The Melanie Avalon Biohacking Podcast Episode #123 - Dr. David Minkoff

TRANSCRIPT

Melanie Avalon: Hi, friends, welcome back to the show. I am so incredibly excited about the conversation that I am about to have. So, as listeners know, out of all the macronutrients, I am very obsessed with protein. You guys know this, you know that I eat a lot of protein that I often talk about the importance of protein. I've done quite a few episodes where we talk about a more general view of the importance of protein in our health, but I have not done a really deep dive into protein I was hoping to. And then a book came across my lap called The Search for the Perfect Protein: The Key to Solving Weight Loss, Depression, Fatigue, Insomnia, and Osteoporosis. When I saw this title, I got really excited. I was, "I really hope that this is the deep dive that I would really like to explore on a really granular level." I read it, it turned out to be all of that and more. So, I am so excited to be here today with the author, Dr. David Minkoff. I can tell listeners little bit more about your bio, but Dr. Minkoff, thank you so much for being here. 

Dr. David Minkoff: Very excited to talk to you, Melanie.  

Melanie Avalon: All right, so, like I said, I can let listeners know a little bit more. So, you are board certified in pediatrics, you completed a fellowship in infectious diseases at the University of California in San Diego, that seems very timely for everything that we're experiencing today. You worked in emergency medicine at the Community Hospital of Newport, is it Richey? 

Dr. David Minkoff: Richey. 

Melanie Avalon: Richey-- Richey, Florida. And you also have extensive postgraduate training in complementary and alternative medicine. So, it sounds like you're best of both worlds as far as conventional, and then, like I just mentioned, alternative medicine goes. So, to start things off, would you like to tell listeners a little bit about your personal story? What made you so interested in this macronutrient of protein and everything that you're doing today with it? 

Dr. David Minkoff: Sure. I grew up in Madison, Wisconsin. And when I was 13 years old, my Boy Scout troop took us on a tour of Oscar Mayer meatpacking company, which was based in Madison, Wisconsin. When I went through the slaughterhouse, I was really turned off by the idea of what was happening to the animals and I decided to become a vegetarian. My mother was really distraught about it, because she was a very good cook, and she wanted me to eat her food, and there was a big worry that if I was a vegetarian, I would become anemic. We certainly had a battle going on for years, and when I turned 16, and I wanted to get a driver's license, she said, "Unless I start eating meat, she wouldn't let me get a driver's license." I held out for a year and then she acquiesced and that's what happened. I wasn't eating necessarily very good because I didn't know anything and that went on for a long time.  

In 1982, which was a bunch of years after that, so, I was training in pediatrics and infectious disease, and then eventually, emergency medicine, and in 1982, I saw the Ironman triathlon on TV, and I decided I wanted to do an Ironman. About six months later, went to Hawaii, and did the Hawaii Ironman in 1982. So, I was pursuing a medical career, and then I was very interested in athletics, and was training a lot. I got an injury in probably about 12 years ago, where I pulled a hamstring and I could not get it to heal. As a medical doctor, I had access to about anything to help me, and I massaged it, and chiropractored it, and supplemented it, and it just wouldn't get stable. I was meeting with a friend and he said, "You could use amino acids maybe to create a better way to build protein than if you just tried to do it with regular proteins." So, I got a product that was in Europe, and I started to experiment it, and we sort of finagled with it.  

After about six or eight weeks of taking this product, which is a mixture of the eight essential amino acids, and if you're into nutrition, most nutritional guidelines say that there's 10 essential amino acids, at least for old people and babies. But really, there's eight that have to be there in order to make the body work. I started experimenting with them and in about six weeks, my hamstring healed, and I went to the track, and I pushed it, and it was fine. A few years before that, I had started a nutritional company because the way I got from emergency medicine to a more complementary holistic practice is because my wife had gotten sick after she decided to have the silver mercury fillings in her mouth removed. She's a nurse, and she was very health conscious, she was also a triathlete. She went to a dentist and he drilled them all out, and about six weeks after that she got sick. She got thyroiditis, and then hepatitis, and then one morning, she woke up and she couldn't lift your arm up, and the neurologist-- 

I'm in the emergency room, I know all the good doctors, I had her see everybody, and they thought that she had MS. They wanted to put her on big time serious drugs prednisone and interferon and that really worried me, and we started to look around as to what else could be done, ran into a dentist who was a holistic dentist, and he said, "Maybe she's mercury toxic?" And she was, and that started to started a whole education and transitioned me over to the kind of practice that I have today. She got better, and so, these amino acids, when I started putting in them into the practice, I saw big changes in many types of people. In menopause, a woman said, "Their hair and their nails were growing better." When we gave it to people with osteoporosis, their bone started to fill in, and athletes started to recover faster from their injuries, and we saw just like, maybe this was a nutrient that was below the level of being looked at by nutritionists and doctors. 

When I used it for my own benefit, after my hamstring healed, I went up to Canada and did Ironman Canada, and done the race many times. And I had my best time, and I had some major physiologic changes like my maximum heart rate went up 12 points, and my lean body mass went up, and it really made a difference in how I felt and how I looked. That's how I got into it. Then using it in the practice, it just made a huge difference. I started to measure virtually everyone that we saw doing blood levels of amino acids. I found that almost everybody was low and that if we supplemented with the amino acids, we could bring their blood levels up and a lot of their chronic conditions got better. So, athletes started to use the product because they could heal faster and workout harder. One of the guys who had won Ironman Hawaii twice started taking the product, and he would always-- two months before he went to Kona for the race, would go to Kona, and he had 150-mile ride that was his like final test ride. 

Two months before, he does the ride, and he called me in a panic when he got home from the ride because he said, he'd done it 30 minutes faster than he'd ever done it before, and that he was afraid there was some kind of drugs in there and he was going to get in trouble. It's NSF certified, there's no drugs in this, this is pure, and it's just what it is. He went on to win the race that year for the third time and have his best time ever. So, there's a lot of application for it, and there's a lot aspects of this I could go into, but that's the overview of how I got started in what I was looking for, and kind of some of the effects that people expect and can expect from it. 

Melanie Avalon: Okay, that is an incredible story. How many times have you done the Ironman?  

Dr. David Minkoff: I've done 43 full Ironmans, about 200 half Ironmans. 

Melanie Avalon: I wish there were more doctors that have your background as far as like the visceral experience of performing in your body because I think it just adds-- so it's reality to your experience of everything. I really identify with your wife's story. I had mercury toxicity as well. So, I completely empathize with that. I have so many questions from what you said, but I think a good one to start off with is-- so with supplementing with the protein in the amino acid form, is it filling in the deficit because it's more digestible and what I mean by that is, is it possible people are eating enough protein in theory, but they can't assimilate and digest all of it or is it purely an amount thing? 

Dr. David Minkoff: I think, some people, it's one and some people, it's the other. If someone has a cup of coffee, and a doughnut or a bagel for breakfast, and a salad with a little bit of chicken at lunch, and maybe the same thing for dinner or they have pasta with a little meat sauce, and that they're probably not getting enough protein for what their needs are. So, in that case, it's not enough. In the other case, virtually everyone living on planet earth now has an intestine that's far from optimum. People get heartburn, and bloating, and gas, and they take remedies or they go to doctors who give them remedies, which very rarely addressed the real problem, and then give them symptomatic relief. So, they're taking Pepcid or Nexium, or things to control constipation, or things to control diarrhea. But the basic underlying problem with their digestion, and their absorption isn't really being handled. When I saw that almost everybody had low levels of essential amino acids in their blood. Then I started to look-- started to do stool test-- functional stool test. What we found is that virtually everybody doesn't have enough good bacteria, is overgrown with pathogenic, or bad bacteria, or yeasts, or parasites. 

