Welcome to the Wellness Transcription Podcast. I'm your host, doctor Patrick Gurley.
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Now let's get into today's episode. All right, guys, welcome to
another episode of the Wellness Transcription Podcast. It's been a minute since we've had
a show out and I apologize for that, but to make up for it,
I have got a wonderful guest on who's a true expert in the field
and not only a friend, but a true mentor of mine that took me
under his wing during pharmacy school and really push me to kind of stay on
the cutting edge of where science is going. So, without further a deal,
I want to introduce you guys, doctor Ryan Yates, a true pioneer
in the field and just a great all around guy. Ryan, thank you
for coming on. I really appreciate it. Yeah, Patrick, thank you
very much for having me. I've been looking forward to this. So,
as you know, my background is was for many years as a professor,
tenured full professor at the University of Tennessee College of Pharmacy, and in that
where my research focused primarily in the area of inflammation, so animal models and
discovery and traditional academic drug discovery. And then you know, before that,
when I was in pharmacy school. So bys my background, I have a
pharmacy degree and a PhD degree in clinical pharmacollege. Who always in pharmacy school,
I had an opportunity to do a lot of pharmacogenetic research while working at
Saint so they're a lot of interesting polymorphism and genotype screening, essay development and
really enjoyed that. And then as I said, when I finished pharmacy school
and then PhD and stayed on his faculty there at the University of Tennessee College
of Pharmacy, and then in twenty nineteen I retired and moved my laboratory my
research to the National Center for natural products research, where I do a lot
of work with your esteem father, doctor Bill Gurley, and he and I
Ronfay's one human clinical center there where we do a lot of human pharmacokinetic work
focused on dietary supplements. It's a really hot area right now, understanding the
pharmaco kinetics and oral dosage forms and all those pharmacy related things that pharma has
dealt with for years, and as pharmacists we really hadn't thought much of the
natural product world. But all that's changed the exciting time to be in the
natural product space. And so about four or five years ago I got into,
as you know, artificial intelligence and how artificial intelligence can be utilized in
the discovery space. And for me, the transition, in addition to retiring
from Tennessee, that transition was from a discovery really more from for a discovery's
sake to discovery for a commercial application sake. So I've been doing a lot
of work in the last five to ten years on translating a lot of the
work that we're doing in the laboratory into commercially viable and science evidence based products.
I think that's really where the interesting world of natural supplements is going,
particularly with the Federal Trade Commission's recent meeting December of twenty two a statement about
the requirement for if you're going to make a structural function claim for a dietary
ingredient, you need to back with a randomized double bliples see well control trials.
So it's a really exciting time in the natural product space. And so
that's what I've been doing the last five or six years, applying artificial intelligence
and doing discovery, particularly the diabetes you know, you know, I've talked
a lot about what's come out of that and the supplement that my group has
developed with commercialized just in the marketplace. Exciting time. We just got notice
of allowance of our first patent a couple of weeks ago from the USPTO,
the US Patent Trademark Office, so that's really exciting as well, and getting
finishing up our first clinical trial with that product and getting ready to commence our
second trial with that. So that sort of a little bit of background of
what I do and where I've been in the last twenty to twenty five years
in the space. I do think it's worth noting that, you know,
I think sometimes in science and research, when we make discoveries that we hit
a brick wall, especially when trying to translate things out of the laboratory,
particularly natural product space. We can discover I'm being hypothetical here, you discover
a cure for cancer, but it may be in a plant that doesn't commercial
you know, it doesn't scale, and so you don't have the opportunity to
really do that. We do some really interesting work a couple of years ago,
and I'll continue that at some point with America's Caffeine, continue playing yopon,
but ran into difficulty with the supply chain. So it started work with
a really interesting group called agg Launch, nonprofit group out of Memphis, Tennessee,
and so I'm doing some volunteer work with him. They're promoting specially crops
and how we move away from this commodity based agriculture of focus over generative agriculture,
and where that goes is making now discoveraging the laboratory and then being able
to work with seal trial specialists to develop supply chains for that. That's sort
of what what we look like in the future. So that's sort of broad
spectrum of area and interest, and there's a lot of depth there as well.
So you're kind of going to flip it back to you and say where
would you like to die in? Where do you think whether user or your
listeners would like to hear about. There's a lot to unpack there, and
I feel like there's four or five different topics we could usually spend hours talking
about there. I think what's what's interesting for me? And I'll just say
this when you when you and you came to when I first really got to
know you back in pharmacy school, when I was doing a coming up with
the business plan idea for trying to translate wellness and genetic testing and all that
stuff into a pharmacy type aspect. My dad I remember asking him and kind
of saying, this is where I'm interested, this is what I want to
try to do, and he was like, talk to Ryan. I was
like, okay, I'll talk to Ryan. And then literally within a few
minutes of talking to you, it's just you can tell there's just it's it's
beyond what I would have ever thought a scope of someone like me would be
in. I thought I'd just be a typical retail pharmacist doing retail pharmacy things.
And then you've really encouraged me to kind of push the boundary there as
far as where this field goes. I think the first part of your background,
your extensive background, that is where I'd like to dive in first is
is really just how I guess we sell a lot of supplements at our store,
and I think there's a basic kind of assumption in the supplement field that
there is all this research that's already been done. That's why these formulations look
the way that they do. I don't ever really get questions that often in
my day to day work with supplements about clinical trials and stuff that back up
their evidence. People just assume that that's already done. So I guess let's
just briefly touch on I can say briefly, but go into what it takes
to kind of undergo a clinical trial for a dietary supplement. What are kind
of some of the hoops that you have to jump through to get that type
of study going? And then I guess my second question to that, which
kind of bleeds into it, would be, you know, you talked about
the product. I'm very familiar with the product that you guys have come up
with. How where, why that product? Why did that start, what
interest got you into pushing that product as opposed to the yap On Holly product
that you mentioned that I'm also familiar with. So I guess just kind of
give us an idea of how all that comes to be and then how you
take that laboratory data and then translate it into a patent the thing the patient
can be fully invested in and understand just all the science that went into it.
Wow. So there's a lot there, and I'll try and take it
in the sequence that you ask, which is the first is really sort of
focusing on clinical trials and how that requirement is different than historical and by historical
I mean over the last thirty years. As your listeners know, the regulations
around dietary selfless. One of the one things that one of the things that
makes me WinCE as a pharmacist, pharmacologist and natural product guy is when people
say that supplements are not regulated. As you and I know, they are
extremely regulated, and oftentimes it's on the enforcement side just due to sheer numbers
and the number unfortunately bad actors in the space that makes it seem sometimes unregulated.
But again, as you know, the regulations are laid out very clearly
in the so called de Shay or the Dietary Something Health Education Act of nineteen
ninety four. And when that came out, it defined a dietary something,
a dietary ingredient, did define how these products should be manufactured under so called
cGMP. There is a language that pharma lives big pharma lives by right in
terms of just the rules and regulations around just producing something to be put into
a bottle. And what lagged in the regulations was, well, what did
you need to provide as far as evidence to substantiate your so called structure function
claims? And that may be a new term for some of your listeners,
but this concept of structure function and claim would be, for example, promotes
healthy blooded And what you see is the reason people use language different than the
pharmaceutical world is because, right, that's what that labels on there are your
bottles, right, which is that this product is not proven to or allowed
to be talked about in terms of diagnosed, treat, mitigate or prevent a
disease. Those are so called disease claim. So where I'm going with that
is when you start talking about how do I substantiate a structure function claim and
a human clinical trial. It's unlike the typical pharmaceutical trial where Okay, my
endpoint is lower in cholesterol for a statin and how that relates to law firm
morbidity and more mortality, but more disease type claims. When you do a
supplement human clinical trial, you have to be very clear and careful not to
promote your product and interpret the results in the context of that treat mitigating prevent
disease. And so you go back to your sort of definition in the d
Shay Act of a structural function claim. What is it you're trying to modulate
in the body, and how does that relate to a disease without directly linking
because you're not doing a doing excuse me, a clinical trial under a so
called new drug application or investigational new drug applicate right the traditional pharma path Now,
I'll take a quick aside there because oftentimes even people expert in the field
aren't aware that there's actually a provision, a pathway within the Food and Drug
Administration to approve disease claims, treatment claims for botanicals and so called botanical drug
approval rout And so there's been literally thousands of I and DS investigation new drugs
for natural complex substances for the treatment of disease, but only a couple of
products natural products have actually made it from the process into the marketplace. We
can talk at length about why that is. I'd be a discussion for another
day, but the bottom line is that's your typical disease claim. But back
to the clinical trial side is let's say that you are, in my case,
very interested in the liver. So why is a pharmacist, healthcare practitioner,
resurgery a lot interested in the liver. Well, it's really interesting how
the medical community, the medical education has become so compartmentalized, specialized that we
lose sight that we're treating patients. And that hit me in the phase this
past week when my wife is her mother another wads my mother in law.
She was needing to have to be seen by a cardiologist, and so this
was trying to get a cardiologist. Finally got a cardiologist and then oh,
well this guy or gal is a Vowels cardiologist. You need somebody that's an
atrial stib yeah, and so you need a specialist for a specialist for a
specialists. Yeah, I think that's been. That's definitely tricky. You know,
it's hard to just okay, you know PCP. Usually it used to
just be a referral to a cardiologist. Cardiologist. Hey, this isn't a
really crazy problem we got going on. Here's what we'll do now. Let's
oh, I don't know anything about the abnormal rhythmia is to your point,
let me forget you to this guy. Yeah, I can definitely see where
the frustration and the bills then add up to on top of that. So
that's I definitely share your sentiments there. Yeah, well I'm bringing it back
to the liver. Is. If you're a cardiologist, it's all things hard,
if your pulmonologist, it's all things lung and go on at length,
right, But what we know is that through clinical research and basic research,
there is oftentimes a common thread that runs through those different indoorgan disease states.
