According to the CDC, up to 25% of Americans have arthritis.
Dr. Miller discusses how arthritis forms and ways to help prevent and treat it.
In addition, Dr. Miller, Dr. Marbas, and Dr. Scheuer discuss ways to improve your weight, B12 supplement recommendations, and much more!
Questions Answered
- (00:03)
– What are Osteoarthritis and Inflammatory Arthritis? - (02:38)
– Reactive Arthritis - (03:56)
– Osteoarthritis - (10:44)
– My B12 is high, but my doctor didn't seem too concerned about it. Can the B12 be causing my chronic insomnia? - (15:35)
– Methylcobalamin or Cyanocobalamin, which is better? - (17:20)
– Someone with Graves' disease and taking antithyroid medication, can she eat soy? - (20:13)
– What are your thoughts on B12 shots? - (22:26)
– I'm 55 and I'm wondering how many calories I need to lose weight. Any advice? - (27:05)
– Do you take medical insurance, Medicare or UHC AARP secondary? - (31:16)
– I struggle with food sensitivities. What would be your advice to help me get back on the whole food plant based bandwagon? - (35:05)
– Any thoughts on some lingering elevated cholesterol or pre-diabetic A1C? - (39:34)
– What is a good supplement for peripheral artery disease or peripheral vascular disease?
Complete Transcript
Dr. Chris Miller
(00:03)
I wanted to talk about arthritis today because it's so common. And I feel like we're always talking about heart disease or diabetes or autoimmune disease. We're talking about some of these big topics. But this is something that affects, according to the CDC, this affects a quarter of Americans and that's over 58 million people. And I would argue it's even more than that, but these are the people that are diagnosed and known to have it. That's a lot of people. This affects people's livelihood. It impairs their ability to be active. And we're talking about lifestyle and getting out there and doing all these fun things and people with severe joint pains, whether it's in their backs, their knees, their hips, their fingers, their shoulders, their necks, they're greatly impaired.
Dr. Chris Miller
(00:47)
And so I really wanted to talk about it because there's a lot we can do. First of all, when I talk about arthritis, just to clarify, arthritis is inflammation in the joints. Anything with an itis is inflammation in the joints. And there's three main types of arthritis. No, I'm sorry, there's more than three, but I'm going to cover three main types today. There's multiple reasons for arthritis. Arthritis can be osteoarthritis and that's what we think of as kind of aging arthritis, it's degeneration of the joints and the actual cartilage starts to disintegrate and you get these osteophytes forming, these bony speculations and can cause pain. Usually it can be in any joints, it's often in big joints like the knees, the hips, the feet, but it can be in fingers. We see it as people age, it becomes more and more common. This is called osteoarthritis.
Dr. Chris Miller
(01:35)
The second one that I'm going to cover today is inflammatory arthritis. And this is the one that's so near and dear to me, this is in people with chronic inflammatory issues. It's known in autoimmune diseases, such as rheumatoid arthritis, lupus, psoriatic arthritis, but truthfully it's seen in so many autoimmune diseases. So hypothyroid people could have joint pains, people with Crohn's disease. Some of the GI autoimmune diseases can have joint pains, so it's really common.
Dr. Chris Miller
(02:09)
And there's so much we can do to help those people with joint pains as well. My joint pains went from being about eight out of 10 to zero. And that was even on medications that I was having that much pain, so there's a lot we can do for that. And then the next type that I want to talk about is gouty arthritis, or I should say crystal induced arthritis, there's gout, and there's pseudo gout. And these are different types of crystals deposited in the joints. And I actually have quite a few patients with gout.
Dr. Chris Miller
(02:38)
And so I wanted to cover a few basic tips that we can share that we can help us out. And I'm not going to talk a lot about this one, but I just wanted to talk about what's called reactive arthritis. It's known as raeder syndrome. And what this is, is following a viral infection. You can get joint pains. And so it's known to happen after chlamydia. It's known to happen after salmonella. So people who get GI issues get a bug, a gastrointestinal bug can get it.
Dr. Chris Miller
(03:10)
But now in this day and age in 2022, it's starting to be known after COVID. So about 15% of people with long haulers are going to complain of severe joint pains. And this turns out to be actually an autoimmune presentation as well. And so when we talked about autoimmune, we'll talk a little bit about this reactive arthritis, but it's a similar thing.
Dr. Chris Miller
(03:29)
Those are the types of arthritis that I want to cover today. And I want to just explain a little bit, because I'm a lifestyle medicine doctor. I want to talk about the benefits of lifestyle and the things that we can do that are very effective and I hope people are doing so. And if you guys have any questions, feel free to post them and Kim or Laurie can let me know if there's any questions. I'll be so wrapped up in the benefits of healing these arthritises.
Dr. Chris Miller
(03:56)
First, osteoarthritis, which is loss of the cartilage. It's very common in people as they age, especially as they get older than 50. And like I said, 25% of Americans are actually diagnosed with this. What we notice is that joints get stiff after sitting or resting. When they're cold, they get stiff. You may notice what we call crepitus, so that cracking, popping sound, people get up and walk and they have lots of pop, being limited range of motion. So we're supposed to be able to have nice big joints range of motion and that becomes limited because of pain. And because these little spicules are growing out with the loss of cartilage, loss of fluid in that joint, and we're getting loss of range of motion because those spicules are getting in the way and without the cartilage there.
Dr. Chris Miller
(04:47)
We think of it as being an aging thing, or it follows trauma. So if you have broken your ankle when you were a teenager, you may feel arthritis when you're 50 years old in that joint. So previous trauma is definitely a reason for osteoarthritis. Some of it is a little bit genetic. Some people get more than others. Being overweight is significant risk factor for arthritis. In fact, you're twice as likely to get osteoarthritis if you're overweight, even just a little bit of weight.