Many people don't have enough digestive enzymes or they don't make enough hydrochloric acid in their stomach to be able to digest protein, that this leads to digestive troubles, but it also leads to not being able to digest the food that you eat, so that you can get the benefit of it. When you take an acid blocker, which there's something like 20 million prescriptions or more a month of written drugs, but now many of these are over the counter, and you watch TV and it shows the guy, he ate a hoagie and he got a stomachache, and his solution is next time if he takes Pepcid and he goes to the Italian restaurant and eats the hoagie, he doesn't get the heartburn because now he doesn't have any stomach acid, and he doesn't digest, and he is at high risk for mineral deficiencies and stomach cancer and things like this, that he's doing the exact wrong thing of what he should be doing. So, by supplementing amino acids, we can hit both of those camps. Like the people who aren't eating enough and the people who aren't digesting it because these are eight essential amino acids, but they're already predigested, and they're in a form which is absorbed, even through damaged intestines. So, you can build a level in your body of amino acids and then proteins, so that the body can rebuild its structure and its function.  

When I first started the product within a couple of months, I added actually about 11 pounds of lean body mass. I did not look any different from the outside. My biceps weren't any bigger, and my waist wasn't any bigger, but I gained all this weight and the weight was bone density, and organ density, and connective tissue density that because I had been a vegetarian, I was lacking essential amino acids, and my body wasn't making the structure that was really needed to support it in its optimum form. So, sometimes, we see the same thing happen in other people. When people come into the office, we have a scale that will measure their body compartments. So, we get fat, and how much water, and how much lean body mass. We'll see people who maybe don't gain very much weight, but their lean body mass goes up, and it's accompanied by-- "Oh, my nails don't break anymore or I'm not really happy with you doctor because I used to go to the hairdresser every two months, but now I've got to go every five weeks because my hair is growing so fast," things like that. Where these-- hair is protein and if you got enough, you'll make what you should and if you don't have enough, that may be a target for the body where you don't-- It's growing slower because it just-- the raw materials aren't available. 

Melanie Avalon: I've been fascinated by the studies on overconsumption. When they do hypercaloric diets and just use protein for those extra calories, and how people-- what I've seen, they don't really gain weight. They gain lean body mass if anything, which is really, really interesting. Stepping back just to paint a broad picture, because I feel like since we're throwing around words like amino acids and protein, could you just paint a picture of what are amino acids and what's the difference between amino acids and protein?  

Dr. David Minkoff: Okay. So, if you look at what are called macronutrients, these are the big things. We have carbohydrates, and fats, and proteins. And that's what makes up the body. If you add water, and vitamins, and minerals, you pretty much have everything that the body is made out of. Now, all of the macronutrients have three elements in common, like all proteins have carbon, and hydrogen, and oxygen and all carbohydrates have carbons, and hydrogens, and oxygens, and all fats have carbons, and hydrogen, and oxygens. So, the basic building blocks of each of these things is the same and the way they're arranged are different. But amino acids have one difference, which fats and carbohydrates don't have, and that is they have nitrogen. Amino in Greek means nitrogen. So, all amino acids have carbon, hydrogen, oxygen, nitrogen. 

One of the ways that is easy to think about it is if you think of language, so, in English, we have an alphabet, and the alphabet has 26 letters, and if you put the letters together in different combinations, you get different words. Some words are very short they have one letter like I or A, and some words have 25, 30 letters, and there may be, I don't know, 400,000 words in English language, so, you can get all these different arrays. If you think of proteins the same way, there is amino acids, which are the simplest building block, and the alphabet has 22 different ones. So, there's 22 different amino acids. They all have carbon, hydrogen, oxygen, and nitrogen, but they're arranged in different patterns. If you put these amino acids in the alphabet in different ways, you get protein. So, protein is by definition 30 or more amino acids in a specific sequence.  

Now, our body has in the neighborhood of 50,000 different proteins. So, that's the structure of the body. It's collagen, and bone, and hair, and nails, and enzymes, and immune cells, and muscle cells, these are all made out of proteins, which are made out of amino acids. Now, some proteins have a lot of amino acids in them and some don't have as many. So, if you look at thyroid hormone, it's not really a protein, but it's a single amino acid, which is called tyrosine with three iodines on it and that's thyroid hormone. If you look at say insulin, it has I think 140 amino acids in a specific combination and that's insulin or growth hormone. I think it has 89 or 90 amino acids in a specific sequence and that's growth hormone.  

Skeletal muscle, one of the parts of skeletal muscle, it's a protein called actin has over 5,000 amino acids per one muscle spindle, one muscle fiber. So, the body has to make all this stuff but the building blocks are amino acids. In the amino acid biochemistry, there are eight of them, which are in every protein. So, if you're missing any of the eight and your body wants to make a protein, if the levels in the cell of that amino acid are low, that protein can't get made because the slot where that amino acid goes in in that protein can't be filled by something else.  

What we find is, if people have low serum, low blood levels of amino acids, that means that the cells are probably going to have low levels and when the cells you do a hard workout and your muscles are sore, if the amino acids are there and available, the muscle starts being made actually while you're doing the exercise. If it's not there, you might be sore for five days or seven days because by the time you eat enough to fill in all the holes, the recovery, the muscle or connective tissue or whatever it is, doesn't get made. That's why you either you heal slow, or your workouts aren't giving you progress, or you're not seeing growth of what you're trying to do is build lean body mass. If you supply excess amounts of essential amino acids, then you fill that gap. Then your body can put its building and repairing mechanisms in use right away because it has the raw materials to do it.  

Melanie Avalon: So, the non-essential amino acids, they can be made from the essential amino acids?  

Dr. David Minkoff: Exactly. There's eight essential, 14 non-essential, and we didn't experiment with PerfectAmino, which is we measured levels of serum amino acids fasted. We gave people 10 grams of essential amino acids, a PerfectAmino, and then we measured blood levels of their amino acids at 30, 60, and 90 minutes, and we found that within actually 23 minutes, the amino acids if they're taken on an empty stomach with water, juice, or a sports drink, that the amino acids were in the bloodstream within 23 minutes. That within 30 to 60 minutes, the non-essential amino acid levels went up too, because the body will make the non-essential ones that it needs from the essential ones and then all you have to do is give the essential ones.  

Melanie Avalon: It's really interesting. People pretty consistently test two macronutrients in their bloodstream, so blood sugar from carbohydrates, and fatty acids, and cholesterol, and all of that. With the amino acid testing, it seems to be with blood sugar and blood fats, we often want lower levels. But with protein, that's not the case, correct? Higher would be better or could higher also indicate that maybe it's not being used?  

Dr. David Minkoff: Well, sometimes on the test, you'll see that people have real high levels of a whole bunch of amino acids, and then they're not being used. In order to utilize them, usually in that circumstance, we'll find that they have a B6 deficiency or magnesium deficiencies, because those are two cofactors, which are necessary for the body to put amino acids into-- to manufacture them into proteins. But most people have low levels of essential amino acids. All vegetarians, all vegans, I could look at a profile and tell you, this person doesn't eat any animal protein. Because they're very low and there are a few people who have a gut bacteria profile that are more like a cow than they are a human. Their bacteria are able to synthesize for them amino acids and they have decent amino acid levels in their blood, but those people are very rare. So, there're some famous bodybuilders that were vegans or plant-based only, and obviously they built big muscles. Those guys have very unique microbiomes. But for the vast majority, 98% probably 99% of people, if they're not eating adequate animal protein with good digestion, absorption, or they're not supplementing with PerfectAmino, they're going to have low levels of essential amino acids. 

Melanie Avalon: Oh, wow, I'm really glad you touched on that. I was going to ask you if most likely the figures we see that are vegan have ample muscle, it's likely that they have a constitution with their gut microbiome that they're able to do that, and that might not pan out to the general population?  

