Episode 163: Dr. Paul Kolodzik ON Reversing Metabolic Disease through the use of Continuous Glucose Monitor

In this episode of the Ketones and Coffee Podcast, I have a deep and insightful conversation with Dr. Paul Kolodzik, a double board certified physician in both Preventive Medicine and Emergency Medicine. Dr. Paul is notably specialized in the area of metabolic health and has made significant strides with the use of Continuous Glucose Monitor (CGM) in helping patients prevent and reverse metabolic diseases. 

We delve into his recently published book, 'The Continuous Glucose Monitor Revolution', which highlights the potential of CGM in achieving profound health. Moreover, this episode explores a host of topics such as understanding insulin resistance, the importance of fasting insulin levels, the appropriate use of CGM, and the impact of lifestyle changes on health. Dr. Paul also shares one of his inspiring patient stories, showcasing a real-life example of the significance of metabolic health initiatives.

00:00 Introduction and Guest Presentation

00:41 Dr. Paul's Journey from Emergency Medicine to Metabolic Health

02:11 The Role of Continuous Glucose Monitor (CGM) in Metabolic Health

08:35 Understanding Insulin Resistance and Metabolic Syndrome

14:37 The Misconception about Cholesterol and Heart Disease

17:48 The Power of Continuous Glucose Monitor (CGM) in Managing Blood Sugar

22:26 Dietary Choices and Their Impact on Blood Sugar and Insulin Levels

25:01 The Role of Fasting and Strength Training in Reversing Insulin Resistance

27:34 The Power of Continuous Glucose Monitoring (CGM)

28:23 Why CGMs Should Be Used by Non-Diabetics

29:45 The Importance of Fasting Insulin Levels

32:41 Understanding GLP-1 Medications

34:42 The Role of Medications in Weight Loss

37:39 The Impact of Medications on Metabolic Syndromes

38:58 The Use of Medications in Weight Loss

47:11 Success Stories and Transformations

51:42 Final Thoughts and Contact Information

Practice website:  www.metabolicmds.com

Book on Amazon:  https://a.co/d/8O13wje

 Twitter @dr.kolo.md

TikTok @drkolomd 

YouTube @metabolicmds

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Transcript

0:49

We got a big time guest today, guys. I am truly, truly on there to have hosted Dr. Paul Kolodziej. He is a wealth of knowledge when it comes to reversing metabolic disease through the use of a C G M minder. He is a double board certified physician in both preventive medicine and emergency medicine. He empowers his patients in preventing and reversing metabolic diseases. This is my all-time favorite guy. So make sure you take notes. We discussed the role of continuous glucose monitor in their bollock health and even the misconception about cholesterol and heart disease. Very, very same stuff guys. So without further ado, here's my interview with Dr. Paul called out sick.

Lorenz: 1:30

Our guest today is Dr. Paul He is a double board certified physician holding certifications from both the American Board of Preventive Medicine and the American Board of Emergency Physicians with an illustrious 30 year career in the emergency room. Dr. Kolodziejk also started his metabolic health practice and changing lives. He's revolutionized the use of Continuous Glucose Monitor, or CGM. to help his patients not only shed excess weight, but also prevent and reverse metabolic diseases. In his recently published book, The Continuous Glucose Monitor Revolution, Dr. Kolodziejk shares the secrets behind helping thousands of patients and achieving profound health. Dr. Paul Kolodziejk, welcome to the ketones and coffee podcast.

Dr. Paul: 2:16

Yeah. It's a pleasure to be here. As I mentioned, I was just looking through your list of podcasts and it's a who's who of metabolic health. And I'm privileged to be included in that group on your podcast.

Lorenz: 2:28

Well, I'm honored. I'm honored to, you know, talk to you today. You know, this is such an Honor for me because I actually wanted to learn about the use of continuous glucose monitor for myself. I was actually looking into TGMs and wanted to learn more about it. And I was planning on getting one just to understand insulin and blood glucose. And then I got a message from your assistant and incredible. We were, we're here today. So, got a lot to discuss and I really want to get us. started right here. So, you know, my focus on this interview is, you know, to get people to consider getting a CGM and how a CGM really changed lives and no better way to understand this topic than Dr. Paul here and who has been using this tool to help thousands of patients change their lifestyle. We got a lot to get into. So, but let's start with your background, Dr. Paul, and kind of introduce yourself and your practice. My

Dr. Paul: 3:26

much, Lorenz. First of all, the last chapter in the book is CGM's Change Lives, and you're absolutely right, and we'll get into why that's the case. But my background is in the emergency department, as you mentioned, and after, you know, many, many years of Seeing the ravages of obesity and um, uh, vascular inflammation blood glucose. And, and I think you alluded to, we aren't only talking about physical problems, we're talking about mental health as well. Um, as Chris Palmer is, really pushing, uh, now, um, appropriately. his book, energy, um, my background again in the emergency and you know, what gets all the press in the emergency department is the overdoses in the, in the stabbings and the gunshot wounds. But what emergency physicians do day in and day out their entire career is take care of vascular issues. Uh, so we're talking about blood lining that results in heart attacks and strokes and kidney failure. from diabetes and peripheral vascular disease. And then that's coupled with the other things we see, which is the problems associated with obesity, even the musculoskeletal issues, the back pains and knee pains and the hip pains. And so, you know, after spending many years in the emergency department, I recognize that, you know, we can prevent people from ever having to go to the emergency department if we can get out in front of primarily Blood glucose elevation and obesity and blood glucose lowering through keto diets or even low carb diets Helps do that. And so that's why I started my metabolic health practice about seven years ago

