Jay Feldman  0:05  
Are you curious about the optimal diet and supplements for brain injuries, the impacts of drinking alcohol, and whether you should be concerned about fructose, digestion and absorption? We'll be digging into all of these topics today in this episode of the energy balance podcast, a Podcast where we explore health and nutrition from the bioenergetic view and teach you how to maximize your cellular energy, to maximize your health in today's episode, in particular, we'll be going over how fructose gets absorbed and whether it's really a FODMAP. We'll be talking about whether you need to be concerned about excess fructose in foods. We'll also go over whether you should avoid sugar and supplement fish oil for brain inflammation, as well as diet and supplement suggestions for brain injuries and also the impacts of drinking alcohol from the bioenergetic view. As always. To check out the show notes for today's episode, where we'll link to the studies and articles and anything else that we reference, you can head over to Jay Feldman wellness.com/podcast, and with that, let's get started.

All right, so our first question is from Garrett, and he says you mentioned that fructose is much better absorbed alongside glucose. So I'm wondering, if I can balance the glucose to fructose ratio by adding a bit of white rice to my higher fructose fruit. Would this also make the fruit not high FODMAP? So this is a great question. There's a lot of detailed things to get into here, as far as how fructose gets absorbed in the intestines, whether we need to be concerned about it feeding bacteria, and being concerned about it as a FODMAP, as it potentially can be, depending on how well we're absorbing it, it can then go on to feed bacteria. So we'll discuss that, and also how you can determine if you need to be concerned about this in the fruits that you're eating based on the fructose to glucose ratio. And we'll also talk about why the typical categorization here of the fruits or foods that are excessively high in fructose isn't necessarily relevant, and there are some pretty significant issues there and disagreements we have in terms of some of the application of this. So we'll be talking about all of that, but as a starting place, we first just need to discuss how fructose actually gets absorbed in the intestines, because that will then inform how we can best absorb it and make sure that it's not being under undigested and then heading on to or unabsorbed, and then heading on to feed bacteria. So Mike, why don't you start us off with that?

Mike  2:32  
Sure. So I guess the first thing to understand is how fructose is actually absorbed in the intestine. And so there's two major transporters that control the absorption of fructose in the intestine. It's actually a bit different than the absorption of glucose. So the major transporter of fructose in the intestine is GLUT5. So this is a receptor that takes fructose up from the lumen of the intestine and brings it into the intestinal cell. And then there's also GLUT2, which is seen with kind of like a co transport with glucose that brings fructose again into the intestinal cell and then also the glue to moves the fructose from the intestinal cell into portal circulation. So you have these little receptors on the cells, or these little kind of transporters on the cells that take up the carbohydrates and move them across the intestine. Now, some things keep in mind here is that the the amount of these transporters and their functions are not stagnant overall. So basically, when you're exposed to higher fructose intakes, your ability to fructose, to absorb fructose, actually increases due to an increased expression of these different transporters and things along these lines. So basically, when you first start having fructose, you're not having a lot of fructose in your diet. When you when you increase it a bit, the amount that you'll absorb will increase over time due to changes in these these transporters. At the same time, if there's a lot of intestinal inflammation and damage going on, you can also have a negative impact on the ability to actually uptake these carbohydrates due to adjustments and intestinal function related to some of the effects on these transporters. So the state of the intestine and the substrate that's being put into the intestine determine how well the intestines able to absorb certain substrate, like fructose. And fructose is a little bit different than glucose, because in a large proportion of people, the ability to absorb fructose is actually can be a bit impaired, and without having adequate amounts of glucose present. So if you don't have adequate amounts of glucose present. Their ideal ratio is one to one glucose of fructose. And now when you start to get over that, when you start to have more fructose over glucose, so the ratio becomes in favor of fructose, that's where you start to see people have issues. But there's a wide range of tolerance. Some people five grams of fructose is a problem over glucose, and other people, it's upwards of 50 or more, 50 or more grams of fructose in a sitting so there's also this inter in individual variance in response to fructose. Overall there's and so there's a lot of moving parts going on for myself personally, the way I like to determine with clients how this works is, you know, I'm not trying to do a test to measure their GLUT5 receptor activity. It's more just how much like you have foods that have higher or lower fructose, and you see if you have a negative response to them or not, you want to make sure that it is like a fructose component, because that'll talk about some of the high fructose containing foods that people tend to have issues with also have FODMAPs. And so with that said, you want to make sure it's not the FODMAPs like a sugar alcohol, like sorbitol, that we would see in apples or versus the fructose itself. And so to this answer, this question specifically, can you add a bit of glucose in the form of maybe dextrose or white rice to other foods that are higher in fructose, and it will help to improve intestinal absorption of fructose, I think so, especially if your tolerance for it is low. You're one of the people close to that five grams of fructose over glucose. But at the same time, if the problem is not fructose related, if it's more of an issue of a FODMAP, like a like a sugar alcohol, like sorbitol, or lactose, or whatever, the lactose wouldn't count, but it's more of a function of one of these FODMAPs, then the adding sugar or adding glucose wouldn't necessarily help that. It's just in the case of fructose, that's why it's important to understand with the different foods, what type of fermentable fibers they have in them as well. The other thing I want to mention here is the major problem that I see with fructose malabsorption, especially so with fruits. I think this is less of an issue because of the polyphenol compounds and fibers present. Bonnie, just when we look at the studies and you do a bunch of free fructose feeding, or you have high sources of free fructose that doesn't have a lot of polyphenol components and fibers, then the bacteria in the gut with the free fructose feeding, can start to produce endotoxin, and this starts to create inflammatory responses and issues overall. So that's kind of the that would be my rundown on fructose specifically.

Jay Feldman  7:12  
Yeah, and when you're talking about the free fructose, in that latter context, you're talking about excessive free fructose over the amount of glucose present, right?

Mike  7:20  
Well, I'm saying even if they are just to feed them pure fructose, because that's what happens in the studies. Is like, here's a 75 gram bolus of pure fructose in like, in a solution, and let's just see how it goes. And it's like, it's probably going to go bad for the vast majority of people, when you look at the fructose malabsorption studies, and then to then try to understand what's going on metabolically, without understanding that piece is pretty questionable, because it's like, you're not this is not about absorption now. This is about, how are you dealing with endotoxin and malabsorption of fructose in these, in the different studies?

