Cyrus Khambatta, PhD: Welcome to the Mastering Diabetes Audio Experience, where we teach you how to sit in the driver's seat of your diabetes health for the rest of your life. We’ll teach you how to reverse insulin resistance, achieve your ideal body weight, gain energy and get your best A1c following more than 85 years of evidence-based research in the Mastering Diabetes Program.
Robby Barbaro, MPH: Our program teaches you how to reverse prediabetes and type 2 diabetes, and how to simplify your life with type 1 diabetes by maximizing your insulin sensitivity using food as medicine.
Cyrus Khambatta, PhD: We're on a bold mission to reverse insulin resistance in 1 million people. We are glad to have you joining us.
Robby Barbaro, MPH: Welcome back to the Mastering Diabetes Audio Experience. We have another great episode for you today, Cyrus and I are here together. How you doing today, Cyrus?
Cyrus Khambatta, PhD: Oh, I'm hanging in there. Today's a fun day actually, I'm excited to get into depth about finding a diabetes doctor, but overall, I have nothing to complain about.
Robby Barbaro, MPH: How are the cats doing?
Cyrus Khambatta, PhD: Oh my God! Sometimes I sit there and think to myself, like, I think I have two of the world's cutest cats, but I'm not 100% sure. I really feel that way. I ask Kylie that all the time. I'm like, “Are our cats abnormally cute? Or is it just my bias?” And she's like, “Well, I think both of them are true.”
Robby Barbaro, MPH: Probably both of them are true, but I think you can make a strong argument that they are just very unique. They really are.
Cyrus Khambatta, PhD: I mean, you would agree with that statement, correct?
Robby Barbaro, MPH: I absolutely would agree. I've spent a lot of time with them, and I definitely have my favorite. I mean, Mew and I have a special connection, but I love them both.
Cyrus Khambatta, PhD: Okay, well, we're going to be displaying more and more photos of them on social media and beyond. So, if you've never seen Mew or Blue, go visit us on Instagram and you'll find them. They're adorable. And if you don't think they’re adorable that's okay, but you're not in the norm.
Robby Barbaro, MPH: So, guys, we really appreciate all of you who have taken the time to leave us a review on Apple, so on the iTunes platform. Those reviews mean a lot for this Podcast, we have over 300 already, and we certainly would love to get to maybe like 350 or so in the near future.
And so, it's really easy to go leave a review, just scroll down to the bottom of the Apple on your phone, and you can just easily leave a review. So we want to just share a few.
This one came in recently. It's from John and he says, “This show is truly great. I very much appreciate the condensed and transparent discussion of peer reviewed science in the nutrition community. As a physician, I will be recommending this Podcast to many of my peers and patients.” So thank you, John, for that review. Sharing this with your peers and patients mean a lot, we just have so much respect for the medical community, which we'll be talking about a lot today on the Podcast. So the fact that you're recommending it to your peers means a lot.
So Cyrus, maybe you can read this next one.
Cyrus Khambatta, PhD: Yeah, we actually got another one specifically about our book, the Mastering Diabetes Book that just went out to the public on February 18, of this year. This one you can find on Amazon.
This one comes from Rithvik, Rithvik. He wrote, “Reading this book will teach you the single most powerful thing you will ever learn about diabetes. It challenges everything you thought you knew, and explains the shocking truth about what actually causes insulin resistance, and how to reverse it permanently. It's backed by almost 100 years of rock solid scientific evidence. I highly recommend this to anybody, and everyone looking to live a long, healthy life, free of diabetes and other chronic diseases as well.”
And Robby, you and I actually had an offline conversation about the fact that a lot of people are telling us these days or they're asking us, they say, “Hey guys, correct me if I'm wrong, but the Mastering Diabetes Method doesn't only pertain to diabetes?” And the answer is yes, absolutely. The Mastering Diabetes Method definitely works for all forms of diabetes, but if you think beyond diabetes, this method is applicable to anybody, as long as you're human, and you don't have to be living with any chronic disease for that matter.
But if you are, fatty liver disease, chronic kidney disease, Alzheimer's disease. Can't necessarily reverse Alzheimer's disease, but you can certainly improve your nutrition habits and, you know, cardiovascular disease falls under that umbrella as well.
So, what I think is important to understand is that the Mastering Diabetes Book, the Mastering Diabetes Method, the Mastering Diabetes Audio Experience, we're constantly talking about diabetes, because we live with it, and we understand the science inside and out. But if you don't have diabetes, or you are trying to prevent and reverse… Sorry, trying to prevent diabetes from happening in your life, this method is truly powerful and can certainly improve your overall health. No questions asked.