Lorenz: 5:11

know, that transition from, you know, you talked about acute care to focusing on metabolic health, where you talked about, you know, coming from doing reactive measures, you know, did you discuss this really eloquently on your book? when you prescribe medications for symptoms to a more proactive focus on metabolic health. So for acute care, you prescribe medications. That's the response to the symptoms the patient experiencing, of course. And a lot of times it seems to me that it's not evident. For some doctors to prescribe, you know, lifestyle change like you're doing now it's just not the focus at severe stages of diseases, right? And the advance and the advice it was certainly not to prevent, right? So I understand that it will change, right? And the people in the know, knows that traditional medicine, it takes 10 years. for any change to implement, but I'm curious about what first got you introduced to metabolic health in general.

Dr. Paul: 6:19

Yeah, it was I'll be honest with you it was seeing those changes of those patients in the emergency department and it's It's like, you know, it's not always their fault. I mean, they don't understand, some patients don't understand that carbs raise blood glucose. Um, and the reason it's not always their fault is you know, the medical industry now and the pharmaceutical industry now is all geared toward a disease management model. Um, and, you know, I don't know how it you are, Lorenz, but, but here in this area um, what has happened is over the since I've been in practice, that docs initially were in their own small practices. I know in Canada, there's a different model, but. Docs were in their own small practices um, and I think they paid a little bit more to these things. And unfortunately that model has changed. Now uh, primary care docs are primarily employed by health systems and they've been relegated. They are the backbone of medicine, the primary care docs, but they've been relegated primarily to disease management because they get 20 minutes with a patient every six months. Or, or every year. And so it's really all they have time to do really is, is uh, Oh, your blood sugar is up a little bit. Let's this medicine or your blood pressure is up. Let's add this medicine. So they don't really have time to address. the preventative approaches uh, in, in way, in really way to reverse diseases like pre diabetes and diabetes that, that I have the opportunity to address. Um, when I started my practice, primary were kind of looking at me like, what's he doing over there with that? And, and now they refer me patients because they see our success and. You know, de prescribing medications and patients losing a lot of weight. Um, so I became early on, why I'm doing this. I became passionate about it early on. When you see the changes in people's lives. I remember one patient, you know, 19 year old parents, diabetic, he's 70 pounds overweight and with just a CGM, a low carb diet, intermittent fasting and some strength training, his life direction changed from going this way. to go in this way and he'll never go back. And in fact, once we'll, we'll talk about this. Once you see the patterns on a CGM graph, you, you can't unsee that. So you know what your diet is doing to you and it's a teachable moment. So,

Lorenz: 9:45

Awesome. And we'll talk about CGM in a minute here. But I'd like to, for people to look at this book called Continuous Glucose Monitor Revolution. I love this book because it explains the root cause in depth of diseases as diabetes, you know, heart disease, fatty liver, PCOS, without making it too complicated. And simply put, it's You know, these are metabolic syndrome and to get the root cause we can understand that our metabolic health and what does it mean, right? So, let's talk about, you know, metabolic health. Let's, let's first define metabolic health and what measures can we take to improve it?

Dr. Paul: 10:30

syndrome in is people that are overweight. Increased abdominal girth, hypertension, high cholesterol. And then of course, a host of things go along with that, like fatty liver disease and sleep apnea, and that's really my target population. I know that there are a lot of young, relatively healthy. tech oriented people that are using CGMs. But, but my population is primarily the metabolic middle aged patient. Um, that, that really I wanted them to diabetes reversed. Uh, excuse me, their pre diabetes reversed. before becomes diabetes, get de prescribed medications related to that. And that's really the focus of my CGM use.

Lorenz: 11:13

And when we talk about, you know, how insulin resistant is like. What causes obesity, weight, right? Weight around the waist. You know, when you're obese and somebody's overweight, these are symptoms of, what, insulin resistance, which may lead to these metabolic syndromes. Give us a few more examples of what causes what other causes of insulin resistance, what other diseases that can be caused by insulin resistance. Mm.

