The Chain Effect Podcast

CGM Part 3 - Digging Deeper!

• Chain Effect

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In this episode we continue our fascination with the Continuous Glucose Monitor, and reveal new ways we are looking at the data. We also explain some of the conundrums we are most often confronted with when discussing CGMs with our patients.  

SPEAKER_03:

Welcome to the Chain of Facts Podcast, where a physical therapist and a dietitian married with two kids juggle the struggle of running a business, raising a family, and prioritizing our own health all while trying to have as much fun as possible.

SPEAKER_01:

We're your host, Taylor Pope, Doctor of Physical Therapy, and Caroline Pope, Registered Dietician. Together we own and operate a health facility bringing together physical therapists, dietitians, personal trainers, and active recovery services to create what we call the chain.

SPEAKER_03:

Chain effect. So it has been a little over a year since we first released our two-part series about CGMs.

SPEAKER_01:

And we're back.

SPEAKER_03:

And we're back with more. Because you've probably, at this point, you've probably seen people wearing the CGMs on their arm. You know, there's the over-the-counter ones are advertised. One of them is even starting to being sold on Amazon. Uh depending on what, if you live in more health conscious cities or different parts of the country, you might see it more regularly. But still people ask us, like, what is on your arm? Yeah.

SPEAKER_01:

You know, do you have the diabetes?

SPEAKER_03:

Yeah, they're like, what is that? You know. So you it might be more common around you, maybe not. Um, but we, you know, last summer they came out with the over-the-counter version versions, and we've been experimenting for much longer than that, about a year and a half now.

SPEAKER_01:

We've tried them both. We've tried the lingo, which is the Abbott variety, we've tried the Stello, which is the Dexcom. You know, they both have their pluses and minuses. Um, right now, I'd say the app on Lingo is much better, although it's not great because you can't really share it with your health provider, right? Recurrently. And then um with Stello, you can share that data, but the app is it's just not quite a bit of a lot of different things.

SPEAKER_03:

I imagine they're gonna be gonna keep improving different versions more and more and more. But since the release of this last, the last podcast we made, we have had even more and more insights, yeah. Insights and more clients using them because they are over the counter. We don't have to go through insurance or your doctor getting a script. And we have heard and seen firsthand so many benefits of CGMs.

SPEAKER_01:

And we've also been scouring the research, right? We've been searching out all the books on on this topic, and we've found some really interesting information, and just the more we learn about particularly insulin sensitivity and insulin resistance, the more we learn that insulin sensitivity might just be the holy grail. Getting your body to be as insulin sensitive as possible could help you attain your ideal weight and main and maintain it, attain and maintain. Right. It can help you avoid the four horsemen of chronic disease and slow death, which we're gonna talk about. And it just gives you that metabolic flexibility to be able to enjoy certain foods and even enjoy like a carb-heavy meal and not have the same like response that you would have if you're insulin resistant.

SPEAKER_03:

Yeah, right, and feel better doing things and and you know, I would say, I would dare to say reduce cravings as well. Because if you start eating to increase this insulin sensitivity, you get more insulin sensitive, you're not craving as much, you're getting more of the foods that we need. And so this really is the holy grail, like you said, especially in our country, but all over. Um, and especially when you get to you know 30s, 40s, 50s, where things just aren't working like you want them, or as quickly. And the biggest thing I tell my patients is it is all about subjectivity. It is subjective to your body. It is not track this, and these are your macros, and this should work. For some people, it works when you hit a certain age and there's hormones involved, or metabolism is slowing down, or whatever it is, maybe you're not, you know, exercising the same, it just things don't work as quickly. And you also need to see what is working for your body because there's so many factors involved in how you process foods, what your body is doing, how much muscle mass you have, which we'll talk about, all these things are super important. So, why don't you get into the four horsemen of slow death and explain that a little bit?