Jay Feldman  8:00  
Right. Right. Exactly. And that's pretty much never going to be a good thing. And so that's what even led to like is one of the main things that have led us to talk about this previously is looking at the sugar and fructose research in the vast majority of time, whether it's for rats or humans, they're giving free pure fructose way in excess of glucose, or sometimes with zero glucose, as you said, and then this is a question of just purely feeding bacteria endotoxin production and the impacts of that, rather than it having anything to do with fructose. And so that's what you know, has led to, I think, the question of that's being asked here, because, as we've said, You need to have glucose alongside the fructose to absorb it. And so just to get into that in a little bit of detail, as you said, there are two primary receptors that help to transport fructose in the intestines. There's a GLUT5 and a GLUT2. The GLUT5 is always there, and it just transports fructose. And it's a pretty low capacity relative to the GLUT2, which has a much higher capacity for transporting fructose, and the GLUT2 receptor is basically recruited when a different receptor, the sglt one receptor, is active and is transporting glucose. So that's what leads to that is why having the glucose alongside the fructose helps. Basically, it is it increases the activity of an sglt one transporter, which then helps to recruit the GLUT2 transporter, which allows for increased fructose absorption. And this is important, right? This is why feeding excess fructose can be an issue. But as you were saying, the amount of excess fructose that is an issue will vary considerably, right? Could be as little as five grams on the much worse side, or as high as over 50 grams on the other side. And it's going to vary, as you said, based on gut health, you know, bacterial issues, General, inflammatory state, thyroid function, metabolism, all of that. And so that then when we're looking at specific foods, we need to consider all these things, right? We need to consider our particular tolerance. As you said, testing is generally the best way to identify that. But the problem with testing, as you said, is most of these foods that have excess fructose don't only have excess fructose. They have other potentially fermentable carbohydrates as well. And a good way to test it would be exactly what Garrett was saying, which is, you bring in some extra glucose alongside it and see if that helps with the digestion symptoms that you're getting, let's say, from an apple. If it does help, then we know, in our case, it was an excess fructose issue and a fructose malabsorption issue. If it doesn't help, then we know some other fermentable carbohydrate or some other aspect of the food that was causing the digestive issue. So that's kind of the big picture concept here. It's also worth mentioning that. So having the glucose to fructose in a one to one ratio is almost always enough to fully prevent any fructose malabsorption. But the there's actually like you can get away with a bit more than that. So the because of the way that the recruitment happens, you can get away. Let's say if you have 25 grams of glucose and a little bit extra fructose, let's say 30 or 35 grams, that is often better than just having the five to 10 grams of free fructose with zero glucose. There's a little the glucose helps in more than a one to one ratio. But again, it's really hard to identify because of the way that the studies are done. There's so much different variability in the different protocols and the people that are being looked at, and there's just such variation there, which is why you have a range of anywhere from five to over 50 grams of free fructose before it becomes an issue. So a lot of variables here, but it's also worth considering that if you're eating something that maybe it has five to 10 grams of free of excess free fructose when you're having, you know, 60 grams of carbs, that might not be an issue, even if you have an issue with five to 10 grams of pure fructose. Although also, how would you even know that? Unless you were just trying pure free fructose, which almost no one does. So just different kind of intricacies here that are worth considering and but it is worth again mentioning here that having some glucose is very helpful. And so that then brings us to the question of, is this an issue with different foods that we might be eating? And normally, when it comes to the fructose to glucose ratio, this is one of the biggest issues I have. I mean, when it comes to the general idea of FODMAPs, it's a great idea, but in practice, I think there's a lot of or in application, I think there's a lot of missteps, and this is one of them. A lot of times when looking at the fructose to glucose ratio, only free fructose and free glucose are considered, and the other carbohydrates, like sucrose, are not considered. And that makes a huge difference, because, and we'll get into this with something like a mango, which has a lot of sucrose and much less free glucose and free fructose. If you just look at the three values, you're going to have a ratio of fructose to glucose of almost three. But if you add in the 50% glucose and 50% fructose that you're getting from the sucrose, you then have a ratio that's just over one. It's like 1.3 almost 1.4. And so, that's something that's really important to consider when you're looking at the carbohydrate composition of the foods, that you don't only consider the amount of free glucose and free fructose, but also the amount of glucose and fructose that are in the sucrose that can be in the foods. So that's one thing that's important to consider. And with that in mind, when it comes to fruits, there are really only a few that have a pretty high glucos to glucose ratio when Sucrose is considered, and this would be pears, apples, watermelon and mango, but there's a pretty huge variation between them. So when we're looking at apples and pears, the fructose to glucose ratio all carbs considered ends up being around two and a half. And so just one apple or just one pair could be enough to get your five grams of excess fructose, which, if you are compromised, gut wise, could be an issue if you're not compromised. And as you're saying, Mike, you're used to consuming carbs like you normally consume carbs, including fructose or even just glucose, you're going to be better at absorbing it, and five grams of free fructose probably won't even be an issue. But if you are sensitive, just one apple, just one pair could be enough. When it comes to watermelon and mango, the ratios are the fructose to glucose ratios are about, you know, 1.3 to 1.5 so nowhere near as as significant as apples and pears, but enough that if you're having a pretty decent amount of carbs from those things, you could get, you know, five to 10 grams of excess fructose, but it would really require, you know, if you're trying to get 10 grams of excess fructose, you would need over 50 grams of net carbs from watermelon and over 65 from Mango. So we're talking about pretty high amounts of carbs here, net carbs, in order to actually get to a level of excess free fructose where it's an issue. So if we're sensitive, we might want to keep an eye on those types of fruits. If we're not sensitive, then it probably won't be an issue for you. So that's something that's really important when we're talking about any food, any like, Yeah, any sort of carbohydrate or other type of food that can cause digestive issues when we're compromised. And when it comes to choosing foods, creating a diet. With that in mind, I've created the energy balance food guide to help you determine exactly what types of foods will work well if you're compromised in terms of your digestion, and if you're not, what kinds of foods will work well in terms of supporting your metabolism and allowing you to improve sleep, hormones, digestion, increased energy, all those types of things, basically the energy balance Food Guide. It's a one page infographic, and it organizes foods on a spectrum based on how effectively they support your metabolism. And it has a separate spectrum that adjusts the scale in the case that you are dealing with digestive issues, like the ones that we're referring to. So you can head over to Jay Feldman wellness.com/guide to download that free energy balance Food Guide. And that leads me to just one other food that I wanted to mention to consider when it comes to a high fructose to glucose ratio, and that's agave, agave syrup. And Agave is often used as a sweetener because it's very low glycemic, and it's low glycemic because it's really, really high in fructose, but it's really easy, especially because it's used as a sweetener to have excess fructose when you're consuming agave. And I've seen that in people, especially who are already having digestive issues, that then they consume something that's sweetened with it, or they see it, and they're like, oh, that's low glycemic. And so it must be healthy, and it causes a lot of digestive issues. So that's definitely one to be aware of when it comes to the fructose to glucose ratio.

