Reversing Diabetes with Dr. Mona Morstein: Rational Wellness Podcast 78
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Dr. Mona Morstein discusses how to overcome Diabetes with Dr. Ben Weitz.
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2:57 There are four or five main types of Diabetes:
- Type I is an autoimmune disease where a person’s own immune system attacks their pancreatic beta cells, and destroys it enough so that they cannot produce the insulin that the person needs to live.
- Type II is the most common type and it is due to insulin resistance.
- Type 1.5 is Latent Autoimmune Diabetes of the Adult (LADA), which is type I that happens in people over 35, say generally 35 to 60 is where we see people getting a less intense type of type I, but can lead to the need for insulin.
- Gestational Diabetes, which is when a nondiabetic woman enters pregnancy, and then becomes a type II diabetic, generally due to gaining too much weight during the pregnancy
- MODY, mature onset diabetes of youth, which is diabetes because of gene defects, like when the beta cell produces insulin, but lacks a good gene to secrete it, or a cell doesn’t genetically have a good receptor.
5:34 Type II diabetics if poorly controlled or poorly managed, the high blood sugars cause oxidative damage that can destroy their pancreatic beta cells and these patients end up needing insulin, like type I diabetics. And most diabetics are not properly controlled. 75% of type II diabetics do not get their HgA1c below 7 as recommended by the American Diabetic Association. And type I diabetics, if they end up injecting too much insulin in order to try to control their blood sugar–say 100 to 200 units a day–can develop insulin resistance like type II diabetics. Normally our bodies secrete between 30 and 40 units of insulin per day, so 100 units is a lot. The reason so many diabetics are poorly controlled is that we are only using a big pharma approach based around medications. We need to use diet, exercise and lifestyle approaches to control blood sugar. And most of the drugs do not directly affect insulin resistance, except for Metformin, which deals a little with insulin resistance. But Metformin’s main job is to decrease the liver’s production of glucose. The TZDs like Actos and Avandia were directly affecting insulin resistance, but they are not in broad usage because of all their side effects. The 2nd most common category of drugs for diabetes are the sulfonylureas, like Glyburide and Glipizide, which can cause weight gain, hypoglycemia, and they can aggravate insulin resistance. They also don’t significantly reduce the HgA1c. The DPP4s like Januvia lower the HgA1c at the highest dose say 0.5%, but a low carb diet can take someone who’s at 10 and lower them down to 6 in 3 months. There is no drug that can do what diet, exercise and lifestyle changes can do, what a Functional Medicine approach can do.
13:30 With type I Diabetes you have a gene that can turn on and give you type I Diabetes and then we have to look at what factors might turn this gene on. These could include gluten, dairy, vaccine, environmental toxins, family stress and nutrient deficiencies. Finland has the highest rate of type I Diabetes and they have done studies showing that giving newborns vitamin D and fish oils reduces the onset of type I. Celiac disease can lead to type I diabetes. Leaky gut seems to precede type I diabetes in many kids, so the gut is an important factor.
26:16 When it comes to type II Diabetes, eating refined sugar, refined grains, junk food, and fast food and lack of exercise are important causative factors. But Dr. Morstein also believes that saturated fat intake can play a role in worsening insulin resistance. If you are getting too much saturated fat without omega 3 fats to offset it, this will make diabetes worse. Here is a reference: Dietary fat, insulin sensitivity and the metabolic syndrome.
30:06 The lab testing that Dr. Morstein recommends for patients with diabetes include the following:
- Chem screen (liver, kidneys, etc.)
- Ferritin, which is the best early sign of fatty liver.
- Fasting glucose, HgA1c C-Peptide, which tells us how much insulin your pancreas can secrete, insulin (as long as they haven’t injected insulin)
- GlycoMark is a test that gives you a better idea of blood sugar control than HgA1c because it picks up blood glucose excursions better.
- HsCRP for inflammation
- Testosterone in guys.
- Red Blood Cell magnesium and zinc.
- Fibrinogen to see how clotty they are.
- Random Microalbuminurea through urine to pick up early, early liver damage
35:05 The best diet for Diabetes is the low carb diet and two of the most well known advocates for this are Dr. Richard Bernstein and Dr. Richard Feinman and here is a paper that they were among the authors of: Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. There is another approach that has evidence to show that it is also effective for diabetes, the Macrobiotic diet, which was demonstrated in the Ma-Pi2 study: The Macrobiotic Diet for Diabetes. Dr. Mornstein feels that for most patients, the low carb program will work better. She does think the low carb diet can include nuts and 30-40 grams per day of carbs, but no grains or legumes. She does not think you have to do keto, which is very, very low carb and harder to follow. Dr. Morstein thinks you can include some muffins or bread or pancakes made from almond flour. and she advocates including at least 5-10 grams of fiber powder to make up for the lack of fiber in a low carb diet.
40:34 Dr. Mornstein recommends not snacking between meals in contrast to some nutrition programs that advocate having a small meal or snack every 3 hours to maintain a stable blood sugar. The human organism easily has the capacity to not eat for 5 hours and that way you let your body rest from having to process foods. And this lets the liver and the digestive system rest.
46:00 Dr. Morstein recommends certain supplements for patients with diabetes, including a good multivitamin and mineral, like one that might require taking 6 capsules per day. Taking a one a day multi may be a waste if the nutrients are not found in therapeutic dosages. Dr. Morstein mentioned that she is big fan of fish oil and she is not a big fan of krill oil because each capsule contains fairly small levels of EPA and DHA, the active ingredients, such as a total of only 50 mg of EPA and DHA combined in a capsule. To get a therapeutic dosage of say 2000 mg of EPA and DHA would require taking 40 capsules per day. It’s a joke! Dr. Morstein designed a proprietary formula made by Priority One called Diamend that includes therapeutic levels of nutrients that can benefit diabetics, including Zinc, Chromium, Berberine, R-Apha Lipoic Acid, Gymnema extract, Benfotiamine, Bilberry, NAC, Green Tea Extract, Turmeric, and Vanadium (4 capsules taken after breakfast and 3 capsules taken after dinner). With respect to Lipoic acid, if you take R Lipoic acid you get twice the amount of the active ingredient than if you take just Lipoic acid, which is a combination of the R and the S isomers, but the S form is not active in the body. An elevated HgA1c is causing oxidative damage to the body, so taking the proper anti-oxidants can prevent some of this damage, such as R Lipoic acid and NAC that can provide antioxidant protection, reduce insulin resistance, and also support the liver. Berberine is a great herb that is comparable to Metformin and also supports the liver. Benfotiamine is the fat soluble form of thiamine (B1) which can prevent damage to the nerves, the kidneys, and the eyes, at a dosage of 450 mg per day. The Burmannii or Indonesian type of cinnamon is a helpful supplement that if taken in capsules at bedtime can help to lower their morning glucose at a dosage of 1000 mg per day. Fat cells in the stomach region can make tumor necrosis factor alpha that causes insulin resistance and curcumin can help to decrease the inflammation and help with insulin resistance. Curcumin can also help rpotect the brain and reduce the risk of developing Alzheimer’s. Gymnema sylvestre is Dr. Morstein’s favorite botanical and it has been shown to help the pancreas produce insulin again, and it also reduces cravings for sugar. If you are going to a holiday party, bring some gymnema sylvestre and swish some around in your mouth and it will reduce your craving for sweets.
