Mark Cucuzzella transcript

Written by Christopher Kelly

March 30, 2017

[0:00:00]

Christopher:     Hello everyone, before we get into this week's interview with doctors Cucuzzella and Wood, I wanted to read to you an extract from one of our highlights emails and this is one action item to add to your health routine this week. Eat berries with concentrated carbohydrate sources to minimize insulin release. At nourish, balance, thrive we love a well applied low carbohydrate diet. However, we also spend a lot of time telling athletes to eat more carbs if their lifestyle or chosen sport demands it. This often revolves, reminding people that fueling for your sport with real food is very different from indulging in highly refined Western diet. Regardless of your current goals, optimizing the amount of insulin that gets released in response to meals is still an important goal for long-term health.

    That's why we love this Finnish study which showed a purée of strawberries or a mixture of berries decrease blood glucose and insulin response to eating bread despite adding more carbs to the meal. We particularly like diet berries, rich in anthocyanins, like Bill berries or blackberries, which probably have the greatest effect on blood glucose and insulin responses to a meal. So, head over to http://www.nourishbalancethrive.com/highlights and you will receive this email with the references and I think Tommy's doing something really amazing here, which is creating maybe a training course or a book or something called -- but anyway, if you need over to nourish, balance, thrive.com/highlights you will be able to sign up and you'll get this in installments, week by week. Now over to the interview.

Tommy:     Hello and welcome to the nourish, balance, thrive podcast. My name is Tommy Wood and today I'm joined by Doctor Mark Cucuzzella, hi Mark.

Mark:     Hi Tommy, how are you?

Tommy:     Good. Thanks. First things first, how was my Christopher Kelly impression?

Mark:     I think it's good, you both carry the same Queens accent, so to me, it's all good.

Tommy:     Okay, good. I know you've listened to the podcast a few times, so I tried to get his intro going. So, we are recording downtown Westin Hotel in Seattle. You've been here at a conference for the week and for people who don't know you or your work. I'll just briefly, your family physician. A professor of family medicine at the University, or West Virginia University and Lieutenant Colonel in the US Air Force reserves, is that, right?

Mark:     Correct.

Tommy:     And we had a little bit off email back and forth like a year ago, and then met, just briefly at low-carb record reach and then you come up to Seattle this week and we've made a couple of times, which had been great. But the first time I heard you speak sort of extensively was actually on a Robb Wolf podcast, maybe that was six or seven months ago, I think it come out and I remember him saying that it was one of the most important podcast he has ever recorded, which, considering the number of podcasts he's recorded is pretty impressive. So why don't you give us like an introduction to your work and what you've been doing and why it's potential is an important.

Mark:     Well. Thanks, Tommy. It's fun being here in Seattle. It's 68° and sunny back in West Virginia and I've enjoyed some nice runs along the water here in the Seattle weather, but with good gear it's all fun and got to catch up with a lot of friends here in the military. I'm 29 years in now as a reservist and I have a few classmates that are still around that graduated residency with me, so it's fun to kind of keep up with them and see what's going on in the active duty world. Yeah, but to have Robb say that, that humbling because he does do a lot of podcasts and I'm just trying to do basic grassroots type of work.

    You know at several layers, I'm a professor at West Virginia University school of medicine and for those of you in the states your kind of know if you looked at a CDC map of obesity, we are, I think it's a black color now, meaning 40% obese us and Mississippi. So, we've got a long way to go in West Virginia, but its low hanging fruit. So, I think we can make some change there and we are making change their and starting at my campus with low carbohydrate interventions for hospital patients, and we might be the first hospital to actually do that. You know, true low carbohydrate intervention like 10 g part for a meal, to the diabetics. And that to quite a few years to get that through so, you think the listeners of your show kind of know that's obvious, right?

    They're sugar intolerant, you know, so don't do that. We also have a program now in its third year, because there's a ton of folks in my community and many other world communities and urban communities where families suffer from what's called food insecurity and that's where their ability to purchase food in their health kind of come into conflict, you know, most of our chronic illness can be improved by better nutrition. But if it's not affordable then it's hard to fix. So, we double a snap, which is food stamps at farmer’s markets. So, if they come in with $20 on their card, they can make $40 in market bucks.

    And that's great, you know, but it's a small change. You know, it's hard to ramp that up to the entire country, but I think it's a model that, I think the highlight that that does is show, where snap dollars are being spent on. Anahad O'Connor just wrote a New York Times article, maybe a month ago, and if you were to guess what the number one item purchased with snap is, snap dollars, which are federal dollars for food, which are supposed to help nutrition a family, what would you guessed that item would be as a category?

[00:05:20]

Tommy:     I'm going to say its soda or something like that.

Mark:     Yeah, it is, its soda. And you know you would think, it blows your mind that it, I'm not even saying food. I'm like stumbling on the work as it is, you know, so it's a beverage that's actually anti-nutritional for most people. I mean, it drives them towards disease. So, we're supplementing them to buy something that striving them toward more disease. So, this has to go to policy change. And maybe we can make a little noise in West Virginia and start at our local level which is happening now. Trying to get taxation on sodas, but it's like moving a rock, you know it's really hard to do but chip away at it and make some progress up. On the Air Force for about five or six years I traveled around the military bases and try to teach people how to run without getting hurt.

    I think for most people out there who are runners, the kind of assumption is running causes injuries. You know period, right. Running causes injuries and I think the opposite is true. I think we can train people to run, to make you injury resilient. I mean safe I'm a special forces soldier, I want to be injury resilient. The more I run and run correctly, the more I can go do my job and not get hurt. So, you want to turn that on its head. Teach people how to move well. So, them down. You know, most people are type A, and go out and run too hard. So just get them to embrace the purpose of running which is part of your whole health plan to make it bulletproof so to speak. That's what we talk here this week at uniformed services Academy of family physician’s annual assembly. I myself and three colleagues taught a workshop on you know, mind, body, nutrition, resiliency.

Tommy:     Yeah, so I came, [00:07:02] [inaudible] invites me to come and see the session on Monday, which is great, actually, because it's there, it's the family got for the services, so it's all the uniformed services taking part here. You know, sitting next to a couple of guys, so one is in the Navy. You know, he looked like you could probably snap me in half and he is, you know, very strict vegan. Seeing the guy next to him, there was this big butch guy who said he spent the last four years, like researching Taoist principles and doing all this, you know, type of meditation. And then you had your so colleague Colonel O was talking about, CrossFit and paleo and somebody else who's talking, yeah, Megan. And Jode Accur was talking about mindfulness and then you were talking about the running and movement, so it was really amazing just too kind of see all those different principles is coming together. But this is obviously kind of a small core within the armed services, is my guess. So, how are you finding, kind of trying to expand that out into maybe the Air Force or other armed forces in general?

