My guest today for the very
first time is a reconstructive hand and microsurgery
he practices at the Mayo Clinic. Never had one of those
on the exam room before. Brian Carlsen,
M.D., is here with us today. Sir, it is good
to make your acquaintance. Thank you
so very much for being here. It's great to meet you, Chuck.
Nice to meet you. And thank you so much
for having me. The pleasure. Okay, Brian.

The pleasure is all mine. I like that. Call me Brian.
That means that you're not, like,
all buttoned up and stuffy. It means that
we can actually have a good, honest conversation here
today. I'm excited about that. I think it's fascinating,
though, the fact that your background
is as a plastic surgeon, but really,
we're not going to talk a whole heck of a lot about that
today. Today
we're going to be talking about the benefits
of a whole food plant based diet for people
living with type one diabetes. Before we get into the science
behind that. Why is this one
near and dear to your heart? Yeah, it's my it's
my favorite topic to talk about. As anyone who knows me. So I am a type one diabetic. I was diagnosed with Type one diabetes
as a third year medical student when I basically got the classic
symptoms of Type one diabetes.

And for those that aren't aware
there's two types of diabetes, type one and type two. Type one is an autoimmune
disease where your immune system dysfunctions
and attacks your pancreas and you can no longer
make insulin as opposed to type two diabetes, which is a little bit more complicated
in its etiology. But it's a disease characterized
by insulin resistance. So your pancreas can make
insulin a normal way but but, but
because you're resistant, that insulin doesn't work
very well. And so the bottom line
with both of those is you have a high blood sugar. So that's the common common
symptom. And actually what causes a lot of the disease problems
in both and both conditions. So I was a type or third year
medical student and just got the classic
symptoms of hunger, thirst, fatigue
and because I knew a little bit I, I tested my own urine
when I was working in the pediatric emergency department
and was folate, glucose. And so I went out
and told the attending and she said, go next door, which was the adult emergency
department. And there I was without question
diagnosed with type one diabetes with a blood sugar of 686,
which is very high.

That must have come
as a shock to you. How long had you been
experiencing those symptoms or did it really just kind of
hit you out of the blue one day? Not out of the blue one day,
but I guess I know that it wasn't going on
for very long. I was actually on a military
scholarship with the U.S. Navy and was on
some summer duties and wasn't having any issues
and actually had lab work done. I don't know
exactly how long before, but I've had lab work done
that summer, which was normal. And so my recollection,
it was about a month. But, you know, things
take a long time to reach our conscious mind.

So probably what's going on
longer than that. It was October
that I was diagnosed and yeah, it was it was a shock and it was you know, I guess I knew something was wrong, though,
and it was whenever something is wrong,
it's a little bit reassuring. To know that, you know,
you get a diagnosis as as bad as type one diabetes
is to receive as a diagnosis.

It's nice to know that there's a definable problem
and something you can do to to control it. Yeah. And what was that
something what was the initial plan of action
after you got that diagnosis. Well this was, this was in 1995 and things were a little bit
different now. And I was a medical student
which I think led to some assumptions
that actually knew more than I did.

But so I was sent home
with insulin and a, and a visit the next day with our internal medicine physician
and eventually got with an endocrinologist and dietician
and kind of a process to figuring out
the insulin regimen. Eventually I was on an insulin pump which I worked
for a number of years. There was, you know, I was told
that I shouldn't be a surgeon and that was my dream
at the time. And fortunately with the medical
school I was that had a third excuse me, had a resident and general
surgery resident who was type one diabetic and somehow
I had gotten connected with her.

And that was extremely helpful and allowed me to understand that I can
I can do that with this disease and I can you know, basically
just gave me a lot of hope and inspiration that I can
I can do what I want to do. Still, the recommendations at that time
I think are important to know. You know, I met with a dietitian and
since we are going to get into of food and nutrition, you know,
that the recommendations were and are to a large degree
to do a low carbohydrate diet.

And that is really the emphasis on trying to minimize the carbs
or have a certain percentage of carbs. And then carb counting is
and was and still is in my my my current
life to to a certain degree how, you know, how much insulin
to give yourself. So you need to have a baseline
insulin and a and the insulin when you
when you eat to get all that all those carbohydrates
into your into your cells where you need it,
where it needs to be to work, why would somebody tell you
that you probably can't be a surgeon
if you have type one diabetes.

