Mind Pump: Raw Fitness Truth - 1815: Improving Fat Loss, Muscle Gain and Fitness With Continuous Glucose Monitors

Episode Date: May 16, 2022

In this episode Sal & Justin speak with Kara Collier and Dan Zavorotny of Nutrisense about how continuous glucose monitors work and how they function as a tool to improve health & fitness through personalized real-time data and individualized nutritional coaching. What are continuous glucose monitors (CGM) and what are their values? (1:47) Driving meaningful behavior changes through CGMs. (5:16) How the numbers are a reflection of your current health. (6:41) Why it’s more important to capture yellow flags and early warning signs than to wait until you have gotten to a disease state. (9:14) When glucose rises, insulin usually follows. (11:36) Why you don’t realize that mind-body connection until you have the data to back it up. (14:30) Identifying how different we truly are. (18:01) Insulin, the boy who cries wolf. (23:42) The most important form of exercise to combat increased levels of glucose and insulin. (24:59) Why are prescriptions required for CGMs? (27:34) Why having the hardware, software, and a registered dietician has been the playmaker for NutriSense. (31:19) How they use the data to coach their clients. (32:25) The 4 variables you want to sink through when having a response to certain foods. (34:06) The importance in implementing stress management tools and how the CGM can bring awareness. (37:23) Are there supplements that mitigate higher glucose levels? (40:22) Why she recommends eating 2-3 meals a day for the average person. (43:40) The impact CGMs have on weight loss. (45:04) How their device helps with the flexibility of tracking. (49:55) Why with nutrition individual variance MATTERS! (54:13) Have they seen customers/clients sticking around after the 2 weeks? (58:49) Understanding how to eat through CGMs. (1:02:17) Related Links/Products Mentioned Visit NutriSense for the exclusive offer for Mind Pump listeners! **Promo code MINDPUMP at checkout** May Promotion: MAPS Starter Bundle and MAPS Spilt 50% off! **Promo code MAYSPECIAL at checkout** Blog - NutriSense Berberine Supplement — Health Benefits, Dosage, Side Effects Effects of berberine on blood glucose in patients with type 2 diabetes mellitus: a systematic literature review and a meta-analysis Apple Cider Vinegar - Examine.com Promising Treatment for Type 2 Diabetes: Fecal Microbiota Transplantation Reverses Insulin Resistance and Impaired Islets Visit Drink LMNT for an exclusive offer for Mind Pump listeners! Mind Pump Podcast – YouTube Mind Pump Free Resources People Mentioned Robb Wolf (@dasrobbwolf)  Instagram

If you want to pump your body and expand your mind, there's only one place to go. MIND, MIND, MIND, MIND, MIND, MIND, MIND, with your hosts. Salda Stefano, Adam Schaefer, and Justin Andrews. You just found the world's number one fitness health and entertainment podcast. This is Mind Pump, right? Today's episode a really fun one. So we talked to Karen and Dan from NutriSense. So this is a company that uses continual glucose monitors to help people burn body fat. Actually measures their glucose

and how they respond to different types of foods. You know what's really interesting about this is that believe it or not, different people respond differently to certain foods. In other words, white rice is supposed to cause a higher spike in glucose than let's say oatmeal, but that's not always the case. Anyway, there's stuff like that and more in this episode. NutriSense is actually a company that we work with because they use continuous glucose monitors and they work with licensed nutritionists to help coach people with fat loss. So everything's super individualized and awesome company. In fact, you should check them out.

Go to mindpumppartners.com, click on Nutressense and then use the code MindPump. You'll get $30 off, so you can get set up yourself. Also, we're running a sale this month. We have a workout program bundle and a workout program on sale. Okay, both are 50% off. Here's what they are.

The starter bundle is Maps and Obolic, the Intuitive Nutrition Guide in Maps Prime. So that's the starter bundle. And then we have Maps Split. This is a advanced bodybuilder, bodypart split routine. Both of those are 50% off. Again, it's a huge sale. It's only happening this month.

So if you're interested, go to mapsfitinistproducts.com and then use the code MaySpecial for the 50% off discount. All right, here comes the show. Caradam, thanks for coming on the show. So I wanna start out by talking about, I remember when I first heard about continue with glucose monitors, I thought it was the coolest thing ever.

Basically a device you could wear that measures your glucose response in real time. And now we've come such a long way. Let's talk a little bit about continue glucose monitors. Did I explain that right? Is that what they're doing basically? And how does this help with nutrition

and what are the applications? So like this. Absolutely. Continuous glucose monitoring, we can just use CGM from now on for ease of use, is exactly what it sounds like, what you said. You're continuously monitoring your glucose values. And as you mentioned, this is pretty unique and interesting

technology in the sense that we're not a lot of things that we can measure continuously. We can get one-off labs, we can prick our fingers with a glucoseometer to get our glucose values. But there's not a lot of things that we can see the ins and outs of. And this device, which is just something you can put on at home on the back of your arm,

you all have worn one, so you can attest to the fact that it doesn't hurt. That's always everybody's first question. I describe it as kind of like an easy button. It comes in a little applicator, and you just push the button, and it's on the back of your arm. They last for about two weeks at a time, and you can shower with it, work out with it,

do all your normal activities with it. And meanwhile, it's gathering your glucose values in real time. And then you can just use a phone app to see what is happening in your glucose. Yeah, and it's like a tiny, it almost looks like a acupuncture size or like short, like little needle, like a tiny needle. Yeah, like you don't even feel it. And that's like literally measuring off your blood. Yeah.

So what's actually happening is there's a needle for insertion. So when you're putting it in at home, the needle is putting a microfilament just underneath the surface of your skin. So the needle doesn't actually stay in your body. It's just for insertion, which is why it's so painless and comfortable. If you, when you take it off, you can hit the little microfilament

and it's flexible. and it's going just believe beneath the surface of the skin. And so it's actually measuring your glucose in your interstitial values, which is the space in between your cells. So it's not even going to the depth of your blood, which is why it's so shallow, so comfortable, but then you're able to measure glucose continuously in there. Because our glucose values diffuse from the blood stream into that interstitial space. So it's really the same thing, but it's just an easier way to be able to measure it comfortably

and in that real-time nature. Now, is it as accurate as the old traditional way with the pinprick? Yeah, the most accurate way to gather your glucose values would be to go to the doctor's office or order labs and get it from a blood draw. This is the same level of accuracy of when you're pricking your finger with a glucose meter.

There can be a little bit of variability from that blood draw, but the good thing about the CGM is that it's extremely precise and that it's going to capture those changes in your glucose value. That's what's unique about being able to measure it in real time constantly, is that instead of a snapshot, an image of your glucose values, you're getting a movie.

So let's say you check it at 8 a.m. and it was five minutes after you ate something and it's 80, it looks great, you're like, okay, that's excellent. But really in reality, what might be happening is it's about to spike really high and crash down and that's why you got hangry and then grab for some more food.

You know, it's that movie that's really gonna tell us the whole picture of what's going on. Okay. Now this technology was it developed primarily for people with diabetes and then how did this then move into just accessibility for your average person? Yeah, absolutely. So this technology is originally for diabetics and really mostly insulin-dependent diabetics. So this is type 1 diabetes or further uncontrolled type 2 diabetes. Only about

a third or close to a quarter of type 2 diabetics have ever even worn a CGM. So it's actually not even that common for doctors to prescribe it in the diabetes community either. But that is what this technology was developed for and it's primarily been used between you and your physician. So your physician looks at the information, adjust your insulin dose, and then it's a medical tool in that sense. And so me coming from a background as a dietician working in the clinical world and the hospitals, I've worked with type one diabetics who use these, and it's an amazing, powerful tool for them. But I began to realize that if we could put this device on anybody, then we could really

solve some of those core problems that we're seeing in the healthcare is that we can identify some of these issues way earlier in people and actually drive meaningful behavior change. And that's when companies like ourselves started to use this hardware in a way that's more applicable to the everyday person. So what is it showing when you see your glucose levels go up and you said crash? I mean, what are we looking at and what does that mean? So let's say it goes up. We know that there's more glucose in the system, the rate at which it goes down, that's something to watch as well. Like what is it all telling us about somebody? Yeah, absolutely. So really when we're looking at

your glucose values, you can think about it, both what's happening in a fasted state and then what's happening after a meal. So in a fasted state, that's telling us how is your body self-regulating essentially? When we don't have any food coming in, any glucose coming in, how is our body being able to find homeostasis in a sense? So just thinking about also measuring heart rate. When we're just at rest, it's like your resting heart rate tells you

a lot about your general health. That's what we can think about in a fasted state. So we want it to be usually somewhere between 70 and 90 milligrams per desoleter. It's okay if it's fluctuating a little bit, but if you're seeing big dips or large rises while you're fasted, that's a warning sign that maybe we want to dig in a little bit deeper

and see what might be going on. And similar to heart rate, I actually like to describe glucose as a vital sign. Instead of a metric of, do I have diabetes or not, which is what most people think of when they think of glucose, you can think of it like a vital sign as in it's reflective of your overall health. It's telling us how different variables

and lifestyle habits are impacting your body. And so then we can move to what's happening when you eat. And so when you eat, you might expect your glucose to go up, depending on the composition of the meal. If I eat chicken and rice and broccoli, my glucose is going to go up and that's OK. I think one misconception is that people expect a flatline glucose, and if it budges at all, they're like, what's wrong?