And so my research is focused on the liver as a contributor to chronic inflammatory
diseases. And so to that end, my research looks at right evolving if
you will, from or devolving back the way it used to be before farmer
right, we had the reductious approach, right, Your typical you have a
target and a small molecule in general that that modulates that target and gives an
out an effect, right, a pharmacologic effect. But it's really that sort
of reductionists. There's one pill, one drug for this particular disease, and
it's evolving that to more of the systems pharmacology. That's one of the things
that I wish I had more time to really talk about and educate people's concept
of systems pharmacology. So my first sort of experience in this concept of systems
systems thinking was in my first career, which was actually before my pharmacy career,
when I was in the United States Navy and running nuclear reactors on submarines,
and I was in charge of all the electronics on the submarine that were
related to the nuclear reactor. And if you're at sea, if something broke,
you had to break out the schematics and you had to figure out what
was wrong with the sister, you know, this capacitor or whatever. And
so I started I learned at a very young age how to think about the
entire system as opposed to looks I'm only focused on this resistor or this capacitor,
you know, as the analogy here is I'm only focused on this receptor
or as transporter. You look at the body from a systems pharmacology standpoint,
and so I think that's where artificial intelligence, not bringing it for a full
circle, allows us to consider the body as a whole. So you see
some really interesting work coming out now in the application of artificial intelligence, machine
learning, et cetera that says, Okay, you tweak this particular receptor and
you see this effect on the other side of the spectrum. And if you
look at specifically, what I'm interested in where my research began six or seven
years ago in this particular topic area and working with artificial intelligence, is how
do we approach diabetes as a holistic systems pharmacology problem? And I say diabetes
where diabetes is in my sort of mantra, is example of a chronic inflammatory
disease. And oftentimes in my mind, I don't differentiate. I'm at the
mechanistic level, right, molecular level. I don't differentiate between diabetes, metabolic
syndrome, Alzheimer's, chronic card disease, these sorts of things because of those
common elements that are linked back to the liver and so What my initial foray
into artificial entailors told me is you need to understand polyunsaturated statty acid metabolism,
right, your old omega three's and omega sixism. No, you know g
diet p s of it, but you've got to understand in order to understand
diabetes from a system's pharmacology approach, you need to start with polyunsaturated fatty as
metabolism. That's where I was pointed with the artificial intelligence engine. I was
working with fellow by the IMA wrong and Supermarprin guy who's in the tech office
for Hewlett Packard Enterprise now continues to blaze trails in this area. In fact,
he's got a one of the graduate students he funds at the University of
South Carolina is developing an artificial intelligence based algorithm for food substitution for type two
diabetics type one diabetics. That they're really fascinating topic as well. But so
where this all came together through the omega threees is we see all this literature
about how healthy health promoting omega threes, and we know your prototypicals right,
your EPA, your DHA, right, those hardcore polyen satuated fatty assets that
are in our officials are fatty fishes. We know their health promoting and study
after study, it's equivalent, right, we give people, you know,
look at fish intake, we look at their fishual intake. We look at
polyen satuated fatty asset, metabolism, etc. And frustratingly, sometimes you'll see
a connection to long term outcomes sometimes you want So that really got me started
down as pat and says, Okay, we know omega threes are imported,
but why is it that when we look at omega three levels there's no direct
correlation between omega three levels and outcomes in disease states. So that started me
thinking about sort of the systems pharmacology. Okay, yes, omega three's are
absolutely a critical piece to the equation, but there are other things in The
aha moment for me was three or four years ago when I read a paper
that was looking at two basic elements and their relation to cognitive declinin and so
of course they looked at you circulating omega three levels. Those with the highest
quartile of circulating omega three levels should have a reduction if you will, in
cognitive client but they didn't. We know that vitamin B twelve as a so
called methyl donor. We know methyl donors are really important for various metabolic processes
and brain health in particular. And so they looked at vitamin B twelve levels
and said, okay, now the highest quartile of vitamin B twelve levels and
these folks should correlate negatively with cognitive decline, meaning to higher the vitamin B
twelve, the lower the decline rates. They didn't see a relationship. But
then when they put the two together, meaning the highest quartile of the Mega
three's the highest quartile of vitamin B twelve Bingo, that's when the association popped
out. He says, yes, the MAGA three is important, Yes,
vitamin B twelve is important, but they're important together in a system's pharmacology way.
And so that started me down the pathway of developing a supplementation regimen that
would focus there. Now, I took a slightly different tech and you can
argue for various and Sunday reasons, whether it's from a sustainability standpoint or cost
or whatever is right. Is there a different way to think about omega threes
and how we promote omegas res in the body. Right, So instead of
giving official supplement an EPA or a DHA, and the answer is yes,
we absolutely can modify polyensaturated fatty acid metabolism, and by modify a mean influence
polygensaturated fatty acid metabolism with dietary ingredients that actually promote omega three formation from omegas
ree precursors at the expense of omegasix into the these like arachidonic acid right in
his pharmacy school, right, arachodonic acid. Everybody things right, Cox two
inflammation, right, everybody knows that arachodonic acid is I should say, as
taught, arachodonic acid is associated with inflammation. But arachadonic acid, right,
it's not too much of a good thing. Aracadonic acid is really good for
us. But because of diet, because of genetics, because of various as
sounded factors, that we get too much omega six. There's too much rachadonic
acid relative to those omega three's EPA and dha. So how do we manipulate
in a good way the body so that it produces more of those omega three
is relative to those omega sixes. Said differently, more EPA and DHA relative
to arachidonic acid. This is you know, and then ultimately relative to all
the satty acids, whether their monolin saturated fat acids, saturated fatty acids in
the body right in this so called ratio is the omega three index. So
my research focused on sesame seed oil in particular ligman in sesame seed oil.
This ligman is called sessimin, and sessimon is the ingredient if you will,
and sesti seed oil that drives that preferential formation of epa and dha at the
expense of arachodonic acid. And so you see sessiment promotes the omega three index.
But get that's only the first piece of getting the omega threes to where
they need to and so the next piece is, okay, how do we
activate those omega three So there's for years we have thought about omega three's purely
from an oral supplementation standpoint. Said differently, if we can get just getting
a little more EPA and dha into the blood stream, then we can get
those increases to where they need to go, so dha, for example,
to the brain. But that's not the way the body works, and so
well, if that's not the way the body works. Then how does the
body work? Well, it's really simple, and that is the liver is
responsible for taking those omega threes and other fatty acids, but particularly the omega
threes and converting them into a storage form in the liver. Said differently,
just because you have dhas floating around freely in your blood stream. Right,
we talk about unbound fraction and some nightmares from talking about pharmacokinetics, which I
talked for many years. Right, I'm down fraction. We talk about that.
That is not what makes it into the moraine meaning of the DH form.
It has to be in a transportable form of the way it gets there.
It starts in this storage form. So I'm gonna throw out techie term
here, right, nerdy term why sophoster ethanolamine so so called lpe SPCs,
as well as phosphatidal ethanolamine. So what your liver does. It takes those
omega three's and it stores them in the poster title ethanolamine form, so the
so called PE form. Okay, and I call it the storage form because
in order to activate. Now, think about you've got this storage form of
p It's sitting there preloaded with these omega threes by your living and it's sort
of stuck there in the absence of further conversion to the active. So here's
a term that the listeners are much more familiar with. The are so called
phosphatidal cholines or PCs that we convert our PE species. Those are megan freeze
here. They are in the PE storage form. When they're converted to the
PC form poster to coli form, that's when they increase their potential, their
activation energy, if you will write our enzymology and our physics coming back,
right, they're activated, and what's key to that activation, not surprisingly,
is methyl vitamin B twelve. Right, many also have heard of batain,
another supplement that's a natural right, and batain comes from our diet, the
dietary ingredient called coline. Right, most of your listeners here coline, you
think of cetal cooling exactly the same coline, right, dietor called it at
least as cetocoline and coolinergic synaptic transmission exactly. But it's also converted to batain,
which contributes that methyl donor pool. And so I'm gonna take a quick
aside here on the methyl donor pool because just within the past week. And
I sent this to you a couple of days ago. It's a fascinating paper
that was just published that looks at this concept of aging and biological clocks and
what really is the difference between our actual age and our biological age. And
what's shown very clearly from this study it's published and it supports what's been done
for the last twenty years and aging is that methylation status of our DNA is
the biological clocks say that differently your methal donor status. The ability to methylate
your DNA is directly related to your biologic age. As we age, that
methylation decreases, either because they're in less methylation or the processes themselves that require
methylation are starting to slow down. But the higher your methylation of specific sites
within the DNA, and we will go into all at them in this podcast,
but suffice to say, in regulatory region of the DNA, more mestilation,
the more that you are able to slow down that aging process. Right,
So that is the current thinking, and by current I mean within the
last week of biological aging clocks. So how does this relate? So now
you say, I'm sorry, So I just want to make an important point.
So we do at my work, we do a lot of long term
care patient management, so we have quite a few nursing homes that we deal
with, and you see this combination pop up over and over again. So
a lot of our patients that have dementia or whatever they're dealing with that's already
well established. We're already at the point of cognitive decline. We're trying to
slow it down. And I'm not kidding. Just about every one of those
patients to a degree, is on some sort official will supplement quality unknown in
some bordom, some form of B twelve. Now like they it's like they're
making they're getting there, but they're not quite making the full connection. It's
like, okay, we know these help, let's just give it to them
and see what happens. When in reality, I think what's important to distinguish
is having the idea of getting on top of it now, knowing how it
works. As far as preventing cognitive decline, I think is really important because
a lot of times you'll throw those on late after it's already established, and
then just hoping it doesn't progress. But I think that's really cool. That's
where my brain went, it's like, Okay, I've got all these patients
on these things already and we're not really seeing improvement. Why is that.
You've already answered that question. It's because we may not be methylating and properly,
we may not be converting that storage form that we've that we're giving the
patients and we're not facilitating that fospitual coaling build up. And then you know,
you just if that doesn't work, the next thing you do is up
to aceudocolonesteration inhibitor medications and just hopes that it doesn't get worse. Whereas,
what you're telling it, or at least what I'm hearing, is that this
is something that we should be focusing on im media to not even have to
get to that point. So I say that as it's very interesting that all
of that's finally starting to get teased out in what you're seeing in these papers.
Yeah, so you set a couple of really interesting things that triggered responses
from me. So first is upping the dose of the acelical master race inhibitor,
and we know the downside of that is, well the upside and side,
and so as you point out why we do that is because we don't
have the acetal cooling right, which is degraded by these acetical master races floating
around in the brain. So we need to enhance the acetal coaling. So
that's what I'll call the last piece of the puzzle, where getting the omega
three's right with assessment, getting the donors methyl donors right with vitamin B twelve,
and it treat us another common natural sub dictor, suptmate, methyl sulfonal
methane MSM. And so my lab was spent a number of years really promoting
methyl sulfonal methane, and by promoting, I mean researching that as a methyl
donor. And so where that relates to the biological clocks is one of my
dear friends at the University of Arkansas Medical Sciences, Igor, excuse me,
Igor. What he did was he showed that, yes, Run, that
hypothesis is right. MSM methyl sulpontal methane is in fact a methyl donor.
But he showed it in the context of DNA methylation. Right, So now
MSM DNA methylation, biological clocks, you can start to see the connections there
that doctor Koda Bush put together approved some of the hypotheses that we had,
and so now you've got the methyl donors take care of and the ideas you're
starting to activate your omegacreies in this fospitial cooling flood. But PHOSPHATITL cooline is
degrading as we age because right we know it's a component of cell membranes,
and cell membranes are undergoing constant attack from its lammatoid processes, so we're constantly
having to replace phosphatial cooline. Well, if you're not replacing it with the
foster to the lefthand alamine because you don't have the methyl dollars, right,
one of the things that you can do is, as you said, well,
let's look at maybe a cetocol mesturation hibbers from description or maybe an old
prescription that is a dietary ingredient so called citycolin. So citicoline is a precursor
for fostertial cooline. So the thinking and adding citicoline is to give you the
ability from a different direction to restore or to increase phosphitlcoline levels and reduce some
of that negative pressure on phosphitalcoline, which would then require chewing up the cooline
precursors and reducing a cetocholine production, so you don't need that acetoceutocolinesterase inhibitor as
much. And so that's the mix that we put together and patent it.
So again the sessment for the omega threes, the methyl donor's MSM and the
vitamin B twelve and then the city cooline adding that piece to really start to
change phosphatidocoline metabolism and the liver so that we start to see all these other
chronic diseases impacted it. And so the link I think is important for your
listeners is let's look, let's focus back in on this relationship between the storage
form PE and the active form PC of these omega threes. What study after
study is showing it across all chronic diseases, whether it's Alzheimer's heart disease,
even acute disease is sepsis for example, A already a sepsis and diabetes.