Dr. Chris Miller
(05:14)
Being deficient in vitamin D is a risk factor, poor diet, which of course we're going to cover that significantly, being deficient in nutrients. So you need to get nutrients into the joint. If you are deficient in nutrients, that's risk factor. And being deficient in, or having vascular disease. So any vascular disease will be a risk factor. And so treatment of it really is basically anti-inflammatory pains. And I think of it as anytime you give someone anti-inflammatories, that means there's inflammation. That means there's something we can do. It's not a systemic inflammatory disease, but it's local inflammation.
Dr. Chris Miller
(05:56)
And so because of that, you can get anti-inflammatories are helpful, so ibuprofen, pain control medicines like Tylenol, although they may not be as helpful. And what else is helpful is what's also done, oftentimes is joint replacements, surgical, cleaning out those osteophytes. So that's kind of common medicine. Any questions or any comments from the other doctors or anyone on there, so far of osteoarthritis? Because now I'm going to jump into the lifestyle, which is the fun part of it. That was the boring part of it.
Dr. Chris Miller
(06:28)
Okay. So now what can we do? So that was modern medicine. I just kind of gave a really brief summary. Now what's the exciting parts that we can do with lifestyle. Actually let's talk first about some of the studies. In 2006 in The Journal of Nutrition, Health and Aging, it showed that people who eat meat even just one day a week, had an increase of 31% risk of getting osteoarthritis in women and a 19% increased risk in men. So that's just one once a week. Imagine you're eating it seven days a week or even more than that.
Dr. Chris Miller
(07:01)
If anyone watching this is still eating meat and having joint pains, it's a significant risk factor just to eat meat according to the study, 2006. And then in 2015, in the Journal Arthritis, they did a randomized control trial where they put people on a standard American diet or a whole food plant based. And in just two weeks they reported significant reduction by 50% or so in joint pains in just two weeks. Imagine if you continued on that whole food plant based diet longer than just two weeks, the benefits that you would begin to feel. Those are two studies supporting what I'm about to say about it as well. Why is this so powerful?
Dr. Chris Miller
(07:38)
Well, one is packed with antioxidants, right? We said that there's local inflammation, so eating antioxidant rich foods, vegetables, fruits, colorful fruits and vegetables as well, legumes, all of our whole food plants that we eat are packed with antioxidants, so that's one. We're removing some of these pro-inflammatory factors, such as the meats, all the animal products. In addition to that, when you eat a whole food plant-based diet, you increase your circulation. So you're increasing circulations, you're able to give more blood supply, more nutrients to the actual joint.
Dr. Chris Miller
(08:14)
And then coming from the other side, the capillaries go through the tiny little capillaries, the other side you're able to clear the waste out. So just eating a whole food plant based diet opens that up. And then in addition to just the diet, staying very well hydrated is extremely helpful. So it helps also to flush this out for people. Losing weight, so people on the whole food plant based diet, maybe even just lose five or 10 pounds. But pick up a five or 10 pound weight, that's heavy actually, so that much less weight. I do my little five pound weight sometimes and I think, wow, if I just lost five pounds, it feels like a lot. So any weight that you lose is going to help improve your joints.
Dr. Chris Miller
(08:53)
Those are some of the reasons that diet is so powerful. You get all the right nutrients in the antioxidants. You clear out your vascular chair, you can help clear out waste products as well. And adding moisture can help those joints, reducing your weight. And then things of course like not smoking, staying well hydrated, super important. And I want to talk about one other lifestyle factor that I'm a huge proponent of, and that's physical therapy. I cannot say enough good things about physical therapy for people with osteoarthritis.
Dr. Chris Miller
(09:20)
Because if your knee is struggling and having a lot of pain right there in the joint, you can be strengthening your quadriceps muscles, your hamstring muscles, your calf muscles. You can strengthen all of these muscles so that the joint doesn't have to take the brunt of it. Now the muscles are supporting it and it does wonder. Especially if you can get a good physical therapy, if you live in Colorado and especially in the Aspen area can help you find, I got some great physical therapists out here. But it's super, super duper important.
Dr. Chris Miller
(09:52)
Also if you're having lower joint pains to remember that good shoe support is really important. And if you are walking around pronating or with bad support, that can definitely cause ankle, knee, hip pain too. And so a lot of people get relief just with that alone. I hope that answers some of the questions on osteoarthritis. It's super duper and common, but by going plant-based, eating a real whole food plant based diet. Oh, I forgot to mention, eliminating sugar, sugar definitely triggers the joint pains, so you want to get that sugar out as well, by eating a clean whole food plant based diet high in antioxidants and drinking plenty of fluids, getting some physical therapy and sticking with it longer than two weeks. So we get even more benefits than they talked about in that study. That is how I recommend treating osteoarthritis. Any questions, comments, anything from anyone?
Dr. Laurie Marbas
(10:44)
Okay. That's fantastic. Actually let me, I was pingy, there we go. I'm going to make this our galley view, there we go. So Dr. Scheuer can be seen as well. Basically, yeah, we do have a question and it was interesting question actually. Let me pull it up here, she says, Paula asked, “My B12 is high, but my doctor didn't seem too concerned about it. Can the B12 be causing my chronic insomnia? My endocrinologist says the inflammation is causing high B12. I have type two diabetes and two forms of arthritis. Thank you.” Any thoughts on the high B12 correlation with inflammation?
Dr. Chris Miller
(11:26)
I personally don't know of it, if it raises it, so maybe one of you guys do.
Dr. Laurie Marbas
(11:31)
Yeah. While you were talking, I was doing a little quick research and found some interesting, just quick glances at some abstracts and some studies, two things. One, low B12 can cause some inflammations, just briefly looking over this, remind you this is a very cursory view of what I was reading very quickly. But some other ones were showing elevated B12 was correlated with increased mortality and inpatient individuals. So is it the supplementation causing worsening effect or is it the B12 is elevated because of the inflammation, this person's sick? That I don't know.
