10x doctor vs average doctor
What are the most important things that your clinic does that the average doctor does not? An example might be looking at 30-year risk for ASCVD versus 10-year risk. Phrased alternatively, if you could only make 3-5 changes to how the 'average' doctor practices medicine, what would those changes be? What are the highest leverage changes? Thanks!
Two orthogonal approaches to correcting metabolic syndrome
I've been listening and re-listening to the two fantastic podcasts with Inigo San Millan. His experience of finding himself as a former cyclist in poor condition rings my bell. In those podcasts, the discussion centers on Type 2 diabetes being a problem with our mitochondria, which can be addressed with a very modest volume of Zone 2 training. This seems completely unrelated to the Virta Health (I'm a Virta patient) approach of resolving Type 2 diabetes with diet. In that approach, we specifically target insulin resistance through carb restriction. It's not clear to me that cutting carbs will increase my mitochondrial density. Or that increasing my mitochondrial density will correct my insulin resisitance. I can imagine a link, but it's not clear. As another example of the same question, in Peter's very old TED talk, he says he developed metabolic syndrome while working out 3-4 hours per day and suggests that he resolved metabolic syndrome with diet. From that we know that a massive amount of exercise alone is not enough to resolve metabolic syndrome. Dietary change is required. Whereas Inigo says that he resolved his weight problem with a very modest volume of Zone 2 training and minimal dietary changes. This was targeted at improving mitochondrial function. From that we know that exercise alone is adequate. In podcast 85, Peter talks about two levers, diet and exercise, but his experience seems to be a great example of someone pulling very hard on a lever with no result. So I think I'm asking two questions: 1) in what way are a ketogenic diet and Zone 2 training addressing the same mechanism? 2) what was the difference between Peter's and Inigo's experience using exercise to address metabolic syndrome? Thanks!
Escaping THC Insomnia Rebound
One of my children, almost age 20, has long had a sleep disorder, diagnosed as narcolepsy, and she also has generalized anxiety. The approved treatments for narcolepsy either aggravate her anxiety or don’t work. Unfortunately, there does not seem to be a good prospect for an orexin agonist that would address the root cause. So she has fallen into the THC trap out of desperation for sleep. Can CBD possibly be used to escape the trap of THC dependency to fall asleep in a way that serves to navigate around the insomnia rebound that occurs when you try to quit THC? And, even if it can, there is then the optimal dose quandary - is there any legitimate data, scant though it may be, to provide any guidance in this regard? I actually think the fact that the wrong dose can produce wakefulness created the prevailing belief that CBD does not help resolve insomnia. Very unfortunate. Or perhaps there is a study that may help navigate the treacherous passage away from THC to help salvage young people being harmed by its use but who otherwise literally cannot sleep? Thanks!