Dr. David Minkoff: Well, it definitely doesn't pan out to the general population. It is mostly the general population has a terrible microbiome profile. But you look at the guys and there's some guys that they look great, but they're not ordinary. If they are really just eating a plant-based diet, they have a special microbiome as far as I can tell.  

Melanie Avalon: Out of the eight, maybe, I should list what they are if listeners are familiar. So, it's methionine, leucine, isoleucine, how do you say, is it phenyl, phenyl, how you say the phenylalanine-?  

Dr. David Minkoff: Phenylalanine. 

Melanie Avalon: -phenylalanine-- phenylalanine, lysine, valine, threonine, and tryptophan. So, out of those is one needed way more than the others, is it a pretty even split?  

Dr. David Minkoff: Well, here's what's interesting and this is what we discovered is that, there is an optimal amount if you're going to use it as a dietary supplement for protein, there is an optimal amount of each one in the mixture, so that you get the maximum utilization of the protein. Let me just take a step back and talk about utilization of proteins. If you look at other proteins, like you look at, say, cow muscle, or fish, or eggs, or soy beans, or dairy proteins, they have their own mixture of amino acids in those proteins, and then when we eat them and digest them, what comes into our body is whatever the mixture is of those things. You can do a balanced study. Since proteins have nitrogen, and carbs and fats don't, you could do a test with someone where you measure how many grams of nitrogen based on the food that they eat, did they take in, in a 24-hour period. 

Proteins by weight are about 16% nitrogen. So, if you had someone eat as their protein source, let's say, whey protein, and they ate fruits and vegetables, which have negligible proteins, so, their main protein for the day was whey protein, and they had four scoops of whey protein throughout the 24-hour period, which would be 100 grams of whey protein, and since about 16% of it is nitrogen, it'd be 16 grams of nitrogen that they actually put into their body. If that 16 grams of nitrogen in the form of amino acids, that the body took it and used it 100% to make body protein or repair body protein, then if we looked in the urine, we collected the urine for the whole day, none of the nitrogen that came in would come out or almost none of it would come out, because it got utilized. It got incorporated into the body protein.  

Let's say, the guy worked out hard that day or he was in a car accident and he had a lot of trauma where the protein was utilizable, then if the whey protein were perfect, it would all be utilized and no nitrogen would come out. There would be no calories from what he ate because none of it would be burned because it would all be utilized to make protein. If you actually do the study, what happens is, is only 16% of the nitrogen that's taken in is retained and 84% comes out of the urine. So, if you look at different foods, so dairy products are about 16% what we call nitrogen utilized, where 16% of the amino acids in that food got made into body protein or incorporated into body protein. 84% didn't and the didn't what happens is that the body takes the nitrogen off of that carbon-hydrogen-oxygen chain, it complexes it with some other things in the liver and we pee it out. One of the big reasons why we urinate is to get rid of nitrogen. 

If everyone seen a blood test, which is B-U-N, blood, urea, nitrogen. It's a measure of how much nitrogen is actually in the blood from the proteins that you ate. People who have kidney problems who can't get rid of the nitrogen, their BUNs go real high, and they might have to go on a dialysis machine to get rid of the nitrogen. So, if we eat whey protein, 16% gets utilized, 84% doesn't, that comes out in the urine. If you look at meat, fish, and eggs, they're about 33% utilized. They're about twice as good as dairy. Still, though we have 67% of it is coming out. So, people who are doing carnivore or something, are they getting any carbs? Sure, they are. They're breaking their meat down into carbs. Some people are wearing continuous glucose monitors and they may find that when they eat a big meat meal that their blood glucose goes up, it's because their proteins are getting turned into glucose because that's the body can do that.  

The best regular protein in terms of utilization is whole chicken eggs. So, if you eat the yolk and the white, 48% of the amino acids are retained by the body, are used by the body to build protein. If you just use the white, you know, for a while low fat was in fashion and yolks were bad, and people ate egg whites, and the egg whites without the yolk reduced from 48% utilizable, the 16% utilizable. In the yolk is methionine, it's one of the essential amino acids, and you need the yolk to complement the white to make it the best sort of protein you can eat. The only thing better than that is breast milk. It's about 49% utilized, but it's hard to get breast milk in quantity for people to consume. So, we can't have it.  

The magic of PerfectAmino and the reason I called the book The Search for the Perfect Protein is that when you take PerfectAmino which is the eight essential amino acids in a very specific ratio, 99% of the nitrogen is retained. So, the effect that people get which is very powerful, and there are thousands of stories on the BodyHealth website of people who like, "It changed my life. My energy came back. Blah, blah," whatever it is. "My sleep got better, my depression lifted," is because these amino acids are utilizable by the body to do what the body is supposed to do, but it couldn't do it because of some block in digestion, absorption, or the quality of protein that they ate. Because it's 99% utilizable, there's virtually no calories. So, 10 grams, 10 tablets of amino acids which is what we recommend people take every day is only four calories. So, if you want to use it for weight loss, you can supply your whole daily protein by taking 10 tablets three times a day, and it's 12 calories whereas if you're eating chicken breasts, or roast beef, or eggs, you're going to get hundreds of calories in order to meet your daily protein requirements and so this makes it something that if you're trying to cut, you could really do it.  

Melanie Avalon: If you, for example, were just eating PerfectAmino, once you hit your requirement for essential amino acids, what would happen then? Then would you start excreting nitrogen or what would happen?  

Dr. David Minkoff: Yeah. 

Melanie Avalon: Okay. So, it's like, no calories up until you top off what you need for protein, and then it would be burned as fuel, what would happen to it?  

Dr. David Minkoff: It just be burned. Yeah, it just be treated like any other excess. It's actually hard to do. We have-- We say that you could meet your body requirements and 30 grams a day, and depending if you're a bigger person, if you're more active, we all actually have a different need and I actually have people experiment with it. If they come in and I see that they've got osteoporosis and they've got lean body wasting, and they've got low hormone levels, I will put them on more right away. I'll put them on 10 grams twice a day, plus have three meals a day or two meals a day depending on, are they fast-- they're trying to do an intermittent fast or not with animal protein. On the ones who are vegetarian or vegan, I'll give them a lot for a long time because they're depleted and they're actually protein malnourished, and now then they can fill in, and they notice a difference. Their fatigue or their hormone levels, they improve. Three to six months their levels in their blood will go back up to what they should be.  

The other beautiful part of this is because there's a lot of people are trying to control glucose or they're doing ketogenic diets, and they don't want to raise their blood sugar, and they want to keep their ketones high that, if you take 10 grams of PerfectAmino on an empty stomach, there is no spike in insulin and there is no spike in blood sugar because it's not being turned into a carbohydrate. So, this is very easy to add into anyone who's using those that it's not going to pull you out of a fasted state and it's not going to raise your blood sugar.  

Melanie Avalon: I thought proteins themselves were insulinogenic on their own.  

Dr. David Minkoff: Well, dairy is very much so. Soy beans and dairy are about the same. They're about 16% or 17% utilized, but it just depends. It's also individually dependent. You can have a protein meal, and if you're testing your blood sugar, you can see in your body, what is it actually doing? Is it raising blood sugar, is it raising insulin? You can do a glucose challenge test not with glucose, but you could do it with, "Okay, I'm going to eat a pound of hamburger. My zero-level insulin fasted is this and my blood sugar is this, and then half hour, one hour, hour and a half, two hours, what did those do in response to that meal? In most people, you will see a rise in insulin and a rise in blood sugar because they are turning it into carbo-- Some of it, you know, 67% of it into carbohydrates, again, depending on their digestion and their absorption.  

