Looking Deeper at Your Blood Tests – Podcast # 168

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Dr. Justin Marchegiani welcomes Dave Korsunsky, founder and Chief Executive Officer of headsuphealth.com, which is a website about tracking health data. Join them as they discuss about blood sugar levels, ketone levels, blood test and other health-related data that can be integrated with smart devices and the website as a means of analyzing your health.

Know about preprandial and postprandial blood sugar readings and glucose functional ranges. Also, find out more about the Carb Tolerance Test and learn how it can provide value and insight to how your body responds to sugar from different food sources.

Dr. Justin Marchegiani

In this episode, we talk about:

05:08 Functional Glucose Tolerance

13:45 Body Composition and Postprandial response

18:16 Quick walk through on Headsuphealth

31:51 Heart Rate Variability

35:54 Stress and its associated markers

Dr. Justin Marchegiani: Hey there! It’s Dr. Justin Marchegiani. Welcome back to Beyond Wellness Radio! My good friend Dave Korsunsky is in the house. Dave Korsunsky, how we doing today?

Dave Korsunsky: Fantastic, Doc. It’s been far too long since we've connected, so happy to be back.

Dr. Justin Marchegiani: Excellent. Love it. So happy we’re connected here, too. Let’s talk about I mean you run the website headsuphealth.com— Heads Up House, phenomenal site where you can track your data. Again, you’re putting lots of new features in there where people can—can plug-in or integrate some of their smart devices, Fitbit, some other ketone or blood sugar reader scales, blood pressure cuffs integrate with lab companies. Lab Corps, coming out soon, you mention Qwest. So great way if you're kind of like a bio hacker or a health hacker and you want to put everything in one place. Awesome place to look at there. So we have uhm—we have a new feature, where we talked about the new features that are coming up. So we’ll have an affiliate link here below, so if you're listening to this information and it resonates with you or you want to try plugging it in, we’ll have an affiliate link down below that you can click to get access to some of this information to get your account moving. And again, start integrating some of the features that we’re gonna chat about today.

Dave Korsunsky: Great.

Dr. Justin Marchegiani: Okay. So off the bat, let’s dig in. So, one of the more important things that it's coming here is we have some newer ketone readers in the market. Uh—one of those readers is called the “Keto Mojo” Cool thing about it is Keto strips are cheaper, which is great. It's gonna measure ketones along with blood sugar and and it’s also gonna measure hemoglobin and hematocrit. Love it. I'm waiting for just that extra feature of insulin then we got like just freaking lab in the little reader right front of us. Wouldn’t that be amazing?

Dave Korsunsky: Every time I see Dorian the founder, I beat him up to say, “Hey, Dorian, can we get an insulin strip?” Because as you know, that's— that would be a game changing piece of information that currently there’s no way to do that in a consumer test. But if you can start testing things like postprandial insulin just at home after different meals, it’d be awesome but nonetheless, they've put a great product out there and it's really made ketone testing affordable and accessible to people who perhaps couldn't have access to this before. So that's a great one. We’re gonna to talk more about it as we go here.

Dr. Justin Marchegiani: And the reason why insulin is so important is because you have a lot of people that are insulin resistant with their blood sugar looks decent, let's say 90 or 95 right? But it's only decent because insulin is compensating and going so, so high. So insulin is shoveling out that blood sugar into the cell, so then the blood sugar looks lower because the insulin is basically the shovel. You got a lot more shovels shoveling that out. So it’s different coz if your blood sugar is here with high insulin, then you're developing insulin resistance, right? Coz you have more shovels—cons—you know, compensating for that. If we decrease—and your blood sugar’s good, that means you are insulin sensitive.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And we need low insulin to increase ketones, right? Ketones and insular on the scale. So people are like, “Hey, I’m like trying to lower carb or my blood sugar’s low but my ketones are low.” Well, that’s the missing variable is the insulin could be high. So to keep that in mind, we have this little seesaw fat with insulin and ketones. Anything you wanna say about that?

Dave Korsunsky: Yeah. We wrote a blog post exactly on that topic. And we talked about why fasting insulin is one of the most important test your doctor probably isn't running because you'll—you'll get a typical fasting glucose test with no indication of whether or not insulin is artificially inflated, keeping that number down. That's why it's important to test both at the same time. So, yeah, I would agree. I think it's incredibly important. I'd love to see the day we can start testing that at home. But right now, the only way to get an insulin test, whether it's fasting or postprandial or whatever, is at the lab. And we’re gonna talk about that a little later in this metabolic panel that you have cooked up here.