I think for a lot of us
who don't have that or like, well, I don't understand
why that would be limiting. So what is the thought
process there? Yeah. Yeah. I mean, I think, you know, nowadays
we know, you know, with social media in particular,
there are NFL athletes, there are NASCAR drivers. There's people in all
all fields of, you know, all areas
that are type one diabetics, and, you know, proving to everybody
that you can't do anything. I actually did lose
my Navy scholarship. I got a medical discharge. And the concern is that,
you know, it's it's that is really the hypoglycemia.

So if you're not if your blood
sugars aren't stable, you can Even the smartest person
in the world is not as smart as the human pancreas,
so that you can still, you know, go low and you're
trying to operate within a tight range of normal
glycemia, which most, you know, normal people do with
their pancreas does for them. But when you're doing it and trying to factor
in all these uncontrollable, it is a little bit
tricky nowadays.

And back then, it was safe
and that wasn't an appropriate concern. But nowadays we have continuous
glucose monitors which really make that concern completely not
not a valid concern because we can keep an eye on it
and have alarms that go off if we get low or, you know,
to try to prevent hypoglycemia. But that's really the concern
is that you're going to have hypoglycemia,
you're going to lose your ability to think clearly. And that's problematic. It might be problematic potentially. Yeah. Do you would you say in your estimation
based I'm just curious, based off of what it was
you were just saying, is it trickier
or to kind of regulate type one diabetes compared to type
two with the standard course of treatment
like you were on initially I would say yes.

I mean, as a type one diabetic,
you're having to titrate your insulin
dosages to your activity and stress. And those things are harder to
to predict and control. But basically your activity
and your your carbohydrate intake. And so, yes, it's tricky
because it's a type to even though
you're insulin resistant, you can go high, you're not that some of the medications for type
two diabetes can cause you to go hypoglycemic. Hypoglycemic,
that's not that common. But with type one, it is it is a real legitimate concern.

Yeah. How long was it before
then you started researching whether you could see
some benefit by making further changes
to your diet, eventually landing on the whole food
plant based diet? And what were some of
the obstacles, Brian, that you encountered
to make you ponder such a thing? Yes. So I had so from fast, fast forward
for a lot of years there. So I was a third year
medical student.

I did. I matched into general surgery
and I did it. I did like vascular surgery is kind of what I was thinking
I wanted to do. And I discovered plastic surgery as a as
a general surgery resident. And I like that a lot better. Resonated with my personality
and that and you know, what
I like to do in day out and so got through residency
and for me that included two years of research
to your subsequent training in plastic surgery
and then a one year fellowship. So ten years
total of training for me and then kids along the way. So I had four kids to during my residency
and one during my fellowship and one
in my first year of practice.

So kind of a large gap there. My all, my, my son, my only son
is the second oldest. He was a freshman in high school and was playing soccer,
was getting some palpitations. I went to the cardiology
appointment with him and I had had palpitations
in the past myself. I kind of mentioned
just the cardiologists course. It's always
all about me as a surgeon and my sense is, is how patients
actually got their workup and they were fine. I actually got my palpitations
worked up their fine benign, but in the process they said,
well, you've been type one diabetic now for 17 years. You probably should get a CT
scan of your coronary arteries. So I did that and I was doing basic science
research at the time. I had a research day,
which thankfully I didn't have patient care as a part of it,
and I was just in my office. I pulled up my images
on the computer and I saw something white and
I thought, Is that a lymph node? What is that?
This is not my specialty.

And so I Googled imaged coronary calcification, and the picture looked just like
my just like my CT scan. So that was devastating for me. My my youngest was
four at the time. You know, I felt like I still, despite having diabetes,
considered myself healthy, I thought I was going to live
forever I was
I still thought I was active and kept a tight control on my
my glucose. So this this came out of
this was a big surprise for me.

And I thought,
well, what what else can I do? What else can I do? So that day I got on the Internet
and I found colored by Esselstyn I had Apple Books. I bought the I bought his preventing reverse
heart disease book. And I think I got the CT scan
at 7 a.m. by 11 a.m.. I had read enough of that book to be a whole food
plant based guy. And that was March 12th, 2014. Okay. So I mean, as somebody
who's in medicine themselves, to have a four hour window
to read a book and say, Yep, this is what we're going to do, I mean, that's
got to be some pretty convincing evidence in there.