Dr. Mona Morstein is a board-certified Naturopathic Doctor who is practicing Functional Medicine at the Arizona Integrative Medical Solutions with a focus on treating patients with obesity, diabetes, thyroid, hormonal imbalances, and gastrointestinal disorders like SIBO and IBS. She is the author of the best-selling book, Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type I and Type II Diabetes. She is the founder and executive director of the Low Carb Diabetes Association. Her website is Arizona Integrative Medical Solutions and Dr. Morstein is available for telemedicine.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Dr. Weitz: This is Doctor Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes, and YouTube, and sign up for my free ebook on my website by going to doctorweitz.com. Let’s get started on your road to better health.
Hello Rational Wellness podcasters thank you so much for joining me again today, Doctor Ben Weitz, here, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review, so more people can find our Rational Wellness Podcast. Our topic for today is diabetes and prediabetes, which are epidemic and increasing in the United States and around the world. 9.4% of adults in the US are diabetic, and in some states as many as 15%. This equates to about 30 million Americans with diabetes, and somewhere around 90 million with prediabetes, and these rates are climbing among children and teens.
One out of three Americans have diabetes or prediabetes, and 90% to 95% of these are type two diabetes, which are caused by diet and lifestyle. Rates are even higher among certain populations among American Indians, blacks, Hispanics, and Asians, and among whites. This paralleled by an increasing shocking rates of obesity and being overweight with about 70% of the US population being overweight or obese. Of course, these numbers are pretty much paralleled by the rest of the world especially as we spread our American lifestyle around the globe.
I’m happy to have Dr. Mona Morstein to join us today to give us some information. She’s a naturopathic doctor from Tempe, Arizona, who’s practicing functional medicine at Arizona Integrated Medical Solutions with a focus on treating patients with obesity, diabetes, hormonal imbalances, and gastrointestinal disorders like SIBO and IBS. She’s the author of the bestselling book, Master Your Diabetes: A Comprehensive Integrative Approach for Both Type I and Type II Diabetes. She’s also the founder and executive director of the Low Carb Diabetes Association. Mona, thank you so much for joining us today.
Dr. Morstein: Thanks very much. Ben, I really appreciate it.
Dr. Weitz: I’d like to begin the discussion by talking about the different types of diabetes, and the distinctions between these.
Dr. Morstein: Yeah. There’s kind of four or five main types, there is type II diabetes, which is the most common type is due to insulin resistance where usually early on at least for sure people can make insulin but their cells are no longer responding to the signals to take glucose in, and like you said there are a number of reasons the cells don’t respond. Obesity being one of them, but there are other factors involved, as well. Type I diabetes is an autoimmune disease where a person’s own immune system attacks their pancreatic beta cells, and destroys it enough so that they cannot produce the insulin that the person needs to live. There’s gestational diabetes, which a nondiabetic woman enters pregnancy, and then becomes a type II diabetic, generally due to gaining too much weight during the pregnancy. There’s MODY, a mature onset diabetes of youth, which is diabetes because of gene defects, like the beta cell produces insulin, but lacks a good gene to secrete it, or a cell doesn’t genetically have a good receptor. Then the last is type 1.5, Latent Autoimmune Diabetes of the Adult (LADA), which is type I that happens in people over 35, say generally 35 to 60 is where we see people getting a less intense type of type one, but they can still for sure lead to full need of insulin.
Dr. Weitz: Yeah. Type 1.5, right? I never heard of that, before.
Dr. Morstein: Yeah. Type 1.5. Yeah.
Dr. Weitz: Interesting. I think there’s some confusion among the general public, I’ve heard people discuss diabetes and say that type twos become type one-
Dr. Morstein: Yeah. Right. Yeah. We have a couple things. One, we have a lot of patients who are adults getting type two, very commonly misdiagnosed as type two, and there’s a very simple blood test that can be done. We do have some lean type two patients. You will see lean, so we have to make sure is it really type two, or do they have LADA. Now, the type two becoming type one, so if you are under poor care and/or are not making changes you need to reverse your type II, if you have bad control of your type II, the damage that these high blood sugars can cause over the years can affect the pancreas as well as eyes, kidneys, nerves, and heart, you know the blood vessels, and so people can kind of destroy their pancreatic beta cells and this oxidative damage from poorly controlled diabetes, and then as a type II need to be on insulin, like a type I.
Dr. Weitz: Right. Then type Is can also have concurrent type II, if they’re poorly controlled?
Dr. Morstein: Yes. I’ve seen type I’s coming into my office that are injecting a 100 or 200 units a day, so for a nondiabetic, say for not a lean, but a normal weight nondiabetic, so we make maybe around 30 to 40 units of insulin a day, for whatever we eat, or drink, or whatever. If you have someone walking in the door, and they’re injecting a 100 units a day to control their blood sugar, that’s going to cause insulin resistance. That’s way above the physiological norm of what the body is designed to have in it all the time, so you can get type Is that have insulin resistance. Now, a type I is going to develop insulin resistance when their blood sugars go over about 170 anyway, just high blood sugar can make them insulin resistant, so that is a part of it, but it’s not the core nature of their condition, which is the autoimmunity.
