weight-loss-fatty-liver-coaching-diabetes

 

Many people wait for a serious disease to strike before they decide to adopt a healthier lifestyle. They wait until they are so sick and running out of options before they are finally open to making the much-needed changes in their lives.

With over 20 years of experience in the field of medicine, Dr. Mark Berger, has observed how people’s health deteriorate through the images that he is exposed to every day. This made him conscious about his own way of living; he realized that his addiction to junk food, candies, and soda was creating minor health issues for him as well. He decided to avoid these types of food and it led to a dramatic change in his life – he had more energy, it improved the quality of his sleep, and he was no longer plagued by migraines, which was something he had to live with for years.

This life changing event set him on a mission to empower more people to make tough health changes in their lives. By using imaging as an educational tool, Dr. Berger is able to let people know what is really happening with their health through his practice, Vitality Visions.

In today’s episode, he shares his insight about the effects of excessive sugar on our body and the benefits of maintaining a low carb diet. He provides us with some simple tips that can help make the necessary changes early on to prevent disease and improve the quality of their lives.

“If you make the change early on enough in this disease process this stuff is reversible.  You can change it.  You can be empowered to do the right thing.”
– Dr. Mark Berger, MD

On Today’s Episode of the Low Carb Leader:

  • The role of adipose tissue and visceral fat – how it affects our hormones and makes us susceptible to serious diseases.
  • The alarming effects of excessive sugar in our body and how it alters the functions of the liver, pancreas, and other organs.
  • The effects of a low carb diet, some of the outdated concepts concerning fat and sugar, and how these things have affected the food and eating habits of people.
  • Being mentally ready to make the change and adopt a healthier lifestyle.

 

Dr. Mark Berger’s Top 2 Tips to a Healthy Start

  • Get rid of soda
  • Take a period of time off from gluten, white bread, wheat products and processed sugar.

Connect with Dr. Berger

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Read Podcast Transcript

029 – Low Carb Radiology with Dr. Mark Berger, MD

DAN:
Hello, and welcome to The Low Carb Leader. I am your host, Dan Perryman, and you have joined me for Episode 28. Today we have Dr. Mark Berger. He is a practicing radiologist, and I have actually coined the phrase, “Low-carb Radiologist” for him. Mark is a highly-educated radiologist. He received his undergraduate degree in biology at Hamline University in St. Paul, Minnesota. He went on to medical school at the University of Minnesota Medical School. He then went on to do his residency at Mayo up in Rochester, Minnesota, in diagnostic radiology. And he continued and finished a fellowship at Duke University in abdominal imaging. Dr. Berger also served in the U.S. Navy, and he spent six months in Saudi Arabia during Operation Desert Storm. And he has spent the last 20 years in clinical and diagnostic radiology.

So Mark had a life-changing moment as he continued to see people’s health deteriorate in the images that he was looking at. He then kind of realized that his own way of living, eating junk food, drinking sodas, was creating some minor health issues for him, as well. So this led to a completion of a two-year Fellowship in Integrative Medicine through the University of Arizona in Tucson followed by a certification from the Institute for Integrative Nutrition.

I actually saw Mark speak at Low-Carb Breckenridge, and he presented on visceral fat and imaging in radiology and what the low-carb lifestyle could do. He also discussed a small study that he completed and the positive effects of that. So I interviewed Mark a few weeks ago, and it is a fascinating interview. He is truly committed to helping people become healthier. I know you will enjoy the interview. So Dr. Mark Berger.

All right. We have Dr. Mark Berger here today. Welcome, Mark. How are you?

MARK:
I’m very good. Thank you so much for having me.

DAN:
So you are calling in from where?

MARK:
I am – well, currently I’m sitting in River Falls, Wisconsin, but it’s across the river from Minnesota where I live in a suburb outside of St. Paul.

DAN:
Oh, gotcha. So it’s early March here, and today was like 65° here. How was it up there?

MARK:
Well, we had a storm blow through here the last couple days, and we had winds of about up to 60 miles an hour, so actually a lot of trees had fallen down. We had some really unseasonably warm weather earlier, but now we’re into the 20s and 30s, so kind of back to reality for March.

DAN:
But it’s probably beautiful up there during the spring, right?

MARK:
It is. Usually it’s – you know, spring’s – yeah, as long as the – once the snow is gone and all the salt is off the road it gets better.

DAN:
That’s what we say; once July hits for you it’s a great spring.

MARK:
There you go.

