discovered you.

And I think it was, I can't even remember how many years ago.

I believe you were on the Dennis Prager show.

Yes.

And I used to geek out on Prager all the time.

He's a personal friend.

He's become a patient of my practice.

And I was sitting in my office, I think his show was over the noon hour or something like noon to three.

So I'd have it on in between patients and so forth.

And I heard this guy, Dr.

Sears, and he was talking about things that I had never heard of before.

And specifically, you you had brought to my attention, I think for the first time the importance of focusing on inflammation as the source for illness in the body.

And you talked about mechanisms, both nutrition and supplements to reduce inflammation.

You also brought up a term that I'd never heard about until I looked it up, and it's a thing.

And I'll bet you 90% of all practicing physicians have no idea what this word means, and that is ecosinoids.

And these are little hormonal messengers that are made by every cell of the body, and how we take care of ourselves determine whether we're going to be producing more inflammatory or anti-inflammatory ecosinoids.

So you may not know this, Dr.

Sears.

And I know we periodically talk, or I'll throw you a question out there about some article that comes out that tells us that fish oil isn't helpful for much of anything.

Your response often is, well, sure, if you have a subtherapeutic dose, you're going to get a subtherapeutic response.

And that's true.

I now use in my practice every single one of my patients gets a fatty acid profile.

There's a couple companies that do them.

And specifically, I look at the AA EPA ratio as a mechanism for me to guide patients to take better care of themselves to reduce inflammation.

And then, of course, you make the finest fish oil in the world in your zone fish oil.

So, Dr.

Sears, how did you get into this to begin with?

How did you learn about inflammation as being a key to driving human health and human disease?

Well, actually, my background had nothing to do with nutrition, but everything to do with cancer drug delivery.

In the uh late 70s, I was kind of like the boy genius, as a long time ago of cancer drug delivery systems.

But in 1982, the Nobel Prize in Medicine was awarded for understanding how these hormones called a cosinoids control inflammation.

So I stepped back and I said, wait a minute.

These are if they control inflammation, they probably control virtually every chronic disease, including cancer.

So I said, my feature is probably better off looking how to control these acosinoids, keeping them in a zone, not too high.

You need some, but not too much.

And so that led me on a kind of a new journey of looking at uh nutrients.

Initially uh omega-three fatty acids.

To say what would be the appropriate ratio of our amount of these omega-3 fatty acids to control inflammation.

Well, it turns out it depends on the individual.

It depends on the chronic disease system.

Uh, for example, when you look at neurological disease, you might need nearly 10 to 15 grams of omega-3 fatty acids per day to make an effect for other disease states.

It's less.

But that's why the test you mentioned is so powerful.

It allows the physician to fine-tune the amount of omega-3 fatty acids that patient needs to keep the balance of these acosinoids in that zone, allows them to control inflammation, and that's one of the key steps to living a longer and better life.

Now, I don't think anybody had the idea or information or the utilization of using a fatty acid profile in the blood before you did.

And specifically, there's a lot of information you get from a fatty acid profile, but I drill down on the AA arachidonic acid to EPA.

EPA is some unpronounced name, but it's one of the more important omega-3 fatty acids.

Tell tell the audience a little bit more about why those two fatty acids in particular are important.

Well, the omega, the uh a rocketonic acid, uh, this is the building block of all these very powerful pro-inflammatory acosinoids.

This is really our first uh round, our first line of defense against microbial invasion and also physical injury.

This basically alerts our immune system, something's wrong.

Basically, get the immune systems down this area and start basically fixing the problem.

But then you have to turn it off.

Now, the uh EPA or Ecosapentinoic acid, it also makes a cosenoids, but they are far less inflammatory.

So the balance of those two fatty acids, arachidonic acid and EPA, will give you a very good and very precise indication of the amount of chronic low-level inflammation.

This is inflammation below the perception of pain.

You can't feel it, but it's grinding down every organ in your body.

And so that ratio gives you an idea of how to basically modulate that.

Now, that's step one.

Step two was another breakthrough coming about the year 2000, finding another group of hormones.

These are called resolvents.

And these are the most powerful hormones uh knowing the mankind.

They're orders of magnitude more powerful than other hormones.

And what they do, they turn off inflammation.

So now we can look at the omega-3 fatty acids to what?

Reduce the level of excess inflammation, and if you have sufficient levels to turn it off to bring the system back to homeostasis, or resolve in something that we can measure in the blood.

With great difficulty, because they're really work at uh pikeamore levels.

So that's why they're they're very hard and they self-destruct within seconds.

So it takes very sophisticated instrumentation, but uh you basically these are the ones you have to make to turn off the inflammation that let allow the system to finally heal.

So one, you can reduce it reduce inflammation, and then you have to turn it off to get ready for the next assault to your body.

And how do we how do we how do we actually reduce or increase resolvins uh to be sure that we're reducing inflammation?

Well, now uh resolvins come from both uh three different types of omega-3 fatty acids.

One is the cosopentinoic acid, another one is DHA, another one is DPA.

So again, we use the blood.

Do we have adequate levels of these three precursors of the omega-3 fatty acids?

Say, well, can I just take a pill?

Well, the problem is these resolvins that you might find in a pill have a lifetime of maybe 30 seconds.