Dr. Weitz: Right. It’s amazing, though, the patients that I’ve seen how many are poorly controlled, the kids they really don’t want to prick their finger, they don’t want to test their blood sugar, it’s a pain, and the type II a lot of them are in denial, or just think everything’s okay, and they don’t want to test regularly, so I don’t know what the percentages are, but it seems like a lot are uncontrolled, or poorly controlled.
Dr. Morstein: I know the last statistics we really have in that regard, you know, from 2002 to 2006 where almost 75% or so of people couldn’t get below seven-
Dr. Weitz: Wow.
Dr. Morstein: Which is the ADA guide.
Dr. Weitz: On the hemoglobin A1C. Yeah.
Dr. Morstein: There’s a significant generally 50 to 60, to sometimes 70 depending upon the study do not obtain at least what they consider the three ADA goals, which is an A1C less than seven. LDL’s less than a 100, and blood pressure less than 130 over 70, so we have very bad goal reaching in our country, and a lot of it is of course due to the obvious, that it’s a big pharma based treatment, that it’s drugs, and those with type II there’s only one drug really that was designed to deal with insulin resistance, and that was the TZD’s, which because of a lot of problems with them have essentially gone off the market. I mean, you can use them, but-
Dr. Weitz: What drugs would those?
Dr. Morstein: Those were the Actos and Avandia type drugs.
Dr. Weitz: Okay.
Dr. Morstein: Right? Now, Metformin deals a little bit with insulin resistance, but it’s not it’s main job, which is to decrease livers production of glucose, so you have a disease of insulin resistance, and essentially no medications out of the huge list of medications that they give patients that actually deals with insulin resistance, they’re all just about clear the glucose out of the bloodstream, and the way they do that can actually cause quite a number of problems in patients.
Dr. Weitz: Why is that? I guess they’ve just been unable to develop a drug that controls insulin resistance.
Dr. Morstein: Yes, or that controls insulin resistance, but again you’ve got it also might cause this or that damage. Right?
Dr. Weitz: Right.
Dr. Morstein: Drugs have side effects, many of them, we’re lucky with Metformin that it’s just some gastrointestinal distress, and doesn’t really cause anything else. But some of these other drugs, the second most common one, the sulfonylurea’s, they cause weight gain, they can aggravate insulin resistance. They can cause hypoglycemia, significantly. They’re all just designed to clear the glucose-
Dr. Weitz: By the way, what drugs are included in the sulfonylurea?
Dr. Morstein: Sulfonyurea’s are like glyburide, which is the worst for causing hypoglycemia. Glyburide, Glipizide, so those kind of drugs, but they’re cheap. They’re going to be by conventional care, another drug to use, but they have problems. Right? Also, many of them don’t really significantly reduce the A1C’s very much, like the drugs like Januvia, the DPP fours, they may lower the blood, the A1C in three months at the highest dose of maybe 0.5% where a low carb diet could take someone who’s at 10 and lower them down to six in three months. The diet, and the lifestyle there’s no drug that equals the amount of improvement that just what we’re trying to do on this naturopathic, or functional level can do. Right?
Dr. Weitz: Right. But that word doesn’t seem to have gotten out.
Dr. Morstein: Yeah. Well, you know the ADA acknowledges there is a low carb diet, it’s not like they’re saying, everybody should be on it, and then now they’re approving bariatric surgery for people who can’t get their A1C’s under control, but they can’t just come out and say, hey, everybody, you guys, everybody, really just do the low carb diet.
Dr. Weitz: Right. Yeah. They’re still recommending whole grains, and a low fat diet.
Dr. Morstein: Well, you know, I went to the ADA site, and you know I will say there’s a lot of good things about the American Diabetes Association. For one thing, they devote a lot of money to research, and they have also, if you’re a fireman, and you’re a diabetic, or you’re in school, and you’re a diabetic patient they’ve paved the way for the rights, the civil rights, and the working rights that people with diabetes in our country. However, to become a sponsor in the ADA you have to drop at least a $100,000.00, that’s the lowest level.
Dr. Weitz: Wow.
Dr. Morstein: You know, who aside from drug companies can be supportive of the ADA? That’s their funding.
Dr. Weitz: Yeah. Let’s talk a little bit about type I diabetes.
Dr. Morstein: Yeah.
Dr. Weitz: What are some of the most common triggers? A lot of people have talked about milk products–dairy sensitivity–as being one of the triggers. Can you talk about that?
Dr. Morstein: Well, here’s the deal, obviously the number one cause of type I diabetes is you have a gene that can turn on and give you type I diabetes.
Dr. Weitz: Right.
Dr. Morstein: It starts from you just randomly got this gene. Then what might be factors turning on the gene? Well, you know I go through things with every patient, and there’re questions on vaccinations on gluten, on dairy, on environmental chemicals, on stress in the families, on nutrient deficiencies. The Fins, Finland, had the highest per capita onset of type I diabetes, and they’ve done studies where giving new born vitamin D and fish oils reduced the onset of type I in those populations compared to the kids that didn’t get those supplements. What is it individually that affects each child, who knows? We have a lot of kids drinking milk, and they’re not getting type I, so we can’t say, oh, my goodness. I will say this, I read a good article, a study saying that with, you know, for me, as I note in my book, if we could identify kids with celiac disease early on, right away, and we got them off of gluten their risk of developing type I would go down about to zero.
Dr. Weitz: Wow.
Dr. Morstein: We’ve got all these pediatricians giving them antibiotics of their ears, or vaccinations whatever, but we need to get them to screen every child who’s now eating gluten, because you have to be eating gluten, so toddlers, a two year old, right, test them for celiac disease before potentially it’s unknown and then we get kids developing type I diabetes since those two are so connected, but-
Dr. Weitz: By the way, what’s the proper test for celiac?
Dr. Morstein: The proper test with celiac in a child is you can do a stool sample for toddlers. Right? There’s also a blood test, a pediatric blood test, but people, you know, you have to be eating gluten every day, like equivalent of about a piece of bread for at least three to four weeks before the test, otherwise we can’t see if there’s celiac disease.
Dr. Weitz: Unless you do an intestinal biopsy.
Dr. Morstein: Well, they’re going to do that after the blood work.
Dr. Weitz: Right.
Dr. Morstein: Yeah. We’ve got a lot of kids, I see kids, they never had a vaccine, parents, they’re a very loving family, there was no stress, like a pet dying, or grandma, God forbid, they don’t spray environmental, they don’t have an exterminator come into their house, or outside, and you’re just like, why did this happen? We just don’t know. We can’t identify it on each individual.