Dr. Justin Marchegiani: Yeah. Absolutely! And we’re gonna do a screen sharing just a few minutes. The key—we’re gonna kinda just dial a couple of key components here. So let’s say you kinda already transitioned from a Paleo template approach or maybe you're doing a Keto Paleo where you're focusing on nutrient dense, anti-inflammatory, anti-toxin foods, right? But you're keeping the grains, the dairy, the legumes out and such and you’re doing higher-quality fat, but you're trying a very lower carb version 20 or 30 net grams. Big thing that we can work on integrating today is some of the heads up features looking at that fasting one hour, two hour and three hour glucose tolerance where we called it a functional glucose tolerance. Meaning, we’re not going to drink that 75 gram of glucose artificial sugar crap at the doctor’s office. We’re choosing a real meal not a fake exaggerated meal, but a real meal that we can see how our blood sugar fluctuates over that three-hour period. And you've integrated that in there. And why don’t we go to the screen shot on your side and you can kinda just walk us through how that looks. And just for everyone below here, if you listen to this on podcast, the YouTube channel click the affiliate code below we’re gonna have so you can get access to this information.

Dave Korsunsky: Yeah. I remember when you and I first started working together, doc. And I was your patient and you educated me on what the functional glucose tolerance test actually was versus the oral glucose tolerance. And the functional glucose tolerance being something you could do at home after any meal. And for those who were unclear, the oral glucose tolerance is the formal test we go to the doctor, drink the sugar and you hang around and get the— the postprandial blood glucose test done. Not really that practical in reality. But the functional glucose reference you can test with anything. So I've got my screen shared, can you see it here, Doc?

Dr. Justin Marchegiani: I can see it. You're up.

Dave Korsunsky: Yes. So, this is something we ended up calling initially we called it the functional glucose tolerance test, but it was just a little too wordy to fit in. So it's really just a carb tolerance test and actually Rob Wolf talks about this in his book as well, where based on some research out of Israel, there was a study done following 800 different people and they found that you could give two people the exact same carbohydrate source whether it’s sweet potato or bread or lentils and they would have very different postprandial glucose responses. So the key take away was that it’s different for everybody. And back to the functional glucose tolerance, where you're actually having people test their favorite breakfast, test their favorite restaurant meals or meals they’re eating at home. So here's how this works and you can see on my screen here I've got the future called the Carb Tolerance test and you can just click the plus button here. You can test anything you want. So let's say you test your—your favorite breakfast of Denny's bacon and eggs. And all you do is just put a name in here, but this could be anything. It could be a muffin, it could be 50 g of Sweet potato, it could be anything that you're curious about. You say I eat this food regularly, I want to understand how my body— my body's postprandial glucose responses are going to be. So I've called this anything I want. And what I do is I test my blood sugar before I eat that food. So let's say that my—my pre-prandial for example was 85, and if this was a fasting reading, I could also take it as such. And then what you do is you just test one hour, two hour and three hours after the meal and update this intro info accordingly. You can also record any subjective symptoms and this could help you identify—even though you may have a nice, healthy postprandial glucose response, there's also the ability to record subjective symptoms. “Did I have an energy crash?” “Did I get brain fog?” Did I feel hungry 30 minutes later?” or “Did I have digestive issues?” And you can save that and then share it with a practitioner like yourself. So I’m gonna answer my pre-prandial glucose reading here and then hit save. And you'll see this will create a new entry here. And then all I have to do is just update the one hour and a two hour and a three hour after I go. And just to give you an example of what that looks like when it's completed is here's what I did at In-N-Out Burger because when I'm traveling, often you don’t have access to all of the healthy, low-carb food to do a home. So I go to In-N-Out, I'll get two lettuce wrap burgers with—they call it the protein style. And I wanted to see, does—does just a protein burger with no bun have an effect on my glucose?

Dr. Justin Marchegiani: Uhm.

Dave Korsunsky: And here with the results: 90- 106 at one hour; 89 at two hour; and then back to about 95 at the three hour mark. So, maybe I’ll kick it back—back to you, Doc. And you can share more about what you're looking for in the postprandial glucose curve as you have your patients test different meals and different foods.

Dr. Justin Marchegiani: Absolutely. So, in general, you know, we have this kind of fasting ideally below hundred and 95. Again, we got to be careful in the morning because in the morning and that from when you wake up to 30 minutes later, your cortisol is increasing nearly 50 to 60% in that 30-minute period. And because of that healthy cortisol response, you can actually increase blood sugar and that big spike that's like, you know, you're making them over three quarters of your cortisol just in that zero- 30 minutes. So that spike can increase blood sugar and you may think, “Hey, you know, this is partly because of my diet.” And it may or may not be. So just kinda keep it like a little, you know, asterisk next to that and really look at your lunch and dinner ones, especially if you're seeing an anomaly in the morning. So we like that zero below hundred and 95. We like hour number one, below 140 for extra credit. For extra credit, we like it below 120.

Dave Korsunsky: Right.

Dr. Justin Marchegiani: Below 120 and then at two hours, below 120 or close to a hundred and below— at three, definitely, below 100. So, kinda keep that as your— as your kind of your baseline. Remember we went out to eat out like a few months back. We went to a steak restaurant. I think I tested mine one hour after a meal and my blood sugar was 70 or 75, right?

