Today we hear how nutrition can prevent and reverse chronic diseases from two leaders in the field. 

David Rambo is the founder and CEO of Simplex Health. 

Dr Avi Gurwitz is Chair of the Department of Pediatrics and Medical Director of the Pediatric UrgiCare at Holy Redeemer Hospital. He CMO at Simplex Health. Ari received his medical degree from

State University of New York Downstate Medical Center College of Medicine 

 #longevity #wellness  #Ketones #lifestylemedicine #younger #ketosis #biohacking #chronicdisease #RobertLufkinMD #readouthealth #alzheimers #simplexhealth #davidrambo #avigurwitz





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Robert Lufkin 0:00
Welcome back to the health longevity secrets show with Dr. Robert Lufkin. Today we look at how nutrition can prevent and even reverse chronic diseases with two leaders in the field. David Rambo is the founder and CEO of simplex Health. Dr. avi gurwitz, is chairman of the Department of Pediatrics and medical director at the pediatric urgent care center at the holy Redeemer hospital. He is also Chief Medical Officer at simplex health. Barry received his medical degree from the State University of New York Downstate Medical College Medical Center College of Medicine. Before we begin, I would like to mention that this show is separate from my teaching and research roles at the medical school which I am currently affiliated. It is part of my continuing effort to bring quality evidence based information about health and longevity to the general public. Now, please enjoy this interview with David Rambo and Dr. avi gurwitz. Dr. avi gurwitz. David Rambo. Welcome to Health longevity secrets.

Avi Gurwitz 1:09
Thank you for having us. Yes, thank you.

Robert Lufkin 1:12
Great, I think we all three share a common vision that I know it’s it’s your vision of reimagining the conventional health care model with progressive evidence based clinically proven protocols that can prevent and even reverse the world’s most disruptive diseases and chronic conditions. And before we before we dive into that, perhaps we’ll just take a moment. And you could tell us a bit about how each of you came to be involved in this fascinating space.

David Rambo 1:55
Great, well, I’ll take that one. First off. So again, I’m happy to be here. Thank you for having us part of this. You know, we’re really excited to share our story and be part of this change. So, simplex was formed primarily out of a personal experience that I dealing with my own diagnosis at age 34, I was diagnosed a type two diabetic with an A one C of 11.8, a fasting glucose of around 350 following a couple year period of moving along the conventional care paradigm, where I’ve been feeling sluggish in 2009, was addressing some thyroid conditions that led to another host of medications, you know, from there, before I knew it, I was on compounded t three, t four, and some other medications. And then finally, the diagnosis came in June 1 2012. And I was, you know, treated accordingly. My primary care physician, you know, set me up with medications to help me manage this condition. It was around 13 months later, where I was introduced by a physician who’s no longer in practice now, but was in the concierge side of the field, who had helped my son with a skin condition that he had had plaguing him his whole life, you know, eczema, since he was four years old, despite creams and the conventional treatments and stuff and the antibiotics. And in a matter of two weeks, just from adjust thing, his food intake, all of that was plaguing him was gone. So that got my attention at that point. And through just meeting with this physician. And sharing my diagnosis, she had introduced this concept that what I was dealing with type two diabetes was something that she could help with. And I don’t want to say I dismissed it. I didn’t take it as seriously at first. But I immersed myself into some of the work that Dr. Lustig had done in the space. He’s actually a advisor with simplex now and went on a pathway to really lean in to this idea that this condition that I had been living with and managing for 13 months was eminently reversible. And at that point, I about well, about four months after me applying a food as medicine approach. I was off all five of my prescription medications, I lost 50 pounds, and my life was just changed. serendipitously. I know, I met Dr. gerwitz. Being in the ED ironically I was in the wellness space. I met Dr. gerwitz at a, at a health club, I had an ownership interest in at the time. And him and I became friends and he had been following along that journey with me. And then learning about you know, we were discussing the tenants of functional medicine and he being in the space that he was in was seeing the need for change. And we just, you know, brought these these ideas together, where we were going to do something about it and, and, and bring the model of care that I had to as many people as possible. So that was the idea behind where simplex started is that we were going to be the execution behind the idea, the idea of this food is medicine model.