Dr. Laurie Marbas
(12:09)
But it is an interesting correlation. There really is no reason to keep your B12 high, right? So if you are too high, work on getting it back into that normal range, anywhere between. Personally what I like to do is even on some recent labs, which is interesting, my anecdotal experiences that people below 500 especially, but I try to keep them above 600 on their B12 levels are actually having symptoms, right? You'll see MCV, their red blood cells are large. They could be anemic. They have neuropathic symptoms. But you keep them above that 500, 600 mark, they tend to do better and haven't had anybody with having any problems, so just keeping that in mind. But I like between 600, 1100, 1200 on my B12. You guys have any preferences to that?
Dr. Chris Miller
(12:54)
I keep it a little bit higher as well, 500 to 900 is sort of what I'm aiming for. And that study about mortality, we talked about that about a year ago and had come out that at first we thought that people with high B12 were just peeing it out. And then they found out that study came out that showed that, no, actually people with higher B12, higher or cause mortality. And I don't know what the link is, that study did not tell us. It was just a correlation that they found that.
Dr. Chris Miller
(13:22)
If I see people with crazy high B12s, I work on correcting it. But I don't know if that's linked with joint pains. I thought that was sort of the question. And I'm not sure if there's a link there. But remember any nutrient deficiency is going to lead to your body struggling and can lead to inflammation, which can contribute to joint pain. So you don't want your joint deficient in any nutrient. That's something that we correct with Plant Based TeleHealth. We're always searching to make sure people aren't deficient in nutrients. Kim, did you have a thought about that too?
Dr. Kim Scheuer
(13:53)
I agree with not keeping the B12 too high or too low. And I was just thinking in general about what you were talking about. I've seen studies on back pain, which people think are not associated with nutrients, but they can be. Knee pain, there's studies on that and shoulder pain. So getting on the whole food plant based diet, having better endothelial function, so you have more blood flow to the area. Having less inflammation makes a huge difference in all of these parts, not just … So people think, oh, I just getting older, my shoulder, I'm getting a frozen shoulder kind of thing.
Dr. Kim Scheuer
(14:30)
Well, no, that's actually associated with heart disease. And that's a chronic disease that we can fix with plant-based medicine and lifestyle medicine. And then the other thing I was thinking when you were talking was the difference between arthritis and arthrosis, which arthritis is the inflammation part. I've had knee surgeries when I was really young skier and a lot of us in Colorado are. And so I have the damage, the damage is there, but I don't have the pain anymore because I changed my diet. This does make a huge difference, exactly what Dr. Miller was saying. It makes a huge difference in keeping moving and eating healthy and keeping your inflammation down. Those are great points that you've made.
Dr. Chris Miller
(15:18)
Yeah, that's a great example. And that's like now what I was talking about is you've had trauma, you've been skiing. And so you're high risk to have arthritis in your knee, but you're managing and keeping an FA and that's perfect example. Lifestyle medicine at its best. Great.
Dr. Laurie Marbas
(15:35)
We had another, we'll just kind of stick in the B12 category here is methylcobalamin or cyanocobalamin, which is better? I prefer cyanocobalamin and I'll explain, unless you're a smoker, there's some interesting studies on that. But I'll explain what we've been seeing. Some people think it doesn't really matter, but I think it really does. What we'll see is you think about B12, there's multiple pathways that B12 needs to be utilized. You may have heard of someone saying, checking methylmalonic acid, checking your homocystine.
Dr. Laurie Marbas
(16:06)
And we're checking these things to make sure someone's adequate B12 inside of their cells, we'll see the serum B12 be normal, which is the blood test, the plain B12 blood test. But their homocystine would be elevated, but their methylmalonic acid was normal. And I'm sitting here in my head going, “What is going on?” And you start looking into the little bit finer details. And most of these patients are on methylcobalamin. As I switched to cyanocobalamin, and before you know it, the homocystine is normalized. Unless you have very specific needs to be on the methylcobalamin, go with the cyanocobalamin, it really is the better choice. At least that's my preference. Any thoughts there guys?
Dr. Chris Miller
(16:44)
Well, cyanocobalamin is absorbed fine and it's a little bit cheaper. So it's sort of the go to one. There are some people that don't methylate it, and so some of those people may need. So if you are on cyanocobalamin and you're still having an elevated homocysteine and methylmalonic acid, then you may be someone who's not methylating, you may benefit from the methylcobalamin. But I think Dr. Greger is the one who I saw the study from, reported that the majority of people are just fine. And since that's the cheaper kind, it's the go-to one that I use.
Dr. Laurie Marbas
(17:20)
Yeah. And if you're going to do methylide, I would also add in adenosylcobalamin. I would do a combo, so you're not going to be missing that other pathway. Kim, any quotes, questions, thoughts? Okay. Someone else asked … Okay. She was just talking about her MTHFR and her B12 was 2000 last year. She's going to have it tested again. Okay. I think these are all, some other questions. Okay. Another question, Denise is asking for a friend, I love those. Can someone with Graves' disease and taking antithyroid medication, can she eat soy?
Dr. Chris Miller
(17:59)
That's a really good question. There's been some studies or some people in the past that have said, “No, you can't. That it interrupts with a thyroid.” And so what it looks like is if you have a normal iodine level that the soy does not inhibit anymore with the thyroid, and what can happen is the soy has phytoestrogens and it can actually look like iodine, get in the way of your iodine uptake. And so by making sure that you have an appropriate iodine level, it has not been shown to be harmful.
Dr. Chris Miller
(18:32)
And in fact, people are eating a ton of soy who have thyroid and their thyroid is improving. And we're able to take them off some of their hypothyroid medicine, their levothyroxine. And we've been seeing this for years, and there are several studies supporting this. If you have thyroid disease and you're worried about soy, I would make sure your iodine level is okay. And once you share that you have a good source of iodine and your iodine's level okay, you should not have to worry. And in fact, it's so good for you, anti-inflammatory and promotes good health that you may actually have to lower your thyroid medicine over time, because you're doing so much better. What do you guys think?