SPEAKER_01:

Yeah. So the four horsemen of slow death, I think I don't know who actually coined the term, but I'm giving credit to Peter Atia because that's where I first heard about it in his book, Outlive. Um but the four horsemen of slow death are you know cardiovascular disease, uh neurodegenerate decline, neurodegenerative decline, cancer, and type 2 diabetes or metabolic dysfunction. And the idea is that those are the chronic diseases that are most plaguing you know aging adults and are shortening our health span. And so we've gotten really good at managing these diseases through medication, maybe some lifestyle interventions, but particularly through uh medications and managing, and when I say managing, I'm saying keeping people alive, right, and getting a band-aid on giving them stuff to like help the symptoms. But we are not as a society thinking about how do we prevent these. We're not it's not commonplace for the medical community to be hyper-focused on the upstream goal of preventing these diseases from happening in the first place. And the sad truth is that the and Peter Tia calls it the the last decade or like the marginal decade where you're alive, but you're not enjoying your life to the fullest. You're not engaging with your community, you might have disability that's preventing you from getting outside, engaging with family members, you might have tons of doctor appointments all the time, and you just don't feel good. And we all sort of imagine ourselves, you know, oh, in my 80s, like I'm I'm gonna still surf. I'm gonna be, you know, traveling the world.

SPEAKER_03:

Do people say that? You do.

SPEAKER_01:

I don't know if people think they're gonna be surfing, thinking about like, you know, still trying to hit the track when I'm 70 and you know, beating our kids. But yeah, you know, I think that a lot of people, you know, you sort of have this image of retirement, and it's for most people, it's not, well, I'm gonna be like shuffling from doctor's appointment to doctor's appointment, you know, worried about falling down and you know, taking 20 medications a day.

SPEAKER_03:

Right. It's like, are we are we working ourselves into the ground to retire like that? Or should we also, alongside our work, like our career, our job, sustain, you know, making money for ourselves, shouldn't we also be working to have a healthy retirement? And the the less talked about diseases that you know is the neurodegenerative decline is like Alzheimer's and dementia, right? Which is very debilitating and one of the leading causes of of death in like females in certain countries. I was just reading. Um, but even that before CGMs were over the counter, a lot of uh it's not a it's a more informal term, but a lot of the functional medicine doctors and and researchers were talking about type three diabetes being the link between uh insulin resistance and Alzheimer's or like diabetes of the brain.

SPEAKER_01:

Yeah. And the and the thing about all four of these conditions is they all have a direct link to insulin resistance. So much so that it is starting to be pondered as is that the cause of all of these chronic diseases? And your body is just sort of picking between one of them. And a lot of you know, a lot of people have both. You know, you're gonna have you have nerge neurodegenerative decline and you or you have Alzheimer's and you also have cardiovascular problems too, you know, and so and I and I love that because it's that metabolic dysfunction. Right, right. And I love that analogy. Um, and this was also an outlive, but he talked about you know dysfunction starts at the cellular level, and that happens in midlife, you know, 30s, 40s.

SPEAKER_03:

Yeah, you may not be thinking about it.

SPEAKER_01:

Yeah, you may not be thinking about it because you may be just cruising through life and you're feeling healthy and and vibrant, and metabolic dysfunction, you can't tell from an outside, you know, you can't tell from the outside if someone has that. So, you know, you may be overweight, you may have a lot of visceral fat, and that's more obvious that you have that metabolic dysfunction, but you may be thin and you may be very insulin resistant.

SPEAKER_03:

And your labs may not show it. Your standard panel of labs may not show that insulin resistance, which I'm finding in some of my clients until later, but a CGM can reveal those trends.

SPEAKER_01:

But I uh again, going back to that, you know, the dysfunction starts at the cell and then continues to the tissue, and then from the tissue continues to the organ, and then from the organ continues to the system, and then our body will start to show these outwardly problems, these systemic changes. And that's frankly when a lot of the medical community will start to pick up or start to treat these problems, is when you hit a certain A1C, when you hit a certain fasting uh blood glucose, but not before. You know, and that's the most frustrating thing is like the damage has been done for years.