Robert Lufkin 5:46
Yes, food is medicine is is definitely a very powerful concept. And one theme we’re hearing repeatedly from our experts in this interview series. Several people have commented that the single most powerful lifestyle choice we can make in our lives is managing our nutrition. And some people even go so far as to say it, and that is by removing sugars and refined carbohydrates from our diet, or at least decreasing them. But nutrition, yeah, is is a key area. And I’m excited to hear about your approach to nutrition at simplex health. Specifically, we hear a lot of things about, about choices in our in our diet, how much we eat, when do we eat, what types of food we eat, and, and even macronutrient sequencing. So what what is your approach to that.

David Rambo 6:45
So we set out to be to challenge the status quo of conventional dietetics. And our model is based upon using registered dietitians so that way we can work alongside, you know, well intended physicians that maybe don’t have the education, training or time to help their patients implement nutrition changes that challenge the conventional dietetic paradigm. So we learned and just through and through myself, following the work of the thought leaders in the space of the carbohydrate insulin model there that we were doing this all wrong, and that conventional dietetics was really just making everything worse. But at the same time for our model to work and provide the accessibility and remove the barriers to entry to work with us, we wanted to use the conventional surance insurance model. So that’s why we are set out to find dieticians that were philosophically in line with us that were willing to follow a set of protocols that were challenging, you know, the challenge what they were taught in school. So what are current therapies focus around, and I’ll just speak to one of them, that is probably our most effective the tenants of it are, it’s an insulin optimization protocol, and its two components are a low insulin diet. Okay, that was developed alongside, you know, Avi and Dr. Lustig in our clinical team, and increasing amounts of intermittent fasting. Okay, and we use so that would be so we have clinical guidelines that we provide to our practitioners to guide them through that therapy with a patient based upon some other bio behavioral clues that we learn from their blood work that we get back that we have access to, through the EHR that we’re a part of, with the health systems that we partner with. And we all you know, their current status in terms of their understanding of the role of nutrition, what barriers there are, you know, what their cultural persuasion is, so we fine tune an approach for them, that helps them you know, look at that, you know, that insulin resistance, that disease pathology all the way through, and then we apply one of our nine therapies to that.

Robert Lufkin 9:16
It’s certainly a challenge, I guess, in multiple ways and in my medical training, which was a long time ago, but I’m Can I also teach at medical schools outside I do see the medical education that that students and residents are getting in nutrition. It’s I have to say it’s better than what I had, but it’s still given the fact that nutrition is such a powerful factor in health, I think we could still do a lot better in our medical school education with nutrition and then, as you say, The other challenge is sort of differing views about what The ideal nutrition is and some, some dietitians and other health experts have have dramatically different views about the best way to approach chronic disease and even what constitutes a healthy diet. So your affiliation with Dr. with Rob lustick is real as is a strong credential. And he is he’s, of course, one of the thought leaders in this area and has some great ideas on it. What? What diseases are you? Are you looking to address initially? And what are you what do you find this, these these nutrition approaches most effective for in your experience?