DAN:
Yeah, so why don’t you introduce yourself to our listeners? Kind of go back to why you decided to go into medicine and what path you took.

Dr. Berger’s Background

MARK:
Sure. Well, kind of way back I actually started off, after my medical school I was in the service for several years. Worked with the Marines and went to a couple of deployments, one of which was the Gulf War, way back when. But afterwards I became interested in radiology and did my training at the Mayo Clinic in Minnesota and then a fellowship in body imaging at Duke University. And so spent the last 20 years or so doing basically a lot of diagnostic imaging procedures with imaging guidance. And during that timeframe, and I think even more recently, just became quite amazed at the changes in diseases that I was seeing on imaging that all were pretty much self-inflicted. And when I say that these are things that really are under people’s control, whether it was emphysema from smoking, or from excessive visceral fat, or fatty liver disease, or premature osteoarthritis, or early atrophy in the brain because of drug or alcohol abuse, so many things that were avoidable.

And so I really became curious as to how over such a short period of time these changes were showing up in the images I was seeing. And at the same time I had some health issues. I had headaches my whole life, and actually I lived on a very poor diet, much to the chagrin of my wife. So I finally took her advice, and I came off of all the junk, all the sugar and processed grains and wheat. I got rid of the soda pop, and I had some dramatic changes in my life. My headaches after 20 years finally went away. My energy level went up. I slept better, and I lost 15 pounds. And I said man, you know, this was dramatic. You know, if I could share kind of the new found passion I have with what I was seeing of imaging, I thought maybe this is a tool I could use to kind of help educate other people to make these tough changes in their lives using imaging as kind of a guidepost and a motivating and educational tool to have them better understand what was going on with their health. So that’s kind of how I got to where I am.

DAN:
I know everybody likes to hear kind of the personal side. So you mentioned you were in the Marines. What year were you in?

MARK:
I was in the Navy, and I was in there from ‘89 to ‘92, and I was a medical officer assigned to the Marines. The Marines hate to admit it, but they’re actually a department of the Navy.

DAN:
Yeah, I was in the Navy at the same exact time. Where were you stationed at?

MARK:
I was stationed in Kaneohe in Hawaii on a Marine base there, and shortly after I got there I spent six months in Okinawa and then got back. And then when the Gulf War broke out we were deployed to Saudi Arabia in August of that year, and then we were there until about March, so about seven months over in Saudi Arabia, pretty close to the Kuwait border.

DAN:
I was stationed in Guam and Japan and the Philippines, and then during this time I was stationed in San Diego. And actually a lot of people volunteered to go over to the Gulf War. We had some people from our squadron go over on deployment. That’s pretty cool. When you say the Gulf War you have to classify it as the one a long time ago.

MARK:
That’s right. But you know, and I’m sure maybe you felt the same way at the time. There was a lot of unpleasantness, but now in retrospect, looking back it was something that I feel very privileged and proud to have been a part of, and I grew a lot during that period of my life.

DAN:
Yes, thanks for your service there, definitely. For the listeners, I don’t know if they understand all the training that you go through to become a radiologist. It’s four years of undergraduate, four years of medical school, and you typically do a five-year residency. Is that correct?

MARK:
Yes, usually what – it typically requires a year internship, kind of more in general medicine or even general surgery, and then following that internship is a four-year radiology residency program. So at the end of that you’re a trained radiologist, diagnostic radiologist. But most people now go on to do fellowship training. And so there are various subspecialists within radiology, whether it’s neuroradiology, or body imaging, or interventional radiologists. Those all require at least a year or two additional training after the residency.

DAN:
So you too can be a radiologist in only 15 years.

MARK:
Yeah, I know. My son is interested in going into medicine. I said well pal, you can’t think of it that way. It’s just got to be a year at a time. You’ve got to do it in small increments. Otherwise it seems like it’s undoable.

DAN:
Yeah, that’s funny. So you talked about how you changed your life a little bit around sugar and grains and bad food. Talk about what you ate before you started eating in a new way, and then what do you eat now?

Transitioning from Junk Food to Health Food

MARK:
Sure. You know, it’s interesting. It gets almost no emphasis in medical school about the value of nutrition and food. And even to this day the curriculum I think maybe some medical schools have a week or two, tops. But it really is not given very much importance, and I think that’s why a lot of us in the medical realm historically have not given it much thought. So I just ate classic, you know, fast food from all the hamburger dives you can imagine. I drank a lot of soda pop, a lot of candy bars, chips. I mean you name it. My wife sometimes kids me. She goes you were the guy who drank the Pepsi through the red licorice straw. I mean it was that bad. And you know, fortunately I didn’t ever have a real issue with my weight. So that wasn’t a big concern. But I clearly had other problems with headaches and fatigue and poor sleep. And I just kind of never put two and two together.