Dr. Laurie Marbas
(19:05)
I'm a big soy advocate, a 100% agree. Yes.
Dr. Chris Miller
(19:08)
Right. Because you eat a lot of soy and you-
Dr. Laurie Marbas
(19:10)
Oh my gosh, I love it. And my thyroid continues to get better. I was hypothyroid 25 years ago after the birth of Jonathan, number two. And 15 years kept escalating doses. And then wham, plants entered my life. And I was eating some plants, but then went strictly plant based diet 10 years ago, thyroids dramatically better. TSH was like zero when we figured it out, because I had some other symptoms. I was like, “What's going on?” And had to lower it for a couple of years in a row.
Dr. Laurie Marbas
(19:40)
And then it was pretty quiescent for a while, and then it had to lower it again this year. So I'm like, “I don't know what's going on with my thyroid.” It's coming alive in little spurts. But anyway, yes, and I eat at least two servings of soy daily, just because of the [inaudible 00:19:54] density, the lowering cholesterol effect, it decreases breast cancer. And shall I go on and on and on. So yes, go soy. That's anybody. I'm always preaching soy to the patients.
Dr. Chris Miller
(20:06)
I love it too. Yeah.
Dr. Laurie Marbas
(20:08)
Good protein. Great calcium source. Amazing.
Dr. Chris Miller
(20:11)
[inaudible 00:20:11] as well.
Dr. Laurie Marbas
(20:13)
Yeah, absolutely. And just trying to gather all of our … clump our questions together here. What are your thoughts on B12 shots?
Dr. Kim Scheuer
(20:28)
Only if you need them.
Dr. Laurie Marbas
(20:28)
Right.
Dr. Chris Miller
(20:31)
You don't give yourself a shot if you don't need it. But, excuse me, if you're not absorbing it for some reason or you have an autoimmune intrinsic factor. Certain people have got issues because B12 can be hard to absorb in the stomach and the intestine. Some people just aren't able to, so if it's deficient and you've tried these different forms of B12, like doing the droplets are easier to absorb than the supplements, the capsules. But if you've tried these different forms, then I would recommend a shot.
Dr. Laurie Marbas
(21:00)
Yeah, it's really interesting. I had another job where I had to do, they're like, “Oh, you're vegan. Do this B12 deep dive and give us some clinical guide.” I dove into almost everything I could find on B12. And what was interesting was even if you take a much higher dose for some of those who really struggle to, even with intrinsic factor deficiency, there's some passive absorption that's outside of use of intrinsic factor.
Dr. Laurie Marbas
(21:24)
Even some of those who struggle to get enough, if you're doing a high enough dose, you can potentially get enough, but that's not everybody. But especially if you've had any type of gastric bypass surgery or some other things, there can be a real issue with absorption or a metformin or any type of medications like antacids like omeprazole, things like that. So yeah, absolutely, shots only if necessary, but I would definitely consider working with one of these amazing doctors on Plant Based TeleHealth and they can absolutely direct you into the right way to get your B12 where it needs to.
Dr. Laurie Marbas
(21:56)
Because the majority of people will be able to just do an oral supplementation, and it might be the supplement you were taking, right? So not all supplements are created equal. They're not FDA regulated. So you want an independent third party testing of that supplement brand, make sure that's a good one. Look at all the factors, it may not just be you. It might be actually the supplement that you're taking, so that's some-
Dr. Kim Scheuer
(22:19)
And that's why testing on that is so important. You really want to do the testing, so that's why. Come see one of us if you need to.
Dr. Laurie Marbas
(22:26)
Absolutely. Had another question. Heidi ask, “I'm 55 and I'm wondering how many calories I need to lose weight.” Well, let's dive into the weight loss midlife. What do you guys think? Tell me. Go ahead ladies.
Dr. Chris Miller
(22:43)
Well, I would say, okay, so that's a great question. Very interesting, of course. But with a whole food plant based diet, if you're eating high fiber, if you're eating no processed foods and avoiding sugar and additives like that and no animal products or dairy products and avoiding high fat, so good clean whole food plant based diet like we advocate for. At this point you don't necessarily start, I don't anyway start with counting calories. I start with the high fiber and you may want to be more low glycemic.
Dr. Chris Miller
(23:16)
Instead of eating tons of white potatoes, you may eat a little sweet potato, but a lot more vegetables, different types of vegetables, mix it up. Middle age, I find that processed foods really affect people a lot more, sugar, oils, so really careful with those types of things. And eating even more whole food and even more raw or low glycemic really helps. Including a big salad and then maybe a bean soup or something like that versus before you might have been able to eat a piece of bread with a little avocado smeared on it.
Dr. Chris Miller
(23:48)
And now that you're 55, you're not going to handle that as well, so lower glycemic, whole foods, including some raw for your meals. So that's how I help someone build their diet and then finding out what they do for movement, exercise. What is their lifestyle like is another. And then how insulin sensitive they are is another factor that contributes. So if they are a little insulin resistant, it's harder to lose weight.
Dr. Chris Miller
(24:10)
And so we may tweak the diet even more, help them with that type of thing and/or exercising after eating or getting the movement in also, things like high intensity workouts or building muscle mass or resistance training. So we have to sort of shift our exercise patterns. And then stress and thyroid and hormones, that all affects. But that's how I start. I don't start with counting calories. I have counting calories with patients. So it's not that I finish there always, but that's how I start. What are your thoughts about for her question?
Dr. Kim Scheuer
(24:44)
I'm with you on that. It's not the calories in, it's the calories absorbed. It's the kind of things that you eat. If you're eating a very bulky, full of water, full of fiber food, you can eat a whole lot of it. I try to keep people away from counting calories as a way to do it. It's eat the healthy high bulk, high fiber, high water content foods. And then it'll improve your stooling and you'll poop it out more, you won't absorb it all. And also you want to have not high processed foods, which you get.