What do I need to do? And we expect glucose to go up. But it's how high does it go, and does it come back down to normal afterwards? So we really want to avoid glucose spikes above 140 is kind of an upper threshold for a non-diabetic. And then we usually want to see it return back down to pre-meal values within two to three hours of eating. That's a good signal that, okay, we're processing this meal and we're getting back down into that more fasted state. So those are the general trends we're looking for. And then we can also look at, in our app,

it'll tell you all of this information. And you know, if it's good or bad, so you don't have to memorize it. But we can also look at a more macro view. How is your average glucose overall, and how big are those swings? Okay, so why is it so important? What is it telling us about our health if our glucose, first of all, let's go back to the fasted. You said, you don't wanna see it go up and down

when you're fasted. Where's this glucose coming from? Is your body releasing it from your liver, from your muscles? Like, why would it go up in a fasted state? There can be a variety of reasons, but it's primarily the regulation from your liver. So your liver is doing a lot to kind of self-regulate. It can stimulate the breakdown of glucose, so glycogen stores, if it thinks we need energy,

or it can create new glucose through gluconeogenesis, or it should be able to halt those processes if it realizes we have enough energy. And when those messages get gunked up, so to speak, that's kind of when we're starting to see some insulin resistance or metabolic dysfunction, because communication, that cross-talk in the body is starting to get a little dysregulated. And as we know, insulin resistance and good metabolic health is sort of the core of which all good health stands. And we can't prevent diabetes or cardiovascular disease or dementia

or cancers unless we have good metabolic health at baseline. So this is giving us a unique insight into that metabolic health and how our body is able to self-regulate. So is this could this predict like oh if you're not managing this properly or the fact that it's going up and down your fast and the fact that it's reacting the way it is when you eat is that a somewhat good predictor to say, if we stay down this path in three, four, five, 10 years, you're gonna be, you're likelihood of getting diabetes or of dementia is increased. It's a lot higher.

Yeah, absolutely. And that's where we describe it so much easier and more important to be able to capture yellow flags and early warning signs, then to wait until we've gotten to a disease state. By the time you get a type 2 diabetes diagnosis, over 60% of the beta cells in your pancreas have been damaged or destroyed. That's where insulin is produced, and so do we want to wait until we get a diagnosis

until we're starting to cross those thresholds? Not really. If we do, not to say that once you have diabetes, you can't do something about it, you absolutely can. But the earlier we can catch these deviations and do something about it, the easier it is to fix it. Okay, so this is a question I've been meaning to ask actually someone like you. So there's this debate in the fitness space over whether or not insulin

is the main driver of fat storage or knowing you need to eat more calories in your burn, which we know that to be a fact, although that's somewhat general, I think it's a little more complex on that. If you eat more calories in your burn, you'll store body fat. Where does this, your health, the health as indicated by your glucose responses play into that? Is it because now it's showing that your insulin response may be off or is it more a behavioral thing? Because I know when I tried wearing one, I noticed that when I would look at my chart

and I saw my glucose do things that, you know, maybe not so ideal, I would feel not as great or I feel hungry. I'd notice I get cravings when it would drop. So how is this help in terms of like, people who are just interested in fat loss or body composition changes? Yeah, and there's always the debate of, is it insulin and hormones or is it calories? And I think it's absolutely both. I don't think we can isolate these things

to say that calories don't matter, I think is ignorant and incorrect. And to say that hormones and insulin don't play any sort of role in your health journey, I also think is ignorant and incorrect. And to say that hormones in insulin don't play any sort of role in your health journey, I also think is missing the picture, which is historically the route we've gone is down plane, the metabolic side of things. So I think it's both. And it becomes more important to pay attention to your insulin levels in glucose.

So essentially in a nutshell, when glucose rises, insulin usually follows. So measuring glucose is a good proxy for understanding kind of what's happening with your insulin levels. And to be able to track that is important because an estimated 90% of the population doesn't have optimal metabolic health. And so if you are insulin resistant or on the way the path towards insulin resistance, then it's going to be harder to just calorie count because your hunger hormones are going to be off. You're going to have that dysregulation and communication within your system where, you know, maybe I'm eating, but my body isn't putting the energy in correctly.

So essentially the more insulin resistant you are, I think the more you need to get glucose and insulin under control to be able to manage your calorie intake effectively. Because of the things like you're saying like cravings, that's going to make me eat more, which at the end of the day is higher calories and that's what's driving the weight gain. But I can't reduce my calories effectively and in the long term until I've understood and mastered the metabolic side of things. Yeah, people who say hormones don't matter, it's silly because the studies will show

you could take someone, put them on exogenous hormones to change their profile and you'll see a body composition change. Even if their diet doesn't change, a guy will build more muscle and lose more body fat with more testosterone. And you can see it's with Goural hormone and other hormone plays the role. Have you, what are some of the, because you're working with people, and not only you're

working with people, but you're also watching their charts. So you can see what's happening throughout the day. What are some of the behaviors or feelings people are getting that are correlated to these rises and these drops and what's some of the craziest variances to in terms of person to person and what you've seen so far? Yeah, to touch on behaviors like you mentioned, you don't realize that mind body connection often until you have the data to back it up. And so a lot of people are like,

well, I think I know when I'm hungry, or I probably know when my glucose is high, and then you start to actually see the data and correlate it with your subjective experience, and you're like, oh, that is actually what it feels like when my glucose is high and then crash it. And what does that normally feel like to people? What are they saying?

Yeah, when it's high, people often feel jittery, nervous, kind of like anxious. Interesting. And then a lot of times, so this is the concept of reactive hypoglycemia, which is extremely common, even in non-diabetics, is let's say you just did a hard work out, so you're in a really insensitive state, and then you chug some juice, or something really sugary,

your glucose is probably gonna shoot up really quickly and then it's going to dip down super low, kind of below that 70, that much. So reactive hypoglycemia meaning, you've created this state in your body where you're hypoglycemic because of the spike, the initial spike. Yeah, because of that quick flood

of easily digestible energy you just gave it, we kind of see that spike in insulin to chase that glucose and we've over corrected a little bit because the body would rather process that and try to fix it later than not deal with it anything with it. So we see that reactive hypoglycemial lot and that dip is then often stimulates cravings hunger because your body is like, I don't have enough energy. I'm in this low glucose state. Now, I need to eat more. A lot of people will notice this behavior.

We see this even in desk jobs. So, skipped breakfast, didn't eat all day, got lunch around one, and you're drinking your caramel frappuccino while you're waiting for your meal to be ready. Then you're seeing this big jump and then this big dip afterwards, and you're waiting for your meal to be ready, and then you're seeing this big jump, and then this big dip afterwards, and you're feeling really crappy, and then you eat your meal and you're hangry. Low glucose, when that drops down, do you get tired and crabby?

Yes. Okay, you know what's funny? You're talking about post workout. In our space, especially the, I don't know, part of the space I don't like so much, like the bodybuilding fitness space. Yeah, they'll be like, oh, you gotta have super fast adjusting carbs afterwards to replenish glycogen

and they'll literally recommend. Dextrous. Like gummy bears or candy. Pop tart. Yeah, and then, and then people will be like, yeah, I don't, I'm so tanked after my work, about an hour later, I need to take a nap and they think it's the workout, but it could be

what you're talking about. And that's not a great thing. No. And it's like a great thing. No. And it's like, I'm sure you guys can speak more to the need of how quickly you need to replenish glycogen stores. Oh, it's a great thing. Yeah, I was going to say, I don't really think that's very important. And you're probably compromising your overall goals by doing something like that as well.