And fortunately for me my wife always had a tremendously healthy diet and way into whole foods and sustainability before it was en vogue. And so she used to comment, how can you be in medicine and be a doctor and have such a poor quality diet? And I said I just really didn’t pay much attention until kind of this coming together of what I was seeing on imaging and then her encouragement over this long time period to change my diet. And finally I relented. I said okay, I’ll give it a try. And it just really just turned my life around. I couldn’t imagine living without sugar and all the junk that I historically do, and now it’s just – I mean I don’t miss it hardly at all. Once in a while I have some chocolate with dessert, but for the most part I find that the further I get away from that I really don’t miss it much. And now I’m eating great food. She makes wonderful meals. When we go out we try to really focus on ordering things that are sustainable, hopefully that are local organic. And now again it’s a little more expensive perhaps doing it that way, but on the flipside what are the expenses of chronic medical bills by the sickness that eating all this lousy food results in? So that’s where I was, and that’s kind of where I am.
DAN:
People who eat a lot of sugar, they don’t understand how people cannot eat sugar. Once you stop eating sugar I really don’t have any urges whatsoever to eat candy or anything because it’s so sweet at this point. I share with my friends that if I eat a handful of blueberries I’m like oh my goodness I am just cheating. These things are so sweet. And it completely changes your palate, completely.

MARK:
I would totally agree. And your comment on the sweetness of things is so true because what you used to really almost not think anything of now is just this blast of sweet, sweet sugar, and it’s like oh my gosh it’s just brutal. So yeah, I would totally agree with that statement.

DAN:
So as a radiologist you’ve been practicing for how long?

MARK:
Well, I graduated from a residency in 1996, so 20+ years.

DAN:
So 20+ years. So what have you seen in 20 years, the changes in the population and the level of obesity and the diseases that you see? Talk a little bit about that.

The Detrimental Effects of Adipose Tissue

MARK:
Well, I mean we see it all around us. It’s no surprise that adipose tissue is the big thing. But it clearly is where is that adipose tissue, and that kind of is an important finding in that the fat that’s located deep within our bellies that we call visceral fat is much more metabolically active and has a much more risk profile than subcutaneous fat or that found underneath the skin. The skin fat doesn’t have the same profile. It’s not healthy in that it weighs you down, and it’s tougher on your joints, but from a metabolic standpoint that visceral fat should really be considered an endocrine organ. And it secretes all sorts of hormones and inflammatory cytokines that can really result in an increased risk for many diseases, including insulin resistance and cardiovascular disease.

So I think this adiposity clearly is a biggie. And then the effect that that adiposity can have on the liver. And we see fatty livers now, I mean many, many times every day. And it used to be where gosh I could go a month and maybe you saw a couple of them, and most of those were secondary to people who were alcoholics or taking steroids. But now almost all of these people are on a high sugar diet, and particularly a high fructose diet, which is very toxic to the liver. So I think those two big things are – those are two primary ones. I think cardiovascular disease that we see in imaging is a big one, too. We see plaque in the coronary arteries on a routine basis and plaque elsewhere in the aorta and the iliac arteries, the renal arteries and the mesenteric arteries, those vessels that supply blood to our gut. You know, those are extensive atherosclerotic disease.
And then you’re seeing in younger people, too, premature arthritis. They’re too heavy, and they’re starting to put too much stress on their joints. So I could keep going on, but I think those are probably some of the biggies that we see. But it’s just dramatic kind of organ and systemic throughout our bodies as we’re just seeing disease that is vastly more prevalent than we saw, or I saw at least, early on in my career.

DAN:
So Mark, for those who haven’t went through 15 years of medical school and residency, what does a fatty liver mean? Why does that create problems for you?