Dr. Kim Scheuer
(25:23)
For example, an apple, eat an apple, the same amount of calories in an apple versus the same amount of calories in apple juice is absorbed differently. So you want the apple, you want the whole food. And so you don't need to pay attention to calories. I'm myself a weight watcher, diet center, counting calories, all that kind of graduate and it never worked. But going whole food plant based and eating as much as I want of these wonderfully high nutrition, low calorie foods just makes me … I actually had to eat more to not lose too much weight. Focusing on that is not where I start with my patients. I start with other things to help them feel full, eat better and get healthier.
Dr. Laurie Marbas
(26:10)
That's a great message, Kim. Because now you're focusing on abundance versus deprivation, right? We are not made to count calories. If you think about a thousand years ago, the human that was running around eating the food available, they weren't like, “Oh, can't have that today, that's a thousand calories.” They were like heat food, seafood, eat food, live to see another day, right?
Dr. Laurie Marbas
(26:31)
If we had that natural food only available to us, none of us would be running around with the diseases that we do today. But when you start saying restrictions, I can't have this because it's too many calories. I need to just do this. People start thinking about it, even when they're like … and that's where we lose our willpower. Willpower is a finicky friend, don't rely on it. It's a disloyal lover type thing. So you want to think about it, those type of ways, just eat these less calorie, less calorically dense foods, full of fiber, like you said. There's a tidy stretchy in the stomach, sending the receptors to the brain that you're full.
Dr. Laurie Marbas
(27:05)
And then we have people like you who say like I have to eat more to not lose too much weight, that's a fabulous thing. But yeah, there are some other interesting stuff with women in this age group, for sure. Cindy does ask, “Do you take medical insurance, Medicare or UHC AARP secondary?” Well, that's a great question. We are a strictly cash based practice as of now, we're working towards taking insurance and making the services as affordable as possible. In the future we're looking at doing potential other options for patients like subscription models and stuff. We still haven't figured all that out yet.
Dr. Laurie Marbas
(27:42)
We are certainly growing company, but we're pretty lean and trying to get these doctors to you guys. And so we try to make these as affordable as possible yet, and also support our doctors so they can do this as a full-time basis. There's a balance here that we're working on. So we do appreciate everyone's patience. We can provide what we call a super bill, which is a receipt. It's not a bill, it's a receipt for the services rendered. And you can actually submit those to your HSA, FSA, your insurance company. And they may provide you reimbursement.
Dr. Laurie Marbas
(28:16)
The special part about Medicare unfortunately is that most of our doctors have opted out of Medicare. And unfortunately if you see a physician and they bill you for medical services cash basis and they've opted it out, it is actually against the law for you to submit for reimbursement. Thank you, Medicare. That's how we choose to treat our seniors in the United States. Anyway, you can see I'm a little bit upset about that.
Dr. Chris Miller
(28:40)
Will you explain why the doctors have chosen to opt out because they just choose to not [inaudible 00:28:46]?
Dr. Laurie Marbas
(28:46)
Right. No, absolutely. We would've stayed in Medicare except we can't see Medicare patients if we don't opt out, right? So if you're in Medicare and you see a patient and you are in Medicare, you're required by law to accept the payment of whatever Medicare gives you. It could be a dollar or it could be nothing. It could be $50 or $100, it doesn't matter, you have to accept that.
Dr. Laurie Marbas
(29:08)
If you opt out of Medicare, you're not obligated to accept Medicare payment, hence we can see you and take a cash payment. But Medicare does not allow you to attempt to get reimbursed. Basically what they're trying to do is force doctors to stay in Medicare and accept these very low payments for services rendered, which is really frustrating. I mean, that's why people are turning away Medicare, Medicaid patients regularly. There's a big problem. Anyway, I have a whole philosophy on that, so that's a whole nother discussion where I can get up and walk around and calm down [inaudible 00:29:47].
Dr. Laurie Marbas
(29:47)
But it's a sad situation, but we really are trying our best. And many of our doctors go out of their way to provide excellent services. And so it's, well, you're getting a lot for your $150 for half a hour. It's $300 for a full hour, which we do recommend. And if you have a very complicated case doing a full hour visits, you'll get so much more of it than you got in any other physician appointment, I guarantee it.
Dr. Laurie Marbas
(30:12)
And we have doctors, like I said, across the country, amazing doctors. And I'm only accepting doctors in certain states right now. I have a very full panel. So I'm only accepting patients where I'm either the only non-Medicare provider that can see patients or I'm the only doctor licensed. We encourage everyone to see these other incredible doctors. So that's really, really important that you understand where we're coming from. We're not trying to be greedy in any sense. We really, really are trying hard to make these as affordable as possible for everyone. And I hope that answers your question. Maybe it was too long.
Dr. Chris Miller
(30:47)
No, that was a good answer. I think it's helpful for people who don't understand.
Dr. Laurie Marbas
(30:53)
Cindy says she worked in the medical field, so she fully understands. Thank you. Oh, and Jean Schumacher who's been an early supporter for us. She mentioned to someone who is asking the question. She said going plant-based gives you the freedom to eat, no counting calories, carbs, measuring, weighing. It's awesome to have the freedom and she lost 200 pounds. And check out our website, she's pretty awesome. And thank you, Jean, for always supporting us.
Dr. Laurie Marbas
(31:16)
Tammy says, “I went whole food plant-based for eight to 10 months and absolutely loved it and did great at it. But at the end of that time, I developed terrible food sensitivities, really low iron and ferritin levels and ended up with candida trouble. What would be your advice to help me get back on the whole food plant based bandwagon because I still believe in it.” You guys like to address that?
Dr. Chris Miller
(31:37)
So am I understanding right? I don't see the question in front of me. After going whole food plant based, this person-
Dr. Laurie Marbas
(31:44)
She struggled. So she went plant based, did great, loved it. But after eight to 10 months on the plant based diet, she had some food sensitivities, low iron and ferritin and candida. I have my thoughts on that, but any of yours? You guys have any ideas?