Dr. Weitz: Right. I notice in your book you mention the A1 milk being more problematic than A2 milk?
Dr. Morstein: Yeah. I think most people understand, or not most people, but milk in America, that A1 milk is from cows that have a different amino acid basis to the protein molecule of milk, and that is more allergic in humans versus many other countries in the world use cows that make what’s called the A2 milk that has a different amino acid, it’s very less reactive. Our milk is why we certainly see many people have at least a cows milk sensitivity, which can be a lot of mucus, and sinus, and asthma, or it’s the number one food that causes GERD, reflux, even without mucus, it just goes right to the stomach. Those are from the allergy to the milk protein.
Lactose intolerance, you just can’t you just can’t digest the lactose, that would be A1 or A2, but in terms of allergic to milk, and there are some connections if you have that allergic to milk, there are some similar proteins on the pancreatic cells, so if the immune system is kind of attacking the milk, and it could get confused and maybe attack the similar proteins on the pancreas.
I do want to mention one thing, though, when we talk about food sensitivities, or just in general we’re talking about often times leaky gut, and what’s interesting with leaky gut is that when kids have diabetic antibodies, but are not yet showing the disease they pick up an upregulated Zonulin, they show leaky gut in these kids. Another reason people might get type I is a virus getting through the gut wall, and then attacking the pancreatic beta cells, and causing damage to them, so we look at the gut quite a lot, and if you’re getting into food sensitivities, we’re going to think your gut is unhealthy, as well, since it all comes from the gut, but leaky gut seems to precede type I diabetes in many kids.
Dr. Weitz: That’s interesting, because we heard about the research from Alessio Fasano, who talks about this triad of autoimmune disease where you have a leaky gut, and then you have gluten, and then you create this upregulated immune system and that sets up the potential for autoimmune disease.
Dr. Morstein: Yeah. Although, I will differ in one regard, I know there’s a very big anti-gluten, anti-dairy, but for those of us like myself who does a lot of food sensitivity testing, you know some people are sensitive to corn, and some to soy, and some to eggs, and some to almonds, and I think before we just pull everybody, and not everybody actually reacts to gluten. I really think that we should always strive to do very individual care with the food sensitivities and really see what does this patient, what does their body reacting to?
Dr. Weitz: One of the problems is these food sensitivity testing is so problematic. Sometimes you do a test, you seem to get reasonable results, and then you do a test and nothing comes up except clams, and some other bizarre food, which they’ve never eaten, and now you spent all this money for this test, and nothing comes up, or-
Dr. Morstein: I would say there are-
Dr. Weitz: Or you do a test and everything comes up.
Dr. Morstein: Everything coming up, obviously, is a-
Dr. Weitz: Leaky gut.
Dr. Morstein: Sign of leaky gut, but I think there’s a lot of labs doing food sensitivity, but I know the lab I use, I’ve flown out there, I visited their lab. I can verify the one I use for the last 16 years, which is Alletess Labs at foodallergy.com, they must have got that right at the beginning. I mean, I can verify their consistency with truly finding what people seem to be reactive to, and if people have a lot of foods, you know, the idea with food sensitivities you take them all out the first month, start healing their gut with the supplements, and then they come back in a month, then they should be significantly better, and then you can start adding the foods back in. Nobody has to be off all of these foods for a year, or two, or whatever. It’s an indication of something needs to be healed, but guts heal from leaky gut enormously quickly when the irritant is removed, because they’re so vascularized.
Dr. Weitz: Yeah.
Dr. Morstein: Yeah.
Dr. Weitz: I just want to point out, I just had a discussion with Cyrex where I had one of these tests come back where there was nothing tested, and they said, from now on we can include a total IGG with the test at no additional cost, and that way you can tell if the person’s immune system just isn’t working well, and they’re total IGG is suppressed then they can factor that in, and recalculate the results, and-
Dr. Morstein: I guess there’s also cheaper tests than Cyrex.
Dr. Weitz: You mentioned vaccines as triggers.
Dr. Morstein: Yeah.
Dr. Weitz: As possible triggers for type I diabetes
Dr. Morstein: Possible.
Dr. Weitz: And I noticed in your book you mentioned giving the kids some supplements to help with their immune system like you mentioned vitamin D, and echinacea, and milk thistle.
Dr. Morstein: Yeah. When I was in medical school we had a pediatrician come in and say, “Hey, when I have to give vaccinations I’m boosting their immune system a couple days before, during, a couple days after.” Then obviously it made great sense to us, because we don’t usually get exposed to viruses by injection, we breathe them in, and then it takes days for the process to happen, so it’s a little bit of a shock to the immune system. I think giving NAC, you know, there are kids that maybe can’t make glutathione, that might get, as well, they might get some nerve damage.
I do a product called Immugen from a company called Progena, because it’s glycerine, kids love it, it’s a great immune system booster, and D, and maybe some Liposomal, now, I give glutathione, because kids can’t really take, obviously, an NAC capsule, and it’s nasty flavor wise, so by giving some ways to support antioxidant status, immune status, it can really, I hope, seem to boost things in the kids, so they don’t have a really serious reaction against not only just against the vaccination, but the liver as just part of the excipients, but I have a good website where the CDC lists all the excipients in all of the vaccinations, and so-
Dr. Weitz: Yeah.
Dr. Morstein: That’s what we’re trying to have the liver clear better-
Dr. Weitz: Right.
Dr. Morstein: It’s that junk that it comes with, you know the virus that they’re injecting.
Dr. Weitz: Yeah. The World Health Organization actually recommends giving 200,000 IU’s of vitamin A prior to the MMR vaccine.
Dr. Morstein: Yeah. They came out 25 years ago saying they’re very much into 2,000 units of vitamin A, also for treatments, if someone has measles they said, “Hey, give them a 100,000 vitamin A,” as this huge immune booster. I’ve used that in many conditions in toddlers that were pretty sick. Of course, I do it maybe for three days, or four days, but vitamin A is cheap and the World Health Organization can use it in rural villages, it’s easy. It’s a huge immune booster. I would just give a clinical pearl, don’t give it all at one time, if it overwhelms the kid, they can have a really nasty headache, so you want to break it up into several doses throughout the day, and that should stave off the headache that can last for a few hours with acute elevated vitamin A.