MARK:
Well, normally the liver is our primary detoxification organ, and the function of those liver cells – or we call them hepatocytes – are critical in processing the foods and the toxins that we ingest, converting them into molecules that are then water-soluble and can be excreted either into the bile and then into the stool, or into the bloodstream and then the urine for excretion. What happens is when these liver cells are exposed to excess sugar what it first does, it converts it to glycogen. And glycogen is the storage form of energy that we can utilize, whether it’s in our liver or in our muscle. But once you’ve filled up your glycogen stores the only thing the liver can do at that point is to start filling up its own cells with fat or something called triglycerides. And once those are full, then what it does is takes those triglycerides and sends them out in the bloodstream where they are then deposited in our fatty tissue. So you’ve gone from a normal liver to a liver that has a lot of glycogen. And once you’ve reached the capacity, now you start filling up those liver cells with fat or triglycerides, and then ultimately it sends out any excess sugar that you then take on to these carrier molecules and then on to our storage sites.

So once those liver cells then start becoming filled with this triglyceride or fat, now you’ve just altered their function. And now they can’t process and detoxify the way they are supposed to. And many people then start on this slow road downhill to the next to disease entity called nonalcoholic steatohepatitis, and that’s just kind of a fancy term for those liver cells becoming inflamed. And there’s a subset of people then that will ultimately develop cirrhosis, and that is becoming more and more of a cause now for end-stage liver disease. It used to be hepatitis and other causes. Now it’s too much fructose. So it’s dramatic what is going on with the liver, and much of that is related to just too much sugar and fructose.

DAN:
That’s incredible. So what used to be reserved for alcoholics and rare conditions is now pretty much mainstream?

MARK:
Very much so. And it is truly dramatic. I have this conversation with my colleagues. It’s almost every other case you are seeing a fatty liver. I mean it’s just dramatic.

DAN:
Wow. Talk a little bit more about the difference between subcutaneous and visceral fat, and why is visceral fat so dangerous? You talked a little bit about the hormone functions and the hormone changes, but kind of walk us through that.

The Relationship of Hormones to Visceral and Subcutaneous Fat

MARK:
They are still working out all the physiology, kind of why this happens, but one of the things that – or I should say a couple of hormones that are instrumental in this deposition is number one, insulin, and number two is cortisol. And again, insulin is critical for many things, but too much insulin gets to be a problem. And the big problem with insulin, it’s the most lipogenic hormone we have, meaning it’s impossible to burn stored fat with insulin in your bloodstream. And the reason insulin is in your bloodstream is because you have sugar in your bloodstream. And the body just cannot tolerate excessive sugar. So every time you take a sugared meal insulin is secreted in order to take that sugar from the bloodstream and deposit it in the cells for energy.

Well, as this happens over and over again and there’s too much sugar what happens is these cells then become what’s called insulin resistant. And so they’re not as responsive to the effects of insulin. So insulin levels then have to go up. And so this is a vicious cycle of too much sugar and too much insulin. And again, as insulin stays and increases in your bloodstream and throughout your body you are unable to burn fat. Well then that fat has to be stored somewhere, and it’s stored both in that visceral compartment and the subcutaneous compartment. So that’s insulin.

Cortisone is kind of a stress hormone that goes up, produced by primarily our adrenal glands when we are stressed. And it’s been shown that actually this cortisol results in redistribution of where the fat is. And it takes it kind of from the subcutaneous department and brings it into this visceral compartment, the fat that surrounds our organs, the liver and the kidneys and our bowel. And once that’s deposited, that fat also has its own receptors and ability to make active cortisone. So it’s this kind of vicious cycle of too much insulin and too much cortisol and where the fat ends up being deposited. And it’s that central fat that has been shown to have this increased risk for not only the fatty liver we talked about, but cardiovascular disease and heart attacks. So kind of a long-winded explanation, but I think much of the physiology comes down to what’s happening with insulin and what’s happening with cortisol.

DAN:
And what drives insulin up? It’s sugar.

MARK:
It’s sugar.

DAN:
Yeah, sugar, all the stuff you shouldn’t be eating, right?
MARK:
Yeah, I mean it is. Fat and protein have a much, much milder effect on the pancreas, which is where the insulin is secreted from. So it really comes down to if you control your sugar intake you can really control the insulin. And once you get insulin down, now you can start burning fat. And that’s the key. That truly is the key. You’ve got to get that insulin down to a level where it allows you to start what’s called beta-oxidation. You can start breaking down your stored fat and using the fat for energy rather than the sugar for energy.

DAN:
How does the constant intake of sugar affect your pancreas? All I know is that you definitely don’t want anything happening to your pancreas.

MARK:
No.

DAN:
Yeah, that’s from a cancer standpoint or anything else, right?