As you get to build up a P species relative to PC. So if
you think through that, right, that makes sense in terms of the disease
manifestation. If I build up the storage form of the omega trees at the
expense of the active form meaning the PC species go down, then I can't
deliver the active form ultimately to the tissues. So that's what you want to
do, is you want to restart that process. But here's the good news.
It's really a nutritional approach. So we know that there are a number
of things, and you don't have talked about this at nauseam, there are
a number of things that, for example, deplete our methyl donors. We
know met form and is notorious for reducing Yeah, it's one of the vitamin
B twelve is notorious. And then you also also got to think, like
to the point I made earlier that a lot of these people are suppimitting with
B twelve, they're not supplimenting with like a methylated version of B twelve.
So yeah, it's your typical sianic abum and cheap everybody can get it.
But whenever I reach for that, at least in the pays that I've talked
to at length on this same process in the pharmacy, is yes, we
need to be methylating as well. So let's take methylated forms of these things
and also ask every one of these patients to come in, Hey, do
you take any prescription medication? I may already know the answer to that question
if they already fill with us. But you know a lot of times you're
like, yeah, I take, you know, a statin. I take
My doctor did say may whence he was a little bit high. So I
take that, foreman. And I'm sitting here going, okay, you need
you need a methylated B twelve and you need cookie ten, like just off
the off the jump, because we're already dealing with depletion of certain of certain
things just from the pharmaceutical side. So it's like you're just getting hit with
negative after negative and you may not even realizing It's like, well, I'm
taking meds and I know they have side effects, but I don't think it
has those types of those types of implications. Yeah, and now we draw
a straight line potentially potentially from vitamin B twelve depleting prescriptions, reduction and messal
donor and ankle back to this concept of methylation and biological aging. It's not
a great leap to say that some medications may actually be counteracting that methylation of
DNA. Now that remains to be proven, sure, and so I'm not
going to stand on the soap box. And that's what's happening. But there's
certainly a correlation. There an interesting correlation that requires some hypotheses and texting.
But it's it's not a it's it's not a leap, so to speak.
I think the other interesting thing, particularly in a post COVID wood is,
uh, you know, you've got these patients with brainfall all the time.
That is often and that's often a feature of another interesting cardiology related malady known
as postural orthostatic tactic cardia syndrome. But pots I'm not a cardiology pharmacist.
I hope I said you did. You did, But we have we have
a few patients that have come in with with a new diagnosis of that too,
Like we're I'm seeing it's interesting all these terms you're you're it's like,
okay, people, I used to not have an answer for it because people
come in, you know, I got either they got COVID or how how
have you? And they're like, man, I just it's been months and
I can't. I'm just I get to about two pm and my brain is
like just not working and it's like never felt like that before. And you
know, I'm who's Who's who am I to say that that's not the case,
because you know, let's be honest, if you live with the condition
long enough, like you pretty much are the expert on how you feel and
what's going on there. So it's important to key in on those things and
pots. I've seen a handful of times which I had no idea what that
was when I was in pharmacy school. It's relatively new term for me.
But when you see it coming in your door over you know, every now
and then, it's like, Okay, there's some something's going on, and
then you know, your science brain kicks in and go, okay, you
know, I've got all these things they're coming in for answers, So I've
got to be able to give them something that's rooted in in science. And
I think that's where your mentorship with me has helped significantly with helping my patients
manage this stuff in a pharmacy setting, because who else are they going to
go to that has these epic answers. Your typical PCP won't really be familiar
with this process unless they're in it and they actively research it themselves. So
it's a really important point you make there. I definitely see a lot of
yeah, well, it's it's the science link and you make the right sort
of direction there. Patrick Is. Let's use pots as an example where if
you look at sort of the science behind what underlies pots. In the features
of POTS, one of the interesting things is coming up is that there seemed
to be antibodies against the specialized cells in the GI tract excuse me, our
gas of paratal cells. And so those gas of parato cells are specialized cells
which, among other things, they help absorb vitamin B twelve. So there's
this thinking that this, for reason unknown, post COVID, you've got these
antibodies attacking these vitamin B twelve uptake cells, and can that be contributing to
what is known that there are vitamin B twelve deficiencies in these parts patients.
I think another piece of that, in terms of sort of the autoimmune or
the immune response post covid, as we talked about this is our adronergic receptors,
and there are is depletion or attacking of our adenergic receptors. And you
couple that with the inability to methylate, right, so making adrenaline epinf or
nor epin f right, that going back to your medicinal chemistry, your pharmacology,
and that's all methylation and so you see all these things point to methylation
aging disease, but it's only one component of the systems pharmacology. So that's
why it's so important to when you're talking supplementation to patients how they can think
about it and in a more holistic way. And so as a pharmacist also
think about sort of what's the cost ultimately to the patient. And you know,
you're not discussed this last week. It says, Okay, how do
you look at the cost of a multi ingredient supplement versus individual greets? Okay,
patient with diabetes. Right, you got the methodistian. Okay, here's
a vitim of the twelve years assessed me to see the le extract years.
Right, you got all these bothers. Right, we've all seen the brown
bag of the answer we had to go to and all that sort of thing.
But if you can compact that, and by compact, I mean aggregate
that into a single supplement, but do it in such a way there's a
ration, sure, And I think that's what is why in the healthcare practitioner
space, pharmacists included. Right, If you're not really a deep in this
world is sort of this hit or misapproach and what we call ferry dusting,
and so, yeah, what's the latest ingredient. Well, there it is
on the label, but there's not enough in there too. It's like,
given one microgram of your stating each day, there's a statin in there.
Oh, but by the way, there's only one microgram of it, and
so you see a lot of that. So those are the two biggest issues
I have with formulators, particularly formulators who are not scientists, pharmacologist pharmacists.
And let's face it that the vast majority of formulators in the natural product space
are not science and certainly not pharmacologist. A lot of goodwoods out there.
But you know, there's a reason why I don't find my own lawsuits if
I'm suing somebody, Right, I'm not a lawyer, and so but I
could do it, but you wouldn't want me to do it. So that's
the other thing I cautioned, patience is right when you look at something that
is quote science based and clinical base. And let's bring this back to your
original point about clinical trials and sort of evidence base, right when you read
a website I was reading this morning we're talking about continues to close monitoring and
how how fascinating it is in the patients and in our study, in our
study, and it's not public, meaning it's not peer of view. So
that's just an extra level of evidence that the consumer of the practitioner can look
at and say, Okay, at least this is peer of viewed. I
can look at that and see what that clinical evidence is. And what we
see sometimes in the diet supper world is that this supplement is clinically tested.
And so there have been thousands of prescription medications over the years that have been
clinically tested, but that doesn't mean they work. So it's language that we
have to be real careful with as well. Right, Yeah, that's why
it's important to have that study result there so that you can really vet what
they mean by correct. Yeah, that's an important point you make, because
you know someone that I'm very evidence spased, and that's kind of the whole
point of the podcast. I was really trying to sift through a lot of
that and I'm getting there. We'll get there breaking down some of this stuff.
But yes, there's a big difference between Oh, there was a study
that showed this and it's like, okay, well, can you explain what
type of study it was. Can you explain what the outcomes were? You
know, what were they in animals? Was it in humans? Like there's
all these other questions that people just don't know to think about. Whereas yeah,
I can say I tested it in my you know, in my lab,
but if it didn't work, I'm not really helping anything. But yeah,
I did test it, but I didn't there was nothing beneficial that came
out of it. And again, yeah, I think when you have people,
I think, let's let's just be honest. If there were more people
like you doing these in the supplement field and everybody had your similar approach,
we would have a lot less supplements on the market, but the ones that
we would have would clearly we would be able to show, in Layman's term,
is why it works and why it doesn't. And that's just yeah,
because because going back to your like brown Bag, a point that you made
earlier is like, yes, I could have a protocol that would help with
you know what, say someone comes in with cholesterol issues as well as post
COVID brain fog type stuff. Immediately, I know, based on our conversations
over the years, like I know where to go. But if I wanted
to get sesamia extract, if I wanted to get omega three's, if I
wanted to get a beat a method to be complex up with that, and
then I wanted a fosil toil chin on top of that and hit all the
aspects. I've got seven supplements there that I'm trying to convince someone to take
that. There's literature to back it up that you've shown me that works.
But it's like, I don't want to pay two hundred dollars for all of
these things every month because that doesn't make sense. So it's like, hey,
but I have this one product that costs this much, it has all
your bases covered. We're good to go. It's like, as a it's
a win win because you're taking a minimalist approach, but you're also knowing that
you there's no doubt that the clinical evidence is there as to why that formulation
is the way that it is. And it's patented too. I mean,
anybody could take a formula and add one thing to it and then say,
oh, look, this is unique or proprietary to what we have going on.
But you ask them a couple of questions as to well, what's where
was your study published, Like you said, it was clinically tested, what
were the outcomes? And it's like they'll start squirming, and it's like,
okay, you know, but the lay person, you know, your average
every day consumer, doesn't know to ask those types of questions, or if
they did, who would you reach out to. So that's a very important
point you make because a lot of times in the pharmacy world, I've seen
it, you know, not necessarily said to me, but it's been hinted
at that, like, oh, y'all just push medications, y'all, don't
really try to get to the root cause of things, because you just want
to prescribe a medication to treat a complication, and that's it. A so
called you want a sick type approach, which I think is unfortunately kind of
the the all too popular nowadays, especially on like social media and stuff,
when it comes to anything pharmaceutical related. Whereas someone like you is a pharmacist
by trade, knows all the absorption and like it, knows all the things
to amplify and make perfect da dosage for him for a natural product, that's
not your approach. I mean listening to you talk to this point, I
mean that the listeners are gonna it's blatantly obvious that you care as to the
whole, the whole mechanism and getting it to the what issue we have.
Whereas you know, people just hear pharmacists and they think, oh, they
just want to throw a pill at it. It's like, now we're really
trying to I don't want you on medications, and if I can, if
I can come up with a natural remedy to not have to even go down
that route, that's what I'm gonna do. You know. We want what's
best for our patients. So I think that's an important, important distinct should
like to make because yes, we're pharmacists, but I think the true pharmacists
that are really trying to push the boundaries of where the field's currently at,
like yourself, have that everything's interwoven everyone's unique type of approach and mentality to
things. So I think that's that's a thing that's really fascinated me with you
got you and my dad and y'all's groups approach. It is just how you're
able to take the science and really apply it and make it unique to where
it's not just this cookie cutter type approach that really you're kind of not so
sure if you had the clinical data to back it up. Yeah. Excellent
description of the sort of the overview of the whole process, right, Patrick,
And I think what is you know, I'll poke fund it myself as
an inventor and scientist for you know, thirty years is I've come up with
a lot of solutions to problems that don't exist, and so the focus now
in my career is trying to come up with solutions to problems that do exist.
So let's go back to I think it's very important for your listeners is
to make that final connection to sort of the mechanism in the process to the
disease related phenomenon. So let's go back to the phosphatidalpoline. Right. So
we're taught in bio chemistry key component of cellular membranes, but now let's talk
about phosphaticholine in the liver as a signaling molecule. Signaling molecule in the context
of disease relevant endpoints. So slost fotidocolines are absolutely critical for constructing the vodal
molecules that secrete triglycerides from our liver. Right, secreting triglycerides from our liver.
