Mindset Meets Muscle
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Mindset Meets Muscle
#32 NHS Dietitian Explains The Real Cause of Type 2 Diabetes is Not Sugar Consumption - Max
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This was such an INCREDIBLE episode with Max @maxyourhealth_
Tash and Emily learned so much it was so valuable and we know it is going to be SO valuable for the listeners too so we hope you enjoy this episode!
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Welcome back to Mindset Meets Muscle Guys. I am Tash and I am Emily. And in today's episode, it's a really important one. We are diving into type 2 diabetes and not just what it is, but what's actually driving it and what people can actually do about it. And we have a brilliant guest on for that today. Yeah, we are joined by Max. He is an NHS dietitian specializing in diabetes, and we are going to challenge a few common misconceptions and get into the mechanisms behind things like carbs, fat storage, and insulin resistance.
SPEAKER_02So, Max, welcome to Mindset Meets Muscle. I'm really excited about this podcast. It's a topic that Emily and I would like to learn a lot more about as well. And I think even though we personally don't actually have any clients suffering from type 2 diabetes, but I think everyone in their circle knows at least someone, probably, that is suffering from type 1, type 2 diabetes. And I think it's just a really important thing for us to educate ourselves on in general so we can help or just more aware of what is going on and support the people that might be in our circle. So welcome. And I'd love to start off by just telling us a little bit about yourself and why you got into this work.
SPEAKER_00Yeah, so I did my undergrads in 2017 in sports science. So that was at Loughborough. So I was in 2014, finished in 2018, sorry. So after that, I did a PT qualification at the back end of 2018. Worked for a company for about six months in 2019. Didn't really like it very much. So I went to do my master's in nutrition at King's College London. And that was where really got into it, studied lots of different topics, of course. Then I took a year out after that with COVID, and then I started working on the remission programme. Well, we are in October 2021. So I've been on that for five years. I speak to 14 patients a day. Um they've all been diagnosed with type 2 through the GP, which, as we'll get on to, is caused by being overweight or obesity. Um and then I've been involved in various projects. So we've got an app with 3,000 patients. So I write articles for that in terms of all kinds of things, help out with training coaches and things like that. So fish down a nutritionist by trade. So my degree was registered with the AFN, which is the Association for Nutrition. Um and yeah, I've been working on the program for the best part of five years now. So it seems like a very long time. Spoken to an awful lot of patients. Um so yeah, that that's me and my background.
SPEAKER_01Amazing. I think if we touch base on obviously diabetes, because that's clearly what you specialise in, when we sort of zoom out and we look at what's going on with the body, because we hear people say high blood sugar, but don't understand what that means in practice. What would you like to talk about if we're zooming out?
SPEAKER_00So, in terms of how it's diagnosed, so it's diagnosed through what we call an HBA1C. So that is the test that they have with the doctor. So you've got the finger prick test where you go like that. So that's what we would call an active or live blood test. So that would normally give a reading under 10. So the healthy range is between four and six. Over six would be pre-diabetic, and over seven would be type two. So the confusion here is normally that diabetes UK say that people should manage their blood sugars between four and seven, which causes a lot of confusion when people come onto the program because they come on with a blood sugar reading around seven, which is type two, and the guidelines say that's okay in terms of management. So that's one thing for people to be aware of. In terms of diagnosis, it's officially through a blood test at the GP called the HBA1C. That is called glycosylated hemoglobin, so it's how much glucose is attached to red blood cells. The difference with that blood test is it's a three-month average. So if we did it today, it would be, you know, what are Max's sugars from the 7th of January up until the 7th of April. So it's a much broader test and it's slightly skewed in some ways. So in terms of the thresholds for that, up to 41 is healthy, 42 to 47 is pre-diabetic, and then over 48 would then be type 2. So most of the people we're working with are in the 50s when they get that. So that's in terms of how it's diagnosed, and then they are referred to us. So, do you want me to say a little bit about the program briefly?
SPEAKER_01Yeah, run for it.
SPEAKER_00So, in terms of the actual program itself, it's it was called the Low Calorie Diet Program. So that was the Newcastle pilot study with the soups and shakes. Um, run by Roy Taylor. I mean, I could probably say his name is pretty well known. So that's where they did a 600-calorie pilot with three soups and shakes. And then they did another one, which was a bit higher because people said it was too low. So that's with four soups and shakes a day. So in total, that's 900 calories a day, give or take. So they're not eating anything other than the soups and shakes for 12 weeks.
SPEAKER_01Oh wow.
SPEAKER_00No food at all for 12 weeks.
SPEAKER_01I think I'd go insane.
unknownYeah.
