Using Blood Tests to Fine-Tune Your Metabolism with Dr. Richard Maurer

Dr. Richard Maurer, author of The Blood Code, discusses how to use the results from common blood tests to fine-tune your metabolism. If you are having a hard time determining if you should be low carb or higher carb, can’t lose weight, or can’t get your blood sugar or cholesterol under control, this episode should help.

If you’re interested in learning more about The Blood Code and how it could work for you, click here.
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Episode Intro….. 0:42
Dr. Rich Maurer Bio….. 1:46
Finding Your Optimal Macronutrient Ratio with Labs….. 5:01
Carbohydrates, Saturated Fat, and Paradoxical Responses….. 13:01
Different Diets for Different People….. 19:22
Fitness Principles….. 25:54
The Blood Code….. 41:02
Episode Wrap-up….. 46:18


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Episode Intro

Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. Today, I am here with Dr. Richard Maurer. I’ve come across this gentleman lecturing at a few different conferences we’ve both been speaking at. And when you’re speaking at a conference, it’s always kind of like you’re being pulled in a thousand directions.

And I always catch bits and pieces of his lectures. I’m always very intrigued but never have had a chance, unfortunately, to sit through a whole lecture. But I’ve caught some really interesting stuff about helping people find the best macronutrient ratio for their metabolism.

And it seems like Dr. Maurer has done a really good job of documenting some of this and has some great tips for helping people to best find their macronutrients as it pertains to things like cholesterol levels and blood sugar. So I’m sure there’s more to it than that. But those are the things that really caught my eye and what I really wanted to have him expand on. So he’s here today with us to dive in. So, Richard, thank you so much for coming on the show.

Dr. Richard Maurer: Michael, it’s a pleasure to be here. Thank you.

Dr. Rich Maurer Bio

DrMR: Can you tell us just a little bit about your background and how you got into this current healthcare model that you’re using?

DrRM: I can. I can go back as far as you want. But somewhere around when I was 20 years old and in music school, I was playing as a professional musician. And for some reason, the books I gravitated towards and the books I liked to read were textbooks on nutrition.

This was in the era of Mental and Elemental Nutrients by Carl Pfeiffer—very old text, challenging some treatments for some very complex conditions using micronutrients in this case. But it got me thinking about how to apply nutrition for all kinds of considerations, not just nutritional deficiencies. But that’s 30 years ago now.

And my study has since become naturopathic school. And after 20 years of practice, I specialize in metabolic recovery. So using predominantly blood test results and in-office metrics like skin fold calipers and heart rate variability and heart rate recovery—using all those together to assess how someone’s metabolism is heading either towards disease or towards long, healthy, productive life.

DrMR: Sure.

DrRM: And it’s been a vibrant practice. The first 20 years were family practice. And it was pretty diverse. So I was mixing the type II diabetics in with kids with ear infections and skin rashes. And now I spend my week in the realm of hypothyroid and blood sugar and weight and all those metabolic considerations that come up for actually a growing number of conditions.

DrMR: I like it. And one of the things that really stuck out to me is regarding helping people find the right macronutrient intake for them. And there’s always the human nature, I think, to go to extremes. Everyone should be low carb in one camp. Then you have another camp of the Pritikin and Ornish that low-carb diets are bad because they’re high in fat and high in protein. And those are easy points for people to gravitate toward. “There’s the villain. There’s the hero. Let’s just fit in this little box.”

But I think many people who follow our work appreciate that we’re trying to look at this broadly and not trying to be dogmatic but trying to help the right people find the right approach for them. And so clearly, I think everywhere from a lower-carb diet all the way up through a higher-carb diet can work for different people. And I really like the way you’ve been uncovering this and using people’s metabolic responses and their blood work responses to steer this whole picture.

Finding Your Optimal Macronutrient Ratio with Labs

DrMR: So I’d love to kind of get maybe your big-picture views on the macronutrients and how you help guide people with that.

And then maybe we can follow that with going in more specifics about blood sugar and cholesterol and weight and how different people may do better or worse with those markers relative to a different macronutrient consumption.

DrRM: That’s a great lead-in. And if anything, let me go back to my history for one moment, because before writing my current book, The Blood Code, I had written a book. I was given very good advice at one point which was, “Just go out there. Write your first book. Stick it in a drawer. Don’t ever show it to anybody. And then start on your second book.”

