Sick of Sick Care? A Doctor’s Real Fix - Dr. Seneca Carrillo

The modern healthcare system won't help you heal. It's designed to keep you sick and dependent on drugs. If you want to get well, you've got to get out of the system. You've found Predictive Health Clinic. Join us as we get well and stay healthy.

Tired of pills that mask symptoms but never heal? In this unvarnished talk, Dr. Seneca Carrillo, an ER doctor turned metabolic health pioneer, dismantles the myth of modern healthcare’s “sick care” model. With 25 years of experience, she shares practical, no-nonsense tools—think intermittent fasting, carb hacks, and sleep tweaks—that flipped her husband’s health and now transform her patients’ lives. From a fasting insulin drop that stunned her to biofeedback tricks like glucose monitors, she lays out a roadmap to reclaim vitality without drowning in prescriptions. This is for anyone who’s felt trapped by chronic illness or dismissed by rushed doctors. Watch, listen, and steal the strategies that could rewrite your health story—one small, powerful choice at a time.

Contact Info -  Dr. Seneca Carrillo

Toolkitmd.com

"Most doctors are trained to prescribe medications, not deprescribe them—we're really good at putting them on, but taking medicines away is a whole course in itself that we are never given in med school.”

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Jack Heald: Hey, folks, thanks for joining us. This is the Predictive Health Clinic Podcast. I am Jack Heald, and I am joined today by Seneca Carrillo, who I met, oh, what, three weeks ago at Low Carb AZ. Seneca, welcome. 

Dr. Seneca Carrillo: Thank you. It's a pleasure to be here. It's good to meet you.

Jack Heald: As you know, the purpose of this show is to identify particular health issues that people can either take steps to prevent or to recover from. So, what particular health issue do you want to talk to us about today? 

Dr. Seneca Carrillo: I'd like to kind of address what in medicine, you know, I've been practicing medicine for 25 years now is more sick care, medication management of healthcare, and I'd like to talk more about tools for keeping one healthy and prevention. 

Jack Heald: We are going to start over. I really should have you give your, give a brief bio start over. Let's try again. Hey, folks, it's the Predictive Health Clinic podcast. I'm Jack Heald, and I am joined today by Dr. Seneca Carrillo, who I met, oh, three weeks ago, I guess, at Low Carb AZ. Dr. Carrillo, welcome. If you don't mind, give us a quick bio, and then we'll dive into the guts of the show. 

Dr. Seneca Carrillo: Excellent. Good to be here. Thank you for asking me. So I am an emergency medicine physician, at least trained in emergency medicine, and I've been practicing for about 25 years. About three to five years ago, I started to enter this metabolic health space. And I opened up my own, what I call, a boutique metabolic health practice about two to three years ago, where I work one on one directly with a cadre of patients who seek me out specifically looking for help with some of their chronic diseases and chronic illness, but through lifestyle and potential medication management.

With deprescribing of medication when possible. So this has been super fulfilling this part of my medical career, although I still work in the emergency department. 

Jack Heald: And you still work in the emergency department. Okay. So, what particular health issue do you want to address today? 

Dr. Seneca Carrillo: So I kind of want to touch on, what we do in medicine is being mostly medication management and sick care and talk a little bit more about tools for health prevention and how, like all the potential varieties that you can institute as tools to keep yourself healthy through a lifestyle perspective. I'd like to talk about that. 

Jack Heald: I'm going to translate that into English as best as I can. It sounds like rather than using pills to manage a disease, you want to talk about how to maybe get away from that and actually get healthy. 

Dr. Seneca Carrillo: Correct. Yes. 

Jack Heald: Did I misstate anything? 

Dr. Seneca Carrillo: No, you got it.

Jack Heald: How'd you get interested in this? That's, sadly, that's kind of weird for a doctor these days. 

Dr. Seneca Carrillo: Yeah, I know. And I guess how I got introduced, which was very fortuitous, was through my own primary care doctor, which was, I actually had dragged my husband to our PCP, who doesn't like to go to the doctor. And I went with him because I know he's not always forthcoming about his medical issues. When we were in her office, she introduced me and him to a book called Obesity Code by Dr. Jason Fung. And she said, Hey, this is your homework. I want you to read this. This has got a lot of good information. And we took it home, and I read it. And he did not, but I devoured it within a couple of days. And I felt like my eyes had been opened, and that started me down a path. So you know, Dr. Fung talks mostly about insulin resistance, but sort of how to manage it with fasting.