Mike  16:24  
Yeah, a couple things I want to add specifically. Is that even if you don't have a problem with the excess free fructose, for watermelon, mango, pear and apple, the fo other FODMAPs in them, so fructans, which are like chains of fructose, like fructoligosaturides, or something like inulin, and then also the sugar alcohols are still a pretty big concern for a lot of people who have digestive issues. And so even if it's not a fructose issue, it could specifically be a FODMAP issue. And people who are dealing with digestive problems like you have, you know, bloating, gas, IBS, SIBO, things like this, those fruits are still going to be an issue, even if you don't have an issue specifically with fructose. And also, people coming out of a low carb diet, they're coming from carnivore, they're coming from keto, they're coming from low carb paleo will still likely have problems with those foods because of the FODMAPs. And also, for those people, there's, there's a transition coming out of those diets where gut function has to upregulate to deal with carbohydrates versus the fats, and probably shift the microbiome and the colon and all of these different components, and also have the liver kind of adjust and the body adjust metabolically to the carbohydrate. So you may find initially that you will have a negative effect with some of these, especially the ones that you mentioned, Jay, agave, syrup, pear, apple, watermelon, what was the other one? Mango, Mango. So you'll see the effects with those foods. But over time, as you expand the dietary sources you tolerate, you get to tolerate carbohydrates a bit better. You'll probably find that your tolerance will increase, and the amounts that you may be able to have will increase. But if it doesn't, you may, like, some people just don't do well with certain FODMAPs. Like, there's quite a few people I work with where it's like, mango is just not going to be a good option in large quantities, because every time they have it, they get bloating and gas. And so you may be able to have some. But there's also the point that you may not be able to, you may never really be able to tolerate it super well. And again, that's because of the FODMAP. And that's not necessarily. That doesn't necessarily mean you have a gut dysbiosis, or that your intestines are impaired, or that you have IBS. It's just that you don't do all those FODMAPs. You're the microbiome is creating symptoms for you, and there's nothing. There's not really anything specific to do about that, unless you want to start playing around the microbiome and see if that makes a difference. But for a lot of people that I've worked with, in my experience, I haven't seen people tolerate some of these foods super well in the long run. And that's not even a fructose problem, it's a FODMAP problem. So I think it's when looking at these things is always important to understand context, like, where are you at right now? And then also your individual variability in response to different foods. And this plays out as well with other foods. As an example, I can tolerate, for example, broccoli, fine, which does have FODMAPs. I don't get bloating and gas from it, but I get pretty bad bloating and gas from something like yams. And the FODMAP content and fiber is very different, and then the microbiome interacts with it in a different way. So these are all important things to understand with this overall.

Jay Feldman  19:28  
Totally, and that's, I think, part of what falls short with the simplified, kind of low FODMAP approach. I mean, even the just the fact that fructose is universally considered to be a FODMAP, which I think is something we need to be careful with, just like we're describing like it takes a pretty decent amount of these foods to get any excess fructose that is normally known to cause an issue. So same with lactose, that's another one on there where our ability to to digest and break down lactose can vary considerably and improve as our gut health improves, thyroid health improves, can also improve based on what we're consuming with the lactose. So having sugar with the lactose actually helps us break it down and absorb it. So there's so many things like that to consider that we don't want to have some sort of rigid idea around those sorts of carbohydrates being an issue. And as you were saying, Mike, as well, there's a ton of other types of FODMAPs that may or may not be causing an issue. So yeah, those would all be things I'd be thinking about, things I would consider and again, coming back to the question, just to wrap up trying a bit of glucose, whether it's dextrose or white rice alongside the foods, would help to rule out whether or not is a fructose issue, and help you identify if it is maybe a different FOB map that you're struggling with. The other thing I wanted to mention there is there are certain things that are not considered when it comes to FODMAPs that may potentially be FODMAPs depending on your digestive capacity, and starch is one of those, you may or may not effectively break down starch. And there's different types of starches, and we've talked about this before, amylose, amylopectin, we talked about resistant starches in a recent episode that I'll link back to. And so that's a whole other area that we would also need to consider. And so again, there can be complexity here. It can definitely, I guess, it requires the nuance and understanding of these things in order to effectively make the changes and tweaks so that you can identify what sorts of foods might be feeding bacteria and causing issues for you.

Mike  21:22  
Yeah, I think that the implementation there, too, just to wrap up, is get yourself down to a relatively baseline setup that minimizes a lot of problematic foods, and then instead of kind of ideologically cutting things out, oh, it has FODMAPs. Oh, it has, oh, it has, you know, casein. Oh, it has salicylates. Oh, it has oxalates. Give the some of the things a test to see how you respond to them. Because the other problem that I think people run into is when you start to set up your diet and you create all these theoretical kind of boundaries around what you can and can't eat, what you wind up running into. And we see this all the time, like we were having a conversation last night about endothelial dysfunction, and it's like, well, glucose increases it, and it's like, and then fructose doesn't, but then fatty acids do as well, and it's like, so you don't like, what do you eat? And so that's, I think, the problem that people run into with the with all this stuff, is, well, I can't eat salicylates, I can't eat oxalates, I can't eat FODMAPs, I can't have carbs, I can't have saturated fat, I can't have polyunsaturated fat. So it's like, you just get protein and monos left, and it's like, well, then you can't have protein because mTOR and so I think with a lot of this stuff is like, the theories are interesting to think about, and they're helpful to be used as a guide, but you want to really be putting this into practice and testing out how you respond to these different components, and structuring the diet from there. Because if you get too caught in the theory and ideology, then what winds up happening is you can put your paint yourself into a box that you you don't have any sustainability, or very or sustainability, or the ability to actually implement the diet effectively, because there's just too many rules that some of them are actually relatively arbitrary. And so for me, I see this all I get asked by clients all the time. It's like, well, this person says that I can't eat this. And it's like, well, how do you do with it? It's like, Well, I do pretty well, and I feel good when I eat it. Okay. Is it? Is it corn oil? No, okay. Is it, is it a bunch of, like, really terrible processed foods with industrial additives. No. It's like, oh, sweet potatoes. Oh yeah, I do. I really enjoy them. And I do well, it's like, okay, well, if you're not having problems with them, you're tolerating them. You like them. Maybe they have beta carotene and the low vitamin A people will say, that's terrible. And maybe the they have oxalates, and the oxalate people will say, that's terrible, but you're doing well that it's, it's part of your diet. It you're you have it all set up, then run with it. It should work fine where we should be able to eat some of these foods. It doesn't only have to be two steaks a day with salt and water.