And I did that. I wrote this, at the time, what seemed like a novel and wonderful book called The Fat Back Diet. That book is in a drawer. And I took it out about a year ago. And it’s really not good. So I’m glad I did that.

The second book, The Blood Code, is very clearly not a diet book. It’s a book about utilizing these metrics we have in the medical realm to better establish what our body is thriving on or not for, like you said, the macronutrient intake. So rather than telling everybody, “Go on a low-carb, high-fat diet” or the extreme of that, “Go on a ketogenic diet,” or, “Eat more whole grains,” like came out in the New York Times last week—“to feed the microbiome we need different fibers.”

It’s getting very confusing. So how do we tease this apart and get away from diet books and picture our bodies as the book? And what we’re using textbooks and podcasts for, like this one, is to help distill what’s going on inside of us and reveal what our inner book is already showing us.

DrMR: Sure.

DrRM: So that’s, from a macronutrient perspective, I can take it apart in terms of what I look for on a blood test panel. Well, why don’t I start with that, if that’s okay.

DrMR: Yeah. Yeah, please do.

DrRM: So what I’ll do, before I even see somebody, I coach them to get certain blood tests done right off the bat. So I want to see a serum insulin test. I want to see a lipid panel. I want to see a blood sugar and the chronic blood sugar proxy, the hemoglobin A1c. So between all those tests, I can tell whether someone is storing too much or whether is storing too little.

DrMR: Sure.

DrRM: If someone’s triglycerides are up at 150 and higher, they’re likely storing too much. Their insulin is probably high. Their sugars may be drifting up. They probably have a little apple shape where they’re getting higher body fat around the middle. Those people thrive on a lower carbohydrate diet. They have to raise their fat intake and lower their carbohydrate intake. These people do not make good vegetarians.

So I use that as one simple piece. And I see a number of people who, like you referenced, have already taken it too far. Having spoken for the past three years at the Paleo (f)x conference in Austin and a number of conferences that advocate lower-carb, higher-fat diets, what are called LCHF, some people who are young, they’re lean, they’re exercising CrossFit style—I measure them.

Their triglycerides are below 40. And their insulin is below detectable limits. And they’re chronically breaking down. Their body is in a metabolically catabolic state, which comes with its own set of problems.

So backing those people out and giving them license to bring rice and legumes back in the diet—certainly not what I do for a type II diabetic who’s insulin resistant. But it’s something that works fantastically for that person with very low insulin, very low triglycerides, and functioning too lean.

DrMR: Now, are you finding a relationship between blood sugar also? Because I’m sure more people listening to this probably have a fasting blood sugar test at their disposal—

DrRM: Yes.

DrMR: Than they do an insulin. So for people who are trying to say, “Ooh. Which camp do I fall into from a blood sugar perspective?” do you have a range where you consider this high and that low for the blood sugar?

DrRM: Yes, very simply, I use 75 to 95 mg/dL. For anyone listening outside of the United States, you want to convert that to millimoles. But if most of our listeners are in the US, that’s 75 to 95 mg/dL. I’ve seen some places where someone touts that it should be even lower—85 or less. There’s no evidence to state that that’s actually healthful.

DrMR: So the 75 to 95, is that what you’re considering normal? And then above or below that is high or low?

DrRM: Correct.

DrMR: Gotcha. Okay.

DrRM: And most labs will use 70 to 99. It’s a very similar reference range. I’ve just squeezed the top and bottom down a little bit. Once you get close to 99, you’re really entering that pre-diabetic, slightly insulin resistant state.

DrMR: So this is pretty practical, at least on the surface, where, if you’re having a few markers high, then you’re in excess and you need to limit carbs. And if you’re having some of these markers low, you’re in deficiency, and we need to bring the carbs back in. Is that an accurate restatement?

DrRM: It’s very accurate. And then, of course, the rules are always proven by studying the exceptions.

DrMR: Right. Well said.

DrRM: We could have a much longer talk about the exceptions. But while I touch on that in The Blood Code, that’s really probably not our conversation.

The message I’d send for people is glucose is very misleading on its own because the body can do an exceptional job of compensating to keep that sugar in normal. So if someone has a pancreas that’s really youthful and robust and they’re from a family of good athletic peasant stock, their insulin may be way above normal to keep that sugar between 75 and 95.