Why do we want to do that? Because we want to get those
fats I have the livers to them build up in the liver and cause fatty
liver non alcoholic fatty liver disease or metabolical associated fatal liver disease, whatever we're
calling it now. So the triglyceride lowering effect of phosphate cooline is is I
think the other part of this is phosphate of choline right where it participates in
this sort of lipid metabolism. It more familiar is as a result of its
metabolism fosph to cooline, it's attacked by enzymes and our bloodstream. It is
as able to increase our HDL. And so we've got to have phosphateicholines,
not only phosphate of coolies, but those foster tocolines that are laden with the
omegus rees. We have to have those in order to increase our HDL.
It is part of increasing our HDL. So now we've got two disease relevant
indpoints here. Right. If I've got good phosphate cooline levels and they're packed
with the right ingredients and mega the reason in particular, I can increase my
HDL, I can reduce triglycerides. And you know that's the other thing.
We don't talk about triglycerides to HDL and their commentational ratio. We so been
so much time talking about LDL. But I would encourage your listeners to really
dive in and start to understand this concept of tricklyscride to HDL ratio. I
think if you read the literature, you'll be fascinated where it is probably in
my reading, the most relevant, one of the most relevant indicators of chronic
disease, Heart disease, sattering for sure, those two ingredients. Yeah.
I mean, if you just Google a put med search and you look up
metabolic syndrome trigo sorry to HDL ratio. I mean, there's hundreds of papers
that are all linking it. I mean, I was talking to one of
my other our wellness director, Rodio, the other day, and I was
she was very fascinated with metabolic syndrome. We have different approaches to certain aspects
of that, but she's she's really gets kind of the biochemistry, and I
was talking to her about that ratio and she's like, oh yeah, I
mean that's one of the telltale things, super easy to calculate, you know,
based off labs if we're dealing with it, and she goes, I
see it all the time in my metabolic syndrome patients or patients with obesity or
cholesterol issues. They go hand in hand, and you're exactly correct. I
think that ratio and then like that Omega three to Omega six ratio I think
is finally just now starting to get teased out in the literature, and as
a person myself, that's where I start to really kind of look as well.
So it's it's really cool that you bring that up, for sure,
because it's definitely for the longest time, like even in pharmacy school, it's
like fish oils, these types of things increase HDL and then someone like me,
it's like, well, well, how is it do that? And
they're like, it just does. That's what that's what the black box,
right, Yeah, it just does. Like it's like yeah, it's like,
yeah, cool, that makes sense. We know most of denovo cholesterol
synthesis comes from the liver anyway, so it's not a you know, not
a stretch to assume that it's something there, and it's finally cool and interesting
to kind of tease out that mechanism. And I think you've done a good
job of explaining that in Layman's terms, and it makes a whole lot of
sense, Like there's so many implications for that mechanism and batty liver disease.
When you were explaining you know, these storage forms, you may just load
it up all the time, but it doesn't go anywhere, or if it
does, you start seeing you know, triglyst ride of VLDL go up,
it starts to shut it down that other pathway, and it's like, no,
we want to make it go this way so we can get all the
added benefits of excess phosphatial calling that you've talked about. So it's just it's
really cool just to kind of finally have an answer to that question. Because
every biology course or pharmacology course that I had, when this topic of omega
threes comes up, it's like, well how, and then no one could
ever really give a clear answer until yourself. So I think that's awesome.
Yeah, yeah, it's really cool. And I think if you look at
it sort of as a pike, the input would be the amina threes,
and now we're talking about the outputs. The outputs are impacting HDL, are
impacting triglyst rides. But let's sort of bring it full. So as a
result of increasing HDL, omega three's and methyl donors increasing HDL, a side
product of HDL production, interestingly enough, fascinating enough, is the actual transportable
form of DHA. So, in other words, remember we sat over here
on the left hand side of the pipeline where you have all this DHA floating
around in the bloodstream and it's not able to make it into the brain when
he goes to this pipeline and that last step where you form HDL, what
comes out of that as a side sort of product is the brain's transportable form.
So now I've got a form of DHA that when it passes through to
the blood brain barrier, there's a transporter there that sits at the blood brain
barrier that recognizes that transportable form of dha, not tree dha, the transportable
form of DHA, and pulls DHA into the brain. So, now if
you don't send DHA through that pipeline and reap package it into the transportable form,
then you can take dha till you're blue in the face, right,
and it's not going to do any good. But here's the downside is we
know that too much of a good thing, anything is not good, that
correct, and we know then when we get too much DHA, too much
EPA in particular DHA. In some studies is shown that DHA is actually cardio
toxin because it starts to replace other fatty acids and key membrane lipids in our
monicondi, our energy producing organelles, and they don't work as efficiently. And
you know it's because the DHA, because there's so much how it replaces these
other key fatty acids. So that's the other reason why that sometimes as humans,
right, we think we know how the body works, and we see
an endpoint, Right, I've got to get DHA into the brace, So
let's give more dha. But we don't get a body enough credit for it
their regulated processes. And there's a reason why, Right, you can eat
you know, fish once a week and still have plenty of DHA if you've
got all the other dietary ingredients there to help your deliver do what it's supposed
to do, right, which at the end of the day, I always
remind myself these are dietary supplements. Let's go back to nineteen ninety four to
shave. They're designed as nutritional supplements, meaning supplements to our diet. What
are we not getting in our diet that we should be getting in our diet.
And so that's the other thing to keep in mind is right from a
pharmacist perspective, when you're talking with patients, and right, we're really good
at patient, take this antibiotic with food, without food, or oftentimes we
talk about with it because it's going to upset your stomach, but we don't
think about supplements. Right, If you think about it in the context of
their supplement to our food in our mill, then it rolls off the tongue.
Be sure and take this with food, because it's a nutritional supplement.
And what that means is that your body produces to physiologic process. It's the
necessary chemistry to absorb all those things that are in these dietary supplements. And
if you don't eat, then you don't have that secretion of these you know,
Lessithans set of these solutlizing agents in the small testine and they just pass
right through the GI track. So yeah, I would give that as a
take home for your listeners today too, is I can't think of a single
reason why you would give a nutritional supplement not in the context of extremely I've
always open to being important. Yes, yes, that's extremely important. I
always recommend and I always recommend any supplements with food and not just you know,
yeah, if you take fifteen twenty supple. Iman know a lot of
people that take a lot of stuff and if they take it on in stumm,
it's like, I feel nauseous and terrible. It's like, just eat
with it, you'll be good, and it's it's like and then you know,
we haven't even gotten into the part that most of these extracts and large
proprietary blends with all these ingredients just kind of thrown in, so to speak.
Now, some of them may not just be thrown in. There might
be a reason why they're all combined. Let's play both sides. But that
dissolution profile of those certain extracts may not be very good, and you may
be taking it and it's not getting absorbed, which is a whole other thing
that I think is what farms to spring to the table is just especially you
guys at the NCNPR, you are really good at going. My dad says
this all the time. I'm my dad, what do you know about this
supping? And I haven't heard of it before. It goes doesn't work,
it doesn't matter, it doesn't get absorbed. And I'm just like okay,
and he's like, yeah, I mean you could take you could take bottles
of it. It's not get absorbed. And it's it's one thing that and
that's if you tell that to a patient that's been on it for a long
time, it's really frustrating. They're like, why didn't anyone tell me that.
It's like, it's not very many people know, and they think,
oh, it's natural source. Of course it's going to get those order.
Why wouldn't it. It's like, you know, it's just not, That's
not how chemistry works. It's just it's very important distinction. But yes,
definitely eating with it. And again I tell people that all the time too,
that supplements are meant to supplement a proper diet. So not only do
we have you can take supplements to your blue in the face, and yes
that some needles will improve, but again we've got to also facilitate that through
that same those same principles through dietary management as well. Another point I'll make
briefly because I just thought of this when we were talking about so you know,
your product centers around sessament extract, which is from sesame seeds, which
is there's a lot of there's kind of a push now and I'm not sure
if you're super familiar with it, like the all seed oils or the cause
of all the chronic problems. Now that narrative is starting to get pushed,
and to a degree I can kind of get it. But sesame seed and
all these different you know, seed oils, do you have large clinical benefit
when you when you look into the research for them, especially if amounts are
controlled, you're not overdoing it, just like anything else. So I think
if the listeners get nothing out of it, if you're elling the anti seed
oil type of train, I think I think Ryan's proved that the sessamon sesame
seed oil part of that shouldn't be included at bare minimum. So I just
I just want to make that quick point because as humans, we tend to
fight, we tend to fall into these camps of things like, oh you
know what, yes, this scary. This these seed oils, there's there's
negative clinical benefits if overconsumed, So now they're all bad. It's like we
take one thing and then we just go too far with it. Same thing
with carbohydrates. It's like, oh, you know, yes, if you
eat too many of them, and if you don't eat the right types,
and we're not we're not really watching that a lot of people will go,
Okay, all carbs are bad, you don't need any of them. So
it's like when you talk to the actual scientists and people say, yes,
balance and moderation is important. You got it. There's definitely truth to it.
I don't think we're really going to get anywhere in the field of science
if we all just take these if we all just hop into these camps where
it's like an all or nothing type approach. If that makes sense. I
don't know if you've been if you share any of those sentiments, but I
just want to make that quick point because that's just what I was thinking about
it when you were when you were talking about it. You know what I'm
find fascinating about the seed oil is particularly sesame seed oil. I mean,
it's been around since time and more in memorium, I think is the term
I'm looking for. And the reason why it was so easy to transport is
because of its high any oxidant activity, and so it was utilized for thousands
of years. And so as a result of that, the listeners should know
that there are a few people out there who interesting enough have sessame seed allergies,
and so I think it's had been estimated there may be as much as
a million people in the world that have assess me seed allergy. So we're
very careful to put that on the ball, right. So it's it's like
anything else. There is a generalization about health benefits, but you can always
find a situation or scenario where it's not the right thing for a specific patient,
and in that case you have to have alternatives for those individuals. But
I think if you can come up with something that is generalizable for your patients
on and gives them an option, right with both pharmacists. And there's a
tremendous amount of benefit that comes from prescription medications, I would never say that
there is no there's a tremendous amount of harm and misuse that comes from that
as well, So we have to balance and our patients know that, and
our patients want to be as natural as possible. And I think it's incumbent
upon us as pharmacists to give them the education and the knowledge that we have
around this topic and say, Okay, here is an option that you have.
I'm never going to push something instead of a statin for example, I'm
going to say, here is an option or a companion something that you know,
you never want to get between an individual and his or her physician,
right because they know the patient best, correct, But again, the patient
at the end of the day knows themselves best, and so you give them
the options to make the decision and informed decision. And I think at the
end of the day, right, that's who we are as pharmacists. Our
job is to inform the public, and we're the most accessible, you know,
all those things that we've been told for years that we are, we
are and that's why we have been one of the most trusted professions ever because
we give information, but we don't typically have skin in the game, so
to speak, and so it is a little bit concerning. And when you
know you mentioned earlier, people say, oh, you just want to push
the fill and if you're able to counter that with well you have options,
and here are those other options, then you can make a much more compelling
case. I think actually, for you're interested in treating the individuals in not
selling them a prescription, and we won't even getting yeah, the costs of
prescriptions and are you any make any money selling prescription? Oh dude, yeah,
I mean I've told a few patients about that just in general, like,
oh, yeah, I can't feel that, and they're like why.
It's like, well, every time I do it, I lose money.