Jay Feldman  23:50  
Yeah, obviously trying not to get on too many tangents with each of those different possible avenues opened up, but it's I think so what you mentioned, in a bigger picture sense, is when we get stuck with rigid rules and a yes and no kind of black and white sort of perspective, that is what can cause us to run into trouble, as opposed to listening to ourselves, identifying how we feel and building a deeper understanding of why or whether or in what circumstances, these things could be an issue. In this case, we're focusing on fructose. Same thing could be talked about in terms of anything from, you know, as you were saying, beta carotene or oxalates or anything else. There are different things, metabolically different pathways that could leave us susceptible to these causing issues. We can work on those and improve those so that they're no longer issues or much less likely to be issues. There's so many details and things that are important to understand if we are going to get into the physiology that allow for the nuance. And so we want to be careful about just getting that surface level information of this thing could be a problem and not understanding the context around it, because then we lead to what could be a very restrictive diet. And that's not only an issue from the psychological side and the enjoyment side, but it can be a major issue from the health side. Like we are remove, we don't want to just remove things, just in case they could be an issue, because then you will miss out on a lot of really beneficial things. So yeah, it's, word of caution,

Mike  25:15  
and you won't be able to eat, you won't be able to eat because you you're like, you have all of these structure and that for half the battle, for me, working with a client is like trying to expand some of the options. And so you start at a diet that's like an elimination diet, but it's like, it's you still have fruits, you still have cooked veg, you still have starches, of you tolerating them. You still have dairy if you're tolerating it. And then you kind of like, expand from there based on how you're feeling and what you respond to. And so you're only starting at this one place, just so that you can get, like, an objective perspective on where you're at. Then you bring things, you open things up from there, so that you can see what your personal tolerances are. And the other thing is, you and I will, we could talk about all these theories, and they're great, and they can be guiding principles for you to understand why you're not responding well to something. But at the end of the day, the ultimate arbiter of whether or not something's going to be incorporated in your diet or not is going to be your response, how you're feeling, how you're functioning. And with these guiding principles in mind, but you also it's not just the theories. It's a it's like the practice and the theories together, and you're moving back and forth between them. You're moving back and forth between the map and the territory, instead of just relying on the map or just relying on the territory. So you want to kind of use both. That's, I think, the best way to go about it, and that's how you get the most effective response. Because there's so many things that we don't even know in terms of how they interact, between microbiome, hormones, genetics, inflammatory signaling compounds, neurotransmitters, that these, all these environmental factors. So it's there's a lot of pieces moving simultaneously, and we're still figuring all this out as like a society, both myself and and Jay as well. So it's like, it we can only we need to rely on like what we're seeing in practice, because we there are blind spots in the theories that that haven't been uncovered yet. And so, yeah, that's, I don't want to go too much further on a tangent, because I know I took us on a tangent, but I think that's important to understand with this stuff, because I see that as a big hang up with a lot of people that I'm working with on a regular basis.

Jay Feldman  27:19  
Yeah, yeah, definitely. And we'll, we'll leave it at that, and maybe link back to some prior episodes where we've talked about experimentation and the value of our experience. I'm sure there's been quite a few of those. So we'll link back to those longer discussions, and let's move on to the next question. You want to read this one off? Mike, sure. So

Mike  27:39  
Lexi says my eight year old has had two concussions, and now we are pursuing a PANDAS/PANS diagnosis. Regardless of the diagnosis, we are seeing many symptoms showing neurological dysfunction. Pretty much everyone and everything I'm reading is saying to go on an anti inflammatory diet, cut out all sugar and caps and use fish oil to lessen all the inflammation. The one doctors says in his book, it must be fish oil and no other animal oil, like emu, because only fish can penetrate the blood brain barrier. I've been a close follower of metabolic health for several years now, and I feel really confused. Any advice, if not going off sugar, what can I What can I do, diet wise, to help the obvious brain inflammation. What can I do instead of fish oil? This the common narrative for helping children neurological differences, or, I think maybe dysfunction, and it saddens me, so I don't know if you want to jump in on that one, Jay and start us off with how to actually manage like, cognitive dysfunction or neurologic dysfunction after a brain injury?

Jay Feldman  28:42  
Yeah, I think we'll definitely talk about that. Maybe we'll even just start with this idea of the anti inflammatory diet, right? This is something that we won't go too far down this path, but something that's talked about a lot, and we have the typical cut out sugar, often cut out dairy. In this case, we're talking about also adding lots of fish oil and omega threes. And I would, I mean, we've talked a lot about sugar and carbohydrates, so I won't go too far down the path of why they're not inherently inflammatory. And instead, I would say largely the opposite, right, carbohydrates, including sources of sugar like fruits and honey and maple syrup and even some granulated sugar are incredibly beneficial and anti inflammatory when we're using them well and in decent amounts and a balanced diet, all of the caveats, of course, that we've made historically and so I don't think it's a good characterization of an anti inflammatory diet. An anti inflammatory diet would include carbohydrates, including good quality sugar sources. And on the Omega 3 side, it's a side that we would want to be really careful, especially when we're talking about brain health, and especially when we're talking about injury and states with high amounts of inflammation, damage and oxidative stress, because that's when, I mean there's.

That kind of reactive state is always going on in any cell, in any tissue, because there's a lot of I mean, we're very active metabolically. We have a high body temperature, so there's always potential for damage and whatnot. But if you're in a highly oxidatively damaging state, we want to be even more careful. And we talked about this in a number of different episodes, talking about the Omega 3s. But the Omega threes are more susceptible to damage and oxidation, lipid peroxidation, than any other fat that exists that we can consume, and we want to be really careful about that. We don't want to be having high amounts of damaged, oxidized omega threes in our brain. That's something that we see in various degenerative states when we're talking like Alzheimer's and Parkinson's and all sorts of other issues, areas where situations where you have damage in the brain, you see damaged omega threes and providing more omega threes to a state like that is, I would say, dangerous. I guess. I mean, it's, it's just adding something really flammable to a fire. I mean, a fire that is already there in this case, let alone a case where there's lots of sparks to begin with. But yeah, so I think we've talked about this a lot. We've talked through studies showing that the Omega 3 consumption causes lipid peroxidation just through the digestion, even just when they're staying on the shelves, typically, there's already peroxidation that's gone on happens in our digestive systems, and then once it's absorbed, it happens as well, like we see increased levels of peroxidation as a result of the consumption of the Omega 3s. And we cited tons of studies and pathways describing this, some that are really, really well established, like the pathway of how omega 3s lower cholesterol production through lipoproteins in the liver. How it lowers LDL is basically by causing oxidative stress. And so, yeah, it's pretty clear there. And with that in mind, I would

Speaker 1  31:59  
I would have caution about the idea of using omega 3s or fish oil in a situation like this.