Because now you're most likely going to overeat or yeah, you feel crappy. It's not setting you up for success. I try to say it's all the time. How you feel will dictate your behaviors, your behaviors, then will dictate your results. We have to look at that. We can't just look at everything on paper and say eat this and eat that

because if you feel crappy or you have lots of craving, eventually it's not going to be so effective. Yeah, so in terms of actually using it, it has to bring a lot of weird insight into some people's behaviors. In terms of some foods giving you a crazy spike versus others that you'd never even anticipate. So are there some examples of that? You guys have found through all the data you guys sift through? Yeah, absolutely. And that was one of the most eye-opening experience when you start working with clients with this data is just how different each person is. Like, I guarantee you, if all of us in this room eat the same exact thing right now, we're going to have a different response.

And even with myself, so I've tested just about every fruit that exists to see how I respond to different fruits. You know, same portion size, same setting, same time of day, and consistently the glucose response that is lowest is to bananas, which is a higher glycemic index. You would think bananas are a huge, huge, huge spike. Just the variation between predicted glycemic index and your actual individual response is all over the place. Glycemic index is an average of the population. So maybe 50% of the

people will respond a certain way to bananas, but there's going to be all of those people who deviate from the average. And that's what we see day to day is that, you know, it's all over the place. Yeah, and this is the real value of it because you're absolutely right. There's a huge individual variance. I knew this is a trainer and I wouldn't have objective tools. I would have loved something like this when I was a trainer, but it was all feel. Yeah, that's a lot of questions. There'll be a lot of questions.

You have to be really like in tune with your body and how I feel. And I did notice a while ago, we talked to a good friend of ours, Rob Wolfe, and he was one of the first people to use these CGM devices back when they first kind of came out and he had some of his friends using this stuff. And he talked about how weird it was that some people would get this glucose response to a food that like had mostly fat

and proteins in it, right? And he's like, what's going on? His theory, I'd love your opinion on this, his theory was that they must have had some kind of a low level immune response to that food, which is the individualized, you know, the kind of the difference between people. So in other words, this personated an avocado, which is mostly fat and some fiber, but because they had a kind of like low level immune response, what maybe an intolerance, their liver spit out a bunch of, you know, glucose and they got a spike. Is that? Is that? It can happen. Yeah, and we had this instance recently with somebody to macadamian nuts, which is like the most like perfect keto food And they kept getting a glucose spike to macadamian nuts and then ended up having an intolerance moving that and

Always good So sometimes it can be that inflammatory immune response happening to a meal and sometimes there are some secret ingredients in there that is also eye-opening. For me, a personal example is Costco rotisserie chicken, has a bunch of dextrose in there, who knew? But I kept getting glucose spikes to the rotisserie chicken and I was like, what the heck is going on? Oh, man, we gotta run. Even as a diet nutrition, you forget to look

at the actual label and see what other ingredients are in there. So that can be another part of it is just being able to objectively identify what your go-to foods are doing to you. Back to you know, addressing things early, yellow flags versus waiting. It's okay if you have a glucose spike every once in a while. Like I want to make sure that's normalized is if you have a glucose spike once a week

or once a month to something you enjoy, it's not a big deal. But if it's your go-to breakfast and you're eating that every single day and you're having a massive glucose response to that and you don't realize it, those are the sort of feedback loops, consistent habits that are gonna lead us

towards this negative downstripe effect. I would have killed for this when I was a trainer, because it would take me months or years with clients to figure some of this, I remember one lady in particular used to have, she would get lots of anxiety in the kind of late morning. And couldn't figure out what was going on and we did the workout and her diet was,

what I thought was good, and she had to kind of treat herself with some medications for some anxiety. And then I remember reading that high glucose spikes in cause anxiety. And so I said, you know what, for breakfast, let's just have a fat and protein meal. Like no carbohydrates whatsoever and see what happens. And tremendous response. You felt so much better because she didn't get that.

But it took me, I think it was like a year of training or to kind of figure this out. So you're seeing this right there real time. Here's what's happening. Yeah. And I would say two of the unexpected results we see often is that people have a much better mental health or, you know, states of anxiety after being able to adjust their meals to improve their glucose responses. And the other is better sleep. So there is a strong connection between sleep and glucose levels as well. It's actually a bi-directional relationship and that if you're going to bed with high

glucose levels, your nervous system is on alert. Your body is in more of an active metabolic state. It's harder to get into those deeper states of sleep. And then the same goes the other direction of if you're not sleeping well, if you have poor quality of sleep, poor quantity of sleep, you're putting yourself in basically an insulin-resistant state the next day. And so those are the factors where we need to be able to be malleable in our habits. If you know I got a crappy night of sleep last night, maybe I'm going to just my breakfast to be something more low carb or more fat heavy because I know I'm in a little bit more of an insulin resistant state today as my

body is just didn't get the repair needed last night. When usually we do the opposite, we get a crappy night of sleep and then we're like, I just want the top tarts in cereal or some sort of cravings. So I was just going to say, so what kind of, so you see cravings go up when the glucose drops down low. That's when the cravings start to kick in and people then want to eat more foods that raise glucose. So you're stuck in a cycle of up, down, up, down.

So are people more, so I've, so okay, I've noticed this after a night of drinking or, you know, you hang over the next day like what do you want? You want the worst food of all time, which then causes a spike in glucose, which then will cause the crash again, and then like you're saying, you get this spike. So insulin resistance, is this, this is when your, your body continues to produce too much insulin, and it starts to react less and less to it? Yeah, the way I like to describe it, sort of like the boy who cries wolf, essentially, it starts with that high insulin levels

because for some reason, maybe it's your diet, maybe it's your lack of exercise, and there's a variety of factors that can cause that where you're pumping out more insulin. And at first, your body is responding well to that. You know, the boy who cries wolf, cries the first time, second time, third time, everybody's listening, but eventually,

they start to ignore them because that signal gets dulled, and that's when our insulin sensitivity starts to drop. So we're pumping out more insulin, but it's not as effective as it used to be, which results in then high glucose levels, which is the hallmark of eventually type 2 diabetes. Are you seeing any, because I know what the data says generally speaking, that if you build muscle, it's a very effective way to make yourself more insulin sensitive and muscle itself is an insulin sensitive tissue plus You can store some glycogen in muscle not as much as the liver, but it's kind of like another additional kind of storage bank if you will. Are you seeing this in the people that you're working with where if they start to build muscle you start to see better responses?

Absolutely. Yeah. So, when we think about controlling glucose levels, I talk about it as four pillars to think about. There's nutrition, exercise, stress, and sleep, and all of those are going to have an equal impact on your glucose levels. And when it comes to exercise, the two most important thing is building up lean body mass, that skeletal muscle, and you can actually store more glycogen in your muscles

than your liver if you think about just surface area. Your liver only has so much space. We do now want our liver to get bigger than it's supposed to be. That is not a good thing, but we can make our muscles bigger. And then there's more room for that glucose to go. Our skeletal muscles are actually the largest sink for glucose. So 80% of circulating glucose usually goes to the skeletal muscle. So the more muscle we have and the more we're using it, moving around, just literally

five minutes of walking. If you're standing all day of a desk job, if you can break it up with some body weight squats, whatever you've got to do, any sort of movement will help pick up some of that circulating glucose. I was just going to ask, so what are the most effective forms of exercise that you see for this? So you mentioned building muscle, so I'm assuming strength training. Yeah. And then you just said something very interesting.

You said, kind of activity throughout the day. Does that seem to be more effective than like, for example, with a 10-minute walk after breakfast, lunch, and dinner, which equals 30 minutes? Would that be generally more effective than one 30 minute shot of cardio type of deal? Yeah, if you had the opportunity to break it up and be more consistent throughout the day, that would be the preferable option. Being able to just move your body throughout the day is going to stimulate that glucose to be taken up by the muscles, and it's going to have a better

result in your overall glucose values. With that being said, any movement is better than no movement, so if all you can figure out is the 30-minute walk, do what you got to do. But the mistake a lot of people make, I think, is going hard at the gym for an hour and sitting all day. And sitting all day. And sitting the rest of the day. Yeah.