Melanie Avalon: I'm wearing a CGM right now. So, listeners are pretty familiar with that. That would also be another good way to see how you're reacting to everything. Another question about the essential-- I have so many questions about the essential amino acids. You mentioned how there's eight, but then there's talk out there about histidine and arginine, and actually you mentioned fasting as well. I was curious about fasting and the implications of could the body create all the proteins that it needed and definitely through autophagy alone, and I was reading how arginine was essential and possibly couldn't be created through autophagy and was needed for the heart. You talk in the book a little bit about arginine and histidine. So, are those essential or not?  

Dr. David Minkoff: Well, in the textbooks, they're usually termed conditionally essential. But they're not essential because when we did the experiment with, "Okay, measure serum amino acids, give 10 grams of PerfectAmino, measure levels of amino acids at 30, 60, 90 minutes, arginine, histidine go up, the body does make it. They're not essential. Now, if you took other amino acid mixtures, it may not work because the formulation of this is unique. One of the most interesting aspects of this is like you look at collagen and the biggest dietary supplements on the market are the ones that have been-- that have had the best marketing, not necessarily the best science. Centrum vitamin, I think, sells a billion a year and it's all chemical, toxic, petroleum extracts. It's like a horrible thing, but it's well, well marketed and so they sell a lot. The same thing was done with whey protein. Whey protein was an extract of making cheese. It was a byproduct of cheese which at some point was thrown away because they didn't know what to do with it.  

Someone got the idea, well, this could be a good protein. That's what whey is. Dairy protein has two main proteins. One is casein, which is what the cheese part is, and whey is the other part, which used to be thrown away. So, now, whey has become a multibillion-dollar industry. But as a protein, a lot of people have digestive trouble with it, and it's insulinogenic, and it's only 16% utilized. So, it's not a great protein. If you look at collagen, which is the one that's come next, where billions are being sold in collagen, if you look at the amino acid profile of collagen, there's no tryptophane in collagen. So, it's missing an essential amino acid. The ability to make protein from collagen is going to be very compromised, and most of the amino acids in collagen are proline and hydroxyproline. They're not essentials. If you do the balance studies on it, it's going to turn out really not very good, but it's popular, it's in flavors that people enjoy, and I'm not saying it's bad for you except a lot of the sources of it are animal feathers and beaks, and who knows what those animals were fed and what's in there. There are some organic collagens and of course they're better. It isn't good dietary science.  

Melanie Avalon: Yeah, actually, the episode I aired today was with Dr. Campbell-McBride, who wrote the GAPS Diet and she talked about the potential toxicity of collagen. I've been coming across that more and more just because of the potential for toxins to attach to that matrix. It's a little bit scary. So, another question about the actual amino acids. What do you think about the inflammatory potential of the different ones like a lot of people in the low protein sphere, or vegetarian or vegan sphere demonized animal proteins because of their high methionine content? What do you think is going on with all of that?  

Dr. David Minkoff: I think it's mostly baloney. We do a lot of cancer in our clinic. So, I've looked at this literature pretty extensively. They tried to do low methionine diets, so that you could starve the cancer cell, and it wouldn't be able to replicate because it didn't have enough methionine. But methionine is an essential amino acid. It is in every protein, in every cell in the body. You can't selectively starve one without starving the other. You can do it with glucose in cancer, because many cancers are glucose hungry, and if you starve them from carbohydrates, you can affect the cancer cell and slow it down. But it doesn't work with amino acids. Vegetarians, there is no literature that I know of that vegetarians have less cancer than anybody else. It just isn't true and-- it just isn't true. So, I think that our bodies evolutionarily, I know of no long-term vegetarian populations, we were hunter gatherers.  

A lot of time on planet earth was ice age where there just weren't good vegetables, and fruits, and people ate what they could get, which was squirrels, and fish, and deer, and whatever else was around. I grew up in the 50s and if you've ever eaten an apple-- a wild apple from the 50s, we all knew that you could eat one kind of but they were really sour and pulpy. But if you ate more than one you are getting a stomachache. Because wild fruit through the generations until this modern era of hybridizing fruit, so all the apples, and strawberries, and oranges, and papayas, and mangoes, and all these fruits virtually, have been hybridized to look beautiful, and have more shelf life, and be sweet. But that's not what fruits and vegetables were like. They were bitter, and they were pulpy, and the amount of nutrition in them wasn't very good. Most people aren't going to eat a whole lot of very pungent dandelion leaves. You can put some in there, but if you're going to try to get your nutrition from it, you're going to eat something more substantial like have a piece of fish or have some eggs. I just don't think that that's correct. That people who do it they just look more and more muscle wasted again, unless they have this special bio .  

Melanie Avalon: So, throughout history and the food that we've been eating, you just mentioned how fruit has changed and the carb content, and we know that fatty acid contents and things have changed. But protein, the makeup of the different essential amino acids and things like that, does that stay pretty consistent throughout history or does that evolve and change as well?  

Dr. David Minkoff: Well, no, I think a buffalo liver is pretty close to a cow liver is pretty close to a goat liver. I think there's a little bit of differences but in terms of the nutrition, I think in old times, they mostly were eating the organs and not as much the skeletal muscle because the organs had more nutrition, and they tasted better. Now, we have gotten-- I was bred on, take the fat off the meat, and eat the lean meats, and don’t eat the organ meats, because they're not good for you, or they don't taste good, or they have too much cholesterol, or whatever the thing was. But I think all of that is, somebody just made that up, and then they got people to agree with it, and they paid scientists to show that if they said that they could make more money at it, and that's where nutrition is at today. You can buy what you want, and you can buy the science that you want, but really, I think if you go back to 2 million years of evolution on earth, what were people eating and what's good for us.  

Some of the [unintelligible [00:42:23] literature on just acne in teenagers. I think, there was 5,600 teenagers with acne, and they put them on a paleo diet. So, meat, fish, eggs, fruits, vegetables, nuts, and seeds. Nothing processed, nothing added, no grains, no beans, no dairy. I think, 90 plus percent of them in six months, their acne was gone. I think that's what we find in our clinic that many people within six weeks if we can just get them on the correct foods and depending on what their disease process is, it's either some form of keto or some form of paleo, get them off grains, and beans, and dairy, and nightshades that their digestion gets better, and they usually lose a couple of pounds if that's what they wanted to do, and they start to feel better, and they have cravings for a couple of weeks but that goes away, and they get more to what I really think a native diet is for humans.  

Melanie Avalon: What do you think is going on with the long-lived populations to have lower protein intakes? I'm haunted by this question. I'm haunted by the low protein for longevity theory.  

Dr. David Minkoff: Well, what they say is, eat low protein, push your IGF-1 down as far as you can, have a body that you're cold all the time, and lose your muscle, probably your brain, and that you can live longer, and that's ideal. On the flip side of that is, manage your mTOR by getting plenty of protein with periods where you don't have protein, and keep your hormone, and your body temperature, and your growth hormone, and your other hormone levels up. Keep your muscle mass that I think, you're going to live just as long and the quality of your life is going to be better. I just think this other thing isn't right. [chuckles]  

Melanie Avalon: I actually recently had Dr. Valter Longo on the show and he does a lot of research in fasting and low protein diets, and I was asking him because the diet that I follow is I eat super high protein, but I do fasting every day. So, I have periods of low mTOR during the fast and for listeners mTOR is basically the genetic pathway for a growth stimulus responding to food and other things, maybe, but probably-- or just food, I'm not sure. In any case, having low mTOR during the fast and then eating a really high meal at night, I feel like it's the best of both worlds because you mentioned, you get all of that-- the building blocks that you need and all of the support, but then you can still have the fast during the day. When I don't want to eat low protein, I'm starving. I crave protein like none other. I asked him if my body would adjust to a low protein diet? He was saying that the body does adjust that it would take like a few months. I've heard that before that like your body adjusts to your protein intake. Is there something actually going on with that or not really?  