MARK:
We use to say yeah, don’t piss off your pancreas because [an inflamed 0:20:05.2] pancreas is not a happy pancreas, and yeah, it’s been interesting. You know we talked about fat deposition in the liver we just discussed. Well, you can actually have fat deposition in the pancreas. And we see this on CT where the nice, normal pancreatic tissue is now interspersed with little fat globules. That is actually a reversible condition if you decrease the sugar. But within the pancreas itself are something called beta cells, and those beta cells are actually what secrete insulin. And this whole concept of insulin or beta cell resistance comes up when there is just too much sugar in the bloodstream. So I think you can be nice to your pancreas, number one, by avoiding high sugar and number two, avoiding high alcohol because historically pancreatitis was something that typically was caused by excess alcohol intake, and we still do see that. But we’re seeing more and more I think diseased pancreas from ideologies other than alcohol use.

DAN:
That’s incredible just the impact of sugar on your body. You talked a little bit about a study that you completed. Talk a little bit about that.

Dr. Berger’s Moderate Fat Diet Study

MARK:
Again, I was trying to figure out a way where people could actually see the impact of their diet on their organs. So what I did was I enlisted 30 people who followed a higher fat, kind of a Mediterranean-style diet, which has been shown one of the most successful diets in decreasing cardiovascular and chronic disease risk. And so we put them on a moderate fat diet. We did imaging with MRI, both at baseline and then at three, six and 12 months. These people met with a nutritionist to kind of get the exact detail of the diet that they were going to be following. They kept a food journal, and then we did kind of track a little bit of their activity level with a pedometer. And what we did then was followed them over the course of the year and recorded in detail their dietary intake and see how that affected not only what we were seeing on MRI, but we also did blood testing throughout those same periods. So we could watch what was happening with the triglycerides and HDL and inflammatory markers, such as C-reactive protein and homocysteine. And we could see and correlate the imaging findings with their biometrics, these biomarkers, and really get a good sense of what was happening on a physiologic standpoint.

DAN:
What were the key findings?

MARK:
So we – unfortunately only nine of the 30 completed the study, which goes to show how difficult it truly is to kind of change your diet and lifestyle. But the motivated people actually did quite well. Out of the nine that finished we had five that had dramatic changes, not only in completely reversing their hepatic steatosis, or this liver fat, but improving their visceral fat, as well as their blood markers. In a couple of cases in particular, one individual lost 35% of their visceral fat. They completely reversed their liver fat in every one of their blood panel markers, including the triglyceride and the HDL, LDL to a lesser degree, and then the inflammatory markers all improved and then stayed improved over the course of the 12 months.

When we sat down with these individuals and actually showed them this is what you did; this is reversible; you are empowered to be able to make these critical changes in your health not only on imaging, but on the blood markers, which is kind of proving what we’re seeing, it was very inspiring for these people. A couple of people were in shock that they actually had really control over the ability to do that in their bodies and I think were just very keen and appreciative that they got to be able to sit down, have these images explained to them and then use that to kind of go forward and motivate them to keep on with their healthy diet.

DAN:
That’s really cool. Do you think that most physicians, just traditional physicians – not the functional medicine because they think a little bit different – but do you think most conventional or traditional physicians think that type II diabetes is reversible?

Are Conditions Like Type II Diabetes Reversible?

MARK:
You know, just speaking for I guess my tribe, or I guess the people – I shouldn’t say that – my previous tribe. Let me put it that way. No, I think they think diabetes is not a reversible condition. Once you have diabetes you are a diabetic for life. And maybe changing your diet can have some effect, but you’re looking really at long-term medication. And you start off with non-insulin type sugar lowering agents, and if those don’t work ultimately you’re on stronger drugs and usually a combination of drugs, and insulin ends up being one of them not infrequently. So I think the conventional opinion would be that this is not reversible and that what you can do is just kind of hopefully mitigate the advancement of the disease.

DAN:
But there’s a lot of research around changing the diet, going to a higher fat, low carb diet completely reverses a lot of the diabetes, type II diabetes.

MARK:
That’s right. And it’s a good distinction because the type I diabetics, of course, those are the – that’s an autoimmune condition, and they’ve had enough of their pancreas destroyed where they just aren’t producing insulin at all. So they do need insulin replacement. But in the type II diabetics it’s the exact opposite. Instead of not producing enough, they’re producing way too much. It’s been shown in many studies that if you can bring down the sugar and bring up the fat and kind of go against conventional guidelines, which I think have just been so destructive over the past half-century that somehow a low-fat diet was healthy for us and the whole cholesterol and saturated fat myth, that somehow those were the instigators of cardiovascular disease and the twin demons and had to actually be avoided at all costs, you know that is just being dispelled time and time again over many, many studies. And it’s surprising that it still gets the press that it does.