So really prioritizing that movement in any way, shape or form, just as much as you would prioritize making time for the gym. Excellent. I think we've been right then, Justin. Yeah. We're getting it right. Yeah, I wanted to bring in the business end of it a bit. And I know Danny has been sitting here nice and patient,

but in terms of incorporating nutritionists and dieticians and being able to actually coach people through all this data. First of all, how did you get involved in continual glucose monitors? And where did you see the opportunity there? Yeah, the one thing I'll mention is the food that impacts me or I guess, drink coffee. Every single person we've seen, say, we'll have an increase in coffee, some people will decrease, and some people have a flat line. And I think that's something super interesting

that people forget about, that coffee is such a different impact. I have a rise, and I think it's because coffee comes from beings, and I may have some kind of an immune response to it. So I can have caffeine, but if I have coffee, I feel, I'll get the crash, and I'll feel crappy. So that's me, very interesting. Oh, coffee helps me, it's like, it's like, it's a lot of things,

it's a lot of stuff. Just in drinks it all day. Yeah, yeah In birch a business side my background is in healthcare consulting So my job is basically to optimize profitability for hospitals medical device manufacturers and insurance companies Not the it's a fun job But not the best for the world as you can imagine yeah, I always tell people a fun fact that If you ever do need to go to a hospital, look at the CEO. If the CEO of the hospital is a former doctor, the chance of you having good outcomes

are actually much higher, because a lot of times in hospitals, the CEOs are actually like former finance people, accounting people, and they're just looking at numbers and we're like, how do we cut costs? Oh, interesting. There's a doctor who knows like he was in that room for a decade before, and so they are aware of how to actually, you know, understand numbers are not just the old results. There's more things that matter besides numbers. So I was in those, a lot of meetings and I saw this trend that you guys all know that people

could be getting sicker and sicker and sicker. We all know that. But the side I didn't see was that we keep spending more money per person in the hospital setting on these people. And so how does it keep happening? We keep spending more money. person in the hospital setting on these people. And so how does it keep happening? We keep spending more money. Yeah, people keep getting sicker. So I wanted to do something about it,

but I didn't know what, frankly speaking. And so I was in a healthcare conference, San Francisco. And I ran into one of my friends who was wearing one of these devices. And I said, why are you wearing this? Are you diabetic? And he said, no, I'm not. I'm just trying to understand how to improve my glucose control. And he said, do you know anything about it?

I said one from professional perspective I do. But also my sister's type one diabetic. And so she's seen these devices from day one till now. And so I've been around it. So it happened to kind of be an expert in this industry. And he said, hey, I'm thinking about starting this company. You intrigued the helping. Because I don't know the business side.

I understand the engineer inside of things. That's a sure. I quit my job two weeks later and launched it. And about two and a half years later, we have 120 people on the team and helped tens of thousands of people now. Now, they used to only be available by prescription. It's still is only by prescription.

Oh, I didn't know that. So what we do is, this is where the business side gets kind of complex. We write digital prescriptions in all 50 states because every state has different regulation, different laws. So, you have to, every time somebody submits a form, they fill out a health questionnaire. And then we send it to the state they're in and that doctor reviews and decides if they're approved or denied.

They're approved and they send it back to a pharmacy partner and the pharmacy sends it out on our behalf. I didn't know that. Now why is it by prescription only? Is it because it's considered invasive because the tiny little filament thing that's a good question. We're still trying to figure out. I mean, Canada does require prescription.

Makes no sense to me. No prescription. It's the arbitrary. The FDA just decides this is a medical device because you can buy a glucometer over the counter, which is even more invasive. Yeah, you're really about it. You're drawing bloodeter over the counter, which is even more invasive. You're maybe about it. You're drawing blood, but that's a little arbitrary.

That's crazy. That's crazy to me. So okay, but anyway, it's an easy process because we went through the process. Yeah, really fast. And that's what people don't realize. Those prescriptions are back in. But we found that having a hardware itself is nice, but you need to software as well to help you kind of track all this data because objectively, you know, I want to sit there and write things out by hand

all day every day. And you know, you stress, you have to track, you're asleep, you're exercise. And even then, unless you're an expert like you guys, it's very difficult for the average person who's an accountant or a marketer or some of that nature to sit there and figure out like, okay, I have these data. What do I do with it? There's so much data, it's an overload, right? And a push notification by itself on your phone telling you, don't do this, is also not enough. And having a human being on their side, which in our situation is a dietician, we've seen

that drive a lot more improvement. And so, combining the hardware, the software, and the dietician together, has really been the playmaker for us. Yeah, full disclosure, we've had companies come to us and approach us, but the reason why we like you guys is because of that, because we know, like we train people for the most of the component always. Yeah, I'm like, this state is not gonna help anybody if they don't have coaching along with it, because you could go on Google and learn all kinds of stuff

about exercise and diet, and that doesn't help anywhere, either, so it's that coaching component. I wanna ask, Cara about that coaching component. I want to ask, care about that coaching component. How do you use this to coach people? Like what does that process look like? Yeah, so as Dan mentioned, all of our members get a one-on-one dietitian

that they communicate with through the app. And as a dietitian, this is also a game changer and that you have data, objective data, to work on with your client. You no longer have to rely on incomplete food logs, you no longer have to rely on memory when you're only meeting once a month or once every couple of weeks. What did you eat then?

How has this been feeling? You get to talk real time with that client and then from the members perspective, the customer, they also get to communicate in real time. You don't have to wait for your specific visit. You can say, I just had a glucose bike. I'm feeling really crappy. What can I do next time to prevent this? And so it's an async texting type of communication that we use with our customers. And the dietician is, of course, getting to see all of the data that they see. They're getting to see their foodian is of course getting to see all of the data that they see.

They're getting to see their food logs. They're getting to see whether they logged that they had a stressful day or if they got poor sleep. We also sync data from a bunch of other wearables. So data from your Apple watch, from your aura ring is going to get- Also, you can connect sleep activity all that stuff. Yeah, so they're able to see all of that as well and kind of point them in the right direction. Really depends. Somebody might be really healthy and they're just to see all of that as well and kind of point them in the right direction. It really depends. Somebody might be really healthy and they're just there to learn as much as possible. And they might just nerd out with a dietician about what this means, how they can optimize

their health, or maybe somebody has PCOS, their overweight, their going through menopause, and we're just going to be taking baby steps based off of what the data is telling us. So it really varies. Yeah, how do you identify, I guess, like intolerances or somebody, you're trying to interpret that data and then also you're trying to kind of troubleshoot with them. Like, how does that all kind of work as way out?

Yeah, so the unique luxury we have had is that we've now seen thousands and thousands of data sets. So the more you've seen it, and then we can train new dieticians on the experience we've had, the easier it is to quickly identify patterns. And so you just get used to it. Like I can look at a glucose data set and probably predict exactly what happened

without even knowing the context because I've just seen it so much. But a lot of times it's looking at those four pillars. You know, what is it that you were you have eaten at that meal or what was the meal before that? What is your sleep like? What is your stress like? And what is your exercise routine spend like? And those are the variables you kind of want to think through as you're trying to understand why you might be having a certain response. Yeah, you know, you just reminded me. I had a client once who he had just become diabetic and he because he had just become

diabetic, he's like super motivated to work out hard. And I remember he came in and he worked out really, really hard. And then his blood sugar just went through the roof. It spiked. It was a stress response. A lot of people don't realize that other factors will influence you because you would think working out hard would cause it to drop. But it actually went through the roof and he was so confused. He's like, I just worked out, I worked out real hard. What's going

on? Let's talk about all these other things that can affect your glucose. I have nothing to do with food because I find that so fascinating. Yeah, absolutely. And like you're mentioning, the really intense workout can spike your glucose. And you could think about that as a supply to demand ratio. If you're doing steady state cardio, you don't have a really urgent demand for energy. Your glucose will probably either stay even or go down a little bit. If you're lifting heavy, if you're sprinting, if you're doing a hit workout, you might see a glucose spike.

That's because you have a really intense demand for energy. Body releasing. Your body's releasing it. But it's a lot different than if you just drink a soda and your glucose spiked. Your body's like, I don't really need this energy. Thanks for that. But in the exercise, you're using that energy immediately. So it's not necessarily a bad thing.

