The Prediabetes Warning Sign Your Doctor Is Not Testing For, with Dr. Keith Berkowitz

Show Notes

If you feel worse after you eat instead of better, that is not normal, and it is not in your head. It may be the earliest signal your body gives you that you are on the road to diabetes, and almost nobody is testing for it.

Dr. Ravi Kumar sits down with Dr. Keith Berkowitz, founder and medical director of the Center for Balanced Health in Midtown Manhattan. Dr. Berkowitz trained at Memorial Sloan Kettering and went to work alongside Dr. Robert Atkins in the late 1990s, at the height of the low fat era, when Atkins was simultaneously the most famous and the most attacked doctor in the world for saying that refined carbohydrates and sugar were driving obesity, diabetes, and heart disease. After Atkins died, Dr. Berkowitz became the torch bearer for that way of practicing, and he has spent 30 years since treating the whole person instead of chasing one number on a lab report.

The center of the conversation is reactive hypoglycemia, a condition most patients have never heard of and many physicians do not look for. It is your blood sugar crashing in the first few hours after a meal, driven by an inappropriate surge of insulin. Dr. Berkowitz explains why the symptoms people write off as ordinary life, the post meal fatigue, the brain fog, the anxiety, the vivid dreams, the hangry crashes, the 3pm reach for caffeine or sugar, are actually the cortisol response firing to pull your glucose back up. He describes his own glucose tolerance test dropping him into the 40s, and what that taught him about how invisible this is on a standard panel.

They also get into the long runway of insulin resistance, which can build for 20 years before fasting glucose ever looks high, which is exactly why so much of this gets caught late. Dr. Berkowitz makes the case that real metabolic health rests on two foundations, blood sugar and digestion, and the two are connected through the gut microbiome. The conversation covers how the sugar industry helped villainize fat and eggs, what the research actually showed at the time, the practical way to protect your microbiome when you have no choice but to take antibiotics, and why the continuous glucose monitor has changed what is possible to catch early.

Dr. Kumar also discusses Clarity TX, a human curated AI health platform built to help patients understand what is happening in their own bodies and walk into an appointment prepared. Full disclosure: Dr. Kumar is an advisor on the board and Dr. Berkowitz is a founding member.

Episode Resources

Dr. Keith Berkowitz, Center for Balanced Health
Clarity Blood Sugar
Dr. Ravi Kumar on LinkedIn
Dr. Ravi Kumar’s Website

In this episode, you will discover:

What reactive hypoglycemia actually is: A blood sugar crash in the first few hours after eating, driven by an inappropriate insulin surge, and why up to half the population may have it without knowing
Why you feel worse after a meal, not better: The tired, foggy, anxious pattern that gets dismissed as a normal afternoon
The symptom you have been blaming on the wrong thing: Why it is cortisol, not the low glucose itself, that produces the shakiness, the sweating, and the racing heart
The everyday clues: Vivid dreams, afternoon crashes, hangry spells, and needing caffeine or sugar just to focus
The 20 year head start: How insulin resistance builds for two decades before glucose ever looks abnormal on a standard lab, and what to ask for instead
Dr. Berkowitz’s own test result: The glucose tolerance test that dropped him into the 40s, and what it revealed about how this hides
The Atkins story from the inside: What it was like to stand against the low fat craze in 1999, and why almost every warning Atkins made has held up
How fat and eggs got villainized: The sugar industry’s role in shaping the message, and what the underlying research actually showed
The two foundations: Why blood sugar and digestion, not any single supplement or drug, are where real metabolic health starts
Protecting your microbiome: The simple, evidence backed approach when you have to take a course of antibiotics
Why the CGM changed things: How continuous glucose monitoring finally makes the early pattern visible
Turning data into a plan: How Clarity Blood Sugar combines human curated expertise with AI to validate what you are feeling and build something you can act on

Key Takeaways

Reactive hypoglycemia is a blood sugar crash within a few hours of eating, caused by an inappropriate insulin surge, and it is one of the earliest predictors of prediabetes and diabetes
The symptoms most people write off, post meal fatigue, brain fog, anxiety, vivid dreams, and hangry crashes, are the body’s cortisol response trying to pull blood sugar back up. The distress comes from the rescue mechanism, not the low number itself
Insulin resistance can build for 20 years before fasting glucose looks abnormal, which is why a normal glucose on a standard panel is not reassurance that your metabolism is healthy
A single lab value taken in isolation misses the pattern. Dr. Berkowitz’s approach is to look at the whole person and the trajectory rather than chasing one number
Metabolic health rests on two foundations, blood sugar regulation and digestion, and the gut microbiome ties them together
Dr. Atkins was treated as a heretic for arguing that refined carbohydrates and sugar were driving obesity, diabetes, and heart disease. Decades later, most of that has been borne out
The continuous glucose monitor is the practical tool that makes the early pattern visible, because it shows the crash a fasting lab will never catch
The biggest levers cost nothing and need no prescription: protecting your sleep, paying attention to when you eat and not just what you eat, exercise, and easing up on caffeine and alcohol

About the guest

Dr. Keith Berkowitz is the founder and medical director of the Center for Balanced Health in Midtown Manhattan and a founding member of Clarity TX. He trained at Memorial Sloan Kettering and worked directly with Dr. Robert Atkins before carrying that integrative, root cause philosophy forward into 30 years of his own practice. He sees patients remotely in New York, New Jersey, Florida, and California.

Disclaimer: This show is for informational purposes only and is not a substitute for medical advice. Everything shared here is meant to empower you to ask better questions and work with your own doctor. This show is completely separate from Dr. Kumar’s role as assistant professor at UNC.

Transcript

[00:00 –> 00:54] Dr. Ravi Kumar: Welcome to the Dr Kumar Discovery. My name is Dr. Ravi Kumar. And today, I’m sitting down with Dr. Keith Berkowitz. Now if that name doesn’t ring a bell, let me give you some context. Back in the late nineties, Dr. Berkowitz went to work alongside Dr. Robert Atkins, who at the time was probably the most famous doctor in the world, and also one of the most attacked. Dr. Atkins stood up in the middle of a low fat craze that was sweeping the world, and said the thing that nobody wanted to hear, that refined carbohydrates and sugar were driving our epidemics of obesity, diabetes, and heart disease. The major health organizations called him a heretic. They said he was going to hurt people. And here we are, decades later, and almost everything he was warning us about has proven to be right. Dr. Berkowitz was right there next to him through all of it.

[00:54 –> 01:52] Dr. Ravi Kumar: And after Dr. Atkins passed away, he became the torch bearer for that whole way of looking at medicine. Today, Dr. Berkowitz runs the Center for Balanced Health in Manhattan, and he spent 30 years treating patients the way Dr. Atkins taught him, by looking at the whole person instead of just chasing a number on a lab report. A big part of our conversation today centers on a concept that Dr. Berkowitz is introducing to a lot of people for the first time. It’s something called reactive hypoglycemia. And before you dismiss this as irrelevant, I just want to say that there’s a decent chance that you might have reactive hypoglycemia and not even know it. Most people have never heard of it, and a lot of physicians haven’t either, but it could affect up to half the population. It’s basically your blood sugar crashing in the first few hours after you eat, and it’s one of the earliest predictors of prediabetes and diabetes.