So their doctors are never getting alarmed because the sugar is always fine. But they’re gaining weight. Or they don’t have energy. Or they have migraines. They’re having symptoms of disglycemia. They’re having symptoms of their sugar being erratic. Yet their fasting sugar always looks fine.

DrMR: Sure, and I agree.

DrRM: So that serum insulin—if someone actually has to pay for the test and they go online, I link people to the Ulta lab test at The Blood Code. But there are all sorts of direct labs people can use. Getting an insulin fasting is about $21. So this is not a break-the-bank hormone to run.

DrMR: Sure.

DrRM: And if someone asks me what’s the one test they should pay for because they’re not going to buy a whole panel of five tests—they don’t want to spend $94. They want to spend less. The one test I’d say to get would be the insulin on a fasting sample with a glucose at the same time.

DrMR: Gotcha. Yeah, I think that makes a lot of sense.

DrRM: Yeah.

Carbohydrates, Saturated Fat, and Paradoxical Responses

DrMR: Now, another question I’d like to get your feedback on is kind of the carbohydrate intake and maybe we could lump in with this saturated fat and how that pertains to what may seem like a paradoxical cholesterol level. And what I’ve seen sometimes is some people will go on a lower-carb diet, not necessarily like a ketogenic diet, but they’ll just be on a lower-carb diet that has a little bit more saturated fat. And that will paradoxically cause the lipid panel not to look good.

And I don’t just mean the elevation of LDL cholesterol, which can sometimes happen on a low-carb diet. But everything else looks good, and the overall picture looks healthy. I’m talking we see triglycerides start to creep up maybe. We see LDL high, total cholesterol high. We don’t see a very good HDL. Maybe their blood sugar is a little bit high. And ironically, when we have them shift to a little bit more carb in their diet and maybe a little bit less saturated fat, we actually see all those markers improve.

And I’ve heard some discussion that the APOE4 genotype may be at increased risk for that scenario to play itself out. It’s on my list of things to really kind of dive in and do a literature review on. And I believe I had seen you present on a few kind of case studies that you went through something similar to this.

So I’d be curious to kind of get your thoughts on that because I’m sure there are people either reading or listening to this who may be struggling with some of these markers off and trying to figure out where to go next.

DrRM: Absolutely. And I’m not going to claim to be the expert on the APOE4 genotype. I know there are some docs out there who are really locking in protocols for people based upon that one test result. I think there are so many more mechanisms involved here.

DrMR: Agreed.

DrRM: I think we’re addressing the microbiome that some people have tendency towards. Remember, as we know, the liver is actually part of gastroenterology in the specialization of medicine. So the liver is producing over 90% of all the fasting lipids that we’re looking at on this panel. When we see this disruption of balance, that higher triglyceride, or the HDLs drop, to me that does mean you’re on the wrong diet.

I’m not going to tie it to the APOE4. I am not convinced. And I’ve read and delved into this to some degree. I don’t think it’s valid enough for me to change my life. In fact, I’ve not even gotten the test done on myself. And I love to do these things. I just haven’t done 23andMe. And I haven’t done the APOE3, 4.

DrMR: Well, just in quick agreement with you there, Richard, I sat on a gene panel at Paleo (f)x. And I am certainly not a gene expert.

I’m thinking maybe they put me on there to get a gut-focused practitioner’s perspective on some of this gene stuff. But I was on the stage with a few people who have literally written books on genes.

And the thing I took away from that that I found very interesting—no one felt very strongly that we have any great treatments based upon genes. And even the people who have written the books on genes—no one really felt that you can take a 23andMe and have super solid clinical data to take away from it. And so I just want to throw that out there for the audience because I think it’s important to voice that.

DrRM: Absolutely. So I’m sure, even if we go back to Peter Attia—I don’t know if he’s been on your show before. But I know he’s very enthusiastic about this test. Basically, the people I see whose lipid profiles do go awry, I make adjustments in their diet until it does look better. That triglyceride/HDL ratio should be 1:1. And in someone who’s fit, it should be less than that.

The body never wants to have it below 0.5. So if someone’s HDL is 100 and their triglycerides are 50, that is as metabolically lean as anyone will ever want to be. As soon as that goes to a lower number, I tend to see more, what I said before, catabolism—more breakdown of muscle structures.

DrMR: Right.