Dr. Paul: 11:49

disease as you're probably aware. Um, but really, insulin is the origin of many other diseases more than any. thing. And, and, and so it's what leads to this metabolic syndrome and these other problems, hypertension, even high cholesterol. Cause I think people should care a lot more about their insulin level than they should about their cholesterol level. And maybe we'll get into that, but you know, the way I look at this simply from a physiological standpoint is you eat and eat a carb and your blood sugar rises. And you know, Then the pancreas releases insulin, drives that blood glucose into your organs. And so far so good. You know, you need, your muscles need to contract. You need energy. But the problem is in, in the U S at least since the seventies, we got the fruit food pyramid. And we were told not to eat fat. We were told to eat carbs. Um, and then, uh, after that, the epidemic obesity took off. And then 10 years after that, the epidemic of diabetes took off. And then as expected, 10 years after that, the epidemic of vascular disease took off. So I look at this. I like simple models, as you mentioned, and in the simple model is really, you know, your blood glucose rises and that's fine if you need energy. But if you have excess blood glucose for a long period of time, it stays high in your system. Your organs store as much energy as they can in the form of complex glucose molecules called glycogen. And then your organs, let's say your muscles, they stop listening to insulin. And that's fine. They say, insulin, we are not going to listen to you anymore. That's, that's a simple way to think of insulin resistance. Your organs are saying, insulin, we aren't going to listen to you anymore because we got all the energy we need. And then, of course, what happens? Because that blood glucose has to go somewhere, you know, or it would result in death in a short period of time. It goes to the liver and gets converted to fat. And then it gets deposited around our midsection causing us to gain weight, causing fatty liver disease, causing the metabolic syndrome issues. So the way I look at insulin resistance is we want to get the way for those muscles and those other organs to welcome the signal from insulin. And the way you do that is by lowering your blood sugar. Um, and so those organs are looking of energy. They want blood glucose, but if there's none there, they're gonna look for something else. And of course, you know this, what do they look for? They look for that fat down around the middle. And those fatty acids start getting broken down and provide energy. So you're reversing that entire process. And that's when weight gets lost and health improves. Your original question was, you know, the issues associated with, the other health issues associated. Um, with high blood sugar and metabolic and insulin resistance really is the origin of that, you know, all, all those disease processes, even inflammation, not only the vessel linings, but of your cartilage and of your joints that they all get glucose attached to them and they become inflamed. And when you can reverse that Um, and people feel a lot better and they

Lorenz: 15:01

We know that we reached an understanding about a certain topic when you can explain it to children, right? I think we can explain this to children that they can understand. And that's, and that's when we know that we. Have that understanding that complete understanding of the problem, right? And now we do, we do understand that insulin resistance causes these other metabolic syndromes. And I love how you explain it in your book. Which is very much you know, understandable by anyone. It's not complicated. It's not complicated at all. It's just simple, you know, when you eat something, it raises your blood sugar, insulin resistance, insulin comes up converts to glycogen. And if you are always, if your blood sugar is always elevated, that creates a problem, right? And your, your body starts to become insulin resistant. If you bombard yourself with glucose all the time, and which is such a problem with our, the standard American diet, right? 50 percent of your diet has to come from carbohydrates. You talked about the debate about cholesterol. I want to talk to you about that. You know, one of the most deadliest disease in North America is You know, heart disease, right? And a huge debate about cholesterol. And you know, we don't need to get too much into detail about this, but I just want to shed some light on the real cause of heart disease or atherosclerosis or the buildup of plaque. What, what is it and what causes Really causes arterial blockage and what is the role of cholesterol in all of this

Dr. Paul: 16:52

So, you know, cholesterol got a billing early on as being the reason for heart disease. Here in the States, it was, you know, Dwight D. Eisenhower got heart disease, and Ancel Keys, along with the U. S. Department of Agriculture. Decided the reason for that was high fat, a lot of bad science going on back then. Um, and so, you know, the pharmaceutical industry joined in because statins became popular. Now the most prescribed medications, I think at some point to be replaced by the GLP one medications, which we'll get into. Um, and so there's this huge emphasis on cholesterol, as you know, only 20%. of cholesterol levels are, are influenced by diet. The rest of the cholesterol in your body is manufactured in the liver. And having a high cholesterol or an LDL in and of itself without knowing your subunits, I don't want to get too wonky here uh, doesn't mean a lot. And practice, what I have sorted out is that the, what you asked about was the inflammatory process that leads to all these diseases that I saw the acute culmination of in the emergency department, I think is due much more to high blood sugar. Um, than it is to cholesterol. Now, not, you know, I don't ignore cholesterol. If I have a patient that has a high cholesterol, significantly elevated cholesterol, I'll send them to a lipidologist to get their subfractions done. You know, but you can have, you know, an LDL component, again, without getting too wonky, where it, you know, your subfractions are such that it's really not an issue at all. Um, so we focus much more sugar because I think it is the much bigger, bigger issue. Related to vascular inflammation and the potential onset of all these diseases than high cholesterol is.

Lorenz: 18:42

So if we just manage our blood sugar, we can reverse heart disease. Is that fair to say? Yep.