Speaker 1  32:06  
Which then brings us to the question of what, how do we actually create an anti inflammatory state in the brain, or anywhere? And in general, the answer there is going to be providing ATP, a low reactive oxygen species production generally, or at least a high ATP, high carbon dioxide environment, and one where we're effectively producing energy. That's how we heal, that's how we repair. That's how we keep inflammation down. Inflammation is basically just a signal that is saying there is damage here, and we need to activate our backup repair systems to try to resolve the damage that's going on to try to resolve the energy deficiency that's existing. That energy deficiency can occur due to an impact, due to injury, or due to a metabolic issue, or any number of other things. And so what we want to do is maximize the metabolic state, which would involve avoiding things like the Omega threes and making sure to consume good sugar sources. And there was a number of supplements that we could use, and other interventions that we can use that would help with metabolism in general and specifically in the brain. And so those would be ones to want to focus on. And so this would be things like

Jay Feldman  33:14  
some of the protective steroid hormones, like progesterone and pregnenolone, which can have a lot of benefits in the brain. Can also increase the production of allopregnanolone, which has a lot of benefits in the brain, and progesterone, specifically, has been shown to be extremely protective and allow for repair and regeneration after brain injury. So those would be things that would be on my radar. I'd be thinking about something like methylene blue, which has also been shown to protect the brain against injury or after injury, and allow for repair regeneration. I would also be thinking about something like carbon dioxide, ways that we can increase it, and we've talked about this in previous episodes, so I'll link to those. This could be different breathing techniques, like potato breathing or bag breathing. And it could also be trying to create, like high carbon dioxide environments, which would all be things I'd be considering here. And other things I'd be thinking about would be when it comes to healing and regeneration, something like red light, which, again, there's so many details there, but that's something I would consider and look into. And then there's also when it comes to our metabolism and effectively producing energy. The B vitamins are incredibly important. So I'd be considering a number of different B vitamins, but more specifically, there's a form of vitamin b1, that more effectively crosses the blood brain barrier, that's called alithiamine. And so that's what I'd be considering as well.

Mike  34:36  
Yeah, yeah. In terms of the the anti inflammatory diet and the Omega 3s, I think with the Omega 3s, one of the main mechanisms by which they're working through is blocking the inflammatory enzymes, so cyclooxygenase and lipoxyoxygenase, and then also shifting eicosanoid metabolism. So the icosinoids are the inflammatory mediators and. And so you can do this without having to use a highly lipidperoxidizable fatty acid. And a lot of this stuff is centered around polyphenolic plant compounds, which block cycloxygenase, block lipoxy oxygenase. They also shift what's going on with these inflammatory mediators, and they block some of the major inflammatory pathways in the body, like nuclear factor Kappa Beta. So these are things like incorporating fruits and some of the vegetables in the diet, which you would see in the anti inflammatory diet, except they wouldn't have fruits. But I think the fruit is extremely important in the sugars, as you mentioned, because the the number one, the fruits have very potent and important plant compounds, and the sugars are important in providing energy substrate for the brain to produce that ATP. And when you have a brain injury, what winds up happening is, when you damage that tissue, you get these areas of swelling in the brain. And it's like the water in that area becomes unstructured because the damage, because the metabolism has been impaired and so fixing that, providing the carbohydrate, providing the lowering the inflammatory state, with some of the polyphenol plant compounds, and also providing the vitamins and minerals. So those things can work effectively, like thiamine, so that you can use the carbohydrates in the mitochondria, the particularly the fat soluble thyme. These things are extremely helpful in this point in time. And then so that the focus on my end would be shift towards, you know, have the carbohydrates, have the fruits, have some of the juices, especially for an eight year old kid, let them have some of these things. Make sure they have a decent nutrient density in the diet and things along these lines. And then if you still want to hedge and you're really concerned about the Omega 3s, incorporate seafood in the diet, shrimp, mussels, some clams, if you have oysters here and there, if you have scallops, if you have some fish in the diet, incorporate like, like, cod, sole, flounder, et cetera. Incorporate those because, number one, they're going to provide vitamins and minerals that are going to be lacking from the diet otherwise, so things like iodine and selenium. So those things would be important. That will be important for lowering ROS because the Selenium is involved in the enzymes that produce glutathione, which is one of the major antioxidants in the body that will help to control reactive oxygen species in the brain. In that damaged area, you get a good protein source, and then you also whether or not the the mega threes in the fish are super beneficial, the them being rancid, like super rancid and peroxidized, is probably going to be less of a concern than like, taking fish oil caps, which is very likely to be already rancid, even though the digestive process may adjust and create some rancidity or lipid peroxidation for the Omega 3s. So I would still, regardless of the stance, I would always hedge with seafood over the Omega 3s that you're purchasing on the shelf, because of the peroxidizability and because the fish itself has benefits that I think are beyond what's going on with the Omega 3s. So I'd incorporate the seafood in the diet. The other thing, the other can but so we have, we have carbs, we have some seafood. We have the plant compounds. The carbs be the fruit sources, and we have the different plant compounds that would come from those. I'll talk about some specific ones. But then the other thing that we want to do is the they say no carbs at all in this anti inflammatory diet, because you want to get ketones in because ketones have all this benefit. And it's like, okay, incorporate some coconut oil in the diet, or, if you really like, incorporate some MCT oil in the diet, and you'll get some ketones without having to drop all the carbohydrate content. And again, the insulin signaling in the carbohydrate content is extremely important. Provide NADPH for glutathione production as well, which is going to help control the reactive oxygen species. So an anti inflammatory diet could include some seafood that types that I mentioned, some fruit sources and some juice sources, maybe some starch sources that work well. And it also can include some things like the different plant compounds, and then maybe some coconut oil or some NCT oil in the diet, if you if you wanted to still get some of the benefits in these other areas, and still incorporate the benefits within components that we are talking about now, with that said, with the with the brain injury element, like for a child as well, for an eight year old, Like red light is a low hanging fruit option, because you don't have to worry about the supplements and all this type of stuff. And, like, oh, the narrow steroids in a kid. What's the effect? We don't have all the research on it, so you can do the diet plus the red light component. And I think those things would be super helpful with, like, very, very low risk for a child in the circumstance now, somebody like an adult who has brain injury, the things that you mentioned Jay are great. There's a variety of options that have either preclinical studies or clinical studies showing benefits. So we have things like vitamin d3 vitamin E and vitamin C to lower the reactive oxygen species, help protect against lipid peroxidation, you have the B vitamins, you have the amino acids glycine and taurine. Then you also have something like CDP-choline, or acetylcholine, which has been shown to help with brain injuries. I think in clinical studies, we have methylene blue to help improve metabolism, which will actually synergize with the red light and will also synergize with the thiamine, because the methylene blue will be the electron acceptor in the mitochondria. The thiamine will increase pruvate dehydrogenase to allow carbs to go in. And then red light will help with the water structuring process, and also help with cytochrome c oxidase function inside the mitochondria as well. So essentially, they will synergize together have like, pretty significant benefits. And then you have the neural steroids that you talked about, Jay progesterone and pregnenolone. And then in terms of some of the polyphenol compounds, some options here as well would be something like pykenogenol, curcumin, boswellia. These will all block cyclooxygenase and lipoxy oxygenase and have microbiome modulating effects to lower endotoxin, things like this as well. So they would be beneficial to help control the inflammation, and some of them have even been tested in brain injury models and animals, and I think some of them have even been looked at in humans. The last one I'll mention briefly is some i This hasn't been tested in the TBI models, but there are certain compounds. This is the most benign. The other ones are a little bit more experimental. I'm not going to bring those up, but you can use something like like Lion's Mane to possibly increase BDNF a little bit after brain derived neuro traffic growth factor after brain injury, to see if that can help move the needle as well with the recovery process. So there's a variety of options available besides just fish oil. And as a side note, when I was working in a brain injury unit in the hospital, and I was a neuro unit, but I was seeing patients who had gotten pretty severe brain injuries get fish oil pills on a regular basis. So it is a thing. They are using them in certain ICUs. But overall, I think that there's a bunch of other strategies that I consider. And for a child, I would situate the diet very like, really dial in the diet, because I think that's going to be one of the lowest hanging fruit, safest options available. And also incorporate the red light and then the supplements. You have to really weigh the risk with a child, so an eight year old and not fully developed, you don't know how some of these things will affect but I think the frame that we're coming out with the sups is more so for an adult, for an older individual with a brain injury, where there's not really a worry about the effects of these things on development or something like that. And again, these are all relatively safe. It's just kind of like we had to had that disclaimer has to be there. So just things to consider overall.