So my husband and I did a brief experiment because he was having hypertension issues, and we were trying to look at ways to avoid medication. And so he allowed me to experiment with him. And we just did intermittent fasting for a three-month trial. And I made him get some blood tests done before we started. And then some blood tests at the end of that three-month period and it was eye-opening what happened. The issue is that he had normal fasting blood glucose. And most doctors, that's all they're going to check, and if they saw that, they wouldn't even worry about him from an insulin perspective.

But we ended up getting fasting insulin, which is one of those tests that PCPs don't typically order but Dr. Fung talks about, and I had learned about it as I sort of went down this rabbit hole. And so we got a fasting insulin on him, and normally that should be less than 10, and that indicates that your insulin production is appropriate.

And when you have pre diabetes or you're having some metabolic dysfunction, that insulin level typically is going to start to climb before you actually develop diabetes 10, 20 years before that fasting glucose goes up. So his fasting insulin was 40, which is four times what it should be with a normal blood glucose.

So we started doing intermittent fasting, and it was the sort of easiest version, which is, you know, I like to call it time restricted feeding, where he would just eat in this window of hours during the day typically between 10 a.m. and 6 p.m., we did like an 8 hour window, so it wasn't too difficult, he'd eat his first meal around 10, and stop around 6 - 6:30, and then the rest of the day he'd fast, And we did that for three months and he didn't really restrict the food that he was eating while he was eating. And we rechecked his insulin, his fasting insulin at the end of the three month, he'd lost 30 pounds just doing that one tool. And his fasting insulin went down to 24, just almost in half, and it was by no means normal. But that was really impressive. And so just seeing those results with that one tool got me just hooked. And I felt like for so long, we didn't have anything to offer patients in the ways that they can manage something as debilitating as diabetes, which is connected to so many other chronic illnesses. So yeah, that's kind of where it all started. 

Jack Heald: Wow. Okay. Normally the question I would ask here is what are the common, what are the most common misconceptions about this? Folks who have been immersed in the metabolic health field for a while, this is just kind of the, this is the starting point, but the reality is a lot of folks still haven't heard it.

What's the common misconceptions? 

Dr. Seneca Carrillo: I think the big issue is whether it's in the Lay media or with your primary care doctors, your specialists, it's all about calories in, calories out. That's how you lose weight. That's how you get healthy. And it's this mantra we hear in our space all the time of, you know, Eat less and move more. And that's been touted for decades, and it's not working. I think that is the crux of the problem is that it's one tool that's offered for everyone.

And it can work for some people, but it's by no means a panacea. Often, it's very unsustainable to be calorie counting and just to try and exercise your way to better health. So that I think is the issue, and if we can start to employ different tools that are sort of specific for different types of people, there's just much more hope and how people can get healthy with their lifestyle management, right? 

Whether it's nutrition, stress, exercise, or sleep, those are sort of the four pillars I look at with my patients. And there are lots of different tools within those pillars that we can tap into. And it's not just eat less and move more.

Jack Heald: Okay, so for somebody who's struggling with some sort of chronic health condition, whether it's obesity or all the other things that are out there, um, let's go down those four. Let's just start with what's the low-hanging fruit with nutrition? 

Dr. Seneca Carrillo: So most of the time with my patients, we'll start with nutrition.

That is the sort of easiest thing to tackle. I think that's the thing that people think they can control the most, and it doesn't seem as onerous. Even though I think it's one of the harder things to sort of continue to do regularly. And so with nutrition, the big tools, I'll talk about is carbohydrate restriction. So that's going to be limiting carbohydrates. And this is really in the setting of people who are insulin resistant. And those are the people that are coming to see me. This is the source of most metabolic disorders. And so the goal with insulin resistance is to lower glucose so that we can lower insulin production and resensitize the body to its own insulin production. 

Jack Heald: Without going too deep into the weeds. Describe how someone would know whether they suffer from insulin resistance or not. 

Dr. Seneca Carrillo: So, like the example I gave with my husband, you can actually get a fasting insulin and potentially see that your baseline insulin level is being overproduced, which is a state of hyperinsulinemia, which causes insulin resistance.

So that is one way. Obviously, there are the disorders of insulin resistance. So, if you have diabetes, you have insulin resistance. If you have hypertension, you usually have insulin resistance. If you've had any issues with your heart, you probably have some insulin resistance. The criteria that make up metabolic syndrome, metabolic syndrome is basically a disorder of insulin resistance, and that includes having an HDL to triglyceride ratio.