SPEAKER_03:

And what we're finding in research is A1C, which is typically like a three-month average of your blood sugar. That's a typical, that's in a typical annual PCP visit lab um panel, it's it's not always indicative of like it's it's it could be lower uh than let's say pre-diabetic range or diabetic range with someone, and then you slap a CGM on and you say that their levels are all over the place and their average, which we talk about like an estimated average, is much higher than it should be. And so we're finding in our research, A1C may not be the best, you know, there's there's a full panel you could do related to blood glucose alone that we wish would be done, and maybe in the future it will be covered by insurance and kind of the standard. Um, but if you have you so if if your A1C is less than 5.7, then it's like you're not necessarily in the clear.

SPEAKER_01:

Yeah. And you know, the crazy thing too is like I've read where A1C can be artificially high, especially in people that eat a lot of red meat, because the blood cell like lives longer, and so it collects more of these antibodies on each blood cell that is the actual measurement of A1C.

SPEAKER_03:

So, like there's definitely factors or a period where you yeah, I mean A1C, and just to go back to the definition of that, what that actually is is um the portion of hemoglobin proteins that are glycated. So that means like holding onto that glucose. Um, so that so in that three-month period, it's kind of just a measurement, like they usually live about three months. So, how much glucose is held onto that hemoglobin protein? So there could be influence from lots of things, right? And someone's blood might be a little bit more glycated than another naturally, or the sample might be a little, you know, so there's a lot of different factors. Um, so that's why it's not always the best indicator, or you could think it's normal, and then like we said, you're seeing your day-to-day, every minute glucose levels and saying, oh, that's actually not very good range.

SPEAKER_01:

And so, yeah, I think, and I think that the the measures of A1C and fasting blood glucose, they don't really touch on the elephant in the room, which is what's going on with your insulin. And so, you know, a lot of the resources that we've been looking at talk about you need to get an insulin test at the same time that you get your fasting blood glucose test. And then you can do some, you know, some math and find where you're at on actually being insulin, insulin resistant. And and we'll talk about some of those more specific tests and like what you should be asking your PCP for in another episode. But for now, we're just gonna talk about some of the higher level things that we've been learning about CGMs and about um and how we've been using them in our life and answering some of those questions.

SPEAKER_03:

And to start off, we've realized that or we've seen firsthand that you can become more insulin sensitive.

SPEAKER_01:

Oh yeah.

SPEAKER_03:

Like our level, the more we do it, our levels are staying lower average, less spikes. And that's one of the big things, you know, we've we've come to realize. We kind of knew last year, but we've come to realize spiking and then that drop is a sign of normal insulin function. So that insulin hormone is being released, right? It's getting the glucose out of the bloodstream, which is healthy, that's important. It's storing it. But we don't want those spikes all the time. So you actually, if you see a sharp drop, that is a good sign that your insulin is working properly. If you see a little hump or you're eating a big carb meal, or you have a big glycemic load, which we'll talk about, and then it's slowly going down and you just ate, that may be a sign of some insulin resistance. Yeah. Where your cells are like, uh-uh, they're not responding to that insulin knocking on the door.

SPEAKER_01:

And it's taking it, yeah, it's just taking longer. So it's that time under curve. So the area under the curve, which is definitely a metric that they're talking about. Yeah, and that's so interesting too, is that you know, it really is the frequency of spikes because what we're really talking about is as being the problem. It's not glucose as being the problem, because but glucose is the driver of insulin release. So indirectly it's the problem. But the problem is really how much daily insulin is your body being exposed to. And so more frequent spikes up and down, and more frequent um elevations to your blood glucose is going to lead to more frequent um exposure to insulin. And it's just like any medication that you would take or you know, caffeine, the more you're exposed to insulin, the higher, um, the more you're exposed to insulin, the more resistant your body will become to that insulin. And so if we can decrease your body's exposure to insulin, you will naturally become more sensitive to it over time. And so the real goal is minimize the exposure to insulin throughout the day. And we're here to talk about some ways, some ways that we've been some ways that we've been doing that.

SPEAKER_03:

Yeah. So the idea is, you know, we want those rolling hills, which we talked about in the last two uh episodes about this. The rolling hill is what we want, or a flat line in your case. You've been really maintaining.