And again, that's why it's really important to have a human on the other side who can reassure you. No, it's good to work out. Please keep doing that. We'll just need to tweak some things. Tristan, so mental stress or non-exercise stress can cause spikes in glucose. Absolutely. That was another really surprising thing when we started to see so many people's data.

Often, people who are relatively healthy, eat a relatively, whole food, clean diet, is that some of their highest spikes of the day are from stressful moments, not food at all. They're like, I'm having this huge spike at 9 a.m. every morning. I have no idea what's going on. I'm fasted and you dig a little bit and you're like, oh, it's when you're commuting and your boss is calling you

and you're trying to answer work emails. It's these stressful moments. Or it's flip-flops sometimes depending on a person's life, but their glucose levels could be really high during the week when they're really stressed out, they're working, and then it's low in the weekend. Or it might be vice versa, depending on your personal life.

But often we see these variances just because of stress. Okay, so with the coaching, obviously you'll focus, you're a dietitian, you work with nutrition, but you're also coaching them through this other stuff. Have you seen improvements in people's numbers from stress management exercises? So you're like, okay, you get the spike at 9 a.m. because you're in traffic every day or whatever.

Obviously there's nothing we can do with exercise or diet in that moment. Have you seen improvements with people doing things like meditation or awareness or whatever? It's like, like, pair like a calm or something like an app where it's like, yeah, you can get some kind of meditation guidance. Does it make a big difference?

Definitely, it does. And really, the first step is awareness. If you don't realize the impact that stressful moment is happening, then it's hard to change it. And a lot of people are so stressed out and running so on red line all the time that what's normal feels normal, even though it's not normal. You know, they're like, I always feel like this,

I'm fine. And then you see the data and you're like, well, okay, maybe I need to do something about this. Maybe stress is actually something I need to take more seriously. And maybe I'm meticulous about my diet and exercise, but I haven't cared about stress because it's hard to quantify. When you can see that and it's clear that it's impactful on your health, then it's much

easier for people to insert those habits. That's where I think the CGM is a really powerful behavior change tool, whether it's force stress, exercise, sleep, you know, whatever your Achilles heel is, when you see that in real time and it's personalized to you, it's not somebody telling you, hey, I think your stress is out of control. You see it yourself objectively, it's much more intrinsically motivating to do something about it and to experiment. Maybe you try meditation in those moments and you can't get it to work.

And maybe it's not for you. So then maybe you try debriefing instead, and that does work. It's much easier to speed up that experimentation feedback loop as well when you have the data to see that work, that didn't work, what's real estate. Well, you got the feedback. So do you have an example that you can tell us about?

Obviously, you can't give us names, but you have an example of someone who implemented a stress management tool, and you have an example of someone who implemented like a stress management tool and you see this improvement just from that. Oh yeah, I mean, we see this all the time. The examples of people commuting and having those glucose spikes are very real.

That's common. That's me, I can't stand that. Yeah. I mean, it is stressful. And so maybe instead of doing that, you instill some sort of mindfulness habit during that. So let's say you're in an Uber and you're all stressed out because you're going to be late or whatever.

Instead, it's taking that time to put your AirPods in and use a mindfulness app. It can be simple things that are extremely effective. And they make a big difference. They make a big difference. Oh, absolutely. Like how big of a difference do you see with this kind of stuff? I mean, you can get your glucose back to just being flat in those moments if you can mitigate the stressful effect.

Because what's happening in those acute, stressful moments is your body is essentially having that surge of cortisol, which tells your body, I need energy. And so if you can prevent that surge of stress, you can keep it even. Are there any supplements or nutrients that you've seen in impacts that can impact glucose? Like I know alphalopolic acid. I've seen in studies can help with glucose or insulin. Is there anything like that that you see people will supplement with and then you see it positive? Yeah, I've seen the most success with barberine. Oh really? And is that before you eat or right after? Yeah, a lot of supplements, you know, the supplement industry is a whole mixed bag, but

there'll be a lot of burberry supplements that are targeted towards like car manager and it's like, eat this right before, but I see the most success with burberrying if you take it consistently. So if you're seeing high glucose levels and you've done a lot of the right lifestyle habits and you want to try supplements, I would say take burberry daily for a couple of weeks and see how it impacts. Okay. So rather than it being acute effect, take it regularly and then you start to see improvements in when it comes to a cute effects. If you want something for like a specific meal, apple cider vinegar, it's the way to go.

It actually works. People always say like does that work? that work. There's certain things or it's kind of a boss up. Doug saw that. Doug used apple cider vinegar and some improvement. It really works. Yeah. So, okay, here's something that I saw with mine. I think, I want to say Adam did too, maybe Justin, you wear it all night and I would see spikes in the middle of it.

I'm actually, but I'm like, what's going on? Am I having a bad dream or whatever? And I think maybe, and I don't think my wife told me, I snore sometimes, can, can like snoring or that kind of stuff produce spikes in glucose as well. It could, if your sleep is disrupted because of it. We often see that people have these high glucose values while they're sleeping.

And the most common reason for that is usually a late dinner the night before. So it's typically the timing of your evening meal. This is one of the most common. Yeah. That's a bad idea. Yeah. So our insulin sensitivity and our ability to use processed glucose and kind of keep glucose levels even, works on a circadian rhythm similarly to other hormones. So most familiar is melatonin. You know, it peaks in the evening to get a sleepy and then it's really low during the day.

Our insulin levels are opposite of that. So insulin and melatonin are actually antagonist in that when melatonin is high, our insulin sensitivity is at its lowest. So insulin's high, you're not gonna produce enough melatonin is high, our insulin sensitivity is at its lowest. So if insulin's high, you're not gonna produce enough melatonin. Yeah, so as a good general rule of thumb to kind of keep those glucose levels even while you're sleeping, is to try not to eat when you think your melatonin levels would also be high. So daylight hours is a good general rule of thumb, trying to avoid food at least three hours before bed. Again, I know everyone's routine or schedule is sometimes

not suitable for that. So if your meal time in the evening with your family, the only thing you can do is 9 p.m. which would be pretty late, but who knows. Then trying to make that a little bit lower carbohydrate, a little bit smaller, importion size, not the time when maybe you're also having a bunch of desserts or snacks, which is the most common, of course, because we're in a naturally decreased insulin decreased insulin sensitivity state, and that is evening hours. And it's also in verse 3 related to growth hormone, right? Insulin is uproof. So, okay.

Small meals. Do you see better results with people eating, you know, because bodybuilders for years have done the whole, like eat every three hours versus big breakfast, big lunch, big dinner, or is there an individual variance there? There's an individual variance, and I think both can work. And again, it's more what's most realistic for your lifestyle, like what is actually, are you going to be able to stick to?

There's so many people who are like, intermittent fasting is hot right now, so I must do it, even though it really doesn't work for my schedule, so it's kind of like, figure out what's gonna work best for you. What I would recommend not doing is being very mindful of like grazing and snacking. So maybe you're eating every two to three hours,

but having like bites of food in between that, we really don't wanna do that, because then you're never giving your body that ability for glucose to go back down in between meals. So you don't generally see a difference then between eating five meals versus eating three if the calories are somewhat equal. I think both can work.

The problem I see for the everyday person, I think a body builder is very disciplined and they can stick to their calories and eat every two to three hours. You're talking like a trainer now. Yeah, I agree with you. But the everyday person is like, oh, I'm gonna eat these smaller, more frequent meals and they end up just eating more. Yeah, or the bars because nobody pretty good. And so I think the everyday person, two to three larger meals and trying to avoid snacking in between is usually a better option,

but it's gonna depend. Now, most of your career, you did not work with CGM devices like that. You worked in hospital settings, you want to... How is it much more effective now at getting people to lose weight because you have this data that you can point to and work around or does it not make that big of a difference? Like, let's talk about weight loss. Yeah, it makes a huge difference. Okay. And a lot of that is just the motivation Like let's talk about weight loss. Yeah, it makes a huge difference. Okay.

And a lot of that is just the motivation that comes as a behavior change tool. I liken the CGM as similar to like calorie tracking. At first it's about awareness. You know, most people are totally off in their assumptions. You know, if you're gonna, somebody's never tracked before and they're gonna guess how many calories

and protein they're eating, it's totally off. Yeah. Same is gonna be if you're going to, and somebody's never tracked before and they're going to guess how many calories and protein they're eating, it's totally off. Same is going to be if you're trying to guess what your glucose response is, you're going to be off. So the first step is awareness, gaining knowledge, gaining insight, and then it turns into behavior change. You know, you're not learning as much after as a while, but it's helping you stay accountable and consistent. And we know that that's where results really happen is being consistent and accountable.