Dr. Chris Miller
(31:58)
Yeah. I would say a couple things. One, first of all, I'm sorry to hear that you had ran into those problems, that's a bummer. But I would say, I would want to know what you were eating and if you were on a well-balanced diet. Some people who are eating gluten, if they have a gluten sensitivity can run into trouble, because now they go whole food plant based and they're eating more gluten. And also people can have reactions to greens.
Dr. Chris Miller
(32:24)
And so some people, if they're eating a high grain based diet, we see people sometimes developing food sensitivities. Food sensitivities are sign that your gut microbiome is out of balance, that your gut lining is getting disrupted. And that goes along with iron deficiency because then maybe you're not absorbing nutrients as well, including iron, so they kind of all go along together.
Dr. Chris Miller
(32:45)
When I work with people with food sensitivities, the goal is to be on a diverse whole food plant based diet. But we may do a phase where we get some of those foods out for a little bit and really flood the body with nutrients and get the healing process going, taking supplements if you need it for iron or for whatever nutrients initially at least, and getting that gut to heal. And then as that heals, then we can get you back on a diverse whole food plant based diet and make sure that's well balanced, so hopefully something like that won't happen again. What do you guys think?
Dr. Kim Scheuer
(33:19)
Sorry. I was muted. One of the things that I like about working with the docs here is we are all very similar in a lot of different ways. And so I think Chris, you mentioned, or Dr. Miller, you said it perfectly that you want to look at exactly what you're eating. Was there any other issues that happened right beforehand? Did you get a viral infection that may have kicked you off, upset your microbiome? There's a lot of different things we would look at as a … once getting much more information from you. Dr. Marbas.
Dr. Laurie Marbas
(33:54)
Yeah, I agree. Thanks. That's a very good point. And she also mentioned here just as a secondary that she cut out gluten. So of course celiac disease is one of the things we look at. But the other thing that I'm seeing recurring, a lot of times you'll hear people who switch to a plant based diet are having a lot of bloating and discomfort, maybe some diarrhea, especially when they eat more raw foods.
Dr. Laurie Marbas
(34:15)
I start checking a fecal elastase, so this is a pancreatic enzyme. And so what I'm finding is that I'm seeing actually some folks that are low. And so then we reintroduce some pancreatic enzymes that are prescription based on weight and they're doing phenomenal. So just some ideas there. This is typically idiopathic, but if you have a history of pancreatitis or alcohol use, that can be one of the causes. Sometimes diabetics, it'll be a little higher risk. That would be my suggestion is definitely seeing, again, one of these amazing doctors who can do a thorough analysis of what you're eating, symptoms involved. Timeline is key. The diary is huge and let their detective skills go to work for you. I mean, they really can be quite amazing. Here's some other questions. Do you care for another few minutes guys?
Dr. Chris Miller
(35:02)
Yeah, sure. This is fine. I like the questions.
Dr. Laurie Marbas
(35:05)
Kathy mentioned … Hold on. I have to open it up here. Okay. “I lost 21.9 pounds on a vegan diet.” Congratulations. That's awesome. “I was doing Weight Watchers for years and could only lose 10 pounds.” Well, there's a reason people celebrate their anniversary in Weight Watchers because it doesn't work long term. “I eat potato chips now and I don't beat myself up anymore if I eat processed food every three months. My cholesterol went down 30 points. However, it is still high, LDL is 156 and my A1C is 5.9. I've been total vegan for seven months. Any thoughts on some lingering elevated cholesterol or pre-diabetic A1C?”
Dr. Chris Miller
(35:48)
I would say so for that, that it has a little bit to do with your diet. So if you are still eating some potato chips or eating cheat days, it really affects people. Oil really affects cholesterol, so in eating processed foods. Number one, I would say to aim for a clean whole food plant-based diet for one to two months and repeat it, because you can see dramatic rapid improvements in that, so that's the first thing that I would aim to do for you.
Dr. Chris Miller
(36:20)
And secondly it would be if some people genetically don't clear cholesterol as well. And so they just need a little help with that. And so we can help with there's many supplements that we are using, things to help you pull it out or anti-inflammatory, or to help you get rid of … even though you're not eating cholesterol, your body has the receptors that pull it out and get rid of it. And so we can help you with that.
Dr. Chris Miller
(36:41)
And the third thing is to restratify you and to see if that's actually depositing plaque in you [inaudible 00:36:46]. Because some people have a little bit higher cholesterol, but it's not depositing plaque. And so it doesn't matter as much as someone who have a lower cholesterol level, but it is depositing plaque. And that has to do with your inflammation, with some of your genetic markers, like LP little a or homocysteine, things like that, other things affect it. And so we can restratify you with what's called the coronary artery CT scan, and it's extremely helpful. There's so much more we can do this day and age than just check a cholesterol level. So what else, what do you guys think?
Dr. Kim Scheuer
(37:18)
I agree 100%. You obviously make enough cholesterol yourself. So anything else that comes in can be a problem. And we do have protocols through Plant Based TeleHealth on how to lower cholesterols for people who have it. But as Dr. Miller said, doing a test, whether it's a coronary artery calcification score or a carotid intima-media thickening test, they can tell us how your vessels are inside the lumen of the vessels and inside the vessel wall itself and see whether it makes a difference on you. But I agree a lot of people think, oh, I can just have a little bit every once in a while. And for some people that's okay, but for a lot of people, it really isn't. It really does affect you. It continues to affect you. So we'd have to go into that with you.
Dr. Laurie Marbas
(38:07)
I agree 100%. All of that was right on. The inflammatory markers are really key, like Chris was mentioning the CRP and the homecysteine and then some other independent genetic risk factors like the LP little a. 20% of people are probably going to have an elevated LP little a, so we need to be monitoring that and just make you aware of it, use that as motivation to stay on a low fat, let me stay it.