SPEAKER_01:

Okay, so going just going back, I put a CGM on for the first time this year in January. So right after the holidays, and I was spiking like crazy. It was all over the place. So it was looking like coming off the holidays. It was looking like a roller coaster at at um what's the what's the one in North Carolina? Carowins. I've never I've never actually been, but it was looking like a roller coaster at Bush Gardens, which I have been to, and you know, up and down, up and down. And I've done it continuously now for six months. And now it's like a sidewalk.

SPEAKER_03:

It's like uh, you know, yeah, a flat line.

SPEAKER_01:

Yeah.

SPEAKER_03:

But and that's and we'll talk uh towards the end about what you've been doing for that, but you know, the rolling hills or the flat line is good, but you also have to see where that lies on the graph. So it's also not good. Let's say you look at a chart, which I've seen, um, and you could see someone's levels are really not sharply increasing or dropping. It's rolling hills, like we talk about, but they're maintaining an average level in the 120s, 130s, 140s, and it's not really coming down even overnight.

SPEAKER_02:

Yeah.

SPEAKER_03:

That is a red flag.

SPEAKER_02:

Right.

SPEAKER_03:

Because your estimated average glucose level is high. And we want it closer to that fasting. We want your body to be able to go back to that fasting level, which ideally is under 100 when you wake up. Ideally, even a little bit lower. If you can push it down and get it below 90, that's even better. But under 100 when you're fasting, like when you go to the doctor and get your panel, fasting glucose, we want it under 100. So if you're not ever able to get there, um, and your your average, you know, 90% of the time is 120 or 125, that would indicate insulin resistance. Yeah. So those rolling hills need to be on that lower end.

SPEAKER_01:

Yeah. We want, yeah, you want to be, you want to be under 100, right? Or like at least at like at the high point, hovering around 100.

SPEAKER_03:

Yeah. And I know the apps and in all the research, it's like, you know, 90% of the time you want to be between 70 and 140. That's kind of the parameter they set. But a step below, like a step further, I've seen also seen 70 to 120, which is good. But really, 90% of the time, you should be a little bit lower than that.

SPEAKER_01:

And you can customize that range on most of the apps. In fact, the the Libre 3, which is the one I use, the the range is 70 to 180. Because it's because it's the it's meant for diabetics.

SPEAKER_03:

That was the prescription one.

SPEAKER_01:

But and and also too, like keep in mind like when you're using these CGMs, there is, you know, and they'll say this right on the website, there is a little bit of plus minus that you're looking at. So it can be 10 higher or 10 lower just based on that individual sensor. So what's best is to do it several times to really.

SPEAKER_03:

Just to get a fill with it, your body's doing. But how do we get a lower estimated average glucose level is less frequent spikes throughout the day. And so that you're not so that your average could be, you know, you're only throwing the average above 100, let's say, when you're eating. So if you're eating three times a day, two times a day, four times a day, but one time a day.

SPEAKER_01:

Oh mad.

SPEAKER_03:

That that uh that average level is gonna be lower. Now, what I found doing these is I'm at home. I'm always giving snacks to the kids. I'm, you know, taking a little handful of this here and there while I give them food, packing lunches, making breakfast, a little bit of this, a little bit of a few, a little bit of grazing, a little bit of that. I also get full more easily, so I think that's why I don't have big portions at meals. But what I found is I'm spiking, not big spikes, but little spikes throughout the day, but like eight to nine times a day. Right. And my body is not getting down below a hundred in between these meals. It doesn't have the chance. So that blood sugar doesn't have the chance to go down, and that's why you you know you want to look at your average levels and make sure they're they're on the lower side.

SPEAKER_01:

And that and that's a good time to kind of talk about fasting and talk about mini breaks or mini fasts. Conventional, like nutrition science, I would say, talks a lot about like getting your snack, like not letting your blood sugar. Well, managing blood sugar.