Mark:     Yes, I have a program now available, it's online for anyone now called efficient running. They are using it in a research protocol now at Travis Air Force Base to take people who are marginal or who have failed the fitness and show them these online modules, you know it's teach a little bit about physiology and they have all count up 40 different videos for movement rules, form, running form, little bit on footwear. I think it's hard just to look at a computer and learn how to run, but maybe a few things people can get out of that can stop them from making some of the same mistakes again and again, I see people making the military, especially, making the same mistakes. They go out and run too hard. We actually got a policy change at basic training. Basic military training. This past year to give them permission to slow down because most air men who joined basic, you know, you constantly feel like you're being evaluated by your leader or your cadre so if they tell you to go on a self-paced run you know you and I may just go out and job along the lake and you know, stop for coffee. But if you tell a basic trainee to do a self-paced run. Do you think he's going to go?

Tommy:     Yes, I remember this from back from my rowing days, we used to have these like anaerobic session on the running machine for an hour. We put a UT 2, utilization two at the lowest price, but you'd sit next to this guy who is pushing a little bit harder than you and you push harder and harder and harder. By the end, you're just like completely destroyed as opposed to be...

Mark:     That was your recovery.

Tommy:     Yes, exactly. [00:09:32] [Inaudible] exactly the same.

Mark:     Exactly the same. I mean, they're basically type A, by definition, when they join the military and easy. It's like one step ahead of the dude or lady next to you. So now it's like show jogging. You know its okay, we're doing mobility drills, dynamic warm-ups, no static stretching. You know, just kind of getting back to the very basics of injury prevention and proper training. Running them less, you know, when you take someone basic training, you know you're taking a kid that probably been sitting on the couch for you know, maybe his own life and he somehow just signed up with a recruiter. And then you march him 10 miles a day, just being on base. And then tell them to go do PT, it's a ticket to disaster and overload.

[00:10:15]

Tommy:     Yeah. So, is this being rolled out across, how many bases or what level is this being rolled out across?

Mark:     Yeah, so that's basic training and we hope this will trick a lot over the past five years have gone to a hundred military bases. Tomorrow I'm going to the McCourt, which is the right down the road in Tacoma. There will be about 100 folks that are involved, they are called PTL's in the military. Physical training leaders. And so, that's a group that leads the core PT, as recorded in military physical training or fitness. So, training that group in these principles, because they are leading larger groups. They used to have in the Air Force, they called Hawks, health and wellness centers, led by exercise physiologist. So, they were the key group, but then the Air Force downsized and reduced the number of those slots. So yeah soon as you find a group that understands this and they start pushing it through, like any government program, it all shift.

    So, we keep at it. So, I go, on March 20 I'll be at the Pentagon working with the fit to win clinic, you know, with their exercise physiologist, there and lead athletic trainer. So, I like collaboration. So, I'm a physician, but maybe I know a little bit about running mechanics. But then you bring in the exercise physiologist and the strength trainer, you know. Together we come up with some really good ideas. You know good collaborative teaching. And then you leave the people at the base there with some schools that when they get to evaluate people, they could do things a little bit differently. So yeah, it's fun. I mean, I see lives being changed.

Tommy:     I mean, that's amazing. I just think off, all the guys, particularly you know if they go out, they're coming back getting discharged, maybe injured. You know, having some skills that are gonna keep them fit into the future right. I mean, you want to keep them fit for the battlefield essentially right. That's their job. But in the future, you want to keep them going as long as possible.

Mark:     Yeah, and I'm really trying to, over the last, like four or five years, you know I first started doing this mostly with the running focus, but then I realized that most of the people who were there have metabolic illness to which was affecting their running. And when I started talking about nutrition. It seemed like it was an area where there was tons of confusion and people are spending all kinds of, wasting all kinds of money on various programs. You know, you'd have on the basis, they have all GMCs, you know, marketing all these products and most of them hogwash. People trying these liquid diet plans. You know, try to make weight because there's a body composition component. So, I started just talking about healthy fats and low carbohydrates because as people go on in their careers, most of them become insulin resistant. And now we're seeing the 18-year-olds were all insulin resistant. So maybe you know...

Tommy:     They show up insulin resistant.

Mark:     They show up. They are born insulin resistant, you know, which is really scary. But yeah so, it seems like that's the area people are just fascinated by. Because usually what I've done, almost every base of gone to, if there is you know, 1500 people that are in the seminar, you know, ask the question. You know, is anyone in this room, you know, taking 50 pounds off and kept it off for a year? And maybe one or two hands would go up. And I'm not afraid to ask the question, what did you do? And across the board I got rid of sugar. Because I don't think you can do it without that. I mean it's so, and kept it off for a year. And then I asked the question, well, how do you feel now? Great, yeah. You know they are the ones who are just like you know, even angelical, leading PT because their body's burning fat. You know they're not in a deprivation state where you know you go buy the latest shake program of 800 callories a day to try to make weight and your body's gonna rebel against that cause you're shutting things down. The body's going to protect itself.

Tommy:     Yeah, absolutely.

Mark:     The people in the room. Explain it because that's how you succeed is doing it that way. And tomorrow I'll ask the question too, you know, saying [00:14:05] [inaudible] and they teach the class. You know what you avoid? Bread. Sweet drinks. I got rid of soda, you know, so let's like so simple. The bases are loaded, it's like there's a Burger King and the McDonald's on every base, in the subway, you know, it seems...

Tommy:     It seems out of hand.

Mark:     Free refills and all that stuff.

Tommy:     Because it makes me think off weight watchers as the other comparison right. And I think, I don't do the exact number, but it's something like a 93 or 94% failure rate to maintain long-term weight loss. And it's just, that's crazy. Its crazy just doesn't work.

Mark:     Doesn't work. And it's a good business model, because if I get you to stick with the points and you in essence, reduce your calories to for three months and you could take a nice pre-imposed selfie and you are falling 20 pounds off here, okay, the program quote worked. But then your kind of try to, but you're using all their Franken food. You know you're using all their products and its fixed meals and then the quote transition phase, back to the real world, you gain the weight back. So, who do they make you think is a failure?

[00:15:13]

Tommy:     Yeah, you. You just didn't do it right.

Mark:     Yeah, so you're the failure. Not us. Come back and get back on the program. I can just cry. You know there's, I heard this, you may know Tommy -- you know name of link, but its 60 billion a year in the US is spent on weight loss. 45 billion national defense. Like, we can look it up, but I heard that from a legit source. I'm trying to remember where it is, but...

Tommy:     I felt like defense is more than that. Maybe not.

Mark:     its billions, were talking billion. So, more money spent in America on weight loss.

Tommy:     And look how well it works.

Mark:     And it doesn't work. Yeah, it's, so you know everything I do with, you know, fat loss, you know, I want people to lose body fat if that's their problem. There are no products, this is just a food list. Now they eat some type of, if there a vegan and they need some B vitamins, you know, certainly fix that, but not, I mean, there's no holes in the roof if you have a good nutrition plan.

Tommy:     And you based that around the real revolution list?