DrRM: So if someone’s doing a low-carb, high-fat diet—and I’ve seen this a number of times in practice—it’s often people doing it because of lifestyle. They’ve gone to Paleo. They’re following the media about it. And they’re introducing it into their life. But they didn’t have pre-diabetes or type II diabetes or really an insulin resistance to begin with. And sometimes, that’s just not right for them.

Whether it’s a gut flora imbalance that’s driving their HDLs lower, LDLs higher; whether it’s something else about soluble fiber; whether it’s something about the liver and that dietary profile, I don’t know. But this is really where I fall back on why I wrote The Blood Code. And it’s, “Let’s look at the tests that are expressions of basically the interface between our unique genetics and phenotype and how that’s interacting with our diet, lifestyle, and environment.”

DrMR: Yeah, I think you make a few really good points there definitely.

And I’m sorry. Were you saying something else?

DrRM: So it’s really I’d rather focus on our expression with tests that are really hard and fast about marking health and longevity.

DrMR: Completely agreed.

Different Diets for Different People

DrMR: And I think you make an interesting point that I’d like to maybe expand on a little bit for the audience, which is sometimes we will see a diet that works really well for a certain population, like Richard was saying, maybe a low-carb intervention for those with diabetes or metabolic syndrome. And it works really well for them.

And then we extrapolate that that must because the best diet for blood sugar for anybody. And we see the same thing happen with something like maybe a low-FODMAP diet is really good for those with IBS. But it doesn’t mean that a low-FODMAP diet is going to be the best for someone with normal gut function.

And so we shouldn’t take these extreme points that are helpful for certain conditions or certain populations and extrapolate that back to the masses or other people or other conditions, because this is where I think we get people on overly restrictive diets that don’t need to be.

And I think you make a great example of the person who’s maybe a CrossFitter and really healthy. And they’re going on the best diet for someone with type II diabetes but not for someone who is already lean and doing a heavy volume of exercise.

DrRM: Right. I wish I could say I had this kind of wisdom my whole life. But like many people in the health and wellness world, I was swayed back in the early 80s by a book called Recalled by Life. It was a radiologist in Philadelphia where I was living at the time who wrote a book because, after having prostate cancer, he went on a vegetarian diet with Michio Kushi and macrobiotics and lots of soy along with prostatectomy. And he had his testes removed. And he had shots. So that kind of diet was touted as a brilliant testament to why macrobiotics is so great for everyone. And, boy, in my late teens if I didn’t fall right into it!

DrMR: Right.

DrRM: Ultimately, that diet is great for helping keep your testosterone down in the basement. Maybe for that disease—

DrMR: Yeah, yeah.

DrRM: Of testosterone sensitive tissue, that makes sense. But don’t tell a young, healthy 20-year-old. And if anyone sees me, they know I’m not overtly large. And I was 20 pounds lighter when I was following that type of diet. It was pretty awful. But that’s a classic example. And it took me growing up to learn, “Ah, we can’t apply—” It’s kind of that basic logic experiment. If A is B and B is C, that doesn’t mean A is C.

DrMR: That’s right.

DrRM: We can’t leap over these logical break points.

DrMR: Exactly. And I forget who I heard say this recently. But they said something along the lines of, “You really have to be careful with taking advice from young, healthy fitness professionals because they would probably be fine no matter what they did.”

DrRM: That’s exactly right. Yes. Right.

DrMR: And yeah. So I think for—this is a little maybe off topic. But for people who are maybe working with a young, healthy trainer at their gym and they’re getting a kind of dogmatic view on you have to do it this way, just take that into consideration. They probably have the best intentions.

But just because someone is young, fit, and healthy doesn’t mean if you do what they do, it’s going to work best for you, especially if you’re 10, 15 years older and maybe you have some sort of health condition that you’re trying to co-manage. So don’t fall in love with a pretty wrapper, meaning someone looking fit, as an indicator that they actually know what they’re talking about.

DrRM: Right. I had a great example of this just before this Paleo conference in Austin this May. I was talking to a friend who’s down there. And he’s on a sort of ketogenic, low-carb, high-fat diet. And he tested his blood ketone levels. And they were about 1, 1.5.

His wife was following the same diet as he. But his wife weighs almost half of what he weighs. So her lean body mass is so small relative to his, she carries so much less glycogen. So she can’t manage those in-between cycles without dietary glucose, because her body is not storing that same reserve of glucose as glycogen and body fat. And she takes the same blood test. And they’re eating the same diet. And her ketone levels were almost 8.