Dr. Laurie Marbas
(38:31)
But sometimes just thinking about other mechanisms, yes, the processed foods, those that once you go out to eat once a week, you're thinking might be okay, is an issue outside of the potato chips. With the pre-diabetes, so what that tells us is that your blood sugar's running high for a little bit, we would need to look at a few different things. There's actually quite a bit of things we could talk about. And again, that's where I would say looking at you as an individual and those really deep dive into your lifestyle, your genetics, all those things really play a key role.
Dr. Laurie Marbas
(39:05)
And we've worked hard to create some unique protocols that aren't found other places to help you with cholesterol and some other things that we've trialed on some patients and had seen some really amazing results. Others are kind of flat, but for some it's well worth it and they're like, “This is fantastic.” Again, I would really encourage you to see one of our docs. Few more questions, maybe two more.
Dr. Chris Miller
(39:31)
Sure. Yeah.
Dr. Laurie Marbas
(39:34)
All right. We answer Tiffany's question, great. Cindy asked, “What is a good supplement for peripheral artery disease or peripheral vascular disease? Thank you.” I wouldn't say supplement, I would just say plants, but go ahead. What do you guys think?
Dr. Kim Scheuer
(39:47)
I think I'd go with Dr. Esselstyn's approach. You want the high nitric oxide foods that really work on vasodilation. I would say steam some green leafy vegetables, keep them in your fridge and have a handful multiple times a day. So you keep your levels really high and keep you working well, and then avoid things that will cause the vasoconstriction and so oils and things like that.
Dr. Laurie Marbas
(40:16)
Yeah, and absolutely. And Jonathan mentioned he's answering [inaudible 00:40:21] he's saying saturated fats, genetics, coconut oil, things like that, simple sugars, also dried food, right? Alcohol can raise your triglycerides. And also I've seen some transient elevation in triglycerides when people lose a rapid amount of weight very quickly, so it might be worth retesting just that as well. There's some really interesting other things that had triglycerides that can then elevate your LDL, which elevates your total cholesterol in the calculations.
Dr. Chris Miller
(40:47)
Triglycerides are interesting to me because it's almost a marker of what people are eating more than the other ones I feel like. And so when I have a patient who has a consistently low one, and then all of a sudden it comes back high. I want to know if they change in their diet. Often they've gone on vacation or they traveled, or they had a family member in town because it is like you just said, Laurie, it's so sensitive to fat intake and sugar intake in your diet, even dried fruit. And so we can really see a change in that. It's so interesting to me to monitor that with people.
Dr. Laurie Marbas
(41:17)
No, absolutely.
Dr. Kim Scheuer
(41:18)
Chris, you had mentioned earlier gout, and dried fruit actually can trigger gout too. So just don't forget that one because that's … even if you're eating a very clean diet, but you're eating a lot of dried fruit, that can actually trigger gout. So be careful on the processed foods or the dried foods if you need to.
Dr. Laurie Marbas
(41:37)
Yeah. Like the dates and things, people think, oh, apples sure is okay, in small quantities and baking or whatever on occasion, sure. But for those who are struggling, just be looking at everything in your diet, that there really does make a difference.
Dr. Chris Miller
(41:51)
Yeah. I wanted to say one thing that I learned late in my plant-based journey, and I'm going to share with everyone. Even today we said this, you can eat unlimited whole food plant-based and you lose weight and you get healthy. When we say unlimited, what we're referring to is whole plant based and especially the plant foods and especially the lower glycemic ones.
Dr. Chris Miller
(42:11)
You can eat unlimited vegetables and probably for the most part fruits as well. Although I've had people eat 12, 15 servings of fruit in a day. But for the most part, you can eat unlimited fruits and vegetables. But if you eat unlimited dried fruit or nuts. And I misunderstood this or maybe I chose to, but when I first went whole plant based, I was like, “Oh, well, I'm just eating dried mangoes.” I can eat unlimited. Everyone says we can eat unlimited till I'm full.
Dr. Chris Miller
(42:35)
And so a bag later, and then the scale goes up and I'm like, “I don't understand why this is not working for me.” And now I see this in some people, when we say unlimited, there's only a few things that are unlimited, everything else we're eating as meals are in proportions. They're realizing that these are higher calorie dense, like dried fruit as we're talking about right now. And so I want to share that with other people, if other people are experiencing that the way I did many years ago
Dr. Laurie Marbas
(43:01)
Makes sense. I'm always a big fan of saying beans and greens make you lean. Really just pick up those beans and greens, of course and other things, but vegetables. Someone also has the difference between a regular CT scan and a CAC order or a coronary artery and calcium score. The regular CT scan, she said the CT scan results showed no coronary atherosclerosis, but that's just a cursory view. What's nice about this is the coronary artery and calcium scores focused directly on those heart arteries and looking at all of your different arteries.
Dr. Laurie Marbas
(43:39)
And I'm not sure if it's a smaller slice or something, but I wouldn't just accept that as, yeah, I'm okay. I would actually get a score because that score between one and a hundred is something to think about, is it over a hundred? Is there a little bit? It just would be nice to have it. They're usually not very expensive and they're like a five to 10 minute test. Literally there's no dye.
Dr. Laurie Marbas
(44:03)
I'm ordering them quite regularly for patients who are in this kind of, we're not sure what to do. They'd like to get more information. And I find it that's very helpful to just add some, either we're moving in this direction or we're moving in this direction. But this has an interesting question I had wanted to ask you guys, this will make our last one here. My plant-based friend has a high potassium level. His non plant-based doctor wants him to stop eating a lot of the things that he's been eating. He already has difficulty maintaining weight, any ideas?
Dr. Chris Miller
(44:33)
I would start off with for your friend, finding out why he has a high potassium. Is he having kidney issues? So that's something he should be working with his doctor about. It's super important to know that. Does he have low sodium? Is it an adrenal thing? There's certain reasons for. So that's number one, that hopefully he is working with his doctor to figure that out.