Dr. Paul: 18:52

at this and, and you know, the, the, the um, the, the big used for this, which I work on patients in my practice is the calcium scoring CAT scans. So some of that disease is reversible. I'm not going to tell you that all of it is reversible. There's no question though, by lowering your blood sugar, you can inhibit progression of that disease. Um, so, you know, there, there is of reverse about reversibility. I would say it's not complete if you have significant plaque buildup. Um, but you certainly can inhibit

Lorenz: 19:30

Awesome. I love it. I love it. In your book the use of CGM and this is key to understanding our metabolic health and reversing metabolic syndrome, you know, the CGM will not only address weight loss, but also other range of metabolic issues since they are tied to insulin, right? A powerful tool for sure. I love the concept of CGM since the individual. Right. The patient is empowered by real time information. You talk about this in your book where it's you know, you, you get the result the same day, right. Making, making what you're doing, you know, giving you sort of a motivation to keep going, right. Cause you're seeing results right away. And you make the decision based on the results, which can be done in real time. Right. So. I want to get to CJM right now. Could you share more about how managing our blood glucose closely with CJM? How is that done properly and what's the proper use of the tool? So,

Dr. Paul: 20:32

So, um, these devices were originally made diabetics to help dose their insulin. I think they have exceptional utility. Um, as actually tool to some degree with people. So I prescribe them in pre diabetics and non diabetics. You can have a doc, primary care doc, in their offices talking to their patient about their blood sugar for years, but then when they see those graphs on their CGM and they understand how their diet spikes, their blood sugar is causing potentially all these vascular issues or, or even just. Simple issues like, you know, decreased mental clarity with the variable that you see in the curves or zapping their energy they understand. So that's a teachable moment. How I use the devices is, and again, my patient population I understand kind of self selects. They're overweight, metabolic syndrome patients, that's why they come to me. And one of the things we do is we put a CGM on them for the first couple weeks and we say, don't change your diet. Okay, let's just see where you live in terms of your CGM patterns. Um, so we put this device get to see their blood glucose is 24 7. I get to see, you know, I see many patients that say, I'm just here to lose weight um, but they're spiking into the pre diabetic not infrequently, above 180 milligrams per deciliter. Some are spiking to 225.

Lorenz: 22:00

225

Dr. Paul: 22:01

Uh, and are diabetic and they don't even know that. And once they see those curves on their graphs, in the words of my patients, is you can't unsee that. You now know what a donut does to you. Or you know what that candy bar does to you. Or even that baked potato does to you. Um, and so it's a teachable moment. And you know, I mentioned that one young gentleman whose life turned around in terms of his health. Part of that was just seeing that data on the graph for the first time. And it's an ah, excuse me. It's an aha moment. Um, a light bulb goes off and people understand it. Once they see that they can't unsee it and it can change their lives forever.

Lorenz: 22:45

Yeah. Definitely. I can see how, like when it, like somebody who doesn't know anything about metabolic health and they see the results in a monitor or in their phone, it is somehow empowering for some, for somebody. Right. And it's much. It's now much easier for the practitioner to really point out what's really going on within their body, right? For them to understand, okay, you said baked potato, like, you're probably, the patient probably doesn't know what spikes their insulin or spikes their blood sugar before they started. And that's. I can see that I can see how that can be a teachable moment for a lot of people. And because a lot of people really doesn't know what converts into blood glucose, right? What, what foods converts to blood glucose and most of it will be a shocker for them. Right? So, for, for some people really fruits, they is one of the biggest ones out there. That is. a health food considered as a health food, but then it does raise your blood sugar and will raise your insulin levels. And if consumed on a daily basis can really, can really impact your health in a, in a, in a bad way. So, insulin spikes when we eat carbohydrate, you said. In your book, the higher the insulin, the higher the fat storage, which leads to a cascade of events, right? Our dietary choices, especially carbohydrates, the macronutrients that, you know, which raises our blood sugar the most, right? Clearly managing it will help insulin levels consequently with our weight. What does it mean for people, for anyone who wants to reverse insulin resistance, or also for those people who just want to manage their blood sugar? That they don't Accumulate fat around the waist for first, for example, what is the most appropriate amount of carbohydrates for somebody starting off? You're really

Dr. Paul: 24:58

Okay. That's a little bit of a loaded question, but I, I, I agree with you completely. So it really depends upon the patient. I know you're an advocate, advocate of um, keto diet. So my patients, again, you know, I have patients that are come in, come into me and they're eating 350 or 400 grams of carbs a day. You know, they've never really understood this. I do think that to lower it gradually um, is just painful. You know, it's we'll try and get to 200 and then we'll try and get to 150. And so I don't do that, but I usually do start people, you know, which, you know, from your perspective is probably going to be pretty liberal, high number. I usually start people in the 50 range, 50 grams a day. I find it's easier, even if they've been eating 300 grams a day, it's easier just to rip the bandaid off and get there because a gradual reduction over a period of months, they don't see the results from it. So we usually go to 50, sometimes I'll allow 75. Um, and then we, you know, we'll use the CGM diagnostically initially in that first two weeks along with fasting insulin levels, which we might want to talk about um, and, and then I will lower 35, 50 to 35. If they want to go keto, less than 20 um, or even less. I support but most of my patients want to be in the low carb range. And then we couple that with the other things that fight insulin resistance, which is intermittent fasting, of course. Um, and then another big one, is, you know, been, have been taught that they need to go to the gym and get on the elliptical and, you know, burn a lot of calories. I'm not a calories in calories out model. I'm an insulin resistance model person related to weight loss with low carb or keto. You can always eat something, but the emphasis also has to be less on cardiovascular. And more on strength training. So the reason strength training is important is because you increase the quality and the receptivity of the insulin receptors on your muscles when they soak up more insulin and soak up more blood glucose, and that also helps reverse your insulin resistance. So that basically is the program, low carb or keto. Um, intermittent fasting and then strength

Lorenz: 27:17

So let's talk a little bit about that, about fasting what sort of fasting regimen do you start them with, and and then how does that help with reversing insulin resistance?