Now, for those people who are familiar with this, this is blood ketone levels in millimoles per mL. And to see that kind of difference, they called me, surprised, saying, “How did this happen? We’re both eating the same diet.” It’s so clear, knowing them, that this is not appropriate.

I, on the other hand—my mother was type II diabetic at 60. I am from a family of thin diabetics. We produce low insulin but have more insulin-resistant tissue. And for me, I can stay on that very low-carb, high-fat diet, keeping my carb levels below 20 grams a day.

And I still have blood ketone levels at around 0.3 to 0.5. I rarely get above 1.5. And it’s because I’m just insulin resistant enough that I always have enough sugar around. I can skip an entire day, and my blood sugar is still 94, 96. It’s absolutely the right diet for me, given my expression.

DrMR: Gotcha.

DrRM: So that’s something obviously I’ve worked on. But it’s not like I came to this from divine wisdom.

DrMR: Right.

DrRM: I ran the blood tests and saw my A1C at 6% in my early 40s and scratched my head, thinking I was doing everything right.

DrMR: Right.

DrRM: But that is my family expression. And when I live in accordance with it, I feel the best ever. And that’s been my journey over the past eight years in my diet and fitness. But I’m not going to tell other people they should do this unless it shows up on their Blood Code panel.

DrMR: Sure.

DrRM: Very simple.

Fitness Principles

DrMR: Now, exercise. I also heard some of your remarks about exercise and having people transition from maybe a more CrossFit or circuit-training-type intervention to a more cardiovascular-based exercise program. Do you have any kind of broad statements regarding who might do best with what or when it may be a good time to consider switching from one to the other?

DrRM: Boy! It’s a good question, Michael.

DrMR: I’m asking a hard question.

DrRM: Well, I’m pausing just because we tend to want to go all or nothing.

DrMR: Right.

DrRM: I’m from a family of marathon runners. And it’s very clear there is nothing healthy about a marathon. Period. That doesn’t mean going for runs and aerobic activity is unhealthful. I think performing at those events—there’s nothing really uniquely healthful about it.

I refer to my aerobic activity as a LLALA—a low-level aerobic life activity. I want to walk. I want to commute by bike. I want to have just constant, regular aerobic activity in my life. But my exercise is going to be—three days a week, I’m going to have a 20-, 25-minute circuit that I’ll do, a very ambitious super set of strength, weight, resistance exercises.

Adding that in two to three times a week, into whatever someone’s doing, has a profound impact on their insulin resistance. It’ll move people one large notch towards being more insulin sensitive. It does trigger more fat catabolism. So it does trigger more breakdown of both visible body fat but also the fat stored in the liver. The triglyceride in the bloodstream will drop. The resistance piece has to be in there.

There are some fabulous studies related to this. One of my favorites was six days a week of 20 minutes of aerobic exercise. And then they compared it with six days a week of strenuous circuits. And then they had another group. And they were told, “Do this six days, but on the days, you can’t do it for 20 minutes, here’s a four-minute workout to do.” And it was an ambitious four-minute workout.

The people that did the strenuous circuit workout only two days a week and then took the other days off because they didn’t have time—that middle group was told, “If you don’t have the 20 minutes, just skip that day.” The group that did the four minutes, they could do four minutes three to four of the six days a week and have absolutely just as good an outcome as the people who did six days a week.

DrMR: Of the circuits? Or of all the groups?

DrRM: Of the circuit.

DrMR: Yeah.

DrRM: Of the circuits. The aerobic group didn’t actually do that well.

DrMR: Gotcha.

DrRM: Their blood pressure did not reduce significantly. Their home IR did not reduce. That’s a number—we know this. But for the audience listening, that home IR is a calculation utilizing glucose and insulin and giving us a quantification of how insulin resistant someone is expression at that time.

So we really see four minutes most days a week is enough. If one or two days you get a 20-, 25-minute circuit in, great. But my message to anyone who is a walker as their exercise is, “Just put that five minutes in, 10 minutes in where you do more ambitious strength exercises.”

DrMR: Yeah, I think that makes a lot of sense. And it’s kind of reminiscent of one of the points Ben Greenfield made when he came on the show. He’s a pretty high-achieving triathlete.

DrRM: Yeah.

DrMR: And I was expecting his weekly training would be fairly robust. And I was surprised at how little he was actually exercising. And his commentary was that as long as you’re healthy, you have a pretty innate endurance capacity. And it’s more important not to overtrain and allow that reserve than it is to train copiously and burn out that reserve.