So by the time you put the pill in the mouth and it gets in the blood, they're gone.

They're they're basically turned off because they're so powerful.

So you have to make sure you have adequate levels of these in the circulation.

So when the time comes that you need do need them, the body can basically activate them, turn down the information completely, and then they'll self self-destruct.

So we want a balance of uh of AA arachidonic acid and EPA in our blood, and we can actually measure that.

And we can and we that is easy, and that's what I do, and we can adjust the amount of fish oil, let's say, that somebody takes to get that AA EPA ratio in the zone that you recommend.

And as I recall, it's somewhere between 1.5 and three.

And that's kind of what I shoot for.

And by the way, for those listening, it is routine and normal when I measure that first in patients, that that number AA EPA ratio can be as high as 20, 30, 40.

That's that's normal because most people don't eat healthfully.

They eat way too many processed foods and seed oils, too many simple carbs, and it drives that AA to EPA ratio way high.

And then as a result of cleaning up their nutrition and supplementing with a highly purified concentrated omega-3 fatty acid, we can then lower that AA EPA ratio in that sweet zone, the zone, which is the name you gave your first first book uh that became very popular.

I know people looked at this as a quote, diet book, but it was anything but that.

It was a mechanism to eat.

Correct me if I'm wrong, Dr.

Sears.

It was a mechanism to eat in order to be in a zone where your inflammation was balanced and you had a fighting chance to naturally fight the various diseases that might come your way.

And now we have resolvants, that's correct, which are important uh ecosenoids that turn off the inflammatory process.

We need enough of them, of course, to create inflammation when we need inflammation, but not too much.

How do we how do Do we manage uh resolvins in our body?

Well, again, think of this as a water tower.

Uh what you want to have enough of the omega-3 fatty acids in the blood.

So when the body calls out for resolvin, there's the raw materials to make it.

So that this uh so you really can't uh actually give resolvents per se, but you can make made sure that the pressure, the pressure in the water tank is high enough that if you have to turn off inflammation, that basically you can because once you uh the lifetime of a typical omega-three fatty acid in the blood is about seven days.

So after seven days, anything you put in there seven days earlier, it's gone.

It's been used up as energy.

So this is a constant uh not struggle, but a constant effort to maintain high enough levels so you can basically make these powerful hormones, both acosnoids and resolvents when you need to to turn down and then eventually turn off the inflammation.

Now you wrote this book many, many years ago called the zone.

It was viewed as a diet book.

It's anything but it was a strategy for eating uh so that your body has a fighting chance against disease.

You followed up that book with which in my mind was a better book because it was more accessible to your ideas, and it was called the Mediterranean zone.

Actually, I I have it.

I know this is uh this is audio only, so people aren't going to see, but I'm holding up the book.

Uh, it's torn and tathered.

I don't even know what what year you wrote this, but I've got notes throughout the book because it was how revolutionary is too strong of a word, but it was certainly meaningful and helpful to me to uh to create the right disposition for what I recommended to patients.

Tell us a little bit about your nutrition strategy and why you think it's better than others.

Well, again, any type of nutrition strategy says what is your goal?

And uh ultimately all chronic disease comes from a disrupted metabolism.

So, what do you really want to do if you want to treat uh chronic disease?

If you want to increase longevity, you need an efficient metabolism.

So uh we think of about the great genetic uh revolution.

Actually, genetics had gives us little information.

What's really important are epigenetics, how our genes are turned on and off, and that's controlled by our metabolism.

And that is basically now is controlled not only by the omega-3 fatty acids or the polyphenols, which I uh described in the Mediterranean zone, but basically going deeper into looking at kind of the master switch.

This master switch is called AMPK, which is also under dietary control.

Yes, absolutely.

So once once you basically so once you can control AMPK, you have the keys to the kingdom to begin to address virtually every chronic disease state.

And that basically, so my 30-year journey, starting with the first book, the zone, has continued to go deeper and deeper into the molecular biology of our metabolism to understand what really is the underlying uh uh keys of the kingdom, and how can you basically now manipulate your diet to maintain you in that epigenetic zone for as long as possible?

Uh tell our audience how they can follow the work that you do.

What's the best way to be able to see what you do and also have access to the products uh that are available, fish oil and others?

Well, the best thing that you can do is go to my website, which is drse.com.

And this is my kind of a personal website to I can communicate really the breaking news, really on a really uh monthly basis of what's germane to basically of metabolic control.

So uh I really view the whole uh uh Ganesh is saying I call it metabolic engineering.

It's what we can do with our diet to basically restructure, reorder our metabolism, not only to treat chronic disease states, but basically go to the core of the aging process itself, basically the elimination of senescent cells that drive aging.

And it's all controlled by our metabolism.

There's a lot of different diets out there from ketogenic diets to the rage of late has been carnivore diets.

Uh there are people that think fasting is a good idea, uh, eliminating carbs, eating carbs, vegetarian diet, Mediterranean diet.

What do you think is the right strategy that somebody should think about when choosing uh proper nutrition?

Well, first of all, uh you basically follow the facts.

Uh you know, that's why we looked at say, show me the clinical data.

Uh let's take the ketogenic diet.

Uh, I published a study of back in 2007, again, where we treated the individuals like uh metabolic ward rats.