Avi Gurwitz 10:46
I’ll take this day. So I work in the acute side of medicine, I see more of the injuries in the VR side of things. And what I started noticing is, you know, people that come in over and over and over again, with BMI is beyond numbers that we can say. And it’s almost as if it seems like the world has accepted that if you get older, you get diabetes, hypertension, hyperlipidemia. It’s just because that’s what happens. He had 4050. And you just, this is normal. And, you know, that’s that’s what got me into a deeper dive into. Well, it’s not normal, looking back, you know, yes, acute injuries and illnesses, like infections killed us. But the ones that live didn’t die. And the ones that currently live long don’t die of the same things we do, which is cardiovascular disease, etc. And so you know, what ties this all together, what makes us different, what makes us or countries that adopt our lifestyle, develop our diseases, what’s the common theme, and it wasn’t that because we look at the Eskimos, they eat fat and protein, there’s an A car to be grown out on the ice. And there it wasn’t a specific food, different groups of people eat different foods. But what seems to be the common theme, and the evidence is really bearing this out is processed foods and refined carbohydrates. And the reason why I lumped them together is because both of them together, increase insulin output. And if and everything we do revolves around improving your insulin sensitivity or decreasing insulin, we think, and I think others will agree that insulin is a prominent hormone meal, amongst others that is driving the host of what we call chronic disease. Chronic is a misnomer, chronic is basically saying you have a disease that’s treatable. Rather than treat it, we’re going to manage it and we’re going to name it chronic. So therefore you accept the fact that we’re going to manage it, as opposed to say it’s not chronic. It’s an acute thing that happened over time, that can reverse by the same things that caused it, which is nutrition. You spoke earlier about nutrition being so powerful. This we think of above health of the five pillars and nutrition, physical activity, sleep stress is spiritual well being. And I would say 90% of your health comes from nutrition. You don’t see animals running on treadmills, or sprinting on races or lifting weights. When you see them as eating the food they’re supposed to eat at the amount they’re supposed to eat it. And so we live in a world where ultra processed refined carbohydrate foods and and foods that really questionably are even foods at all, are eaten all the time. And so the basic tenant and the protocols obviously are individualized and will work to a different people is eat whole food, real food as as close to where it came from as possible. And eat it as a meal. Instead of consistently eating allow your body to heal. During periods that you have finished supplying your body with energy we have the capability to store energy as opposed to like oxygen which we need to constantly get. So we don’t need to constantly take in energy. We just need to take it in to provide nutrition and then allow body to use it and heal it and grow and do things as as such. But that’s not how our society we have three meals a day, three snacks in between meals, something before bed, something in middle the night when you wake up hungry, when are you ever going to utilize that energy, if it is even healthy energy at all. So that’s sort of the overarching theme that we espouse. And I think, Robert, Robert Lustig you were all yourself to a spouse. And I think that is the future in the sense that diabetes, cardiovascular, these are an end result of insulin resistance that happened 10 1520 years earlier. In fact, as early as pediatrics, and it’s absolutely reversible or non reversible. It could be litigated before before it becomes a disease. And that education is just not there yet from both lay people and more importantly physicians. And that’s what we’re hoping to get to, is to at least start with the physicians and the interested lay people to start a movement to say we don’t have to see a ballooning health care cost of 18% of our GDP, we can bring that down because 90% of our costs are chronic disease management, how about spending a little more or less money on chronic disease reversal or mitigation, and make people healthier and save tons of money?

David Rambo 15:37
So there’s been, there’s been, and again, you know, medical nutrition therapy has been around for, you know, decades just been underutilized, primarily because it was really failing. Not only was the advice that was being doled out, but the nature of helping patients support them, and behavior change wasn’t there, the tools weren’t there, right? So you had this very episodic kind of experience with a registered dietician, they would give you a very strict meal plan wouldn’t give you a rhyme or reason it was based on all of these, you know, this outdated dogma, and they’d say, Good luck, see in six weeks, right. And that was what the conventional outpatient medical nutrition therapy experience look like. So you’re a physician, you’re staring at a patient who they know, right? The best intervention is, you know, eat better and exercise, right. But the execution on that was horrible. Now we have these digital tools, which are exciting. But simplex believes in the potent importance of human connection with the addition of technology. Now, conventionally, anytime you add human connection, you add costs, especially when you’re helping people through a program that is a lifestyle change that has an accountability component that’s necessary to help people get through that as well as an education implementation component. So we have a wealth of resources. But our plan doesn’t just include meetings with the dietician, there’s health coaching support in between, there’s the education, there’s the Hey, let’s go through your pantry together, and don’t throw out everything, let me educate you on the things that cause these insulin increases, that now we can come virtually into that patient’s pantry that you never would have been able to do before. And something that very difficult, not everyone really just wants to AI that experience yet. So the human connection, the reason why we’re getting the outcomes that we’re getting, and the last thing applicati The last thing implications, because not only are we rewiring the hormones that you know, drive, you know, those toxic cravings, essentially, but we’re also they’re coming out with an understanding of the role of this hormone insulin, you know, and that was really one of our primary goals. It was so easy. When I reversed my diabetes, I was like, This is almost too scary to talk about how, in a matter of four months, okay, I was able to eliminate all of that, and no longer be a diabetic. And the fact that that what was it was, it was harder being made it make more sense, why more people aren’t doing it. But again, I became more obsessed than I expect our patients to become in the research, but in a short period of time, that we can dramatically impact the lives and they’re learning about insulin. So they become, they get to this place where they’re not owned by cravings. They’re not owned by confusion, we separate that friction, they can live a life, essentially, when they get insulin sensitivity back where they know what’s going to potentially send them back into a bad, you know, into a place they don’t want to be. But they’re able to regain control of their life in a way that’s really exciting. Long term. Not sure.