Dr. Chris Miller
(44:53)
Number two, potassium goes up if it's drawn and then it sits in the lab and doesn't get run. So it can be a lab error. So if it's just one time randomly high potassium, which I'm guessing it's not that, but that is something to think about if you get a one time high potassium to recheck it super quick, if it doesn't make sense.
Dr. Chris Miller
(45:09)
And then the third thing is, so to answer that question, there's a lot of high potassium foods. And so if it truly is high, you can avoid some of the higher potassium fruits, but you can eat plenty of low potassium fruits and vegetables. And it's total quantity of potassium, so usually if someone's like a kidney patient or they need to limit their potassium, they work with a nutritionist and calculate how much potassium they can get. So say it's, I don't know, making this up 2000 milligrams of potassium in a day.
Dr. Chris Miller
(45:37)
And so then you can look at different foods and you get an idea so you can still eat kale and broccoli, but you have to limit the amount. And certain, I can't remember offhand, but we have a whole list of high and low potassium fruits and vegetables. And so you can eat from the lower and then you can eat a whole food plant based diet. And I have kidney patients I'm working on that are on a whole food plant based diet, eating low potassium and thriving because it's those whole food plant based that heal you and heal your kidneys or heal whatever's causing the high potassium in the first place.
Dr. Chris Miller
(46:06)
The last thing you want to do is stop eating them, so don't do that. Instead work with someone, either a nutritionist or one of us or someone who's knowledgeable and can get you under the low potassium and you can monitor it and make sure that you don't raise it. And you can also check blood regularly to make sure something you're eating is not raising it so you can keep a close eye on it. But yes, I've worked with patients. I know you guys have too, and we've seen them do well, choosing those lower potassium foods or at least keeping it within the range that they're supposed to be.
Dr. Laurie Marbas
(46:34)
Oh, I agree. Kim, did you have some thoughts?
Dr. Kim Scheuer
(46:38)
No, I was just going to say this is a complicated question for an individual person that should be seeing a doctor who understands plant-based medicine and follows it. Because the kidneys are important. Are you hemolyzing and having some lab errors. There's a lot of reasons for the high potassium. And so to get rid of foods that are helpful is not the right idea.
Dr. Laurie Marbas
(47:04)
Yeah, I'd agree. Remember, animal derived proteins are really harsh on the kidneys, right? There's these other components that are beating up your kidneys. So plant protein is where you want to go, so yes. Plant-based diet is key to healing the kidneys and trying to get back some of that, the non scarred kidney functioning. Because once a kidney's scarred down, I mean, that's it, there's no going back to that. But because it's a very vascular organ. Remember it's always filtering blood constantly, right?
Dr. Laurie Marbas
(47:35)
We want to open up those amazing arteries. And by doing that is these plant foods. I've seen some pretty severe kidney patients. We do need to keep a close eye on their potassium. What you do is you want to probably eat the same amount of those potassium rich foods daily, and then keep a close sinus, so like every seventh day checking potassium, and if you're doing okay, great.
Dr. Laurie Marbas
(48:00)
But if you change your diet, check it in five to seven, 10 days or so, another potassium, and see what's happening. If your potassium rises, pull back again. But it really is important that they're under the care of a knowledgeable nephrologist like Dr. Sean Hashmi, who's in California. He's a plant based nephrologist. He's incredible. He has a wonderful YouTube channel. He's on Instagram. One of the nicest people to meet. He's been on our show before here, but it's a selfprinciple.org is his website.
Dr. Laurie Marbas
(48:28)
And we definitely recommend you sign up for, I think he has a newsletter as well. And so wonderful, wonderful. And there's also a book called the Plant-Fed Kidney. I would recommend that as well. That's a great starting point. And to give that to whoever, whatever doctor saying, “Stop eating plant rich foods.” Because that's the opposite message you should be telling someone with renal disease.
Dr. Laurie Marbas
(48:50)
And I will tell you personally, my mother-in-law had a kidney transplant. Gosh, it's been over 20 years now. Primarily eats a lot of fruits and veggies and she's done phenomenally well. I will just tell you, really think about the message and who it's coming from. Are they actually looking at the research and giving you the best message because you'll see endocrinologists tell people, “Oh, eat a low carb diet and not check your blood sugar. Don't worry about it.” Hey, just you're going to have to be on medications. This is what we do.
Dr. Laurie Marbas
(49:19)
And no, we're fueling the fire, so we need to stop fueling the fire with all these chronic diseases. Anyway, I hope that is helpful. You guys are credible as usual. Again, you can find us at plantbasedtelehealth.com. Please refer your friends, your family, we're here to help. You don't have to be fully plant-based, we meet you where you are. But we will be pushing you towards this healthy fiber rich diet, low calorie density diet to help you with your chronic disease. But Dr. Scheuer, Dr. Miller, do you have any other final thoughts?
Dr. Chris Miller
(49:56)
Thank you everyone for participating. Those were awesome questions. It really pushes us too to keep up with our research and the data and make sure that we're giving you guys accurate information. I appreciate all the knowledgeable people who are participating and keeping us on our toes, so hopefully helpful to you guys as well.
Dr. Kim Scheuer
(50:14)
And thank you Dr. Miller for all of the information on arthritis. That was awesome.
Dr. Laurie Marbas
(50:18)
Yes. Thank you. And I really want to echo what Chris is saying as well is because you guys totally keep me on my toes. I am constantly being sent articles and this and questions. I'm like, “Oh, man.” I'm constantly researching. It's made me a better person, a better provider, so thank you very much, a better physician. And I can't thank you enough for that. And you guys have a great day and we'll see you next Thursday at 12:30 mountain time, 2:30 Eastern time with the wonderful Dr. [inaudible 00:50:51]. Dean and Aisha are going to come speak to us. It's just super exciting, a special day for us. And we'll hope we see you there and you guys have a blessed weekend. Take care.
Dr. Chris Miller
(51:00)
Thanks. Bye everyone.
Dr. Kim Scheuer
(51:02)
Bye.
Recorded on 1.16.22