And I was really taken aback by that. But I think it makes a lot of sense. And the overexercising can definitely be a dangerous thing. And so I like the recommendation in that study showing that a little bit less, as long as it’s done strenuously, can really be effective.

DrRM: Right. And the participants in that study did say, just like people say when they work out in our—I work with a trainer here. And we do some of these metabolic recovery circuits. People do express that it’s a lot more intense than what they normally do at home.

DrMR: Sure.

DrRM: As people know, when they’re doing these sort of boot-camp-type super sets, there are times where you feel like you’re going to lose it.

DrMR: Right.

DrRM: It’s a little nauseating. And what gets us through is that in 10 minutes it’s over.

DrMR: Exactly. And just to retouch on something else that I think is also really important to reiterate, the importance of low-level aerobic activity like walking or hiking.

DrRM: Right.

DrMR: I just don’t think that can be overstated. And I’ve re-learned, or had a heightened appreciation for that over the past several months as I’ve been incorporating a few walking breaks throughout the first half of my day. And it’s just completely changed my energy level, my cognition, my clarity.

And it’s just so simple. It’s just going for a walk around the block. It’s nothing crazy. It’s not some meticulously programmed periodization routine, cycling between strength, power, flexibility. It’s just going for a walk. And it’s yielded such huge dividends. So I think it’s just important to reiterate that.

DrRM: You’re absolutely right. And we see the headlines of neurodevelopment and cognitive improvements with that kind of aerobic activity. It’s very simple. If people are just doing that and they’re not doing the strength, weight, resistance circuits, I never see that insulin lower significantly.

DrMR: Sure, that makes sense.

DrRM: That’s a really important component if someone’s insulin is above 10 and they’re struggling with weight or getting their blood sugar corrected. And I had someone in just the other day. Her A1C just was not budging down. She was walking 13,000 steps a day. But I know that if she did something else for five minutes—

DrMR: Right.

DrRM: Five, six days a week, we’d see it improve. So my work was really to convince that. And of course, I tell everybody, “Whatever you do, do not believe in what I’m saying. Just do it, and run the test.”

DrMR: Yeah.

DrRM: “And see whether it was effective or not.”

DrMR: Yeah, I like that.

DrRM: Simple.

DrMR: So if someone’s exhibiting some of these, I guess, broad signs of deficiency that we were talking about later—triglycerides being low, blood sugar being low, maybe insulin also being low—and they’re doing more of a circuit-training-based exercise program, do you lean toward having them do—I’m assuming, of course, walking is always going to be in there.

DrRM: Yes.

DrMR: But would you have them maybe—or have you found people maybe do better with subbing out a few of those circuits and doing maybe like a 20-minute jog or swimming or something like that?

DrRM: That’s a really good question. Obviously, those people are the smaller subset of people I see in my office.

DrMR: Sure.

DrRM: These hyper-trained. For the most part—I think Ben Greenfield would agree—these people just need to decrease the time they’re working out. And they need more days off. And they need to be getting 8.5 hours sleep or more.

DrMR: Sure.

DrRM: So oftentimes, it’s that lifestyle stuff. Just had a conversation with a fellow today. And it boiled down to his sleep. He was blaming it on his workouts. He wasn’t getting what he wanted. And very quickly, we’ve all learned in practice to ask detailed questions about someone’s sleep habits. And six hours and a lot of stress. I said when you’re under those circumstances, just walk. Just lay off the weights. Don’t do your deadlifts on a week—

DrMR: Breathe.

DrRM: Where you’re stressing about your daughter. That’s just not when you do it. You do your deadlifts when you’ve just had a string of really good nights, you feel your best, and you’re giving yourself time to recover and relax.

DrMR: Yeah, absolutely. Totally, totally agreed.

DrRM: And—

DrMR: And this—oh, go ahead.

DrRM: Yeah, the other—I do hand everybody those fitness principles that I talk about with exercises. One of the big principles is not to eat before workouts, too. So a little thing I adjust that I’d say 25% of people who come in actually have phobia about not having energy for their workouts. And they feel like they need to eat something, even people with type II diabetes.

They’ve been so programmed by some of the hospital education programs—miseducation programs—that they’re told to fear hypoglycemia. So they eat something before they work out.