Robby Barbaro, MPH: You're exactly right. I have seen so many people write on social media, “I don't have diabetes, but I bought your book, and I'm blown away by what I've learned. I'm already making some of the recipes, and I just love it.” Well, thank you guys so much, and that feedback means a lot. So you're right, this book is applicable for a large number of people.
Cyrus Khambatta, PhD: For sure. There's also a couple of negative reviews that we've received online, on Amazon in particular, about the fact that we are making erroneous claims. People say, “Well, guys, this is a misleading subtitle. You can't reverse type 1 diabetes. You can't do it. Therefore, don't say you can do it. And this is misleading. And you guys are a bunch of quacks.”
So, Robby, how do you feel about those types of comments, and let's sort of clear up a little bit of the confusion there.
Robby Barbaro, MPH: Yeah. Part of it is a little bit funny, in the sense that when somebody is writing that review, they clearly did not read the book, Cyrus. That's the unfortunate part.
If somebody wants to write a review that they don't like something, that's an honest opinion, that's cool, but you got to read the book. And the fact that it's written by two people living with type 1 diabetes, who share our experience of how we use insulin to manage our blood glucose levels, and how to actually do that is super important.
So, we're definitely not claiming that you can reverse type 1 diabetes, we've never said that. And the subtitle is, it's more important to actually understand what it is saying, because what it is saying is the crux of the whole thing here, it's everything we do, which is that you can reverse insulin resistance, and that is absolutely true and important for people living with type 1 diabetes.
Cyrus Khambatta, PhD: Yeah, absolutely right. And I think a lot of people, maybe not a lot people, but some people might get confused because they see the word “reverse” and then “type 1 diabetes” in the same sentence, even though, with the claim that we're making is that you can reverse insulin resistance in all forms of diabetes, including type 1 diabetes.
So, you know, we're not trying to call anybody out here by name, that's not our purpose, but we just want to make sure that everybody is on the same page here about the fact that this whole method is specifically designed to target and reverse the root cause of what makes your blood glucose fluctuate, which is insulin resistance. And insulin resistance is just a thing, it's a state of metabolic health that applies to all forms of diabetes, regardless of whether you're living with type 1, type 1.5, prediabetes, type 2 diabetes, or gestational diabetes.
So, this message I think is very important to understand, and insulin resistance, unfortunately, is only generally talked about in the setting of prediabetes and type 2, and we're trying to expand that conversation to include all forms of diabetes because it's very important, and it can be the key to really improving your overall health in ways that you didn't even think were possible.
Robby Barbaro, MPH: And it's definitely happening. That's definitely happening. The conversation is expanding, and that's great to see.
So, in today's Podcast episode, you are going to learn all about telemedicine with Dr. Laurie Marbas. So, I hope you guys enjoy it, and we'll catch you in the next show.
Cyrus Khambatta, PhD: And one other thing that we'd love for you guys to do is, please head over to iTunes, and leave us a review. We would really, really appreciate that. If you've been listening to the Mastering Diabetes Audio Experience for, you know, two episodes or since it was born, we'd love to hear your thoughts. There's absolutely no pressure to have to leave us a five star review. You leave us an honest and open review based off of your own personal experience. That's all that we can ask for.
It means a lot to us to hear from you guys. And all the reviews help this Podcast travel farther and reach more people. So, thank you in advance for doing that, and we really appreciate your time and dedication to learning the Mastering Diabetes Method.
Robby Barbaro, MPH: Today we have a really exciting interview with Dr. Marbas and Anthony, who have started a brand new telemedicine practice.
So, we have worked with Dr. Marbas by sending her many of our clients over the past few years, and then she switched practices, and so we are super excited to be able to have this service of providing you guys with a diabetes doctor who understands all the nuances around the different types of diabetes.
So, if you haven't picked up our book yet, in here is our Brand New York Times best-selling book, we talk about the different types of diabetes, and the different expectations, the different goals that each type of diabetes, people living with each type of diabetes should have.
So, it's a different mindset if you're living with insulin dependent type 2 diabetes versus those who are living with non-independent type 2, or prediabetes, or gestational diabetes, or type 1, type 1.5. There's different considerations, and working with a diabetes doctor who totally understands the differences, and can also help you with the complications that are associated with all types of diabetes, we're talking cardiovascular health, kidney health, brain health, we're talking about, you know, some people struggle with erectile dysfunction, various types of diabetes. There's just a lot of considerations that is really important to work on with a licensed medical professional, and today, you're going to learn all about how you can work with, who we believe is, one of the world's best diabetes doctors in Dr. Laurie Marbas.