Dr. David Minkoff: Well, people in all different cultures, in periods of starvation adjust to little or no food. But in today's world, the challenges to being healthy these days are very tough, because there's so much poisons around that we're in and so much denatured food that I think if you're eating low protein, you're eating starches all day long. You're eating starches. You're going to eat potatoes, and rice, and beans, and I've done that, and you can adapt to it. And I think that there are-- that it isn't for me a one size fits all. I saw somebody today and she's a tall, muscular female, very athletic, and she's been trying to do protein fat, and she's starving all the time. I said, "Well, why don't you add some carbs and see if that doesn't help you better?"  

I think some of it is working with what you got but I think if people who are eating, 60% of the population is obese and has insulin out of control. And most people I see that are high carb diets cannot control their insulin with high carb diets. It goes high and they build body fat and they lose body protein, and if you have your CGM on and I've been wearing a CGM for three years, my body will not tolerate. Everyone in my family has diabetes and heart attacks. So, everybody has their own genetic sort of makeup. But if I do a six-hour bike ride pretty much fasted I'm taking PerfectAmino and electrolytes, and I'm totally fine. My blood sugar at the end of six hours is 87. It's steady, and my mental clarity is really good, and I go home and think, "Oh, boy, I deserve some carbs now. I'm going to eat some carbs" and I put a cup or a cup and a half of blueberries in a smoothie with some green powder and some fish oil and throw a couple eggs in there. My blood sugar will go to 180 on a couple of blueberries. 

Now, that's me, but when I have people wearing these CGMs and I have hundreds of people wearing them. If they want to get their blood sugar under control, they can't eat carbs, they can't eat potatoes, and they can't eat rice. I've done this experiment with myself. I love black beans. But if I go there's a Mexican restaurant across from my office, the food is fresh, it's really good, and I go in there and say, "Okay, I want a bowl." Now, usually they'll put rice on the bottom but I can't eat rice. So, I say, "Okay, put a couple of handfuls of shredded cabbage," and then they'll put a spoonful of like a big portion of guacamole and a big portion of some chopped up pico de gallo type stuff, and then they have some peppers and onions sauteed throw that in there, grill me up six shrimp. perfect meal. I go in there with my blood sugar 90, it goes to 102, it comes right back down to 90 within an hour, and that's a perfect meal. If I take that same meal and I say, "Okay, I want some beans today," and they'll give me a scoop of black beans. It's probably a third of a cup, my blood sugar will go to 155. So, I just don't find that if you do those diets for most people, at least the people I'm seeing that they'll ever conquer their weight, or their visceral fat accumulation, or their insulin glucose dysregulation. 

Melanie Avalon: Yeah, I'm so glad that you touched on that because I'm all about finding what works for you personally and people seem to react all over the board especially to different macronutrient breakdowns. For me, I actually-- so I mentioned I eat a ton of protein like pounds of meat or fish every night, but then I will do either low carb or low fat. So, when I do low carb, I add fat to it, but when I do low fat, I actually eat tons and tons of fruits. So, I bet listeners were listening, laughing during the blueberries because I will eat like pounds of blueberries every single night with a lot of protein. 

Dr. David Minkoff: Does your sugars stay good? 

Melanie Avalon: Yeah, so, it normally like before eating, it'll usually be in the 80s, and then it'll go up maybe to 120, maybe a little bit higher, but then it goes back down, and then it's back to normal.  

Dr. David Minkoff: Well, you're lucky.  

Melanie Avalon: If I were to add fat as well, then I can't do that. It's like I have to be in like a low-fat context to have the high carb. So, it works for me. Something you mentioned, though, I did want to ask you about the BUN a little bit more. Is that a good indicator of kidney health or could you have a high BUN if you're eating high protein and still have functioning kidneys? I guess the GFR more important or? 

Dr. David Minkoff: The GFR is more important. I think you have to look at creatinine too. So, if you're creatinine's under 1 and your BUN is say high normal and you're eating a high protein diet, I think it just means that you're breaking the protein down, the nitrogen showing up in your blood. I don't think it's unhealthy. But I think if it's running too high, it may be that you are getting too much protein assuming that you have normal creatinine and normal GFR. 

Melanie Avalon: Okay, gotcha. Yeah. Mine's always high, which could be from all the-- 

Dr. David Minkoff: Above their range?  

Melanie Avalon: Mm-hmm. When they do the other kidney tests, they're normal. So, I think it's just the massive amounts of-- The only time I've seen it low-- because it's always high. The only time I've seen it low was I actually had anemia, and I had to be in the hospital for it. So, I was eating hospital food and wasn't able to eat my massive amounts of protein. So, my BUN normalized during the hospital stay. 

Dr. David Minkoff: You know the other thing you might try is because the protein has a high-water content too, and before the blood test in the morning, drink a couple of pints of water, an hour before the blood test, because BUN also can show like, if you're a little bit dehydrated, and you hemoconcentrate a little bit that it may be that, and so if you get up at 7 o'clock and you have a couple of quarts of water, and then your test is at 8 o'clock or 8:30, it may dilute you out to what would be normal for you if you weren't mildly dehydrated and then it might look normal.  

Melanie Avalon: Thank you. I will definitely try that. Some random questions I thought of, you're talking about the different usability of the different foods and with eggs being the most usable and chicken being up there as well. So, I'm doing an episode pretty soon on spirulina, which gets the-- what's the word? Something about it being like the highest protein content per weight or whatever. But you do talk about in the book, so, what should be understood there with things that are branded as being high protein, but maybe that's misleading. So, spirulina-- 

Dr. David Minkoff: Well, spirulina, we looked at 20 some strains of spirulina. What's important in the byline is, that's all that whales eat spirulina and they eat this stuff, these algae and look you can grow a 20-ton whale or whatever they weigh. But we're not whales. The amino acids that we need are the ones that we need. So, a baby calf can drink cow's milk and grow into a substantial animal but spirulina has a very low net nitrogen utilization. It's missing a couple of essential amino acids or they're there in very low amounts. The analogy is like, you want to build a car which would be a protein and in order to build a car, you need four wheels, and a chassis, and a steering wheel, and a motor as sort of the basic minimum thing. So, the protein is the car, and it's got components of wheels, chassis, steering wheel, motor. Now, if I drop off on your manufacturing lot a hundred wheels and a hundred chassis, and a hundred motors, and 10 steering wheels, how many cars can you make? Well, you can only make 10 because if you don't have a steering wheel, you don't have a car.  

Now, what are you going to do with all the rest of the stuff? In the body, there's no storage depot for protein. So, for carbs, there's a storage depot, it's glycogen. For fats, there's a storage depot, it's fat. So, some of the carbs can get stored as fat and some of the fat can get stored as fat, but in proteins, there's no storage depot. It's the tissue itself. So, now, you've got all these excess amino acids or these car parts, which weren't utilized to make that car. You got a whole set of wheels, and 90 extra chassis and in the body, what happens is, that's your BUN It's not utilizable. So, it's going to get broken down. So, the nitrogen comes off, that's the BUN and the other stuff is the calories, and the calories get burned or stored depending on what the body needs are. So, spirulina is a lot of wheels, and a lot of chassis, and a lot of motors, and hardly any steering wheels. So, the body just doesn't do much with it, because it can't, because it isn't what's needed.  

Melanie Avalon: So, because I'm assuming with your PerfectAmino supplement that it by itself works with itself to be completely utilized, if you're in a situation where you have your normal meal with your normal protein, and then you just add some PerfectAmino to that meal, does it at all help utilize the protein from your meal or because it's perfect in itself, does it just utilize itself?  