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: So you can eat really well and you can choose foods that keep your blood sugar from spiking. And the whole benefit that is when your blood sugar’s not spiking like that, you're not over secreting insulin; when you're not over secreting insulin, you’re not gonna develop insulin resistance and all of the effects of that may have with ovarian cyst or cancer cells or inflammation and our blood pressure. So all those things kinda benefit. So, just kinda highlighting on your side, we can plug those in and we can map them and we can put the notes in there regarding what meals. Then you can say, “Hey, protein style In-n-Out.” “The steakhouse where I did” or “The cheat day where I ate this dessert or this crappy food.” Right? And then you can kinda map it out. And that can provide a lot of value and insight of how your body responds and also there's the immunological qualities that Rob Wolf has talked about where it may not be a carbohydrate thing. It may be a cortisol response to a food allergen that’s getting your immune system wound up that could— that cortisol can increase the blood sugar as a—as a side side effect.

Dave Korsunsky: Yeah. And we—we’ve had several users on Heads Up Health test different foods that they thought were metabolically safe for their body and the results were absolutely shocking for someone will test certain foods that they've been eating. And I'll share some results with me anecdotally and I’ll say, “Wow, I thought this food was safe.” And then they tested and it’s—the blood sugar still skyrocketing at the three-hour mark. It hasn't started to come down at all. It's a runaway train. And—and people actually had no idea. So this can be incredibly helpful just to make sure that there's nothing really sabotaging your efforts. And unfortunately, you do need to test these foods yourself. You can't just rely on things like the uhm— the guidance from the Diabetes Association or from the uh—glycemic load tables. There's so much individual variance that this is why postprandial blood sugar testing— even if you're not diagnosed as having a metabolic disease, even just for your own personal health, it is helpful to test different foods and—and just make sure that you are having a healthy postprandial response. So, that's the new feature we've built into Heads Up Health. You can test anything you want and just make sure it's metabolically safe. All of these readings will be stored. And actually, you can probably add more here, Doc. But after you’ve been on a clean Paleo eating template for several months, you may actually be able to tolerate foods that you couldn't tolerate before as your body composition improves, your gut microbiome improved. So, maybe, you can comment on how something that might not be metabolically safe now could potentially be reintroduced at some future point after you’ve made some progress on your health journey.

Dr. Justin Marchegiani: Absolutely. So, of course, if you're not breaking that food down, not digesting it well, that can create a stressor. It could just be a food allergen kinda like gluten. That could be a stress or dairy or casein, right? People on the Keto community, Keto Paleo community, they are notorious for maybe doing excess casein because you know, “Hey, you can do dairy or cheese or all these things.”
Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And you got to be careful with the case in uh—from a Ketogenic perspective because that could be__. And uhm—of course, if you have an infection or SIBO or parasite or H. pylori something that's driving gastrointestinal permeability or the word “leaky gut” That can get your immune system wound up, too. And of course, if you have you know, low levels of probiotics in your gut that can create issues. Coz probiotics help with the immune function to help reduce B vitamins and vitamin K. And of course, you know, good bacteria eats poop and poops nutrition, right? Bad bacteria eats nutrition and poops poop. Essentially, good bacteria provides more nourishment; bad bacteria provides more toxins and stress in your gut.

Dave Korsunsky: Yup. Exactly. So and—and what about body composition as well? Have you seen for example as you increase your lean muscle mass, for example, that may— does that also have an impact on postprandial response? Because we—we talked to a lot of guys who are bodybuilders and they can go out and need a huge quantity of food and—and postprandial responses are very low. So, I know you mentioned gut microbiome, but what about body composition muscle mass in response to uhm— postprandial glucose?

Dr. Justin Marchegiani: So, number one, if you have more muscle mass, you’re gonna have more glut 4 receptors to soak in that glucose. So, think about it as your kid makes a mess on the table, you go with a tiny little sponge to clean it up. That’s like tiny bit of muscle is a tiny of sponge.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: Whereas like a huge—like one of those big sponges you used to kinda wash your car you have more muscles equivalent to a big sponge like that. Lots of glut 4 receptors. You can soak about that glucose just like you can go to your table with your kids mess and you can soak it all up and you didn't even— didn't even bat an eye, right?

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: So muscle does that. Also, muscle, if you have more muscle, that means you automatically have less fat, right? So fats and exocrine gland within itself so it will produce estrogen as well.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And what pretty much drives the fat is gonna be insulin. So excess insulin drives more fat; more fat drives more estrogen. So it’s kinda like this vicious cycle. More estrogen can make you more insulin resistant, especially if you’re a guy and then more insulin increases aromatase, which will take your testosterone and bring it downstream to estrogen. So you become more of a female hormonally and with women, it’s actually the opposite. They get more insulin – more insulin will drive the 17,20 lyase enzyme, which then increases androgens and then they get ovarian cyst and then they get more, you know, hair growth, acne. So it’s this vicious cycle our mother nature kinda swaps the roles there.

