Get ready for an exciting, fun, and informative show with Dr. Mark Cucuzzella!

Dr. Marks returns to the podcast for an educational conversation about his incredible work practicing family medicine, how he has overhauled the dietary practices in the hospital he works at, and much more. An accomplished marathon runner, Dr. Mark owns a unique and innovative running store to promote and share his enthusiasm for the barefoot movement and minimalist footwear. 

This show blends important medical recommendations with helpful information like how to assess and minimize heart disease risk factors, and you’ll learn interesting facts, such as why the triglyceride to HDL ratio on your blood test is the most important marker for heart disease risk factors, as well as useful info about EKG stress tests and coronary calcium score tests, and how to generally live a healthy, balanced lifestyle!

TIMESTAMPS:

This podcast will be filled with recommendations and information about how to assess and minimize your heart disease risk factors. [01:27]

It’s good to keep a competitive edge. Running is good mental therapy. [05:40]

Mark talks about his medical history during his running experiences. [07:00]

What happens when we hit “the wall?” The Central Governor will not let you die. [14:05]

The key is to figure out how to turn it on and off. [18:30]

It is important to get more than an EKG to predict heart health. You need the coronary calcium score. [21:12]

A good measurement for your body is two times your waist should be less than your height. [29:49]

It is still taking the medical community too long to catch up with this information. [33:21]

If a person is fit and eats healthy, how does a high calcium score come in? [42:25]

Your competitive intensity and your drive can all serve to harm you if it gets out of hand. 

[49:36]

Pre-diabetes can be making too little insulin sometimes. [51:55]

All people need to look at their individual body to see what diet is best.  Is there a strategic inclusion of carbs recommended? [56:48]

The barefoot minimalist shoe lifestyle is a big part of Dr. Mark’s life right now. [01:02:04]

NOTES:

Where did the term “Type A” originate?

Coined in the late 1950s, the term “Type A” originated when cardiologist Meyer Friedman observed a relationship between incidences of heart disease and personality type — namely, that those most likely to suffer a cardiac event also tended to have, in his estimation, more driven, impatient, high-stress personalities.

LINKS:

• Dr. Mark’s Desk (Dr. Mark’s website)
• Two Rivers Treads
• Coronary Artery Calcium score
• Run for Your Life book

LISTEN: 