Robert Lufkin 19:04
Yeah, Thanks, David. That’s such an important concept. And I’ll be also that of insulin being fundamental to chronic diseases. I mean, we still have colleagues who should know better, but they conceptualize diabetes as a disease of glucose. So of course, if you wait till the glucose is elevated, or they wouldn’t see goes up, you’re already 10 years into the game and monitoring insulin, although it’s less convenient now. But, but it’s really the way to go. Do you? Do you guys? Or what’s your approach to monitoring insulin to just with blood tests, I presume right following along periodically throughout the course of their treatment.

Avi Gurwitz 19:52
Yeah, so the problem has been and the reason why the ABA has to recommend this and I believe will be standard of care in the next five to 10 years. Because insulin assays are not standardized across labs. And that’s been a big bugaboo as was a one ca once he used to never be used to be diagnosed diabetes, it was the cardinal rule, you can monitor patients, because trends were important, but you couldn’t diagnose diabetes. And then the essays were all standardized. And now a one seems to be used for diagnosis for diabetes, pre diabetes, that’s what’s happening in the world of insulin right now. So, you know, quest, for instance, has an insulin resistance score that has been correlated to the keys to the Cleveland Clinic as a to the gold standard of insulin resistance. And they’re trying to show that but we aren’t going through specific companies. The idea is that health thought leaders are coming on board with the need to standardize insulin resistance, whether it’s measuring intact insulin versus C peptide, or using mass spectroscopy, and coming up with a score. But when you’re born, your insulin is near zero when you’re fasting because you don’t need much, and it should be there. And so if you want to use a weed, so while we don’t have yet the standardized insulin, we try, we definitely monitor insulin levels. And healthy insulins, on non standard, our scale should be about under five, fasting, between five and 10, you’re getting up there beyond 10 to 15, you’re pretty insulin resistant. And that’s a number I can show a patient and say, Look, you’re passing your pancreas, there’s gonna be a day in the very near future where you can’t make any more insulin. And your sugar will rise by the mere fact that your insulin is plenty there. It’s just not sensitive, your receptors are not acting to that. And so and that’s because of the diet that you did your lifestyle, something you can then change. And your pancreas will stop being that stress, as opposed to waiting longer and longer getting beta cell dysfunction and beta cell destruction. And having long term damage, kidney damage, I damage all this stuff that comes along cardiovascular disease. And again, a lot of this is reversible, but some of it is not. And so why not start earlier, why not start off when I can show you insulins rising and you’re already getting damaged from the hormone insulin and bring it down and it could come down pretty quickly. Because if you make a dietary change, your insulin goes from 15 to seven. And you feel better and you lost some weight. You never even had to go down that path ever become pre diabetic and diabetic. Besides the money it saved the life that’s changed. That is the right way to practice medicine.

Robert Lufkin 22:40
There’s so much interest in biological clocks versus chronological clocks for aging. Like we’ve had people talk about DNA methylation clocks for consumers and Steve Horvath clock and other ways of measuring health risk and longevity overall. One way to think of it based on what you’re saying ABI is and one if you want one blood test as a biological clock, how about a fasting insulin, and that will give you a window into where you are with insulin resistance, and overall risk for chronic diseases for all the way from Alzheimer’s stroke, heart attack,

Avi Gurwitz 23:18
I don’t have the data but I guarantee you people look at me and go while you’re practicing medicine for 15 years, you look so young, and I say well my fasting insulin is under one. So I’m not saying that I have the empirical data but I guarantee you that if you measure insulin across generations, it would correlate to some sort of longevity of life whether it be due to chronic disease and earlier mortality or morbidity or just overall health because insulin was never meant to be that high. It no other no other species of animals no other healthy population eat whole foods as insulin levels the way we do.

Robert Lufkin 23:57
And now fascinating Lee we’re finding that for longevity, all the all the nutrient sensing hormones, you know, ANP kinase, Ser two ns mtorr are all based along the same things that influence insulin influences and also insulin like growth hormone. So their growth factor there’s they’re similar. Insulin is really key to growing up and

Avi Gurwitz 24:24
growing. It’s literally a growth hormone. It’s aging you literally by growing constantly, it’s like having growth hormone all the time. You know, if you’re anabolic all the time, you are going to age and grow quicker and live shorter and hence the studies of intermittent fasting in animals showing longevity. There’s some combination here whether it’s the intermittent fasting or it’s the hormonal changes that happen with it, but insulin is key here.