Dave Korsunsky: Yeah. I talked to a lot of people who are doing everything right in terms of the macronutrient profiles. They are eating low-carb, they’ve got things dialed in there, but— but little to no exercise. And yes, you will— you will lose that to a certain extent body composition will improve, but there's—it’s also critically important to be building muscle mass, lifting heavy things and sweating. Those are two of the most important ingredients in my own regimen. Making sure I’m building up lots of muscle mass in in the quads, in the back, in the large muscle groups. And I think that's something that at least in my experience, people I don't think appreciate as much as they start down this path. They think that diet alone is going to handle it, but lifting heavy even if you're just starting out starting to learn some of the functional movements that are— that build a lot of core body strength and really hit the big muscle groups. I think that's perhaps the next level to get to once you have a solid foundation with the diet. Would you agree?

Dr. Justin Marchegiani: Hundred percent. And also, say make sure you get your 10+ thousand steps. Yesterday I got a 14,000 steps. That's helpful because that— the steps really allow you to start basically cleaning out some of that extra—there’s little bit of extra carbohydrate in there. You can clean some of it out coz you're constantly moving and the extra steps really help. And of course if your— you know, “ I don’t have a ton of time, so I'll just jump in and do a couple cattle bells swings to failure, some push-ups to failure.” And that could help because the—the push-ups, right? You know, I have a push a bar so I can go really deeply, so I get a full range of motion push-up all the way down all the way up. I can get the upper body going. I'll do my TRX Rose to get the posterior side nice and some kettle bell swings as well. And if you have a lot of time, throw a Tabata in there coz that high-intensity gets the growth hormone. And growth hormone is really gonna be stimulating a lot of that—that muscle tissue.

Dave Korsunsky: Yeah. I definitely have a home gym envy, Doc. I've been over to your place and I’ve seen your set up. It's pretty nice, so I definitely would love to have something similar someday in the home.

Dr. Justin Marchegiani: And if you’re on a budget, really simple, TRX that hangs over door.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: You have the adjustable kettle bells on Amazon and get a push-up bar. Push-up bar is optional but I just like it coz you can get really deep coz I would go so deep I bang my head against you know, the floor. So I can go really deep full range of motion and not have to you know make out the floor, so to speak. So that's a great option for you.

Dave Korsunsky: Those are great. I'd love to maybe see if we can find some of the recommended products on Amazon— the adjustable kettle bells, the TRX stuff and just actually may be included that here in the notes so people know which ones you’ve tested and they can just go out and get that and try it. So I think that would be uhm—yeah, that’d be cool.

Dr. Justin Marchegiani: We’ll get that in the show notes, for sure. Also, let’s just give—we kinda show some of the functional glucose tolerance stuff but you know—you just give us a cursory. Just just give us a quick walk through through Heads Up so someone that they’re gonna click on the link below, they’re gonna get to the site, but then what do they do? How does it work? Give us that like little round up there.

Dave Korsunsky: Yeah this is—this is my—my personal data. So let me just refresh the screen here because uh— some of the information didn't actually come in on the last load. And as you share screen that's what I wanted. So the first thing we’ll ask you as a new user is, “Which devices and apps you're using to measure your health?” And so at least everyone who signs up has at least one of these devices. A withing scale an eye health wireless blood pressure monitor or glucometer, a fit bit, uh— my fitness pal for tracking the macros, Apple Health. These are gonna be able to pull in things like heart rate and blood sugars, sleep, macronutrient profiles. So all of that will flow in so you can connect as many of these sources as you want and then you'll see were also starting to build some of the more specialized sources as well. The ones I showed first were more of the commercial grade stuff, but you can also see we’re starting to integrate devices like the Oura ring and the level breath acetone analyzer and things like Elite HRV and the other HRV monitors are coming in. So uh—we’re also working on the decks com, CGM device so we want to make it easy for people to build their own custom dashboard because everyone's tracking different metrics. So this is all completely customizable. So that’s step one. And then you’re allowed to build your own custom dashboard. So I’ve got the carb tolerance test data here, but if that's not something I'm working on, I can just actually hide it. And you can see my top three metrics are glucose, ketones and the glucose ketone index, which is just a ratio of these two numbers. A lot of our cancer patients and people with serious metabolic dysfunction are tracking the—the index of the two numbers. And then you can see I've got my weight and body fat readings those can come from a withing scale. They can be entered manually. This year is my heart rate variability, which actually comes in from the Oura ring and so that's on here as well. Same as sleep. So that ring gives me a good sleep and HRV reports. So this is all completely customizable, breath ketones, resting heart rate. And then really what people try and figure out is how is this affecting my clinical markers? Are my lifestyle changes lowering my inflammation or not? And the only way to see that is to put the clinical markers in the same system as the light markers. And typically, the doctor has this clinical data. So it's very difficult to compare lifestyle changes to clinical markers and that’s what we wanted to solve here and make it available for everybody. So I could just jump down and look at things like my inflammation markers and say, “Okay, is CRP coming down as I go on a clean Paleo template?” And we can actually link directly to your medical facility and pull this data out. So all you do is click the connect data button and let's say that you're sending patients to Quest Diagnostics. They would be able to just link their quest account to Heads Up and all of that information would flow in or if they're using a more traditional health system and billing their insurance, you can connect Stanford, you can connect UCLA, you can connect the Cleveland clinic. There's over 10,000 medical facilities in here and what we’ll do is we’ll take all of that data, clean it up and organize it from oldest to newest so people can actually have the full picture of their health and what we’re seeing is patients can look back into their history five 10-15 years into the past. Maybe even decades before they've even started working with their current doctor and see these patterns emerging years before the disease was diagnosed. And the reason you—you can’t do that today is because every time you change doctors, your health record get fragmented but when we put it all together for people, then you can start to see, “Wow, actually that trend was visible 10 years before I even got the diagnosis.”