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B.Rad Podcast

0 (1m 28s): Hey listeners, get ready for a fun, exciting, informative show with the one and only Dr. Mark, Cucuzella returning to the be rad podcast. This guy is on a mission in every area of life. He’s doing so much incredible work right there on the front lines, in the great state of West Virginia, where he practices family medicine and has been responsible for overhauling the dietary practices in his hospital. He also owns a unique and innovative running store in his spare time, promoting minimalist footwear and the barefoot movement. He’s an incredibly accomplished marathon runner. 0 (2m 8s): He has been for decades. He did 30 straight years of running a sub three hour marathon. So for those of you who know much about marathon running, that is absolutely astonishing. He talks about his recent 100 mile run finished. The first time he’s done that at the ripe old age of 55, he’s taken on new challenges and just live in that lifestyle of continuing to push himself and pursue athletic, competitive goals, but also do great work with his patients. He does a lot of cardiac testing. So this show is going to be kind of a blend of important medical recommendations and information about how to assess and minimize your heart disease risk factors. 0 (2m 55s): We’re going to talk about the EKG stress test and the coronary calcium score test. How finally dietary practices are seeping into prestigious medical journals. So your doctor needs to get up to speed on this stuff and realize this marker that we keep hearing about the triglycerides to HDL ratio on your blood test is the most important marker for your heart disease risk factor. If you talk to this about your doctor and they don’t know about that, or they want to focus on LDL, this is flawed and dated information that’s decades old. So it’s triglycerides to HDL Dr. Mark’s going to talk a lot about that. It’s going to talk about what your calcium score means and how to improve that, how to mitigate the risks of overdoing it with an excessive approach to exercise, which has become such a common problem, and so much more including his own battles with the pre-diabetic condition and how he’s thrived on transforming his diet about a decade ago and still putting out amazing athletic accomplishments, eating a clean diet and living the dream. 0 (4m 1s): Dr. Mark, Cucuzzella coming to you from West Virginia. He’s the author of a wonderful book called Run for Your Life, which blends a lot of insights about the minimalist footwear, but also great commentary on just living a healthy fit, happy balanced lifestyle. Here we go with Dr. Mark, Dr. Mark Cucuzzella. We are live, and this is going to be a fun show because we’re just going to let it flow. There are so many fun things to talk about. We’ve, we’ve thrown out this topic, thrown out that topic, and I think maybe we’ll just start with a cute little intro about your, your life’s work and your journey, and, you know, got to throw in a plug for the running store and all that stuff. 0 (4m 43s): So I want to, I’m going to turn it over to you for a second. And then we’ll, we’ll hit some hot topics about healthy living, especially anti-aging and walking the talk like you do. 2 (4m 54s): Yeah. Gosh, it’s great to be back on Brad. I love listening to your show and I listened to it when I’m out for some nice mellow runs in the morning when it’s nice and cool here I’m on the east coast. So it gets, it gets hot as hot as blazes mid day. So I’m an early morning exerciser in the summer, very calming, but yeah, keep doing the great work. You know, you’re helping educate people like myself. Great. 0 (5m 17s): Well coming from you. I I’m, I, I appreciate that very much. That’s awesome. 2 (5m 22s): Oh, you’re sharing human experiences, you know, and then you interview great people too, that, you know, know the science and we’re all that individual experiment of aging people, you know, you’re may I turned 55 next month, so, oh my goodness. We’re about the same 0 (5m 40s): Sharing, the 55 to 59 I’m I’m licking my chops. I’m going for those, those standards and master’s track. And it’s nice to, you know, still have goals, still have a little bit of a competitive edge, but especially in your case, you’re, you’re kind of, you’re, you’re doing it the right way. You’re here obviously steeped in the th the medical aspects of, of how to live a healthy lifestyle and seeing patients and doing cardio treadmill, stress tests, and, and well, well versed in the potential drawbacks of, you know, an adverse approach to fitness, but what’s, what’s working for you. And, you know, tell us a little bit about the athletic background too. 2 (6m 21s): You know, so I’m 55. I’ve been a runner my whole life, and I ran high school, ran in college and kept running distance, distance running, mostly marathons. I dipped into triathlon very early in the day when I had a little more free time. I actually worked in high school. This store was called the race pace triathlon store. I think it was maybe the first triathlon store. This was like in the eighties. And Scott Molina would come in there and, you know, this was Dave Scott era, your era, you know, like the Oxford triathlon was like the big one in the region. That was, I think that one’s still, it turned into an iron man event in the same area, Cambridge, Maryland, and the bay, but, you know, it was, it was becoming data, right? 2 (7m 1s): There’s a Columbia triathlon. I did the first Columbia triathlon, a 13 year old. And I, I finished third, you know, with, with a pretty good adult field with a little 10 speed with toe clips. This was like all scope. You know, there was no tri bars or anything, and swimming was my weakest leg. And then I was constantly hurt running. So that’s how I got into triathlon. And I, my, the folks who owned this triathlon store, where iron man triathletes, you know, back in the early days, and they swam with the master swim club at the local community college. So I started go into their masters swim workouts at like five in the morning. I got my swim pretty good. 2 (7m 41s): After about a year or two with real coaching, I could get my miles. It was down in the 20, 21 range for a mile, you know, and I was kind of a, a flailing runner in the pool before, you know, one of those bricks with no body fat. But yeah, so, you know, I’ve loved watching that sport evolve, but, you know, as I went through college and med school running became more of my mental therapy and I just happened to enjoy racing. So I would hop back into races a few times a year just to keep my competitive juices going. But running really was the therapy that made the rest of my life work when you’re studying and, you know, on call nights and stress at work, you know, you’d find a time to get out just to do, do a, an aerobic style run. 2 (8m 25s): And most of my running after college was aerobic, you know, without even knowing what that was really because in college, you know, like you talk about, we just beat the crap out of ourselves until you broke. And, you know, I ended up doing pretty well in marathons, you know, stayed injury free. I had a streak of 30 straight years just under three hours for a marathon. And I lost, I lost that streak in that year, the Boston marathon, when that horrible weather, I think it was 2018, the winning time come out to you want from Japan and like two 18 or something, you know, in the blazing headwinds and horrible rain. And you’ll have to feel drops out, but I ran a 03:04 that, that year. 2 (9m 10s): And, you know, I got it every bit for that, for that 03:04 full battle rattle gear. And then, and then COVID hit, so, you know, the world of marathon and kind of shut down. So, so I’ve been doing some trail running now, you know, just mixing it up. And I haven’t stepped into like a real, like race since before COVID and it’s been kinda nice, you know, I’m like, it’s just, you go out and run and I’ve enjoyed running no less not having like a competitive marathon. I did a hundred miler last fall. I’d never done anything like that. 0 (9m 45s): Wow. 2 (9m 45s): Kind of out of my wheelhouse, you know, I just gonna keep moving finished with a little bit of headroom, you know, just to finish under the cut. So it made it in under the cut. So yeah, living life of a little bit of adventure out here in West Virginia. 0 (10m 2s): So how does that degree of difficulty compared to break in three or getting down to, I think you’ve been in the two thirties, or as far as your PR and hitting the 2 (10m 12s): Back when I was a little bit younger bunch under 230 oh a hundred mile or blows it away. Oh my gosh. Yeah. I had to dig deep in every bit of my soul to, to kind of make it through. It’s just a different word. I mean, it’s not like, you know, a taxing, you’re looking at your watch and you’re slowing down from whatever pace, but it’s just aid station to aid station. And, you know, you’re running through the night, you’re hitting routes, take some falls. Yeah. It’s it’s and you could get lost, you know, there’s that aspect to it. And you’re like, if you’re running the Boston marathon, you’d have to be a knucklehead Brad to take a wrong turn, but you have to have situational awareness in these ultra is different than like a road race, you know, at night going down single track trail. 