[01:52 –> 03:01] Dr. Ravi Kumar: Dr. Berkowitz walks us through how to recognize it and what you can actually do to treat it. We also get into a tool I’m super excited about called Clarity TX. Full disclosure, I’m an advisor on the board, and Dr. Berkowitz is one of the founding members. It’s a human curated AI health platform built to help patients actually understand what’s happening in their own bodies and what to do about it. Clarity TX is the intersection of integrative medicine and AI, and products like this are gonna make the world a better place. Okay. So before we dive into all that, I gotta give you a quick disclaimer. This show is for informational purposes only. Everything you learn from my conversation with Dr. Berkowitz is meant to empower you. So take this knowledge, ask better questions, and work with your own doctor to build a more informed, healthier life. And just to be clear, this show is completely separate from my role as assistant professor at UNC. Okay, let’s get into it. My name is Dr. Ravi Kumar. I’m a neurosurgeon in search of the causes of human illness and the solutions that help us heal and thrive.

[03:01 –> 03:46] Dr. Ravi Kumar: I want you to join me on a journey of discovery as I turn over every stone in search of the roots of disease and the mysteries of our resilience. The human body is a mysterious and miraculous machine with an amazing ability to self heal. Let us question everything and discover our true potentials. Welcome to the Dr Kumar Discovery. Okay. So Dr. Berkowitz, thanks so much for joining me on the show today. I’m really excited to talk to you. Tell us first off how you got involved with Dr. Atkins back in the 1990s, and what that was like. And for anyone who doesn’t know who Dr. Atkins maybe is, maybe you could tell us who he is.

[03:46 –> 05:00] Dr. Keith Berkowitz: Okay. Well, we’ll start off who he is. Probably when I first met him, it was probably about 1998, 1999. He was probably the most famous doctor in the world at that time. He had, you know, a big reputation for diet. His Atkins diet, which was high fat, low carbohydrate, moderate protein, was in those days revolutionary. Today we look at it as kind of the norm. Right? It’s so interesting. And it was interesting that time is I was about to get married, my ex wife, she’s a nutritionist. She looked at some job offers, and there was an opening for a nutritionist with Dr. Atkins. And she goes to me, know, this is interesting. What do you think? I’m like, yeah. You should do it. You should take it. She’s like, but no one in my organization will ever talk to me again. I’m like, who cares? Like, you know, try something new. It may be exciting. You may learn something new. And and what’s interesting in those days, I think, you know, to put it into contextual sense, in 1999, the American Diabetic Association’s main two sponsors were Cadbury and Nestle’s. So they kinda missed the link between glucose and diabetes. Today we take that for granted, right? Everyone knows that. Think They totally do. Yeah. Middle school they learned it. Maybe even elementary school.

[05:00 –> 06:15] Dr. Keith Berkowitz: But in those days that was kinda controversial. And so she ended up working for Dr. Atkins. And over the years, I I got got to know him, got to meet him, and eventually he kinda wheeled me in. What really changed, and one of the ringing reasons I went to kinda work for him, is I met these three women. And each of those three women had breast cancer. And what was interesting about them, they were all terminal. And it had been 15 to 20 years earlier. And he had kept them alive, you know, using things like intravenous vitamin C, which we talked about the other day. Yeah. And other nutritional supplements and lifestyle changes. I’m like, wow. That’s really impressive. I had just finished my training at Sloan Kettering, you know, not too long before, and breast cancer, I’m like, wow. Well, look at these outcomes. Like, these patients who really were given up by conventional medicine, right, and left, you know, basically to you know, say goodbye to their family, were still alive 15 to 20 years later. That was awesome. Right. So I wanted to learn more about it. So then he finally got me to work for him. The the challenger, and this is kinda the funny part, is he was notorious for not signing contracts. So I actually made him sign my contract on Christmas Eve, so that I would come join him in January. So Okay. Basically I drove to his house in the city, his apartment, and he signed my contract. So then I go meet with my chairman of medicine.

[06:15 –> 06:53] Dr. Keith Berkowitz: At that time I was working in North Shore, And I go to him, you know, I’m really thinking about going to work for Dr. Atkins. What do you think? He’s like, you should go. You’ll learn a lot. It’ll be new. I’m like, wait a second. I don’t think you heard what I said. I may I actually made him repeat it three times to make sure he was telling me the truth. And and basically what he told me, which was really interesting, I kinda take it with me today, is I wasn’t gonna grow anymore in my role. At that time I was a hospitalist, before hospitalist became popular. This was in the late nineties. And that for me to really grow into medicine, I had to leave. And I had to you know, at that time, I already had started my executive MBA with the intention of actually leaving medicine.

[06:53 –> 06:53] Dr. Ravi Kumar: Okay.

[06:53 –> 07:14] Dr. Keith Berkowitz: And what really saved me was meeting Dr. Atkins and seeing a different type of medicine. It wasn’t medicine I was unhappy with. It was I just wasn’t growing in the hospital situation. Mean, we all know that now today. And it was so exciting I got to work with him, and really work with one of the leaders in metabolic health. Yeah. And integrative medicine.

[07:14 –> 08:06] Dr. Ravi Kumar: And that must have been kinda scary, right? Because even though you’re saying, hey, back then the you know, we didn’t even fully understand that refined carbohydrates and sugar led to this metabolic derangement. But Dr. Atkins was saying the exact opposite, stuff that we understand clearly now, but at at the same time, I mean, he was basically seen as a heretic by these major health organizations like the And and you’re going to work for him. So I I imagine that was kind of, like, scary because you guys, I mean, you guys were swimming against a current of voices that were leading the health message around the world, and now you’re gonna be these two, you know, two guys speaking out against it. And as far as someone trying to build a career, that’s kinda scary. Did you feel that at all?

[08:06 –> 09:15] Dr. Keith Berkowitz: I think my age worked for my favor, right? I was I think I was about 32, 33 at the time. Okay. I think I was too young and naive to really understand it. Like I think now if I in my fifties, if I went back and said, hey, wait, I think I’d be a little bit more nervous. It wasn’t as bad. And one of the things that happened, and it happened a couple months before, the summer before I went to work with them, Gary Taubes released his famous essay in the New York Times about, you know, maybe sugar’s bad. And then also Dr. Atkins soon after went on Larry King. And that was really a a central moment where he talked about thyroid and how, you know, people had fatigue and other issues, and it may be thyroid related. And the phones rang off the hook. So I actually kinda I think my timing was really good for that aspect, where you you got some mainstream, you know, attention for the first time. And and really people started to doubt, you know, the previous message. I mean I mean, it’s so interesting. If you look at like I remember in college, that was the beginning of the low fat era. Remember we went to I think it was Snackwells. It was like these cookies that had almost no fat. And I remember gaining like 15 to 20 pounds during college. And what really happened is we stopped going from one cookie. Right? We had one cookie.

[09:15 –> 09:58] Dr. Keith Berkowitz: Now we’re consuming five, ten, 15 cookies. And and that really was really interesting. And then when I incorporated that in my own life early in my career, you know, I realized, wow, I really feel a lot better. You know, this is really a game changer for me. And that was Yeah. Really huge at that time. I remember when I first changed my diet, I was rounding in the hospital, and I would carry meatballs in my pocket. And I was so hungry because I had such severe withdrawal symptoms, which Dr. Atkins and my wife at that time both neglected to share with me that I would get that. And but I realized like a month later, I mean, my weight dropped. I felt so much better. I was performing better in the gym, and in every aspect. My focus, everything was better.

[09:58 –> 10:18] Dr. Ravi Kumar: Yeah. Okay. So for the audience, I think most people have heard of the Atkins diet, and they know who Robert Atkins was. But back so back in the eighties and nineties, we were on this I mean, even before that, we were on this huge low fat kick. I mean, everyone remembers these packages that say low fat. In fact, they’re still packaging this as low fat

[10:18 –> 10:19] Dr. Keith Berkowitz: up here.