SPEAKER_03:

It's kind of an older school of thought about managing blood sugar, eating every three to four hours. Now, I will say you can still have a good diet and and probably really good insulin sensitivity if you eat four times a day. If your if your break between lunch and you know, your time between lunch and dinner is usually a lot longer. That afternoon snack can really help people if it's the right balance of fat and protein, you know, not a lot of carbs and definitely not um processed carbs, because some people that that backfires if they don't have that snack, and that's a lot around it too. You want to maintain your energy, you want to prevent huge crashes and prevent huge cravings where you're binging or overeating. Yeah, so that that's kind of that is still true, but I think there's a way to do it where maybe you have time restricted feeding or you you delay your breakfast a little bit, and then you don't have that morning snack, and then you have a lunch, and then you have a small, balanced afternoon snack, and then dinner if you want. But if you're not hungry and you're not having that crash because you're eating more fat and protein at meals, which we should be, and lots of produce and volumetric eating, maybe you don't need that snack and you feel fine. Right. And that would be a great place to get to for a lot of people.

SPEAKER_01:

And so the research shows that it takes several hours for insulin levels to come back down to baseline once there's been a big release. And so one of the things that we want to talk about is having those fat forward and or and even just like fat and protein type meals where you're really limiting the carbs and then you know, having carbs selectively and thinking about it for function, right? And that's one thing that I've really changed in my mindset was thinking about food function. Carbs are gonna give me that quick hit of energy. So before a workout, I'm not trying, I'm not trying to eat a bunch of fat. No, because I don't want that to sit on my stomach, right? And so I'm gonna have those carbs because when you are actively exercising, insulin levels retreat to the background. So insulin levels drop with active exercise, with active muscle contraction. And y'all, muscle is your best friend. Muscle is your best friend because it is one, while you're exercising, insulin levels drop and glucose is just being fed directly into the muscle. So the glucose in your blood is being fed directly into the muscle. Two, when you're not working out, still 80% of your blood glucose is going into your muscle, but it's going in there via insulin. Right. So the more muscle mass you have, the more that that blood glucose, the the food that you're having, the energy that you're you're having is being shuttled into your muscle and not into that long-term storage, you know, fat deposits.

SPEAKER_03:

So body composition definitely matters. And you know, we've talked about this. You have so much muscle, you're just so big with so much muscle that that's helping, you know, that's that's helping your cells be more insulin sensitive and your workouts, your your hard workouts, your frequent workouts. Um, but it is having carbs to fuel your workout. That's been a long time, you know, message by dietitians, performance dietitians, but we're seeing in real time, you can see with the CGM how it really helps. And now that you know, even if you see a spike when you're exercising, you know that that's from your muscle cells. Either stored glucose, glycogen is being released into the blood for energy, or if you eat a carb snack, it might go up initially, but you know that insulin is not being used and your body's using it in real time, which is really cool to see.

SPEAKER_01:

Yeah. And so then at night, when you're not about to work out, this is a time where you really shouldn't be hammering the carbs. You know, and that's the hardest thing for people because they're at the end of the day, carbs taste, you're tired, your willpower is down. Maybe you finally put the kids to bed and you're like, oh my gosh, just let me breathe for a second. And and you know, you're thinking, oh, let me get some popcorn, oh, let me get some snacks. But that will wreck your blood sugar, not just for the next couple hours. It's gonna wreck it all night.

SPEAKER_03:

And what we found, yeah, you can see that in your sleep.

SPEAKER_01:

Yeah. When my blood sugar is elevated at night, I will not sleep until I get back down to baseline. And then it's like, oh, when did I go to sleep? Oh, let me just check my CGM because boom, like when I finally got down to baseline again, that's when I started sleeping soundly.

SPEAKER_03:

Yeah, a lot of people I've seen a lot of people if they have a higher carb dinner or um like a snack, like ice cream or a carb snack before before bedtime, it's all over the place. Or there's some big spikes and drops later on, like a reactive hyperglycemia, like a few hours later, which is odd, like at midnight or one, two a.m. Often they're not sleeping as good, or they wake up with a little anxiety. And then your cravings, if you're not sleeping as well, it's two part, you're gonna crave more carbs. That is studied, that is evidence-based. Like when you don't sleep as well, you crave more carbs the next day. But you also having those like you know, dysregulated levels throughout the night, you could wake up and want carbs for breakfast.