2 (11m 4s): This one was in the New River Gorge in West Virginia, which is a gorgeous place. They just, where did the national park, but it goes up and down in the New River Gorge. But you know, you kind of learn a lot about yourself when you’re doing something like that. And I learned that I was pretty gritty, you know, at the end I had a couple after I finished, you don’t even realize how far you took yourself. And a, probably like to the topic of health. I don’t think for me, it was healthy. You know, I w was trained kind of morning rounds. You, I didn’t put any really long runs specific work in, and after the event, I had two significant bagel sink apiece, you know, probably like whether it was volume depletion, I may have thought it was up on my salt. 2 (11m 47s): I mean, you’d taken a ton of salt. I mean, you’re doing everything you can to try to keep equilibrium for that amount of time. And, you know, you’ve talked about parasympathetic tone and vagal tone. So my body very kind of vaguely driven my resting pulse is like 35. And yeah, I got out of the car after driving back to our lodge, just stood up, you know, and just went right down. Luckily my good friend was medical, so she didn’t like panic and called 9 1, 1. She just lifted my legs up. And I came back to, they put me on the couch and they’re like, you should have some broth or some salt, but I was like, I was done. I needed to just sleep. I slept for like two hours, like coma. 2 (12m 28s): And then I went to get up again, you know, boom went down again and she lifted my legs up. I woke up and she’s like, no, go ahead. You’re going to drink this broth. I’m taking you to the ER, cause your friends want to take you to the ER now, but that was fine. I drank a bunch of really thick broth and then took another nap. And then it was okay, but that’s probably not a good place to put yourself, you know, week in, week out, you know, it took me a couple months really to feel like I had my legs back under me, you know, like springy legs, you know, felt like I, I could go sprint relaxed. It was, it was, it was a totally different recovery than a marathon. 0 (13m 12s): So you were sodium depleted. Is that why you had those? 2 (13m 15s): Yeah, I don’t know. It could be a little sodium depletion, a little volume depletion or just your body is just been somewhere where you don’t even, you know, we have barrel receptors, you know, there’s feral receptors when we stand up, wake up and they constrict our blood vessels in our legs to keep blood in our brain. You know, maybe my whole neurologic system. Cause you’re on your feet, you know, a hundred percent, you know, for it was 31 hours, you know, you’re on your feet, just marching, running for 31 hours. So maybe there’s something in the neurologic tone or something that just wasn’t awake yet. You know, it’s like, say I need to take a rest. My bear receptors say I’m done. I’ve been keeping blood going to your brain now for 31 hours without, without sleeping without the legs up. 2 (13m 57s): Right. Maybe there is something there that was, you know, the tone or blood vessels, but it’s, I don’t think it’s a place that I would want to keep putting myself in. 0 (14m 6s): I like that the doctor threw out a lot of maybes there and it’s kind of cool because, you know, you’re, you did something so extreme and so grueling and it doesn’t, you don’t need an explanation for everything. You were just toast at the end and this happened and that happened. So what’s going on out there on the race course when we’re pushing those limits. And I know you’re familiar with Tim Noakes, central governor theory, and it is this fatigue, you know, a blend of mental and physical and the vehicle system is, is getting literally worn out. Th the sodium potassium pumps are fried or, you know, talk us through what happens when we, when we hit that wall. 2 (14m 46s): Yeah. I’m a total advocate of Tim Noakes, his work he’s preeminent sports scientist in the world. You know, certainly, you know, his, his dietary advice now would save the planet. You know, I, I ascribed to a low-carb diet. I have maturity onset diabetes of youth. And I heard Tim speak 10 years ago in Capetown when he had started to talk about this stuff. And I was like, oh my gosh, I’m not crazy. When I heard Noakes talk about low carb diets. I’m like, okay, this is legit. Cause he said, it’s taken me five years of research before I felt confident enough to tell the general population that I think the food pyramid is upside down. But back to the central governor, Brad, for people that don’t know what that is, that’s where your brain is kind of captain of the ship. 2 (15m 27s): You know, we could say you’re at your VO two max or some other physiologic function, but, but the brain allows us to keep going or to cut itself off. So the brain is going to protect you from killing yourself. So some people’s central government governor might kick in and you’re going to stop before you die. Right. You’re going to stop. You’re going to say, because there’s always someone who finishes in second place. He’s not dead yet. So what happened to that person versus the one who won the race and it could have been by a lean, you know, somehow that central governor might turn off motor units. Now a mom is trying to pick up a car off her child. The central governor is off. She can lift a car, she can recruit a hundred percent of her muscle fiber, you know, probably never would ever be able to do that again. 2 (16m 13s): But that self protection mode has gone. So I think in a race like an ultra, you know, you kind of ignore that central governor a little bit and you kind of go someplace that you wouldn’t go on a training run. One of my friends told me this, you know, I had some friends there kind of crew in and hanging out, you know, it’d be at the aid stations and you had to do a shoe change at about five miles to go because my foot, I kept banging one of my toes. Right. Cause you hit, hit route. So like I needed to change these shoes and my feet were a big, hot mess. I changed shoes. He looked at my feet, they’re a mess. We put different pair of shoes on, made it the last five miles. But afterwards he said, I never saw quitting your face. 2 (16m 54s): You know? So he saw me in a couple of dark places there, but he said, I never saw quit near face. And I think, and you see a too, Brad, you’ve probably seen that on the course or maybe in your own face on a day that you just said, okay, your brain just said, look, this isn’t my day. I’m going to exit the course, you know. But I think, yeah, like we’d probably see it in our friends or other competitors. When you see that quit in someone’s face, that’s the central governor saying I’m done, right? Don’t I don’t want to go any place further. But when that quits, not in your face, maybe you’re kind of pushing through that central governor a little bit to a place that might not be healthy, but we know humans can do pretty extreme things that aren’t really healthy things to do in the case of emergency and maybe athletic competition. 2 (17m 43s): Sometimes since we’re not, you know, getting chased by lions out there are states of emergency now where we put ourselves in that space, our athletic competitions, you know, you know, you can look at the average suburban dad, maybe may driving your kids to soccer practice, going to work. You’re like, where’s that where’s that, you know, I’m a military person, you know? So it’s like, where’s that part of your life that you’re, you know, that part of you needs to be, you know, inspired and men, and that’s, you know, you joined a Spartan race or you joined an ultra where you’re going to challenge yourself to be in that space. You know, we’re, you’re either gonna turn on the governor and step off the course or slow down or ignore the governor and go somewhere that maybe you haven’t gone before, you know, that’s how people make breakthrough performances. 0 (18m 31s): Yeah. I think the key here is to figure out how to turn it on and off. And of course, you know, you mentioned this suburban, suburban dad with the dad bot, I guess, as a term now, whether they’re just heading around and sitting on the sidelines, watching their kids play soccer and, you know, lost all that intensity in that things that really make us human. And so it’s great to put yourself on the starting line once in awhile and go forward and see what you’re made of. But I also think we have to figure out, you know, how to apply the governor, because if we just, you know, rage through life every single day, I mean, I had to learn the hard way when I was training for the professional triathlon circuit, that it was really easy to overdo it due to my competitive intensity and tremendous desire to win and to beat my time. 0 (19m 21s): And so I could go out there and work too hard. So I had to kind of have these personality aspects where, you know, there was the bad-ass on, on the starting line on race day, but also there’s this wimpy guy that needed his naps and needed his sleep and needed to stretch more and needed more food for the last 30 miles of the bike ride. And that’s a tricky part to figure out, I think, especially if people are, you know, leaning on one side or the other away from healthy balance. 2 (19m 50s): Yeah, yeah, for sure. And that kind of comes to like, you know, if you’re advising athletes or I’m advising people, you know, we talked a little bit before we started recording about cardiac testing. You know, so who is safe to kind of release that governor sometime and take yourself into a real place to stress. So I think if you’re out there listening, you know, make sure your cardiac health is good because you maybe have a bagel and pass out and that’s fine, you wake up. But if you know, you have a cardiac event because you took yourself to someplace, that’s not good because then you might not come home. And cardiac disease is prevalent out there, way more prevalent than most of us understand, even in people that are highly fit athletes, you know, you’ve written about Fitbit not healthy. 