We controlled all of their foods uh for a six-week period.

They couldn't think.

So we had one group uh getting both groups got the same amount of calories, same amount of protein, just change the balance of protein or carbohydrate to fat.

So one group was ketogenic, and the other was basically in the zone.

Now, what do you find out after that six-week period?

Well, what you find out is that the both those who are following the ketogenic diet were basically becoming more inflamed.

That's probably not a good idea.

Now, uh, a more recent study on uh rats, uh, which are probably applicable to humans, that a ketogenic diet also increases the number of senescent cells.

These are the cells that drive the aging process.

You say, oh my God, I thought by calling a ketogenic diet, I live forever.

No, what you're doing is basically increasing more inflammation, and that inflammation is an increasing number of senescent cells, which will do one thing shorten your lifespan.

So uh again, we have more uh political statements on diet than scientific statements.

The only way you can really look at uh a scientific diet is basically treat humans like lab rats, either do metabolic ward studies, or basically take the people and say we are going to now control your diet for X period of time, six weeks, six months, and see what happens.

Uh, one recent study looking at type two diabetes, epidemic in America, and uh one group got the zone diet, and the other group got uh both were calorie-restricted diets, which is zone is uh, but the other one had a little more carbohydrates, a little less protein.

And what did they find out by doing that?

Well, after six months, those following the zone diet with all the foods being prepared, their diabetes was gone.

Total remission.

In fact, they've gone from being diabetic and shot all the way through pro-diabetic, and we're now normal.

Now the other group, same number of calories, uh, but just a different ratio of protein to carbohydrate, more like the Mediterranean diet, they're still diabetic.

So again, this is why you have to have clinical data.

Uh, human data is hard to get, so people make up stories.

It makes great for uh blogging, but basically it does the average person no good because it's like show me the data.

And there's tremendously poor data out there in humans because people are too lazy to do the studies.

So, what nutritional strategy do you recommend?

Well, uh, I one basically based on uh a couple of things.

One, you have to restrict calories.

Oh my god, I'm gonna be hungry the rest of my life.

No, read my lips.

You have to restrict calories, but without hunger.

Now, that's possible, but if two things are happening.

One, you have adequate protein at every meal.

Now, what's adequate protein?

About 30 grams.

That's the amount you put on the palm of your hand.

So I can get that at dinner.

Say, yeah, probably too much, but not at breakfast and like not likely unlikely lunch.

Now, why is this important?

Because you need to have that a picture of protein to shut down hunger, just like GPO1 drugs.

Uh second thing, you need to basically activate another gene transcription factor called mTOR.

That is the factor that allows us to rebuild damaged tissue.

That's why those diabetic patients who are on the zone diet, they lost fat.

It's a cow restricted program, but they gained lean body mass, the holy grail.

Now, the other group who basically had the same degree of cow restriction, but a little less protein, more carbohydrate, they lost fat, but they also lost lean body mass just like Ozempic.

So you need two things having adequate protein in each meal, stop hunger for about five hours, and basically make sure the gene transcription factor is turned on that you can repair damaged tissue.

Step one.

Step two.

Yes, now you have to have adequate levels of omega-3 fatty acids.

Now they last a little longer, so about the seven days.

So taking them once a day is more than sufficient.

And now, step three, getting adequate levels of these polyphenols.

That's what the book, the uh Mediterranean zone was discussed.

These things, how do they actually work?

Well, they work through activating that master switch, AMPK to basically activate the uh antioxidative enzymes, they could basically repair DNA damage, which is another driver of basically a shortened lifespan.

So taking these three things together, a calorie restricted program that has adequate protein and basically a low glycemic load of adequate levels of omega-3 fatty acids and adequate penals.

I call this metabolic engineering.

It allows you to go in there and reprogram your metabolism to do two things to live longer and live better.

So let's talk a little bit about the omega-3 fatty acids.

I'm a huge fan of uh of having taste patients take fish oil, and I base the amount on the uh omega the AA uh EPA ratio.

But not all fish oil is the same, is it?

No, uh basically uh is it you know very quite significantly.

Now, one of the problems with taking omega-3 fatty acids, people say, oh, but I'll get AFib.

Now, there is some indication that people who take omega-3 fatty acids do have a slight increase in apib.

But even those that have slight increase in aphib have a decrease in mortality.

So, okay, I can handle a little AFib, but uh decrease my mortality.

But what's causing the A, what's causing the AFib in the first place?

Remember back about 2000, we had the whole uh controversy about trans fatty acids.

Yes.

And basically trans fatty acids cause AFib.

Now, what causes trans fatty acids?

It's how you process oils.

Uh the standard way of processing fish oil is squeeze the fish and then concentrate it up and then basically refine it to get all the bad things out of it.

That's usually done with a process called molecular uh distillation.

You heat the fish uh the fish oil uh up to about a oh a hundred and ninety degrees uh centigrade and hopefully drive out all the bad things.

So it's almost like pasteurizing.

Almost like pasteurizing, but omega-3 fatty acids basically are very prone to isomerization.

They change their configuration in space from cysts to trans.

Now those trans fatty acids now become anti-nutrients.

And as a consequence, they can start giving rise to significant problems.

What to do?

Well, there's a new technology uh that we've been working with for a number of years.