Mark:     Yeah, I think that's, we used that one in the hospital so Doctor Tim Nokes, if you go to his site real meal revolution now everyone's gonna be a little bit different on the spectrum, but if I have a, you know, patients I see are usually the full catastrophe, you know, their sugars are 500 and their A1C's are 11 or 12. So there's that green, yellow and trade. Green eats a satiety, yellow caution, red do not eat. So usually you know I'll say like two weeks just green. If it's not on the list, don't eat it. And then the last meal, what about this? I'd say is it on the list? The look and they'll be like, let's flip to the red. You know, it'll be, you know, muffin or you know, but it makes it pretty clear. And it's just like there's evidence and you know you can look this one up too. So, if I want to get someone to quit smoking, you know cold turkey is easier than telling them to gradually taper down. And the evidence supports that because if people are like, okay, I can only have four cookies today, what are you thinking about all the?

Tommy:     Cookies.

Mark:     Cookies, yeah. So, I want you not to think about cookies. So, you're just not gonna eat them. But I don't want you hungry. You know, so if you eat healthy fat, certainly be mindful of your meals. Sit down with people. Chew your food. But you know, if you eat fat, you’re satiated. And just make people believe, you know, so if I'm not sincere. And if someone believes that they can get well and they don't need to suffer, there are lots of doing it are better than if they don't believe. Then their odds are zero so you know I mean, I'll show them pictures of people who have been willing to share their stories. I mean, like here's a gentleman. You know, he was just like you a year ago, you know, look at him now. You know he's, well. This can be you.

Tommy:     And that's a mindset that you can take because that's very different from the standard medical approach to metabolic disease, which is, it's chronic, it's lifetime, it will get worse, it doesn't get better. But when you have that evidence, right, you give somebody that believe because they know that they can actually be better, then that's gonna dramatically increase their likelihood of actually being better.

Mark:     Yeah, and I think you saw the image I passed around you know on that little sheet of paper on Monday, which basically was the lady in a fork in the road. You know, you go down the left side of the road and be a chronic medical patient for life or you go to the right side of the road. You know there's a fork in the road. Which one do you take? You know, if you take the one on the right, which get you healthy. You know that can make all the difference. So, you just did people in that mindset that they don't need to be a medical patient for life. And that in itself. I think, I mean, do you want to be a medical patient for life?

Tommy:     Absolutely not.

Mark:     No, I'm enough of broke my ankle falling off the curb. Maybe I'll need to see a doctor, but I don't want to be a medical patient. I want to be me and do what I want to do. Not need to see the doc every three months for med refills.

Tommy:     Yeah. And actually, I mean the evidence is really starting to gather forces. You probably saw publications came out, to better health rights came out just yesterday.

Mark:     Yeah, they're my friends and colleagues, yes. So, powerful study. I mean, people want the data that this can be done in a large-scale without 50 doctors, you know, you know, six doctors per patient or the you know DPP trial, diabetes prevention trial. You know, so yeah, you can with an intense regime, you can reduce your odds of progressing to diabetes but that was 16 One-on-one visits, culturally sensitive with a nutritionist, telling you what program to use. So, that's hard to scale that. So, the verta program for those that don't know it, it's based on either picking the right patients, you know these aren't, you know some of the ones to look better in jeans. These are people who have type II diabetes.

[00:20:06]

    Metabolic syndrome obesity. So, these are the sicker patients and they're using the low-carb, high-fat diet and they are monitoring blood glucose so it's virtual support. So, your health coach every day will get a report of your blood glucose. You step on a scale which is wired to the health coach, so you can't lie about that one. And they do check. You know, depending on the patient they'll check, it's a precision ketone monitor. So, that will help them tune. So, if someone's not doing well, okay, let's just use some tools in the toolkit.

Tommy:     Yeah. But I think a coaching model is still really important. But if you can do virtually, which is actually very similar to what we do, right. We have a fairly intensive coaching program, but it is all virtually based. And it's a big push to kind of make things automated and artificial intelligence and stuff, but actually at the end of the day, people still need some kind of coach. But if you can make it an online system like that, you're gonna be able to scale them, nothing [00:21:02] [inaudible] to do.

Mark:     Yeah, people just need support. They need to know someone's there, you know, there are so many Facebook groups now on low carbohydrate support, but you know, certainly, that's not gonna be specifically tailored for you and scientifically valid. You know, so behind Virta is Steve Phinney and Jeff Volek and Doctor Sarah Halberg. So, you know three of the leading you know, physician scientists who know what they are doing so when I see Phinney and Volek, who together have like 700 papers you know behind the scientific side of this. It's like okay, I think they probably got it dialed in. And then Sarah Hallberg, you know, maybe you can link to her video where seen diabetes is all about ignoring the guidelines. It's a great [00:21:41] [crosstalk]. Yeah, 15 minutes to just show you, do not follow the guidelines, if you want to get better, right. If you want to go to the left side of the road, follow the guidelines. Get your med refills. Spend all your co-pays, get rid of that stuff. Try this.

Tommy:     Yeah, absolutely. I'll make sure, we stick that in the show notes. But I did want to, sort of the other half off, you and your story is sort off a change in terms of the way both the way that you ran sort of biomechanically, then also, and in the way, you fueled that by changing to those sort of low-carb, high-fat type diets. And you know, maybe you could kind of give us a little bit of insight into how you did that sort of and I could probably get a PDF of this sheet I have in front of me, which is two of your VO2 max results. So, from 2016, 2017 and there's a significant change in your, you know ability. The amount of fat that you're burning. Sort off during exercise. So, you dramatically increase your fat burning capacity to fuel exercise with that stores. But maybe you could kind of give us a bit of insight into what you did, what you measured? How you make those changes? Because I think that something that our audiences would be interested in.

Mark:     Yes, so I'm trying to get the short story of all this. So, Tommy, I'm 50 years old and I've been a competitive runner since about age 13, when they decided to throw me into running races. I was one of those kinds of hyper kids before video games. We just played outside and someone decided to -- my father, because my brother had run cross-country so he signed us up for a half a marathon and my younger brother was 11 and I was 13 and I ended up running like a 123 and he ran at 130. You know, just right fresh out-of-the-box. So, we become runners. Which is probably not the smartest thing because we know now, when people become single sport athletes, they get hurt and they get fried and they lose the joys of, I mean we both had a lot of success when we were young, but we were constantly hurt, but went on to run at UVA, University of Virginia. But again, half of my time, as my teammate’s time was in the trainer journal on the injury list. None of us, but that was normal for the day, none of us understood anything about why we got hurt.

    We just shut up and ran as hard as we could every day. But that's probably, I mean anyone who's done collegiate athletics, that's kind of what you do. You know, we're kids right. There's no such thing as easy, went on to continue running after that, more just for fun as I got into medical school. But found the joy in it again after college and again was heard off and on. And mostly [00:24:18] [inaudible], the injuries. Feet injuries, [00:24:21] [uncertain sounds like planoferciosis]. You know got my marathon times down below 2, 25, but I would always be hurt. You know, you start to get fit, then you get hurt. And then I didn't realize what was going on structurally to my feet. You know and probably, you know all this choose I've been wearing were too small, including track spikes. I had really bad what's called helots velgas. Helots velgas abductas, which is where that big toe is kind of paint inwards and fused, from all the arthritis. And that was affecting all of my movement. If you don't have a base...