Cyrus Khambatta, PhD: Yeah, and actually you bring up a lot of good points here, Robby, which is that, trying to find a doctor that you trust is a difficult enough exercise unto itself, but now there's a whole collection of patients around the world that are looking, not only to just trust their doctor, but actually work with a doctor that is skilled at reversing chronic disease. Whether that chronic diseases diabetes, or cancer, or heart disease, or fatty liver disease, or chronic kidney disease, or any combination of autoimmune diseases.
So, really finding a doctor that you trust and knows how to reverse chronic disease using food as medicine is a whole… It's not easy to do. It's really not that easy to do. And with Dr. Marbas and with Anthony, we trust them implicitly, and we know from personal experience, and from previous experience with our clients that they do tremendous work.
So, both of them having each worked decades in very different areas of traditional health care, and learning separately that there is in fact a better way, Dr. Laurie Marbas and Anthony Masiello have shifted their focus to the prevention and reversal of chronic disease, just like we're talking about
Now, Laurie Marbas is an MD and an MBA, and she's double board certified as a Family Medicine and Lifestyle Medicine Doctor, who has been utilizing food as medicine since the year 2012.
Anthony Masiello is a Nationally Board-Certified Health and Wellness Coach, who has been helping individuals transform their lives for more than a decade.
Together, the two of them are working to make lifestyle change, and to make lifestyle medicine as accessible as possible for everyone, regardless of what medical background you come from. And they utilize modern technology, that they put together to create what's called “The Plant-Based Telehealth Platform.” You can find that at PlantBasedTelehealth.com.
And this is a platform where people across the country can access knowledgeable and experienced physicians, who are going to support the reversal and the prevention of chronic disease using lifestyle medicine and a whole-food, plant-based diet. The best part is that you could do this from the convenience of your own home, and that's the brilliance here.
Now this service is being launched with the ability to serve patients in 13 states currently, and you'll learn exactly which 13 states these are, but in addition to that, they also plan to have the coverage rolled out to all 50 states by the end of 2020.
So, we're very excited to be able to bring both Anthony and Laurie to the Mastering Diabetes, not only to Mastering Diabetes clients, but also to those who are just interested in reversing chronic disease. So, we hope you really enjoy this upcoming episode, and let us know exactly what you think.
Robby Barbaro, MPH: Dr. Marbas, Anthony, it's great to have you guys with us today. We're really excited to share about this brand new telehealth practice you guys have created.
Laurie Marbas, MD, MBA: Thank you for having us.
Anthony Masiello: Yeah, thanks a lot.
Robby Barbaro, MPH: So, in our community, we have thousands of people who are looking for a diabetes doctor, a doctor that can help them with their diabetes care, their diabetes medications, no matter what form of diabetes they're living with.
So obviously, most people, they're seeing an endocrinologist and that's who's already taken care of their diabetes health. But you guys now have a telehealth practice that can help people who are looking for support outside of the current care they've already received. So, can you just give us an understanding of what have you created, what is telehealth? Why don’t we start from the top?
Laurie Marbas, MD, MBA: I've been doing telemedicine for a few years now. And so basically what it is, it's taking care of a patient remotely. So, we're not in the same physical building or room, but we're actually taking care of you, like a video conferencing tools.
We actually have an EHR, Electronic Health Record that we describe as HIPAA compliant, meaning that you're safe, all of your information is up to, you know, the United States, laws on keeping your information private. And we have video chat, we can order medications, we can order labs, we can make those appointments and follow up as needed. And it works really well for this.
Cyrus Khambatta, PhD: So, you guys actually like fully replace an individual's in-person doctor, or you guys are like a supplement to somebody in-person doctor?
Laurie Marbas, MD, MBA: Right. I like to refer to it as a consultant to a primary care doctor. There's many things that can't be taken care of via telemedicine, but lifestyle medicine is actually a very easy move to video conferencing, because a lot of it is coaching, a lot of it is guidance. As long as they have like a blood pressure cuff at home, if they have high blood pressure, the glucometer, when we get the labs you can always discuss that they have their blood sugar logs and different things like that. We can do this very easily, but we do not replace a primary care doctor.
Cyrus Khambatta, PhD: Okay. So, what are the things that a primary care doctor would be able to do that you guys can't do via computer? Just give us a couple examples.