It's called supercritical fluid technology.

It allows you to do the final purification step at a much lower temperature, about five times lower, which means you're dramatically reducing the production of these trans fatty acids, which are known to cause AFib.

So uh again, when uh most people go out and buy fish oils, uh basically it's buyer beware.

They say, but I can get them on Amazon.com.

Read my lips, buyer beware.

Sure.

I I know I remember, I don't remember if I heard this from you or somebody else, but a bunch of years back, consumer reports did a study and they looked at fish oil.

They looked at the claims that was on the bottle, and then they checked the fish oil to see if it was accurate for the claims.

And it turns out many of the brand names, and I I don't need to bag on brand name fish oil, but many of the brand names that you can buy on Amazon or Costco or elsewhere were actually rancid and should not be good for human consumption.

And Barry, we're gonna take a quick break here, and when we come back, I want to hear your thoughts on this consumer reports that came out a while ago.

And what fish oils do you think actually meet the standard?

So we'll be back in 10 seconds.

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Okay, we are back with Dr.

Barry Sears, who is a pioneer in the anti-inflammatory space, has written several books.

My favorite is the Mediterranean Zone.

You may remember him.

I think it was in the 80s when your first book came out, The Zone.

It was viewed as a diet book, but it's anything but that.

It's really a way of thinking about nutrition to reduce inflammation, uh, to reduce weight, and to help with chronic disease, which unfortunately is rampant now.

I was talking about this consumer reports that came out that studied brand name fish oil and discovered that the claims that these companies were making were anything but when they actually tested it, including some of the fish oils that they found to be rancid and should not even be consumed by humans.

Barry, you're familiar with this study, aren't you?

Oh, yes.

Uh again, uh when you purify fish oils, remember they are very, very prone to uh not only isomerization, forming trans fatty acids, but also oxidative damage.

So uh what you find that uh one of the early tricks they found out say, okay, the fish oil doesn't taste very good, yeah, as you expect for rancid oil, it would not taste good.

So if I add lemon to it, yes, it's gonna taste a lot better.

Yet yet if I add lemon to it, then one of the standard international standards of basically all edible oils is called peroxide levels.

The peroxide levels rise dramatically, make it unsuitable for human consumption by international trading standards.

So here's a good rule of thumb.

If you see a fish oil product and you see lemon as one of the flavoring, probably run the other direction.

Uh the other aspect we don't talk about is basically PCBs.

PCBs are everywhere.

So when you extract out the fish oil primarily from sourdines or anchovies, you're pulling out a lot of PCBs.

So say I want my PCBs to be as low as possible.

That requires another different processing step.

So this is a little more difficult.

You don't rarely see these in consumer reports because it's a very sophisticated testing, but that's something because the PCBs, once they check in, they're not checking out.

So the two biggest problems with uh standard fish oils, they use lemon flavors that really make them unsuitable for human consumption, or they're rich in PCBs.

And the average consumer, they really don't know.

And as a consequence, it's basically of uh, you know, a buyer, you know, kind of going to a turkey bazaar and say, hey, what's the best price?

The cheapest one must be the best.

And that's not the way it works.

Sure.

And you you make you manufacture a fish oil called zone, and uh, I think it's zone-living.com where they can look at our the our listeners can go and look at your fish oil.

By the way, that's that's the fish oil that I take personally.

Um why is yours better than others, do you think?

Well, one, we do two processing.

One we uh two steps.

One to remove the PCBs, and then two, to do the final processing step using this new technology called supercritical fluid technology.

So we can do the final purification at a much lower temperature.

Lower temperature means less isomerization, means better basically performance in terms of the oil in one's body with the with the caveat that you're taking enough.

If you're not taking enough, it doesn't matter what fish you're oil taking, it's not going to work.

Now, you mentioned about the ratio of a rocketonic acid to EPA.

We've done studies with uh children with major depression.

Their levels were nearly 200.

Wow.

Is it fair to say that uh the amount of fish oil somebody should take should be enough to lower that ratio somewhere in the 1.5 to 3 level?

Yes.

Yeah, and why do I why do I choose that though?

That's the level found in the Japanese.

Now they're very large consumers of fish, uh, but they also have the lowest rates of cardiovascular disease in the world.

Not surprisingly, it's related to the levels of a rochidonic acid EPA.

So I'll I'll I use that as my standard, and uh it allows you to personalize it to the individual.

Uh, everyone will be different, and even for the individual, you'll be different in different stages of your life as you get.

Older, you may need more.

I personally take about 10 grams of omega-3 fatty acids per day to keep my level at about 1.5.

Now I'm an old man, so I that's why I need higher levels.

But again, that's the beauty of personalization.

Basically, we're not all genetically the same.

Now I've had a lot of patients say, I don't really want to take fish or all, can't I just eat fish?

The answer is yes, you could.

Well, you could, except our fish supply and our oceans are polluted.

So I have patients that routinely eat fish.

So I then have to add on a mercury level to them.

And oftentimes I have high mercury in patients that are eating tons of fish and tons of sushi.

I don't personally like fish particularly.

Um, so that's my excuse to take more fish oil.

But technically, somebody could eat a lot of fish, except you have to be very, very careful because much of our fish unfortunately is polluted.

And if you are going to eat fish, you should never ever eat uh um farmed fish only wild fish.