What was it about that book
that that had you so convinced
Yeah, that's a great question. While one he's a he's an M.D., he's
a surgeon. I, you know, I read research
to me from Cleveland Clinic. He's not not someone he's not. It was pretty clear to me he's not someone trying to sell
anything and his and and the story
he told about the patients that were cardiac cripples,
they were no longer candidates for angioplasty,
stenting, bypass and he took them put them
on this nutritional regimen, which, you know,
we can talk about.

It's a whole food plant
based diet with some added specifications of really
minimizing your fat intake. And and and they didn't
have any recurrence of events not only did they not have any recurrent heart disease,
which is astonishing for me as a as a medical provider where we
that's that's unheard of. I mean, that's you don't get that you don't get that with statins.
You don't get that with Mediterranean,
Mediterranean diet. I mean, this really gives
someone like me hope that this is a condition
that I can I can beat. How was that transition for you? A lot of people are so nervous
going into it, even if they have like the best intentions,
like reversing heart disease, they're still
a little bit nervous about changing up the diet
that they've been eating practically their entire life. What was that transition
experience like for you? Yeah, it's a good question. And and there's so
and as you know, there's so many so many people have their own history and nuances
that make it difficult.

So my experience and my
personality, I've learned along the way don't don't work
as a prescription for everybody. But just my nature as a as a person
is I jump in with both feet. I'm going I'm
going all in and I'm committed. And that is the approach that
I like the best because I hit four
patients because it gives them very quickly visible changes
that are not subtle you know, one meal a week
or one day a week. Those are those might be easier
technically to do, but they're not going to give you that really positive
reinforcement that you you can objectively experience
in your own in your own body. So that I mean, that that's
just been my approach, that everything, you know, and I run
I want to do a marathon. I don't want to do a five K.
I want it. It's just this maybe an
unfortunate glitch in my system. But so for me as a type one diabetic, you know,
there still is a transition.

I still didn't understand what I could eat
and what I couldn't eat. That book is great
and kind of gives you a little bit of guidance.
But for some reason, it took me I don't remember exactly a week or a month before
I discovered beans and rice. I would like hot. It was hard to get full. You know, I was I was
I was losing weight in the end. I only lost £10. I was
I wasn't overweight technically, but I was carrying
extra fat on my body. I lost a layer of fat. So my appearance did change
more than my body weight did and that was very surprising
thing. That was unexpected. You know, that book is not written
with type one diabetes and mind is that I became
extremely insulin sensitive. So to the point, you know,
I was getting low blood sugar. A lot of I didn't
I didn't know what was going on. I thought, man, did the diet
cure me of my diabetes? It seemed like I could eat
anything and my blood sugar was still got low.
So I just kept decreasing the amount
of insulin I was taking and eventually figured that out.

Now, now I, I would hope that most people
that go on this or are listening to this
that are type one diabetes, you know, no to it
just that. And in a similar way,
if you're type two diabetic and you make these changes
as drastic, you know, like make this go all in, then you probably need to have some medical supervision,
maybe come off all of your medications
which I think is what people like at Mastering
Diabetes. Do they you know, if you're
going to do a total immersion, you probably just stopped
those medicines and and you may not
ever need to take them again. I mean, just to surprise,
the diet seems to affect the body
in so many different ways. You know, 99.99% of them
positive, if not more. So that's
that's really impressive that that happened for you. What did that do in terms
of your athletic performance? I mean, you just said
you're a guy that doesn't like to run
five K's.

You want to run a marathon
so you are a fit individual. You do pound the pavement. Did you
notice any changes there? Yeah. Yeah. So if
I come back up a little bit, so when I was life and residency
and kids, I was about I played basketball
all my life up into college then I, I went to junior college
for two years, played basketball, went to university
and decided to focus on academics and try
to get into medical school and so I continued to play
basketball and go for runs. It was nothing to structured or intense. And then when when this all
happened around that same time, you know, I decided
I was going to exercise before
I had had a few years before. It had a ridiculous apathy,
so pinched nerve in my neck. And that's kind of scary
as a surgeon because it was
affecting my dominant hand that that kind of went away.