Tommy:     Like a bunion.

Mark:     A bunion, yeah, a bunion with a fused joint. So, you can't bend that first toe. And if you think of the foot as a spring, you know or like the lunar lander, where you've got to have this spring mechanism or a jump rope, you know, think of jumping rope, if your foot was just a big clump.

[00:25:06]

    It doesn't work. So, I had that surgically corrected, at least got the toe straighter, got some of the arthritis out and was kind of told at that time if I won't run again, or at least competitively. Because you know whatever you did before, just screwed you up so don't do it again. But I missed running so I knew, you know, as most doctor’s kind of in the space I'm in now with low-carb and running mechanics and the screwed-up footwear we all have is that most of what we learn in medical school for chronic conditions is wrong. You know, so and I knew that pretty early on in the game. So, I went back and studied running mechanics and that was about the year 2000 and touchwood that was my last running injury. And slow down.

    I came across an article by Phil Mathatone or it was by Mark Alan, but talked about Phil Mathatone. I'm on a plane in a pickup this airline Journal and it talks about, the title was get fast by going slow. And it was about the methadone method which you should take 180 minus your age and you just start running at that pace. So, that's how you develop your mitochondria, improve fat burning and your kind of built the pyramid up from the bottom. So first I went out and did that method, I'm running like 12 minutes a mile. I was 30 and maybe give or take, and the heart rate monitor would go beep and in the old days I would've said screw that and just ignore it. Like what the hell, like grandma is, like my dog is waiting for me you know.

    But I was drinking the Kool-Aid and you know, next month and running, you know, 11 or 10 minute a mile at the heart rate of 150. The next month a 9 m.mol at a heart rate of 150 and I got onto the fall that year, you know it was maybe seven months after surgery and I'm running around this little park in Denver, Washington Park, running pretty close to six minute a mile at the heart rate of 50. So, I think a lot was coming together. Maybe I fixed my metabolism. But it forced me to start running really slow. You know, and that probably helped my mechanics because you're not over striding. I got involved in some footwear projects too, involving, before the word minimal shoe was around, I was sponsored by Brooks shoes and they had some projects going on which were kind of the pure project. They didn't have a name yet, but the guy there, his name was trip Alan. Was the lead design guy and he was sending me shoes that were leveled off. You know, quote zero drop shoes that basically hacks off for some reason those felt really good.

    I didn't know much about the shoes, but when he explained it to me as an engineer, engineers are pretty smart. Doctors maybe not so much but the engineer is like, yeah, you know, you put the foot up at an elevation, your Kiley’s diamond spring can't work well and you know you just compromise everything. It screws up your arch and your blah, blah, blah. And I'm like, just try the shoes, right. So yeah, I was running in all the zero drop Brooke shoes, but then the, you know economic crisis hit. So, that project went to the drawing board or not, you know, went off to the closet essentially because it wasn't a good time to launch a new product.

    And actually, that project came, that shoe came back out as the pure project. You know, just kind of cool to see all those designs and so that got me into the more minimal shoe space. But I didn't really discover, I kind of understood slowing down and building my Anacondrai and don't beat your body up, it's easier to recover and anaerobic base so that goes back to Athur Videard [?]. I mean they all did a ton of aerobic miles to support the anaerobic work. You know, so it's not all people misinterpret that, is a well it's all easy. It's like know the more aerobic work you do, the more you have the capacity to tolerate the anaerobic work, when you need to do it.

    And so, I would you know certainly do some anaerobic work is whatever event I was prepping for needed some of that but without the endurance base you know, I found that I could tolerate intervals of recover, even though I didn't do that many, maybe 4 to 6 weeks before an event if I was getting specific, I would start to do some innervose [?]. Didn't know anything about nutrition, other than it a lot of carbs. So, I mean none of us are talking about that yet. So, I did party become a bitter butter burner, so to speak without eating low-carb. Just by doing that training because I never bonked. I mean my so is Marathon is under three hours or actually write at three hours, out of over 100 marathons. So, I think I'm pretty bonk proof. Even before going low-carb at about five or six years ago, when I was doing and Air Force project on why people are fighting the fitness test. You know I started to learn about nutrition because that was the big problem, was these people had high BMIs. You know, not that they weren't doing their PT and I needed to figure that out. And just by chance I came across an article by Gary Talbs, it was a 2002 article, maybe it's all been a big fat lie. You know you're just sort -- I had like six months to do this project and so you just spend a day, just searching stuff, you know.

[00:30:03]

    And there's, like, as a doctor I'd never search anything on nutrition. We got like zero or probably less than zero at medical school because we were told the diet heart hypothesis. Well of course you know, eat fat, you get fat. You know its cholesterol and clog your arteries and you get a heart attack. So, that was what we were convinced was true because our senior mentors told us that. So, it's probably worse than knowing nothing. And I, you know, I read that article and I just thought about the people I was dealing with, which were hard-working military people. These weren't lazy inglentanis people. That's like, well, that makes sense. And then I bought his book and read it like three times and that was like another two weeks, you know. And his book is like a 400 and -- good calories, bad calories. It's the only thing written on it at the time. You know, 450 pages, not a wasted word. And then I looked at my own labs and how I was living and my families got early heart disease, diabetes and you know I looked at my last military labs and my HDL was like 40s and triglycerides were above 150 and my sugar was 120, somewhere around 120.

    Which is of fasting, because we always did fasting and I'm like, you know, I looked at what I was doing. I was eating a huge bowl of cereal with skimmed milk pretty much every four hours, through the 24-hour cycle of the day. So, I was becoming insulin resistance. Couldn't even store the carbs and was just burning them. And I was the negative, you know, I was kind of the other bias when you come into a doctor's visit is, here's a lean guy who is fit, but he's labs are, just an outline [00:31:40] [crosstalk]. And it is curious my roommate here this week, is another.

    His name is Antonio Apaliro and he's a runner, really good runner. He's 48 years old. And he roomed with me last year and hiss, after hearing some of the stuff were hanging out and his HDL, we looked at his lab. His HDL was 30. He's traits were over 150 and his A1c was 5.5. So, he's leaner than I am. And so, Antonio went all in and turned the food pyramid on us. He was like, here's the bagel junkie. We've hung out a lot and you know he's always got, you know, bagels in the room and stuff. So, he did the opposite. This year, you know his weight's the same. He's running better than ever. He ran like a 123-half marathon a few weeks ago, but he's HDL is 90. Tricks are like 80. A1 C is 5.1.

Tommy:     Wow.

Mark:     Yeah so, but people don't realize that you can be at risk of heart disease, you know and be really uber fit, right.

Tommy:     This is the classic, again, you used the word paradox. It's there, I don't know why, you know, Jo had a heart attack. You know, he runs every day or you know he runs all these marathons. You know, these are the guys who are dropping dead.