Is that correct?

That's correct.

Uh you you pay a price for convenience.

Not is there mercury uh in wild fish, but there's also high levels of PCBs.

That's not that's really not talked about.

That's kind of put under the rug.

Um but the uh the fact is you know that we have to be aware that we have polluted uh much of our uh you know food supply, especially that containing omega-3 fatty acids.

So, yes, if you like fish, it's a great source, but keep in mind that basically they're that's why you purify fish oil to remove those contaminants that we have put into the environment, and the fish are just basically the end of the food chain that we consume.

You mentioned earlier um the GLP ones, the medications that are out to help people lose weight, there's a variety of them from Ozempic and Manjaro and Z bound and there's oral products and injectable products and so forth.

What are your what are your thoughts on patients using uh Ozempic and the like and compounded semi-glutide and so forth?

Well, they do work.

Now, they work because they shut down hunger.

And if you shut down hunger, you consume fewer calories.

You consume fewer calories, you basically lose weight.

Now we get a little more nuances, but losing weight isn't different than losing fat.

And that's why the clinical data for these GPL 1 drugs indicates about 40% of the weight loss is lean body mass.

Yes, that's muscle mass, it's also the mass of your kidney, your heart, your liver, your brain.

These are the types of weights you don't want to lose.

And we also know once you stop taking those drugs, basically the weight comes right back.

Now, most likely as excess body fat.

So that if we're looking at excess body fat as really a marker of likelihood of cardiovascular disease, for many people taking these drugs, and about half stop taking them within a year's time because of the side effects.

When they regain the weight, they've more likely, very likely to be more obese than they were when they started, which means from a cardiovascular standpoint, they're actually in a worse position.

That's right.

Now, one of the components that you mentioned as far as nutrition strategies, eating enough protein, reducing your calories, do doing so without being hungry, uh, getting plenty of polyphenols in your diet.

Polyphenols are basically antioxidants.

They're the chemicals that are found in like blueberries, for example, the skin of blueberries.

They're the compound that we used to say uh is healthy for you in red wine, but uh you'd have to drink about five bottles a day to get enough, and the alcohol is not beneficial in any way, shape, or form.

Certainly enjoy it if you like a little alcohol, but not because it's a health benefit.

How do people get healthy amounts of polyphenols?

Well, the old-fashioned way.

This is when your uh grandmother told your uh parents to say, eat your vegetables.

You can't leave the table till you eat your vegetables.

One of the things about fruits, people say, Oh, I love fruits because they're full of sugar.

That's why you love them.

Yeah.

Uh the polyphenols are quite bitter.

Here's uh take get some baker's chocolate, which is basically uh kind of a crude extract of cocoa, put in your mouth.

Incredibly bitter.

Spicy are rich in polyphenols.

Put a spice in your mouth, incredibly bitter.

So uh what you're uh finding that fruits, because from an evolutionary standpoint, basically surround the polyphenols with sugar as a way of basically increasing their likelihood of being eaten by other animals.

Um again, the best way to get your polyphenols is eating a lot of non-starchy vegetables and primarily the ABCs, asparagus, artichoke arts, Brussels sprouts, broccoli, cauliflower, and spinach.

They say, oh, that that's not fun.

Hey, I didn't say it's fun, but that's why you use uh basically cooking skills to make it more healthy.

So again, uh people say, I'm eating plenty of berries to say, not a really good idea because that extra sugar, those simple sugars like uh glucose and fructose can inhibit that master switch.

I talked about earlier, AMPK, that controls our metabolism.

And once you inhibit that master switch, basically you're going to down a fast track toward early chronic disease and a shorter lifespan.

Sure.

Now I routinely, in addition to measuring the AAAPA ratio, and I view this, I think this was your language where I made it up.

I'm not sure which, but that AAEPA ratio, I tell patients is really a foundational or cellular inflammatory marker.

And in addition to that number, AAEPA, I also do a robust robust number of other anti-inflammatory or inflammatory markers, such as HSCRP, LPPLA2.

Uh, I look at interleukin 6 or IL6 and a few others as a measure for inflammation.

And then if it's elevated, of course, first step is to change the way they eat uh to reduce inflammation.

And then I also institute um supplements, of course, fish oil uh to get that AAEPA in the range, and then other anti-inflammatory supplements, you make some anti-inflammatory supplements as well, in addition to your fish oil.

Can you tell us about those?

Well, these are polyphenol uh extracts.

Uh I talked about cocoa, very bitter.

Uh now, if you basically purify the polyphenols of cocoa to much higher concentrations, they're even more bitter.

But there is some, you know, hints that they have some benefits.

Uh, however, in terms of basically controlling inflammation, controlling basically your epigenetic, uh, they have only contribute maybe 10% of the overall benefit.

So don't let the tail wag the dog.

Um, they're good to have, uh, but the fact is most of your about 60% of your success to living longer will come from restricting calories without hunger.

About 30% will basically come from taking adequate levels of omega-3 fatty acids.

Maybe 10% from polyphenol extracts, if that's a big if, if they have the toxicology that makes sure they're basically suitable for human consumption.

Now, so we talked about a bit earlier about acosnoids.

These are lipid-based uh inflammatory meteors.