The fact is you’re trying to get those workouts to improve your fat adaptation. You’re trying to get those workouts to release those stored energies. And that requires a lower insulin, a relatively empty stomach, and a little bit of stress during the workout.

DrMR: Yeah. No, I think that makes complete sense. And what you were saying a moment ago, talking about this population of people that may be kind of burnt out from overtraining reminds me of something that Mike T. Nelson may have discussed last time he was on the show. Or it may have been a couple studies he emailed me afterwards.

But some of the background is, many in this space are of the belief that cardio is bad for your adrenals. It’s bad for fatigue. In the exercise physiology literature, it’s typically called overreaching or the term for overtraining.

But what was interesting about some of the studies that Mike has shown me—and I go to Mike for the fact-checking on a lot of these concepts, because I look at him kind of like the exercise physiology counterpart to what I do with a lot of the gut research that we do. He’s fact-checking things and not just going with just the standard quo response.

But what was interesting was he showed that circuit-type training is actually worse for people who are in that overreaching state or burnt-out state or adrenal-fatigue state. And doing lower intensity cardio can actually be better for those people, which kind of flies in the face of some of the stereotypes floating around.

But I thought that was very interesting. And I believe that he elaborated on that in one of the last episodes. So if people wanted to use our search box and type in Mike T. Nelson, they could probably pull that up.

But I think this just kind of comes back to this whole discussion that we’re having, Richard, which is questioning assumptions.

DrRM: Yes.

DrMR: And thinking for yourself a little bit.

DrRM: And I think I’ve really taken—the research that’s come out in the past three to five years in fitness and metabolism has been incredibly interesting for me, being a metabolism geek and really delving into research whenever possible. There’s been no shortage. And it’s all pointing to a very similar trend that when you do these interval circuits or super sets and strenuous whole-body-exercise type exercises, man, it really doesn’t need to last long.

DrMR: Yeah. Yep.

DrRM: It can be very short. And the good news there is these are busy people with high blood sugar.

DrMR: Yeah.

DrRM: These are busy people trying to get their metabolism corrected.

DrMR: Yeah, like we all are. Exactly.

DrRM: So if I can really promote that everyone’s been told. It was 30 years the narrative was 150 minutes a week—30 minutes five days a week—at 70% of your maximal heart rate.

DrMR: Yeah.

DrRM: I can spit that out because I had it programmed into me throughout medical school and following. And the good news is it’s much shorter than that. Whether it’s intense interval aerobic exercise—those three 20-second intense sprints mixed in with three minutes of jogging like we saw on that study only a few weeks ago. Of course, they ignored the 9 minutes of jogging. The claim on the headlines was one minute of intense exercise worked as well as 45 minutes of moderate jogging.

DrMR: Sure.

DrRM: That wasn’t quite a true headline because it was 10 minutes—

DrMR: Right.

DrRM: Not one minute. But the take-home is that when you do this more intensely, not only is it as effective, but you really do need to rest more. That’s incredibly important.

DrMR: Absolutely, and that was one of the things that was in the papers that Dr. Nelson was citing, which is I think this overreaching syndrome can occur when people are doing these circuits that are too long.

And personally, I can say I’ve pushed that boundary. And I’ve got to have everything dialed in to be able to do four or five days a week of 45-minute circuits. It’s very easy to tip into the edge of burnout, I learned from doing that, unless you have everything else completely dialed in. And I feel like very few people probably have their life dialed in enough to be able to recover from that much.

DrRM: Right. I got pretty excited having been a long-distance runner so many years, a number of years back, switching my exercise routine to more weights and more interval circuits. And boy, doing sprint intervals felt so good that I was doing it four times a week.

And I was humbled by a cross country and track coach that is very well known here. And he has his 17, 18-year-old phenom superstar runners only doing their sprint intervals once a week. So I was reminded even then if these kids are doing it once a week, what am I doing?

DrMR: Yeah. Well said.

DrRM: Who am I?

The Blood Code

DrMR: So, Richard, can you tell us a little bit more about your book and who you think the book might be the best suited for?

DrRM: Sure. The title is The Blood Code: Unlock the Secrets of Your Metabolism. I took a year off practice. This was after 20 years of family primary practice. And backing off, writing the book. And really, it has become more of an at-home, probably for the health hack—someone who’s not intimidated by the word insulin or intimidated by the word ratio, because there’s a little bit of math right up front.