Actually, a triglyceride to HDL ratio of greater than 3, often greater than 2, is a form of insulin resistance. Your waist size, your waistline measurements, for men and women it's slightly different, but if that's above a certain range, you have metabolic syndrome. Blood pressure. There are five criteria. I'm totally blanking on the other two. But so if you have these, if you have these disorders, you have a good idea that you have some insulin resistance. But if you're not sure and you think you're doing things pretty well, one of the best labs I think people can get is a fasting insulin that's going to give them a kind of a gauge better than a simple fasting glucose about where their state of insulin resistance is.

Jack Heald: Isn't that interesting, that a PCP will not normally test for that? 

Dr. Seneca Carrillo:  No, and it's a really cheap test. It's like $7 to $10. So even if you didn't want to have your insurance pay for it, it's pretty, pretty cheap to have done, but it's not something we're taught in medical school to look for. It's definitely not something most primary care doctors or even endocrinologists are looking for when they're worried about insulin issues.

Jack Heald: I'd love to go deeper down the rabbit hole of insulin resistance, but we'd totally run out of time. Nutrition, you said carbohydrate restriction. 

Dr. Seneca Carrillo: Time restriction and carbohydrate restriction would be one issue because of the insulin component there. 

Jack Heald: What does that mean? What is a quantified carbohydrate restriction for me? 

Dr. Seneca Carrillo: So carbohydrate restriction is a variety of whether you are keto, low carb, or you're just trying to cut back on some carbohydrates, right? So most of the carbohydrate intake in the standard American diet is upwards of around 300 grams of carbs per day.

That's a lot. If you're on a keto diet, you're usually between 20 and 50 grams of carbs per day. That's very low. And that can be very challenging for people. And then a low carb diet can be anywhere from 50 to 150 grams. And often, if you talk to a primary care physician or specialist, they'll say, you know, the Mediterranean diet is sort of the best-studied diet, and it's the way that most people should eat. That can vary in carbohydrate intake from 50 grams all the way to 150 grams. It's kind of a low carb diet, but it can vary depending on what you decide to include in a Mediterranean diet. Then there's carnivore, they have absolutely no carbohydrates at all. So these are like nutrition tools that you can use to sort of target.

The food component, and then there's like hacks within the food, whether it's the order you eat your food, right? So if you eat carbohydrates in your diet, but you put them at the end of your meal, they have much less impact on your glucose and much less impact on your insulin. So, food order is a hack we can talk about with patients.

If you eat fibrous veggies up front, it will slow the glycemic load of any carbohydrate you have afterwards. Adding vinegar to food will do that as well. And then sometimes with starches that you know you're going to eat, specifically potatoes, if you heat it and then cool it and then eat it, then reheat it, it actually becomes more of a resistant starch and has a less glycemic impact on your body. So these are just little hacks that doctors are not going to talk to you about and even dieticians don't always talk to you about. 

Jack Heald: Oh, be darned. That's actually how I eat my potatoes, but it was just by accident. 

Dr. Seneca Carrillo: Leftovers, right? Leftovers have a benefit. 

Jack Heald: Okay. So, nutrition, what else did you talk about?

Dr. Seneca Carrillo: So we usually we'll target sleep. Sleep is a big one. I talked about this with a client today. She's, you know, if 95% of the serotonin that we make in our body is from the gut, which it is. And our gut microbiome is disrupted. How are we going to sleep? 

Melatonin is made from serotonin. And if you're not making adequate serotonin in your gut, you're probably not going to make adequate melatonin. You're probably not going to sleep really good. So getting your gut health in order to get your sleep in order, they're so intertwined. So we'll talk about sleep, but we'll have to include the gut and how to help heal the gut if you're having gut issues or dysbiosis, trying to get your gut bacteria livened and enriched.

The other issue is, you know, how you sleep. Sleep hygiene is what we talk about, so try to avoid screens before bed. You know, sleeping in a really cool room. You want to avoid liquids before bed. So you're not getting up multiple times during the night. And then there's a little couple of hacks that I'll use with supplements to help patients get a better, deeper sleep and their supplements so they don't feel like they're being sedated. There's usually a magnesium component, an amino acid component, and it's just helpful for cell signaling and for relaxation and it kind of preps your body for sleep better. 

And those can be nice little add-on tools for someone who's suffering and not getting good sleep. Because if your sleep is disrupted, the following day, your cravings are going to go up, your hunger is going to go up, your stress cortisol levels are going to be higher, and that means your insulin is going to be higher. Thus, sleep dysregulation alone can lead to significant insulin issues. 