Dr. Weitz: Yeah. I never liked the idea of giving one huge bolus, the same thing with the 20,000, or 50,000 injectable vitamin D, it seems to make so much more sense to give 5,000 or 10,000 a day over the course of a week than give them a 50,000 unit shot.
Dr. Morstein: Yeah. Shots are a little rough, anyway.
Dr. Weitz: Yeah.
Dr. Morstein: With vitamin D, it’s oily.
Dr. Weitz: Moving on to type II diabetes, and-
Dr. Morstein: Yeah.
Dr. Weitz: Mechanism for type two. Most of us are aware of the fact that eating sugar, and lack of exercise are some of the main factors, because we got this rising blood sugar, and insulin resistance, but I read in your book that you also said that increased saturated fat intake can play a role.
Dr. Morstein: Yeah. I mean, I know there’s a lot of ketogenic, and et cetera, Paleo people out there, but the science is pretty clear that if you are getting too many saturated fats and I believe it’s too many saturated fats unopposed by a good amount of omega three fats, so omega three fats lower insulin resistance. Saturated fat, if you’re getting too many they can absolutely worsen insulin resistance. The idea is not that you can’t eat saturated fats, but that we have got to make sure people are getting into their diet a balance of omega three oils, for sure. If you get even with meat, if you get grass fed, grass finished organic meat, half of that is essential fatty acids, but if you’re getting it, you know, you’re just lazy, or you’re going out to eat a lot, that’s feed rot meat, that has no omega threes, after 90 days of being fed grains, that meat has no omega threes left in it, so this can be throwing people off with their oil balance.
Dr. Weitz: Interesting. Yeah. It’s true with the Paleo movement, and the ketogenic movement there’s a big push for saying that saturated fat is perfectly fine, and a lot of people are sort of like, can it really be fine? Should we really have as much butter as you can consume? Then of course, there’s the fat with sugar problem. You know? That I think Mark Hyman calls sweet fat, which is that’s really a bad combination is when they’re eating junk food, and they’re getting the saturated fat with the high glycemic carb, sugar combination.
Dr. Morstein: Yeah. I mean, it’s certainly refined sugar, refined grains, junk food, fast food, but if you just want to overeat anything, gluttony, unfortunately is whatever you’re overeating to gain that abdominal fat is going to be a problem, and of course the problem with insulin resistance is once it sets in insulin is one of the hormones that tells your brain I’m full, I’m done, that’s enough, you know, that’s it, I don’t need to eat more, and you can get that insulin resistance in the brain can tell people I’m still hungry, I still want food.
It’s not lack of willpower, it’s literally our appetite is driven by chemicals and hormones, and when they’re thrown off we’re just not going to get signals that I’m done, that’s enough, walk away from the table. Once people get on a low carb diet in a week, they’re like, “Oh, my God, it’s easy. I can just eat a piece of fish, and this, I’m full,” because that can settle down in their brains very quickly through food when we get that under control. Whatever you’re overeating to become overweight, or drinking, of course, soda pop, you know, energy drinks, these sugary, sugary things they’re just really some of the worst. Right?
Dr. Weitz: Yeah. Even Gatorade-
Dr. Morstein: Yeah.
Dr. Weitz: And some of the things people think are healthy. When it comes to lab testing, what labs do you like to run for patients with either prediabetes, or diabetes?
Dr. Morstein: Obviously, people need to have their yearly with the liver, and kidney, and glucose, and the lipids, and their CBC. I always include ferritin, which is not standard on labs, not just ferritin, has three different roles in the body. One is storage of iron. Two, we store it when there’s a bacterial infection, a serious bacterial infection, and three is acute phase inflammatory marker, and if we have a type two who’s got elevated ferritin while you do maybe have to rule out a condition called, hemochromatosis, which is a genetic hyper absorption of iron from your food, mostly these people have fatty liver, and so we need to do an ultrasound of their liver, and we can pick up fatty liver. That really drives insulin resistance, and fatty liver is the number one chronic disease of the liver in our country, today, and can cause the same kind of fibrosis and cirrhosis that alcoholism does.
Dr. Weitz: And truly caused by sugar and high glycemic carb intake. Right?
Dr. Morstein: It’s just caused by too much fat, really, whatever caused the fat. It’s the abdominal fat will then go and get to the liver, and cause the liver to have now too much fat in its cells. Of course, an A1C, a C-peptide, so you can draw insulin to see how much insulin they make as long as they’ve never injected insulin. As soon as someone’s injected insulin, that you can’t measure it anymore, it’s an inaccurate reading, because as soon as you inject insulin you’ll make insulin antibodies, so C-peptide is the part of the insulin molecule that breaks away from it for it to actually form insulin, so they’re equal. There’s one C-peptide for one insulin, but we never make antibodies to C-peptide. That tells us what is your pancreas able to produce in terms of insulin. There’s another test called GlycoMark, which is a 1,5-AG substance that helps us look at excursions, and sometimes interpret the A1C better, because you can have an A1C at six, because you’re having lows all the time-
Dr. Weitz: By the way for those who don’t hemoglobin A1C is believed to be a three month indicator of blood glucose levels.
Dr. Morstein: Yes.
Dr. Weitz: Right?
Dr. Morstein: A1C is our monitor, how you’re doing longterm. It could the same number of A1C can be there if you’re under good control, or if you’re just going up and down all the time, so the GlycoMark can help us interpret that. I do vitamin D, we might need to check thyroid, we might need for guys, we might want to check their testosterone levels, there’s just maybe some red blood cell magnesium, red blood cell zinc, these can be low in people with diabetes. I would want to do an HsCRP, which is a monitor of inflammation that’s related to cardiac disease, and a fibrinogen to see how clotty they are, just because people with diabetes type II, well, if it’s not well controlled have a very high increased risk of dying of cardiovascular disease, which is basically what they usually die from. These are broad base labs that we’ll want to do.
Dr. Weitz: Cool. Do you include adiponectin and leptin in your labs?
Dr. Morstein: I don’t. I don’t do either of those.
Dr. Weitz: Okay.
Dr. Morstein: For one thing, leptin, you know there is a leptin resistance, or adiponectin, those are going to be fixed when fix their weight, so to measure them we don’t really have any specific ways, I feel, that’s really effective in that, and those will readjust once the insulin resistance is settled down.
Dr. Weitz: Cool.