[10:19 –> 11:29] Dr. Ravi Kumar: And, yeah, fat became totally villainized. It goes all the way back to Ancel Keys, but it was this this thought that fat somehow went into your arteries and caused heart disease, and that we needed to have less fat in our diet. And all the while, you know, heart disease and diabetes and metabolic syndrome and, you know, neurodegenerative diseases are just exploding, even though we’re all eating low fat. And Dr. Atkins came in during the height of this craze and said, hey, listen, maybe we should switch our energy metabolism to fat burning rather than carbohydrate burning, and this will fix so many problems. It will fix, you know, cardiovascular disease and metabolic syndrome and all these problems with having perpetually high glucose. And, I mean, he was he was called a heretic. I mean, people thought he was, you know, basically gonna hurt people. I mean, as far as from the medical community, they were saying he was gonna hurt people. All the while, he had like, I don’t know, like 20,000 patients with fantastically good outcomes like weight loss and, you know, resolution of degenerative diseases and chronic diseases.

[11:29 –> 12:05] Dr. Ravi Kumar: And at the same time, he was treating patients with cancer who, you know, cancer is a metabolically based disease. And so, you know, he was a voice that was was making a ton of sense at the time when everyone was speaking a different language, essentially, in medicine. And we we don’t understand that if you if you don’t have history, and because now everyone’s saying, yeah. I mean, if you eat high lots of high refined carbohydrates, you’re gonna have metabolic syndrome, you’re gonna develop diabetes, and you’re gonna have all these chronic diseases. Everyone understands that now. But back then, it was just you and him, basically.

[12:05 –> 13:08] Dr. Keith Berkowitz: Well, you know the ironic part of this? Like, you go back to 1930, you know, a guy won the Nobel Prize showing that cancer cells fed on sugar. I mean, Otto Warburg, right? He won the Nobel Prize in the thirties. And then Dr. Atkins took his dietary advice from an article in the Journal of American Medical Association from the early sixties, and there was another one in the early forties. He he learned from someone named Carlton Fredericks was his mentor, and Adele Davis. So they had brought about, you know, low carb diets. Actually, someone bought me a book once, and it’s it’s a low carb diet from the sixties. It didn’t really take off. It was whipped cream and martinis. That was the name of the diet. But the point is that he took it from the old medical journals. That’s the crazy part of this whole story. And the lack of conversation I don’t know if you you heard this. Like, there was a Sentinel article that was published by these three Harvard professors, I think it was in late sixties, about how fat was the cause of heart disease. And it turned out that it was sponsored by the sugar industry. Right? And then you see going to the seventies, eggs start to get vilified. Right?

[13:08 –> 14:14] Dr. Keith Berkowitz: Eggs are bad. Soy industry started taking off. And now you look in, I think it was 2025, 2024, the FDA actually now said eggs are good for you. And and it’s really kinda interesting that like how, you know, I guess profit. Right? Or, you know, food companies really change it. And people forget, like the food businesses really followed the tobacco business. In the 1980s, a lot of the food companies were owned by tobacco companies. And it was the same kind of program. And again, that low fat led to this obesity epidemic and diabetes epidemic. I mean, it’s it’s heart disease epidemic. They’re all and and the the interesting thing about heart disease, and I and I think what’s and we we talked about you and I the other day, is we we missed the beginning point. Right? We don’t talk about arterial inflammation. We don’t talk about arterial damage. We’re we’re so focused on cholesterol. And what’s interesting, we now know cholesterol in food has no impact on cholesterol in the body. Right? Which was that was never the case. And ironically, I I read a study that eggs today have less cholesterol than they did in nineteen sixties, you know, when you buy eggs today.

[14:14 –> 14:56] Dr. Keith Berkowitz: So that all got translated kinda and you talk about Ansel Pease, who cherry picked basically countries that fit his narrative. Right? Mhmm. As opposed to using others, and that this, you know, low fat thing. And what the other part of it, which I find so interesting, a big part of my practice today, infertility came out of this. We have so much now in fertility, a lot of it’s related to originally called polycystic ovarian syndrome. Now, you know, it’s polymetabolic, you know, syndrome And that’s really the consequence of this. I mean, the the the unintended consequences of this dietary change were enormous for cancer, for heart disease, for fertility, for autoimmune disease. It’s it’s it goes on and on and on.

[14:57 –> 15:23] Dr. Ravi Kumar: Yeah. And, you know, when, you know, Dr. Atkins is saying this back then, the tides don’t change quickly. I mean, I would say, like, medical dogma or medical mess messaging is like a freight train. If you’re gonna stop it and turn it around, it takes a long time. And, you know, if you’re willing to say, hey, this train’s going the wrong direction, you’re at high risk of being run over. That was You like, the only

[15:23 –> 15:34] Dr. Keith Berkowitz: example that is? Trans fat, right? Trans fat, studies on trans fats from the nineteen forties. When did we make a change in the food supply? Nineteen nineties? Maybe, you know, so that’s almost sixty years.

[15:34 –> 15:36] Dr. Ravi Kumar: So No. Was like 2017.

[15:36 –> 15:43] Dr. Keith Berkowitz: Didn’t 2017 or even later. Yeah. And that’s nineteen forties research, right? So it’s that’s talk about slow, right? That’s tremendously slow.

[15:44 –> 16:06] Dr. Ravi Kumar: I mean the cardiovascular carnage from trans fats is unbelievable. I mean it’s probably equivalent to the the carnage from saying, hey, we should eat high polyunsaturated fat, high carbohydrate meals, which was totally off base. But yeah, trans fats are just straight up poisons. Know that They’re illegal now. They can’t put them in the food supply It

[16:06 –> 16:35] Dr. Keith Berkowitz: took like almost seventy years for that conversation to really happen, right? From the from the research to, you know, to actual change in in guidelines. And and I think it’s it’s and we look at like the food pyramid for example. Right? Now we’re trying to change it. Right? It’s kind of upside down. But that look how many years that took to change. Right? Yeah. And now And how much controversy that involved. I am not sure why real food is so controversial, to be honest with me. I don’t either. I still can’t figure that one out, but for some reason that is controversial.

[16:35 –> 17:09] Dr. Ravi Kumar: Yeah. I mean it’s it’s crazy that, you know, we still have synthetic additives in our food. I mean, pretty much every packaged processed food has synthetic additives in it. These are not food molecules, but they’re put into food. And like one is BHA, it’s a preservative that they put in most of the grains, processed grain foods. And in 1990s, the US government said this is probably a carcinogen, but it had already been labeled as generally recognized as safe, that GRAS labeling. I mean, they said it was probably a carcinogen. It’s still in our food today.

[17:10 –> 17:32] Dr. Keith Berkowitz: Well, look at the studies now on artificial sweeteners, right, that for sucralose, which is can change DNA. You think about what the impact of it’s huge. Yeah. But you know where also people don’t realize they see it? It’s in medical products. You go to buy, you know, any kind of over the counter medical product. They all have red dots, or blue dye, or or you know, these food additives.

[17:33 –> 17:35] Dr. Ravi Kumar: Why? Vitamins. Kids vitamins Yeah. Have

[17:35 –> 17:53] Dr. Keith Berkowitz: It makes no sense at all. You go to other countries, it’s gone for years. Mhmm. And and I think, you know, radical change metabolically really involves that first. Right? We can do all the other changes with diet and everything else. But if it’s still in our food supply, that’s really challenging, I think, to make a longstanding change.