The other ones that you're measuring, like the the interleukin uh six and uh TNF of alpha, these are basically what are called cytokines.

These are protein-based.

The uh acosenoids will have little effect on them, but it will have a great effect on them is that master switch called AMPK.

And the best way to activate ABK, restrict calories.

How do you know how many calories to eat?

Well, uh basically the best way is to take your clothes off and look at yourself in the mirror.

Now I say that because uh we remember what we have with our accumulation of body fat is a unique ability to basically store energy.

So the fact is that people say, well, I'm gonna wither away.

No, you're not gonna wither weight if you have adequate levels of body fat.

That's not being obese, but adequate levels are basically for males about 21%, females about 25%.

Now, that's about maybe 2% of the U.S.

population.

Now, even if you're 21%, yeah, you don't look like a world-class athlete, Olympic athlete, but you have plenty of body fat.

So the fact is, as long as you're measuring body fat, and there's some very very simple calculators you can use uh to measure your body fat say, I have plenty of reserve to pull from.

And I want to pull from the reserve because any excess body fat is inflammatory fat.

So how long can you basically uh go on a calorie restricted program if it has adequate protein and about uh and balance with uh you know a lot of non-starchy vegetables, uh, you can probably do that for a lifetime at about a level between 1200 and 1500 calories a day.

Now, once your percent body fat drops below uh maybe 13%, that means you look like a world-class athlete.

Think about adding some more calories.

But until that point, you've got plenty of calories to draw upon.

There's a book not long ago that came out.

I think it was called the plant paradox.

I don't remember the name of the author.

Uh, the premise basically was that because we're apex uh uh predators, that eating a lot of vegetables is not a good thing, that we should eat the the animals that eat the vegetables because they can digest them and we can't because we don't have ruminant stomachs, and then a lot of Vegetables like spinach and kale and others have high levels of cytotoxins and uh and and oxalates in it, and eating excessive vegetables is not a healthy thing to do.

Thoughts on that.

Well, uh again, uh we look at basically science versus basically uh uh social media.

That basically that has no credibility.

Uh now, yes, do uh vegetables have certain potential of uh you know negative consequences.

That's why you cook them.

Now eating raw vegetables, that's probably not a good idea.

Eating cooked vegetables, especially sauteed and olive oil, that's a great idea.

Uh-huh.

So again, we're looking again getting balance, balance of protein to carbohydrate, but really balance of protein to the glycemic load.

Uh-huh.

Uh, and so that is, and then saying, am I taking in too many calories?

You know, if you can see uh a six-pack, you might need a little more calories, but for most of us, we're never gonna see those again.

Maybe 50 years ago, but the those days are long gone.

But uh we we can do very well on a very limited number of calories if they're balanced.

So we're recording this in the evening.

Uh, this podcast will come out uh several days after we record.

What do you have to eat today, Barry?

Tell us.

Well, I I had I tried to have the same thing every day, you know, because you're looking at this, you're treating food like a drug.

I'll start the day off with a some oatmeal, but basically an oatmeal that I have you know added now protein to it to get the right appropriate balance of protein to carbohydrate.

And um, but so I have enough about 30 grams of protein in that uh meal.

Uh for um lunch, I might have basically uh a little container of Greek yogurt and basically some of protein fortified soup, easy to make.

And for dinner, I'll basically uh make about uh 30 grams of protein, it could be let's say 30 grams of chicken breast or 30 grams of salmon and add to it uh about a pound or actually a pound and a half of vegetables.

Boring, boring.

When's the last time you went out to a restaurant and cheated and just ordered a big ribeye and ate the bread with butter at the table and and just enjoyed yourself?

Well, I don't.

I said, Well, is it worth it?

Now, when I go to Italy, I go there quite often, I eat the same meal over and over and over again.

Every lunch and every dinner is exactly the same thing.

I have grilled vegetables for the um the um appetizer.

I'll have grilled fish and grilled vegetables, extra grilled vegetables for the entree.

And have a small bowl of uh fruit for dessert.

I say, well, that sounds so boring.

If I want the best grilled vegetables in the world, I'm gonna go to Italy.

If I want the best grilled fish in the world, I'm going to Italy.

So this makes it very simple.

So you we're looking to get in the patterns.

Patterns of saying the diet we have is basically our most important tool to live a longer and better life.

It is the number one thing that controls our metabolism, which keeps us alive.

Now, as I as I recall, I haven't purchased food products from you in a while, but you used to have some food products that were glycemically balanced with extra protein.

Like you used to sell a pizza crust, as I recall, and even like a breakfast cereal as well.

I don't know if those still are on your menu.

They are, and because again, saying so what you can basically, that's why I say you can now use understanding food processing to actually construct foods to give you even greater variety.

Uh the conference size in Mexico, uh, our Mexican partners, you know, they have uh their own uh food commissary there for making pizza to treat diabetes.

It's a very effective uh intake.

So you're looking to say uh you can you basically use food technology to construct foods that have that right balance of protein to carbohydrate that stop hunger?

The answer is yes.

Therefore, you have a little more leeway, uh, basically maintaining a little wider variety of a diet.

So you're not bored.

But basically, once you start going through the New York Times getting the recipes, you basically you've lost all hope.

You basically say uh you're doomed to basically uh a life of you know greater inflammation.