SPEAKER_01:

And you haven't been fasting as long as you would otherwise, right? And so we're not allowing our our body to have that metabolic flexibility of switching between glucose-based fuel and ketone-based fuel, which the the sort of metabolic process of switching back and forth between uh ketones and glucose is super complex. And you know, you'd definitely be we don't have time for all that. You would definitely be the one to kind of really get into the weeds with that, but we'll save that for another episode.

SPEAKER_03:

But basically, when you when you run out of glucose as your glucose is the body's preferred source, but when you run out of that, if you're fasting, your body makes ketones, which it then uses as fuel, yeah.

SPEAKER_01:

And it and it makes these ketones essentially from your fat your fat deposits, right? And so there's a big process there, but being able to switch between those fuel sources is your metabolic flexibility, and being able to, you know, get into that burning those ketones means that insulin is not present. And that and so your insulin levels have dropped. Now you're burning ketones, and the more the longer you can stay in that stage to a certain point before you, you know, obviously you you don't want to start breaking down muscle because you can fast too long, but the longer you're in that state, even though you're hungry, you're burning your fat. You're burning your excess storage.

SPEAKER_03:

And so it can help with appetite control, it can lower appetite. Yeah, and we're not promoting the ketogenic diet necessarily. This is different. This is just when you fast for a certain period of time every so often or during during the night or a little bit longer. Maybe it's a little bit longer of a fast, you're delaying your breakfast, um, then this can be beneficial.

SPEAKER_01:

And the ketogenic diet, I mean, unfortunately, that has gotten sort of a bad rap in, you know, a lot of mainstream diet science. It can be super beneficial, but that is really strict carb uh restriction. I think it's like five. Technically, and it's you know, it's not necessarily you know wanting you to have as much produce. The um the macros that we've been researching, and and a lot of this is coming from um Ben Bickman's work. He's released a couple really good books. One is called Why We Get Sick, and that really draws the connection between insulin sensitivity, insulin resistance, and chronic disease. And then the second one is um how not to get sick, where he really goes through it's it's like half research, half cookbook, and it's it's where he really goes through his protocol for increasing your insulin sensitivity. And the macros there basically, if you are insulin resistant, um, and we know that because you can get blood work done, you could have visceral fat for females. You could have PCOS, um, you might have some skin tags or different uh integumentary uh things going on. For those people to reverse your insulin resistance, you want to have the macro percentage be, and this is gonna sound crazy for a lot of people 60% fat, 30% protein, 10% carbs. Which when I was first looking at it, I was like, holy crap, that's a Lot of fat, right? But fat has only five to six percent of fat can be turned into blood glucose. So it makes sense. Like if you're eating a lot of fat, then you're not releasing.

SPEAKER_03:

It keeps us fuller for longer. The only thing we got to be careful of there is it's very dense in calories. But you know, in comparison, so it's pretty that's still pretty strict, but in comparison to the ketogenic diet, that's more like 70 to 80 plus percent fat and only 10 to 20 percent protein. That's where they've got it really wrong, I think. And then the carbs are five to ten percent, right? But with that little protein, it's hard to maintain muscle mass, build muscle mass, um and again get all your amino acids.

SPEAKER_01:

That's in the that's in his sort of reverse protocol. So that's for the people who are most insulin resistant, and it's probably more short term, yeah. And then once you become a little bit more insulin sensitive, you might transition to the prevent, which is 55% fat, 15% uh carbs, and 30% protein. The protein is consistent throughout, it's 30% throughout all three of these protocols. You're just shifting the carbs and the fat five percentage points with each one, and then the maintain, which I was like, okay, we're gonna maintain. So this is for only 12%, y'all. This is for only the 12% of the US population, which is insulin sensitive.

SPEAKER_03:

So once you work your way up to a little bit more insulin insulin sensitivity, you could maintain.

SPEAKER_01:

Yeah, most people are in are in prevent or they're in reverse. So once you've worked your way up to maintain, it's still 50% fat, 30% protein, and 20% carbs.