[17:53 –> 18:28] Dr. Ravi Kumar: Hey, guys. If you’re enjoying this podcast or it’s helping you, please help me get it out to the rest of the world. All you need to do is rate and review it on Apple Podcasts. Share it with a friend, post it on Facebook, and that’s basically it. The algorithm rewards engagement. Every review, every mention puts this show in front of someone who’s looking for clear, no nonsense health information, the type of information that I’m putting in these podcasts. So thanks so much, and let’s get back to it. So Dr. Atkins died in the early two thousands. I think he slipped on the ice and had a a head bleed, correct?

[18:29 –> 18:38] Dr. Keith Berkowitz: Was there, so I’m the only one that truly knows. Yes, he actually it was an unusual April day where we had his nose drilled the night before, and he had slipped on black ice.

[18:38 –> 19:08] Dr. Ravi Kumar: Yeah. And that and it was such a tragedy. But you you were basically the sole torch bearer from that point on, and you you started your own clinic and have carried on kind of that philosophy or that that message that Dr. Atkins had as far as looking at medicine in a truly curious and skeptical way and and trying to figure out really what’s going on with people and why how they can heal. So what did you do at that point? Like tell me what how you carried on from there.

[19:08 –> 20:19] Dr. Keith Berkowitz: So interesting. So actually I was kinda left on my own running this practice, and then eventually opened up my own practice, and really focused on I believe foundational medicine. Right? Kinda looking at medicine from and to me, those foundational points I look at today were really looking at digestion and blood sugar. You know, with during his era, it was really blood sugar we looked at. Digestion had really not been a thing at that point. I had one of my attendings when I did my training in the nineties, Jerry Mullen, who’s now at Johns Hopkins, started talking about probiotics and the benefit. And he that was also laughed at. And now look, probiotics are now tied to cancer, you know, to other things that, you know, we never thought about it. And really kinda learning that, and exploring my journey, looking at alternative solutions. But more importantly, and I think where we get caught up a lot of the time, is so focused on the numbers by itself, instead of how the numbers fit into a bigger picture. I call it puzzle solving or problem solving. Building a system, right, that could withstand sickness, disease, and really adapt effectively. And the the interesting about medicine, it may not matter so much what that process is in the beginning because the underlying problem is the same. Right?

[20:19 –> 20:56] Dr. Keith Berkowitz: It’s getting your blood sugar, your digestion, you know, under control, getting the nervous system to work better. That’s the key, and that’s what really my biggest takeaway. And that’s what we call integrative or holistic or functional medicine today. You know, that’s that treating the person as a whole. And also trying not to use medications unless absolutely necessary. Dr. Atkins gave me a famous quote, which I like. He always talked about medications work by blocking a process, and nutritional supplements work by enhancing a process. So which would you choose first? Right? You would always wanna choose, you know, enhancing the process rather than blocking the process. And the interesting thing is by blocking the process, there’s an unintended consequence as well.

[20:56 –> 21:39] Dr. Ravi Kumar: Yeah. There is. Yeah. And that’s why all medications have side effects. Okay. So and I always tell all my patients and my friends and and my listeners that, hey, listen, if you are truly trying to figure out root causes of problems, you you kind of have to go to a functional or integrative medicine doctor. I mean, we both went to medical school, and we know that that’s not what they teach you in medical school. They teach you about diseases and drugs and surgeries that alter the course of a disease by interfering with the symptoms. But you’re not ever trying to really fix anything. Maybe with antibiotics, you know, you’re you’re fixing an infection with antibiotics. But I mean, we don’t learn how to fix things. We don’t. You know?

[21:39 –> 22:10] Dr. Keith Berkowitz: But even with antibiotics, right, we don’t get probiotics with it. Right? Because we don’t deal with the unintended consequences. You know, we I would tell you that William Osler’s, you know, quote, right, from he’s of from Johns Hopkins, the father of internal medicine, saying for a patient to recover from a disease process, he has to recover from the disease process, and also the treatment giving to treat the disease process. It takes two things, right? That’s the unintended consequences aspect. And I think when we treat something, when we treat any disorder, right, we want to also protect the body from the treatment at the same time.

[22:10 –> 23:00] Dr. Ravi Kumar: Yeah. Absolutely. I mean there’s there’s like fantastic clinical trials at, you know, Harvard and other institutions showing that if you give saccharomyces boulardii with antibiotics, you essentially preserve the architecture of the microbiome. But I mean, these are strong studies, and really no doctor is doing that. Mean, there’s other studies showing different, basically, probiotics that you can give with antibiotics, but yeah. Now if my kid ever has to take an antibiotic or I ever have to take one, we’re always taking it with saccharomyces boulardii. I mean, we try to avoid antibiotics at all costs, but still, that that’s a simple, no no complication, you know, no side effect way to try to preserve your microbiome while taking antibiotics. And no conventional medical doctors telling their patients do it because we don’t learn it in medical school.

[23:00 –> 23:56] Dr. Keith Berkowitz: Even though the literature is very clear, right? Literature is very clear about that. And and also that now we know a lot of research showing that chronic antibiotic use leads to higher risk of allergies, higher risk of autoimmune disease. Those are issues. There’s a recent study in colon cancer looking at probiotics can kinda kinda change that course. I mean, we’re now learning that they are important Yeah. To protect the immune system from that aspect. And also to so that we digest. I mean, the thing that Doctor. Atkinson has to deal with that I think we deal with today is digestion and that microbiome. I think that’s really I would call like the modern issue right now. Right? Where we’ve really kinda drawn in more attention to in the last ten, 15 years where digestion is really more and more critical for, you know, proper health. And we’re now starting to investigate how probiotics work. And I and I think the future is gonna be using probiotics really, you know, as a treatment modality for a lot of conditions or diseases.

[23:57 –> 24:12] Dr. Ravi Kumar: Yeah. And I also think bacteriophages is another thing that’s going to fit into there at some point because you can essentially pin you know, take a scalpel to the microbiome and cut out what you don’t want and keep what you do. And you know, right now antibiotics nuke everything.

[24:12 –> 24:47] Dr. Keith Berkowitz: Right. Yeah. That’s the future. That’s definitely these phages is the future. That’s the next antibiotic. There’s no doubt about it. Once that technology’s really understood better. And and there are some probiotics already companies now looking at using that in its early stages. I think it’s really critical. I I think that’s so important. And and to bring long COVID in for one second is that’s one of the catastrophic parts of long COVID is the alteration of the gut microbiome we’re seeing. Yeah. And affecting you know, what I what I’ve learned kinda in the most recent is the mental health effect of not having a proper gut microbiome is huge. Yeah.

[24:47 –> 25:11] Dr. Ravi Kumar: No. It’s huge. I mean, you know, we got the the gut alone makes a tremendous amount of neurotransmitters, including serotonin. And there’s a communication, a two way communication from the gut to the brain through the vagus nerve. I mean, it’s it’s literally a direct line from your gut to your brain stem which communicates with the rest of your brain. And so it’s and it’s it’s built like that on purpose. You know? Exactly.

[25:12 –> 25:14] Dr. Keith Berkowitz: That’s for a reason. So I

[25:14 –> 25:22] Dr. Ravi Kumar: mean, the gut the gut feeling that you people talk about, I mean, that that’s a phrase as old as time that came from this brain gut connection.

[25:23 –> 25:46] Dr. Keith Berkowitz: And we’re seeing this this concept of everyone in fight or flight. Right? That’s where they’re fight or flight, where is serotonin? And what’s interesting, if you look at a lot of neurological diseases, right, today, Parkinson’s, Alzheimer’s, we’re really showing that probably underneath, they’re actually digestive diseases to begin with. It’s that neurotransmitter disruption at an early stage within the gut microbiome that’s really kind of triggering that disease down the road, and I think that’s so important.