Dr. Justin Marchegiani: Right.

Dave Korsunsky: But nobody noticed because I moved and my records got fragmented and my doctor can only see back three years, but I can see back 15 years. And that's where this has the potential to I think really help people uhm— have actually more power and more information on their health. So, there's a whole bunch of other stuff that goes into the system, Doc, but it's really meant for patients and then most importantly all I have to do here is go to care team access.

Dr. Justin Marchegiani: Uh-hmm.

Dave Korsunsky: Give you access and you can come in and review all this data whenever you want. And then if I don't want you have access anymore, I would just disable that access.

Dr. Justin Marchegiani: And if you’re listening to this on iTunes or a kind of an audio version, we’ll put a link down below for the YouTube video version as well. So if you’re trying to figure out like kinda find us, we’ll put the link but Justin health.com/YouTube Y-O-U-T-U-B-E and subscribe there. That way, you can see the videos well and then you can also listen to the audio.

Dave Korsunsky: Yeah. So I just killed the screen share, but that's a quick walk-through. I wanted to show people the functional glucose tolerance test because it just allows everybody to test their favorite foods, make sure that they are metabolically safe even things you thought might be safe, may not be. So it’s easy to just test and be hundred percent sure and obviously, you can integrate all the other information. So, that’s a little bit about one of the most recent features we just finished up.

Dr. Justin Marchegiani: Love it.

Dave Korsunsky: And actually we uh— we have a debt of gratitude to Dr. J on that one because he was the one who told me about the functional glucose tolerance test. So we took your vision, Doc, and implemented it into our software program.

Dr. Justin Marchegiani: Love it. That’s phenomenal, man. Very cool. I’m also gonna be doing a live right now—a blood sugar test to myself kinda see where I’m at and put it out live on air.

Dave Korsunsky: Well, I can’t get you go solo there, Doc. I’m gonna have my Keto mojo here.

Dr. Justin Marchegiani: 87.

Dave Korsunsky: 87—that’s respectable.

Dr. Justin Marchegiani: And just so you know, that’s an hour and a half to two hours after having three eggs cooked in ghee with sea salt and then some butter coffee with MCT.

Dave Korsunsky: Alright. Let’s see what I got here. So uh—you mention the mojo here it is—uh 99 ketone strip. I’m not gonna do the ketone test right now. I’m just gonna do a is to glucose strip. This is about I don’t know, half an hour after I had breakfast which is really just a chicken breast today. I'm traveling so I don't have access to all my food and uh—clocked in at 82. Respectable 82. That’s where I wanna be, so, yeah, I’m dialed in.

Dr. Justin Marchegiani: That’s good. Yup. I mean, my ketones are probably around .6 mmol typically is where they are out of, what, like an 80, 80+ percent fat breakfast. I typically get my protein in the morning from collagen. I did some good quality pasteur-fed eggs, but that's important. And let’s just kinda hit a couple of the other blood sugar markers that we can do. So, I like the functional glucose tolerance. One: because it’s specific to the meals.

Dave Korsunsky: Right.

Dr. Justin Marchegiani: Where if you do kind of a blood test, so you go to Labcorp, it may be helpful, but it's kinda like a fixed thing—

Dave Korsunsky: Yeah.

Dr. Justin Marchegiani: And it's not something that someone can do all the time. So we can do fasting insulin, which is really nice. And if you're more insulin resistant, that's great because your blood sugar may look okay, but it's nice to see the insulin coming down. And that's even better coz that tells us that we’re reversing insulin resistance. We can do fructosamine. So, fasting insulin, ideally, below five—the sweet spot.

Dave Korsunsky: So let me—let me jump in on fasting insulin.

Dr. Justin Marchegiani: Yeah, sure.

Dave Korsunsky: A lot of people, probably their doctor might not run it for them because there's not a diagnostic code. My doctor wouldn't run it for me and it’s extremely important. As you said, to see glucose and insulin to make sure that one is not overcompensating for the other. And so that's— sometimes to test that, a patient will have to order on their own and whether they get it from you or whether they go or it themselves online, maybe you can just comment on that. My doctor won't run that specific test for me and—and how could somebody do that themselves if their doctor won't run it?