But I still had chronic kind
of neck and shoulder back pain. And but when this happened, so as a part of that,
I was told like running probably isn't a good idea
for your brain. You know,
you have some this disease. And it's interesting
that we know that some of this
this disease may be related to some vascular disease,
interestingly enough. So I wasn't a runner
for a period of time. I would go
for the occasional run, but mostly
I would do like the elliptical or something like that. So I was on the elliptical
doing that. And then one day I was like,
I'm just going to get on the treadmill and run. I did that and and I was hooked. And not only that, but my neck and back and shoulder
pain I mean, it just it sounds some of
the results can sound crazy. It sounds can sound like you're trying to sell somebody
something. When you when I talk about
how the the the kind of crazy benefits
that I saw, you know, but I could run I had no back
neck, shoulder pain.

I was eating 800 milligrams,
eating 800 milligrams of ibuprofen a day because of the pain
and that was not in a smart way. I was doing that, you know, without coming off of it,
which is never a good idea for anybody. And it just went away. I just noticed one day I was not
no longer reaching for the, for the ibuprofen anymore. And athletically
I started running. I loved it. And I'm kind of
a competitive person by nature. I decided
I want to train for a five K. I did that that that summer and into the fall,
I did a five case series. And then I just continue to
train and get better and faster to the point where, you know,
I was an athlete before and when I was in the military, they have
you do a 1.5 mile time trial. And I remember I was competitive back then to
and I ran that in eight 58, which is just under a six minute
mile and that was age 25.

Fast forward 22 years later, age 47 is the last time I trained
for and race to five K and I did it in 1758,
which is a five 47 mile so 22 years of type one diabetes,
heart disease, heart disease, age
and faster than I was at age 25. Those are objective things that you can, that, you know,
that have happened to me that I have no explanation
for other than my nutritional, I didn't know
my nutritional changes.

So here's what I'm thinking. You were talking a while back about how astonished you were
that you had become so insulin sensitive
when you changed your diet. But then hearing you talk about all of these other changes that came with that, you know,
I'm thinking like isn't the body just equally sensitive
to diet overall? You know, if it reacts in such a dramatic
way in so many different ways, you know, it really does
go to show how sensitive we can be with what it is
that we put in our bodies. Just as, you know,
we can develop, you know, heart disease
by eating the wrong things. How much improvement
we can see, how sensitive we are when we rid ourselves
of all of that stuff, too. I mean, has has that kind of
entered your mind as well? Oh, for sure. Yeah. I mean,
there are so many different ways to think about that
and articulate that, you know, this is clean fuel in there. And we you know, the science, the microbiome, the fiber intake, you know,
even vegans in this in the in the world, in the country
aren't getting that there.

What the USDA is recommending
for fiber intake so if you eat this way, you don't have to worry
about your fiber intake if you're eating whole
plant foods. And yeah, the body just runs
more efficiently. It's it's it's objectively you I mean, it's
you don't have to believe in it. And if you do it, it will work. It's not something
you have to believe in. Just put good feel in your body. And a lot of a lot of crazy things will happen
in a positive way. Yeah. And I'm sure that your
experience and your enthusiasm has caught the eye
of some of your colleagues, the residents there. I know that you get the opportunity
to speak with them and have even kind of
I don't want to say convinced, but certainly encourage some of them to begin
eating this way as well. What has that experience
been like for them and how do those conversations
even begin? Yeah, well,
I mean, I'm I'm outspoken a lot. I mean, this is it's
kind of ironic. I'm on this podcast talking
about my type one diabetes for the for the most of my life, most of my Type
one diabetes life.

I did not talk about this
at all. Just being just for the reasons I mentioned
about being a surgeon, being type one. I just didn't want to introduce
and I didn't I didn't my colleagues
didn't know nobody knew. Some even good friends
didn't know. My very, very close friends,
of course, knew. And it was really it's
really been only in the last five years I've been doing this
eating this way for over eight years.