2 (20m 34s): And there’s some simple ways we can assess that in people, you know, is it safe for you to go charge up that hill? You know, do that Spartan race all out, all out, or should you keep the governor on a little bit more 0 (20m 49s): Suppose for most people, they, they would probably get a, a clean bill of health and be able to go and, and maybe maybe get in better shape, push themselves a little more in general everyday life. But tell me about that kind of category of the, the chronic athlete. Who’s maybe built up for years and decades into a high risk category of heart disease. 2 (21m 12s): And it’s very hard just to look at someone, listen to their heart, look at their blood work, Brad, because you can’t see under the hood. You know, you could look pretty well. You can look bleed, you could have normal cholesterol. And that could mean absolutely nothing. But what we need to know is the status of their artery health, you know, are they developing any plaque on their arteries? You know, I’m in the stress test lab every day and I’ll ask people, well, what causes a heart attack? And they’ll kind of look quizzically at you. Well, no one’s ever asked me that, would they say, well, a blockage. And I’m like, well, what’s a blockage. Like, you know, when you have, you know, when you blockage, right, that’s what it is. But they’re not really clear on what they, they think, okay. A block two a day. 2 (21m 53s): So you have a kitchen sink, okay. It’s 70% blocked. It’s 80% blocked. It’s 90% blocked. And now you have the blockage and that’s kind of what they think. But that’s actually not what happens. So what happens to cause a cardiac of them, you know, a myocardial infarction, the Widowmaker, whatever you call it, as you have a little piece of plaque on your arteries and that little piece of plaque ruptures. So you don’t need a full blockage to have a heart attack, or all it requires is a little bit of plaque on your arteries. And then one day, you know, by the grace of, you know, what’s happening that day, that piece of plaque ruptures, you know, for example, the highest risk profession for cardiovascular events are first responders, police, and fire. 2 (22m 37s): Their average life expectancy sadly is 55 years old. And they die of heart disease because 1% of their day is sheer stress. Someone pulls a weapon on you, you enter a building. And if you look at just the average police or firefighter, their lifestyle is full catastrophe to develop insulin resistance or diabetes, you know, their circadian mismatch, poor sleep, high stress food at the station, you know, so they’re just cardiovascular disease in the making. And then that one day, you know, they go out for the call and they, they don’t come home, but there are plenty of type A athletes out there probably similar that, you know, sign up for a triathlon, but their corporate lifestyle, you know, it’s probably not optimal. 2 (23m 21s): And the development, little bits of plaque, you know, stress a little bit of prediabetes. You know, people don’t understand what that is. Maybe a remote history of smoking. And now they kind of found religion and quit smoking and took up triathlon. But they’ve got plaque on their arteries and they don’t know it. And these people, sorry, we do a couple of types of tests here at my hospital. I run the cardiovascular lab and we’re reduced stress testing, multiple different types of testing. So there’s the standard stress. I think that may have been what you had, Brad, they put you on a treadmill, okay. Up to an EKG game on how far can you go? And how fast can you go? That’s mostly a measure of fitness. If you’re listening to this and you’ve had that test, it kind of tells you how fit you are. 2 (24m 2s): And it tells us what kind of your immediate risk of a cardiovascular event is. Is there something staring right at you that day that don’t go run today, go get checked out. Okay. We see something on the EKG. You’re getting angina, but it doesn’t tell us much at all about your 10 year risk. That would be, what’s called a coronary artery calcium score, which costs about $99. And I think, I think you’ve spoken to people about that test Brad or in your books, but what that is, it’s kind of the mammogram of the, of the heart. So it’s a quick CT scan and it’s available all over the world because about 99, maybe $120, but it gives you a score anywhere from zero to, you know, holy blank. 2 (24m 47s): You know, you’ve got a lot of plaque and that tells you, that’s where it tells you, you know, what your ten-year risk is. So the combination of the standard stress test, which tells you your fitness, which is important, people that are fit overall have less cardiovascular events, right? They’re there, they’re able to deal with cardiac workload without putting too much stress. You know, so if you can go, like you said, Brad, you probably went to stage five or six, you know, fine. So you can go walk the dog without it being a severe stress on your body. So many heart rate goes up to 170 at, at a crawl. They’re basically putting themselves in high intensity stress, getting the mail. 2 (25m 28s): So the fitness markers important, but you could have been somebody who went to, you know, stage five on the stress test, but has plaque all over their arteries. And you just don’t know it. So both of those tests can give you good information. And we use the calcium score for military pilots. It’s the only test that we really trust to be able to determine what someone’s cardiac risk is, you know, before they would fly a performance plane. So, so that tells you how important that test is because the military, we just look at data. We’re not looking at opinions. We’re looking at data. 0 (26m 1s): He’s a really nice guy though. Oh mercy. So the stress test is taking one step beyond the EKG, measuring your heart at rest and seeing how your heart reacts to the treadmill effort. And so are there things that show up for, let’s say the, the athlete, who’s sitting on a chair and does an EKG and it looks good, but then you get on the treadmill. And are you looking for, what’s the, what’s the abnormality that’s going to give you a concern, 2 (26m 32s): Rarely, rarely see these things. So someone’s having say, for example, Brad, every time you go walk up, is it your, you’re a speed golfer, right? So say you’re just an average walking golfer. And the 18th green is like up a steep hill. You know, every time you’re walking up that steep green, you’re getting this horrible kind of shortness of breath and discomfort and it’s getting worse and worse. So we want to kind of, okay, is that just some heartburn or is that what we call ishcemia meaning, lack of blood flow to the heart, with the demand. So we would put you on a treadmill and see, okay, let’s try to replicate that symptom. And let’s look at the EKG. There’s some markers on the EKG that shows some segments of your heart are being, what’s called under perfused. Meaning they’re not getting the right amount of oxygen when the heart is beating faster. 2 (27m 17s): So, so, but those are not the typical story should get, but that’s, that’s the purpose of like a diagnostic stress test. Meaning you’re trying to answer that question. If it’s just for screening of who’s at cardiac risk, it’s not a good test for screening because people define, they don’t have symptoms, but it doesn’t tell us who has plaque or who doesn’t have flat. So your fitness level gives a little bit of information. The more fit people. It’s all about odds. None of us get out of here alive. So it’s all about out. And so if you can exercise, you know, to, you know, fully fit VO, two max, 60 person, your odds of an event are less than the person that you know, can give to a VO two max of 10. 2 (27m 59s): But as you know, you’ve had friends, you know, who could crush it on an iron man who’ve had cardiac events. So, so they were fit. But under the hood, they weren’t healthy. Something going on in their cardiovascular system was, was, was not healthy, even though they were super fit. So the combination of that test telling you more your fitness and then something that tells you the status of your arteries would be kind of the good, you know, like you took your car in, right. You know, short-term check engine light. Okay. Here’s maintenance, longterm check, engine light, or both things looking good. 0 (28m 37s): Oh, so you really need the combo. I guess I misunderstood. I thought the stress test might be catching these poor, tragic stories like Ryan Shea running in the Olympic trials marathon. Obviously he would’ve crushed. The stress test would have been fine on a stress test, but so he needed the one, two punch of the coronary calcium score. And in all cases, or in almost all cases, do you see, you know, some poor results on that calcium score in a fit person? And that’s the red flag? 2 (29m 6s): Yeah. So you can predict who’s going to have calcium mostly by their state of metabolic health. So people with insulin resistance, which would be that pre-diabetic, pre-diabetic state high triglycerides, low HDL hypertension, a little bit of a belly, almost a hundred percent. If they meet criteria for insulin resistance or the metabolic syndrome, they have plaque, you know, they, they have plaque, Dr. Joseph Kraft published a book in 1976 with 3000 matched autopsies of glucose tolerance tests with insulin curves, not glucose curves, insulin curves. So he saw what was happening with the insulin spikes when they would have a carbohydrate meal. 2 (29m 49s): And then he had matched autopsies. So he would call a diabetes insights who, meaning diabetes is there, but you just don’t see it yet. So these people that have high insulin spikes, glucose was still okay. They all had cardiovascular disease. So he said, there’s finally find me a patient who has cardiovascular disease, who says they don’t have diabetes and I’ll prove to you. They’re not diagnosed. So he would use an insulin assay tests, not waiting for the glucose to go high. But yeah. So if they have kind of the full Monte metabolic syndrome, high triglyceride, low HDL hypertension, impaired fasting glucose, and just a little bit of waist. As, as our friend, the doctor Maffetone would say is two times your waist should be less than your height. 