Robert Lufkin 24:50
Yeah, yeah. What what other tools do you find useful for patient monitoring or devices at simplex help that help you manage their Nutrition.

David Rambo 25:01
So one of our we’re actually currently in the middle of of our own proprietary technology build, we’re using, you know, a white labeled EHR engagement platform right now, but we’ve kind of at a point where as a company, we’re going to move to our own platform, just to enable us to kind of create that experiences that that’s unique to simplex, but we do our platform does have device integration, and, for example, our gestational diabetic population, which is, you know, a, you know, just an increasingly, you know, growth sector for us, we’re monitoring blood sugars for that population, and looking at abnormalities and sharing that back with a referring provider essentially being an extension of that practice. So we’re using that in that way, as well. And then other metrics, patients can, you know, log on when their health coach, you know, either, you know, bumps them or certain periods during before we see them to, to record a metric. And then our team on the back end can go and import data from our referring physicians. lab results into our platform. So that way, we’re able to get as much of a total picture in terms of Hey, how is this patient doing during the intervention, and then, you know, a year out just to ensure that what we’re doing is really lasting, not temporary.

Robert Lufkin 26:34
You find continuous glucose monitors useful in your practice.

David Rambo 26:40
So I’ve used and as part of the beta I’ve used as CGM. I think there’s a lot of insights into that. We have not made that readily as part of for all of our patients right now, because it is, you know, the expense of securing a CGM, a set for a one month so our workaround for that is, is that, you know, we’re developing a pathway for patients, if they wanted to, they could kind of you know, they can use a more conventional just glucose. reader after we give them some challenge foods, just so we can see how they respond to that. And then that’s how we can get a little bit more precision like in their therapy. So that’s what we do, but we have not incorporated yet CGM that’s on our pathway, but the cost has been, it’s coming down. And that’s exciting. And there’s a lot of new providers that are offering that and those are interesting potential partners for us as well, too. But we have not had broad adoption of those within our practice.

Avi Gurwitz 27:52
And I would say that I might be stepping the gun because it doesn’t exist yet. But from my understanding, there’s going to be wearables that will get monitoring glucose that, you know, we can tie into them that was good a step sleep and all the other things that they do, but if they can mount your glucose, we just now added a powerful tool. I mean, you already have a single EKG lead on an Apple Watch. So that might make it more accessible. And this is where technology meets the road in the sense that technology is only helpful for what you do about it. And the education and the knowledge is key. And if we’re asking someone to make a behavioral change, so you know, get rid of soda, get rid of processed food, that’s a big ask and people who’ve been doing that for 30 4050 years and that’s why there’s the human component of nutrition counseling. But at the end of the day, if you are empowered to understand why you’re more likely to stick with it down the road even if you’re not perfect, you know you had your soda once in a while but you’re gonna think the next time I am drinking soda my insulin spiking if you think that we’ve made progress, because it’s going to start saying well that’s too much insulin for me is that a thing that’s too much sugar, and that the education and then you pour that pair that with technology that shows the results. And hopefully that’s something that has changed the person forever. Now,

Robert Lufkin 29:17
you’re getting that information into the hands of the patients about their glucose levels on a continuous basis will be game changing. And of course Apple computer has famously patented a Raman spectroscopy tool that goes through the scan for interstitial glucose which is fine which some optimistic people are hoping that it will be announced on this this September’s Apple Watch and we can always hope that would be exciting.

Avi Gurwitz 29:46
Yeah, Raman spectroscopy is is great is was just I mean, it’s just technology earth shattering I mean,

Robert Lufkin 29:55
yeah, and and that and the Android phone manufacturers have access to similar techniques. So experts are saying that when one apple and has it, Android will have it either simultaneously or shortly thereafter. So we’re, we’re in for some exciting times now, continuous insulin monitors maybe further. But

Avi Gurwitz 30:20
I think standardizing insulin, I think is guys coming out there, I think the ADA will be forced with the overwhelming amount of evidence that’s going to come out over time to recommend screening for insulin resistance, because there is a CPT code for it. But there’s no test. So how do you have a CPT code without a test? You know, if you write or someone’s insulin resistant, you’re basing it based on what an insulin level? Well, technically, there is no insulin level that says you are resistant. They’re just general themes. But now the industry is standardizing it. Now. This matches a diagnosis. Now the question becomes, what’s the therapy? It’s not pharmacological? There is no pharmacological treatment for insulin resistance.