And so if you have that data that again, is more intrinsically motivating because it's personalized, it's not me telling you to go on walks, it's not me telling you to lift weights, it's not me telling you to stop eating late at night, it's you seeing it in the data from your own body, it's motivating and it's real time. We have this huge time gap

from our behaviors and the consequences often. If I eat cake every night before I go to bed, I'm not going to see diabetes for 30, 40 years. That's not very motivating for me to stop doing the thing that's really fun and pleasurable today. But if you could see real stuff happening every day. Exactly. Our brains are absolutely hard real stuff happening every day. Exactly. Our brains are absolutely hardwired for that immediate gratification. And we don't get a lot of opportunities for immediate gratification in traditional nutrition, fitness world. Oftentimes it's the opposite.

The first time you start working out, it's not very gratifying. You're like, I'm sore, it's kind of sucks. And so being able to have a positive reinforcement to the behaviors that you actually want to stick to is really, really helpful. So as a coaching tool, it's just brilliant. I would totally see this because when I first heard about these, I'm like, how's it going to help anybody when they just have the data? But when you combine it with the coaching, here's something that really occurred to me.

One of the best strategies for a trainer or coach to be effective is to be able to figure out how to get your client to be honest. It's very challenging to get someone to be truly honest with their dietary habits and their feeling, especially if they're reporting it, you know, you're meeting with them twice a week, but sometimes even less than that. It's like, what happened on Monday, what happened the day before, and they're kind of trying to report it, or getting someone to write something down right in that moment. It's very challenging, but you see the data right now. So it's like, they're forced to be.

Yeah, I've ruined it. Hey, what happened at 2 p.m. yesterday, or what's going on here? And so right away, are you finding people like right away or just like, oh, yeah, I'm honest because there's no way to wander around. Yeah, there's like nowhere to hide. We're in this. We're in this together, I guess. Yeah, that's exactly the mindset. It's extremely difficult for people to be honest.

And even if they're well intended to be honest, it's hard to remember, like you're saying, or it's hard to write everything down. You end up summarizing and then skipping the bites here and there or the little things that actually matter and add up. So being able to have that data capture it objectively is so helpful and in being able to help somebody effectively, you really can't help somebody reach their health goals if you don't know the whole picture. And being able to do that

behind a screen, I also think is really helpful because there's a little bit of a barrier between the difficulty of being honest sometimes of like, yes, I had, okay, not one glass of wine last night, yes, I drank the whole bottle last night. Well, it's interesting. We see people who are like Olympic athletes, professional athletes, and these folks are fit, and yet you look at their glucose response and it's just atrocious. And you sometimes have people who are a little bit overweight, and they're super healthy. And we have a stigma around the way we look is connected to our socials, and you sometimes have people who are a little bit overweight and they're super healthy.

And we have a stigma around the way we look is connected to our metabolic health, which is not complete accurate. No, you're right, because in fact, if you look at the data of diabetes, so type two diabetes and heart disease, a substantial minority, and I say substantial because it's not insignificant. It's something like 15 to 20% is non obese individuals. So there's a millions of people who get heart disease who are not obese. Not majority are obese, but there's a percentage who aren't. And how would you know if you're one of those people, you know, I have a friend of mine whose uncle, you know,

his late 40s got a heart attack. the guy worked out all the time, whatever. How would he know if he didn't have something giving him kind of objective measures? Because he looks in the mirror, he sees his performance in the gym and everything feels totally great. I want to go back to the calorie counting and just how difficult that is as a coach to be able to get that kind of information and data from your clients. In terms of, there's been other, my fitness pal, there's been like other types of apps out there that have tried to be able to make that process easier and try to catalog everything

and be able to upload pictures to sort of make that, simplify that process a bit more. Like, what were some of those challenges in terms of the actual user experience? Like, how did you make those decisions and create that? So it was more valuable to the coach and the client. Yeah, and this is what's fascinating about this. With my Fidence Pal, you have to track every single thing because there's no feedback loop to you, right?

With this, we realize everyone has different methodology of tracking. Some people will track every single ingredient, every single macro, every single calcium zinc they had, but some folks just want to maybe take a picture and that's a move on, or they maybe want to even just like type in yogurt. Because that is always tagged to actual data, you can actually then realize what the feedback loop is on what. So it makes it much more flexible. And even if you like take a picture of something and you don't have the macro breakdown,

because there's a human being on the other side, they can tell a proximate it is, right? They don't need to know it's three bananas, they can see it's bananas, right? And so I think that ability to let people just put much more flexibility around tracking helps. And so people also will, interestingly enough, the only track when they only see negative events.

If you're eating some healthy, do you really need to read it down? Right. Probably not. Right, right, right. Are you, how often are the dieticians in communication with the people using the CGM? Yeah, close to daily. So it depends again on the person. We'll always respond within a day, maximum, to somebody ascending us directly. But if you don't know what to ask, you don't know what

you don't know, the dietitian is going to reach out usually every two to three days in the beginning while you're figuring things out, kind of point things out, guide you along your journey. And then once you get a rhythm going, it might be more like every five days that we're checking in on your goals and you can send a message any time in between then. So some people want much more frequent contact and some people are like, I got my plan. We're on a good path, checking with me weekly, hold me accountable. So it's flexible again to what the person is. If I was training again, I would 100% get clients to do this because you guys are handling

that side. And I would just be able to look and see what's off of the trainers. Do you guys have people who work with trainers who then contact you guys and work with you guys as well? So everybody can kind of work together? Yeah. And right now that's in a more beta phase where we do it a little bit manually where you know, we can give them access to see their data so that we're all seeing it together. And right now, that's in a more beta phase where we do it a little bit manually, where we can give them access to see their data so that we're all seeing it together, we're all working together. But we are working on a platform that will make it easier for people to work with where

their clients are working with us and they are seeing it. And they're getting maybe more of a high level report so that they don't have to be the person who's an expert in looking at the data either. I'll say, there's one point interesting is that we try to reach out to members all the time. We had a one member we reached out over and over his glucose was really, really high. He's always athletic, healthy and we kept reaching out to him. He was now responding.

Three days later, he was finally responding to us. We're like, you okay, what's going on? You're in diabetic range for like 10 hours. His response was, sorry, I was getting married. So I'm just so high. He couldn't respond, but he was just like, he felt pain. Do you see, glue coat? Because I've read how fast digesting protein, like protein powders can cause spikes in glucose.

Do you guys see that? Sometimes I see it. We get a lot of keto people who are worried about getting glucose spikes from too much protein, the obsession with that. And what I actually have seen is that it takes a lot of protein for to result in a glucose spike. And so usually you're probably not overdoing it on protein, most people are underdoing it on protein. But sometimes that fast acting, we can see a little bit of a glucose bump, but it's not anything or it's concerning or it's out of normal ranges.

So most people who are afraid of that, I think it's okay. How big is the individual variance here? Because we know that we generally would think a low carb diet would cause better glucose response. I've worked with clients who have gone vegetarian and felt great. Others that just was terrible for them. There's of course, we were talking about the software. There's carnivore diet, which I believe to be just really good elimination.

It's extreme in the spectrum all the time. How big is the individual variance? Like, do you see people doing the same diet and you're like, this is working for you and this is terrible for you? Is it that big? Yeah, it's pretty big. There's the basics. You know, it's always big. There's the basics.

It's always master the basics of nutrition, whole food, nutrient density, as much as possible, of course, maximize protein. And then from there, there's a lot of variation. That's why I always say with nutrition, I can't tell you what to do besides the basics because it's so personalized. You have to have a mindset of being open-minded

to what's working for one person is not necessarily gonna work for you. We always have people who come to us and they're like, well, my sister lost 80 pounds on keto, and it's, but I'm gaining weight on keto. And I'm like, well, it might not work for you. And even just the variations of what low carb is, somebody's carbohydrate threshold,

where they're gonna feel good and have good glucose values, isn't gonna be the same as somebody else's. Now you were a dietician for a while before you started working doing this. Did you go in with some preconceived ideas and then were you surprised by anything? Yeah, I was. I think I went to extremes where, you know,

when you're first clinically trained as a dietician, which our training is not as good as it should be, it's a little bit archaic in some aspects, whereas more like, okay, carbohydrate counting, consistency, small frequent meals. And then I saw all of these people in the hospitals with diabetes and complications, and I was like, everyone should be lower carb. This is not helping us. And then swung the other way with the CGM where it's really like, oh, it depends, it varies.