Dr. Morstein: One other lab, the Random Microalbuminurea that’s a good urine test to pick up early, early liver damage, before it shows up in the lab work. No, I don’t measure those hormones.
Dr. Weitz: Okay. Cool. Let’s talk about treatment.
Dr. Morstein: Yeah.
Dr. Weitz: What type of diet is best for diabetics, and prediabetes?
Dr. Morstein: Doctor Richard Feynman and Doctor Bernstein, Richard Bernstein and 25 other physicians, or researchers came out with an article that was printed in Elsevier Journal on that a low carb diet is the premiere treatment for people with type two diabetes. https://www.sciencedirect.com/science/article/pii/S0899900714003323 Actually, other researchers just came out showing that type one diabetes pediatric patients were improved on a low carb diet, plus a thousand other studies. Now, you’ve got two, you do have the MaPi2 study, which show that people on a macrobiotic diet, that was higher carbs, but no animal fat at all, no real oils at all, actually was very significant in uncontrolled type two diabetic men at really reducing everything we wanted to have reduced. The Macrobiotic Diet for diabetes study. You get some people that are saying, you know, a plant based diet, higher carb, but for most people it’s got to be low carb.
In our society, honestly, people are going to thrive much better in our society, and be able to socialize and eat out, and on a low carb diet then they will on some macrobiotic diet. Now, the low carb can be what I call the omnivore low carb, where you eat some meat, and fish, and some organic soy, and you make things out of nut flours, and coconut, and eggs, just all around variety, you eat nuts, or there’s the keto aspect, which is very, very low carb, or there’s actually a vegan type of low carb, and then there’s an ovo-lacto vegetarian type of low carb.
Dr. Morstein: For my patients, in reality, most of them don’t want to do keto, and I don’t make them, and I don’t think you need to, but they do that 30 to 40 grams a day of carbs, which will work very well for almost everybody, but it gives them a little more food to eat, you know, almond muffins, or pancakes, and things that make life more enjoyable for most people eating low carb.
Dr. Weitz: Do you let them include any whole grains, or legumes?
Dr. Morstein: No. I don’t. No, the grains, you can’t, no, you can’t do any grains.
Dr. Weitz: What about legumes?
Dr. Morstein: Yeah. Legumes, no, you can’t, now, every now, and then I have a couple patients who are in really great control, and if they have a couple tablespoons of hummus, because there’s got oil in it, and it’s got the garlic in it, they say that a little hummus doesn’t bother them. Okay. No, beans and grains, and potatoes, and sweet [crosstalk 00:38:29]-
Dr. Weitz: Beans are so high in fiber. Right?
Dr. Morstein: Yeah.
Dr. Weitz: And their glycemic index is in the 20s.
Dr. Morstein: You would think with the beans it would work, but for my patients eating beans, you know, they’re going to go up now, they might come down just after an hour or two, say, but it’s tough. The beans are incredibly high in fiber, in fact that’s for a nondiabetic patient, I’m not an advocate of keto, or Paleo at all, and there are studies where these changes in the microbiome by not eating grains, or not eating beans in nondiabetic patients just as a general diet are devastating to the microbiome, because the microbiome, the beneficial bacteria eats fiber. When we take out these great sources of fiber, we change the bacteria, we start making less short chained fatty acids, and that’s not a good thing for colon cells, or even systemically. On a low carb diet I’m very adamant that my patients have to add fiber powder back in. If you’re on low carb, you’ve got to be getting at least five to 10 grams of fiber powder in a day to make up what we’re taking out, because vegetables just really won’t do it enough.
Dr. Weitz: Yeah. Of course, whole grains are also high in fiber, too, which that makes it harder to get the fiber.
Dr. Morstein: Yeah. I mean, for people that are nondiabetic to eat whole grains, and to eat beans I am an advocate of that, as well, for sure, but once you become a patient with diabetes they just can’t do it anymore, so at least with supplements we’ve got to replace both water soluble, and water insoluble that balance of fiber at least into the diet while having to eat healthy diet, or otherwise.
Dr. Weitz: I notice you recommend no snacking, and for years we’ve always recommended snacking, you don’t want to go to long, or your blood sugar will dip, so every two to three hours you have to have some food in your system to keep an even blood sugar, and that theory seems to be gone.
Dr. Morstein: I have from day one in medicine, which is about 30 years ago, I’ve always been an anti grazer, even for hypoglycemia you have to eat many meals throughout the day, that’s called enabling the condition-
Dr. Weitz: Yeah, but grazing is different than snacking, like say, here I’m going to have 12 almonds as a snack, or something at 3:00.
Dr. Morstein: I mean, if you just want a snack, but the question is that the human organism easily has the capacity to not eat for five hours. I eat a breakfast, and I go hike 10 miles without eating, that’s what the human organism can do. Right? This idea we cannot go from breakfast to lunch, and lunch to supper, and then from supper to breakfast, we can’t do that physiologically, this as just wrong, and so we want to at least in terms of intermittent fasting, at least from dinner to breakfast, at least 12 hours. Right?
Now, you want to go 16, whatever, there’re other ways to do intermittent fasting, but we have got to teach people that have trust in your body, eat a decent meal, and then don’t eat for five or six hours, and you’re going to be fine, and not only that, now you don’t have to think about eating, and now your adrenals aren’t stressed, and your liver isn’t stressed. You know what, I tell patients, when we’re measuring your heart rate, or excuse me when we’re measuring your blood pressure, the first number is when it’s feeding and the second number is when it’s at rest, and the second number is really the number we are really interested in. Right? Because that heart needs to rest, and you know what, your gut needs to rest, as well, it does not want to be digesting food all the time. You don’t want to be active all the time, you need your sleep, you need to rest. Think of your gut as any other part of your system that needs rest. Right? That means it doesn’t have to digest all the time. In fact, fasting is the healthiest a human can do to get over an illness, a chronic illness, that’s not eating at all, is putting your gut totally at rest. We just have to retrain people, and especially people who are injecting insulin, snacking, well, how are you going to, that’s going to screw up your insulin totally, so yeah, I’m a very big anti grazer, for everybody.