Dr. David Minkoff: If you want it perfect, take it 23 minutes before your meal, and it's in your bloodstream, and it's 100% utilized or 99% utilized, and then eat whatever you want, and you get whatever benefit you get out of it. If you added it to, let's say, you added it to whey protein, then you'd get somewhere in the middle, it would bring the 16% of the whey up to, I don't know, maybe 50%. Then you dilute down the 99% to where there was a halfway medium. So, it works both ways. But if you want the maximum use out of it, take it on an empty stomach or with something that doesn't have fat because it'll get stuck in your stomach. So, if you have it with some fruit, or fruit juice, or vegetables or you know, it goes in very fast and it's utilizable. It can be used with other foods as well. It just will bring up the low utilization of the other proteins, and the amount that you'll get from the PerfectAmino will be less. 

Melanie Avalon: And how is it different from BCAAs. I bet listeners are like, "Hmm, can I just add--?"  

Dr. David Minkoff: Well, BCAAs, that stands for branched-chain amino acids. Leucine, isoleucine, and valine in the carbon-hydrogen-oxygen structure of the molecule, there is a branch. One of them is going one way and the other one's going the other way. So, they call branched-chain amino acids and those three. There's been a lot of promotion of branched-chain amino acids, as boy, these are the things. If you take branched-chain amino acids, since it's only three out of eight, you don't use any of them. They're going to turn into carbohydrates. The research on branched-chain amino acids, what it shows is that if you use them while you're doing things, you will spare your own body from breaking down its protein, so it can get the calories out of the protein for glucose and fuel or you will burn the branched-chain amino acids, but they're basically a complete waste of money if you're trying to use them to build your own body protein. They don't do it. The nitrogen utilization is zero. Now, if you add them to other foods, you get some benefit and you could sort of maybe piece together something better than zero. But I think you might as well just have a banana because that's basically what it's doing. It gives you some calories that are utilizable and I don't see the benefit of them. 

Melanie Avalon: So, are they muscle sparing? 

Dr. David Minkoff: They could be muscle sparing, yes. If the body needed calories and it couldn't access your own body fat or your own glycogen.  

Melanie Avalon: Okay. Another topic that we haven't touched on yet, but it's a huge, huge part of your book as well is the role of enzymes. I'm obsessed with enzymes. So, what are enzymes, are they also made from amino acids, and how do they interact with proteins, what are they doing? 

Dr. David Minkoff: Yes, so, probably the step-in evolution that occurred very, very early on before there was any life is on a biochemical level, there was an accidental assembly or created assembly depending on how things started. Where you had a protein, which had an ability to put other things together and the things that were put together could do something that the things separately couldn't. And that's what an enzyme is. An enzyme is something that allows a reaction to occur between two or more things that you can then make something different and possibly better out of it or if you have something that's already assembled, and you want to break it down that there are enzymes, which will cleave the bonds between things to separate things out. So, enzymes make the body go, they are the reason that we are able to have a biochemistry that we live, and there's some enzymes that are necessary in digestion, and they break food down. So, if you have a protein with you ate a steak, and you have 5,600 amino acids in a chain, which the body can't use, it's too big. It can't absorb it. So, these enzymes start in the stomach and they come in the small intestine, trypsin, chymotrypsin, pepsin, they start cleaving these amino acids off.  

Now, you have 5,600 separate little pieces, which then can be absorbed in the body, and then another set of enzymes allow the body to put leucine next to valine next to tryptophane, and make XYZ protein. So, they're either used in assembly to put things together or they're used in breakdown to separate things and they're all proteins. So, one of the catch-22s that happens is a person is on a low amino acid diet, and one of the things that the body has to make out of those amino acids is digestive enzymes. So, the pancreas makes enzymes and the stomach makes enzymes to digest proteins. But if you're on a low protein diet and you don't make-- you don't have enough coming in and the body has low levels of pepsin, which is a digestive enzyme in the stomach or chymotrypsin or trypsin, which are digestive enzymes, which enter the small intestine from the pancreas when you eat, then the digestion of those things is going to be slow or not good, and people after a while like I eat meat and I get a stomachache, well, because you don't have enough digestive enzymes for the process to occur smoothly.  

So, we'll measure levels of chymotrypsin in the stool in people and almost everybody we test who's over 40 has a chymotrypsin level of between 5 and 10, that ought to be between 30 and 40. They need digestive enzymes and they need more amino acids, so that eventually, they could get to the point where now they have enough amino acids, they can make all the trypsin they need, they can make all the pepsin that they need, they can make all the thyroid hormone that they need. Something we didn't talk about is all the neurotransmitters, these are the molecules that the nerve cells use to communicate. So, serotonin, and dopamine, and GABA, these are all made out of amino acids. 100% of depressed people, anxious people, sleepless people have disordered neurotransmitters. A good part of the reason is they don't have the building blocks of amino acids to make them. So, they're short. Doctors prescribe medications, Valium and SSRIs, which don't-- they don't complete the amino acid deficiency, they just poison a nerve cell membrane and for a while the person might feel better, but they're not correcting the actual problem.  

These amino acids have such a broad role in overall body health that depending on what your body's deficiency is, it could fill that hole in a relatively short period of time. I'd tell people to give it three to six months you may feel a big difference much quicker. You will fill things in, and when it fill things in your body will work better, your immune system.  Your immune system is proteins. These things, these cytokines and these leukotrienes, they're all proteins. So, in today's world where we have an epidemic, you need amino acids like mad because you want to make sure your immune system is in top shape. A lot of people we see have-- and their blood tests, they have low globulin. Globulin is immune-- short for immunoglobulin. These are proteins that are immune proteins. And they'll have low globulins and they have some kind of low-grade chronic infection. They have a parasite or they have an infected tooth that they don't know about, or they have something or chronic Epstein-Barr or something, and they have low globulins. Their body's immune system is down. It's not going to fight. If we can supply enough amino acids, we can get the body to then fill in these things, and then of course it might be other vitamins and minerals, and essential fats because it's not a one thing corrects everything, but this is what I found is the most neglected one.  

Long time ago, I was the keynote speaker at the American College of Nutrition, and I did a lecture on this topic. So, you had 300 people in there who were all either PhD dieticians or they were clinical nutritionists, and they had never heard any of the information I'm telling you now or what's in the book. By the way, you can download the book free on the BodyHealth website, a PDF version, or you go to Amazon and buy it for nine or 10 bucks, it's cheap. It will maybe fill in some of the holes I'm talking about here, but I was supposed to speak for an hour and I spoke for 15 minutes and then I was going to take questions. The questions went on so long that the next speaker got postponed an hour because these people were basically, "Why haven't we ever heard this, why didn't we learn this, why don't we know about this?" If you look at what normal dietary practice is, it's so off base that what they've been sold is what companies who manufacture different things have sold them. It's really isn't practical tested science. Among the most neglected parts are like amino acids and proteins, and how important they are for healthy body.  

Melanie Avalon: It's so neglected. I'm just thinking back I've seen so many doctors and done so many blood tests. Nobody has ever suggested doing a test for amino acids ever. I don't think they would know what to do if they did like, actually, that's a question. So, say you got back a blood test with your amino acid levels. Is the solution ever to selectively supplement with a certain type of amino acid or is that really always to do something like PerfectAmino where you're getting all the different ones?  

Dr. David Minkoff: For the general blood test, it's PerfectAmino. If I do neurotransmitter tests and they have low serotonin, I will supplement tryptophane or if they have low dopamine, I will supplement tyrosine. So, you can use these individual amino acids because they can be active, and they can push pathways, or they can help. So, I think that in general, people need the whole thing and you may need to add in addition to that, targeted things to make those separate things go faster.  