But you know there’s a lot of powerful factors out there that don’t want things to change. The drug manufacturers, they don’t want it to change, and the food manufacturers are selling a lot of goods and processed food. You’d rather not believe that people would want people to stay unhealthy, but you know I think it’s going to be a slow process for people to kind of realize that the information we’ve gotten was not very good and that diabetes, particularly type II, is a condition where if you take these steps, for some people it is a reversible condition. And it’s certainly worth a try because the only other option is to go on the drug bandwagon for life. Diet is certainly worth the effort to see how that impacts you. Everybody’s biochemistry is a little bit different. We talk about biochemical individuality, which I think is an important concept. So what works for you may not work for somebody else, but you will not know that unless you try it. And so I think certainly those people who are struggling with this condition, it’s well worth a try.

DAN:
Most of the people listening to this podcast are probably low-carbers anyway, so they’re part of the conspiracy theory that we are. I’ve been in healthcare for 20 years, and this isn’t a dig on healthcare because I highly respect physicians, and I highly respect hospitals and what they do. And pharmaceutical companies, I mean they have great drugs, and they save a lot of lives. But it is big, big business. Hospitals are paid based on procedures. It’s kind of changing a little bit. And then the food manufacturers are huge corporations. As business people it’s their job to sell their product. It doesn’t stretch the imagination to think that people are not going to support that changing your diet can reverse diabetes. To me it’s very simple. This is big business, and it’s against mainstream, and it’s going to take a long time. You work with other physicians that don’t believe in this, and I know a lot of people who don’t believe in it. And it’s a difficult movement to get people to change their diets because it is very easy to take a pill.

MARK:
Indeed. And that is exactly right. And people have to be mentally ready, though, to make a change because you can give them all the information in the world, but if they are not prepared to receive it, you know it’s just not going to happen. And I think many of us become frustrated. And they say if you would only just listen to what I am saying I could make you healthy. But they don’t necessarily want to hear it at that stage in their life, and it’s only unfortunately when they get to the point they are so sick that they’re running out of options that they finally come to the table and say, gee, now what can you do for me?

So this is going to be a grassroots thing, as I think we’re all understanding because there is so much money at the top. But if you can get these people to understand somehow, someway that if you make these changes early on enough in this disease process, this stuff is reversible. You can change it. You can be empowered to do it. Once you get to end-stage cirrhosis the game is over. So you just hope that people can see the light before them. But they’re just not getting the right information frequently. Even those who are inclined to do the right thing are just sometimes given 180° the wrong information. It is just so sad to think about that. But that, in reality, is what’s happening. When you have these people being told to go on a low-fat diet and somehow that’s going to help their health situation they don’t got a chance. So you know it’s up to guys, I think, like you and me and people listening in that it’s kind of our calling. And it’s a mission that I’m embracing, and I think we need to spread the word one person at a time and one podcast at a time and hopefully make a difference.

DAN:
I have a couple of people at work that have went on the low-carb and they ask me a lot of questions, and one has lost 31 pounds, and the other one has lost 13, and what’s funny though is a friend of mine was like just kind of a sugar addict, and he has really cut out the sugar, and now every time he goes and has like pizza or something he always comes back to me the next day saying I felt terrible. The other one I know says the same thing. She was like I had a cheat meal because she was losing a lot of weight, and that’s good sometimes, and I’m like you might want to keep it clean because she said she went out and ate something and felt terrible the next day. So you get on this kind of healthy, high-fat low-carb diet – I wouldn’t even say diet, lifestyle – when you do go out and eat something you’re like the next day you’re just like, I call it the carb hangover. It’s just you’re foggy; you don’t feel good. So I actually kind of cut all of that out just because I feel better not doing it. Do you have cheat meals at all anymore?

MARK:
You know, well, on occasion, sure. I’m not a purist. I try to do it as much as I can. When I cheat, gosh, you know, it might be – I’m just trying to think – my wife grew up Italian, and she still on occasion loves Italian food, but we hardly ever eat any pasta anymore, and that used to be a routine staple. So on rare occasions she may make some kind of Italian dish which has a little bit of al dente pasta, but that is really the exception. And I do miss the nice Italian meals, but you know what, it’s just not worth it anymore because I know how I’m going to feel the next day after eating something like that. It’s just going to weigh me down, and I’m going to sleep poorly. And frequently I get a stomachache. So it doesn’t happen that much anymore. And for the most part I really don’t miss it.