Laurie Marbas, MD, MBA: Sure, as a family medicine doctor, so as I’m taking care of newborns through elderly, I can't do a physical exam, in the sense that I can't lay hands on you. So, if you call with a significant shortness of breath, or chest pain, or any type of thing that requires a physical examination, there's something in your eye, there's something in your ear, these are things that I can assess or treat when I can't actually look at them and say, “This is what is wrong.” So that's when you would need to see someone either an urgent care physician or your primary care doctor.
Robby Barbaro, MPH: Can you give us a little bit of insight into the experience you have had working with diabetes patients?
Laurie Marbas, MD, MBA: Sure. It's been a lot of fun actually. You guys have sent me quite a few in the past, and it's been really rewarding in the sense that I can look at a patient and take the time, I guess, to look at them from the whole picture, how is their nutrition? How are their lifestyle activities? Are they exercising, are they resting, what is their stress level? Because stress, I've seen some really interesting things with some of the folks you’ve sent to me, really messing with their blood sugars.
And then honestly, looking at patients who were not diagnosed properly. So, maybe they were diagnosed as type 2 and they were actually like a type 1 or 1 and a half. And that was mind blowing for patients to say like, “Wow, I can actually get this blood sugar under control”, and they went years without being able to.
Robby Barbaro, MPH: Okay, so let's talk about this. We just have a special “Dinners with Cyrus and Robby” for people who purchased one of our books in a bookstore, and we had somebody on the call who was explaining how they have a low C-peptide level, and their current doctor actually does not believe that type 1.5 diabetes exists. Put them on three different oral diabetes medications, and refuses to let this patient use insulin or explore that option.
So, I think what you’re saying, you’re sharing that you've seen this, Cyrus and I have seen this over and over again, is really… And she's in a small town. She's in a small town with literally only two endocrinologist, her insurance does not allow her to see a different endocrinologist, so the service that you guys are offering is really a godsend here for many people who want to work with a diabetes doctor who really understands the bigger picture.
Laurie Marbas, MD, MBA: Right. Actually, that's really frightening and disturbing. I would definitely have… At least maybe, go see a different primary care doctor, that those type of individuals, if we're not there in that state yet, or if we're not able to give her care. That is very disturbing, actually.
Anthony Masiello: And it's exactly the problem that we're trying to solve here. Because as a coach, and as you guys know, and as you just give the example, Robby, we do a lot of really good work with people, working towards reversal and prevention of these chronic diseases. And one of the last things that I have to do when I'm seeing people for a short period of time, is I have to educate them on how to speak to their doctor, and how to arm them with the information that they need to share with their doctor to help the doctor to understand what is possible with this type of intensive lifestyle intervention, right?
And so many times, they go back to their well-meaning physicians, but they end up undoing a lot of the work that we're doing, or they create doubt in people, and I see it all the time and it kind of hurts me because these people who are making great progress, they either slow down or they start to get confused, because the doctors aren't set up yet to give them the kind of care and support that they need.
Cyrus Khambatta, PhD: Okay, so this is actually kind of a really good conversation for us to be having, because we always tell people right off the bat, we're not here to talk smack about doctors, and we don't want to bad mouth doctors in any way, shape or form because, you know, I have five doctors in my family, they're lifesavers, and they go into medicine with a generally altruistic mindset wanting to help people. But the tools that they provided in medical school aren't always helpful, especially when it comes to chronic disease reversal.
So, can you just give us a couple of ideas here of mistakes that a traditionally trained doctor may make when consulting with a diabetic patient, that you guys would be able to identify and maybe correct, because you have a different methodology and the sort of plant focused approach?
Laurie Marbas, MD, MBA: I think primarily, it's going to be nutritional recommendations. So oftentimes, you'll have recommendations of a low carb diet for diabetes especially when they think that that's the only way they're going to get their blood sugars low, and not understanding the underlying mechanism that’s causing the, at least, type 2 of insulin resistance. And won’t even understand that type 1s can develop insulin resistance as well, and use much less insulin than, actually, many times they do.
So that is one thing. And then, the nice thing is I can actually educate the patient, and oftentimes I'll ask the question, “Did your doctor ever explain to you what diabetes is? Or why you have diabetes? What is the mechanism? Can you explain that to me?” And I would say 99 out of 100 cases, someone look at me and go, “I have no idea why I have diabetes, I don't understand.”
And then I explain why they recommended a low carb diet, and then I explain why eating a whole-food, plant-based diet will help reverse that insulin resistance, that's either requiring them to use a lot of insulin if you're type 1. Or if you're a type 2, you may be using insulin or oral medications, and we can either improve or in many cases reverse that process. So, that is honestly the biggest thing that I see.