[25:46 –> 26:13] Dr. Ravi Kumar: Yeah. And that just breaks it, you know, whenever people say, no, we don’t have evidence to support it, you gotta say, listen, the body’s so complex. And we understand that just a fraction of a fraction of what we need to know about how it works. It’s just extraordinary extraordinarily complex, and every system is connected. In fact, the brain receives information from literally every cell in your body. Literally every single cell in your body. And if you think that that wasn’t put there for a reason, then

[26:14 –> 26:46] Dr. Keith Berkowitz: Well everyone forgets our body’s a feedback loop, right? It Yeah. It goes around and around. But also I think our body was designed for backup systems, right? Have many backup systems to help protect us, right? And I think that’s what’s really interesting. And that goes to the unintended consequences of some of the treatments we use, right, can disrupt that. And I I think that’s so critical. Like and that’s why I go back and say the foundation to me is the blood sugar and the digestion. Like, you can get those two things really right and well, then better health is is much more easily attained.

[26:46 –> 27:08] Dr. Ravi Kumar: Yeah. Definitely. That’s that’s very cool. So let’s talk about reactive hypoglycemia, because I think this is something that most people have never heard of, including maybe a lot of my my physician colleagues in the audience. What is it, and why is it pertinent to an extraordinarily large amount of people in the world? Can you explain it to us a little bit?

[27:08 –> 28:18] Dr. Keith Berkowitz: So I’m gonna start with if you do a literature search and you look up reactive hypoglycemia, what’s so interesting, there’s very few papers that don’t talk about type two diabetes. You really can’t find much research, which is I find interesting. If you take out diabetes and kinda think of what it is, it’s your body’s reaction to a glucose load. Right? Either one of two ways. Either from, you know, eating food or from stress. And the body end up, in most cases, overproducing insulin, and we’ll explain that in a second, causing your blood sugar to drop, usually within a four hour period. And what what what the issue is is the body’s actually making too much insulin, and insulin’s job is actually to move glucose into the cell to use as energy. That’s how our body works. And that overproduction insulin leaving your body with a lower amount of glucose than you started with. I I use an analogy all the time. It’s like taking a car to a gas station. Filling up the car with gas, but there’s a hole in the bottom of the gas tank. And and that’s you would expect in a lot of ways that your body should feel better, right, with energy. But in this case, and this is something I suffer from, and I didn’t learn too many years later, is I felt worse after I ate.

[28:18 –> 28:37] Dr. Keith Berkowitz: I felt more tired. I felt more sleep. One of my favorite ways to kinda know that it is a problem is when people get vivid dreams at night. One of the main causes of vivid dreams is your blood sugar dropping, because it’s a panic state on your brain. If you go back to a lot of these kind of studies in the early two thousand, a lot of neurological disorders were really tied to that.

[28:38 –> 28:50] Dr. Ravi Kumar: So, okay, so when we’re talking about reactive hypoglycemia, you’re basically it’s a person who’s eating a meal, and they’re possibly insulin resistant in some in some fashion.

[28:50 –> 28:50] Dr. Keith Berkowitz: Correct.

[28:51 –> 29:01] Dr. Ravi Kumar: And so the body releases the pancreas releases insulin after you eat. The blood glucose doesn’t enter the cells as efficiently as it should because the cells are insulin resistant.

[29:01 –> 29:48] Dr. Keith Berkowitz: Very true. And what people don’t realize so if we talk about type two diabetes, right, the problem with the diagnosis of type two diabetes, it’s so focused on glucose, right, or markers for diagnosing as high glucose, it really is an insulin resistance disorder. Right? And what people don’t realize is the insulin resistance happens years prior to the glucose being high. And and this is and what I would even call reactive hypoglycemia a prediabetic condition. And and what the key is is that inappropriate amount insulin. So it can happen with food, but it also can happen with stress. So Okay. The other part is cortisol also ends up being recruited when blood sugar is low. And that’s why people have those feelings, you know, where they get fast heart rate, they can feel dizzy, sweating, you know, hungry, all those feelings because of that inappropriate cortisol release Okay. Because the blood sugar’s off.

[29:48 –> 30:07] Dr. Ravi Kumar: So okay. So that that initial release of insulin after you eat doesn’t get the response that you need, so your blood glucose stays high. So now the body says, okay. Let’s really pump it. And so it releases a lot more insulin, and that drops your glucose too low, and that’s where you get symptomatic. Is that is that the

[30:07 –> 30:11] Dr. Keith Berkowitz: right Correct. Mechanism? Yeah. You get symptomatic from the cortisol response that follows that.

[30:11 –> 30:11] Dr. Ravi Kumar: The cortisol

[30:11 –> 30:17] Dr. Keith Berkowitz: So it’s not actually the blood sugar itself, it’s the body’s response with cortisol that actually triggers that response.

[30:17 –> 30:21] Dr. Ravi Kumar: And cortisol’s goal here is to bring the blood sugar back up?

[30:21 –> 30:22] Dr. Keith Berkowitz: Correct. Exactly.

[30:22 –> 30:28] Dr. Ravi Kumar: Yeah. Okay. And and what happens to glucagon in this? Because glucagon normally pushes blood sugar back up. Is it failing?

[30:28 –> 30:57] Dr. Keith Berkowitz: Absolutely. And and one of the theories behind it, I I read an interesting study recently that I don’t know if it’s a third or half of teenagers already have fatty liver. Right? So that that fatty liver, or the issue’s already liver, which is responsible for balancing insulin insulin and glucagon, is damaged. That system ends up being damaged. So it’s not able to really properly, you know, secrete glucagon to bring the blood sugar up when it drops low. And it doesn’t filter out the insulin fast enough.

[30:58 –> 31:13] Dr. Ravi Kumar: Okay. So if you’re insulin sensitive, meaning you’re metabolically healthy, that initial push of insulin out of your pancreas after you eat will bring your blood glucose in the normal ranges, and you won’t have that second insulin push and that hypoglycemic Right.

[31:14 –> 32:29] Dr. Keith Berkowitz: Response. I see. You’ll have more of what I call a bell shaped curve, right, over a four or five hour period. Right? Okay. And now instead we see more of this kind of spike, right, up and down. And for some people it can happen with ten minutes, some other people two to three hours. When I did my first, I had a glucose tolerance test, because I had these vague symptoms where I remember going back to medical school. To study, I had to do a family sized pack of Twizzlers, which now I know is pretty bad for you. Then in the morning have this huge cup of coffee. Then I don’t know if you had exams like this in medical school. We’d have like four hours back to back, like back to back exams. Then I would have hard candies during the exam, and then I would have to have something to relax at night. So I wasn’t you know, I was like, why wasn’t I focusing? Why did I need all these things to kinda concentrate? And then I did my first glucose tolerance test, and my blood sugar two hours dropped into the forties. Wow. Okay. And that the one of the issues with and I think why it’s kinda still missed today, is no one looks at insulin as well. You need to look at both. That insulin really is the driving force behind this. And that insulin resistance, where we traditionally thought about that in obesity. Right? We’ve always thought about you have more fat cells, fat cells are more insulin resistant, you need to make more insulin to overcome that. But that’s not that anymore.

[32:29 –> 32:38] Dr. Keith Berkowitz: Like, it’s everyone. And I I wouldn’t be surprised if 50% of the population in this country has has that metabolic disruption, right, where their insulin resistant. Yeah.