Mark:     Furnace is hot enough, you burn it off. That's what people think. But it's not true.

Tommy:     So then that kind of, that transitions really nicely over to something we talked about just before we started, which was actually Art DeVany, right and he has this, he has the idea of physiological head room in terms of what you're capable of versus what you, you know, as a percentage, or what you do every day as a percentage of what you're truly capable off. So just having this head room, means that you're much more likely to -- it makes you hard to kill, essentially right. But he also, back in the day, I don't think he has any more, he had this, on his website something about death by marathon. So, he recorded all these people who was supposedly fit, you know, running marathons.

    Having you know, heart attacks, or whatever. Or you know people who were doing a lot of endurance exercise and obviously was having a negative effect. So, you as an endurance runner, I mean, now you talk about how you move, cardiovascular fitness is like a measured say by a VO2 max is a really good predictor of cardiovascular mortality, but equally things like muscle mass, muscle strength is also really important. So, how do your kind of view the trade-off between you know, high-volume endurance exercise. You know where is there, you know, the U-shaped curve. Where does the strength come in? How do you try and balance those out?

Mark:     Yeah, I'll kind of answer to that in a couple of parts and so just to back up a little bit on five years ago, So I shifted my diet to, that was my last bowl of cereal. So, I became low-carb healthy fat. So, it's, butter, cheese, I'm not afraid of meat, quality meat. Ton of oils, you know, vegetables are vehicle in olive oil and you bodies just [00:34:45] [inaudible]. I forget where I heard that, I think its Doctor Grundy, who said that.

Tommy:     Yes, Stephen Gundry.

Mark:     Stephen Gundry said that. But it's a true if you look at the Mediterranean’s. They just pour the stuff on. Little red mine is fine. So, my body adapted and develop the capacity to use fat as fuel.

[00:35:03]

    Not just for exercise, but I used to wake up at two in the morning and need a bowl of cereal. I didn't want to wake up at two in the morning. I needed to. So now I could have dinner, go to sleep, wake up, not even need breakfast, go for a run, come back for lunch. You know and be fine. So, burning fat is a healthier way to live. And that's these inflammatory. Reactive oxidative species. So, I think that gave me much more physiologic headroom just to go through the day in the life you know and not needing, you know, have six power bars, things like that. At any given time. But so, you know, some of it has to do with age and what's your specific goal and genetic adaptability. All of us adapt differently to different training stimuli.

    So, you line up, I think David Epstein's written about this in a lot of -- he wrote the sports chain and if you take a group of military trainees you know, a group of 18-year-olds and say that all have the same VO2 max. If you give them all the same programs, some might thrive, some might actually go backwards. So, I mean I thrive on just I think for my mind, I only run to recover. So, distance running an endurance running for me and I think anyone who is in this for the long haul, I view running as recovery. Meaning if I go out for a run, and I don't feel better when I get back, I've wasted my time. That's not, I didn't achieve the purpose. And maybe a race, you know, so I'll do 50-mile race once or twice a year or a marathon. All rights at the end of that. I'll probably feel a little more -- but that's the monkey bar day, right.

    That's the challenge day and you could be a little sore, but every other day. If you don't feel better when you come back than when you went out the door, I think you got to rethink about what you're doing. As we get older too, we know our testosterone growth hormone are down, so I got away with not really doing strength training, but just by being a normal human being probably until about 10 years ago, and I knew that. Okay, I got to start lifting heavy things. And so, I just do enough that to fight the tide back. I've got kettle bells in my basement, three times a week I'll go down there for 10 minutes, go through a series of things.

    You know at the hotel here, they have dumbbells, which function as kettle bells and that's the stuff that you're like God, do I really feel like doing it today, but I keep it so short and simple that I know I'm gonna do it. You know it's that positive habit look, you know, okay, a little bit of stimulus gives you that positive response when you're done. And herpes, you know, mountain climbers, you know, just a series of drills that aren't super draining, but intense enough to add that stimulus. I do a lot of ply metrics, short sprints and layer called these a lactic sprint.

    Mean they are not intervals were your building up acidity, breaking things down. You're just, it's neuromuscular. I mean you're keeping that coordination and really keeping that spring in the foot you know, so plyometric training is that the rapid creation of power, meaning force overtime. You know, if you lose that, if your foot is a super ball, versus a hackey sack, you're gonna run. We watch these tenyans run. They're super paws?]. Spring, spring, spring, spring. So, if I keep my spring trained, then it's, you know, then I'm protected in many ways. So yeah, so you have to, if you're getting to my age or beyond my age, you've got, there's no shortcut around. You got to add some strength training. But he doesn't need to be difficult. And he doesn't need to happen in a gym. It might not be the most favorite thing you do during the week, but I think it will make the other activities more enjoyable because you're staying healthier.

Tommy:     And you also genuinely be better at whatever you're given sport is.

Mark:     Yeah, probably should be. If I had more time in my day, I would add more strength training. You know, but being busy with jobs and things. You know, I don't want to try to tackle too much because then I'll probably fall off. So, I want to make sure that my program is something that travel week in week out, nonnegotiable. I can do wherever I am.

Tommy:     Yeah, so it's like if you build it in as a habit, like you said, then you're much more likely to keep it up.

Mark:     Yeah, really simple. Simple stuff.

Tommy:     Yeah. The other thing, sort of related to that, and this is a question that Chris asked me to ask you in terms of, so we have a lot of people who are interested in this and there's also, we tried to get some of you know, experts to talk about it is the risk of AF's, or HB or fibrillation, particularly in high-volume athletes. So, it's, I think it's the greatest risk is if you're doing more, averaging more than an hour a day of endurance exercise for 20 years or something like that. Which a lot of people are gonna be accumulating if their graph leads are high or whatever. So how do your kind of, I know you know a good bit of the literature. So how do your kind of balance that and where do you think the risk is?

Mark:     Yeah, so we know from the literature, so people doing a lot of endurance sport, do have a slightly higher rate of atrial fibrillation. What is important, though, is that they do not have a higher rate of dangerous [00:39:51] [inaudible], ventricular avernmia. Which are the ones that are gonna make you, you know, go to the other side of the grass before your time. We don't know all the reasons that cause that or what type of runners do that, so I firmly believe that most people are running too hard. You know, so I've been through all these tests, you know and I've just had a CAC scored a couple a couple of weeks ago, which is coronary artery calcium score.

[00:40:15]

    You know, these are the true really sensitive tests, that cardiac MRI and cardiogram, stress test. Just do you know being one of these runners that has over a hundred thousand miles and CAC was absolute zero. I mean, 0.0 so not a single thread of calcium is on my arteries. So, for me knock on wood, whatever I'm doing is working. I'm not creating calcification. Endurance athletes for some reason do create an inflammatory response in their coronaries. But I think a lot of that's the diet, right. So how do you control for the diet? I don't really care how many miles someone is running, if they are eating junk food, they are at risk of cardiac disease.