Or they're just given medications that are causing side effects, and now they're taking other medications, and it's just so many things. And the other thing is that many times we look at diabetes as an isolated diagnosis, when it's actually related to the obesity, it's related to the high blood pressure, it's related to all these other conditions, and once we start working on one, it's actually working on all of them. So, they're always surprised when patients get better, fully get better, not just the diabetes.
Robby Barbaro, MPH: Yeah, that's a huge distinction. I think something that's really important that you guys do through your telemedicine practice is, you will help patients learn how to use less medication. There's a science of deprescribing specific diabetes medications, and you have a lot of experience doing that. So maybe you can give us some insight into how you work with a patient on reducing diabetes medications?
Laurie Marbas, MD, MBA: Right. So eight years ago, when I transitioned myself and my family to a plant-based diet and started using this with patients, I was very nervous actually, because I wasn't really sure how quickly patients would get better, who are on insulin. And I quickly learned that I need to be like a hawk in watching these patients.
So, the nice thing about being in telemedicine or a telehealth practice is that it's really easy for the patient to take on their lunch break, or maybe they're at home in the evening and be able to meet with us from the comfort of their own home, and not have to worry about having to travel, take off time off work, and go somewhere and sit in wait for a doctor to see them, and then potentially be rushed in and out. So, that's the beauty of what we do here.
But the art of deprescribing medications is certainly a concern if you haven't done it before, and so that's the beauty of working as a team. We don't hire the doctors, we're contracting with doctors, so this is like their individual practice, but we're all on the same… I guess we're all in the same mindset, that’s definitely a whole-food, plant-based diet, and we work together in always making sure that we're staying on top of, you know, are we on the right track with certain patients, they can consult with one another. That's the beauty too, all the physicians are in agreement on how to approach a patient with using lifestyle medicine.
Cyrus Khambatta, PhD: I actually love this because I remember back in 2003, when I changed my diet from a sort of lower carbohydrate diet of eating about 100 to 150 grams of carbohydrate per day, and then transition to a low-fat, plant-based, whole-food diet, exactly what we advocate. My carbohydrate intake, if you want to put numbers to it, went from about 100 to 125 per day, upwards of 600 per day, and I was expecting my insulin use would also follow, to starts to go up.
My insulin use went from mid 40s, 40 to 45 units per day down to 25 units per day in seven days. And I remember distinctly feeling this, where I would eat a meal and then two hours after the meal, I would be profusely sweating because I was very hypoglycemic, and then I would have to back off on the amount of insulin I gave myself.
I would hit 4, 5, 6 different hypoglycemia per day during the first week, and I thought to myself like, “This is unbelievable how fastest is working.” So, you know, what you just said, you're impressed, and you're still sort of like in shock and awe about how quickly a patient can get better, how they can reduce their need for insulin, but also other oral medications that aren't even related to diabetes as well. So maybe we can talk about some of those other medications, too.
Laurie Marbas, MD, MBA: Yeah. Just to get back to insulin real quick though, I have had patients come off 60 units of insulin in three days, and 70 units of insulin in seven days. So, you know, it's crazy how much insulin some people are on, type 2s especially.
So, some of the other medications, you know, like Metformin is actually not too concerning as far as lowering your blood sugar, but there are some other medications that are oral hypoglycemic, this is what they described them as. There's a whole several different classes, but those have to be treated almost like your insulin as well.
So, sometimes I've seen patients on both, Metformin and oral hypoglycemic, which always worries me, especially if they're elderly. So those are things that we have to keep a close eye on as well. So, just because you're on oral medications does not mean that you're in the safe zone from becoming, like you described, a hypoglycemic or having these really low blood sugars, which can be dangerous, and you can die from that.
Cyrus Khambatta, PhD: Yeah, absolutely. Now, what about some cardiovascular medications? Are these… What is the timeline that somebody can expect to either lower their statins medication usage, or their blood pressure medication usage? Is that also a quick change or something that takes months to year?
Laurie Marbas, MD, MBA: So, I would say each class of medications is going to require, and the patients is going to be very independent of each other. So, let's say we have our blood pressure medications, so I may have had… I've had patients who've been on blood pressure meds, three or more, for decades and be off of all of them within 2 to 4 weeks.
Now, it really just depends on the patient, how severe their high blood pressure is, how well they respond to the diet, so it's really difficult to do a timeline. I just give my patients very… I watch them very closely.