And in the last five years,
I realized you know, I have to I have to I have to be outspoken
about this and my story. I used to tell it without talking about diabetes
or the coronary calcification and it just doesn't it's hard
for people to understand. So I think honesty
and vulnerability or something, I continue to learn and that's how I talk about it
a lot. I talk about I talk about not just about diet,
but wellness overall, about taking care of yourself
and sleep and and exercise
and all of those things. And you know, it's a big it's
just a big part of my life. We it is a teaching hospital. I have medical students,
residents and colleagues, and our residency
is a mentorship model. So really,
when when a resident's working with me, they're with me every day in the clinic,
in the operating room. And that's it's a beautiful it's a wonderful way
to train and teach and learn. But, you know, because they learn a lot more
than just the the patient care and the clinical aspects and the things they need to know
to be a good doctor.

But they also learn, you know, personal
like they're like family for those few months and yeah,
I talk about it all the time. I give them a lecture
every every year, you know, basically telling them my story,
but going through in detail some of the science
because I think every doctor I mean,
you think I'm a hand surgeon, I'm a plastic surgeon, like you go to any
grocery store, mall anywhere, you know, and talk to people
who isn't struggling with lifestyle conditions
if they're eating a standard American diet. I mean, this is
this is everybody everywhere. There isn't a specialty
that it doesn't touch and I talk about it,
you know, even in the hand clinic, carpal tunnel syndrome,
it comes up commonly because, you know, we'll review their medicines are on high
blood pressure hyper high cholesterol medicines. And there's
a lot of opportunity. I haven't made it a lot easier
in my practice. I have brochures. We have dietitians
that are on board here. And we've done a lot
in terms of patient education and and yeah.

So that does resonate
with the residents there
at a different stage of life. It is hard
for them. They're working hard, working hard and longer hours
and usually have young even younger families and
and different priorities. But, you know, they're if you have enough time
with them, you can can I can convince them
that they need to be thinking about it already. We know from,
you know, epidemic or you know, these traumatic injury
traumatic killed children, that current coronary artery
disease starts in childhood. So the fact that I had it
may or may or may have it and may or may not have been due
to my type one diabetes,
I tend to think it is this is the biggest thing
you need to worry about. As a type one diabetic. And but I think that nobody is is especially if they're
on a standard American diet they cannot with any confidence
tell me they don't have coronary heart disease. And I can do a pretty good job
convincing them of that.

And and then getting them
to make positive changes. I think you mentioned earlier about,
you know, people, you know, understanding
and then behavior change. And that continues
to be a challenge, you know, for patients and friends
and colleagues and everybody. That is the big challenge I just think for that, for also
this younger generation, they're very concerned about the environment,
as we all should be and that
and that is becoming more on their radar screen. And they in that science is also
very, very, very convincing. And that's that's something
that can resonate with people. I think if you're super young and healthy,
it can be a little bit the changes can be a little more
subtle, you know, for you and I, who lived lived
a certain way for a long time, that changes are dramatic.

But if you're if you're young
and healthy and, you know, eating not is not that bad
that changes can be more subtle. And so for me, the changes
are super motivating. But, you know, I do
I do it for selfish reasons. I really have to say no. Anymore. I care about
I do care about the animals. I care about the environment and I care about people
who care about me. And I want to be healthy
for them. You know, I want to be
my best person I can be. And for that and that means eating well
and taking care of myself. It's funny, you know,
I always say when somebody brings up
your well, you know,
I went vegan for my health, but then it was, you know, really hard
not to also gain a keen interest in the environment
and in the animals.

And, you know, you really do
kind of get immersed and in all three. But I think what
I really want to ask you about as we start to wind things down
here, Brian, is so you were talking about it
being hard on the residents with their long hours,
those busy schedules. I mean, they're
just working to the bone, like if somebody is on the go. Right. And you I mean, you have duties as a
father you have duties at work. I mean, you're you're an athlete like it's
go, go, go, go, go, go, go. So how does one eat this
healthy way like what do you do to make sure that you're always eating this
healthy diet and not falling victim
to the trap that can be grab and go snacks that are anything
other than healthy? You know what? What advice can you offer there? Yeah, I think that's a great
a great question. And I have to be
a little bit careful because as a type one day, I think that's
one of the reasons why the change was easier for me
than for other people.