It's like and they're like, what are you talking about? You? That's
not how business works, Like exactly, it's how business works. And it's
funny. I was, I was, but a forteous how pharmacy been.
Yeah, it's just a it's a topic for another day, but I may
I may do a mini episode on those, even though it's convoluted, but
it's interesting enough. Like tomorrow, I'm doing an interview with another friend of
mine who is heavily involved with Nimbus at the pharmacy. He's one of the
co founders. It's doctor Richard Harris. He has a he's an m D.
He also has his pharm d degree to, which makes him like super
unique. And he tells me all the time about what he does when he
meets with patients for life style managements. He'll go, Okay, I don't
write prescriptions unless it's like the alarm bells are going off. He goes,
But if I can look at the patient's labs and see that we may not
be going in the right direction, I've got to have options for them.
He goes, Now it maybe everything's lighting up red and not looking good.
It's like, Okay, we need to do a statin and some stuff right
now, or hey, we're kind of trend in there if we don't manage
some of these things like this is these are the options we're going to have
to take in the future, but for right now, here's here's three things
you can do and stuff like that. So he's really pushing the boundary from
a physician side of having options and when we're all on the same page,
like as pharmacists to physicians to patient, if we're all on the same page
and have the same approach, it's only going to be beneficial. I find
it. I find it harder when and patients can can attest to this is
they're like well, I'll have a conversation with one of them, for example,
and they'll go, well, what you're telling me is not what my
doctor said. But doctor didn't even spend a few, you know, much
time with me. Let alone tell me that. It's like, yes,
the doctor doesn't have time to do that as well. So let's not just
assume that the doctor's not wanting to do their job is they don't have the
time. So I think that's another benefit of having a pharmacist. If I
know where their physicians at, then I can take that extra time throughout the
day and help kind of facilitate that process moving forward to where we're all kind
of moving in the same direction. I don't like to, like you said,
I don't want to get in between the patient patient physician relationship. But
if I know what that patient physician relationship is and I can help kind of
elaborate on things they've already talked about, that's that's the most important role I
think as pharmacist that we can provide because let's be honest, you don't see
you may you know, if you're a relatively healthy individual, you may see
your physician a couple of times a year for you know, let's say fifteen
to thirty minutes, maybe longer, but in the scheme of things, you
may come to see me at least once a month, hopefully if you're on
a prescription or something like that, if you're taping supplements regularly. So it's
like I can kind of get to know you, better understand what's going on
outside of outside of a healthcare setting, and then help you facilitate getting good
information good out there and have a plan of attacks so when you go back
to the doctor's office that everything's looking right, and then you can say,
hey, I you know, I've been doing what you said, and my
pharmacists and are my other people that I see are We're all on the same
page and it's only going to be beneficial for the patient at that point.
So I think that's a really important point that you made for sure in that
regard. So let's let's get into So you've already kind of we've clearly talked
about the benefits for sesame and all that stuff. So I know you're one
of your other fascinations and you talked about this in your your introduction. Is
how you're interested in relating that to diabetes, So tell me more about granted
I already know a lot of this, but tell me more for our listeners
out there, how this applies more to diabetes and also where your kind of
business ventures are going, if you can get into that on how this will
help diabetics on like a national scale at some point, because I know that's
kind of how you guys see this moving. So can you elaborate a little
bit on that, and then also some because clearly you know all the cholesterol
abnormalities and diabetes go hand in hand as well as all the liver stuff that
we've already talked about, So feel free if you want to talk about that.
I think our listeners would be really interested because there's a lot of patients
out there that are pre diabetic it may not even know it, that are
looking for these answers before they get that diagnosis if they're going down that track.
So yeah, we'll start here. In terms of the pre diabetes it,
there is extensive in I mean extensive research looking at liver metabolism foster to
coli metabolism, and it's linked to conversion of pre diabetes to diabetes. And
there's one mark or in particular and so called like selfosteral choline, which is
a metabolized form of fospital kolide that is linked to a conversion of prediabetes to
diabetes. So again there's direct linkage beyond the triaglycerride, the HDL, the
forms of absorbable or penetrating DHA. Right, is these bio markers related to
diabetes. So all that is to say that this foster decoline metabolism and the
offshoot of that, the metabolites of that are related to diabetes. I think
where I would go next is, you know, we talk about the triglycerides
and what any healthcare practitioner that's paying attention to the literature, and I only
say it that way because most are so swamped with just their day to day
duties to see in their patients. Right, It's hard to keep up with
the literature sometimes. But those that are able to keep up with the literature
and habitime and energy are reading about fatty liver non alcoholic fatty liver disease.
That's the scourge, and I think it gets lost sometimes though in the discussion
of obesity and diabetes and again trying to put them into different buckets as opposed
to try to look at them holistically and seeing how we can impact all those
things in a more concerted fusion. And so I guess the greatest example that
is this whole gop one receptor agonies in the context of obesity and sort of
in my humble opinions that the train wreck waiting to happen, because what the
patients aren't told is that as soon as they come off these agents, the
clinical trials clearly show that you rebound severely in terms of right, it's just
within a few months, and I forget the exact that we talked, but
it's a few months, you're right back where you were. So I guess
what going with that is. That is something that is a patient wants to
commit a lifetime too. That's exactly what yours. Okay, if you're going
out to GP one, if you want to use them to get you to
a certain point, and actually you were the one and I really sort of
got the thinking in this direction. If you want to use them to get
to a weight, and how do you then sort of rethink what you eat
and how you eat to keep you at a healthy weight. I think that
could be a potential use for those to steal your words from last year.
Yeah, exactly, I'm actually believing or not. Was before we started,
I was working on a script for the next you know, a podcast episode
is gonna do solo, and it was going to be basically everything you need
to know about GLP ones. You know, not only from describing what they
do pharmaceutically or in a pharmacology sense. But yes, that was the thing
that was startling to me. And I think if I remember correctly from the
trial, I remember the authors of it, but it was showing they studied
these patients out for a year and I think by eighteen, by twelve months,
they'd hit there whatever or what their weight goal was. And then I
think it was within the year, I mean some within the year they had
gained all their weight back quests some And you see that time and time again
with just about any dietary intervention, whether that be like a fasting, whether
that be like a keto diet again, all of it. It's about consistency.
Now totally fine with I mean I totally. We dispense GLP ones all
the time, I mean all the time, so I talk about them quite
often with patients. But what I tell them is once we get where we
need to if that's what helps you kind of facilitate doing things and helping with
lifestyle patterns and stuff. So if you need to lose fifty pounds for you
to be able to like feel like you have the energy to go to the
gym consistently, fine, But what do we do when those medications stop?
And that's the big thing is like if you just treat them as the medications
going to fix all your problems, and then when you get off the medications,
you've learned you don't know how to then keep that trend going. I
think that's where people like us come into play. Is I think that's a
very important piece of the puzzle that it's exactly in your word, it's a
train wreck rating to happen, because then guess what when you if you gain
all that weight back, what's all you know to do was I guess I
got to go back on this medication again. And let's be honest, these
medications are not cheap. I'll kind of be brief with this, but on
average, let's say you walk into this pharmacy with the prescription for azempic,
whether that beeper. Now, if it's for diabetes, it's different like insurances
or more apt to cover something like that. Seeing copay is really low.
I've seen some have no copays, but for weight loss, since it's now
an FDA indication for that, insurance are still are still not willing to pay
the cost of that on a monthly basis for everyone who wants weight loss,
because that's pretty much everybody to a degree, So you're looking at paying I've
seen with insurance coverage, I've seen copays five hundred dollars on average. Yeah,
medication for cash is fifteen hundred bucks, so and that's per month.
So again I imagine spending. Imagine being on a medication for six months,
you're paying cash for it, So you're paying a thousand dollars a month for
six months. At six thousand dollars, you've gotten where you want to and
then literally six to eight months later and a year later, you're back to
square one and you've got to do that process all over again. And I
don't know about you, but that's very discouraging as a patient. And I'm
just like thanking I just every time I walk out the door. Nowadays,
it life's expensive, and it's just like, why does it cost so much
to lose weight, and it's like it's not the right approach. These medications
are fantastic in my opinion, for helping get that process going and make it
easier for patients. But again, we've got to be waiting at the finish
line to go, Okay, we're here, we need to stay here.
We don't need to go back to square one. So I think that's a
really important point. I'm glad you brought that up. Yeah, And I
think it's important for the listeners to to understand that sometimes we can be pedantic
and meaning professorial to patience. And by that I mean, look, you
need to eat right and you need to exercise, and if you eat right,
then this whole obesi thing will go away. That's simply not the case
we know. In fact, I was just reading an article the other day
by the guy who discovered left many years ago, and he was talking about
that. Yes, at the end of the day, you can't get past
the basic input output right let you put into your body and how you get
rid of that and metabolize right, has it is a factor in obesity,
but there is a mental part of the diabetes. Excuse me, the obesity
as well, Right, Why am I eating what I'm eating? Why can't
I feel satiated? And that's where these g op one receptor agon is come
in, is giving you that satiety feeling so that you eat less. So
it's sort of coming at it from the mental side, but the manifestation is
that you eat less, and that's that's why you ultimately end up losing weight.
And so I think sometimes it's it's important for patients to understand that these
medications aren't doing something not fat burners. They're not going in and changing your
metabolism and making somehow some superhuman fat burner, right, which is what we
want through a pill. It's it's changing your sort of mental approach to eating,
but using pharmacology. And if we think about that from a just a
normal physiologic process is right the way and I won't go into details, here's
too much to unpack here, but the way we are supposed to eat actually
promote gop one level so many it does this the right thing, right,
So the more processed foods, the pure sugar, these sorts of things that
we eat, the more our gop one levels are adoxically they're reduced. And
so it's like this is vicious cycle. Is the modern Western diet pushes gop
one levels down and tells us we're not full, so we have to eat
more, and it just get snowballs out of control. And so it's important
to really control that caloric intake. And again not for this podcast, but
hopefully for another there's some really interesting technologies and concepts out there right now.
One in particular, as we've all many of us have heard of this concept
of low glacemic index, and the way it's presented is that you know,
you eat certain foods that are the glucose and glucose precursors are absorbed more slowly,
so that's why you don't have the peaks. But the narrative now is
much like a sustained release formulation we give patients. It's absorbed more slowly,
but you still deliver the same dose. And so that's the narrative now in
the low blas semic index world, is that yes, you slow absorption,
but you still deliver the same amount of calories. And my research and my
reading says that doesn't have to be the case. That's a component of its
slowing it. But there's a whole other fascinating area in research and development,
where now you have the potential emphasis on potential, and there's data to back
it up, the potential to eat what you're used to eating, because we're
all human and we're going to we like things we like and not derive the
same calore. Again, taken other words, you can potentially take a white
bread row. You know, people, I love bread too, well,
eat that same piece of bread, right, and then absorb a lot for
your calories from that same piece of bread without impacting the organ elleptics and soil.
The fancy way of saying it just tastes and feels the same way.
And so as that concept evolves, now we have it changes the conversation.
Now from a science perspective and from a development perspective, we get to meet
the patients halfway and saying, Okay, you like this food, well,
have you considered a low gus semic index version of that food? Folks?