Robert Lufkin 31:01
You can’t give people insulin, no, you can’t be resistant. Let

Avi Gurwitz 31:05
me give you some more insulin,

Robert Lufkin 31:06
right? The mistaken therapy for diabetes,

Avi Gurwitz 31:09
right? You made that mistake? Yeah, we made that mistake down the road, but we’re not gonna make that mistake before we even got there. So they’re, the treatment is is non pharmacological, it’s lifestyle. And we’re ready, we’re ready for that change that’s coming.

Robert Lufkin 31:24
That’s so that’s so important. And in the way you’re approaching it with simplex healthy. The tools are very powerful. But the human side, like you say, David, is, is, is is especially effective, I think, could you talk for us a little bit about the patient experience and how that that human connection works for them at simplex health?

David Rambo 31:47
Sure, so a typical encounter with us starts with a conversation with their physician, our business model is to work with health systems that that are, you know, interested in the value based care model, right? That that you know, where there’s an alignment of interest to look at how to help this patient achieve the best outcomes. And so what predominantly, our work comes from referring physicians where there’s a, you know, a clinical outcome or a clinical metric that comes up that nutrition therapy would be an appropriate intervention, we get that referral into our office, we contact that patient, we answer questions about how simplex takes a little bit of a different approach than conventional dietetics. And what they think they know about dietetics okay, because usually everyone comes with some, you know, some information so, you know, we usually will spend a decent amount of time about 1015 minutes talking about our approach, then we’ll go to a verify their insurance eligibility to make sure that this is that, you know, as little to no cost as possible just to eliminate that barrier to entry for those patients. The first encounter will then be with a with a registered dietician, a registered dietician will, you know, having have ingested their intake paperwork, we’ll talk about that person’s history, what their goals are, what condition, you know, they’re looking to treat, and then obviously, identify barriers, and then there’ll be some goals set with that patient in advance of the next visit. And during that time, we have a, you know, most often than not, we’re going to help that patient start to get over their addiction to processed foods and sugar that they don’t know that they have. So there’s an education component, there’s resources and materials to help support them through making impactful meaningful changes between now and their next visit, if you will, where we would then prescribe maybe a more intense therapy, we like to say our approach is aggressive, but achievable. We don’t like to, you know, we the idea of, of everything in moderation, and all of that, you know, systemically if there’s a problem with with processed foods, we’re going to help them get over it as quickly as possible without them reverse that condition. So health coach would engage with the patient in between visits from an accountability perspective, they’re if they’ve connected their device, and we can respond to some of that feedback that we’re getting in between visits that will happen with the health coach. If the patient has a complex diagnosis or on multiple medications. That’s where medical adviser Dr. avi will get involved with that patient and maybe will work in partnership with that referring patients physician. Our model is not take the patient over. Our model is to work in harm. With the provider, all of our chart notes are sent back to the prescribing physician in between. So that way we’re in sync with that provider, we’ll let the patient know that our therapies are pretty powerful. If they’re on insulin, if they’re on some sort of medication, they’re that the wanna, you know, inform their doctor that, that they’re working with us in this regard. And again, we’ll provide them that documentation as well. And then from there, it’s really meeting them where they’re at, right? And if they need, you know, like, you know, it’s kind of like reading a good book, it’s like, you’ve read a book on this, you’re inspired to do it, but like, what do I do next, right? And that’s what we find our patients kind of where we shine, because they’re not alone on that journey, right? So there’s actionable steps, there’s Hey, what do I need to buy at the grocery store, or what’s my plan for the week gonna be based upon what I currently have available, my budget, so forth, and so on. So that’s where we customize that plan for the patient. And you know, this that after a couple days, and then little is 10 days, you can begin to shape shift cravings from top, you know, that are toxic into something, you know, that is a better choice. So it happens in a surprisingly amount of time, they’ll they’ll shed some of that inflammation that’s carrying that water weight, the patients will experience a decent amount of success, which, you know, inspires more that behavior. And then so between additional visits with the dietician and the health coach in between, we’re just providing those emotional accountability and also that practical accountability along the way via video visits chatting with us along the way.