And it also might depend for the individual person depending on where they're at in their life. We have so many menopausal women who come to us. They're like, what was working before? Isn't it working now? I'm sure you've seen this. And estrogen drops when you're going through menopause. We see this in a minor way during just

normal monthly menstrual cycles, but during menopause, you're having this massive change in hormones, again, back to hormones matter. Suddenly, you cannot eat the same as you were before, and most likely you're going to need to be in a little bit more of a carbohydrate- carbohydrate-restricted state during and after menopause, because you're just not as insulin-sensitive. But then again, going back to the importance of strength training, the women who have the most success through menopause and maintaining good glycemic control are those who are still

being really physically active, making sure that they're doing strain training, eating a lot of protein, but their needs have changed now. So it's also a variation of what stage of life you're in, what you're doing personally and then between person to person. My ego feels great because a lot of the data that we're seeing or that you're explaining is a lot of what we learn through trial and error. Yeah. Yeah. Through training people. And oftentimes we were at odds with, you know, quote unquote experts because they would talk about studies and data and from that perspective, we'd say, well, no, I've worked

with a lot of people that this is. I haven't always seen that to be the case. At the end of the day, the clinical experience is the most important. It's like what you've actually seen work with real human beings. Research is great and important, of course, but it's a sterile environment usually, and it doesn't take into account all of the variations of real life and real humans.

A lot of times, you know, this research on glucose, they're using oral glucose tolerance tests, so they're having people drink pure glucose. That's not very realistic of real life, right? So it's important as a guide to understand the research, but you have to be able to be willing to adjust things with your client's experiment, trial and error, like you're talking about. Have you worked with people where they'll go on hormone therapy,

like either testosterone replacement therapy or some women will go on hormone therapy? And then you see a big impact and change in how that affects. Yeah. And same also with thyroid. So we have a lot of women specifically who come to us with Hashimoto's or hypothyroidism and their thyroid levels are not optimized yet. They're not in a good place.

And once those get stabilized, we see much greater improvement in good glucose control. So thyroid, female hormones, testosterone, all of those are going to have a really significant impact. This has to be, this is the most effective. I am, I've been very vocal on the show about this. I'm not a big fan of wearables typically. I don't think that they're going to move the needle. I think they're cool. And I like fitness fanatics don't like it, but I never think, or never thought

that wearables would make an impact to the average person until we started talking to you guys and the coaching aspect through the data. That's what makes all the difference in the world. What is the adherence rate? Are people sticking with you guys? Because that really tells a lot, right? And how long people are able to stay consistent?

They've lost weight, they've been able to keep that off. Do we have numbers? Or do we know what that looks like? So we have internal numbers, but we decided to take a next level. So we actually started working in University of Wisconsin. And one of their leaders is from an MDPG from Mayo Clinic. And about quantifindness and doing a research clinical research

study about this. We've noticed that historically, the research institutions are about 20 years behind, real clinical studies we talked about. And so we said, let's go to the research universities, work with them, provide this data, all this data has never been existence before, and try to quantify this with a stamp of approval from the old school, you know, places.

So that's where we're trying to get to. Again, Cara has way more and what she's seen, but again, we wanna make sure there is a scientific backing of this creation. Yeah, and related to the awareness first and then kind of behavior change next, what we see a lot of people is they'll do it for three to six months in the beginning consistently

where they're wearing it every day. They're gathering that data, they're coming up with a plan. And then from there, there's a group of people who want to keep wearing it forever as that behavior change tool. And then there's a group of people that are like, can I just stay with my coach while I implement some of this? And that I'll come back and wear the sensor periodically. Because unlike an Apple Watch, unfortunately, it's disposable in the

sense that it lasts two weeks and then you have to throw it away and then you have to use another one. You can't just wear it forever and just have a one-time purchase. So what we're seeing a lot of people then will do it on a quarterly basis or every six months as sort of a check-in. Again, related to calorie counting. I think a lot of people will be like, okay, I'm good for a while. But then I need to revisit it to make sure everything still looks good to hold myself accountable. So I think that periodic use is very interesting, but a lot of people are wanting to stick

with the coach throughout that. Well, it's interesting too, because you're thinking about how people change over time as well. Some foods that you may have done really well with, initially may not serve you quite as well in the future. Exactly.

Be interesting to just periodically put it back on and just to check up again. Yeah, but what you're saying makes perfect sense because you can get data can become stressful or what I should say to be more clear is like people who track, if you become obsessive about the tracking, that's a hard way to live all the time. So it makes perfect sense that people would do it long enough, get the awareness, kind of have an understanding. I feel like this one, my glucose is high.

I apply it. I apply it. I apply it. I apply it. I apply it. I apply it. I apply it. I apply it.

I apply it. I apply it. I apply it. I apply it. I apply it. I apply it. I apply it. I apply it. and then you can kind of self-monitor a little bit, but along with the coaching. So that makes a perfect sense. Are you seeing way more success with this than you were without the last six? Oh yeah. Oh yeah. It's night and day. So it makes you hopeful.

Yes, I feel very optimistic. What, anything that surprised you to about using this, about yourselves or anything that you changed about your lifestyles, your workouts, or your diets, that you were probably more than care of, my job was traveling and eating. And again, I thought every different breakfast I would have orange juice,

cause I was like, oh, vitamin C, right? I was spiking at glucose every day. I'm eating bananas, I'm like potassium, getting all my vitamins out today, right, I don't need multiple vitamins. I'll just eat healthy, right? And every single day, banana, orange juice, what else, a bagel, and like, a protein shake.

That was my breakfast for like a decade. And I, the whole time, you think, I'm beyond belief healthy. Look at these other people eating McDonald's. And every day, like, noon, I'll just crash in and I was like, miss, someone's wrong with me. And the first I just swapped some of those things out. What did you know? Now I got it, she's instead of of banana and even if I have a little honey But again, I'll I'll put honey and I'll eat it maybe after Or mix it with something else while I have the protein or the fat first instead of having a carb And it's funny enough. I'll actually oftentimes eat some kind of meat as well. So I mean it sounds like I'm kidding I'm not

Different with your I mean dramatic true difference, right'm kidding, I'm not. But it made a difference with your... I mean, dramatic. Dramatic difference, right? I think the order of food, this is meal sequencing that Caratodme, personal debt to share in my mouth. Really dramatically helped me to understand how to eat. Or even, this kind of sounds silly, but like, you know, people always eat dessert in the afternoon or evenings,

but like, theoretically dessert's a better morning. So if I'm gonna have a cheat meal, and this is probably not the afternoon or evenings, but like theoretically desserts are better in the morning. So if I'm gonna have a cheat meal, and this is probably not the best to do, but I'll have them. I expect breakfast. One to a while, they're rare occasion, right? But it's just healthier, right? Because you have better ability,

control insulin and glucose at that point in time. Well, it's funny, I was just thinking about, you're in the land of deep dish pizza. Yeah, I'm not wondering what I would do. Yeah, it's like, it's a really test the limits of like we're gonna spike out. Justin's like my look is great with deep dish, but deep dish pizza. I'm all about it. What about free

soft care? Did you change anything? Yeah. And I think for me is just figuring out what my optimal carbohydrate sources are. As I mentioned with even testing the fruit. I love bananas. And then I was like, oh, they're too high glycemic. And it's like, okay, they're perfectly fine. So understanding those go to carbohydrate sources. So for me, white potatoes are better than sweet potatoes. Oh my, I see my response.

And I actually like the better. Yeah. So a variety of just figuring out which carbohydrate source, as Dan mentioned, always protein first when possible before the carbohydrates, that actually makes a really big difference. I knew that the walking after meals is important, but much more likely to stick to it now than I ever was.

How big of a difference does it make in glucose? Oh, at least 20 to 30 points for me. Wow. Just a 10 minute walk. Just a 10 minute walk. It doesn't have to be, you know, a long. It's so crazy. We've been talking about that. Just out of our own experience, same exact thing.