Jack Heald: I did not realize the connection between bad sleep and elevated hunger, but just thinking about the last couple of months, I've been fighting some low-level sickness and on the nights that I don't sleep well.

I wake up voraciously hungry and feeling significantly worse. I'll be darned. Okay. 

Dr. Seneca Carrillo: Yeah. And night shifts. When I, you know, in the ER, if I work in a night shift that following day, especially wearing a glucometer, I've got the new lingo on today. You can see in real time what's happening with stress or with the high cortisol from a poor night of sleep. 

This brings me to glucometers. So that's another tool we'll talk about. So sometimes it's easy for your doctor to say you shouldn't eat this. You shouldn't eat those ultra-processed foods. They are bad. Or, stay away from too much bread and rice. And, but when you put on a continuous glucose monitor, just to kind of gauge, just take a peek inside the body. You're going to get a really good sense of what your individual body responds to. 

And it's nobody telling you what you can't eat or not eat, because you're seeing in real time as your sugar changes with what you eat, if that's actually a good enough food for you. I have a client who's, I can do hummus, but I can't do rice.

He says, if I have rice, obviously I'm way off the charts, but hummus I'm good with. And then his partner, his wife. It's the exact opposite. No change at all with the rice, but with the hummus, it's off the charts. Or he can have these little mini ice cream cones, which he's I'm sure this is going to make my, you know, glucose go up and it kind of didn't budge at all. And it's probably because they're small and they have a very low, you know, glycemic load because it's a small portion of something. And now he knows I can have that occasionally and it's not going to spike my sugar and cause my insulin to sort of concomitantly go up. So, having that little biofeedback tool to peek inside your body is super cool.

And you can do that on your own. You don't even need a doctor. Now, those became over-the-counter this past summer. And yes, they are offering them. You can buy them online. 

Jack Heald: Totally did not realize that, but I've done it once. It was still by prescription only. So yeah, it was fascinating.

Dr. Seneca Carrillo: So we targeted nutrition and sleep; stress is the other one we'll talk about. 

I have a client who was 27 years at J. P. Morgan burning the midnight oil for years, decades. And we did a food log and. His food intake was actually pretty clean. He had a lot of dinners out, but they were fancy dinners because they were high-end clients.

So he'd have steak and vegetables, and it wasn't terrible. Maybe a little few too many desserts, but his hemoglobin A1c for diabetes was like 6.4, 6.5. So he was full-blown diabetic, but it wasn't from a diet issue. For him, it was purely a stress-related issue, and it was his work-life balance. And those are patients we'll talk about, meditation, you know, there's some cool apps that you can download that you can learn how to meditate on your own. We talk about yoga, breathing exercises, and sometimes retreats, if you can afford something like that. But ways to sort of train yourself to learn to decompress. And that is one of the hardest things, I think for people to do because they don't feel like it's, I mean, it's your job. Like, this is the thing that I have to keep doing, or the stressors in your life aren't really easy to control. But stress causes cortisol spikes. Cortisol spikes cause insulin to go up and slim up, which is metabolic dysfunction. It's hyperinsulinemia that leads to diabetes, everything, all the things we just talked about.

So, it's a huge component. There are a couple of supplements sometimes I'll talk about that are a little controversial. They're not super well studied that can sometimes help with cortisol levels, like ashwagandha or stress, but a lot of the ways we cope with stress are better managed when our sleep is good, our nutrition is good, and then exercise.

So that's the last pillar is exercise, and if you're exercising, we tell people, we tell patients it's not exercising for weight loss. It's not exercising to, you know, to get yourself healthy. It's for stress management, and it's to build muscle because those are the things that are actually going to improve longevity and health span as you age, not necessarily to lose weight, but exercise is super important.

I will say it's one of the harder things I can get. I have the hardest time getting patients to exercise. I happen to have an older clientele that I'll see. So either it's a generational issue or they've just. kind of been sedentary for most of their life, but exercise is not a regular part of their daily regimen.

So we have to start with very simple things like this is band workouts. Like how do you stand in your kitchen doing chair squats, you know, holding onto the counter and doing lunges using some stretchy bands in a chair just to start with some resistance training. But those are going to be key things we tackle after we kind of. I'm going to grab these other pillars and get them in line.

Jack Heald: This is a really good summary. People will often focus on something really highly specific, but this is very foundational. So I appreciate this. All right. Let's talk about your practice in particular. These are always fun. Common complaints, common compliments. What do you hear a lot of on both sides on the extremes?