Dr. Paul: 27:29

So, um, intermittent fasting is the most other than low carb or keto diet and reversing insulin resistance. So it really needs to be a part of the program. And just like with the gram counts, the uh, carbohydrate gram counts for patients, um, I, I individualize that. somebody Unfortunately, we've been taught, Oh, you need to eat every four hours. If you don't eat every four hours, it's a problem. We've been taught that by the food industry. Um, so, uh, I, if you is used to eating before they go to bed at 9 PM and then they get up at 6 AM and they're eating again, and that's nine hours, I say. Let's go to 11 hours. Okay, then let's go to 12 hours. Then, you know, after you accommodate to that, let's go to 14 Let's go to 16. Let's look at OMAD one meal a day. Um, I usually Recommend level 14 16 hours or you know about 20 hours one meal a day Um, uh, some of my patients want to not opposed to 24 or 36 hour fast once in a while, if you want to do that. But most of my patients are generally uh, 14 to 16 hours a Um, intermittent fasting.

Lorenz: 28:43

you want to, yeah. But most of my patients are general with multiple sclerosis nowadays. So, traditional doctor comes to say, Hey, okay, your, your numbers are off the charts. You have to lose weight. And then you do that by eating less exercise more. Okay. So, patient does that. They don't see results after a week. They're not losing weight.

Dr. Paul: 29:16

Yeah.

Lorenz: 29:17

They're discouraged. They don't know what to do. They just ate like salad for seven straight days and didn't see result. I see now how a CGM can really boost someone's confidence and really validate what they're doing in a moment. Like this is instant. When you, you can check your CGM after a couple hours of eating and you see low numbers, you're like, this is working. Right. I love what's going, I love what's happening and I'm gonna keep doing this. Right. And

Dr. Paul: 29:50

It's, it's motivational when you can see your results on the graphs, you know, see, see how you lowered your numbers, see how you even those spikes out. It can be very motivational.

Lorenz: 30:03

Mm. You talk about you use this as well ICGM. Why should CGMs be used by non-diabetics in

Dr. Paul: 30:10

Yeah, so, you know, there's a little, there has been some controversy about that in the past. I mean, I guess I would say, why would you not want to use a CGM in a non diabetic? Why do you want to wait until they have diabetes before you use this teachable tool and reverse their pathological processes? You know, when you can catch somebody early, Reverse their pre diabetes so they never go on to diabetes, you know, 30 percent of U. S. adults are pre diabetic, half of them don't know that. Why would you not want to capture that, that patient population and redirect their course of their life in terms of all these comorbidities, the hypertension, the high cholesterol, the diseases that go along with that. It makes really the argument. I think that CGM should be reserved for diabetics. I think doesn't make any sense. It's like, let's wait till the problem exists before we treat it. No, let's get out in front of the problem and prevent it.

Lorenz: 31:10

till the problem exists before we bring it in. No, let's get out in front of the problem. And you talked about fasting insulin levels. Why is fasting insulin levels so important to detecting insulin resistance too? You

Dr. Paul: 31:38

yeah, you can get a handle on your risk for progressive disease high blood sugar by checking a fasting insulin level early on. So, you know, I believe fasting insulin levels for most people are more important than cholesterol levels. I know that that's. That's a radical statement, but especially if you're overweight, especially if you have a family history of diabetes, you can develop insulin resistance years before you ever have that fasting blood glucose over 100 or A1C over 5. 7 indicating you're pre diabetic. And I do fasting, excuse me, fasting insulin levels in all my patients and the physiology is. this is that if your insulin is up, it should be forcing your blood glucose down because it's forcing uh, those blood glucose molecules into the like we talked about previously. Um, but if your blood glucose isn't then that means the pancreas keeps pushing out insulin, more and more insulin, trying to force that blood glucose into the organ. The organs don't get the message, and so the insulin level just keeps rising. So if you have a high insulin level in the face of a blood sugar that's not really low, then you have insulin resistance. And I mention in the book, again, I don't want to get too detailed here, but there's a calculation where you can plug in those two numbers, the fasting insulin level and the fasting blood glucose, into a formula that gives your exact level of insulin resistance. The acronym for the test is called AHOMA IR. homeostatic model of insulin resistance and a HOMA IR with a simultaneous fasting blood sugar and insulin level tells you your exact level of insulin resistance and it's gonna tell you if now is the time to act in terms of avoiding any of these problems down the road.

Lorenz: 33:28

I'm telling you guys, if this, this book is the last book that you ever read last health book that you ever read, because it just starts from your story and then why CJM is helping a lot of people reverse chronic diseases and why this is life changing for a lot of people. And you go to in depth information about metabolic health. Why metabolic syndrome happens, what's the causes and root causes of them. I want to confess though about medications, you know, I am somebody who is very much opposed to any medication for weight loss, and certainly type 2 diabetes. And I believe it can be done through lifestyle, right? And if If you're somebody who can work with a practitioner about changing your lifestyle, great, that's a route I advocate for. But talk about GLP 1, GLP 1, you know, I am open to listening about it. And I believe that, you know, in some acute cases, definitely medication has uses, right? Or if someone is Opposed to lifestyle changes and at least they have an option, right? So what is it exactly? And then why is there a need for these drugs? And then who is it for exactly?