2 (30m 36s): You don’t need a fancy scale or like in the dad bod scenario, look at yourself in the mirror, where are you carrying your fat? If you got a little belly, you know, buyer beware. A patient just like that this morning, you know, pretty fit guy, hiker, belly, horrible metabolic syndrome. He’s going to go get, he did fine. He was hyper. He walked fine, but he’s likely going to have some plaque on his arteries, but he just needs to know. I mean, that’s why we do the tests. Maybe his genetics somehow cleaned that up. Some people have good housekeeping and can clean up plaque. Other people don’t have good housekeeping. 2 (31m 16s): That would be indicative of good housekeeping? 0 (31m 19s): Yes. Yeah. So high HDL that if you’re a listener there and you pull up your lipid panel, the most important kind of equation, there is your triglyceride to HDL ratio. So high triglycerides, low HDL is a marker for insulin resistance or metabolic syndrome. Ideally your HDL is higher than your triglyceride. So if you have a high HDL and mine’s like 110 and my triglycerides are like 30, you know, this is a wonderful high protein, high, fat, low carb diet is good. That’s how we’re designed to live. Mine was way different than that before I started eating this way. 2 (31m 57s): But that’s a marker. But again, people may show up at eight, six, and they may have, you know, read Mark’s work 10 years ago. But up until age 50, you know, they were full catastrophe. You know? So yeah. I mean, I’ve had colleagues here, you know, who’ve survived cardiac arrest who are really fit runners, you know who, yeah. But prior life, you know, they were corporate kind of like the Jim Fixx story. Right. I think most people know about him. He was a smoker overweight. Then he decided to find religion. And he wrote the Complete Book of Running in 1976. And then he went out for a run and he didn’t come back. But the backstory to that is he had significant chest pain for like three weeks before his event. 2 (32m 42s): Even went to his doctor. And his doctor said not go ahead, don’t run. But you know, I’m a runner and you know, you’re a runner and athlete, but there was something like he was so type A and then he was probably treating his nicotine addiction with his running, like the thought of not running. Like, no, I gotta run. And you know, so, but unfortunate, but I don’t, you know, we’ve learned a lot since 1976, but unfortunately there’s a lot of things we’ve learned, but not really promoted out well about metabolic syndrome and cardiac health. 0 (33m 21s): Oh, well, speaking to that and putting question out to, to your peers, when are they going to get with the program? Because we still kind of have to absorb this, this flawed and dated message that your, your total LDL is a concern you’re going to get prescribed with statins, if you have a high LDL. And it seems like this triglycerides to HDL ratio is being spouted by many of the leaders in the ancestral health and progressive health movement. But I’m wondering why it’s not translating quickly and urgently into the nightly news and into the doctors across the world. You get getting with the program in that sense, 2 (33m 59s): You know, I wish I could answer that, Brad. It is kind of sad because all this data is in their own journals. This isn’t just, you know, being presented at ancestral health conferences 0 (34m 10s): Or Mark’s wild ideas on the podcast. 2 (34m 12s): Yeah. It’s in their own journals. You know, Ron Krause’s article last year in journal of American college of cardiology, exonerating, saturated fat, three members of the dietary guidelines committee were on that paper, you know, and it went through all of this, you know, in their own journal. There was another two article series just this summer in the JCC, this journal of American college of cardiology, talking about cardiovascular disease from a metabolic standpoint, meaning we need to redefine metabolic disease from an adiposity and glucose dysregulation approach, which was insulin resistance. Like this is the root. So it’s in their journals, but you know, I’m, I’m not a conspiracy theory person about medical training, but, you know, changing any institutional thinking is like moving a battleship. 2 (35m 0s): And our industry, you know, is a for-profit industry. And it’s driven by Pharma, you know, because the ads are out there. Us and New Zealand are the only countries that have direct to consumer advertising. You know, much of the medical training is sponsored by Pharma. You’d go to these conferences. It’s like a Pharma Fest. You know, you remember going to like, you know, Ironman expo, you know, you’d have all the bike companies there and you know, all the goo companies there’s. But if you go to like a medical conference now, other than, you know, something in the ancestral health world, yeah. It’s just like, wow, this is crazy, right. It’s just products and drugs and treatments. You know, we, we treat the smoke, but there’s no financial incentive to the . 2 (35m 42s): The system to make illness go away. We’re not a national healthcare system. If we were, I think we would incentivize that more. But you know, we’re a for profit healthcare system. And until, until that paradigm changes, I think what I’m doing will still be an outlier. You know, I’ve been doing this 10 years and I don’t see a lot of forward progress. You know, it’s kind of one doc and it’s almost a patient driven thing, Brad, where, 0 (36m 8s): And some patient comes in, waving a wave in a book and a challenging the doctor. I love it. Yeah. Why not be patient driven? We don’t have to wait around 2 (36m 17s): Exactly. It’s open access world patients now can, can understand more than their doctors about their own illnesses, as long as they go to the right sources. Right. They don’t want to just go onto Pinterest and pull something up, but people are pretty savvy. Now, you know, they go into the medical literature and then they can bounce things off me. But no, no. We want to empower people to go into the literature, understand like the gentleman this morning, there’s a smart guy, so, okay. Here’s a couple of references. Just go look up coronary artery calcium, you know, go to pub med, read a little bit about it. You know, look up triglyceride to HDL ratio, put that in your search engine and metabolic syndrome and cardiovascular disease. I just tied those together. 2 (36m 60s): And your phone will blow up with articles in Lancet, New England Journal, JAMA 0 (37m 12s): Better shape legit stuff. Well, that’s a, that’s a good point that you make that it’s now leaking into the medical journals, especially the diet associations with your heart disease risk. Because I think previously, and this is sort of in defense of the medical profession, it’s really sick care and disease care is the main focus and the, and the, the main training. And so it kind of had be obligation of a hobby. If you’re a medical professional is astute with, you know, the latest and greatest dietary findings, because that’s not their area of training or expertise. I know they like to talk and spout and tell people to quit eating so many eggs. If their LDL is inching a little high. 0 (37m 53s): And I have to process those recommendations from family, friends, and loved ones, you know, in real time right now. But if now, if this stuff is in the medical journals, then the, the medical professional is obligated to keep up. I know you have to get your points and here you’re training and you should be reading that stuff. So yeah, we can put pressure on the patient driven side to ask your doctor five questions. And if they, if they answer then there, then you can stay with them. Otherwise, you know, shake your head a little bit. But one was, I just heard this on a podcast. Someone said, I’ll tell you if a dieticians, a trained, registered dietician is up with the, with the, the science and the, the emerging science or not ask them one question. 0 (38m 34s): You know what the question was? Does the human need sugar to live? And if, if the dietician says, yes, then you can say, okay, pal, you know what? Go, go look at these medical journals and see, see what’s going on. But I think it was referencing the, the, you know, the, the, the dietetic association, diabetes associations, own recommendations that you want to blend in a strategic amount of carbohydrates to control the disease, which is absolutely shocking. 2 (39m 3s): Yeah. I’ve got a monitor on my arm. I can make it a week with no hydrate with bench. You know, some non-starchy edge. I think that’s good for the microbiome, but yeah, I think it was the Institute of medicine report a year, 2000 Brad that said there is no essential carbohydrates. Right? Right. There’s essential amino acids, you know, which should be balanced. And animal products have the right balance of essential amino acids, higher quality, protein, essential, fatty acids. Most of those are going to come from your natural sources. Not stuff made in plants, you know, no industrial oils. It’s going to come from just a mix of ancestral foods that travel with the protein, right? 2 (39m 44s): So you got eggs, you’ve got nature, cut fish. She got some avocado in there. Olive oil, it’s good quality, it’s good fat cheese, real butter II, or coconut oil. Those things that would taste good. You know, like the good Dr. Cate Shanahan would say, you know, you know, it’s a good fat, if you could taste it and it tastes good. Oh, interesting. 