Melanie Avalon: Okay, gotcha. Then, major question about the digestion that you're talking about. So, the digestive process and the ordering of that and stomach acid, HCL, digestive enzymes, I know I take HCL and digestive enzymes, I know a lot of my listeners do as well. Something I've wondered about for a long time and has made me nervous is, you outline it in the book like the specific order of digestion and when these things are released, and what they do. If a person is supplementing casually with HCl or digestive enzymes, can the timing of that, the ordering of that mess up the natural order of how digestion is supposed to occur, like pancreatic enzymes closing the sphincter or something like that? 

Dr. David Minkoff: No, I think they complement it like we-- at BodyHealth we make a product, we go full spectrum digest, and it's a mixture of digestive enzymes plus hydrochloric acid. You got to get the stomach acid if you're going to prevent heartburn, and you got to get the stomach acid if you're going to absorb minerals and digest protein. So, I usually tell people, eat half your meal, take two or three of these capsules, eat the rest of your meal, and then the digestive enzymes will start digestion in the stomach, protein digestion is supposed to start in the stomach. Hydrochloric acid activates the enzyme in the stomach, which starts protein digestion. That's called pepsin. Then as it goes through into the small intestine, it goes from an acid environment to an alkaline environment, and the body will naturally do that, and I don't think you mess anything up. Hydrochloric acid will close the stomach sphincter so that you're not going to burp back up acid, and in most people, it cures their heartburn. Then the stomach, when it's done digesting will open up into the small intestine, and it seems to go very smoothly without problems. So, I don't think you can really mess it up by doing what you're doing.  

Melanie Avalon: Do you suggest any order to the enzymes in the HCl or just all at once with the meal? 

Dr. David Minkoff: I think you can take them all at once. Yeah. 

Melanie Avalon: Okay. I think about this like every single night that I eat. Okay, well, this has been really, really amazing. Was there anything else that you wanted to touch on that's really important to share with listeners, any other topics related to all of this? 

Dr. David Minkoff: I think, just to go back for a minute, this biochemical individuality. We're all a little bit different, all things that work for us. In my own experimentations with myself, I usually try to find something that I can actually monitor and see if in three months, that is whatever the intervention I'm making has made a difference. There's so much promotion in these fields and some stuff's really good and some stuff doesn't do anything, and it might work for one person, and it might not work for that person. I think there're some basic things that almost all of us need. So, I put every person I see. We make a Multi at BodyHealth, and it's two tablets in the morning, two tablets at night, and it's got about the middle 50s dollar wise for cost. But if you tried to take this stuff, separate CoQ10 and separate activated folate, and separate each of all the B vitamins, and separate 16 whole food extracts in there. So, separate liver support stuff, you spend probably $200. But it's got all this in there and almost everybody needs some of this. So, that that's sort of as a basic, oh, so I put everybody on that.  

We measure levels of omega-3 fats in people and almost everybody's low, so, put them on an omega-3 supplement, because they just needed it, it's an anti-inflammatory, it's well tolerated. The fish oils on the market now are distilled, they're pure, if it's from a good company. We make one called Omega 3 Health, it's really good. That's sort of-- Everybody needs that, and everybody needs essential amino acids, and everybody needs a green powder concentrate. So, there's oodles of them around find one that you like, it's 10 servings of fruits and vegetables, and it's worth it as an easy way to add antioxidant levels to your body. Almost everybody needs magnesium and almost everybody needs a source of iodine. So, if you're eating seaweed, fine. Otherwise, take in iodine supplement because iodine deficiency is real. If you're living in Japan, you won't have it because of your diet. But in most of the United States, the iodine levels in food and soil is low. So, those are basics, like, it'll do almost everybody good. 

Then eat organic. If you're better on carbs or you're better on protein, but organic food really makes a difference and it's really important it's worth the money. Then, I think, the other things that are important is, you got to make sure that you get enough sleep and vitamin D is the other one, and in our BodyHealth Multi, there's 5,000 units of vitamin D. For most people that's enough, some people need more. If you look at things from that viewpoint, you can at least get in things that you must have and then there may be things that you can add to make you better. I've been using an Oura ring for a few years, and I've been watching my heart rate variability, and I'm trying to make my heart rate variability like it used to be when I was 40. I've just not been able to figure out like, "What will make that better?" My variation and exercise haven't done it, and my sleep hasn't really made any difference, but I started taking a couple of supplements, some of the couple of advertised mitochondrial supplements, and my heart rate variability has almost doubled in two months. I feel it by how I feel but I've got a metric, I've got a number that I'm like, "Holy smokes, in my body, this stuff is really working."  

I think and for the people who are like optimization in themselves, that maybe it's amino acid levels or maybe things like this that you can look at, and then you can make the interventions and you could help yourself and you could get better. In our patients, this is what we do. I have a symptom questionnaire. It's a hundred symptoms and every time they come in, they go through the symptom questionnaire. I get somebody who comes in with a symptom questionnaire score of 198, which is terrible. Zero's ideal. They come in at 198 and I see them three months later, and their symptom score has gone to 54. Before I looked at the symptom score, I said, "How you doing?" They said, "Well, I think I'm a little bit better." Show them the thing, you get used to however you are and they took hundred points off their symptom score, this is massive. So, I can measure that stuff, and then we do a bio energy test where we test their mitochondrial function, actually, put them on a bicycle and measure, how well do they produce ATP for their body? When they are getting better, their scores go up, their bio energy scores go up, and then we have objective measurements, and then it's reflected in how they feel and how they look, and then I know their health is actually getting better. 

Melanie Avalon: What is that mitochondria test-- test like what substrate?  

Dr. David Minkoff: The bio energy?  

Melanie Avalon: Yeah.  

Dr. David Minkoff: It measures the inhaled oxygen versus the exhaled CO2.  

Melanie Avalon: Okay.  

Dr. David Minkoff: So, it's a resting basal metabolism. 

Melanie Avalon: Okay, to show if they're burning carbs or fat.  

Dr. David Minkoff: It shows if they're burning carbs or fats, but it also shows if the thyroid's worth anything. It's the best monitor I've got or that I've ever seen. If you've got a-- the test is called an M-factor, it's metabolic factor, if a person has got a metabolic factor, 100 to 110 is ideal. But if someone has a metabolic factor of, let's say, 75, and I reach over and feel their hands, and their hands are cold, they're hypothyroid. I don't care what their blood levels look like, they're hypothyroid. If we start adding thyroid onto them until their metabolic-- until their resting metabolism goes into normal range, their body will warm up, their energy will get better, their thoughts will be clear, they'll start to lose weight, their free T3, free T4 will go from middle low normal to high normal, they won't go high range. But the blood tests are very hard to monitor for that and this bio energy thing really, really is very-- it's not perfect, but it's really helpful for that.  

Melanie Avalon: Wow. Is it they breathe into it?  

Dr. David Minkoff: Yeah, it's a mask and it measures them for 20 minutes breathing, how much in, how much out. Then we put them a bike and we increase and see where they can, you know, like what-- it tests their VO2 max, but it also tests what their exercise tolerance is. Some people are at VO2 max at rest, like they can't push the bike. The chronic fatigue patient that says, "I can't get out of bed. Like my win today was I was able to roll over, and put my feet on the floor, and then I had to go back in bed," because they're anaerobic at rest. What this bio energy things tells you is, what are their anaerobic thresholds and at threshold are they burning fat or they're burning carbs? Your body is supposed to burn mostly fat until you start to stress it and these guys when they first get bad, they stop burning fat, they stop burning carbs, and then pretty soon their thresholds go down, so that it their threshold. Then you look at somebody who's got a VO2 max of 90 and you can't hardly even get them to hit threshold because their performance is so--  

I think, one of the stories with Lance Armstrong was that they had trouble getting his lactic acid up going up a steep mountain and all he could because his body was so efficient at producing ATP and converting lactic acid, and ATP that it gave him the performance that he had. So, you can measure this in sick people and you can get a good idea. It's another way to-- What I'm want to be sure of is what I'm doing working for that guy. Yes, they got to feel better and look better. But what's their medical symptom score, what's their bioenergy score, what's their heart rate variability? That these things are objective measurements that are easy to measure and you can then-- that's the game we play. How can we get this better? The people that are on the high end, their incidence of chronic illness, and cancer, and heart attacks, and all that stuff is way, way down because their physiology is working. 