Dr. Weitz: You know, when it comes to intermittent fasting I just think it’s so ironic, because I’ve been involved with healthcare, and nutrition for 30 years, and I know when we got started the biggest thing was you have to eat breakfast, you have to eat within a certain period of time, everybody skipping breakfast, and they’re running out of the house, and that’s why they’re fat, because they eat too much at dinner, because they didn’t eat breakfast, and you have to eat breakfast, because that gets your metabolism going, so that was so important, and now the big trend is if you want to be healthy you got to skip breakfast.
Dr. Morstein: Well, not me-
Dr. Weitz: Okay.
Dr. Morstein: But that is for some. I eat breakfast. I’m breakfast, lunch, and supper. We have to learn, everybody
Dr. Weitz: A lot of people do the intermittent fasting
Dr. Morstein: Yeah, they do. I do fast from supper to breakfast, but I like breakfast.
Dr. Weitz: I’m with you on that. I prefer to skip dinner if I’m going to skip a meal. Right?
Dr. Morstein: I know. Here’s the deal, we have unfortunately, right now on planet earth we extremism all over the place with politics, and whatever, this, and that, and it’s certainly
Dr. Weitz: Planet Trump, now.
Dr. Morstein: Yeah. You know, it certainly entered into nutrition, too, and I think what we have to realize is that there isn’t one way that everybody is going to thrive eating, and so our jobs with Functional, Naturopathic medicine is what does this person need for their health? Me, I like breakfast, and I work better with it, but other people, especially if you have weight to lose, and so forth, doing a longer fast is great, and working out, where you don’t have food in you can burn more fat. If it works for them, and they can do it, I mean, these are good ways to consider, but we just have to not make rules that everybody has to eat this way, and unfortunately we get too many docs that say, “I eat this way, so now everybody has to eat this way,” and that’s the exact opposite of the beauty of say Functional Medicine where we’re supposed to be looking at each individual.
Dr. Weitz: Right. And individualizing the program
Dr. Morstein: Right.
Dr. Weitz: To their specific physiology, and their needs, and the way their body works.
Dr. Morstein: Exactly.
Dr. Weitz: For the final section, here, I’d like to talk about supplements that can be a benefit for patients with diabetes, or prediabetes.
Dr. Morstein: Yeah. Now, just to get out of the way, I have a proprietary formula called Diamend–
Dr. Weitz: Yeah.
Dr. Morstein: From Priority One, which I think is a really good product. It’s in one bottle, you get everything you need at therapeutic doses, but when we’re taking supplements, yeah, I mean, people with diabetes say everybody needs to me on a good multiple vitamin, and a good one, like maybe you’re taking six a day that gets in all of the basic nutrients, so we know that you’re getting in everything you need to have your body work well, and antioxidants, and nutrients that help your organs, your liver, your adrenals work better, and help you become less insulin resistant, which is zinc, and chromium, and vanadium, and so forth, and it’s just easy to get them in one good package.
Dr. Weitz: I know you mentioned therapeutic levels, and-
Dr. Morstein: Yeah.
Dr. Weitz: You talked in your book about how you can take some multi one a day vitamin-
Dr. Morstein: Oh, yeah.
Dr. Weitz: It has these ingredients that people are reading about in the latest news story, but they’re in trace levels that are going to be insignificant if you’re going to take a specific nutrient like chromium, or like cholic acid, or some of these others, it’s got to be a therapeutic level, or you’re kidding yourself.
Dr. Morstein: That’s an excellent point, and that’s why I think docs like us, because we can have patients bring their supplements in, we know how to read the label, see if it is a valid supplement, a good dose for what they need, or not, and like with fish oil, I’m not an advocate of krill oil. Right? Because when you see the amount of EPA and DHA
Dr. Weitz: Oh, it’s a joke.
Dr. Morstein: It’s a joke.
Dr. Weitz: I know.
Dr. Morstein: It’s a total joke.
Dr. Weitz: 24 milligrams of EPA, and 30 of DHA-
Dr. Morstein: Exactly. People have heard that it’s krill oil, so you’re paying twice as much for a useless therapeutic EPA/DHA product, so
Dr. Weitz: I know you’d have to take 20 of those capsules to get-
Dr. Morstein: Right.
Dr. Weitz: Two grams of EPA and DHA.
Dr. Morstein: Exactly. Thank you. Yeah. I am a big advocate of quality fish oils just like you said, and then there are supplements, you know diabetes damages oxidative damage. There’s several different pathways that happens through, but it’s oxidative damage, so we need supplements that help reduce insulin resistance, and that help protect the body, so that even if their A1C isn’t at 5.1, because an A1C over 5.5, and certainly over 6.0 is indicating by science it’s causing damage to the human body. That damage is oxidative. You’ve got some supplements like alpha lipoic acid, or NAC. they’re not just antioxidants, but they reduce insulin resistance. Right? They both help the liver, and most patients who are type two diabetic, and overweight have fatty liver. You can get some nutrients that really have a really big crossover benefit in several ways to the body. Right?
Dr. Weitz: By the way, in your book when you talked about lipoic acid, you mentioned something that I think most people are not aware of, which is that there’s a difference between lipoic acid, which is commonly seen on the market, and R-Alpha Lipoic acid. Can you talk about what the R four means and the difference?
Dr. Morstein: Right. There’s two different isomers, or chemical ways it presents Alpha Lipoic acid.
Dr. Weitz: We usually think of D and L forms, but-
Dr. Morstein: That’s with vitamin E-
Dr. Weitz: Oh, okay.
Dr. Morstein: Of course, certainly-
Dr. Weitz: Right.
Dr. Morstein: Yes, exactly D and L, and that’s with phenylalanine as well as a DL-
Dr. Weitz: Right.
Dr. Morstein: But in alpha lipoic acid there’s the R and the S isomer. The S isomer is not active in the body. In fact they say it may interfere a little bit with the R. Only the R isomer is active in the body, and if your bottle just says alpha lipoic acid, half of it is R, and half of it is S. About 20 years ago, companies figured out a way to make just R, and have it be stable, and so if you’ve got alpha lipoic acid, 600, only 300 of it is the R, if it says R alpha lipoic acid 600, you know, you’ve got a double effect, so we prefer just the R’s when we’re working with our patients. Of course, Berberine, right when
Dr. Weitz: By the way, what’s a therapeutic dosage for R, lipoic acid?