[32:39 –> 32:58] Dr. Ravi Kumar: Interesting. So I guess if people have, say, after they eat, in the first few hours after they eat, they get this period where they’re feeling lightheaded or maybe brain foggish or they’re sweating or feeling very anxious or just just feeling horrible. It’s a possibility that they have reactive hypoglycemia.

[32:58 –> 33:04] Dr. Keith Berkowitz: Absolutely. Or the term hangry, right? Like you are Angry. Hangry is the new term out there.

[33:04 –> 33:12] Dr. Ravi Kumar: This reactive hypoglycemia, that’s a that portends a possible future of diabetes, correct, or prediabetes?

[33:12 –> 33:13] Dr. Keith Berkowitz: Exactly.

[33:13 –> 33:18] Dr. Ravi Kumar: And so this is actually a pretty good thing to recognize because you can actually intervene early before you head And

[33:19 –> 34:01] Dr. Keith Berkowitz: I think some people suggest, right, and we were talking about this a little earlier, by the time the glucose rises, right, so you have where you have glucose levels above a 100, or in diabetes over one twenty five, or post meal above 40 for pre diabetes and 200 for diabetes, your insulin is already dysfunctional. So that could be 20 years in the making. And we talk about heart disease. Right? We started talking about that. That’s a big driver of heart disease because when insulin is inappropriate, it disrupts intracellular magnesium. And intracellular magnesium is very critical to maintain elasticity of blood vessels so that things like high blood pressure or coronary artery disease comes from that, you know, lack of intracellular magnesium, leaving the vessels to be less elastic and more likely to be damaged.

[34:02 –> 34:12] Dr. Ravi Kumar: Yeah. Okay. So what do you do when you find patients with this reactive hypoglycemia? I I assume you see these patients in your clinic. What what are you doing with them?

[34:13 –> 35:22] Dr. Keith Berkowitz: Always first is to look at any comorbidities. Right? We wanna look at things that can affect it. Let me give you one example. We started talking about digestion. So where digestion plays such a dramatic role, when you first eat something, your body already senses its need for insulin in the palate. Right? We already see that. So the body sends a message to the pancreas, hey. Glucose is coming. Make some insulin. Right? So if your digestion is slow, the problem is that insulin beats the glucose to that area, and that can drop even quicker. So that’s a big thing. So we wanna people with thyroid issues have issues where they don’t convert protein to glucose as easily as others. So we always wanna look at, you know, comorbidities as well. Then we wanna look at kinda dietary habits and lifestyle habits. The one thing that you you and I both know, right, we always talk medicine, sleep is like the golden thing in life. Right? People that don’t sleep well end up with a lot of medical issues. There’s so much research backing that up by this time. Also caffeine, alcohol, all these things that do disrupt metabolic. Right? They’re toxins to the body, and they can disrupt, you know, blood sugar. And also how you eat and when you eat. Right? It’s not only what you eat, it’s also the timing of when you eat is really critical.

[35:23 –> 35:32] Dr. Ravi Kumar: Yeah. Okay. So you look at their comorbidities, you look at their sleep, their diet, their different possibly chronic diseases that they have, and where do you go from there?

[35:32 –> 35:36] Dr. Keith Berkowitz: And also medications. Medications we have to look at as well too. Right.

[35:36 –> 35:39] Dr. Ravi Kumar: Yeah. Because medications are probably the most common cause of hypoglycemia. Right?

[35:39 –> 36:34] Dr. Keith Berkowitz: I mean, the the latest one where no one talks about is the statin drugs and the impact on everyone knows about GLP one now. Right? So that class of drugs impacts GLP one, which affects glucose, you know, regulation. So that’s one. And then we go from that is kinda get a sense of when those periods are happening. Right? So are people getting low blood sugar right after the know, are they getting one hour, two hour? And then adjusting meals and stuff with that. Also, are they getting it overnight? One of the greatest tools that’s kinda been brought to us is the continuous glucose monitor. Right? That’s been game changing in this. And the reason is you get real time feedback. Like, I remember before we had access, I would have to rely on the patient’s history to see, you know, what’s happening. And I read a famous study that was done at Albert Einstein. This was done, it was called the c carbs study. And they asked patients how many grams of carbs they had a day. And on average people said 30. When they actually counted it, what do you think it was?

[36:34 –> 36:35] Dr. Ravi Kumar: Twice that?

[36:35 –> 37:43] Dr. Keith Berkowitz: Was It like a 100. It was like almost a And so so people’s perception of what they’re eating was cut off in that aspect, right? People didn’t really see that understanding from that aspect. So really understanding that point, and really and the nice thing about the the glucose monitor is then we can make dietary changes and see the impact immediately. Yeah. Whether, you know, some of my patients who have bad low blood sugar at night have to have a snack before bedtime. You know, others have to eat every two or three hours. Others do better with delaying breakfast in the morning. So there’s so many different variables. And Yeah. You know, that’s what we’re trying to come up with. You and I talked about one of the tools we’re starting to use is the advent of AI really has become helpful for that. Right? So Clarity Blood Sugar, one of the projects I’m working on, is gonna help people really get real time feedback and understand better, first of all, what it means. Right? I think the hardest part is making the diagnosis. Yeah. Because it’s still not widely accepted. You know there’s really no ICD 10 code, which is our coding system for reactive hypoglycemia. No code to this day. So it’s not really recognized as a disorder among most medical professionals.

[37:43 –> 37:48] Dr. Ravi Kumar: Yeah. If you don’t have a diagnosis code in in traditional medicine, it doesn’t exist.

[37:49 –> 37:49] Dr. Keith Berkowitz: Exactly.

[37:50 –> 37:53] Dr. Ravi Kumar: If you can’t if you can’t bill for it and charge for it, then

[37:53 –> 37:54] Dr. Keith Berkowitz: It’s not real.

[37:54 –> 38:40] Dr. Ravi Kumar: Yeah. Sorry. Thanks. I I got in to the audience that, you know, we’re we’re laughing about this, but it is kind of sad, honestly, because it it just it just identifies how broken our medical system is where we are just such in the think in the box thinkers in the traditional medical system. And the creativity and the the basically, the investigation and exploration that really treating a human being and and fixing them needs is not built into the way we practice, unfortunately. We can still do a lot of good. You know, I can go take a disc out or a brain tumor out for a patient who’s suffering, but still anything that takes any kind of complex investigation and thought usually sits outside the box of traditional medicine. It just does.

[38:40 –> 39:02] Dr. Keith Berkowitz: And you you you’re like me in that way. Like the puzzle aspect of medicine is what the exciting part is. Right? Mhmm. It’s being able to put the pieces together. And that moment I always find. Right? That I get out like, oh wow, that’s what it means. That is beyond satisfying. And I think it keeps me, being 30 years in practice, so engaged and interested even to this date, which Yeah. Which is exciting to me.

[39:02 –> 39:23] Dr. Ravi Kumar: So let’s you mentioned this tool, Clarity. So this is just to, like, so the audience knows, I’m I’m an adviser on the board for this company, and and you’re one of the founding members of this company. Tell us what it is, because I’m actually pretty excited about it. It’s really something that I feel like is going to be super valuable to patients, especially those suffering with metabolic health.