    You know what's their HDL, triglyceride, you know, like my friend who is on a path as I was to coronary disease while running marathons. You know, so not a good thing. I think if you're running mellow, you know, within that aerobic zone, you're not really stressing that electrical system. But if you're constantly doing high-intensity stuff you're up at threshold. You know, I don't think the heart's designed to do that every day. I mean think of why we're here. We're designed to walk around, kill things and sleep. You know, so move often, but not an hour or two hours of high intensity short burst of high intensity, but a lot of endurance. You know, I think the human body is miraculous in its efficiency to burn fat, use the oxygen sweat.

    Even Dan Lieberman's work, even if it was a Sprint we'd be lunch. But in any endurance run we do pretty well or walk. You know, maybe not even running. You know, maybe it's more walking. So, get yourself checked, so I think if you're an aging athlete, look for coronary disease. Make sure you don't have coronary disease. Because that's what really important. Because that's when people go for a run and don't come home. You know that have an unstable plaque. You know, HS CRP is a blood test you can get, the animar lipid profile's, you know, showing small bends, particles. You know, so look for all these things that set your risk at absolute zero. I want my risk to be absolute zero.

    And right now, at least from the labs and all the tests, you know it's and zero as it can be. Which still, there's a chance, right. We don't know, you know, at least for what we know, I've had all the wacky chances and they are all good. So, play it mellow. Eat real food. Then you will reduce your odds of the dangerous arrhythmias, which are absolutely important to know. Know what's under your hood. Don't read a study and assume that that person is you because you could be different than the person in that study.

Tommy:     I think, that makes me think of some of the original studies looking at, I think they were doing cardiac amarotis back then, but looking at, it was an equivalent of acorniotric calcification, type at using cardiac amarotis, maybe the [00:42:58] [inaudible] look at the infusion of the heart and sort of there's a correlation between those who did more running or higher volume running and having more atherosclerosis, but I think one of the huge confounders in those studies are all the guys smoked, or something like that.

Mark:     Yeah, it's so hard to control. There are so many variables.

Tommy:     Yeah, so then, like you say if you're not one of those people, you can't, so a lot of people don't say well, lots of running is bad for you but yeah, maybe if you were a smoker at the same time.

Mark:     Yeah, so if you took a group of hundred runners who are eating junk food and try to tear them by the amount they are running an assessed risk. It's not about the running. It's about what they are eating. And I think probably you know your overall health is probably 80/20 more what you eat. You know the healthiest cultures in the world, that lived the longest aren't running marathons. They don't have CrossFit endurance. These are rural societies, you know. Throughout the world, they are a bit loose on tight places and they're all, you know go back to Western Price. You know they're just people doing what human's do as biologically well humans.

Tommy:     Yeah. Just like thinking about what you were saying earlier, part of that is you know that the long slow continuous aerobic style movement. And you know, be it forging, you know, climbing moving, too, you know, a temple or whatever you know, depending on the blue zone, they will have their own different practices that often includes low-level continuous movement like you were saying. A lot of what we see in athletes, unless to your point exactly the kind of intensity that's causing issues is what we call like that sort of gray zone or blackhole, which is right around the threshold. You’re kind of abusing yourself for hours at a time. And there's actually, at this level where you can just sort of keep going, but you are in extreme pain pretty much the whole time. And a huge amount of literature says that actually that is not going to make any faster. It might be good for like making you mentally stronger if you need that for a race, but the polarized type of training your mentioning is a lot more slow, steady movement at a true aerobic pace and then some sprints on top of that.

[00:45:06]

    So, it's gonna be much better and so we, kind of based on what you're saying, I think they can stick to more than polorized training and don't push yourself then you're gonna reduce your risk a lot.

Mark:     Yeah, I agree. And that's where I think having some objective testing, so you know where that is for you. So many people are running in that area right below threshold but think you know they are type H, right. They think well this isn't hard because I'm not like acidotic and -- but they are really, they are doing negative, native work, you know, at a certain point.

Tommy:     So would you recommend, because you obviously have access to some BO2 testing? Are you suggesting people get something similar? Is that something a lot of people?

Mark:     I think you got to know yourself. So, if you're someone, I mean people like categorizing in horses and mules. So of course, will run till they break. So, when you're looking at college athletics, they are all horses that's why they are on the team. And then if you have a couch to 5K group, they don't need physiologic testing. So, if you chat with your friend and laughing and singing, you're good. You don't need the testing. But people out there listening to your podcast, I would probably guess if they are listening to this podcast, you're probably a horse. You know, this is something in your free time. You're listening to try to get some secret sauce. So yeah, so you might need, but if I breathe through my nose, unless explicitly when I run. So, if you can take a piece of athletic tape, tape your mouth and go for a run. You're probably running to hard. So maybe that's your [00:46:36] [crosstalk].

Tommy:     That's a nice test. yeah.

Mark:     So, do that. And if you're [heavy breathing], ripping the type off, sorry, you know...

Tommy:     Pushing too hard.

Mark:     You're pushing too hard. You should be able to talk.

Tommy:     And give yourself, ideas. Give yourself permission to do that, right. Because you know that actually the [00:46:53] [crosstalk].

Mark:     Over 80% of the time. You know, Stephen Siler's exercise physiology, guy who's probably so much on the 80/20. And this is even, I mean recreational runner stand even need to do that. I mean, they just want to get healthy right. Get off the couch, but the basting the world, you know, no sport across all where there's rowing, running, cycling, you know, 80+ percent is in that comfortable aerobic zone, and then maybe 20% more intense, you know, closer to their advantage. You know being specific to whatever they need to do. You need to run a four-minute mile, you got to do some work at 60 seconds a quarter. You need to run a 2-10 marathon, so you have a group that's [00:47:33] [unclear] group, the milers at the marathoners train together until we've got close to the race and the marathoner didn't need to 60 second quarters but the guy, Peter Snell needed to do 60 second quarters. So, they would differentiate a little bit at that point, but it's, essentially to all the basis, all the same.

Tommy:     Yeah, and I think that's very similar to, you know, we're expanding the sort of the group of people were working with, just like you're working with everybody from you know advanced types of guys, BTUs, more a bit of obesity up to, you know people who are out on the battlefield. People who need to be fit for a living, but you know the basics of the same. Like what you need to be healthy in terms of what to eat, how to move, how to sleep. That doesn't change, right. So, for most people, all of those basics are still the same.

Mark:     And I'm glad you mentioned it to, so the sleep is probably that missing component for a lot of people. So, you could do all this training stuff right. And getting sunlight. So, I think we talk about sleep you know, as an isolated thing, but if you're not getting any kind of sun stimulus, I think that also affect your sleep.

Tommy:     Absolutely.

Mark:     Yeah, so kind of balancing that. So, I don't think you can fix your sleep without getting out in the sun a little. But this leaves got to be fixed and that's what I've really tried to do over the last year. It's been pretty hard charging and then said okay I just got to go to sleep. I'm sorry, it's currently is, if it's not done today...

Tommy:     Don't worry about it.