Dr. Seneca Carrillo: I guess. I mean, the big complaint is often the exercise, right? I mean, I hear complaints from my patients, which is why they're often seeking me out. It is that their doctor doesn't listen to them. They don't have enough time. Oh, or they're very condescending or more patriarchal about sort of the advice that they're giving.

So it is, you know, I'd like you to take this medicine, and now you're going to be on that for your life. And there's not a lot of discussion about what this looks like? What's the cause of this? How long will I need this? What can I do to maybe get off of this or stop taking this medicine? And me physicians and are not trained to take medicines away. We're really good at putting them on, but deprescribing medications that is a whole course in and of itself that we are never given in med school or in our training or in life. So I think that's the thing I find patients are most frustrated with. And it's the lack of access, the lack of time that docs can spend with the patients. And that's just the system that we live in. The healthcare system is not designed to give a lot of time. 

So the things that I get complimented on are. I do spend a lot of time with patients. 

Our first visit is two hours, and it that's with a questionnaire I send to them before we even meet. So that I have some baseline and then we go through that questionnaire in detail and I want to know who's in the house, who's cooking, who does the shopping, who's helping you, who's hindering you, who's sabotaging you where are your stressors coming from you know, what medical issues have you had before, what diets have you tried, what kind of exercise do you like, do not what foods will you not eat, what foods will you eat, that's a lot to get and there's no way, but even a dietician or nutritionist who sits with you is going to spend that much time. So we do a nice long first session, and then every couple of weeks, we meet again for another hour. And it's to check in on the things that we've kind of laid out to tackle. So patients feel like they're getting one-on-one connected with their doctor, and I provide access for them as well.

So I text with my patients. I'm available by text. There's no middle person. There's no PA. There's no NP. There's no MA. There's no nurse. It's just me. And so when they text me, they're texting me and they can text at all hours I may not get back to them at all hours, but I typically will respond pretty quickly, and I think that is responsiveness. It makes them feel reassured so that if they have to adjust a medication in real time, I'm right there to tell them how to dose it.

If they're feeling busy, I've had patients with dramatic improvements in blood pressure. We've had to draw down their blood pressure meds pretty quickly. I've had patients on insulin that we've had to dial back really fast as they make these changes. It's super exciting, but it's also dangerous if they don't have access to somebody to help them.

Jack Heald: Yeah. 

Dr. Seneca Carrillo: So I think the access is key, that's something they love and that one-on-one kind of meeting patients where they're at and working with them so that we'll talk about a couple of different tasks each time we meet. And then if they're not working, we pick new tasks, we pivot, or we'll try a different tool.

I have a patient who tried keto for three months. didn't lose any weight. He tried carnivore. He gained 20 pounds. And then we started doing alternate-day fasting, and he's 50 pounds down in six months. That's the tool for him, not the other one. So it's just sometimes trial and error. It's also about what you can do in your lifestyle, what you don't want to restrict or what you do want to restrict.

But there's not one panacea. It's not just about cutting your calories and exercising more. And this is what we tell patients. So I think that's sort of the benefit of this practice that I have. And unfortunately, I'm just one person, so I can't see a ton of patients, right? I can only see a small little cadre of people.

Jack Heald: If folks want to learn more about what you do and how you do it, what's the best way to do that? 

Dr. Seneca Carrillo: I have a website. It's actually getting revamped right now, but it's up and exists. It's www.toolkitmd.com. 

Jack Heald: Toolkitmd.com. All right. 

Dr. Seneca Carrillo: Cause I'm all about the toolkit. There are lots of tools for lots of problems.

Jack Heald: I like that approach. That seems like a really practical approach. All right. So we'll make sure that information shows up in the shownotes. 

This is my favorite question. The billboard question. You've got to deliver your health information, but you've got no more than eight words to deliver it because people are driving by at 70 miles an hour. What's your billboard say? 

Dr. Seneca Carrillo: I've thought about this. Eight words, right? 

Jack Heald: No more than. Okay. It could be less, but it can't be more. 

Dr. Seneca Carrillo: So, lifestyle matters, invest in yourself, and give yourself grace. That's eight words. That would be my monologue. 

Jack Heald: Lifestyle matters, invest in yourself, give yourself grace. You came in under the wire.

All right, our guest has been Dr. Seneca Carrillo. This has been the Predictive Health Clinic. I'm Jack Heald, and we'll talk next time.

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