0 (40m 8s): Right. As opposed to downing some canola oil. 2 (40m 12s): Yeah. No, there’s a primal kitchen dressings. You can drink them like smoothie, you know, could you imagine just picking up Wishbone or one of those, you know, a couple of brands, you know, there’s Kraft brands or lumens, you know, made with olive oil. It’s like canola oil canola oil. The last ingredient is olive oil. 0 (40m 30s): Same on same on Paul Newman, 2 (40m 34s): Charity, but killing people at the same time, maybe 0 (40m 36s): Speaking of olive oil, I mean, I’ve always gone and tried to source the extra Virgin olive oil as were dutifully told, but the difference between a truly fresh first cold pressed, extra Virgin olive oil and almost everything else you can find is shocking. And the, the, the markers there that it burns, it burns in the back of your throat because of the antioxidant potency. And I just joined the it’s called the olive oil club, or it might even be called the olive oil club. You could probably find it, I’ll send a link, but this guy ships the very fresh processed first cold press only, and you take one spoonful and you’re like, wow, your, your mouth is on fire. 0 (41m 20s): And almost any other brand, even organic, whatever the, the fancy label says is relatively dull, even though it’s, you know, much better than the, the plastic jugs from the big box store. So there’s definitely a hierarchy where you got to go for the top with the fats 2 (41m 35s): And my family. My last name is Cucuzzella they’re psyllium farmers, olive oil farmers. And we used to go over there when I was stationed over in Europe. And this is when you can travel with liquids, but they would give us like a big, like petrol container, like five gallons of pure olive oil. And the stuff was like dark green. It was a commodity, like, you know, you’d bring it back to the base. And people are like, they come over and they’d have this olive oil and they’re like, they would trade. Like, what do you want? Give me a little bottle of that for them. Yeah. Like if you’ve never tasted like that real first press, I don’t think even understand it. Like I can’t get that kind of stuff. Maybe I’ll look into this olive oil club, but you know, like that stuff right out of the farm, that is just so like, it was a color green that you couldn’t even describe. 0 (42m 25s): I want to go back to that calcium score for a second behalf of my super fit, super healthy, lifelong athletic friend. And he went in there, he likes to do self quantification and test everything. His blood work is outstanding and he came up with a big fat high score. Oh man. The CAC. And so I’m wondering is some of that benign because it’s calcified to the extent that it’s just there. Why would someone who’s had a lifelong history of, you know, fit health, fitness, maybe a little excessive fitness is one of those key factors in, in the past. But if you’re eating clean, you’re doing everything right. 0 (43m 7s): How does that look on those cases? 2 (43m 8s): Yeah. So you’d have to look, you know, when you say it’s kind of a CAC score, so we’d look at them from zero, you know, so, I mean, if you could share what his score actually was something in his fifties, like, was he in his fifties, sixties? 0 (43m 28s): Yeah. So that’s pretty high that puts them at about the 90th percentile for age It’s information. So people have cardiac events from plaque ruptures, so the stable plaque and unstable plaque. So if he had a score of 400, was smoking, fully diabetic, going through a divorce, not sleeping, you know, it’s a big, hot mess, right? 2 (43m 50s): Like he’s, his plaque is not stable. Now he could have been, for example. So say your 55 year old buddy before he found sport was a three pack a day smoker weighed 300 pounds. And then a, you know, he read Mark’s first book, you know, and lost a hundred pounds. And now he’s good. You know, his A1C is good. His triglycerides are low. Like if all of his, you know, if all of the markers of the fire or out likely, and then the only way to know. So we don’t recommend redoing that test every year, but maybe about a three-year interval. So he should, you know, talk to someone who really understands all the drivers of inflammation in the heart. Cause there could be something he could have sleep apnea. 2 (44m 32s): Maybe you don’t even know it. You know, maybe some at work is stressing them out, right. Maybe he just has the, is a dude and he doesn’t want to talk about it. He’s gone through something really horrible. Because we know that there’s stuff we understand and there’s stuff we don’t fully understand. And you just would want to kind of do an assessment, make sure you can control the things you can control, recheck it in three years. And this would be a person that I would encourage not to do some extreme type of event until you know, that that plaque is stable and that he’s doing everything he can to create that stability. So training for an iron man with a score of 400 by itself with a full-time job is probably an inflammatory state. 2 (45m 18s): Now, if he wanted to just, you know, go out and run and ride and have some joy and maybe, you know, do a low key type of event, you know, that isn’t like a big deal just to go get in the game a little bit. I think that’s cool, but I think you’d want to do like a HS CRP, you know, make sure, cause that’s kind of a more of acute marker. There’s a cardiac CRP, which is a marker of inflammation and that person you might want to put on a low dose statin. And you know, so I know there’s controversy about which patients benefit from the stat. So there’s this pleiotropic effect of statins. We have Tropic means there’s a multitude of effects. We don’t fully know, but it’s not, it’s not LDL cholesterol lowering there’s other anti-inflammatory effects. 2 (46m 0s): So a low dose statin medication, and this is in the data. So we know that the people that have scores of zero, meaning they’re not going to rupture a plaque, giving them a statin doesn’t change anything. Cause they’re not going to rupture a plaque, no matter what their cholesterol is, but the people are going to have scores in the 400 range. There’s data that iStat and in that group can be beneficial to reduce their odds of a cardiac event. But it doesn’t supersede like if the person was fully diabetic and smoking and took a statin and the is probably useless, you better quit the other things, but these doing everything else. Right. You know, and I have patients just like that in my clinic that I would suggest unless they’re having muscle cramping, you know, like one of the wall water-soluble statins, which are going to have less side effect previs statin, or it’s called LA LA live a low is another, I’m trying to remember the generic name of that. 2 (46m 54s): But, but those are going to be more tolerable for athletes with the same effect. So talk to someone. So it’s not like black and white on the statins. You know, that person probably should take a low dose baby aspirin, you know, just for the event, they, they did have a rupture, but for hundreds of pretty significant score for someone in their fifties, not they were 99 and they had a 400 score who the hell cares. They’re 99, right? They’ve lived long enough. Anyone who lives that long is probably going to have some plaque. But at that young age, that’s a real score. 0 (47m 27s): Now, if you repeat the test, like you recommended and your score kind of plateaus, because I believe this, this calcium scan is an accumulation of plaque over lifetime or whatever. And so if you have a stable score two years, five years later, I guess you’re, I’m giving an indication that the plaque is stable. And I do, I understand that you can’t reverse that number despite the cleanest living possible. If you, 2 (47m 52s): Yeah, it’s a good question. You know, what we really want to know is who’s having more or less heart attacks, not what specifically happens to the score, you know, because as soft plaque calcifies, so people could actually be getting healthier and have a little bit higher score because some of the soft plaque they have, which would ultimately become hard plaque might calcify. So they might have a little bit higher score and still be fine. It just, but if it’s, if the score is like going up by a significant amount, you better sort that out, why that’s happening. Vitamin K2 is something now being used to make sure that vitamin D level is good. You know, some other supplements might be able to kind of reduce that plaque burden a little bit. 2 (48m 33s): So there is some, some research going on now into reversal of CAC, but we don’t know yet whether that, whether that equilibrates to less events, cause all it it’s unstable plaque, which by looking at that calcium score, it doesn’t tell you much about what’s stable or unstable. That’s more, what’s happening to the person in front of you. You know, there’s someone, who’s got a lot of inflammatory issues in their life. It’s going to be unstable. If there’s somebody who’s got everything, you know, they just, you know, found Buddhism after their life. And they’re just living a life of love and giving and whereas, you know, minimalism that they’re probably going to be okay. Like if they just let that, if there’s somebody who’s let that part of themselves go and every now and then we’ll see that not very often, usually it’s hard to take the type A out of somebody. 