Say, boy, that tasted great.

Yeah, you're gonna pay for it.

Uh, not in the way you think, but so again, it's all things.

It's you're trying to get in the good habits, but good habits based on hard science.

Now tell me when you go to Italy, you don't indulge in a little bit of their delicious wine.

I don't, but I do I do indulge some of their delicious gelato.

And so and so, and so I I've learned how to make a zone gelato.

And how's that?

It's not bad.

It's not bad.

Okay, it's not not quite the same as uh uh you know uh Italy, but basically it's close enough.

What's the secret?

How do you make zone gelato?

Well, what do you do?

You basically will take uh you know some of our uh you know shape material we have and basically add uh uh some pasteurized eggs to them to get a little more um uh you know uh body and uh then put them in ice cream maker, it makes a pretty good ligato, uh uh gelato.

And so I said it's not as good as going to Italy, but it's cheaper.

Very good.

There's a seminal book that came out when I was a kid.

Uh it was by a scientist, I guess he was a scientist called Dirk Pearson.

I don't know if you remember who he was, and he wrote a book called Life Yep, yep, yep.

Life extension.

I think he might be your generation.

He passed, I think last year, and he did some incredible research on supplements for healing the body and so forth.

I don't know if you knew Dirk Pearson at all.

I I knew his work very well.

Uh he was obviously very, very big on supplements, but everything we know about epigenetics was not available at that time.

So now we have basically more science to say, how does nutrition really work?

It's not supplying nutrients, it's basically modulating epigenetic.

And so uh we're going back to the future.

Now we know basically it's not our genes per se, is how they're turned on and turned off.

That's the epigenetics.

And once you can master that, if you think basically the science is strong, say, if I do one thing my life and I want to live longer and live better, I want to control my metabolism.

I want to control the balancing of those uh gene transcription factors.

I said the most important is called AMPK.

That's that's the one that basically kind of acts as the great and powerful Oz.

There's another gene transcription factor called mTOR.

Say, oh, that's the bad one.

That causes cancer.

Yes, in excess.

So at the level of the epigenetics, what you're looking to do is try to develop a dietary system that balances mTOR and AMPK.

That's your epigenetic zone.

Can those be measured?

AMP and MTOR?

No, because they never leave the cell.

You can only leave measure things in the blood that leave the cell.

Yeah.

So you could do it by a tissue biopsy, a little painful.

Uh but but you there is a uh a surrogate marker, a surrogate marker called insulin resistance.

Sure.

Which has which has nothing to do with insulin whatsoever.

Uh, this is one of the great uh fallacies of medicine.

But it is uh an indirect marker of your ability to basically have that balance of mTOR and AMPK.

So that once you have that, I can you can measure that, and that'll give you a pretty good indication that you're in that metabolic zone.

So you mean measuring somebody's fasting insulin, hemoglobin A1C, and fasting blood sugar?

Yes, exactly.

And we want to optimize those so they so they are in the right zone.

So now now we now we can basically begin to take those those blood profiles you're looking at.

Say if we had only three blood tests, only three blood tests that we had to basically base all of our practice on.

One would be the ratio of a rockidonic acid DPA.

Are you getting enough omega-3 fatty acids?

A second would be a marker of insulin resistance.

Uh could be HOMA IR, it could be basically the triglyceride uh HDL ratio.

It could be called the triglyceride glucose index.

Yes.

All these, so these are all good markers.

Uh, and then finally, are you getting enough polyphenols?

Now you measure basically you could look at uh isoprosteins, a little difficult, but a simpler marker is glycosolidated and hemoglobin.

Sure.

Those become the three markers of the zone.

And if they're in their appropriate ranges, you have done everything in your power to basically make sure your metabolism is as efficient as possible.

Is there a specific diet and or supplement complex that somebody should consider if they have cancer, if they have cardiovascular disease, or if they have dementia or Alzheimer's early on?

I'd say no.

You're looking at you're looking at the appropriate one because they're all variations of excess inflammation.

So what you if you're looking to keep inflammation in that zone, then basically you have one diet that fits all sizes.

Now getting that maybe you had to maybe personalize to the patient, but the blood will tell you a frightening precision what need what the patient needs to be done.

Uh and as a physician, you're like a coach.

You can't put the food in their mouth.

Right.

But you can say, hey, I'm gonna give you the tools of the trade based on my experience.

I'll say uh I can basically do much more for treating your condition, which is basically uh due to metabolic disruption than any drug can do.

It's not to say drugs are bad, but drugs only treat the symptoms.

What basically a metabolic engineering does is treat the causes.

So say the more you follow this.

Aspect of what I call metabolic engineering, the less drugs, and that includes hormones you need because now a more efficient metabolism makes the drugs or the hormones work better at lower concentrations.

Is there any harm or danger of lowering the AA EPA ratio below 1.5?

Yes, possibly.

This is data from Japan.

That when you get down to about 0.6, there might be a slight increase in bleeding.

So I I try to use always the um the lower marker of 1.5 to say is blow that back off on the fish oil.

Should fish oil be taken with or without food, or does it matter?

It really doesn't matter that much.

Uh, because again, it has a different different routes of absorption.

Um, so again, this is something that you can take once a day uh with or without food.