Robert Lufkin 36:41
Yeah, just just some logistics. As we, as we’ve talked about, these these chronic, quote, chronic diseases, stroke, heart attack, dementia, hypertension, hyperlipidemia, even some types of cancers are relatively late manifestations of a smoldering underlying metabolic inflammatory insulin driven condition. For patients entering your program, is it necessary that they have a diagnosis of other hypertension or, or other type of manifestation? Or can they just be sort of healthy, normal people come in and just say, I want to get healthier, so I don’t have these chronic diseases?

Avi Gurwitz 37:31
Yeah, we’re open to air. Here’s the thing, everyone can use the Education in the treatment. So you know, if you already have a disease, we will work with you to tailor not only to reverse the overall inflammatory metabolic arrangement, but also specifically tailoring to your current disease process. So for instance, if you’re diabetic, we’re going to really hone in on trying to, you know, make you insulin sensitive as quickly as possible, while minding the fact that you might be on insulin, need to monitor that sugar. But if you come in and you’re otherwise healthy, but your BMI is 30, we’re gonna say, well, you’re not really healthy. But you’re in a place where you where you’re easily reversible. And if you truly come in and you say, Listen, I’m 20 years old, I’m perfectly fine, my BMI is fine, I’m active, eat whole foods. And we’re gonna say, All right, we’re just here to give you education. So that as you do get older, and life gets stressful, these are the choices you should make. So there isn’t anyone that can benefit from education, and behavioral treatment, it’s a matter of where they are in their journey in their health as to how intense and what the protocol would be.

Robert Lufkin 38:40
Okay. Yeah, that’s great information. And I understand that in talking to you earlier that insurance will oftentimes cover the cost of this so there may be no out of pocket costs for the patients, but that’ll be determined on a case by case basis. I understand. The other question for our audiences, do you accept patients outside the United States? Or is this currently a US program only?

David Rambo 39:09
This right now, this is the US program.

Robert Lufkin 39:12
Okay, great. In the last few minutes, what I’d like to do is is ask each of you now knowing what you know, as experts in nutrition and lifestyle, and you’ve personally seen how these choices people have made in their lives can dramatically affect their own chronic diseases and risk for them. I’m curious what what lifestyle choices each of you have made as far as you know, diet, exercise, or even supplements or tools that you use to monitor these things.

Avi Gurwitz 39:49
I’ll start here um, I’ve I’ve been interested in health and nutrition for a very long time. I most people look at me and say what Do what. So I do all mad I do one meal a day for the most part, sometimes I forget actually and I miss a day. And then that just blows people away that I don’t have a hunger craving. But at the same time I haven’t fluctuated and weight and 20 plus years particularly, I’ve pretty much stayed exactly the same, which I think is a very good marker for metabolic health. Plus, there’s youthfulness and skin and vitality and energy and all the other things that come along with it. So that’s one thing, oh man, or at least long, intermittent fasting. I do that. And I’ve done that for years. I think the longest fast I’ve done is five days, I think we had a challenge at simplex, but I usually do 24 hours or and then I encourage others at least to to push it together to 16 hours or 18 hours or some amount of time to let the body just heal and recover and get the insulin. Now the other thing is, if it isn’t, look, if it doesn’t look like food, I don’t eat it becomes in a bag, it’s processed ingredients don’t sound like food, it doesn’t look like food to me, I might actually Clorox it, most of them have calories, but it’s not food. So I practice what I preach, I eat whole foods and I eat them in specific times, to the amount I need. And I maintain a metabolic health. So in 20 years, it’s panned out, I’m not dying. I’m not macerating away, I’m not fighting my cravings every day. I just live life I don’t think about food safety easier. My food doesn’t run my life. I pick when I need to eat. And if there’s no healthy food around, I won’t.

Robert Lufkin 41:42
I switched to one meal a day about a year ago and it’s transformed my life. It’s it’s great that and it’s and you’ve been doing it even longer. It sounds like for a long time, Avi How about other any supplements or any drugs? Metformin, rapamycin, any of those things,

Avi Gurwitz 42:02
yeah, having gone that route statens have shown to do some increase in longevity, you know, especially if there’s certain risk factors, you know, for the hyperlipidemia etc. I’m a big believer in fish oil only because we have such an imbalance of omega six to omega threes. And then red rice yeast, I think is a great way to moderate lipids in the UK with a natural sort of a natural status so to speak. So those are my go twos for for metabolic hyperlipidemia specifically given that I have a history of my family of familial hypercholesterolemia

Robert Lufkin 42:42
and your your you mentioned earlier your your fasting insulin is under one

Avi Gurwitz 42:47
Yeah, yeah to 1.1 point nine or something.