Jay Feldman  42:34  
Yeah, I wouldn't rule out the usage of any of these things based on age, but I would just make sure that someone does their due diligence before implanting anything like that. And of course, we are not recommending that they are used without regard for that, but I think they would still all be on the table. They would still be on my radar.

Mike  42:53  
Yeah, the progesterone specifically, as there's some really interesting studies where it shows, like after acute brain injuries, it really helps with brain swelling, which is one of the biggest problems, because you have a skull that has a limited volume, and you can't really fit much more into it. So when you have the brain injury, you start to swell. That's where you you start to see serious issues. And I think this the just the pressure alone can create problems inside the brain tissue. And so you having something that helps with that is super, super useful overall. And progesterone is one of the things that they were looking at for that definitely, yeah, definitely, two other things I just wanted to come back to.

Jay Feldman  43:33  
So, I think you mentioned the ketones, and I would say one of the most important things here, when we're talking about having the brain in a good anti inflammatory state, is having enough fuel to produce energy with, and that is going to be glucose, unless ketones are provided. And shifting into a ketogenic diet will lead to periods of time with a lack of fuel available for the brain. And in order for the brain to get just the amount of fuel that it needs. We need to rely on constant ketone and glucose production, which is, I would say, a much more suboptimal situation than providing adequate amounts dietarily, so, if you wanted to make sure that we were getting any possible benefit of ketones, and you wanted to add in, as you said, coconut oil, MCT oil or exogenous ketones, I think there would be no negatives to that, but I would say there would be potential negatives to avoiding carbohydrates. So that would be the approach that I would take there and talking about the Omega 3s. I think in this case, we're better off without trying to consume them, or like without consuming any amounts beyond what we would get in a normal, healthy diet. And so if you're consuming some seafood, of course, you'll get some it's still unless you're consuming the very high PUFA seafood, like, you know, salmon, you're still not going to be getting very much omega 3s from, you know, shrimp and oysters. There's a bit, but not much if you're trying. So I think if you were trying to get considerable doses, if you're trying to get multiple grams of omega 3s in a day, and you're debating between fish oil and fish, I guess I would say maybe fish is a tad better. But I really think we're talking about the same beast here. And I that's not an approach that I would take. And again, if you're yeah, so it's like, if you're trying to get half a gram or a gram a day, you're probably going to get that anyway from consuming good quality seafood and meat and dairy anyway. So I would caution against trying to get large amounts. I don't think that makes sense. I don't think that's a good idea.

Mike  45:36  
I don't even think, I think that, again, like the mechanisms that they're seeing, the effects for that is through changes in nicosinoid pathways and then shifts in the inflammatory mediators. So it's like, you can if you were just like, so say you came from the perspective that maybe there's this really small requirement for DHA, deoxy hexadecanoe acid. It's like, okay, you're going to want to have high quality seafood in a diet anyway, in terms of the things that we mentioned. So okay, have those sources. There's benefits to them beyond the like, whatever amount of DHA they contain, but to like, super dose omega 3s, probably not an ideal circumstance, especially if the mechanism you're looking for is to shift in inflammatory mediators that can be achieved in other ways without the lipid peroxidation risk that we would see from some of the Omega 3 content. So I think the best strategy overall is, yeah, incorporate, like the seafood options that we mentioned, and I would look towards some of the plant compounds and things like this to modulate the inflammatory pathways without necessarily driving a risk of lipid peroxidation from from high dose fish oil as a also, this is like a little bit tangential, but I used to have to open up the fish oil pills when I had patients who were in comas because they would have feeding tubes, and I'd have to put it in the feeding tube. And the smell of those fish oil pills was absolutely terrible, like one, and even these are, like the special, like ethylester fish oil. It's like, it's disgusting, so disgusting you got it on anything like it would smell for days, like fish in the room. And it's like, definitely, yeah. I don't know if it wasn't in a pill. I don't know if anybody would take it, yeah, yeah. It's pretty bad. I wanted to say also when it comes to, you know, COX inhibitors and and reducing the production of the inflammatory eicosanoids, aspirin is normally something that is really helpful here, normally would be top of the list. We do need to be careful with it in any sort of acute brain injury because of the bleeding risk. So that's something to be aware of, but if the injury is not acute, depending on the stage, depending on what's going on, it might be something that I would have on the radar as well. Yeah, yeah.