Mark:     Don't worry about it. I think that's made a lot of difference just in my own health over the last year and even the results on these tests. You know, moved up my fat burning capacity, even though eating hasn't really changed that much but I'm just chilling out a little bit more.

Tommy:     So you've actually, so just quickly looking at these tests, you've dramatically increased your fat oxidation rate. So, it was previously, was it 1.2 g per minute, you had it at maximum and now it's 1.9? Which is very similar to what they were seeing [00:49:28] [inaudible], so T10 adapted athletes you know. Again, Boronec and Finney, showing that you can oxidize a lot more fat than you previously thought possible. And you're really up there and that change has happened in just a year and you think that's because you've even forced yourself to take another step back. Focus on recovery, sleep better, slow down a little bit.

Mark:     Yeah, I don't have all the answers for this, but I work with a lot of patients and you know I was probably 20 years into insulin resistance and a lot of the patients I seen the hospital, you know they are 10, 20 years into diabetes. So, I think it takes a long time to really, fully make that switch and adapt, to be burning fat essentially all day. All day and night, that's a healthier way to live.

[00:50:12]

    And sleep is important. So, I think I was probably just time. You know, maybe I got the diet in a little bit more now. I mean, I pretty much you know green list you know. Healthy fat, low carbohydrate, really know, grains, maybe once a month I'll make a piece of pizza. It will be very thin crust, loaded with vegetables. I'm not [00:50:32] [unclear], I can have a little bread, but choose not to. And you know, four, five years in the low-carb and I think, just maybe because I've really, you know, this is the mind. Okay, so I'm reading more and I got to meet Steve Phinney last year. So maybe because I met Steve Phinney...

Tommy:     You channeled him.

Mark:     Yeah, I channeled he spiritual, and I read this on the Internet, he wrote his boat from San Francisco, so just by you know, getting to have a meal with those guys, maybe the karma kind of like got into my mitochondria.

Tommy:     Yeah, you mitochondria kind of tuned into that [00:51:07] [crosstalk].

Mark:     Tuned into their [00:51:08] [unclear]. Yeah, so tell yourself I'm burning fat, right. So, I'm a butter burner and then you'll do it. It will become reality. I mean even a year ago, in all, if you look at textbooks prior to, you know, 2010 essentially, you know the human body max fat burning capacity is a gram a minute. You know, so even last year I was over a gram a minute, which is pretty good. But this year it just went off the charts as running six minutes a mile burning fat on the treadmill. So, that at least let me know now that I do have a lot of physiologic headroom.

    Not that I -- there's a question that came up the other day on -- I write a blog about this week in LinkedIn, so then you can share all the numbers. But someone asked, well since your heart rate now is in the 160s and you're still burning fat, does that mean you do a lot of running with your heart rate at 160, so I'm like absolutely not. You know I think if I went out every day now and, because I had this test, so I can just dial in at a heart rate of 160 and you know, run six minutes a mile, I would destroy myself. But it's good to know, like if you do a race, that's okay race they you can bump it off a little bit, but I'm not afraid that I'm gonna bonk. You know there's absolutely no fear in my brain that, I mean, things can go the wrong in a marathon, but I'm not fueling and having enough sugar, is not the problem. You know there's other problems, you know, sandal strap, off or something.

Tommy:     What about the sort of the top end. I mean, I guess you don't necessarily do much tested sprinting, but if you noticed the change in terms of your sort of max speed or your ability to sort of Sprint whether that has changed over time?

Mark:     It's probably about the same. So, I ran Marine Corps Marathon this year in 2 hour, 55 minutes. It was a pretty warm day, it was like 75°. So, that was about on par with the times I've been doing. But it was a hot day. So maybe I'll do Boston Marathon in about a month. The conditions also very able, you know, I feel really fresh now and so I'll give it a go. Now I'm not afraid to maybe charge a little earlier. You know, you always kind of just patient in a marathon and then when you kind of smell the barn, you then pick it up and, but, yeah, the key in marathon running. If you look at, my son looked at my splits with the Marine Corps Marathon this year and I hadn't really paid much attention to it and he said that's freakish dad. Because every 5K was exactly 6 minutes and 40 seconds a mile. Every single one.

    Not, maybe one was 6,41, after they get, I guess freakish and you know most people, especially the temperature rises, but that's fun. It's a fun way to run a race because if people are all coming back to you, just, it energizes you. You feel like you are racing, not surviving. You know you're like, you're in competitive brain, you know. It took off that person. So, that's why we do races. You train for recovery, but you race to get in the game.

    But the recovery thing I think is probably the most important thing when you share those VO2 tests, is, so last year, 2016, if any of you all had done a VO2 match, you know, you push yourself to, not to the point, you're gonna fall of the treadmill, but you've got this big house attached to your face and you don't wanna damage their equipment, but you take yourself, you know, to the point where you kind of put your hand up against your knock and say stop. But I was like, heart rate was 180, at Max and the one minute recovery last year I think it was at 178. So, I probably gave it my Max. You know it's still a little later, but this year. Maybe I was lunchin it, but my VO2 max state the same, like 64 and a half. But my heart rate Max, this year was 178, but at a minute it was 113.

Tommy:     Yeah, zero [00:54:48] [crosstalk].

Mark:    So, one minute after a max of 65 or 64 and a half, which is running pretty hard, 113. So, I could probably go do it again.

[00:55:01]

Tommy:     Yeah. I'm not sure what you want to be able to do, right. [00:55:05] [Crosstalk] physiological revenue.

Mark:     And that's when I think of how I race now in these marathons, you know you surge a little bit and then your cover, surge, recover, surge, recover and I think if you would run, for those that, well, your cycling and for those in the audience that race, it's not about how fast you go, it's about how quick you can recover. You know, like cycle cross, like Chris doing cycle cross. I mean it's like these intense spurts, but can you recover quickly?

Tommy:     To do it again on the next corner.

Mark:    On that little downhill, okay, here's a little stretch I can chill. You know, heart rate is at 220. If you get that heart rate down really quick, you're gonna clear all that nasty doses, like boom. But you know for people that have the opportunity to get themselves tested do it, because there's stuff that you think you're doing or might be going on but until you have objective data, unlike being a guinea pig because I want to know, and then I can interpret it as a coach, you know healthcare provider, you know, like you, Tom, you're coaching people if you know what's happening to yourself and understand all these parameters, I think it helps you help other people.

Tommy:     Absolutely. Yeah, so you can kind of...

Mark:     No, I'll make all the mistakes myself first and then...

Tommy:     You can use that to help and I feel like your own story is, also, when I -- so I always use the example of when I was a rower, I had a lot of physiological potential, you know, I'm a pretty big guy, pretty, tall. Maybe not compared to some other rowers, who are a lot taller than me.

Mark:     Yes, those apes or beasts.

Tommy:     Yeah. But coaches would work really hard to teach me how to row because I had the physiological potential, but I was -- I'm not a very coordinated guy and I actually was never actually a very good rower in a boat, but these people had spent so much time trying to teach me, I was then much better at teaching other people because I had met all those mistakes. Been given all those tricks to try and teach me, maybe they didn't work on me, but then I actually became much better coach helping other people. So, it's exactly the same thing, right. You've made mistakes, you've tested yourself, you know what works, what doesn't, and then the stories as well and then help other people sort of figure out what to do for themselves.