SPEAKER_03:

Now, if the fat also sounds like a lot, but because of the density in calories, it's easier to do than you think. Because, you know, olives and picking even our healthy fats are nuts or seeds or salmon, um, you know, avocado, they're so dense in calories, the percentage goes up a little bit quicker than you might think. Um, and when people track, you know, because I always recommend a lower carb diet for a lot of my patients anyway, not as not the exact, these exact uh macronutrients, but when people start tracking and they're trying to do a lower carb, more whole food diet anyway, with less of the processed carbs, this is much easier to do than you think. A lot of times they they're not hitting their carb goal.

SPEAKER_01:

Right, right.

SPEAKER_03:

And they're because they're trying to aim for more protein, more healthy fats with more produce as carbs. And so it's it is more doable than it sounds like.

SPEAKER_01:

And the recommendation too is gonna be to start your meal off with fat. Start your meal off with fat, then have the protein, and then have the carb. And when you do that, you're gonna be you're gonna be full. You know, you're gonna have that satiation that um that we're looking for with that. And so, yeah, we've been we've been crushing the macadamia nuts, we've been crushing the olives.

SPEAKER_03:

I like olives now, yeah.

SPEAKER_01:

A little bit more.

SPEAKER_03:

We've tried different types. That was like the one food I really that and sardines, yeah. I wish we talked about. Um, but yeah, and and the reason why the the produce works so well too and works for your your blood sugar. Let's talk about the difference between uh glycemic index and glycemic load. Yeah, because this again is more old school, old school terms. Um, American Diabetic Association, those with diabetes in nutrition school.

SPEAKER_01:

Um before I heard about glycemic load, I was so confused.

SPEAKER_03:

It's confusing.

SPEAKER_01:

I was so confused. And so this really cleared some things up for me.

SPEAKER_03:

It's a way of ranking different foods. So basically, glycemic index ranks foods based on how quickly they raise your blood sugar after eating. It's on a scale of like zero to a hundred or one to a hundred, with pure glucose being a hundred. So when you think about white bread and potatoes, um, those are like usually about 95, so very high almost to pure glucose. And so low GI foods, GI is glycemic index, uh cause a slower, steady rise. And then high glycemic index foods cause a rapid rise. But what we've found, or what when you really look at it, that is not the main culprit of your high glucose levels because a lot of these things, like your blue blood glucose levels, because a lot of these things you might not, you know, eat. If you're eating a lower glycemic index food, you'd have to eat a lot of it for it to spike your blood sugar.

SPEAKER_02:

Right.

SPEAKER_03:

So the the glycemic load comes in, that considers both the GI and the amount of carbohydrates in a typical serving with a different formula.

SPEAKER_01:

So that glycemic load is the most important. You know, the glycemic index is still something to look at and keep track of. And you know, the big one for the big for instance is watermelon, right? That's that's always the like shocking one for everyone. And so, like, watermelon has a super high glycemic index, it will spike your blood sugar really fast, but the total carbs in watermelon is very low. So the glycemic load is very low. So think about this as it relates to your CGM graph. What's gonna happen on your CGM graph is you're gonna start to go up, and that might happen very, very fast, but in as soon as insulin starts to be released, it's not gonna take as much insulin as it would if you were eating a bagel to get those to get that blood sugar back down.

SPEAKER_03:

Very dense in carbs and calories.

SPEAKER_01:

A little bit of insulin gets released on that watermelon, and then boom, we come straight back down. So yeah, you mentioned the bagel. The bagel is like the biggest, highest, highest glycemic load where it has both a high glycemic index and a very high glycemic load.

SPEAKER_03:

And glycemic, a high glycemic load is over is considered over 20. And a plain medium bagel, which medium, I would say a lot of ours might be like large out there, but the glycemic load is 36, so way above that 20. And so you don't want to be scared of these carb foods if they're more whole foods with lots of fiber or lots of water, like the our fruits and our vegetables, the calories are not high, which means the carbs are not going to be high. You have to have a ton, kind of like how people are scared of carrots.

SPEAKER_00:

Yeah.

SPEAKER_03:

Like a lot of sugar. Oh, they're so sugary. I stay away from those. But let me go eat my candy over here for a snack. No.

SPEAKER_01:

Glycemic load of carrots, like one serving, you know, the glycemic index is 35. So, you know, it's a little bit on the higher side, but the glycemic load is four.