I typically cut insulin down the first day that they’re fully committed. Now high blood pressure meds, depending on the blood pressure medication, I usually don't do that, just to kind of monitor them, but I watched them within the next few days. We're either in contact via patient portal messaging, secure messaging, or they make another appointment and keep their blood pressures.
Those signs would be like, when you get up you suddenly feel dizzy, or you felt really good on this diet, and suddenly you're just exhausted, that's when your blood pressure's too low. So, I tell them a couple of those things to watch for.
And then your statins, it really depends honestly on their heart attack risk profile. So, if I have patients who maybe are doing okay on their statin, I may leave that, especially if they’re seeing a cardiologist, I prefer to let a cardiologist make that decision. But I certainly think that there is a point that someone could either wean off or come off completely their medication.
But again, if you've had someone who's had a heart attack, it's probably best that they stay at least on the lower dose of the statin. They may not need as a higher dose, but certainly, statins have been proven to be beneficial in certain populations.
Cyrus Khambatta, PhD: Okay, so walk us through this process now. Suppose somebody has listened to you on this Podcast or seen you elsewhere, and they say, “Okay, great, I love these guys, I want to work with them, and I want to have them as my sort of like supplement to my regular PCP.” And they say to themselves having somebody who understands diabetes, and having a true diabetes doctor who's an expert is very important.
So, if they've already committed to wanting to make this work, walk us through the exact steps that they would take in order to make an appointment with you guys, and actually start the process of seeing you virtually.
Laurie Marbas, MD, MBA: Anthony, do you want to do that? He's really been the brain and genius behind setting this all up. So I'll let him describe all that.
Anthony Masiello: Yeah. So, they visit our website at PlantBasedTeleHealth, and then there are a couple of steps. The first step is register for an account to access the patient portal, and there's a form right on the front page. We actually do need first name, last name, email address, and phone number in order to register, to send someone an invitation to self-register for the portal.
At that point, they will receive an email with a link, and they can click that link, and then they go in there, they fill out all of their background information. They answer the questions, or they view our policies and procedures and they acknowledge, and accept, and they agree to create an account and become a registered patient on the practice.
At that point in time, if they are ready to schedule an appointment, there's a big button right in the center of the screen that says “request an appointment.” You click that button, and then you can see Dr. Marbas's schedule there, and you can look for an appointment block to get set up.
At this point, we're starting off with just half hour appointments, so they can just select that half hour block that works for them, and that sends a request to Dr. Marbas, to say this is the time I would like to see you, I'd like to make an appointment. There's a textbox there where they can enter some information about what they’re setting up the appointment for.
Then, Dr. Marbas will accept the request and confirm that they have an appointment. At that point in time, that starts the check-in process. And the check-in process is then when we start asking all the questions that we need to know like medical history, family history, there's a series of lifestyle questions. We've built in a lot of questionnaires to really collect a lot of the background information that Dr. Marbas is going to need to know in order to conduct their visit.
They can enter that information at any point in time between having their appointment confirmed, and when they're going to see their doctor. So, if their appointment is a couple of weeks away, they're welcome to go ahead and start working on that information, you know, as soon as possible. By the time the appointment all of that information should have been completed.
Then they really just go back, they log into their patient portal at the time of their appointment. They click the check-in button, and then they go into what's known as the virtual waiting room. Then that alerts Dr. Marbas and lets them know that a patient is there waiting to see her, and she can then start the visit from her side.
Once she starts to visit, they're connected just the way we are right now. I mean, they'll be able to see Dr. Marbas, Dr. Marbas will be able to see the patient. They can communicate, you know, just like we are, just by speaking with each other over the technology. There's also a text chat just in case something's not working with the audio or something like that, they can communicate back and forth that way.
And then Dr. Marbas conducts a medical visit, similarly to how she would if a patient was coming in and seeing her in an office, only that it's virtual, the patient doesn't have to travel in order to see her.
Robby Barbaro, MPH: And this can be done on basically any device. It can be a phone, a tablet, a computer.
Anthony Masiello: Exactly. Yeah, it works on any device.
Robby Barbaro, MPH: You don't have to be in front of a desktop or anything.
Anthony Masiello: The one requirement, and we keep saying this over, and over, because telemedicine is pretty new, is that the patient has to be physically located in a state where Dr. Marbas is licensed to practice medicine at the time of the visit.
So, it really mirrors, and this is kind of how new the telemedicine laws and all of this really is, it really mirrors the same way where I'm located in New Jersey right now. I live in New Jersey, but I can drive to Pennsylvania, and I can see a doctor who's licensed to practice medicine in Pennsylvania. Or I can drive to New York City to see a specialist, right? Who's licensed to see patients in New York City.