[39:24 –> 40:28] Dr. Keith Berkowitz: I think one of the key factors, right? So we started talking about, you know, that there’s no diagnosis there first of all, right? So an individual going to their physician or or medical professional is not really gonna get the proper feedback on it. And there’s no real drug for reactive hypoglycemia as well. Mhmm. Right? That’s one of the other issues. So really having that access where a couple things, right, where someone can actually make that diagnosis to begin with. I think that is so critical for people. It’s that initial validation. People have the initial validation that what they’re feeling is real, that we say it’s not in their head, That is so critical. The first step to healing actually, think, than anything else. And then using that, and then having a meal plan, having the root cause analysis, understanding the research behind it. And one of the great things about this project is all the research is graded. And then looking at modalities. Right? Modalities can be diet and lifestyle. They could be supplementation. They can be, you know, we call, you know, extra ones sleep related or stress mediation. All those things do matter.

[40:28 –> 41:25] Dr. Keith Berkowitz: It’s remember, we’re doing holistic or integrated approach. But also access to experts and understanding, where you can have access to people that have been in this field a long time and can give you better insight into what, you know, you’re you need to understand this disorder where, you know, that doesn’t have a billing code, so it doesn’t exist. Yeah. But yet, maybe half the population suffers from. So, you know, that’s one of the issues. And and that’s really exciting where I mean AI is here to stay. We all know that. Right? It’s here to stay and used the right way. And I call it the the marriage between humanistic and and computers. Right? Using the the access where we can crunch data so quickly, but also have the human component, which is the community, the support network, you know, the experts. That is the key. That’s the key to success. Having both those components in one is I think where people do the best at the end of the day. It’s it’s interesting. If you look in the business world, the most successful companies are all about

[41:26 –> 41:26] Dr. Ravi Kumar: Mhmm.

[41:26 –> 41:30] Dr. Keith Berkowitz: Yeah. And I think in medicine, that’s really what we need more of, that

[41:30 –> 42:18] Dr. Ravi Kumar: community. Absolutely. Absolutely. So the Clarity TX, essentially, it is this massive curated database of health problems and symptoms and interactions of drugs and supplements and diet and lifestyle. I mean, it is it is this huge compendium of data that’s curated by health care practitioners and then a integrated with AI. And the cool thing there is that, you know, you, me, any other physician or health care provider, we’ve got, you know, this one brain up here, which is pretty amazing, but it can’t put together data and do pattern recognition at the level that AI can. We can exceed AI in all these things like creativity and, you

[42:18 –> 42:20] Dr. Keith Berkowitz: know, skepticism. I call it nuance.

[42:20 –> 43:14] Dr. Ravi Kumar: Yeah, nuance, yeah. And compassion, that’s the other one, compassion that humans have that AI can never have. But but AI can take all this knowledge that we’ve accumulated, this massive, massive amount of knowledge, and apply data recognition and pattern recognition and integration of data, and then give it in a way that people like physicians and patients can understand and use, and that’s essentially what Clarity’s doing. So say you’ve got reactive hypoglycemia, or just maybe prediabetes or, you know, metabolic syndrome, and you want help figuring this out, how to manage it day by day, and a discrete plan on fixing it, Clarity lets you basically tell your whole story, almost like you’re talking to a physician with unlimited amounts of time in the office.

[43:14 –> 43:15] Dr. Keith Berkowitz: And that’s the And then key it term,

[43:15 –> 43:17] Dr. Ravi Kumar: creates a plan for you.

[43:17 –> 44:10] Dr. Keith Berkowitz: The key term is time, right? So there’s where the issue becomes, because in in most of those interactions people have, time is the biggest issue, right? Time is a limited resource, right, more than anything else. So it overcomes the time. I find, you know, then there’s a provider and the consumer facing, from a provider standpoint, a couple things. Right? Most providers don’t have time to do diet and lifestyle. Right? The other thing I like about, you know, we give back is also what you can bring back to your clinician or your your provider, right, with questions. Understanding. Because I think, and you and I both know, when someone comes in who’s prepared for that visit, that visit is gonna be so much more meaningful for them. Right? Yeah. There’s no doubt about that. And you know, that that is pretty Also, real time feedback, which is so important. But you don’t have to wait. At 02:00 in the morning, if that’s what you choose to do, you put in your information, you can get, you know, a real time solution. Yeah. You know, that

[44:10 –> 44:33] Dr. Ravi Kumar: So if you’re hypoglycemic at 2AM, and you can’t can’t get ahold of your doctor, you you tell you get up and you tell Clarity what’s going on with you, and it’s already following your case, and it says, okay, this is what you should think about, and this is what you should talk to your doctor about in the morning. This is likely what’s happening. So is that kind of how it integrates into someone who’s suffering with

[44:33 –> 45:39] Dr. Keith Berkowitz: Absolutely. And it learns Okay. The great thing in AI is it learns about you. Right? As you put more and more information, it’s able to really understand you, see patterns, like you said, pattern recognition, which is so critical. The other part which I really like is is the supplement medication checker. That’s really a challenge for us as as as providers for sure. Right? People come with a lot of supplements, and understanding things can interfere with each other. Right? And they actually may be counterproductive. Yeah. I mean, I find I don’t know if you ever see this. I find probably one out of ten patients is on two medications that work exactly the opposite. Like, they’re on you know? Unbelievable. And and that is kinda critical. Like right? And I always treat supplements as medication, so it’s easier for me to understand that. That’s really critical. And also Yeah. The the more informed someone is, and I and I find from a compliance and a success rate, the better they’re gonna do. One of the hardest parts is people leave off at a provider visit with five new drugs, but not really understanding how they work, and what they need to do, and the nuances behind it. Can they what time do you have to take it? You know, do they interfere with other things you’re taking?

[45:39 –> 46:05] Dr. Keith Berkowitz: That is is a key component that we that needs to be solved. And having that aspect is so critical, where you’re actually not replacing the provider, but building a tool that actually enhances that experience. Think that’s the future. Really like that. And as a provider, it makes our job so much easier. Right? Mhmm. Like if people already have done their homework, and understand what interacts and all these things beforehand, that’s huge. That makes our job so much simpler.

[46:05 –> 46:34] Dr. Ravi Kumar: Yeah. So okay. So just to to be clear, the user can if they get a a subscription to Clarity, and I and I don’t know if it’ll be available by the time this podcast releases, hopefully it will, and I’ll put a link to it in the show notes. But if they get us basically a subscription to this or they interact with Clarity, it’s going to kind of guide them day by day and give them questions that they can ask their healthcare provider. Right.

[46:34 –> 47:38] Dr. Keith Berkowitz: And also access to experts. Right? So the nice thing is building a library of of information. Right? I always think of medicine as a university, and it’s access to say you have nighttime blood sugar, then there’s there’s an expert who talks about what what could be a strategy you can use in real time. That I think is so powerful. Because one of the problems with, and you know this too as, you know, as a neurosurgeon, is that if you’re in certain parts of the country, your access to that level of expertise is just not available. And this gives you that availability, you know, which is so critical, especially in a disorder that, you know, is not really thought of very much, is not really looked at from that aspect. You know? And Yeah. And probably one of backbones to health. I would say, you know, in 2026, there’s no doubt about it. It’s one of the key components, and up to 50% of the population has issues with it. I I think that’s so critical to really integrate. I call integrating the consumer patient within the medical process. I think that’s so empowering to them, and actually makes those interactions much more efficient and successful when they need their provider.

[47:39 –> 47:58] Dr. Ravi Kumar: Yeah. No. I always tell I always say knowledge is power, you know? The more informed you are, the more power you have to take care of yourself and your family and all these things. And AI is going to completely revolutionize medicine. What we we see now is gonna be nothing like it looks in ten years or even five years.

[47:58 –> 48:00] Dr. Keith Berkowitz: Or maybe even six months.