Dr. Paul: 34:58

question. Um, and first of all, you know, by way of I have done for many years is what we have talked about so far without medications. Okay. And I am, I'm seeing myself as a little bit of an outlier now in the metabolic health community related to the use of these medications. But this is the perspective I'm coming from. The genie is out of the bottle. With the GLP one medications and there is craziness going on out there related to people going to medical spas and on the internet and just getting these GLP one medications. We're talking about Ozambic, Wigovy, Monjoro, Zep Bound, generic names, Terzipatide.

Lorenz: 35:42

talking about is that they grow,

Dr. Paul: 35:43

Uh, and semaglutide. And this is my belief, and it's a pragmatic, it's just a pragmatic approach to this. That, that people are going to use these medicines. Um, and there's nothing that we about people not pursuing these medications. So, I am trying to capture, at times when appropriate, I use this, use these in a minority of my patients. But I would rather have them coming to somebody. that is talking about low carb and keto and intermittent fasting and strength training rather than spending 10 minutes on the internet, you know, once every six months with somebody just giving them the medicine and saying, good luck. So I realized that the, you know, a lot of metabolic health practitioners are against the use of these medicines. I'm taking what I feel is a pragmatic approach, which is in a certain limited number of situations, it's better for me to work with people on that. Then. For them to be out there in this landscape of medicine being prescribed without proper consideration or a proper program. So this is how I use the medicine in a different way than most providers. We use very limited doses. I never get to the high doses. I stay in the low dose range and we use it for limited periods of time. The phrase I use with my patients is begin with the end in mind. These medications have side effects. These medications cause muscle wasting. So you got to be strength training. These medications cause weight gain when you go off them. So what's the plan here? You know, you're, you're 33 years old. Do you want me? To start, you want a medicine that you're going to be prescribed for the rest of your life you're going to be dependent on for the rest of your life or else you're going to gain weight, and it might not be physical dependence, but it's certainly psychological dependence, and so we talk about you are not going to use these medicines without doing these other things. Um, if that happens, I'm going to cut you off, and we're going to use the medicines prudently in a time at low doses in a time period. That is measured in months, not years, with a plan to do the lifestyle changes that will allow you to age in a healthy manner.

Lorenz: 38:05

and heal. and

Dr. Paul: 38:06

that, that, that, that's my perspective on this. I know some docs are thinking, you know, these should not be used in, in, in this way. You know, I have patients that have done everything they can do and then they hit a plateau and they still need to lose 30 pounds. So, you know, dipping your toe in the water or using low doses of medications I think is, is a reasonable consideration at times.

Lorenz: 38:32

That's pretty good. That's really good because when people, people, you said, you said it yourself, people will. You can't stop people from pursuing these medications and it is better for them to go to somebody who will educate them and tell them the prognosis, the right prognosis, and tell them the truth about the side effects, potential side effects of these medications and just giving them options, right? If they come to you, they just, they have options of understanding what the cause of these medications can be down the line. And you clearly have foundation, foundations in place for people to come off it. My, my question is, so what, what does the medication actually do to help with metabolic syndromes?

Dr. Paul: 39:32

So, so, uh, GLP 1s have, um, three mechanisms of action The first is they slow gastric emptying. That's a fancy way of they keep your stomach fuller longer. You feel fuller sooner. Um, because the valve between the stomach intestines, the pyloric valve tightens down a little bit, so you're going to be fuller for a longer period of time. The second mechanism of action is what we've already talked about today, which is they lower blood sugar. Um, they're good medicines. You know, they were medicines for weight loss because they lower blood sugar, but they don't cause hypoglycemia with any reasonable frequency. They don't cause low blood sugar. They keep blood sugar in a lower but more stable range. And then the third mechanism of action is they have a direct effect on the brain, the hypothalamus in the brain, which is the hunger center. Um, so they suppress hunger directly

Lorenz: 40:26

Okay. Okay. I see, I can see how it, it may affect somebody's appetite. It's an appetite suppressor.

Dr. Paul: 40:34

Yeah. Yeah. It, it affects the hypothalamus directly causing appetite suppression.

Lorenz: 40:42

Okay. So for individuals who might be considering this for weight loss how is the medication typically taken and what should they expect in terms of like, you know, you talked about dosing a little bit, but I want to, I want you to expand on it. And. Potential side effects for them. Mm hmm.