You feel better too. And you're less likely to overeat, I think if you're like, oh, I'm going to remove myself from the area and go on a walk rather than just kind of like lingering in the kitchen forever. Sure. And then trying not to eat past for me, 7 p.m. is kind of a cut off that I have where I see my glucose values go much higher at night. I actually have the genetic variance for the melatonin receptor,

which is almost a third of the population does. That makes you even more sensitive to that effect we talked about, where glucose will be higher if you're eating later at night. So I noticed that quite a bit in my data. And then there's some situations like I play beach volleyball late on Monday nights. I don't get home until 10 and I eat dinner at 10.30. I'm still going to eat because I just worked out for like five hours straight, but I'm just

going to have protein and not carbohydrates at that time. So tweaks you can make depending on your situation. And now throw it, now food combinations. If I just eat a food that I have a high, you know glucose response to and I add Protein to it or fats. Do we see I mean that's what we're taught right that you'll see a better glucose response is that you normally see? Yeah, it definitely helps if you combine it what helps even more is if you can eat the protein first It actually makes a big difference. So God I've been teaching that to you That's what I tell them, but not because of that.

It's just because I, you know, most people under eat proteins, I'm like, you down first. Yeah, yeah. And it helps with satiety. Exactly. It's a win-win across the board. And that's small things, like, if I'm out to eat and they usually bring you carbs first.

So chips and salsa, bread and butter. I will, now I want, I will wait for those things until my entry comes so I can have some protein first. Little things where it's like I probably wouldn't have thought about it beforehand, that now you just feel more empowered by actually knowing. Do you guys see any glucose responses to non-calorie containing foods like artificial sweeteners or anything like that?

Yeah. And as Dan mentioned, it's kind of a mix-up of how somebody might respond to coffee or caffeine, even if there's nothing else in it. It's probably related to genetic variance, or you said it might even be kind of being intolerant Says as a variety of reasons, but similar with artificial sweeteners and stevia It's it's a toss-up some people seem really sensitive to it and we'll have a glucose response and some people seem nothing So it's fascinating. I wonder if it has to do with the perception of sweetness that make, I don't know.

It's possible. I have a feeling we don't know the answer to that one. Yeah. Well, we definitely don't know. There's probably some sort of microbiome component I would guess. Do you ever see any changes with the probiotic supplementation with people?

Yeah. No way. Yeah. And there is a probiotic supplement on the market that is specifically designed to lower your A1C and we have seen people use that and it actually works and so there's a variety of probiotic supplements out there that we've actually seen quite an improvement with and even the gut health connection to everything is prevalent but it is also connected to glucose, of course. And so if somebody, and there's actually really interesting research on this, where if you

take a lean individual and you transplant their microbiome over, yeah, people transplant. Yeah, people transplant over, that's a, the nice I say is to give it to them, but it's a poop transfer. Yeah. You will see, if, but it's a poop transfer. If you put it in a metabolic unhealthy person, somebody who has type 2 diabetes, you will see their glucose values improve overnight from just having that microbiome switch. So there's certainly that connection. And so the more that we can kind of optimize our health from all aspects, the holistic

view, it's going to have those ripple effects. Generally speaking, from your experience, obviously there's a huge individual variance we've already covered that, but generally speaking, what are the best and worst foods for glucose responses for people? Well, there's the obvious worst foods where it's liquid sugar. I would say it's like the worst you could do. So, soda, juice, dance orange juice, caramel frappuccino, dateurade, also not a good, juice, dance orange juice. A lot of juice. Normal frappuccinos. Yeah, caramel frappuccinos,

Gatorade, also not a good like electrolyte replacement. I don't know if you guys have ever gone on the okay. We work with a company that does electrolyte, but there's no sugar that way. So any liquid sugar is going to be

the worst thing you can do. And then you know, the more processed foods, the worse it is, where it's like the more whole food you can do. And then, you know, the more processed foods, the worse it is, where it's like the more whole food you can do the better. Generally, you see that. Generally. Even if the macros are similar? Yeah, even if you think about the level of processing

within the same ingredient. So I've done this experiment personally of same portion size, same total carbohydrates of instant oats, rolled oats, steel cut oats, and overnight oats. What's the difference? Dramatic difference. It was pretty impactful.

I was really surprised actually, even in myself, of how much of a difference it made, where the instant oats, it was like I was spiking to 160 coming from a baseline of 70, pretty dramatic increase, whereas steel cut oats that then cooled overnight and eat in the next day, so a little bit of resistance starch in there,

there's like a 10 point increase at like 70 to 80. That's it. So resistance starch, this is because it literally develops starches that don't get broken down into carbohydrate. Right, which is even also feeds the gut bacteria even more as well in that resistance starch state. So.

Anything else, it's open, it's a difference. Yeah. And the instant ones are like kind of pre-digested, so that makes it a faster absorbing. while in that resistant starch state. So anything else, it's oatmeal. It's a difference. Yeah. Yeah. Yeah. And the instant ones are like kind of pre-digested, so that makes it a faster absorbing. Essentially. Which is similar to, again, talking about liquid sugar, oat milk. Can we just end the oat milk craze for all?

And for all, it's basically liquid sugar. I didn't milk oats, by the way. Because it's already been processed. That's not milk, I'm just saying. It's like instant oats in liquid form. You know what I think is a kind of fascinating. So I used to travel quite a bit from my work. And when I would eat the exact same foods in year versus US, I'd have a way worse response in US. And I don't know what what the process is and what it is, but exacting breads, the milks, the orange juices. I heard that with

grains specifically. Yeah. It's completely like way worse response for foods that you didn't use. It's got a, wow, that is, so I've anecdotally noticed that. I have family in Italy, so I go over there and I eat the foods there, same thing. And pasta and no big deal. And I believe it is because I'm more relaxed here, like what's the deal? But no, I'd bring food over and I'd notice that I feel different. So I mean, my guess is it has to do with the, because we have different regulations here on additives, whether it's coloring or preservatives,

or even glyphosate, residues are higher in a lot of our food. So that's my guess, but it is very strange. And it totally speaking, I've had lots of people tell me that. That's really, really weird. So how many people does a dietician typically work with at Neutrosense. Is it one versus a sign to so many people?

Yeah, so you'll be assigned one-on-one with someone so that you can develop that relationship and rapport with someone. And then they're usually working with somewhere between 80 to 100 clients at any point in time. Okay. And then how many people now are signed up and working with a company? Do you know how many members it is? Yeah, so historically, it's been over like over 40,000 people

so far. But here's a fun fact. Last time I looked, something like 12%, don't quote exactly number 10, 12% of folks actually healthcare workers, what I mean say that, I mean doctors, pharmacists, other dietitians. That's a huge percentage of people that want to. I mean, a lot of folks go to medical school

and don't ever take a single dietitian course. Wow, that's for my school. That's for my school. And so like, they, you know, they always say like doctors are unfortunately taught to prescribe medicine and cut in US in our system. They're not worried about preventative health and, you know, interesting. Like, last time you go to a doctor like, hey, I need to have an issue. They say, workout, eat better. Yeah. And then come back a year later. Did you work out, need better? Doesn't look like it. Yeah, we re-real about that all the time. I know I asked you about supplement earlier, but creatine.

Have you seen any changes in glucose with creatine? I've read studies that show that it's got a positive impact, maybe indirectly because it helps build muscle. But have you seen anything? Yeah, I haven't noticed anything where it's like a stark impact. With the supplements, as we mentioned, burbring seems the most effective for lowering glucose, but then there's also, if you have a deficiency in certain nutrients supplementing with that or bringing up with food, supplements, whatever you got to do, you'll see a dramatic improvement

in glucose, but then usually supplementing beyond that we won't see that. And those common for that is vitamin D shocker. I was just gonna say. Yeah. Which most likely you are deficient in. So bringing that up, magnesium, chromium, and zinc are the other ones that are really closely related to glucose metabolism. Do you generally see differences in meat,

like beef versus chicken versus fish, or is that not really a big? Not a large difference unless you're having some sort of intolerance. Got it, got it. Awesome. Well, this has been really cool, very fascinating. And like I said, we've had companies approach us

and we've said no, but we worked with you guys because of the coaching aspect. I feel like the data combined with the coaching makes it super effective. And if you take one away, obviously loses its its effectiveness so I appreciate you guys coming on. Yeah, absolutely. Thanks for having us guys. Appreciate it.

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