But I can't sit in New Jersey and see a doctor by telemedicine or any other means who's not licensed to see patients in New Jersey. So, that is the first question that Dr. Marbas is asking the patients, what state are you physically located in at this point in time, and it has to be one of her states. So that's the one of the limitations that we have at this moment.
Cyrus Khambatta, PhD: So, (inaudible) of being physically located there, does that mean… That doesn't mean that they have to actually live in that state, I can literally drive to a state that she's allowed to practice in, I can have the appointment there, and then I could drive back home.
Anthony Masiello: Exactly. And it's exactly the same way as if you were going to a hospital the next state over to see a specialist who you know has a really outstanding reputation, in a hospital that's located in a nearby state. You could drive, you could fly to see a doctor in New York City, I could fly to see a doctor in Los Angeles.
So, we actually did our first test visit, and I drove and I sat in the back of my friend's tattoo shop in Pennsylvania, and we did the medical visit. It could be from the car, it could be from a library, it could be from your office if you work in another state where Dr. Marbas is licensed. You can take the call from your office or a conference room at work. So, as long as you're physically in that state at the time of the appointment, then everything is legal.
Robby Barbaro, MPH: Okay, so everybody listening to this right now is on the edge of their seats, asking themselves, what states is Dr. Marbas covering right now?
Laurie Marbas, MD, MBA: Okay, so there's 13 and I'm working on South Carolina, and New Jersey. So those two are coming. Arkansas, okay? Washington State, not Washington DC, but Washington State. California, of course, Colorado where I live. Texas, Florida, Georgia, North Carolina, Virginia, New York, Kentucky, Ohio and Pennsylvania.
Robby Barbaro, MPH: Okay, that's fantastic. And you guys are planning to add more states over time. And eventually, hopefully all 50 states will be covered.
Laurie Marbas, MD, MBA: Right. So, we're bringing on some other physicians rather quickly that are going to be licensed in other states that are just absolutely amazing, and any patient that season would be blessed to do so.
Robby Barbaro, MPH: That's fantastic. I mean, we are very excited about this at Mastering Diabetes. We have, like you said Dr. Marbas, sent you many, many patients, and the feedback is extraordinary because people are looking for a supportive doctor. There's a lot of nuances to be involved in here
We're not practicing medicine at Mastering Diabetes, and to work with you and partner with a team who really, really understands the nutrition component, and can address the very technical aspects of a wide range of conditions, not just diabetes. Diabetes doctor here is just like the foundation, but so much more, like Cyrus was talking about, whether it's cardiovascular health, whether it's kidney health, you've helped a lot of our patients or our clients who are struggling with neuropathy, retinopathy. So, there's a lot of help that can be had here. So, I think a lot of people are also curious to know, are your services covered by insurance?
Anthony Masiello: No. So at this point, they're not covered by insurance, and really, we're trying to operate this as lean as possible to keep the visits affordable. And at this point in time, there's just the overhead involved to try to take insurance is prohibitive for us at this time.
What we are doing is we're trying to keep the cost of the visit low. At this time, a 30 minute visit is $150. A 15 minute visit which will be for like a follow up visit down the road, will be at $75. And we're working in the very near term to provide what's called a super bill, and this is the medical visit receipt with all of the CPT codes, and everything properly documented, so that individuals can submit their payment on their own to their insurance company for reimbursement.
We don't know exactly what that rate of reimbursement will be. It'll be different depending on the insurance provider that people have, but that's our first step. So, we want to try to get the visits down to where you're actually not paying much more than a copay, you just have to reimburse yourself. And then, we absolutely do want to try to look into being able to accept insurance in the future, we're just really not geared up to be able to do that at this time.
Robby Barbaro, MPH: That's excellent. And if somebody does the initial appointment, they paid $150, they’ve worked with their doctor, what's like allowed as far as follow ups, how many messages can they send, or do they have to set up another appointment? How would that work?
Laurie Marbas, MD, MBA: So honestly, each physician will probably going to practice in their own way, but for me that's limitless. So, if you need to just, want to talk, or if you want to just upload your blood sugar log, and we meet once a month, (inaudible). Sometimes we need to have that face to face, it's fine.
So, there will be messaging in the portal, we're going to be pushing out educational materials, and all of that will be available right there in the portal. So absolutely… The beauty of this is that we can actually be in contact without that appointment.