SPEAKER_03:

Only four. Yeah. Yeah.

SPEAKER_01:

So that's a great one that has a very low glycemic load, despite a moderate glycemic index. Same for grapefruit, right? Grapefruit has a pretty decent glycemic index at 25, but only a three for the glycemic load.

SPEAKER_03:

So for a fruit, it's a lower sugar citrus fruit.

SPEAKER_01:

Yeah. And you know, it's always funny too when people think about like hummus, you know, oh, it's like, you know, pureeed, um, garbanzo beans. And so, you know, those are those are mostly a carb. That again, glycemic index of six, but a glycemic load of zero.

SPEAKER_03:

Zero, because it's got the fat from the um the olive oil usually added in and tahini, and then the fiber from the beans.

SPEAKER_01:

Now, banana was an interesting one, right? It's that has a glycemic index of 51, but uh also a glycemic load of 14. So, you know, we're not telling you to not eat fruit, we're not telling you to not eat your favorite fruit, but there are differences between fruits. So they're not all, you know, created.

SPEAKER_03:

The higher fiber fiber fruits would be good, just like the higher, you know, fiber grains if you're eating those.

SPEAKER_01:

And if you're asking about soda, soda has a glycemic index of 63 and a glycemic load of 25. So that's why fastest route. It is your fastest route to insulin resistance.

SPEAKER_03:

That's why that's the first line of defense uh usually with with um those who are having diabetes or turning that way. It's like sugar sweetened beverages. Get rid of sugar sweetened beverages immediately. Coffee drinks, your fancy Starbucks drinks, sodas, all that stuff. Gotta go.

SPEAKER_01:

Now, when I'm having a big workout, or if I'm going to play like a day of ultimate, I will tell you, I would love to start it off with a bagel. Because you know, I have that. It's like a long bit of fuel source for me. So we're not saying like never eat your favorite stuff, but be strategic and think about it as function.

SPEAKER_03:

Yeah. So the timing of your of your carbs really matters. The amount of fat and protein in your diet really matters. And if you're wearing a CGM, the levels, your estimated average glucose levels and frequency of spikes, that's what you want to look for. So even if it's a rolling hill, if it's pretty high rolling hills and you're not ever getting to that hundred or below a hundred frequently, that that's concerning. You'd want to, you know, think about that. And if you're having lots of frequent spikes throughout the day, you definitely want to work on that towards insulin sensitivity.

SPEAKER_01:

Yeah. So if you're listening to this and you're like, okay, I'm ready. I'm ready to get on board, but I want to have some help. And I would recommend, because when I first started wearing a CGM, I thought I knew what I was looking at. I thought I understood how the graphs work and how to really interpret what I was looking at. But it is a little bit more complex than we're making it seem here. So I would highly recommend that you work with a dietitian and do, you know, three or four visits with a dietitian during your two-week trial with a CGM. And luckily at Chain Effect, we offer that program and we give you a bunch of trials that you're you need to do, a bunch of different things that you can try to really get a gauge of how insulin-sensitive or insulin resistant you are, and then how certain foods impact you. Because, like Caroline said, it is very objective for you, and it's very personalized for you based on where you're at on the insulin sensitivity, insulin resistance sort of spectrum. And that obviously, we said again, changes over time, but also your genetics play a role in how certain foods are going to affect food.

SPEAKER_03:

For sure. And so that's where a dietitian comes in. We meet you where you are, you know, your diet, what we start with you may be totally different from someone else. We will offer, you know, guidance based on what foods you like, what foods you eat, you know, your exercise regimen, your timing. Maybe you don't know when to eat these certain things. Um, even if you're active, you know, that's where we come in. So if you have any questions, you want any tips on that, um, you want to get scheduled with one of our well-versed, you know, team of dietitians, um, shoot me an email at Caroline at Chain Effect.com and again share this podcast with someone.

SPEAKER_01:

Share this podcast with someone who you think might be insulin resistant, and we will help them. All right, y'all. Till next time, we'll catch you later.

SPEAKER_03:

Thanks for listening.