Dave Korsunsky: Yes. So, of course, you want to reach out to a functional medicine Doc like myself. There are others out there because in the realm of functional medicine, we’re not actually treat disease, we’re supporting underlying systems that may not be working optimally. We’re fixing diet and lifestyle and we’re trying to bio hack and kinda maximize optimal performance. So it’s a different mindset and if you're in the insurance model, things tend to be all disease-based, CD 10 code, CPT attached to it and uhm—it’s just you know, if you're trying to utilize your insurance for this type of healthcare, it’s typically not gonna work.

Dave Korsunsky: Yup. And so what I did just for myself and my family is we just— we just went on to one of the websites where you can order your own tests. There's a bunch out there and just ordered our own fasting glucose, our own fasting insulin 70 bucks and just got it done and make sure all numbers were in range. So, at least in the United States, this is not available internationally. But within the United States, we do have direct to consumer lab testing. If you're concerned and you want to know the numbers and your doc won’t run it, do it yourself and track it in Heads up Health.

Dr. Justin Marchegiani: One hundred percent. And again, a lot of people, they maybe listening concerned about you know, cholesterol, eating this much fat and this much good quality protein, again, I just got approved for the highest life insurance policy you can get from uh—you know, grade wise health and my lipids came back 180-185 for total cholesterol HDL is in the mid-60s Trigs were in the 50-60 range. So again, you know, nearly perfect on everything is wide at the highest rating that you can get for life insurance. But just to show you, you know, you’re concerned about thinking about eating these foods and it jacking up your cholesterol, typically not. The biggest thing that will jack it up will be insulin. Insulin will up regulate the enzyme that makes more cholesterol the uh—Hemo Methyl Glutarate COA Reductase enzyme.

Dave Korsunsky: Yup. So, yeah, we–-and that’s great. And you were just actually also, we were talking about a panel we’re gonna put together which is going to be a fasting glucose fasting insulin A1C and fructosamine. So uh— some people may not be familiar with fructosamine and A1C so maybe comment on those and then we'll will put the panel together on the website people can just go do it themselves, Quest or Lab Corp and we’ll put the functional ranges in the show notes because the conventional ranges are misleading sometimes. So what do you think about those numbers in general?

Dr. Justin Marchegiani: Yes. So fructosamine, typically is a 10-14 day window. So in the lower, 200 is gonna be great.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: A1C in the lower fives—

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: Lower 5’s is gonna be great. Of course, glucose, it depends upon the timing. But fasting you know, below hundred, below 95 is great, you know, we got shot it in the 80’s which is excellent. Insulin below five below six is really good from a fasting insulin closer to two or three is—is—is great, too, as well. And again, if we go really low in the insulin, we have a lot of fatigue issues. We do need insulin to help convert thyroid hormones. So we could be driving insulin too low, which could be creating some other metabolic issues. So keep that in the back of your head if you're Keto, Paleo and you're still having some symptoms you may need to actually raise the insulin a bit especially if your body comps are already pretty good. So keep that in the back of head. That could be a little something we have to tweak down the road.

Dave Korsunsky: And that is actually something you help me with last time I was in Austin where I had extremely low carb for a really long time. Potentially, it was even keeping insulin too low and I was seeing some elevated cortisol responses and just having some uh— post exercise uhm— insomnia type issues. And I was able to just dial it back a little bit and over time, quickly correct those. So that was one of the things I learned just from my own personal experience was to cycle out every once in a while and—and dial back up the—the carbs maybe from below 25 to 50 or something around there. I know you’d target 100, you've mentioned before. So, I think variance is good, basically. And uhm—I I know I personally may have stayed low carb too long I didn't need to be I was actually— my body composition was good, but that's a good point. It’s actually being too low can also have some downstream effects on the insulin side as well. Correct?

Dr. Justin Marchegiani: Hundred percent. And again, for me, I always default to go in low coz it's easier to start low.

Dave Korsunsky: Absolutely.

Dr. Justin Marchegiani: Kind of stabilized and then move up.

Dave Korsunsky: Yeah.

Dr. Justin Marchegiani: Coz if you’re kinda in the middle, then which way that you gotta go. There’s more variables that you have to move through; but if you start lower, then you start to move one direction.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And you know, then you’re okay. Then if you hit a point, you know, you got, you got—so to speak, some uh—you have a direction that you just got to go the opposite to get back to where in case you just start having a negative reaction.

Dave Korsunsky: Yup, cool. Okay, perfect.

Dr. Justin Marchegiani: So we talked about those couple of markers there. That's perfect. We hit those things. Also, let’s chat about the HRV a bit. So I see HRV, your heart rate variability, which is the unevenness between the hearts uh—you know, the heartbeat in each second. It’s not a consistent beat, there’s some level of unevenness, which basically is a parasympathetic response. So the more the parasympathetic nervous system is activated, that’s a great sign of being able to heal anabolic hormones, being able to recover, build, back up, recycle neurotransmitters, build muscle. That's really good. So we have some devices that we can utilize I mean you can do the Amway device by HeartMath. Uhm—I like the just the Fit bit, making sure sleep looks pretty good. Uhm you can check in with the Oura ring. So let’s dial in with some of the things that you use to help improve heart rate variability.