That's possible today, and we just have to figure out how to make that
market and understanding and educate so that we can start building products in more products
than that are in it. And you alluded to it earlier. That's one
of the most fascinating projects that I'm working on right now commercial projects is bringing
technologies like that to consumer awareness so that they understand that they have options besides
gop one receptor agones. And I'll stop there because I don't want to take
us to me. You're fine. It's a very import two things it's important
is that's one part of the equation. You know, people in the attrution
space tright don't really focus on It's like, for example, I don't like
the advice to eat less moved more on a basic principle principle, Yes,
that's true, you have to eat less and move more to not to lose
weight. That's true. However, that doesn't really facilitate any like action.
It doesn't really give anyone tips or advice. You're also not talking about the
whole concept of food reward and how you know, humans act and feel after
they eat certain foods. So yes, eating more less processed foods and stuff,
it's gonna beneficial. However, you know, sometimes if you want to
enjoy something, there's a food reward aspect to eating foods that may not necessarily
be the healthiest for you. So there's all these different factors at play,
and I think it's it's fascinating. Another cool thing you mentioned about the low
glycemic index stuff is I would be interested from a nutritional side, and a
lot of dieticians will understand what I'm talking about here, is I wonder how
that technology, especially with the food types that you're talking about. By the
way, I got some. I finally got my delivery the other day.
So we're going to try it tonight with our with our meal tonight that I
cook for my wife and to see how she likes it. But I'll be
interesting, just can't wait it. It'd be interesting to see what the effect,
like the thermic effect of those foods would be, because, like you
know, it does take calories and energy to break down certain foods, but
if we're not absorbing as much of those calories to the beginning, that's going
to have an interesting impact I think on the whole thermic effect of breaking all
that stuff down would be. There's your body had certain foods high and fat
have the lowest thermic effect of food, so like it just takes less energy
to break those down. Glucose is second, and then I think protein it
actually takes a good bit of caloric energy and demand from the body just to
break those proteins down. So it'd be interesting to see with these types of
formulations of these low glycemic index foods and how they have an impact on that
because there's really not from an energy balanced perspective, there's really not anything you
can do too, or at least that I'm aware of, to really increase
the amount of caloric energy needed to break down the foods that you eat because
it's a minimal part of the whole energy balance equation. I'm just there could
there may not be any connection there whatsoever. It's just that's an interesting thought
that I had, especially with knowing the more intricate details that we're not going
to get into about these products and why they work. But yeah, I
think that's fantastic is being able to have a food that may have the full
amount of carbohydrates on the label, but you're only absorbing you know, fifty
percent of those calories. Because that's where the impact on your blood sugar is
going to be. I think that's going to be going to be huge in
that space. So yeah, and I want to I want to point out
your listious this is not hypothetically correct. In other words, their data sets,
right, I mean I have a data set in my hands, human
data set, clinical, try right, powered, appropriate, et cetera,
that shows that this is in fact today, And so you diabetics and others
that are interested in their glucose and particularly they're glucose variation, which I'll come
back to a minute. In a minute, that's here today, what's not
here today? So let's tell your listeners three to seven years into the future.
Okay, why do I say three to seven years into the future,
Because when we talk about blood glucose, we automatically think right first, especially
those of us have been around a while, our fingersticks, and we get
a moment in time a blood glucost level. Now that's evolved with the continuous
glucose monitors. I won't advertise for anybody in particular on your show here,
but or on your podcast, we'll just say continuous glucose monitors that are available
for type two and type one diabetics. The concept there is twofold, right,
and it's all pharmaco kinetics. It's if you're a pharmacist, right,
think about this as glucose pharmaco kinetics. It's about cmax right, our peak
glucose concentration. But it's also that peak to trollh ratio, that variability that
we experience throughout the day. And so where we are today, we can't
talk about glucost variability because we don't have a ready read out unless you're wearing
a continuous glucose monitor and you know someone who can interpret the data that's coming
into your app, right, so is very limited. We don't have the
ability to interpret that data. And so that's not a good way to say
that we don't have the routine ability to interpret that data and it's not routinely
available. Right where when and where is it going to be likely available to
the average health conscious person? Right, it's right here on our risk.
So in March, in March, Apple came out with they had just made
a major breakthrough in continuous glucose monitoring. I didn't know that, Okay,
so now they're able to do absolutely was in March of this year, right.
But the biggest problem, and they didn't say this, this is behind
sort of discussion scene, but my understanding I should say it that way is
the one of the biggest hurdles is that the battery power is when you're doing
a continuous gluecost monitoring, you choose up battery power really quickly. So that's
the problem because we're already our Apple Watch is right, doesn't get us at
twenty four hours to begin with this eighteen hours best. But where I'm going
with this is right, when I said, let's look take your listeners three
to seven years in the future, Apple said, right, and I believe.
Then I'll tell you why I believe in a minute. It's why celbet
is is that they will have continuous gluecoast monitoring capabilities on the Apple Watch within
three to seven years. Well, and so now in this world, as
early as three years from now, you're going to have diabetics, healthy individuals,
whatever. They're going to be able to show you Patrick, they're glucose
and rehability, and studies have already shown. Right, what's most important,
it's that so called coalfiicient of variation around your glucost variation. So remember your
stats class, right, fear of your levels. Here's your average level,
right, you're mean, and here's your standard deviation. So you take those
numbers and come up with cootefficient variation standard deviation INVIDABER the mean. You keep
that below thirty six and that is going to keep you in an a one
seeding range. That is, I hate to stake you worth normal, but
certainly outside an or inside of normal. Okay. And so that is available
now but not widespread. But again, in as little as three years,
we have potentially that ability, if not sooner. Now, what's interesting about
three to seven years? Because I was reading the Apple announcement, I was
asking myself, that's an odd thing. When you're developed continuous glucose monitoring devices
has to be SDA approved, so they are quote medical devices, and so
me the curious guy, right, that sounds odd three to seven years.
It's a medical device, So why do I do that? Go Google?
Right, what's the average time to approve a medical device? Three to three
to seven years? Three? Now, I'm not a rocket size, right,
I'm only a pharmaceutical scide this, But that's pretty darn compelling then.
So now imagine three to five years in the future where some will call him
influencer, you name whomever you would like to. Again, I'm not gonna
show for anybody on your show here, but you kind of said my gluecoast
variability is thirty two, and it's because of right, And then I feel
like, oh well, what's my number, And now you're going to have
an appeah and and now people are going to start saying, okay, you
know, like tonight, if you had a continued to glucose motor when you
guys use this glow glacemic index pasta, if you had day to to prove
that it reduces your peak and overall gluecoast variability, that's all you need packing
And this is not magic. So one of my interested parties, and we'll
call him an investor in this technology of low glacemic index idea, he did
that right, So he's a hip too diabetic. He did his finger stick
and he showed it absolutely. It bay his blood glucose barely moved relative to
what he would expect from eating a postdial and so he was convinced from that.
And that's only that's only a snap snapshot right right again, back to
the glucost pharmacole kinetics CEMAX. Okay, that's important, but the variability to
pique the trough is even more critical. We're getting there. I think it's
important too. And I'll go on this little side because there are some people
on social media and stuff that do have continuous glucoset monitors, and they're in
a situation financially where they can afford one, and they may not necessarily.
I'm still I don't know how to feel about this, to be honest,
because a lot of these people that are promoting you know, continuous glucost motors,
especially on social media, they are not diabetic at all. So they're
just completely healthy, normal individuals that don't have issues with blotcher control and their
thing making videos. Oh look, I ate you know Chipotle today, I'm
wearing my glucose monitor. Look at how big the spike was. It's like,
well, I'm sitting there watching the video, going, well, that
big spike doesn't scare me. You're a completely normal, healthy individual, and
it went up and down and we're good to go. Like it. People.
I've seen people take like a snapshot and a healthy individual and then kind
of promote it in a way that makes people scared of any type of glucose
elevation whatsoever. So if I'm a diabetic, walk can it? Can I
stop you here? Though? Can Can I stop you there? And I
hear you loud and clear, I would ask you to think about it this
way and not the way the influencers thinking about it right now, I'm not
agreeing with them at all. Right, I'm saying that let's stink through this
procesess. We eat processed foods our blood glucose reaches cmax due to fast absorption
and complete absorption. There's those calories of glucose molecules, right, So what's
the body's response. We get a spike in insulin because we had a spike
in blood sugar, and we know in pharmacology that that is spike spike.
Right, It's like turning up and down the volume on your radio right over
a day or two, Not a big deal. You do that over the
course of a lot, Yeah, exactly. Then that's when you start wearing
out that pancrease. You start wearing out those instoreceptors. And so that's what
I'm interested to see Patrick, to follow the research. At what point does
it become important to understand peak to trough ratios? Is it only important in
your controlling blood sugar in a type point or type two diabetic or does that
include pre pre diabetics or does it include you know, a ten year old
athlete. I don't know the answer to the correct Yeah, and that's that's
the point she's going to tell us. Yeah, I think that's an important
point. I to interrupt you, but yes, like there's I'm not in
that camp of like, if you're not diabetic, you don't need these these
this equipment. If you want to, if you want to pay cash for
one, and you want and you have the ability and means to do that,
I think it's fine. The more information the better, but we do
have to be careful with where like we've already touched on this, you know,
where you've said multiple times, we're not there yet. So having someone
who may not necessarily know how to interpret the data that they're seeing on their
app going hey, I ate this food and it went up this high,
not knowing what the ranges really mean in its context, and saying it went
up this high, you shouldn't eat this, because then you're then you're facilitating
people to just start cutting out foods that they may not necessarily have issues with.
That's where I was going with with that, because I think, like
you said, we're not there yet, and again, most people that are
doing that, the average everyday person doesn't quite understand glucose pharmacology or glucosse pharmacokinetics
and how that works, which I don't blame them. They don't They don't
need to know that. But I had no idea well that Apple was working
on that. I think that that'd be That would be one of the reasons
why I went back. Why I go back to an app watch just because
that'd be cool from a science for a science perspective, to get the data
like I have a whoop and I use it more for fitness and sleep tracking
than I do anything else. But one of the big reasons I got rid
of my Apple Watch because I used to have an Apple Watch for forever,
was I felt like I had to buy a new one every year, which
is just about any Apple product, and I hated having a charge it overnight
all the like, if I wore it all day, I'd have to charge
it for quite some time overnight and I couldn't check my sleep with it.
So I was just getting tired of with the of the battery going out.
So when you were saying the Apple was thinking about doing continuous glitcost Maria,
I'm like, they're gonna have to have like just an Apple Watch it just
as that function on it. If they want the battery life to not be
an issue. But that's cool, that's really fascinating. Yeah, But I
mean, right, so let's go back thirty years to my when I did
pharmacochy netting research and developing essays and right really working on converting that to the
real time respects that we could really use that from a clinical diagnostic and treatments
perspective. The reason why it took a number of years, it still requires
a lot of sort of work is to your earlier point about the interpretation piece,
the FDA very quickly stepped in. It says, these are medical devices.
They need the results need to be interpreted by a medical professional because there's
all sorts of potential for a farm dyta flies to the bluecoast monitors to your
earlier point, Right, That's why I think one of the reasons, maybe
the primary reason, speculation that the SDA considers the medical devices to your point,
so that people don't come out like your next you know you, whoever
the next influencer is and starts talking about continuous glucoset monitors and interpreting results.