It's not meant to be replacement of care, you know, but if someone needs, they say, “Hey, I’m out of insulin, I need a refill”, that's a great place to do that, or just request it from the pharmacy, and then I'll get that referral and I'll send it out.
Robby Barbaro, MPH: Yes, I just want to reiterate that, from the experience we've had with so many of our clients coming to you, you guys have been incredibly generous every step of the way. So, I just want people to know that and understand who they're working with, they’re people who really, really care and just want to help, and that's what you guys do.
Cyrus Khambatta, PhD: Now, let's talk about blood tests. What blood tests can you guys help our clients get? Is there any limitation on what they can actually get?
Laurie Marbas, MD, MBA: No. The only limitations will be if Quest or LabCorp, don't have that accessible, for whatever the labs are, so anything that LabCorp or Quest will use is what we can order. So, there's no limits there.
Cyrus Khambatta, PhD: Okay so, one of the tests… There's actually two types of tests that we are huge advocates of. Number one, C-peptide testing. So, can you guys order both the fasting C-peptide, as well as a stimulated C-peptide as well?
Laurie Marbas, MD, MBA: I'm pretty sure we could, we'd have to check in to see if LabCorp and Quest both do, but I don't think that would be a problem. And if it is, honestly, I would have to check, but possibly we could actually create it a paper order, and then they can actually take it to a local hospital, if they know a place that they can, as long as I get that back, or send it back to me, or the patient gets a copy and uploads it to me. That will be fine. We can do it that way too.
But preferably through Quests or LabCorp, because then it comes directly back to their actual chart. I see it, I'm notified, and then there's no question that they had that done. I'm not really sure on the fasting and stimulated, but that's a good question, certainly something I should look into.
Cyrus Khambatta, PhD: Okay, perfect. And then, I don't know if you know this answer off the top of your head, and if you don't, it’s not a problem, but there's a number of patients living with diabetes who don't actually know if they're living with autoimmune diabetes, and there's a lot of indicators that their blood glucose is relatively hard to control using oral medication and therefore they may actually have one or multiple antibodies.
So, antibodies include glutamic acid decarboxylase, or GAD, GAD antibody. Then there's the IA-2 antibody, the ICA antibody, the insulin antibody otherwise known as IAA, and then the zinc transporter, ZNT8 antibody.
So, do you know off the top of your head, if those antibodies are covered by, are available through either Lab or Quest Diagnostics?
Laurie Marbas, MD, MBA: So, I know Quest would cover the first four. The zinc one, I don't believe they did a year ago, but they may have added that. I'm not sure about LabCorp. So, certainly getting even the majority of those will give us some type of idea of what's going on.
Robby Barbaro, MPH: Okay, this is fantastic. You guys are really providing a service that is needed. People are looking for a diabetes doctor that can help them. Thousands upon thousands of people are learning about this information, they're picking up our book, they’re listening to your Podcast, Dr. Marbas, and they need some help. They need some help. There's a lot of questions that come up when people start making lifestyle change. A lot of questions that really need to be answered by a qualified, licensed medical professional, and you guys are making this accessible.
So, really thank you so much for what you're doing. It means a lot. Anthony, I know both of you have worked a lot behind the scenes. Anthony, the tech components to get this working. What you guys have created is a beautiful service. We've tested it out. It absolutely works flawlessly. It's easy to log in, it's easy to communicate with you guys, easy to get on the call. So, kudos to you for what you've done. And we wish you continued success.
Laurie Marbas, MD, MBA: Thank you very much.
Anthony Masiello: It means a lot.
Cyrus Khambatta, PhD: And just to make sure that all of our listeners are aware of exactly how they can get in contact with you guys, you go to PlantBasedTeleHealth.com. Go directly there, PlantBasedTeleHealth.com.
Go there, you can make an appointment, you can register, you can learn more information, you can see the state coverage, and you can really, you know, that's the first step in being able to access Dr. Marbas.
And Like Robby said, you know, we love working with you guys, you guys are providing an incredible service for all people, not just people living with diabetes, and not people who are specifically looking for a diabetes doctor that they can consult with. So, we thank you from the bottom of our hearts, and we really wish that many of our clients that are looking for a plant-based doctor, can find you guys and start working with you guys, and get the help that is truly going to lead them away from chronic disease.
Laurie Marbas, MD, MBA: Appreciate it.
Anthony Masiello: Thank you. We're excited.
Cyrus Khambatta, PhD: Thanks for listening to the Mastering Diabetes Audio Experience, we're very happy that you're making the commitment to learn more, and open your mind to a world of diabetes management and reversal that has truly taken the world by storm.
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