Dave Korsunsky: Yeah. That sounds good, Doc. Give me one second here. Can you hear me, okay?

Dr. Justin Marchegiani: Yeah. You sound great.

Dave Korsunsky: Alright. So, starting to see a lot of individuals who are starting to look at heart rate variability. I think there's still a lot of people who aren’t quite sure what is. They’re starting to hear that term, HRV. You might not know exactly what it is. I've only recently started introducing it into my regimen. Initially I started by very simple—just purchasing a heart rate monitor— a polar heart rate monitor that you can get on Amazon for 30 bucks and it's a chest strap. So in the morning you would—you’d put it on and you would fire up an HRV app. And in my case, I was starting with the lead HRV. There's a number of them out there you can pick one that you like and it will just ask you to sit—sit still for two or three minutes in the morning and it will start doing what's called a readiness score and it will start measuring that variability. The—the time between each heartbeat and looking at the variance and then it will be able to give you a—a measurement of your level of recovery. How well recovered your body is on a given day and it just can help you inform how hard you should push yourself on your training. So some of the popular apps out there that I've come across are lead HRV, bio force and the one I'm using now is actually the Oura ring, which is here and this one actually will measure a number of different metrics. It will measure HRV, body temperature, sleep cycle analysis and give you a readiness score based on all that information. But for those who are not familiar with it, HRV is an excellent measurement to start assessing your level of personal stress, sympathetic versus parasympathetic, your level of recovery from physical training on a given day. And it can be a very helpful metric to understand just—just the level of stress in the body that can have implications for inflammation, can have implications for your blood sugar levels. So for those who aren’t familiar with it, starting to look into doing some basic HRV measurement I think is increasingly becoming a very popular metric that we’re seeing requests for from our users.

Dr. Justin Marchegiani: Love it. Excellent.

Dave Korsunsky: Are you testing? Have you tested HRV? Have you use any products there? do you have your patients measured at all?

Dr. Justin Marchegiani: I don't do a lot of testing with it. I just—I haven't found something that I've been streamlined with because there’s many things out there. So like the bigger things for me are like functional glucose testing. I like the Fit bit. If people aren’t gonna be going to the gym, making sure they’re getting enough steps.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: There’s a cool one that’s out there I’m liking. Coz I see a lot of people poor posture. It goes on your spine.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And then there is an app and that it tells you how straight your spine is.

Dave Korsunsky: Yeah.
Dr. Justin Marchegiani: So you put it on for optimal posture and then if you start moving, there’s a screen alert and it shows you where your posture is. So it’s instantaneous biofeedback for your posture.

Dave Korsunsky: Yeah.

Dr. Justin Marchegiani: That’s—

Dave Korsunsky: Yeah. It’s called—I forgot the name of it. It’s Lumo Back or something like that.

Dr. Justin Marchegiani: Yes. I’m liking that to a certain degree coz if people sit all day, I think it provides a lot of awareness that, “Hey, your posture is pretty bad maybe get a stand desk.” I stand 5-6 hours a day and have a walking treadmill that I slide into my desk and I walk about you know 5 to 10 miles a day while I’m seeing patients. That's I think helpful. So I don’t go crazy on that, but I think it’s something that I will look more into. I— I wish that Fitbit would integrate and have a heart rate variability aspect, too. I think some of the more expensive ones do, but I like the Flex for the Fitbit. It’s just a little more durable.

Dave Korsunsky: So this is something that I think would be uh— helpful—helpful to a lot of users on our system who are managing autoimmune disorders. They are managing metabolic diseases. They are managing cancer, for example. And if HRV is a proxy measurement for stress and perhaps underlying cortisol and elevated sympathetic nervous system response, maybe it's not specifically to HRV, but can you share how things like stress can affect autoimmune, specifically, gut disorders and other autoimmune diseases and how measuring and lowering stress can improve symptoms and associated markers.

Dr. Justin Marchegiani: So, of course, we have stresses –is in a couple different areas, right? We have like when people think of stress, it’s typically emotional stress, right? It's work, families, relationship, finance. Like that’s one element to you know, emotional stress.

Dave Korsunsky: Uh-hmm.

Dr. Justin Marchegiani: Also things are like blood sugar. Having your blood sugar swing up and down because you’re eating too much carbohydrate or you’re skipping meals and you're not getting enough nutrition and B vitamins and minerals at the meals coz you’re burning that stuff up, the more stressed you are, right?
Dave Korsunsky: Got it.

Dr. Justin Marchegiani: Think of you driving a car. You gas it on the highway. You're going faster, you're making fast turns. Well, you go through gasoline at higher rate.

Dave Korsunsky: Uh-hmm.