But to me, these are no different than understanding words like fuel gauge and odometer and speedometer.

DrMR: Sure.

DrRM: These would be intimidating if someone had never, ever seen the dashboard of a care before. But to me, these blood test results are really just indicators that tell us what’s going on under the hood. And anyone who wants to drive their car for a nice long time probably should know it’s not healthy to run their RPMs way up high. And likewise, it’s not really healthy to have your blood sugars up in the mid or upper 100s.

DrMR: Sure.

DrRM: Most important, the question is, like you said, who is it for? Clearly, the list of conditions—it’s going to be the type II diabetic, pre-diabetic, struggling with weight, hypothyroid because people with the hypothyroid trait are about 70% more likely to have insulin resistance as well.

As we talk about in the ancestral world, those ancestral conditions favored both. So to have the save-more-and-spend-less trait kind of was doubly useful in places where the potato blight was a recurrent phenomenon.

DrMR: Sure.

DrRM: So anyone with hypothyroid should run these blood sugar profiles to sort of look at that. It may be that so often practitioners are dabbling and adjusting the thyroid medication. But they’re not looking for what’s a non-thyroid metabolic consideration that’s actually the real culprit.

DrMR: Totally agreed on that one. Yeah.

DrRM: And then if I just go into my clinical pearls, there are a few conditions that have heralded who is pre-diabetes or type II diabetic when I didn’t picture it otherwise. Well, obviously, the medical program is that if someone’s obese, they get screened for type II. You have to have a certain BMI. And suddenly, insurance will cover all these tests.

But 39% of all people that develop type II diabetes are middle to low BMI. So while using the obese profiling is right 61% of the time, it’s dead wrong 39% of the time. So those of us that are lean would never be screened otherwise.

I’ve seen psoriatic eczema on people’s palms. That’s from that high tissue sugar, I presume. Migraine headaches, restless leg syndrome, high blood pressure in someone between the ages of 40 and 60—that’s going to be a hallmark of early insulin resistance. Those are my quick lists of conditions.

DrMR: Sure. Sure.

DrRM: Migraine, psoriasis, and hypertension.

DrMR: And certainly, improving your metabolism likely has the potential to benefit many different conditions. Absolutely.

DrRM: Absolutely. And I was on one of those internet summits called The Cancer Summit, taking that metabolic view of cancer prevention, both primary and secondary. So we can dramatically reduce our risk profile by getting our metabolism as healthy as possible—having nothing to do with it.

This next book I’m working on, I was tempted to call it The Thin Diabetic. I’ve been encouraged to throw that one in the trash. And I have a different working title right now.

But the idea is to really encourage people and empower people to run these blood tests on themselves if they need to. Use the direct labs that are available in most states in the country. Get tests on yourself that look for this because most docs are stuck profiling. And unless you fit that perfect profile of diabetes, you’re never going to get a really good assessment of your metabolism otherwise.

DrMR: Sure. Yep, I think that makes a lot of sense.

Episode Wrap-up

And where can people—if they wanted to hear more from you or track you down, do you have a website or somewhere good to plug in to follow you?

DrRM: Yeah, you can check out That is the website which sort of centers a little bit of everything from access to the book—the book, of course, I link directly to Amazon. As much as some of my good friends running independent bookstores think otherwise, I think Amazon is just great. So my book is available there and Apple and Google and so forth.

I can be followed at Twitter . I am not the most active tweeter—Dr. Richard Maurer. And then there is a And that’s Blood Code. And occasionally, people from around the country will post their blood test results right on the page and give a cheer out to themselves on how well they’ve corrected some of those metrics.

DrMR: Nice, nice.

DrRM: Hopefully, my work was to distill things that are seemingly complex but ultimately, to me, as easy to understand as the dashboard of your car.

DrMR: Yeah, that’s a good analogy. I like that.

DrRM: Okay.

DrMR: Cool. Well, Richard, thank you so much for taking the time. And hopefully, people listening to or reading this have gotten some insights if they’re struggling with some metabolic stuff. And we’ve given you some good resources and some good tools and actionables to move on.

So, Richard, thank you again. And until we see each other at another conference, I’ll be looking forward to that day.

DrRM: I look forward to our next meeting, Michael. Thanks so much.

DrMR: Thanks, Richard. Take care.

If you’re interested in learning more about The Blood Code and how it could work for you, click here.

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