DAN:
That’s so funny because I hear the same thing from everybody that used to like all these meals and now you’re like, oh, it’s not even worth it. That’s what I say, too, and I know people who are on kind of a regular diet, high-carb diet, are thinking how is that even possible? But I know that, like you were saying, I didn’t know how I actually felt until I quit eating the stuff. And then I was like wow, now I have – I’m like pretty ketogenic now, and I wake up, I have so much energy. I’m not weighed down throughout the day. It’s so much different now.

MARK:
It’s so much different. And I think the other thing, too is, you know this is not a calorie-restricted diet. I can eat whatever I want within the low-carb realm. I have no limit on really what I eat, and I eat – maintaining my weight is absolutely easy. I mean I never gain any weight. I just eat as much as I want as long as it’s following the whole low-carb philosophy, and it’s very, very easy. I would highly recommend it for somebody who hasn’t tried it before to give it a chance because I think they will be truly amazed at the results.

DAN:
I recommend just skip breakfast once in a while to kind of get started, and then just keep your carbs low and see how it goes. But I wanted to ask you a question. So for the listeners, we were both lucky enough – Mark was a speaker at the Low-Carb Breckenridge in Colorado, which was a pretty amazing weekend. A lot of great speakers. And during your speech you were talking about the different shapes of women and how the apple versus the pear-shape. I thought that was fascinating of where the fat ends up in the different shapes of women. So kind of walk us through that. I wish we had the visuals because they were really cool. But you’ll have to describe them.

Apple vs. Pear: What Body Shape is Telling Us

MARK:
Sure. If you can just kind of envision the apple, and that’s kind of the android configuration or the male-type pattern, and that’s where that fat kind of accumulates over the central portion of our belly, kind of at the level of the umbilicus, about halfway in between kind of your lower rib and your upper pelvis, in kind of the iliac crest. And that really is this toxic form of visceral fat that I was talking about earlier. And because not everybody is going to go get CT and MRI, one of the default ways we look to measure that is just with a tape measure. And if we do a tape measure at that level and the number is 40 cm or over – or excuse me – 40 inches or over for men or 35 0inches for women, you know that you have visceral adiposity, and it’s kind of a surrogate marker for this visceral fat that we can actually visually see with imaging. So that’s really the big problem, where the fat is.

Now in women they tend to have a more pear-shaped configuration, and their fat accumulates lower down in the hips and the buttocks area, and that tends to be much more metabolically safe. That doesn’t have the same cardiovascular risk in inflammation and the cytokine secretion that this visceral fat has. But now as women go through menopause and their estrogen levels go down, they actually start to develop more and more of this apple-shaped configuration. So that’s kind of – those are kind of the two main areas where fat is deposited. Some people are kind of hybrids. There are some women who not only kind of have this pear shape, but those who are perhaps under a lot of stress and have elevated cortisol levels, as we were talking about before, they can also have a fair bit of deposition into that visceral compartment and have a combination of both.

And then there’s kind of an unusual phenotype called TOFI, or thin on the outside and fat on the inside, and those are people who actually have a normal BMI or body mass index, which is kind of a generic marker for whether you’re overweight or obese or not. So these people come out normal with a BMI, but when you actually look on imaging they have too much visceral fat, and then when you do blood samples their inflammatory markers are elevated because of that. So it’s a subtype where you can’t really appreciate it without some form of imaging. But it’s a metabolic risk factor that they may not recognize. So those are kind of the two biggies, the apple and the pear distribution and kind of what they mean.

DAN:
So on the TOFI, the statement of saying well I’m skinny so I’m healthy, doesn’t hold then always?

MARK:
That is correct.

DAN:
Well, we are nearing the end, but I want to get a couple more things out. What would be your top two or three tips that you would give somebody that is maybe the apple or the pear or struggling with their weight? What would you say is a good way to start?