Jay Feldman  47:50  
Okay, all right, so moving on to the last question here. Got a question from Deb, who says that she would love it if we would do a podcast about drinking alcohol from the bioenergetic view. So we talked a bit about alcohol and the fatty liver series, which we talked about a lot of other things there as well. Obviously, that's a pretty extensive series. We'll just talk about a few of the clearest concerns when it comes to alcohol, just kind of talk through those briefly. And we'll also talk about strategies, things that you can do if you are going to drink alcohol to mitigate the negative effects. But as we'll kind of get to I think it's a situation where less is better in general. So if you can avoid it entirely, that's best. But if you're not going to do that, then here are some strategies that you could try to help mitigate any negative effects. So the main concerns that, I would say were concerned that that there are when it comes to consuming alcohol, I would say there's kind of two categories. On one hand, we have the effects on the gut, and on the other hand, we have the effects at the liver. And so when it comes to the gut effects, one thing that's been shown pretty universally is increases in intestinal permeability, pretty significant ones. However, it's worth mentioning that this requires a pretty decent dose of alcohol in most of the studies to create that effect. Of course, there could be lower amounts of intestinal permeability With lower amounts of alcohol consumption, so it's worth considering. But yeah, so that's one concern. The other is a shift in terms of the microbiome where, again, in large enough amounts, it's been shown to increase the growth of harmful bacteria, increased fungal growth, reduced microbial diversity, all sorts of things that are associated with basically negative outcomes in terms of gut microbiome, and it's also been shown to directly increase endotoxin production and increase nitric oxide, also both things that we've talked about quite a few times in The past, being harmful. So basically, that's one main area where alcohol can cause its effects, and we talked about this in the fatty liver series. But if you provide antibiotics when providing alcohol to the rats, it really mitigates a lot of the damage done by alcohol. We aren't going to suggest that you take an antibiotic every time you drink. But there are other things that could try that will help mitigate the gut effects that are maybe not quite so extreme as that, that don't come with some of the possible negatives. So that's on the gut side. And then there are some direct negative effects at the liver, when it comes to alcohol. And we see basically clear increases in oxidative stress. We see interference with the metabolic state where there's a reduced NAD plus to NADH ratio, there's ATP depletion, and there's also the production of harmful intermediates like aldehydes, and these contribute to the damage and oxidative stress and whatnot. And so that's the other area that we want to be concerned and if in a number of the studies, when they look at the presence of PUFA, or the consumption of PUFA versus saturated fats alongside the alcohol. If you are consuming the PUFA with alcohol, it has way worse outcomes versus consuming the saturated fat, which is very, very protective against the negative effects of PUFA. And we've gone through some of these studies before by Nanji in that fatty liver series and elsewhere, so I'll link to those episodes. But So those would be kind of the main concerns we have when it comes to alcohol, and for each of these concerns, there's different things that we can do to help mitigate the effects. Before I get to that, I'll let you jump in Mike with any other possible negative effects from alcohol, or feel free to jump in with some ways and strategies to mitigate the negative effects.

Mike  51:14  
Yeah, I think I agree with the major effects of alcohol, right? So you have the depletion of ATP, you have the hypoxia that it produces, and then you have the acetyl aldehyde. And I think that the biggest problem is really the endotoxin. Because you see the studies where you have the germ free mice, and they get fed alcohol, and they don't go to cirrhosis, but then you give them some bacteria in the gut, and it's like, now we're getting cirrhosis, so you just kind of get a fatty liver normally, with just alcohol by itself, and so I think endotoxin is underrated as one of the biggest problems with the alcohol consumption. The other thing is that I want to just mention here is that the chronic up regulation of oxidative stress, then acetyl aldehyde, and the lack of ATP and damage to the liver actually drives damage to DNA, which drives liver cancer over the long term with alcohol consumption. So I think the number one strategy across the board with alcohol is just avoid. If you test if it's in your supplement for a tincture or whatever, fine, but like to like drink on a regular basis, I would just avoid. The other thing I would say is, a lot of people say, Oh, well, red wine has all this benefit and yada yada polyphenols. And it's like, yeah, the polyphenols from grapes are great, but just have, like, you can have purple grape juice too, or you can have pomegranate juice, or things like this. So I would shift into those. And the other thing I'd mentioned with the alcohol component is that if you are using alcohol for its GABAergic and dopaminergic properties, there are other things that you can do. So you can make a concoction with something like a grape juice and a pomegranate juice, and then add things like taurine and glycine and l theanine and maybe some herbal compounds like Valerian and lemon balm and skullcap that will calm you down, help you relax at the end of a hard day, and all have health benefits without blowing your liver up and causing a variety of intestinal issues over the long term. And the other thing alcohol is really good at doing is depleting minerals and vitamins, like smashing your magnesium levels down and then also lowering B vitamins pretty significantly. When I was working in the ICU, every person, depending on when I was in Albuquerque, it was like tons of alcoholics coming in on a regular basis, having to, like, withdraw from alcohol, or, like being in liver failure, or things like this. And the protocol was always they need magnesium, they need thiamine. They're going to need banana bags, which is a bunch of B vitamins called Banana bags, because the B vitamins turning yellow. And so we're giving them banana bags. We're giving them fluids, we're giving them potassium, we're giving them magnesium, and then we're giving them benzos to help them, like things like Ativan to help them from deep to not, like, have seizures and stuff when they detox off the alcohol and get bad tremors and really high heart rates and things like this. And so it's that depletes a ton of vitamins and minerals, and over the long term, this is pretty bad for other organ systems as well. Another common thing that people don't know about alcohol is that it drastically up regulates iron storage and absorption. And so I've had a couple people who were carnivore, and they had some alcohol while they were carnivore, and then they came with pretty significant iron overload that we then had to troubleshoot that. So I would be very careful, especially if you have any risk of hemochromatosis, of drinking on a regular basis and consuming lots of meat, because your risk for iron overload is going to go up pretty high, especially as a man. So these are things I think are important context to understand. In terms of dealing with alcohol, there's the acute effects of it, like, how do you deal with it acutely? And in the long term, effects of rehabbing the liver in the intestine and so acutely, there's some things that are super helpful, like, if you're going to drink, because some a lot of people, it's a social thing, I get it, then the option to do is, number one, I would say, have fruit and some type of saturated fat source before you drink. So you could have some berries and some chocolate with a glass of juice. So I would do something like that, because the fiber polyphenols protect the microbiome, the saturated fats from the chocolate will help to protect the liver, as well as the polyphenol compounds and things like this. And then the other thing I would do is I would have collagen and whey protein. The collagen is going to provide amino acids to protect the intestinal lining, and then the collagen, plus the whey are going to provide the amino acids glycine, glutamate and cysteine that will make glutathione, which is like one of the major important components to make in the liver to deal with the reactive oxygen species of alcohol. And alcohol can deplete glutathione. The other thing is to recycle it. You would want to have things like vitamin E and vitamin C. Another thing that could be helpful is while you're drinking, or, you know, around the time that you're drinking, magnesium and a little bit of calcium can be helpful as well, to protect the stomach from the irritation. And then if you had like a zinc carnosine or something like this, this would also help to protect the and rebuild the stomach lining and intestinal lining from the ulceration that alcohol causes. The last couple of things I'd mention is glycine, taurine and B vitamins would be very helpful to help the liver to metabolize the alcohol directly. And then there's two compounds. One is called metadoxine, and the other one is called dihydromursidin, and they can help with the metabolization of alcohol when you when you drink, to help the body, like process it much faster overall. So these are the strategies I put in place, even acutely. But long term, it's the same thing. And another one that'd be important long term would be adequate amounts of something like choline to help manage the fatty liver that alcohol provide. So maybe, like a phosphatidylcholine or CDP choline, something like this, in conjunction with B vitamins, mag, the the vitamins and minerals to basically replete the nutrients that have been depleted with the alcohol. So this is a huge stack. The number one downside of this stack is that you will have a hard time getting drunk, especially if you use metadoxine B vitamins, the sugar and then also the dihydromursidin. So I would, you know, I would say number one strategy across the board. Do not like just avoid drinking as much as possible. There's these. Are some options, if you're going to drink a small amount socially, or whatever the thing is, and then long if you're like, dealing with chronic alcoholism or something like this. These would be strategies that I would start to put on board, like pretty quickly, as soon as you think, even while you're drinking and when you stop drinking in the meantime, to help get the system recover. Because again, multiple areas get destroyed, nutrient deficiencies, gut degradation, liver degradation, oxidative stress, all this type of stuff, microbiome disruption. It's like, pretty negative overall,