Dr. Paul: 41:02

Well, let's talk about side effects first. There's a laundry list of side effects. Um, again, using lower doses, I as much of that. I do see patients that have some nausea with it. Um, but I haven't had any other patients that have other significant problem. Um, you know, you will read about other problems, problems, pancreatitis. You know, I think there is a dose dependent relationship there. So again, if you can keep the doses low, you can avoid a lot of those side effects. And I think that's why um, I've had a, uh, had a with them. Um, the dose is a low dose. So what that means is there's a once weekly injection. You start at a low dose, you take it for a month, same dose for a month. And then you bump the dose up a little bit. You might get some nausea um, the first couple of weeks of those first two but then your body accommodates and you generally don't have any side effects. And then you bump it up again. If you go to the high doses, you're bumping it up six times. I usually bump it up two or three times in my patients uh, before we stabilize there for a while start coming back down. Um, and, and again, um, prepare for both loss and muscle mass related to macronutrients. Uh, I just, it's like, let's keep your cars this amount. Let's make sure you get your protein because of the muscle wasting issue on these medications. Strength training and adequate protein is huge. So you got to make sure you're getting your protein. And then I don't really focus on fat. It's like, I don't care that much about their macros with fat. Just kind of like, I don't care that much about their calories. Now we have a discussion about good fats and bad fats. So we go through all of that. Um, but it's like, keep your carbs low, medicines. Make sure you're getting your protein and make sure you're doing your strength

Lorenz: 42:46

get your

Dr. Paul: 42:47

so basically the dosing is an escalating dose and then back down.

Lorenz: 42:52

basically the dosing is right, and that's the way he does it, and that's how he does it. Yeah, for me, for me, if

Dr. Paul: 43:03

for me, for me, if you're going on medicine, it's required. Okay, I'm not going to give you medicine unless there's some kind of coherent plan. And I am not an energy balance. Uh, uh, I don't believe in the energy losing weight. Um, you know, calories in calories out. Um, I, you can't outrun your fork. saying goes um, so yeah, yeah. If you come going to be doing low carb and we're going to be focusing on getting adequate protein as well. And again, my low carbs usually about 50 grams or less. It can go lower

Lorenz: 43:38

So I want to ask you, Dr. Paul, is this for someone who might be carbohydrate dependent? What sort of patients do you see that would be helped with this protocol here?

Dr. Paul: 43:55

with, with uh, are you talking specifically about the medication, integrating the medications? Yeah. So I use it in two situations. One, if somebody has had recurrent attempts to lose weight and not been successful. And they really feel they need a jumpstart understanding that this, that you are not going to get the medicine without doing the other things that I'm asking you to do. Um, and that it's going to be used for a period of time at low doses. And the other one is just the kind of the one I alluded to. Somebody that's doing everything right. low carb, high protein, strength training, intermittent fasting, and they still got a ways to go. They've got 30 or 40 pounds to go, and they just have hit a stall. So those are usually the two kind of instances that I'll use these medications in. But again, Lorenz, I want to emphasize, it's a minority of patients. You know, one of the issues here um, which I think everybody is aware cost of these medications. Um, if if you do not have coverage only a minority of people have coverage for. Um, that would go these in the ZEP then it's prohibitively expensive. Um, and I, I do use compounded semaglutide. Compounded semaglutide is not FDA approved um, but I, it's, it's created licensed. Uh, state pharmacies limited doses of that prudently to achieve these ends again for temporary period of times. But the, the compounded medicine, you know, the, the, the brand name medicines are, you know, can be, you know, 1, 200 a month out of pocket. Nobody can afford that. You can cut that cost um, by more than two thirds a lot of times compounded medications.

Lorenz: 45:43

two thirds a lifetime. I've I'm warming up to the idea of having these medications because as you said, these are for people who have tried to lose weight and couldn't and needed some assistance, right? And for somebody who who are actually weight training, these are people who are trying their best to lose weight and cannot lose weight. And I see the use for, for, of medicine in that, in those scenarios. So I actually warming up to the idea of medication in that regard, because certainly there is nuance, right? A lot of people were, we're all different. We're all built different. We have a different conditioning. That's why, you know, lifestyle change may be a simple change, but certainly not an easy change. And I certainly had this, this has certainly has a use for it. And then clearly there's a protocol if they go through your clinic and it's a lot more safer if somebody is walking you through it, explaining the differences between, you know, these medications and what they can do to, you know, maybe start with medication and then and then with a mindset of, you know, changing your lifestyle eventually, right? So, warming up to the idea for sure.

Dr. Paul: 47:10

You know, uh, unfortunately, and unfortunately, I, I, I make the, make this like a good evil thing, but you, you know, using them by just getting a shot, you know, and not doing anything else is the, it, it's wrong. It's, it's just wrong and, you know. And um, I, you know, I have acquiesced to using these in limited amounts in order to get, you know, in a good fight to get people going down the right path as opposed to, to going down that path where they started medicine, where they're now committed to life or after a while they can't afford it. Where their insurance plan changes and now they're off it and the weight regain is occurring. So, you know, I, I do think even though you, you know, in a real world, you know, this gets down to an ethical argument, you know, is it diet and exercise? Is it just good old fashioned discipline or are you going to use this medicine like a crutch? Well, even crutches. Uh, you know, if you sprain your ankle or are meant to be used temporarily. So, you know, let's talk about temporary use and tell you've addressed the problem. Your ankle gets better or, you know, you're getting close to where you want to be and then you can fall back on your own strength, which is your diet and lifestyle issues.