Robert Lufkin 42:50
Yeah. That’s That’s great. Yeah. Well David as CEO of simplex health, how do you lead by example in your lifestyle choices.

David Rambo 43:02
So you know, that some of that some people say like, some of their best advice would be like a diabetic, you know, should so I do follow that and not according to the APA standards by any means. But you know, for me, it was I went all in, I didn’t negotiate essentially, with you know, with wanting to reverse this condition, I was motivated to get off the medication, it worked for me. So that diagnosis happened in 2012. And by right at the end of 2013, I had eliminated that so for me, that was enough of what I needed in order to make that permanent change and I just entirely shifted my mind around that I just, you know, was going to do everything I could to be around as long as I could for my family. So I don’t negotiate I’m for but from a practical side, I’m a nomad guy as well, too. I’ve been in Oman guy for at least I mean, it’s got to be minimally seven years now. I think I started the, the, my journey following like a whole 30 paleo template for the most part. And, you know, just got into the quality of foods matters in this house. Big time. And but now I’m just at a point just kind of like a hobby. It’s like, you know, I don’t have to think about food all day. It’s easy. But you know, but yeah, so I’m an old mad person, and I advocate for it. Every once in a while, like Avi said, we’ll do some, you know, we’ll do some in house challenges with our team just so they can experience what we recommend, you know, our patients do which is kind of press those limits that autophagy that benefit there. So we’re very interested in that process as well too. So um, But yeah so practically I’m in my die daily

Robert Lufkin 45:04
yeah the I love what you said I’ll be too about it if it doesn’t look like food Don’t eat it and and both of you being the Nomad guys maybe you can tell me your thoughts on this but since I started doing one meal a day I have to say by the time that meal comes around I’ve never tasted anything more delicious my wife can put out a bowl of celery for me and it’s the best thing I’ve had all day it actually it tastes everything tastes so is so good that way but

Avi Gurwitz 45:38
yeah it’s also that it’s healthy real food and then you know while we have the ability to spice things and add you know and cook things and that’s great in you know we have a great palette and it’s good to enjoy life if there’s healthy ways to do that and by waiting for your body to need that nutrition it’s a double win you’re getting good food while meeting it at that moment because you now have need to restock your your nutritional supplies as opposed to you know having eaten all day and really don’t need to eat anymore for another year.

David Rambo 46:13
No at all also, I guess too for us at least in this household you know we do a decent amount we have a decent amount of patients that have some autoimmunity and so that’s an area of focus for us so when we’re following you know and looking at the you know, the three legged stool are the environmental triggers, you know, we obviously are looking at you know, some of the foods that we’re eating that just have a high Association rate so in our household just because there’s some autoimmunity we also avoid you know, casein and gluten across the entire household in general, and most of the ways as well too.

Robert Lufkin 46:52
And and seed oils we didn’t talk about that what’s your position on on seed oils?

Avi Gurwitz 46:57
Most of them are pie in omega sixes rather than omega threes stick to the the olive oils and other high omega three oils. They’re there they’re there you know, the seed oils are pro inflammatory for the most part.

Robert Lufkin 47:13
Yeah, thanks so much for everything what’s the best way for our listeners to follow you on social media? Or we’re going to have the website on the on the show notes, but maybe you could tell them how to how to follow you.

David Rambo 47:29
Yeah, so our website obviously they’ll be posted Cineplex health calm, but LinkedIn, you know, we’re sharing patient success stories, and and, you know, what we’re up to, you know, on a weekly basis over there. So that would be the best social channel, I think, to to find us.

Robert Lufkin 47:46
Right. Well, thanks again. I’m excited about simplex health. Actually, I just got an email I was on the waiting list. And I’ve just been accepted. So I’m going to be joining myself, I think, trying it out. So thanks so much for spending time. It was it was great to spend an hour with you guys today. And I appreciate hearing all about the great things you’re doing and can’t wait to hear about it in the future as well.

David Rambo 48:16
Thanks for having us on the summit. appreciate

Avi Gurwitz 48:18
all the work you do as well. Yep. Thank you, Robert.

Unknown Speaker 48:22
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