Right, we need to have that in the context of what's the ratio or
what's the ray, etc. So I think that will be useful, but
it once it makes it to the Apple Watch or the fitbit or the whoop
band you know my daughter logan as a whoop band or something like that awareable
that's called it a wearable, then then it becomes even more important for healthcare
practitioners to be aware of its potential and how their patients are using I say
patients because they may not right, if you've got some twenty three year old
young man or young woman doing it, they're not a patient, right,
They're doing it because of what they see on TikTok. So there's the potential
form. Yeah, I think that's a very important. I'm by no means
anti any of these devices, but I think it's important to have to just
understand what you're trying to understand with them. What is the data showing you,
How does that relate to physiology? What changes you can make? Because
let's be honest, that's another key thing, especially with diabetes management in an
ambulatory care setting. When I was in pharmacy school, I went on to
do quite a few of those for clinical rotations, and that was the hardest
part was someone who would come in and we would see improvement in their A
one C. For example, I'll give you a one we had. There's
a patient who had a nearly diagnosed Type two diabetic who had an A one
C. I want to say it was like eleven or twelve way up there,
and we started doing we started doing lifestyle interventions with her. We did
basic like teaching her just the fundamental basics of the nutrition that she wasn't aware
of and just just trying simple things. The next she came back in I
think in three months when we went and checked her A one C again because
you want to wait a while before you do it is sure you check your
A one C. You don't want to check that all the time. And
it went down to like eight. So we're like, okay, we're getting
there where it went from eleven or twelve to eight, So what are you
doing like And we would ask her, hey, did you check your what
are your blood glucause checks? And she goes, oh, I just haven't
really been logging them. And we're like, okay, why because it would
be nice to see because clearly you're doing something right. It's not like we're
going in the wrong direction. And I'm chastising that person or going, hey,
what's happening. She was just like, I hate pricking my finger.
She goes, it gets annoying. It doesn't hurt that bad, it's just
annoying having to do it all the time. And if you try, I've
done this myself, Like if just from purely experimental perspective, it's like,
I want to know what these people, what my patients are, what's it
like? So if I wanted to map out, you know, my response
is to food before two hours after throughout the day, I'm having to prick
my finger eight ten times and it hurt, it's annoying, it's sore,
and then I have to go, Okay, it was okay, let's see
it was this, this response should be around here at this time. Okay,
cool, and you map it out. It is tedious, Like and
I'm a I'm a healthcare professional and know I'm know what I'm doing. I'm
like, this is frustratingly annoying. But Patrick, Patrick, you just made
the case, I think indirectly for where I was trying to take you into
the future. If you're a pharmacy practitioner, right then he's going to have
to be interpretation of that data that's readily available, and you've got to understand,
I think that's a perfect opportunity for the pharmacist and you know, an
independent pharmacy or ambilatory care facility setting or whatever to really step in and take
control of that piece of day, to work with that patient, work with
that patient and his or her physician right to manage them. But that is
again, if you think about it's just it's beautiful if you think about it
from a pharmacist descript and that's why I use gluecost pharmaco kinetics. There's nobody
more qualified to monitor glucost variation than a train from literally mean so there's a
really cool opportunity for people who want to expand their scope of practice. And
now I'm back on you know, now I'm back at UT I'm lecturing to
my pharmacy students right about opportunity and how you practice out you know, above
your license. So and by let me, I'm as I said that wrong,
but you know what I mean, expanding both of your licensy. We
get told that all the time. And you know, when I was a
lowly P one student, it was just like, oh, what does that
mean, how am I going to expand upon for like blah blah blah.
And then I remember talking to you the first interaction we had. I was,
where was I. I was in Memphis at the time, I think,
and I was I was on a trip or something. You were out
of town and no, we actually know. I remember meeting you in person.
We had lunch together. I forget where it was. Oh man,
where was that? We're eating outside? It was like kind of a anyway,
I can't remember the exact spot, but do you know what? You
know what I'm talking about though, Like that first meeting where I met you,
I tried to the restaurant's not relevant, but I remember listening to and
I'm like, Okay, I get what. I get what pushing the boundaries
of pharmacy means now. And then I mean, I the implications are even
even with especially with the telehealth market that we have now and those platforms and
the brilliance of the Internet is like you could have those on a platform,
especially with where we're at with Nimbus and stuff like that platform of having you
know, scheduling a simple twenty minute Google meeting too with a pharmacist or a
physician that knows you to then go over those continuous glucose monitor results with you
and understand what's happening. I think that's yeah, that's there's definite major implications.
We need to put that education. We need to put that education program
together for pharmacists and related nutrition related that that is such a critical need.
And again, when you put it in the context of you've got a three
to seven year head start, you've got a focus group now type two diabetics,
Type one diabetics, right yet, you can really get your seat wet
because the avalanche is coming. It really is right in a good way.
It's a really cool practice opportunity. I see. I think I've told the
podcast listeners a story with my background before. Maybe I haven't, but I
that was one thing we were was P one or P two student right before
I decided to start my masters and nutrition too. Was one of our professors
was saying, hey, like, you need to be able to not only
answer pharmacy questions, you need to be able to answer nutrition questions too,
and be able to like you know, relate all that to what they've got
going on. And everyone else just kind of brushed it off and was everyone
else kind of brushed it off and was like, Okay, you know whatever.
And I'm sitting there going, that's terrifying what you just said, because
I don't know anything, Like I know, yeah, I'm and I was
a student athlete, like I do know about protein goals and importance of eating
enough energy that kind of stuff. However, as we've exhausted my knowledge to
this point and I'm like, you know what, I'm gonna have to get
more educated on this. So I was like, you know, I'll just
reach out to one of my dad's good friends happened to be the dean of
the College of Nutrition and Dietetics, and I was talking with him, got
in to that program. And one of the few things that I found out
really quickly, and a lot of the my advisors and doctor Hakick would attest
to this. He goes, Paedrick, we wish we have more pharmacy students,
and I go, well, why, Like I was the only one
that had ever done it at ums anyway that was a pharmacy student and did
this at the same time, not to toot my own horn, but they
were they were like, you answer questions to our clinical nutrition situations from a
perspective that none of our dietetic students do. And I'm like, what do
you mean? I already knew the answer, but I like, I'll try
to get them to get out there. They're like, the way you guys
understand the pharmacokinetics and like the absorption and stuff like that, They're like,
we don't. We're not, that's not in our wheelhouse to a degree,
but we know it is. It is. But having that perspective and relating
it that those pharmacy drug principles of all of that too, nutrition is it
is very unique because they essentially worked way. So again, it's interesting and
fascinating that you bring that point up, because that way of thinking, if
we can apply it to medications, I mean, why wouldn't it work the
same way from a nutrition perspective. So I think it's I think it's encouraging.
And I'm not saying that every pharmacist has to go get a nutrition degree.
It's not what I'm saying, but it definitely it brings another skill set
to practice. So I think I'm all for trying to tease that out and
how we can develop some sort of training, certification or whatever programs where a
pharmacist can understand what they're looking at, especially if within three to seven years
someone's going to do it. Someone's gonna have to do it. Yeah.
Well, so in my pharmacy school days many years ago, and the buds
term was therapeutic drug TDM. TDM was everything right, it's mine and mine
run. And so that's where I go with this is this is just therapeutic
drug monitoring applied to the folks. And now you don't have to go through
a lab and take to those activity sorts of things, you know. Yeah,
yeah, yeah, theraputic drug monitoring for sure. I mean that's still
a term that we hear a lot in pharmacy school too. I haven't been
out that long, only a few years, but that was something that they
were really trying to push. And I find that the lay public and my
patients that come in there, you know, they're not coming in asking me
like foundational groundbreaking principles and nutritional A lot of it's pretty simple stuff. They
just want to know what to do that, what works, what has evidence
behind it, because a lot of people with certain biases may interpret clinical data
differently to fit whatever nutritional approach they prefer, which is fine, but my
big thing is consistency and what I can work with the patient to get to
where they do it consistently they don't, it's where they don't feel like they
have to do a lot of work because dieting, I think I don't really
even like the term diet because that applies that it's like a short term kind
of thing, Whereas I like lifestyle interventions because that's just part of what you
do at that point. However, I think it's really important as a as
a pharmacist too, with the interactions that I have with patients and the clinical
questions that I get on a daily basis is there's definitely a need for that.
And again you don't have to be go into all the fancy science terms
that you know, make everything kind of a little bit complicated. But knowing
how to take that data and just make it simple for people, I think
it is going to be the key, key factor because you know you can
you can have that technology and if Apple has I mean, if Apple puts
that out for or when they put that out if for their fitness wearables,
people are going to have questions and someone's gotta someone's going to have to to
stand there when the floodgates open, so to speak. And armacy is a
perfect too, whether you're whether you're in a pharmacy, whether you're an ambulatory
care setting, whether you're in lifetime sitness where I work out. People are
going to have questions because it's going to be saturated. I see it because
it has so many health implications. Now the science is evolving, and I
see evolving. There's a tremendous amount of literature on glucose variation and diabetes,
both type two, type one set up. So there's I don't mean to
imply that this is at the research level. We're well beyond that. I
mean, we've been working on this for twenty years, and so that's why
I think it's just really it's a technology problem now. But once that technology
problem is solved, it may have been solved. We're just waiting for the
approval speculation. But we'll see be there, just ready and waiting for your
patients and individuals that you're just curious about health related health and wellness. You
ask earlier or right of it. You know this earlier generations, right,
we're thinking more preventive, whereas the older generations are so brought up in a
treatment medical environment, right, So this is in dovetails with that sort of
preventive, preventive holistic health and well as sort of approach. So who knows
where this is going to go, But if I'm well, I think it's
it is and it's finally you know, And I see it too from another
another angle, is that like it's finally going to help provide answers to questions
that just about every one of these patients has because right now, I mean,
yes, you know, understanding what foods and how they impact your blood
sugar is extremely important. And again I think it's also also will help patients
from a different perspective because I deal with insurance companies all the time with prescriptions.
It's like, okay, yes you could then with this continuous glucose monitoring
and a diabetic patient if you let's say you do just basic labs and they
don't look that much different. Now I see the trends, you know,
if you interpret labs in a different way, it's not oh these are you
know, fine, No, they're trending on the lower end, or they're
trending in a positive way, but they may not necessarily on paper, look
that much different. But then you can extrapolate and bring in that glucose data
and go and look, here's their average. Like you could take that clinical
data you're getting from that wearable and go look from from three months ago to
now, we have seen this change in their in their glucose numbers, and
that could then facilitate like, hey, we're getting better, this treatment's working.
Like there's there's other it ties in IT, ties in another piece of
the puzzle that I help that helps that clinical data. So like for example,
said just looking at A one C like I always like seeing, okay,
well what was their fasting insulin? Well they're fasting insulin improved. It's
like, okay, great, that's what we want. We want less insulent
equals less insulin resistance to a degree. So we need to look at that.
We need to look at what the A ONEC is. We need to
look at you know, you can even get into fractionated HVA one C two,
but that's neither here nor there. But you take that puzzle. Let's
say you're A ONC went from six to five point five. Now, that's
great, you're no longer pre diabetic at that point. It's but someone may
say, well, that's only a half of a point. You know,
that's only point five improvement. But you can then show them go, yeah,
that may not look like a big difference to you, but look at
the trends and your glucose numbers of that continuously. Look how it changed like
this. It's a different frameshift. And then you have the patient not feeling
discouraged about that small incremental improvement you're seeing. You're seeing that that small improvement
looks bigger now because of that other improvement that you otherwise wouldn't have had.