Because as a type one diabetic,
even though the recommendations I don't agree with
in terms of low carb, they do you know, they do you do learn that food is fuel and and and it's it's no longer
something that you can just, you know, do
without thinking about eating
becomes a mindful activity. You have to be very aware of what you're eating
and how and how you're eating. And so that made the transition
a little bit easier for me. So for someone for me, I eat a very consistent diet and it doesn't take me any any time
I do all my meal preparation, you know, at dinner time. So my my wife and I will
usually make dinner together. It doesn't take very long. It might be something
that the kids are eating that's a little bit different
that I don't eat, but I basically
a big bowl of greens. I eat a basically what I call
a beautiful every day, and that's a big plate or greens
with a measured amount of high and high
carbohydrate whole foods. So like sweet potatoes or squash or other potatoes, beans, some things that are going to be high, high calorie
that's really important for me.

Could be whole grains
like rice and chemo. I don't eat
a lot of whole grains, but just because I love the whole I might as it's
just a food preference thing. But I so that's my dinner. That's also tomorrow's lunch. And then after after I make tomorrow's lunch,
I make my breakfast, which is a big bowl of oatmeal
with a bunch of fruit in it. And I put that in there and berries and put that
in the refrigerator overnight. And I eat that for breakfast
in the morning.

That whole process, you know, including the eating dinner
time is probably 90, 90 minutes. Yeah, that's faster. Or that's longer
than going to drive through. And so you do have to invest
a little bit, but it can be super,
it can be super, super simple. Super fast. And that's just what I like you. You don't have to even,
you know, I like to eat
the big bowl of greens. I think it's important
for me. I think those are the leafy green vegetables
are the healthiest food on the planet
as far as I'm, I understand. And now I want that
to be a big part of my diet. But some people don't like that.
And there's just that. There really is a time there's a whole world of produce
out there that is really fun to explore
and and and I love doing that.

I love to mix up the vegetables. I just make sure I, you know,
if it's sweet potato, I know I weigh it and I know
how much carbohydrates in there. And I made this a certain amount
of carbohydrates for each meal. But, you know, for people
without Type one diabetes, they don't have to do that. They can just you know,
eat as much as they want. And that's the beauty
of eating this way. I think that, you know, it's not I often tell people
it's not a weight loss plan.

It's not it's not a diet like like a diet that you go on and then go off
it's it's a it's a lifestyle. It's a it's a it's just a it's
just a healthy way to live. I don't even like really
the word lifestyle. It's just a healthy way to live. In my opinion. The best way to live and the
most appropriate way to live for your individual health,
for your family health, for the environment
and and the animals. Yeah. Yeah. And remember, that exam room is
the next time somebody asks you why you're vegan, just tell them
it's a healthy way to live.

And leave it at that. They don't need any more
explanation. Also want to just kind of circle
back. You were talking that it takes
90 minutes start to finish, but that includes the time
that it takes to actually eat. So that 90 minutes is not that big of a burden,
especially if you just kind of get into that routine. I think that routine here is
really kind of one of the keys to make this so successful
for you, correct? Absolutely. Yeah. Thank you so much for clarifying
that because the dinner in my house is over an hour,
so it's our social time. We sit and eat as a family and yeah. So I would say that the meal
prep is less than 30 minutes. Yeah, there you go. I mean, you think about the time then
that it would take to go to the drive thru and if you're going to certain
establishments you know that you're going to be waiting there
for at least 15, 20 minutes plus the time then
that it takes to drive home.

You're talking about
more than that half hour investment
you may even be talking about the full 90 minutes
depending on where you go and how busy the restaurant is. So I mean keep that in mind. To me that seems like
a very reasonable thing, especially you know,
you're talking about making sure that your breakfast and lunch
are also taking care of in that window too. That's, that's pretty good. I mean, honestly, Brian, that's,
that's really good. I wouldn't call
that much of an investment man. Yeah. Thank you
for clarifying it. Really. And it really it really is not. It really is not.
It's super easy. I mean, I can
and when I'm super busy, I can I can get a box of greens,
put it put it in a bowl and put some grape tomatoes and beans and salsa.

And that may not sound
good to you, but for me that I and I, that's just great. I love that. And and it can be you know,
you could dress that up in any number of ways to make it
even better to suit your own. But that's super healthy. They have you. If brown rice is too much time
to to cook, they have it frozen you can without anything in it
is brown rice it pop it in the microwave for three
or 4 minutes let it cool and then and then you have
that beans and rice and salsa that's a that's
that's a tasty meal and and that's a whole food
plant based meal right there. No question
if if are you a kimchi guy because I would say swap out the salsa for kimchi one time
and give that a try and see how you like it.
Yeah, no, I do that.