[48:00 –> 48:03] Dr. Ravi Kumar: Or even even six months, yes. I know.

[48:03 –> 48:51] Dr. Keith Berkowitz: It’s scary, the rate it’s learning about it. Yeah. You know what, I’ll tell you another interesting use. I actually use it for my migraine sufferers. We create an agent so that they actually could, you know, learn is the barometric pressure gonna be high? Is the humidity gonna be high? So we look at we find and figure out triggers, right? And that’s really key. Right? So with blood sugar, can look at this food is a trigger, or this action, or not sleeping, or drinking coffee, or you know, not ex or exercising at the wrong time. That’s a big one. Right? People don’t even think of exercise. It could be a positive or negative, depending on when it’s Yeah. You know, utilized. And that’s so critical to give people real time feedback, where in a in a five to ten minute visit, which is the average medical visit, right, if that long, that’s not that’s not gonna happen. Just impossible.

[48:52 –> 48:58] Dr. Ravi Kumar: Yeah. So Clarity’s essentially like a coach, but way more informed than any doctor you’ll ever meet.

[48:58 –> 48:59] Dr. Keith Berkowitz: And

[49:00 –> 49:03] Dr. Ravi Kumar: it’s only coming out for metabolic health at first, correct?

[49:03 –> 49:44] Dr. Keith Berkowitz: Right. So it’s gonna be the first one for consumer well, it’s already out for providers on a wide For consumers it’s gonna be Clarity blood sugar to start. But to me that’s again, that’s 50% of the population. I don’t I think most of us have have felt blood sugar issues, right, at some point. Yeah. Where we miss a meal, or if you watch any commercials now, right, it’s hangry. Well, the commercials about, especially for these candy bars Mhmm. Is like, you know, are you hangry? And and that’s kinda critical, and it’s a nice first step to kinda building, you know, your health platform. But also recognizing that you have the issue, like I said before, is so critical. Having that initial validation and diagnosis is so critical for health and and, you know, improvement of well-being.

[49:44 –> 50:10] Dr. Ravi Kumar: Yeah. No. I agree with you. I mean, just the one of the worst things about being sick, if if anyone anyone’s been in this situation, is not knowing what the problem is. And as soon as you know what’s wrong, like you said, half the problem goes away because you you know now, and you’re not fearful, and you can create a plan, and you can figure out how to attack this. But when your demon is invisible, essentially

[50:10 –> 50:11] Dr. Keith Berkowitz: Right. Yeah. You don’t know

[50:11 –> 50:22] Dr. Ravi Kumar: what to do, it’s so scary, and it’s so and you feel so helpless. And so, yeah, acknowledgment, diagnosis, that’s like half the battle to getting better.

[50:22 –> 50:27] Dr. Keith Berkowitz: And now you add community and support, right, where you have other people who have similar circumstances.

[50:27 –> 50:27] Dr. Ravi Kumar: I I

[50:28 –> 51:26] Dr. Keith Berkowitz: always find this interesting. I mean, I see I see this more as I mature as a as a clinician. I have patients that come up with solutions for me that I never even thought of. And and that, you know, that’s because they they have had done their homework or research. And and again, a lot of these solutions are work, and that’s great. Yeah. And I I think that’s and this way, you build that empowered individual. And also, support is so critical. Having a community around you that actually understands what you’re going through. I A new word that’s been in my vocabulary in the last couple years is gaslighting. I don’t if you know that, you use that word. Where individuals feel like their conditions and issues are being dismissed. Because there is no proper diagnosis being made. There is no understanding. Because there’s not that interaction with others that are similar, or that share you know, a common issue, a common thread, or a common condition. And that’s so critical. And it’s so disheartening for an individual to have that issue.

[51:26 –> 51:52] Dr. Ravi Kumar: Yeah. Yeah. So and the community, absolutely. You need to forming a community with people who are going through the same thing as you is very important. And it’s psychologically and, you know, holistically, it’s very it’s part of the healing process. Now the community you’re talking about is there are gonna be community groups around these different issues, and then there’s also gonna be these expert guided sessions, correct?

[51:52 –> 51:58] Dr. Keith Berkowitz: Correct. Is that what it is? One part will have office hours, which is kinda interesting. It’s like almost like a college, right, professor?

[51:58 –> 51:59] Dr. Ravi Kumar: Okay.

[51:59 –> 52:11] Dr. Keith Berkowitz: And the other part is webinars and and but also videos from experts, and videos from from individuals, right, where you can share. Think is so critical among people and leads to so much better care.

[52:11 –> 52:12] Dr. Ravi Kumar: Yeah. Does. Yeah.

[52:12 –> 52:18] Dr. Keith Berkowitz: Absolutely. And it’s here already, right? I mean, you you go on to a lot of these social media platforms, that’s been done already.

[52:18 –> 52:57] Dr. Ravi Kumar: Yeah. No. Absolutely. That’s fantastic. I’ll put a link to Clarity, which I’m super excited about. You’ve been working on this for four years, and I think it’s gonna be be massive as far as this entry into the union of AI and medicine. So I’m really excited to see how it works out. If anyone’s suffering with metabolic issues, that’s blood sugar issues, insulin resistance, hypoglycemia, this app could be a game changer, honestly, based on what I’ve seen so far. So check it out, and you can feel free to send me questions if you want. How can people get ahold of you, Dr. Berkowitz?

[52:57 –> 53:27] Dr. Keith Berkowitz: So my practice is known as Center for Balanced Health. I’m in Midtown Manhattan in New York City, and I can be reached through that. That’s the website, centerforbalancedhealth.com. Yep. And, yeah, listen, like you, I love what I do, and I think this is the most exciting time in medicine I remember in recent years where Yeah. Absolutely. We had huge breakthroughs where we were always talked about patient empowerment. Right? That’s been that’s been always a push. But I think for the first time, this has actually come to fruition in reality, which is fantastic.

[53:27 –> 53:39] Dr. Ravi Kumar: It really is. I mean, we’re gonna watch a revolution in medicine happening within months and years. So I’m I’m super excited about it. Do you see see patients online or remotely, or is it only in person?

[53:39 –> 53:44] Dr. Keith Berkowitz: I see it remotely in Florida, New Jersey, and California, and New York.

[53:44 –> 53:55] Dr. Ravi Kumar: Okay. But otherwise I know people come from all over the world and the country to see you. So if you’re not in one of those states, you’re gonna have to take a trip up to New York to see Dr. Berkowitz. Fantastic. Thanks for coming on the show.

[53:55 –> 53:58] Dr. Keith Berkowitz: Well, thank you so much for having me. Such a great conversation.

[53:59 –> 55:05] Dr. Ravi Kumar: Okay, so I hope you enjoyed my conversation with Dr. Berkowitz. Here’s what I want you to walk away with. A huge chunk of how you feel day to day, like your energy, your focus, your mood, hangry crashes after a meal, they can all trace back to blood sugar and insulin. And that’s something you have a lot more control over than anyone ever told you. Simple things like protecting your sleep, paying attention to not just what you eat, but when you eat, exercise, easing up on caffeine and alcohol that can quietly disrupt your blood sugar regulation. All these things contribute to your metabolic health and blood sugar regulation. And none of them require prescription or a single dollar spent. So if you want to go deeper and understand better, the tool we talked about is called Clarity TX. It’s something I’m really excited about. It’s built to help you figure out what’s going on with your metabolic health, and then walk into your doctor’s office completely prepared. I’ll drop a link in the show notes, and you should definitely give it a look. Okay, folks. Until next time. Stay curious, stay skeptical, and stay healthy. Cheers.