Jay Feldman  57:45  
Yeah. The other negative with that stack is you have to bring your whole supplement cabinet with you, or to the bar or business event.

Mike  57:52  
Ideally you're like, you would do this stuff the day before, like the morning before, you could get some of these things on board. The metadoxine and the dihydromursidin would be, like, the strategies to do there with and then, like, having some fruit and some chocolate, so, like, those be the things that you had that time. But everything else would kind of be just around, like, before or after the person had the alcohol.

Jay Feldman  58:13  
Well, and if you're gonna go to that length of, like, using those compounds to degrade the alcohol and whatnot, Why drink in the first place, like, that's, you know, like, just get something that looks like a drink, right? Get like a sparkling water or something, and what at that point, what's difference between those two things? So, yeah, a couple of things to that I wanted to come back to to kind of wrap up, and then kind of with that last comment. The first is the the idea of needing to drink, I think is obviously an aspect of culture in mostly the Western world, but also kind of elsewhere as well, and one that just because it exists doesn't mean we need to go along with it. We talked a lot about culture. We had a few episodes about it, and our thoughts on it and different considerations, and so I'll just link back to those. I think this would just fit in there, right? And obviously a lot of things we do for our health are directly in opposition with what is normal, common considered to be maybe healthy, quote, unquote, in the culture, just because letting loose is considered to be healthy doesn't mean it actually is. Just because, you know, there's, there's all the different iterations there. So I think it would just challenge that if we're, if you are someone who is drinking for those reasons, maybe that's something we want to reconsider. Just think about in a little bit more detail. The other side, and you allude to this too, is using it as a coping mechanism for stress or issues and relationships for other maybe mental health struggles. And there's a place for band aids. If we're going to use a band aid, I would way prefer to use one that doesn't have these sorts of negative effects. But if we if this is our band aid of choice for one reason or another, we obviously want that to be as temporary as possible, right, and that we actually work on those underlying issues, so we don't need to rely on it as a coping mechanism. So that's obviously a much larger conversation. And and would depend on what specific reason we're using it, but those are really important when it comes to alcohol use. And then just a couple other things to mention when it comes to things to consider in terms of mitigating the effects. So both so fructose and you mentioned, you know, carbohydrates and fructose alongside it, fructose is able to double the clearance of alcohol. So that's something that you could get pretty excessively and and use. Another one is taurine, as you said, which also improves alcohol clearance and detoxification. So get an easier one to acquire and use. As you mentioned, saturated fats are also very protective here. They can protect against the gut effects and the liver injury effects. So something that, again, if we're generally consuming them, should be there. And B vitamins are a great one, as you mentioned. The last thing, which I don't think you mentioned, was activated charcoal. That's something you could use later on, like after the consumption of alcohol. If you use it with the alcohol, it'll prevent its absorption, which you could do. We could also take it later on, and still, even after it's absorbed, help to protect against some of those gut effects. So that would be something I would consider as well here. But oh, and the last thing, when it comes to like the long term issues here, we're talking about healing up a liver that's damaged, inflamed, potentially fatty, all of that. And I would take a look at all of the recommendations and strategies we mentioned in the nfld podcast series. We spend a lot of time going into the mechanisms, pathways of what's going on in those states. But also, at the end, we spend a lot of time talking about supplements and diet and other things to incorporate for long term liver health. And you know, in the state that we're chronically we have chronically damaged the liver. So yeah, and all great points there. You mentioned, you know, nutrient deficiencies, things like that, which I think are important to consider. And you also mentioned, I think the most important thing here, which is that less is more, and if we can avoid it, that would typically be the best option.

So we'll wrap up there. Mike, can you share with the audience where they can find you

Mike  1:02:08  
Sure? So they can find me@mikefave.com and also at my YouTube channel, Mike, fave,

Jay Feldman  1:02:16  
awesome, awesome. All right. Well, hope you guys enjoyed that episode. If you did, please leave a like or comment if you're watching on YouTube, if you're listening elsewhere, please leave a review or five star rating. Those things really do a lot to help support the podcast, and are very much appreciated. As always. To check out the show notes for today's episode, where you can take a look at the studies and articles and anything else that we referenced, head over to Jay Feldman wellness.com/podcast and if you're looking to optimally support your metabolism, lose weight, improve your digestion, improve your liver health, get amazing sleep, rebalance your hormones, boost your energy and so much more, alongside or with clear action steps and strategies and personalized guidance for me, head over to Jay Feldman wellness.com/solution where you can find all of the information for the energy balance Solution Program. This program includes customized health coaching, a video library with videos on regulating blood sugar, restoring gut health, strategies for weight loss without destroying your metabolism, how you can rebalance your hormones, get amazing sleep and tons more. It also includes resources like a sample meal plan and supplement guide and a private community so again, head over to Jay Feldman wellness.com/solution, to check out all the details. And with that, I'll see you on the next episode.