Dr. Morstein: I would say orally if you’re getting around 600 milligrams a day, there’s a very, very rare side effect I’ve only seen in two patients in 30 years, which is it can burn the stomach, but I mean for literally the hundreds, and hundreds of thousands of people that I’ve put on Alpha Lipoic acid it’s very rare. But you certainly can’t open the molecule and drink it down, it’s an acid, so it does have to be swallowed in a capsule. Little kids can’t take it until they can swallow a capsule.
Dr. Weitz: Okay. I’m sorry, keep going.
Dr. Morstein: No, I’m just saying we mentioned Berberine-
Dr. Weitz: Yeah.
Dr. Morstein: Had that great study comparing it to Metformin.
Dr. Weitz: Right.
Dr. Morstein: We like Berberine, it can upset some stomachs, but if you give a 1,000 or 1500 most people can handle that. Also, a very good liver herb as well. That’s another good product to consider.
Dr. Weitz: Okay.
Dr. Morstein: We’ve got the blueberry, bilberries for the eyes. Green tea extract was shown to help the pancreas. There’s little
Dr. Weitz: You got benfotiamine which is the fat soluble form of B1
Dr. Morstein: Yes. Benfotiamine, very excellent, shown in studies for nerve damage, kidney damage, eye damage, and of course that, and the endothelial lining are the four areas where diabetes has its most effects, because those cells cannot prevent glucose from entering them. Insulin resistance does not affect those cells, so if your blood sugar is 300 your eyeballs are 300, and your kidney is 300, and your nerves are 300, and your endothelial lining, your blood vessels, so this is why those degenerate so commonly in people with diabetes, but benfotiamine around the max doses around 450 milligrams a day, very good safe, safe product. Ironically, we usually think fat solubles are harder to absorb than water solubles, but with benfotiamine it’s actually better absorbed than water soluble thiamine.
Dr. Weitz: Cool. In your book, you also talk about L-carnosine.
Dr. Morstein: Yeah.
Dr. Weitz: Which can reduce glycosylation.
Dr. Morstein: Yeah, I actually don’t use it too much.
Dr. Weitz: Okay.
Dr. Morstein: Yes. I learned about that from another physician years ago, and there are some studies supporting that, but to me also vitamin E might be able to do that, I just think if we’re getting the person under better control then that should lower, and it does, the glycosylation throughout their body. We think of it as the A1C, but it can also, fat and protein, it’s a fat and protein reaction, the maillard reaction, and that can happen in joints, and tendons, people with diabetes can get more into injuries of frozen shoulders when their blood sugars and A1C’s are higher, because that’s happening throughout their body, not just on their red blood cells where we can measure the A1C.
Dr. Weitz: How about cinnamon?
Dr. Morstein: Yes. Cinnamon. There’s a type of cinnamon that was shown in studies to help lower blood sugars. Some people
Dr. Weitz: Which type of cinnamon is that?
Dr. Morstein: The Burmannii type of cinnamon. It tastes good, and it’s good in the fall when it’s getting cold. Cinnamon is another. Some patients take cinnamon, like some capsules at bedtime, and they say it can help lower their morning glucose, so it’s a pretty benign substance, it’s a 1,000 milligrams, they did studies on a 1,000, 3,000, 6,000, but even the 1,000 might be beneficial, or just using it as a spice on your food. Curcumin of course, as an anti-inflammatory, we do know that the tummy fat makes tumor necrosis factor alpha, it makes Interleukins, these can go to cells that cause insulin resistance, and so decreasing inflammation via fish oils, and curcumin can all be helpful to patients. Also, we do know the association with Alzheimer’s in people who have had poorly controlled diabetes, and curcumin has been shown to help reduce the risk of Alzheimer’s, so there was a good study in India that people eating more curcumin have less risk of developing Alzheimer’s, so again, and it’s also a good herb for the liver, so these things, again, have really good crossover for our patients.
Dr. Weitz: You talk about fiber and the need for fiber. What do you think about some of the resistant starch supplements on the market, and they have medical foods with resistant starches?
Dr. Morstein: Yeah. I mean, you know I’ve tried those and never really saw they did too much, and historically there were bars that were given to kids at night time to prevent them from having lows during the night, but kids on insulin don’t have to have lows during the night if they’re on a low carb diet. I mean it’s not like, I mean in conventional care eating whatever you want and covering it with insulin is the axium of treatment, and that’s going to cause all kind of highs and lows, but in terms of did I see real clinical benefits to resistant starch, I honestly didn’t, and if people are just eating correctly, that’s going to work for so many people. I mention it in the book as people think about it, I haven’t seen it clinically that helpful addition.
Dr. Weitz: You also mentioned the herb gymnema sylvestre.
Dr. Morstein: Yeah. I should have mentioned that earlier.
Dr. Weitz: Yeah.
Dr. Morstein: Gymnema sylvestre is my favorite botanical. There’s that and bitter melon as kind of two, but I love gymnema sylvestre, the studies have used 400 milligrams, but with some patients I’ve gone up to 2,000 or 2400. Gymnema sylvestre has been shown to help the pancreas produce insulin again, and it also reduces cravings for sugar. In a tincture form, it’s pretty amazing, that if you put a tincture of gymnema sylvestre in your mouth, and swish it around for a minute and then swallow it you can’t taste anything sweet, it’s disgusting. You can’t eat it. For some patients that are still working, you know, the holiday times, and going to parties I’ll give them a little one ounce bottle and say, “Just take this before you go to the party, then try to eat that cookie,” you’re not going to spit it out, because-
Dr. Weitz: Wow.
Dr. Morstein: It’s just going to be nothing in your mouth, and it’s really an amazing way to go, it just numbs the sweet taste for about an hour, or hour and a half.
Dr. Weitz: That’s great.
Dr. Morstein: Yeah.
Dr. Weitz: That’s a great hint. I know we both have patients, and we got to go, so let’s make this a wrap here. For listeners who want to get a hold of you, what’s the best way for them to contact you, and to get a hold of your book?
Dr. Morstein: Yeah. My book, the short name is Master Your Diabetes, it’s up on Amazon, Doctor Morstein, M-O-R-S-T-E-I-N, Master Your Diabetes, and my website is drmonamorstein, M-O-R-S-T-E-I-N, and from there I’m in Tempe, Arizona. I do telemedicine, as well. Check out my website, and give a call if you are interested.
Dr. Weitz: That’s great. Doctor Morstein, thank you so much for this interview.
Dr. Morstein: Thank you very much, Doctor Weitz …
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