Dr. Justin Marchegiani: Well, the same thing happens with people when they are skipping meals, right? And they’re under a lot of stress. They don’t have the gasoline and the take. The difference is our body just starts shifting in the catabolic physiology where it starts breaking down other tissue. The difference in a car is once you’re on empty, right? That Seinfeld episode, how low can you go? Well, eventually, you just—the car just stops. The difference is if the car was equal to our physiology, we’ll start metabolizing the bumper or we’ll start metabolizing the internal uh—gas, you know, the internal oil and fluids and such, right? The car is not quite like us. Once it's on, once it's out of fuel, it stops.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: We don't stop. We break down other tissues and hormones and neurotransmitters and that creates disease because we’re breaking down, we’re getting chronically inflamed. So cortisol is gonna break down of course more neurotransmitters. It’s gonna create— it's gonna a breakdown gut tissue, which is gonna create more leaky gut and create more immune stress. The more immune stress there is, the immune system sucks up a lot of resources, a lot of energy and of course, when the gut is impaired, when the gut is inflamed, we’re not gonna be able to absorb a lot of those nutrients. So, let's say you start shifting your diet back to up to a Paleo template or an autoimmune template and you're not getting better, that’s probably why. Is your sympathetic nervous system is so turned on we have to work on that. We need to support the gut integrity. And there’s probably some infections that have come because your immune system has been shut off. So basically, you left your door in uh— unlocked and now you get five homeless people sleeping your house when you get home, right? That's the equivalent of you know these parasites. You got to come clean them up, right. You gotta go do all the stuff you need to do in the functional medicine program to get them all dial back in.

Dave Korsunsky: Yes. So my take away from that is heart rate variability is actually a way that people construct to quantify stress because—

Dr. Justin Marchegiani: Another way to monitor it, right? Like heart rate variability is not “tell me what to do” but it tells me that what I'm doing is actually working.

Dave Korsunsky: That's exactly right. So if someone is suspecting that they're doing everything right and they’ve got an autoimmune condition, they’ve got some other condition going on, they know that they have some stress in their life that's probably exacerbating things. Starting to get some HRV measurement can actually give you some hard data because otherwise stress is just as nebulous thing. “Yeah I'm stressed out. It may be affecting my markers, my symptoms. I don't really know how to quantify it.” And I think that's where learning HRV can become extremely helpful especially getting that morning HRV readiness score, where it just says, “you got a great sleep” “your HRV numbers look good” “you can push yourself today” or you can say “Your HRV numbers are terrible. Take today focus on rest and recovery.” And it actually gives you a number of quantifiable, accurate number that can be used to start to calibrate lifestyle, actually understand how stressed your—your system is. And then make adjustments and have some data to work with instead of this nebulous “I’m stressed” term. The HRV can give you real numbers to work with. And there's some great tools out there. The Oura ring is one. The elite HRV readiness score is another. Not difficult to measure and that can help you start to move the needle in terms of stress response. So, I guess that's my take away from why I recommend HRV, why I test it personally.

Dr. Justin Marchegiani: And what’s your favorite device again?

Dave Korsunsky: Well, right now I’m using the Oura ring. It's a pricey device that's the thing, but it incorporates a lot of different things into the uhm— stress response score. It includes a lot of data from your previous night's sleep. Deep, light, REM, uh— bedtime, wake time, resting heart rate. Things of that nature. So that's the device I'm using. I also have a Polar heart rate chest strap which I bought on Amazon. I think it was $29 and the elite HRV app is free. So that's another one. And I know that there's other HRV apps out there. Pick one you like. Maybe test a couple. Start getting some basic HRV measurements and then it can be just another helpful data point to help you try to assess and measure and improve metrics associated with stress, elevated sympathetic nervous system, poor sleep quality could also contribute to poor HRV numbers. So those are the products I currently am familiar with.

Dr. Justin Marchegiani: Love it. Excellent. Well, I have to get them to sponsor the show here, Oura Ring, phenomenal. Alright, Dave, hey, phenomenal show. We’re gonna put links here kinda link to get access all this material here for you guys.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: Get people over there. We’ll put some of the material and things we talked about in the show notes section underneath. So if you’re listening to iTunes or YouTube, we’ll be able to give you access some of those information there and some of those tools. Anything else you want to share that you think is really important before we wrap it up.

Dave Korsunsky: No. I think it's always good to—to be on here and just –my whole thing is data-driven health and using having access to your numbers and learning how to figure out what works for you and it's also great to speak with you and get the clinical perspective on how to interpret these numbers as well. So it was just great to be back. We've always got a lot of stuff we can talk about. We could probably go on forever but I think we recovered some good information here so uh— it was it was fun as always, Doc. I'll be seeing you at Paleo f(x) Not to— not too far from now. Always a fun time so I'm sure we'll have an opportunity to have some fun and uh yeah, otherwise, it’s just great to be on the show.

Dr. Justin Marchegiani: Love it. Great to be here, too. And also you're listening to this, sharing is caring. Give us a share. Give us the thumbs up. We appreciate it. Spread the word. Uh again, it really fires me up when I see more people getting healthier so make sure you give that a share. Dave, thanks a lot. Great having you here today.

Dave Korsunsky: Okay, great.

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