I eat a lot of fermented
different kinds of kimchi. I do with kimchi. A lot of it
does have the fish sauce in it. So you just have to if you get yourself,
that's not an issue. And if you buy it, then just by the not the stuff without the fish sauce and the fish sauce,
I don't think there's anything to it at all. Yeah. The companies
have kind of wised up. They know that us vegans, they,
we like our kimchi, so they'll label
it really big there as you go to buy and if you're if you
if you're not making it yourself, I don't say vegan
right across it. So don't worry about the fish
sauce there. But the final question
that I have for you is kind of a curveball one. And it just kind of struck me,
given the fact that your specialty
as a plastic surgeon, you work with a lot of people
who have had limbs amputated.

And I'm just curious,
given the fact that you have type one diabetes and we know
especially even with type two diabetes, that you know,
there is that increased risk of of losing a limb. Is there a connection between
the two? Is that why you gravitated over
into that arena? Yeah, it's a good question. Honestly,
I think I mentioned that before. I was interested
in vascular surgery, which is the treatment
of a lot of people with peripheral
vascular disease. And I actually chose
not to do that. Even though it is
a large diabetic population. And but it is interesting that
I did kind of come back to that. And I do take care of
those patients and I really do like it. And I think more so now that I'm
I feel like I have something to offer
I think adopting this way of eating
and this and, and understanding the power
of nutrition to prevent and reverse
these conditions gives me something that I can add to their care that they're not
going to get from somebody else.

I do get a lot of patients
when I bring up this, you know, I'm the surgeon, I'm
the hand surgeon or the reconstructive micro surgeon
working to save their leg. And I'm the first one, first doctor
that ever brought up their diet. And I've had people cry and say,
you know, you're the first doctor that
ever brought this up. To me. And I knew this. I knew that
this was a problem for me, but nobody ever talked to me
about it. So, I mean, for me to hear that
it's it just inspires me to do
to keep doing the work I do. And and that is a big part
of why I like this part of my practice
is this isn't my whole all of what I do, but it does make this part of my job more meaningful
and something that I can I feel like I can really add
to their care, to be honest, as a type one diabetic,
I don't fear amputation because, you know, I'm
able to control my blood sugar very well and prevent the things that I know
that you need to limit the problems that eventually
would lead to limb loss or kidney failure or blindness, which all can happen as a side
effect of type one diabetes.

So I don't worry
about that personally. And that it's more
feel like it's something that I can offer these patients that I know
they're not getting from some from the
from the rest of the system. The health care system. Yeah, I would imagine those
thank you's that gratitude from the patients,
you know, with the tears.

I mean, that's got to be
everything for you, right? I mean, that's the whole reason
why you get into medicine. It's to help people and to be
able to help them on that level, I would think is probably
one of the more rewarding feelings you'll ever experience. Yeah, absolutely. That's absolutely
that's why we do it, you know,
and I think this that you you didn't go there
necessarily, but, you know, this gets into a bigger issue
in the United States and is that, you know, this
kind of care is not reimbursed.

So preventative medicine,
a lifestyle medicine is extremely powerful. Dr. Michael Greger talks about,
you know, if you could put broccoli
in a pill and sell, it would be the number one
seller for, you know, cancer treatment
and everything else. Just because
it's such a powerful food, but because it is a food
and no one can make a profit, it's not understood
and it's not sold and and it's not something
even talked about in disease treatment. So we need to do something
about that. And just to shout out to Bikram
for the work that you all do with that, that you have your priorities right and your approach to patient care and yeah, it's it's the way medicine needs to be done for the
for our future, in my opinion.

And look,
you're going to be talking a lot more about this
specifically type one diabetes
at the International Conference on Nutrition and Medicine
August 18th through the 20th and your teaming up
with Cyrus and Robbie from Mastering Diabetes. The name of your presentation
is a new approach to type one diabetes,
and that is exactly what it was. You were just talking about,
so I can't wait to hear more about it in depth,
my friend. I'm looking forward to it. Can't wait to see Robin Cyrus
also and all of you in person. It's going to be fantastic. Brian Carlson,
thank you so much, my friend. This has been fantastic.
I appreciate your time. Thank you, Chuck. Take care If your health IQ was a couple of points higher
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