How to Start Down a Healthy Path

MARK:
Yeah, you know, people ask me that frequently, too. I say if there is one thing you could do tonight or tomorrow, one thing you could do, get rid of the soda pop. I think the soda pop is absolutely toxic. And it’s toxic on so many levels, but it’s because it’s this high fructose corn syrup that we know can only be metabolized by the liver. Sugar can be metabolized in about every cell, but fructose can only be metabolized by the liver, and that’s why it is so toxic on the liver. So if you could get rid of the soda pop that would be a great first start.
Then the next one I would say is many people would benefit from a period of time off of any kind of wheat or gluten-related products, and those are all tend to be processed wheat, processed bleached flour, which all tend to just markedly increase your glucose blood levels. And remember bread is almost the same or sometimes even worse than just eating tablespoons of sugar based on its surface area and how it’s absorbed. So if you can get really rid of kind of the generic white bread products – and even wheat bread is not a whole lot better. It’s basically colored white bread. That can make a dramatic change not only on the sugar level, but a lot of people are sensitive to gluten, as well. So you’re kind of eliminating two things at once.

So those would be I think really the two big things. Number one, get rid of the soda pop, and then take a period of time, a week or two if possible, off of any kind of gluten containing products and processed sugar, and I think you’re going to feel better. You’ll probably be impressed at, you know, you’re going to lose weight just because as you get rid of the carbohydrate the water follows that, and so many people at least early on in the first week or two, that’s why you lose so much weight is because it’s the water that was being held onto by the carbohydrate. After that it gets a little more challenging to lose weight, but not if you’re following a high-fat program. So those would be my two big suggestions that I think people would find useful.

DAN:
Those are great tips. And you grew up in Minnesota. Is that correct?

MARK:
I did.

DAN:
Okay, so I lived down south for – in Alabama and Mississippi – for like 10 years. Down south they call it soda. In Iowa they call it pop. And you call it soda pop.

MARK:
It’s just a hybrid. That’s right.

DAN:
I just wanted to point that out.

MARK:
You got that right. Any way you spell it or pronounce it, it’s all bad news.

DAN:
Yeah, and that’s always the theme is every time I ask that question always number one is sugar and soda, always, to get that out of your diet. So you do some health coaching on the side. So if somebody wants to get a hold of you and work with you or look at some of your content, how would they do that?

Connect with Dr. Berger

MARK:
My website is called vitalityvisions, and just kind of spelled how it’s pronounced, vitalityvisions.com. Or people can just email me at drb@vitalityvisions.com. And I am doing health coaching. I am doing a fair bit of blood testing along with that. If people have any imaging that they’ve had done and they want it reviewed or discussed or just want to be educated on what the films mean, that’s what I offer as well. And just trying to, like I say, promote the gospel and get the word out and help people make these tough changes in their lives that can be very meaningful to them but are very challenging. So if people are looking for an open ear, I’m certainly available.

DAN:
That’s great. And we’ll put those in the show notes so everybody has the links. I just want to say you did a great job in Breckenridge, so hopefully you’re heading back there next year.

MARK:
I would love to. It was a thrill being out there. It really was. Meeting people like yourself and then some of the authors, Nina Teicholz and Zoe Harcombe, and so many inspiring people that are leading the charge into kind of a new era of health and trying to dispel some of the myths that have been with us for so long.

MARK:
I was impressed at how many doctors were there. There was quite a few.

MARK:
There were.

DAN:
Which was cool. I think I was the only hospital CEO there.

MARK:
You’re a trailblazer too there, [big guy 0:41:40.2].

DAN:
One last question. Did the altitude affect you?

MARK:
Surprisingly it did a little bit, and I found that a little odd in that I had spent actually a year out in Edwards, which is kind of closer to Vail and Beaver Creek, but that’s more at about 7000 foot elevation, and Breckenridge was I think it’s closer to 9000 if I’m not mistaken.

DAN:
I looked it up. 9600.

MARK:
Yeah, I could feel it. I mean I got little headaches, and hydration and the whole thing. It made a difference.

DAN:
I don’t think the cold helped because it was cold.

MARK:
It was. It was cold.

DAN:
I definitely had the headaches and the cramps and stuff. And we did the oxygen bar, and that actually helped. That got rid of the headache.

MARK:
Oh good, good.

DAN:
Well, Dr. Berger, thank you so much for being on the show today. This has been very, very interesting. And I hope people reach out to you because you are definitely a leader in radiology. I know a lot of radiologists, and I refer to you now as the Low-carb Radiologist. That was very cool. So thank you for being on the show.

MARK:
Well, you’re very welcome. I’m happy to be here. And good luck to you in all your endeavors at the hospital as well.

DAN:
And you, too. Thank you so much.

MARK:
Thank you. Bye-bye.

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