Mark:     Exactly, yeah. So, for those of you that have coaches or seeking advice, make sure you find somebody who has made a lot of mistakes. You find a 20-year-old kid who is the fastest on the track team, it's probably a lot of the genes, but they need to make a lot of mistakes. Get hurt, tell them not to run, break things, get up and go on. And if they are coming back and running again, maybe that but some secret to tell you.

Tommy:     Yeah, yeah, absolutely. So actually the, kind of the last thing I wanted to talk about was some of your thoughts or secrets, maybe even because we have quite a few people who listen, maybe they're physicians, medical students. People who are kind of going in to the health fields. And you know, particularly if you are within a more formal setting, and that could be academic or medical and you're getting advice in terms of nutrition or you know how to, health eat with disease, which is maybe completely against what you and I have been talking about. You know, these guys are sort of hearing these mixed messages, you know, or maybe even somebody who teaches medical students and you're starting to question all the stuff that you are teaching them. So, do you have like any advice for how it's gonna build this stuff in? Because we kind of need to, you know there's a lot of talk about you know, changing government guidelines and all that stuff and you know I tend to not worry about it because, I just don't know when that's gonna happen, right. So, we need the grassroots kind of movement. We need the people listening to start with them themselves, so how do you kind of, how would you help people do that?

Mark:     Well, come to West Virginia. If like you're a medical student and a medical student wannabe, you know, come out to our campus in the eastern part of West Virginia because we're doing it there. So, we had started a curriculum for years ago, called Meds Chester [?]. We're taking med students into the kitchen. You know they're actually learning, we used Doctor Robert Lustig was one of our partners. Initially, so we have two textbooks for our medical students. One is called fat chance and the others the fat chance cookbook. So, if any off you all, maybe we can link Lustics talks, but he was one of the first guys in academic medicine to challenge a calorie as a calorie.

    You know, sort of similar to Garry Telps' work, but he's got the academic and research jobs to back it up. And so, we're teaching our medical students right from the, you know, so it's easy to teach someone something than to convince them that what they've been doing their whole career is wrong. So, I find that the, because they're not already like established into some mode that it's hard for them to back out off and admit they were wrong. You know, I admit I was wrong. I was dead wrong telling people do you know eat more sugar and reduce fat from everything you know. Lower cholesterol. But that's what I was taught you know, so what can you do? I made a mistake, but let's not continue that. So, at my school we're allowed to teach people, so in my clinic they're manning out the green list. I mean, I don't know how many other clinics are doing that. So, that's good.

[01:00:02]

    So, there's bottoms up, we have a big conference statewide so I think its collaboration. So, what I like about my state now is that all the different sectors are talking to each other. So, we have a conference called try this in June, which is all these little projects happening throughout the state in various areas of public health highlighting different you know people that are changing things because it's -- you know cow like what that's persons doing, let me do that. And we're having a one-day health profession summit before this larger conference which has a lot of community folks. You know, that could be a gardener. And Gary Taubes is coming to give the keynote so with Gary there are no -- he's gonna come and challenge us to, we can't wait for the feds to say, well, maybe we've all been wrong. It was in the 2015 guidelines, but said softly.

    It said fat and cholesterol are no longer nutrients of concern, thank you very much, were sorry, you know, we created the diabetes. They didn't say that, but that's all they said. Fat and cholesterol are no longer nutrients of concern and what average citizen in America are reading that and interpreting that to say okay we really screwed up big time, sorry, we created 100 million diabetics. I'm not waiting for that but I'm in, you know we have a group called the nutrition correlation late by Nina Teicholz and so we're really trying to get at policy. So, we, our group spearheaded a movement to get an independent review of the dietary guidelines for 2020. So, we'll see what happens there. Set anything really changes. But I'm not waiting for the dietary guidelines, if you have insulin resistance, you need to get rid of carbohydrates as a first line of defense. That's first therapy. Most evidence is for that. You know, if you choose not to do that, at least you need to be offered a choice of the thing that would most likely work.

Tommy:     So I think that's a good place to wrap up, here. That's kind of the story of what we talked about. This has been great. Do you, I know you have some projects. You have a shoe store you maybe want to tell people about, your little side project that doesn't make you any money, but....

Mark:     That's fine, that has some fun, but I live in a town of three thousand, so we opened the first minimalist shoe store, it's called to rivers treads, so if you need some minimal shoes, like the one at site, because I started hosting races in my community and people were coming and asking where I should get running shoes and I couldn't tell them to go to your average running store because they put them in a big, bulky elevated heeled shoes. So, we opened a running store only selling flat shoes and that was eight years ago, there were only like two brands at that time. There was a vivo barefoot vigrown [?] And Newton running that made flat shoes. And now the whole thing exploded and I have a pair of these euro shoes preos, nice casual shoes on right now. But yeah, it's great. We're actually expanding into a space three times as big.

Tommy:     Oh, wow.

Mark:     And we have, you know, the more things kind of come and go in the industry we're sticking to our initial mantra of you know, let's is more and, I call it the second barefoot revolution because it's all coming back again. You know, there's this big trend, the big puffy shoes and that didn't cure running, so now it's the exact same message that we opened the door with. You know, find just the right amount of shoe for you, but straighten your first, that's the key. It's not about the shoe, it's your foot. We have a plantar pressure mat, we have things like true form Runner, we have things in our store that can actually help you fix yourself versus the treat of symptom and so we're having fun changing lives in my community and the stories really, my staff is great. You know they have so many people that they just helped to get back to running. So, I host a blog, natural running center, which I like to share stories and just share knowledge about health and running on that site.

Tommy:     Yeah, we'll link to that.

Mark:     Freedom trends, so we have two major races in West Virginia, in my town. One is the Harpers Ferry half marathon and the other is freedoms run. So, come, we have a nice cold beer after the race. Since these are old-school low-budget races, you know, volunteers. So, freedom run.org, come out and experience West Virginia, it's a lot of fun.

Tommy:     Okay, great. It's been a long time since I ran a half marathon, but maybe, maybe you'll get me out there soon.

Mark:     Yeah, we have over 40 states coming. So, they are coming. People like the old school, you know, the more they go to these big city things, spend 200 bucks, you know, after spending a fortune on a hotel room. They like coming to hours because its low entry fee and they can park and walk to the starting line.

Tommy:     Those, as you, I mean I've done all spectrums of races, but those are absolutely the most fun. Definitely.

Mark:     Yeah, it's a lot of fun. A lot of kids out there too.

Tommy:     Well. Thanks again, Mark this has been great.

Mark:     My privilege. I enjoy your show. Your and Chris’s show, it's a lot of fun. I learned great stuff.

Tommy:     That's good, thank you.

Mark:     Thank you.

[01:04:49]    End of Audio

 

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