2 (49m 23s): Have you ever seen that happen? Bradley? You seem like someone who is like in that world, but now, now it can ride on the mellow side of the road. You know, we ride on the right side of the left mark. 0 (49m 36s): I appreciate you bringing that up because that is absolutely my profound life goal. That’s been carrying on for a long time because I identify myself, you know, pursuing the career of being a triathlete and their level of training and pain and suffering that it entails. It’s kind of A type a endeavor, right? It wasn’t, I wasn’t a bowler. I was out there punishing my body day after day. And I had to learn the hard way in that journey at the highest level of, of athletics that you can get in your own way. And in fact, be your own worst enemy and your competitive intensity and your drive and your focus and your dedication can all serve to harm you if they get out of hand. 0 (50m 17s): And so I had to kind of grow and learn to, you know, get over myself and kind of have a, a more calmer, kinder, gentle approach to how I train my own body, as well as my mind and where I placed the significance of my results and, you know, trying to not align that with my self esteem or my, you know, my, my overall view of the world. And so I think that’s a wonderful lesson to carry forward into everything I’ve done, where, you know, we got to work hard, we want to do the best we can. We want to make a contribution, but certainly not getting caught up in the ups and downs. And the, you know, w whether we get external recognition that we, we, we, we think we deserve and all that thing. 0 (50m 59s): So it, it’s definitely a daily battle. And I, I, I encourage more conversation about this because boy, isn’t it true that the origination of the term, Type A, can you tell us where that term came from? I think you’re going to get the answer, right. 2 (51m 12s): Okay. You know, I don’t, I don’t know that, or I’m trying to remember the origin. 0 (51m 17s): I thought it was it. I thought it was for a heart disease risk category. You haven’t heard that. 2 (51m 21s): Alright. I’m gonna have to look it up and have to go find that if 0 (51m 26s): The doc hasn’t heard of that, that’s, that’s a big one. It might be hearsay, but you’re a type A meaning you’re in the top category for heart disease, risk and type B is, you know, type a, is always seen as a sort of, or mostly seen as complimentary. But maybe we should reframe that a little bit. 2 (51m 42s): All right. We’ll look that up and put a link in the show notes. They gave me some homework and I’ve used that word so many times in my life. I like digging into the origins of things, but I don’t know the origin of that. 0 (51m 55s): And we will, we will score that one people. Now, one thing you mentioned in passing, I wanted to, to check in on you identified as a pre-diabetic at some point, is that what you were saying? 2 (52m 8s): Yeah, I had, I was on military duty about 10 years ago and my A1C was up in the six range. And I, I looked like this, you know, kind of lean runner. And I was actually kind of in the, you know, probably eating like 8,000 calories a day. And so they’re trying to figure out what was going on with me. And they sent me for a test called a C-peptide, which is a measure of insulin production. And my level was 0.3, which most of the diabetes we talk about now is a high insulin state, insulin resistance. But the other type of diabetes, you don’t make enough insulin. So I was in on that side of the, of the house and they put a glucose monitor on me, you know, similar to the one I wear on my arm now. 2 (52m 54s): And back then they were like, these reads more research type of things. And, and didn’t give you a real time reading that I could see, but we downloaded it three days later and you saw what would happen. So I would, I was eating the runner diet, right? So I would have a bowl of cereal. My sugar would shoot up to 250 or 300. So I didn’t have a good first phase insulin response. But my second phase insulin response was there and I was massively insulin sensitive. So sugar would go up. Second phase insulin response would kick in my muscles were insulin sensitive and I would crash. So I would wake up every, it was happening for like, I don’t know, two, three years I was waking up at 2:00 AM every morning, like needing to eat. And I was just, I was thinking, well, I must, it must be because I’m running. 2 (53m 37s): Right. I must need the calories, but it wasn’t because of my sugars. I going like this. And, and at the same time I’d been working on obesity and fitness tests for the military and had come across low carb diets for obesity. So immediately I knew that it wasn’t a dangerous thing, even though all my medical training told me eggs were going to kill me because my dad had a heart attack. So I just turned the food pyramid upside down in a day, started checking my sugars and get my A1C out of that diabetic range, which kept me able to serve in the military. Cause if you have diabetes, you’re discharged. Wow. So now I’m kind of, I had some chicken and a burger without the bun and you can see what happens. 2 (54m 23s): Three eggs in the morning. See what the scans are. 0 (54m 27s): He’s zapping his continuous glucose monitor people. Yeah. 2 (54m 32s): Yeah. It reached through my jacket here, but it stays good. It’ll kind of be probably in the 90 range here. That’s not picking up right now, but you know, I mean, if you look at my, my timing range, you know, going through is good, but I have fruit that goes up, you know? So just people learn from these continuous glucose monitors of take my jacket off and maybe I can grab a, 0 (54m 59s): Did you, did you eat, did you eat your way into that condition from the 8,000 calories? I mean, someone who’s eating 8,000 calories a day, I know you’re burning it off running a 2 24 marathon, but you’re talking about a massive load of carbohydrates for a person in 150 pound body or whatever your skinny runner frame is. Is that a contributing factor to that condition? 2 (55m 21s): Yeah, it’s hard to know. So when people don’t make enough insulin, some of it’s auto-immune meaning the body has this attack. It’s auto-immune but most cases in adults who get this as called idiopathic, meaning we don’t know. I mean, I guess you could theorize, like, you know, the human organisms not designed to eat the runner diet since age 13. So maybe I did just, you know, tax my pancreas too much from the diet that it just said, uncle, you know, I can’t make anymore viral insults, which are transient, you know? So when you look at people who develop these conditions, sometimes they’re antibody positive. You know, they have an auto antibody, but the majority of the adult cases who have, who aren’t making insulin in sufficient amounts, it’s they don’t know. 2 (56m 3s): Right. And, and you just kind of hope that it was a static situation where you still make a little bit, cause you don’t, you don’t need that much. Like if you eat low carb, you know, you could make just a little bit and stay good. Conventional wisdom would be, well, gosh, you’re going to have to go on insulin, but that’s only if I eat a standard American diet, I’d be on insulin, but I don’t. So I can keep things, you know, in a safe range just by and it’s joy. Right? So the foods I eat or I look forward to my next meal, cause it’s going to be a ribeye or a piece of fish or a big omelet with fresh stuff in it. I mean, that’s, that’s joyful food, you know, stuff that you’d have in your cookbooks. 2 (56m 48s): You know, 0 (56m 48s): Now you’re still putting in a lot of energy expenditure with your running. And so how does that sync up with your, you know, significant restriction of carbohydrates? Are you uniquely qualified to try this? Would you recommend it to another runner or is there a place for strategic inclusion of carbs based on one’s individual particulars, but especially one’s energy expenditure and especially your age. I mean you’re pushing your body at a level that’s, you know, unlikely for, for many people in their fifties. 2 (57m 19s): Yeah. That’s a great question. I think that last part is individual, you know, so, I mean, you wrote about in Primal Endurance, you know, that metabolic flexibility and fed adaptation. So three years of low carb diet, I can oxidize fat at 90% of my VO, two max in a, in an exercise lab, you know, so be running it, you know, close to six minute pace, burning fat, and that’s a good place to be, but that’s a long-term adaptation. Most people flip that switch at, you know, 40 to 50% of their VO, two max, they flip over to carb oxidation 0 (57m 54s): Walking to get the mail, man. 2 (57m 56s): Yeah. And I burn the carbs. So that’s a process and that’s just a choice, you know, that’s a good place to be. I mean, you can burn glucose so you can burn fat, you know? So for endurance training and endurance racing, burning fats, a good place to be. Now, if you’re don’t have any problem medically with producing insulin or insulin resistance, you know, some of the exact theory you’d listen to him, say he’s a massive fat burner, but on race day or some of his harder training runs where he’s kind of burning matches a little bit, you know, sure. He’s going to start trickling in a little more glucose, but you know, the big tank is still, it’s like an electric battery and you’ve got a little gas engine, right. But electric battery is the predominant that’s fat burning and you’ve got a little gas tank, you know? 2 (58m 39s): So the gas tank, you know, you light up when you’re just like you’re in a Prius or something, you’re driving up the hill, right. The gas kicks on and then you’re in cruise mode. So yeah, if you’re racing, you gotta have a little of that gas mode or else you’re going to get dropped. Tour de France. You know, Chris Froome, you know, became tour champion. He went through a low carb diet. So he’s like the best fat burner out there, but sure enough, you know, on those big mountain stages, you know, he’s trickling in carbs, you know? So he’s basically riding the electric battery until they hit the base of lap duets. And then boom, you know, he’s got a lot of glycogen still left in the tank. So work on that. I think every, if it’s a human trait, a healthy human