So it reinforces that you're doing the right thing. You're not anxious about it,
you're not frustrated that you've been working this hard and you've only seen a
little bit of an improvement, because let's let's let's be honest. If you're
anything like me, you know you're you're kind of tough on yourself being a
former athlete. It's like you want to see those big improvements and payoffs and
you feel good when they happen. But especially with labs and health and wellness,
those little improvements add up significantly, and it's a it's a mindset.
You know, a patient may think, hey, how'd your week go?
And you could go, yeah, I struggle this week. I maybe eight
some things I shouldn't have and you can tell they're kind of a little bit
upset with themselves. And then you go, well, your numbers look great,
and then look at these values, like from a practitioner perspective, you
can then reinforce that there actually are doing good and they are making progress.
So I think that's going to be interesting. Yeah, but he gets back
to the mentality part as well, is we assume certain foods cause our blood
sugar to spike that just because they're sort of this food. But then when
you consume them, and they're many examples, do you realize they don't for
various to Sunday reasons. So then it starts to open up things that you
thought you couldn't have that you could have because now you're not worried about bloodsher
right. So it's sex behavior and food choices. And I think that's key
from a nutrition standpoint, is if in the study show this very clearly wearing
continuous glucose monitors sex food choices, because to your point, you can see
you know that a continuous diet they cause a spike after spike after spike,
it's not good for you. So if you're truly interested in reversing those trends,
then you're going to start look seeking out those foods that are similar but
don't give you or right but still give you that sort of food. Or
to your other point with your with the low gipost we're talking about earlier,
and you expand that product line into something like let's say you know, a
cake mix or something like that, to whereas you know, you know,
a normal piece of cake that was made normally, did this to my blood
sugar, but I'm eating the same thing. It's very similar, mouth feel,
very similar, taste, flavor profile like there's all that there, but
it doesn't do that same effect to your blood sugar. So then you're able
to when you do have those types of craybas we're all human. When you
do have those things and you want to reach for those foods, is you
have another option that's not to where you don't feel like you can have to
completely avoid that type of food for forever. Like I know a lot of
people that say, you know what, I love bread, I love passa,
but and I know I probably shouldn't need a bunch of it, but
I enjoy it. It's like, no, it's fine if you want to
enjoy it. But like if you, if you're one of those people that
likes the aposta all the time, why not have why not have a pasta
option that we know don't that we know won't affect you negatively as far as
it's impact on your blood sugar over time. So I think that the implications
for that, I think you are really are really going to be interesting to
see how they tease out. And I'm excited to know that you're you and
y'all's group are on are on that, and I'm excited to be involved with
it too because it's just super cool. Yeah. I mean again, I
just want to re emphasize to your to your listeners, if there today and
without going into a rabbit hole, we don't consumer education. Isn't there enough
for big groups to pick it up because there's not a market, But but
there's a good on swell that has started. And I think to your point,
if you get more people educated and you give them the ability to understand
why is it important? Why do I care? Once you get up,
why do I care? Then the awareness is you're going to hit that adoption
curve, right, that linear portion log linear portion, that adoption curve,
and then you're really going to see a take off, right, So you
just gotta That's my encouragement to any pharmacists looking to branch out or starting out
isn't don't think of diabetes as a dead end. So really it's it's really
going to be an amazing opportunity if you sort of look into the future and
see where those opportunities. Yeah, yeah, I couldn't. I couldn't agree
with you more there, you know, Yeah, it's finally it's it's interesting,
and I have to it's gonna take me a minute to kind of get
my head around that because for the longest time it's you know, you knew
that. It's it's a very similar feel to like ten years ago. I
would have never thought that I would have readily, easily, readily, at
ready access to my genetic profile to a degree. I'm a whole genome mapped
out, but like for one hundred bucks or two hundred dollars, I can
get a test done that that tells me just some cool, interesting things I
didn't know before. I would have never thought that technology would have been available
ten years ago, you know, or let alone be affordable. So and
right now with continuous glucose monitors, I mean you know, des comms,
stuff like that. I mean, they're not cheap still, and then the
ones that are cheaper, the sensors don't last for very on, maybe a
couple of weeks. I mean they're good and effective, but again, some
of them aren't continuously reading it. You have to kind of scan it every
every so often. So there are options, but I think it's gonna be
I think it's gonna be really interesting, especially from a pharmacist perspective on how
do we then take that data that is now readily available and use that to
then facilitate improvement from a clinical side, because that's a task that I think
is right for pharmacists to do, not because you know, I always want
to see pharmacists do more and succeed, but it takes the burden of that
off of a position in the nurses because to do that right and to look
at those trends over time take time, and they've got more important things to
do as far as diagnosing and doing all the lab testing and things that they
do, and there to where hey, I know your We've got you on
this. You know, we know what's your results are. Go talk to
the pharmacists. He knows how to interpret that data. We're all on the
same page, so I think we're I think it'll really help us expand upon
interprofessional practice too, to where we can all kind of be on the same
page, because I know for a lot of folks they feel like every provider
they go to to a degree is telling them something different. And I think
that's a big problem in and of itself. But Ryan, Uh, we're
approaching the two hour mark, which for you and me is not not anything
unfamiliar. I don't want to to take up any more of your Sunday either.
I know you've got a lot going on. I guess real quick,
if there was not on anything we've touched on, what other thing? Are
there any other things you've got working on right now that that that you're excited
for that you I mean, I'm not asking for you to go into like
any great detail, but in addition to the sessiment and the lower GI impact
foods things like that, are there any other things you're working on currently that
that you're also excited about? Before we wrap things up. Yeah. My
two big projects right now are this low blastemic in addition to the the what
I'll call the mighty liver supplement if I can link it to a disease.
In addition is this low glastemic index. I see, this is a revolution
and I want to being part of that. So that's a big push through
me right now. I think. The other thing is it maintaining sort of
overlap between nutrition and dietary supplementation. Is this concept of nutrient density and where
our agricultural practices need to change in the coming years, and the technology around
looking at nutrient density is changing as well. So there is a prototype device
where it makes possible in the future you to walk into your Kroger or your
grocery store and pick up to squash. Right, here's this one yellow squatsh
here's another yellow squatch and boom, look at the nutrient density of those two.
I start to make selection based upon nutrient density, right, And so
that's that's really fascinated is how do we get specially crops to think more in
the regenerative agriculture soil health. But the goal there is again nutrient density.
And the example I give very quickly is that we've gotten so good at fertilizer
and creating growth. But what that's still But now I'm oh, so I'm
being hyperbolic here. But now I've got a corn stalk. It's got two
ears of corn. It's in the same ground, and now I'm making grows,
so they increase four stalks, you know, four ears of corn,
Right, those four ears of corn in Toto still can say the same nutrients
that the two ears of corn did. It's the same ground. So now
you have the nutrient density of the corn on the cob that you're eating.
That's the hypothetical sort of scenario. We are right, just because we can
increase our yields doesn't mean it's the same thing in terms of nutrient density.
And in fact, they can't be, right, It literally cannot be because
it's more than just adding fertilizer to the soil. Right, it's so many
vitamins and minerals, et cetera, and so nutrient density. I guess it
is the other thing I'm really interested in, and how that ties back agricultural's
practices, particularly in especially crop food space. Yeah, that's that's that's awesome.
I've always been really fascinated into regenerative agriculture and farming and stuff too,
because it's one of those things you just can't ignore at this point. But
one of the biggest things that I see is like, man, how do
you see that's awesome on a local level. How do you make it?
You know? How do you expand upon that which is neither which is coming?
I'm sure, but that's fascinating, and I'm you know, I've thought
about it, but never really at that detail of like, yeah, you
know, if we're genetically modifying these things. I'm not a big anti GMO
person. I think that's fine as far as like volume of food and providing
people access to food and stuff like that. However, to your point,
if I take corn and I've modified it to be to where I don't have
to really worried about the weeds and things like that, but I've also made
it to where now we're doubling the yield of said crop, You're and no
one's talking about how do we how do we increase the nutrient density in the
soils, etc. So I never really made that link of oh, well,
yeah, we up the we made they can grow a lot more wheat
or a lot more corn. However that soil, you're just increasing the demand
of the soil and then then next thing, you know, it's not yielding
those crops anymore. That we're yielding four years of corn, and now you
have to go somewhere else and buy up more land and then you just repeat
the process over and over again. So that's fascinating to me as well.
I'm interested to pick your brain more on that in another episode or just another
conversation that we have, you know, just as friends. But man,
I really appreciate you you being on here. I you know, I I
can't thank you enough just from a friend mentor pushing me to kind of do
better as a pharmacist too. Man, I can't. I can't thank you
enough. It's super it's super cool to be well connected to people who are
really pushing the boundaries who in their fields. I think it's it's just I
think it's awesome. And the super humble guy, well, I appreciate well,
I appreciated Patrick An I'm gonna pay it forward kind of guy, right,
And that's what I tell anybody I talked to, Uh, you know,
and I'm honored to be considered a mentor. But I would tell people
that say they paid forward, right, make sure that those folks right,
tell everybody you can to read as much study and learn this stuff and get
involved. You know, you and I've talked about this guy, Jay Phipps
right here, a former classmate of mind or actually I think he was one
year behind me a pharmacy school. With the things he's doing in the field
of pharmacy and independent pharmacy in West Tennessee, you know, we need more
people, and they're out there said, but we need even more people like
Jay Phipps and like yourself and what y'all are doing at Nimbus to really push
those boundaries. Because right now, in one respect, right, So,
when I went to pharmacy school, if the mantra was you need to be
getting out of pharmacy, because this report just came out and said the pharmacy
professional was done the jobs going away. And when we finished pharmacy school and
my wife finished their residencies and the pharmacy went through the biggest explosion in salaries
in the history of pharmacy, right, So completely opposite. So anything you're
hearing now about pharmacy's probably alved and still the same. I heard that.
Okay, I'm not being heard same thing in pharmacy school when I got in,
when I got accepted, even from my dad, he in and I
was like, oh yeah, he goes one of my prescas who was yeah,
I guys, it's the pharmacy builds saturated. There's a lot of pharmacy
schools, not many jobs right now. You are going to really struggle getting
out. I'm like, that was what I heard p one year. And
then when I graduated, COVID hit and then it was just everything changed and
now there's a demand, a significant demand for pharmacists and pharmacy students. So
it's like it went full circle in four years. So well so as a
guy who's seen that over thirty year period, I told every single class I
ever talked, there will always be a shortage of good. That's correct.
Yep, that's correct. Never forget that when you're getting you to our profession.
If you want to become the best pharmacy she can be, you'll always
find a job. There'll never be a right. That's awesome. Never,
Ryan, I don't want to take up too much more of your time.
It's been a long it's been a long Sunday. If you're a busy man,
tell everybody in your family. I said, hello, give him my
best, keep my dad in line. I tell you that all the time.
That's not an easy task, but someone's got to do it. I
was gonna say, but hey, you're better than me. I live far
I live too far away now, But Ryan, I appreciate you being on.
This won't be the only time I plan on having you back, just
whenever you want. Just let me know. I'm really excited to see where
all this goes, and I'm excited that you will. You know, are
allowing me the opportunity to get involved with you too. I haven't really gotten
a chance to thank you for that, but I'm really excited to see where
this goes, and I appreciate your time. Sure, Patrick ahead, thanks
for having me. Thank you guys for listening to today's episode of The Weldness
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