And so it's uh more of a no brainer.

Um but the but the other aspects of getting the ratio of protein and carbohydrate, you want to do that about three times a day because the blood levels of the hormones that basically change with protein and carbohydrate, their lifetime in the blood is only about five hours.

Now, I've I've had patients tell me that they don't like fish oil because they have a burpee fishy aftertaste.

It's been my experience that often that's because they have cheap fish oil that they're taking.

Um also you taught me this trick, and I don't know if it's still valid.

For those patients, regardless of the fish oil, even if they're taking zoned fish oil and they have that experience.

If they take the fish oil and they put it in the freezer and they swallow a frozen capsule, then it's going to get absorbed a little bit further downstream, and they might not have that fishy aftertaste.

But then they have to be careful.

Once they put it in the freezer, they can't take it out of the freezer, because if they do, the gel capsule could fracture, and then the fish oil could become oxidized and rancid.

And and the answer to that is basically now using uh just an old technology is how you make milk.

Basically, milk is basically a little piece of fat surrounded by a monolayer of phospholipids in a matrix of water.

So a really easy way that what I do every day, I will basically take the fish oil, I'll add some uh water to it, uh, and I will add basically some lecetin.

Soy, lecithin, and then take a hand blender, high speed hand blender for about uh 10 seconds, and now you emulsify it, and basically now you've made very small particles, which will have better absorption.

So you use liquid fish oil then.

You use your own liquid fish oil as opposed to the capsules.

Uh, because it's easier than taking 16 capsules a day.

Uh 100%.

So let's go through that again.

You take the liquid, you put it in a little water, and then you and then you use a hand mixer.

Well, no, no, you add some lecetin to it.

But where do you get lecetin?

Well, you get that at uh you know a health food store.

Uh-huh.

These are less than granules, and then take a high speed hand blender and basically spritz it for about 10 seconds, and now you'll be forming an emulsion, much smaller size, better at bioavailability, and basically you'll have notice characteristics.

Interesting.

I I've never heard that or tried that.

And also, by the way, if you're listening, if you buy liquid fish oil, it's also much less expensive than buying the bottle of capsules.

Yes.

And do you store the liquid in the refrigerator or how do you store it?

I always store the liquor, I always store the liquid in the freezer.

In the freezer.

Because at least what the what the capsules there are basically actually as a barrier to oxidation.

But uh in the uh in the liquid fish oil at four degrees, uh, it'll be liquid, but it will basically be more prone to oxidation.

Because it's liquid.

Yes.

And so you try to keep it uh at basically uh in the freezer at minus 20.

But most fish oils are not very well purified, so they freeze.

Yes.

So you say, okay, that's probably not a good, that's a good sign, it's probably not very good fish oil.

Do your capsules need to be refrigerated or can they be stored at room temperature?

No, they their ideal formation or stability is between uh 55 and 75 degrees.

Yeah, so not in the trunk of your car, but you can form at room temperature on your kitchen sink.

Exactly.

And what and it does the shelf life change once you open them?

No, not for the capsules.

But the liquid, yes.

But that's why you always try to keep it as low as temperature as possible.

Ah, interesting.

So there's there's been in the cancer world, there's been a push to use a lot of these repurposed drugs that we played with and used successfully during COVID, ivermectin, membendazole, etc.

Any experience or thoughts about these repurposed drugs?

Well, one, they're not very good.

Uh now one of the drugs which is has some more benefit is raphamycin.

Yes.

Now, rapamycin does, it basically inhibits that gene transcription factor, mTOR.

That that drives growth, including cancer growth.

Uh and by inhibiting mTOR, you actually activate AMPK, which is your primary anti-cancer drug.

So uh a repurposed drug like riparamycin is useful for basically uh again removing senescent cells.

Um I think that we really we have to go say say go beyond looking at drugs or hormones or supplements and look at basically the the nuances of our metabolism and really these gen these epigenetic factors that turn our genes on and off.

So besides your fish oil and your polyphenol blend and your uh coco via or your your cocoa product that you make, any other supplements that you personally take?

Uh the only ones I would take would might be some vitamin D, because I think you like to keep it around 80 nanograms per deciliter.

Uh and I'll take a little extra um magnesium as magnesium uh glycinate uh because it is important.

Other than that, not really.

Other than that, you focus on nutrition.

Exactly.

Awesome.

Wow.

Well, Barry, I could talk to you for hours, and you've been somewhat of a I don't know if this is the right word, but a mentor and certainly an influencer of my life early on when I first heard you on the Dennis Prager show.

I continue to follow you.

I continue to take your products, I continue to read the work that you do.

So I just want to thank you for the influence that you've had on me, and then secondarily, of course, on my patients.

Well, thank you very much for those kind comments.

And that's the one thing you can look back over your life.

Say, how can you basically help as many people as possible?

So if I was able to give you some insight to help your patients, that makes me the happiest guy on the face of the earth.

Well, good.

I'm glad to make you happy.

And very thank you for joining me on informed descent, and I look forward to having you back.

Thank you very much.

All right, you take care.

You've been listening to Informed Descent with Dr.

Jeff Barkey, board certified primary care physician, and Dr.

Mark McDonald, board certified child adolescent, and adult psychiatrist.

Informed dissent, the intersection of health care and politics.