can use fat for fuel. 2 (59m 22s): I mean, I think that’s probably a safe thing to say, you know, when we’re sleeping, when we’re walking, when we’re running, that’s just in our DNA. Sure. Use glucose when you need it. That’s fight or flight. But the majority of the day, we should be able to access fat for fuel. People who are becoming obese, high insulin, state, diabetics injecting. And these are type twos, not type one diabetics. They basically fat trap do. They can’t access that, that tank. So they have to burn carbs. So they’re set up that way. So you get the insulin levels down, slow down, right? Like you say, slow the F down, breathe through your nose, use your diaphragm, conversational pace, teach yourself to burn fat. 2 (1h 0m 6s): It’s like the Maffetone pace, write your math tone. You know, what pace are you running while you’re burning fat, right? It’s 15 minutes a mile and it’s 12 minutes a mile. Now it’s 10 minutes a mile. You’re getting fitter. You know, Mark Allen used that approach 0 (1h 0m 24s): Going to, I believe it was five minutes and 18 seconds per mile or five miles burning fat. I mean, yeah. It’s phenomenal where you can, how you can progress. And then you pretty much have the best of both worlds, competitive advantage. Because like you mentioned with Chris Froome I didn’t realize he was a low carbohydrate eater. That’s really interesting. He’s a, he’s a 2 (1h 0m 43s): Drop the stone or a couple. Yeah. We need to lean down and you can see kind of like if you’re someone who is a fat burner. So if you look, this is, these are my 0 (1h 0m 56s): Hi it’s Mark showing his glucose monitor, which is with a very stable arc. In other words, no blood sugar spikes, just everything right there. And the, you know, the 70 to 90 range 2 (1h 1m 12s): The morning, right? It goes up to 1 20, 1 30. Good because you’re a healthy body, Brad , makes glucose. So I can go out for a run. If I did like high intensity, occasionally it’ll shoot up to like 180 range. Cause your body’s gluconeogenesis. So your body’s making energy. So that’s kind of that nice healthy rise. You go for a run, you make energy, you feel good to come home and you’re good. So, so like that’s a good, most people that can’t burn fat when they exercise their sugar goes down, we don’t want that. Right? 0 (1h 1m 41s): Sure. They’re burning through there, burning them all amount of blood glucose in the bloodstream 2 (1h 1m 45s): And they can’t get the fat. So then they bonk. But if you can make the energy, you can go all freaking day. Right. Other than like your foot hurts or something, you’re going to be fine. You’re only limited by, you know, what your muscle capacity is. You’re not limited by your fuel source 0 (1h 2m 4s): And your brain that central governor has a feeling of getting a hundred miles. Yeah. That’s that’s wild stuff. Mark. I’m so glad to connect with you. I know we, we could probably talk about a bunch of other things, but maybe before we go, I want to get a little plug for the barefoot and the minimalist shoe lifestyle. And talk about how you’ve transitioned. I’m sure you started out as a, as a regular, a runner with the giant waffle sole as seen on the cover of Jim Fixx’s book. And now in recent years, you’re a huge advocate. And I think, have you even run like a, some long distances? Barefoot? 2 (1h 2m 44s): Yeah. Half marathon SpareFoot of sandals. I ran a Boston marathon a couple of times and five fingers and then that’s for Archie sandals and I love them. But yeah, I, I squeeze my feet into tracks bikes for years and ended up with that hallux valgus deformity team. What that is is, is your foot looks like a shoe for those listening, right? You’re you’re like a pointy toe shoe. Your big toe is smashed in his opinion type of thing. But that comes from the footwear. So had some surgery done in the year, 2000 for that, you know, cleaned up some bone there. They straightened the toe out a little bit. And I realized just like nutrition. I realized that no one had ever taught me anything about like the foot or running injury. 2 (1h 3m 29s): So I kind of dug into the dark space on a footwear and the foot. And you know, this was before Born to Run, came out McDougall’s book and before Lieberman’s paper. So I started to have the shoe sponsorship with, with Brooks at the time. And they saw I was into this stuff and they were sending me some hacked off running shoes. They had a guy there and one of their designers was like from the old school. And he knew that like the way the toe box was and flat shoes like was biomechanically, you know, the engineers or the smart people in the room, not the marketers, you know, so The marketers, but I mean, from the scientific it’s, it’s the, it’s the nerds world of world. And I was like, oh my God, this is like, this works right. 2 (1h 4m 12s): And yeah. And then everything exploded. You know, when Chris McDougall wrote his book and Dan Lieberman’s papers, you know, the science started to come out and we opened up a shoe store here, Brad, about 12 years ago, promoting natural foot. We’re not everyone needs to be minimal, but why toolbox light, no heel elevation teach them how to strengthen their feet. It’s kind of like the food movement. Like eat real food, you know, put your feet and real shoes, you know, something that compliments normal anatomy and retrain the foot. So if you have a foot injury, don’t just brace it. You know, let’s try to, you know, what other extremity in our body, if it were hurt where we just brace it for the rest of our lives. 0 (1h 4m 51s): Well, our eyes, we put glasses on, instead of work those muscles, I had Jake Steiner on my podcast talking about how you can correct Miopia with just more, more physical exercise for the eyes and challenge. So we have the feed and the eyes that we disgrace with, you know, th the, the cast of the cushiony shoe. 2 (1h 5m 11s): Yeah, yeah. The middle, there’s a whole subculture in the military about eye training because they have to pass their eye tests. 0 (1h 5m 21s): Oh wow. 2 (1h 5m 21s): Like it, you could probably find them on the interweb. Just say, you’re a 20 year old kid and you want to get into flight school. Right. You gotta be able to see like Chuck Yeager. What if he can’t like, oh, you know, every minute of your life to that point in time has been like, you want to be checking here West Virginia. And by the way, check 0 (1h 5m 42s): Another plug for West Virginia. 2 (1h 5m 43s): Wow. That’s a big plug first man to break the sound barrier. But yeah, there’s some things you can do, you know, to, to train that focused in the lens and the muscles of the lens. So 0 (1h 5m 55s): With the feet we’re talking about trying to spend more time, especially around the house and safe environment with that within barefoot, coming back into the picture, Oh my gosh. In the hospital setting, they not discuss around barefoot. 2 (1h 6m 10s): Where’s my shoe. You know, like this is my hospital shoe, it’s black. 0 (1h 6m 18s): So he’s showing a shoe people that he can make The most minimal lack of support. Walk them down to wonderful 2 (1h 6m 27s): Coffee cup. 0 (1h 6m 27s): Can you put your shoe into a ball? That’s the, that’s the test if you’re a real minimal, 2 (1h 6m 33s): But your feet feel great at the end of the day when you are using them, you know, they keeps them springy. You know, that’s amazing 0 (1h 6m 45s): When, when you get accustomed and we want to talk about that gradual and gentle integration, but once you get accustomed to it, the most comfortable shoe imaginable is, is the minimal one. And it’s just because that’s, that’s how the foot’s designed to stand and support your body weight. 2 (1h 6m 59s): And you get that sensory feedback from the ground. You know, we could, we could do a show on this topic, you know, grounding or things. Some of them, I mean, there’s legit. I mean, it’s not like weird science there’s most of it’s just common sense, you know, evolutionary biology and medical anthropology, you know, this is just the way it is, you know? Right. Re re find it again if you’ve lost it. Right. 0 (1h 7m 24s): Huh? Yeah. It’s nothing, nothing new. It’s only a couple of million years old that we can function 2 (1h 7m 34s): Animal products, right? Like we somehow survived as a species searching for these foods and all right, 0 (1h 7m 42s): Well, ancestral living doing 2 (1h 7m 44s): Two Rivers Treads, and we’re on online. You could call us, we’ll walk. We do fittings. You’ll get to speak to a small town human and a small independent store locally owned by me. There aren’t many running shoe stores like that. Now they’re all like ombig corporate. Two River Treads.com. 0 (1h 8m 7s): And located in the great state of West Virginia, which is often ranked somewhere around 50 on a lot of those lifestyle categories. 2 (1h 8m 16s): The index right on 0 (1h 8m 17s): The cutting edge shoe store can, can top out any of those fancy states that are ranked higher. So let’s go visit that website, Mark. Thanks so much for the great work you’re doing in the hospital setting. We didn’t even get to some of those hot topics like how you got the sugar out of the cafeteria, but you’re, you’re doing great work and we’ll definitely get you on for a whole nother list of topics. So thank you very much. Thanks for listening 2 (1h 8m 45s): The day. 0 (1h 8m 46s): Preserve that cardiac health and go, go get those two tests. I like that. I’m excited. I’m going to go get a score myself. 2 (1h 8m 51s): Yeah, let me know. Yeah. If you need an order, I could probably even send something across state lines just to go get 0 (1h 9m 4s): Dr. Mark. Cucuzzella everybody. Thank you for listening to the show. I love sharing the experience with you and greatly appreciate your support please. 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