Lorenz: 48:31

I love that. Thank you for clarifying that, you know, I am all for everybody to optimizing their health. And if somebody is in need of support, then this is the path you take. And like you said, with, with the mindset of eventually getting to lifestyle change, right? So we, we, which is, you know, thank you for clarifying that for sure. That's, that's, that's a, Well, I want to, I want to get you to talking about success, like, let's talk about transformation here. Any, anything that stands out to you with, you know, a patient that maybe has taken medication and then finally losing it, losing the weight and now on and off medication or any story that you may have that, you know, Has caught your attention and really it has changed your life completely was,

Dr. Paul: 49:27

Yeah. Yeah. I'm going to go back to a person I mentioned in the book um, which was a lady in fifties. Her daughter lived with her along with her grandson that was three years old. Her daughter had to work um, four days a week. And so had to care for the grandson during those days. She was about 70 pounds overweight to begin with. And, and she was having difficulty uh, performing her job, manager for a dental practice. And she was having great difficulty caring for her grandson when her daughter had to go to work. Um, and she was quite honestly, just kind herself. I want to help my family. Um, and I just. Can't do fatigued. Um, so we got her going on, uh, the basic program after that she had insulin resistance, assessing for the first time she wasn't aware that she was pre diabetic. So we got her going with a low carb diet um, uh, intermittent fasting I'll tell you, I don't know if I mentioned this in the book, but it's like she came to me one day and she said she was brushing her hair in the mirror after we had bumped her protein. And we got her strength training and she's brushing her hair in the mirror and she noticed for the first time she had a bicep. First time in her life she ever noticed she had a bicep. Um, and then she went on, she after about 35 pounds. We used the medicine really just for about 5 or 6 months in her. She dropped another. 25 pounds um, felt a world better often happens when you lower blood glucose and you've ridded people of these fluctuations. You know, her mental clarity was better. Her energy was better. She looked forward to watching her grandson and taking him to the park. Um, as opposed to not having and quite honestly kind of dreading that responsibility when her daughter was at work. And so her life was changed. And you know that, that's, that is really what it's all about. Allowing people to live a healthy life and feel, feel, feel fulfilled. You know, whatever that is for you, being able to do certain workouts, being able to do your job. Well, being able to be a good member of your family and meet your responsibilities. That's what this is all about. And that's what I'm why I'm passionate about this. Yeah. You know, I was coming to the end of my emergency medicine career. Um, and I found a new passion here few years. Um, and you know, again, the last the book is CGMs change lives. Um, and a metabolic health program can help somebody change their life. Whether they're that 19 year old that needs to be redirected or an older person that is now going to be healthy going into old age.

Lorenz: 52:21

know, the best part about this is helps so many people with just a simple tool, a CGM monitor helps so many people, right? And it gives a lot of people hope that, you know, these diseases that are known to be a chronic disease and you're known to be on medications. For the rest of your life can be reversed. These are diseases that can be reversed and that's a beautiful story that, from somebody who is limited by a lot of things because of their weight is now able to. You know, go with their grandson, right? And, and, you know, live live a healthy life. You know, every, everyone deserves to live that way. It's a beautiful story. Dr. Paul, I appreciate your time coming on and sharing your story with us today. Any, anything that we missed here that you want to address Dr. Paul before we end

Dr. Paul: 53:26

Now, if I could just make a plug for the book, it's on Amazon. You can just Google my name on Amazon or the Continuous Glucose Monitor Revolution. Um, and then, uh, licensed, uh, now is via telemedicine. become so easy, even for my patients in Ohio where I'm located, but I'm licensed in Ohio, Indiana, Florida, and Arizona. So if there's anybody watching that um, or, or knows that interested in learning more, About my practice or know somebody that we can help and please be in touch. Um, metabolic MDs, mds. com. And I'm sure you'll post all my social media handles when you post the podcast.

Lorenz: 54:08

Absolutely. Get the book guys, Continuous Glucose Monitor Revolution. It's in Amazon and every, all the links to connect to Dr. Paul Kolodziejk will be down in the description box below guys. So check that, check it out. If you're interested. Reach out, there is hope out there, guys. Thank you, Dr. Paul, for sharing your story once again with us today. I really appreciate you, man. It's an honor to, to really be in your presence today and just a beautiful story that you shared with us. Thank you for what you're doing and I really appreciate you and your, and the work that you're doing, sir. So thank you so much.

Dr. Paul: 54:47

Yeah, it's been a pleasure. And I want to come back at you with that. You're out there spreading the word, the, the, the metabolic health story. So thank you for all the work you do as well. Lorenz.

Lorenz: 54:58

Thank you so much. I really

Dr. Paul: 55:00

All right.

Lorenz: 55:01

All right. bye. Bye.

55:01

Thank you for joining me for another episode of the ketones and coffee podcast with Dr. Paul As we discussed the role of continuous glucose monitor in our metabolic health. I have provided links to Dr. Polk Hologic. Logic's work and he's socialist. Please see the show notes, captions below. If you're learning from or enjoying the podcast, please subscribe to wherever you listen to your podcasts. Which is a zero cost way to support the podcast. And you can also leave us up to five star reviews on Spotify and apple. If you have questions, please reach out to me on Instagram or our website at. lawrence.com.