Melanie Avalon: Yeah, I love that you talked about that. The importance of markers that you can actually measure. I, as well. I have an Oura ring. I'm obsessed. I've had Harpreet, the CEO on the show multiple times. The thing that I recently have changed that has-- I'm like shocked at how much it's affected my Oura ring scores is, have you heard of a Somavedic?  

Dr. David Minkoff: I don't think so.  

Melanie Avalon: It's a glass housing and it has various precious stones on the inside. It sounds really woo-woo. But you plug it in, and they've done studies on it, and how it mitigates EMF, damage to cells. I wasn't sure if it was actually going to do anything. I've started using it and my Oura ring scores have improved since using it so much. 

Dr. David Minkoff: Both sleep and readiness?  

Melanie Avalon: Mm-hmm. I'm shocked, honestly. They sent me one originally. Now, I'm so sold. I bought another one so that I could cover my whole apartment with it 

Dr. David Minkoff: S-O-M-A-V-E-T-I-C?  

Melanie Avalon: S-O-M-A-V-E-D-I-C.  

Dr. David Minkoff: Okay. [laughs] Like it took it from 75 to 85, or took it from 80 to 81?  

Melanie Avalon: Like lower mid-70s, and I'm in the 80s for the readiness.  

Dr. David Minkoff: With same number of hours of sleep and same everything else?  

Melanie Avalon: Mm-hmm. Like nothing else has changed. Well, lots of stuff changes every single day of your life, but nothing that I'm consciously aware of. It's impressive. 

Dr. David Minkoff: Is that $5,000?  

Melanie Avalon: Not the $5,000 one. No, they have one that's $5,000. 

Dr. David Minkoff: I was kidding.  

Melanie Avalon: Oh, they do have one that's $5,000 where it's like plated with gold or something. [laughs] I don’t know. But no, they have studies on it though. One is published in the Clinical Journal, the others are not, but they're so pretty impressive. So, yeah one last thing. I just have to touch on because you brought it up and I know my listeners are going to be asking me about this. The iodine thing, there a few like nutritional things I'm haunted by, one we talked about this entire episode, which is low protein versus high protein. But iodine is the only supplement I've taken before where I so severely reacted to it that it just scared me. But then beyond that, I read Dr. Alan Christianson, The Thyroid Reset Diet and had him on the show. He's very much a proponent of iodine being the problem with the thyroid. So, too much iodine, and his approach is actually an iodine restriction diet like a low iodine diet, I'm just wondering if you come across any of that at all because now, I don't know, I get so nervous about supplementing iodine.  

Dr. David Minkoff: Well, I mean, you can eat seaweed. The average Japanese person has about 12 milligrams a day of iodine. That's from their normal diet intake with the fish that they eat and the nori that they eat. It's about 12 milligrams a day which is really a lot [unintelligible [01:21:29], I think is 400 micrograms or something like that. It's really low. For a long time, we did iodine challenge tests on people. We gave them iodine, and then we did the urine, and if they were sufficient in iodine in their body, they would dump all the iodine, but if they don't dump the iodine and they hold it, the theory, the test is that they needed iodine. I think after the 501 with 490 of them showing that they had iodine insufficiency. I started adding iodine to people and we found a lot of hypothyroid people. On their amino acid tests, they had low tyrosine, and they had low iodine, and if we gave them iodine and we gave them PerfectAmino, which the amino acids would convert to tyrosine that their thyroid numbers would normalize and they could come off thyroid if they were on thyroid medication.  

Iodine, I find is-- the thyroid needing iodine will fill itself up with fluoride and bromide. If you start giving iodine, they will start to dump their fluoride and bromide and chloride, and they will get iodine levels that are good. I can't tell you how many women I've seen that have fibrocystic breast disease and you put them on between 12 and 15 milligrams of a day of iodine and in three to six months their fibrocystic disease disappears. It goes away. The breasts soften up, the cysts away, same with ovarian cysts. It's really, I think, rare that someone like, I grew up in Wisconsin and it was the goiter belt. It was a goiter belt because there's no iodine in the soil in Midwest.  

When we were in like fifth and sixth grades, they would give us chocolate flavored iodine tablets in school every day. They tasted really good and we all fought over trying to get a second tablet because they were trying to get rid of this epidemic of goiters, of hypothyroidism. I don't think that-- I mean, he's got his own experience, but my experience is almost everybody needs some iodine, and especially, in those circumstances where there's any kind of cystic disease or hypothyroidism that it helps people. I give them my average as a half of a-- but I order all tablets at 6 milligrams of mix iodine iodide. The side effects of too much iodine are metallic taste and headache. I almost never see it. There're a few people who are iodine sensitive, so, I wouldn't push it with them, but I try to get them to eat food that has higher iodine levels, so that they at least get it. 

Melanie Avalon:  Yeah, no, I love hearing all the different perspectives and your perspective is that, I think the most conventional perspective or what I hear from a lot of doctors. Just it's always interesting to hear the different theories. What happened to me was my eyes turned bloodshot red. I was like, "Oh." That was how I knew it definitely-- because when you're "reacting" to a supplement like it can be vague like, "Oh, I feel different, or brain fog, or but--" No, this was like [giggles] my eyes turned to red. 

Dr. David Minkoff: Well, I mean, hypersensitivity occurs or you got a histamine reaction from it for so sure. So, I think that, it doesn't mean that you are iodine excess. It may have been that you are iodine sensitive which-- that surely can occur. 

Melanie Avalon: Yeah. Well, thank you for listeners. The show notes for today's episode will be at melanieavalon.com/perfectprotein and I will put links to everything that we discussed here. The products and listeners can get PerfectAmino for themselves as well. Oh, yeah, we didn't even mention, listeners, definitely get the book, The Search for the Perfect Protein because we just barely touched on everything that's contained within-- Oh, I was going to ask you, the studies that you talked about that were done like with athletes using PerfectAmino. So, I was wondering if they were actually using yours or if they were using something that was similar to what you've created?  

Dr. David Minkoff: It's the same formulation.  

Melanie Avalon: Okay, gotcha. Awesome. Well, the last question I asked every single guest on this show and it's just because I realized more and more each day how important mindset is. So, what is something that you're grateful for?  

Dr. David Minkoff: Oh, too many things. I've got a wife of 52 years and I've got a practice that is extremely fulfilling. I actually touch people every day and it's an amazing feeling to go home and know that you really helped a lot of people, and I have my own health, which I'm really grateful for because all my family members are sort of train wrecks body wise, and I can still do Ironman triathlons. I can live my purpose every day and enjoy it. I have eight grandchildren and three good kids. I could probably go on for a couple of hours. 

Melanie Avalon: I know. I love it. Well, thank you so much. I'm so grateful for the work that you're doing. I'm so excited that we connected and that I read your book because like I said, this was a topic I've been wanting to learn more about, and dive deep into, and that is what you are doing. Then, on top of that, not only are you spreading the information with the book but you've created this PerfectAmino supplement, so people can actually take some agency and hopefully change things for the better with that. So, thank you so much. This has been amazing and hopefully we can talk more in the future.  

Dr. David Minkoff: Sounds great. Thanks, Melanie. 

Melanie Avalon: Thanks. Bye. 

Dr. David Minkoff: Bye.