SPEAKER_00Sounds like jail. As a lot of them probably do. But anyway, so they do 12 weeks of no food at all. Now, just in terms of the starting weights to give you an idea, the average starting weight on the program is 110 kilos. So that's roughly equivalent to 17 stone. A lot of the patients that, well, I'll say a lot, a reasonable percentage of the patients that we work with are up to potentially 25 or 30 stone. So that's 150 to 180 kilos. And this is where people start to see, right? It's probably caused by being overweight, not by the carbohydrates. So they do the 12 weeks of the soups and shakes, they then go through food reintroduction, which is where we give them the option of a three, four, or five-week periods to wean off the shakes and onto normal foods, which is where the difficulties arise. And then they do what's that? You've got eight months remaining for the maintenance period. So the idea of that eight months is that they keep the weight down, because that's how they maintain their emission status. But of course, when it comes to nutrition, with it being driven by the biological appetite, it's very difficult for them to keep the weight down.
SPEAKER_01I was gonna say, do you see people coming back in?
SPEAKER_00A lot of people do, yeah, because of the way, you know, in the game we can have a chat about the biological appetite, but you know, our appetite is there to prevent starvation at the end of the day, right? So if you're and then everyone's got a different set point. So, you know, your set point might be 60 kilos, like us lucky people who don't, well, I don't know about you guys, but we don't appear at face value to struggle with it too much in terms of our weight. And then, you know, it could be 15, 20, 25, 30 stone. So if they are genetically predisposed to be at that body weight, you chuck them on the shakes to lose weight. The reason why it's easier to lose weight on shakes is because it eliminates all of the decision making around foods. And for some reason your appetite drops, which we're not quite sure what happens, but um, you guys are used to cutting and bulking, I'm sure. So if you go into a small calorie deficit, let's say two to five hundred calories, you get quite hungry some of the time. Some people don't, some people do, to be fair. Some people are luckier with it than others. But if you put someone who's very obese and put them in semi-starvation, around eight or nine hundred calories, they don't get that hungry. And we don't really understand why that is. So you then put them back onto foods, and the hunger goes like that for some so we're not quite sure why that is. So a lot of people, when they're on the soups and shacks, excuse me, they're losing weight consistently and quite rapidly, often for the first time in their lives. So, you know, these are people who are most of the time we're speaking to them, they've been at Weight Watchers or Slimming World for 10, 20 years. They'll lose a couple of stone and regain it over a six-month period, they then come onto our program. The average weight loss is a kilogram a week for 12 weeks. Um, and then they go back onto feeding their appetite skyrockets. So it's quite difficult, but so that's what the actual program is in terms of what I work on. And then, yeah, um, we can go on to whatever you like next.
SPEAKER_02So, how do you navigate? I'm interested to know how you navigate the period between obviously they've lost, say, up to 12 kilos in the 12 weeks on the soups and shakes. How do you then navigate them going back onto normal food? Because obviously the hunger is so high. Like, how are you able to control that and keep them sort of like at their new maintenance?
SPEAKER_00Yeah, that's that's the difficulty. So a lot, so what actually happens in terms of the averages is they they lose the weight on the shakes, they go like that, and then they get back onto food and they just go like that. So in the majority of cases, the weight loss stops.
SPEAKER_01So they're they just play just stay at maintenance.
SPEAKER_00They they they plateau, yeah. So for some of them the sugars have dropped enough and for some they haven't.
SPEAKER_03Right.
SPEAKER_00So um that's probably a good time to move onto the personal fat threshold in terms of how it actually works. So the biggest misconception, of course, being that it's carbs caused by sugar and carbs, which there's not. And I've even had, you know, GPs and diabetic nurses come onto the program and say, I just need to cut my carb intake. At which point I say, Well, why is that? And they say, Well, it's the sugar spikes that cause it. So it is the biggest myth in the world that it's caused by sugar and carbs, and it's not. And it seems to be that the reason for that is that as they eat carbs, their sugars go up and down, of course. And most people seem to think that it's the glucose peak that actually causes type 2 diabetes, and that's not the case. So if you actually break it down, if you think of a healthy individual like the three of us, the sugars are going up and down all day. But they're not diabetic. So, what actually causes it? So, as you develop more fat mass, are you guys familiar with subcutaneous and visceral? Yes. So genetically, we're designed as humans to store fat in the subcutaneous first, all the stuff under the skin. So everyone has a different genetic threshold whereby they will store fat in the subcutaneous stores. A lot of it's around the gut for people, of course. And then everyone has a genetic personal fat threshold, at which point those stores spill over and go into our visceral fat, which is within our organs. Now, for some people, that's at 10% body fat, some people 15, 20, 25. So that's why we get people saying, Oh, I'm skinny, but I'm type 2 diabetic. Which is the case for a lot of the South Asian population, whereby they have a very low BMI but become they become type 2. Because their genetics determine that they might be 15% body fat, but they'll then stop storing in the subcutaneous stores, and it'll go into visceral. So when they spill over that personal fat threshold and it starts going into their visceral stores, it goes into the pancreas, it goes into the liver and all that unpleasant stuff, and that's when it causes dysfunction in the pancreas and causes issues with insulin production. So you've basically got an issue whereby your subcutaneous stores on one side under our skin are at capacity, meaning that for a very complex biological mechanism, they can't then store energy in the cells. So that's where the term insulin resistance comes from. Plus, you've got reduced insulin production from the pancreas. So you've got reduced insulin production combined with what the insulin resistance essentially is in the fat cells. So that is just to say it doesn't really have anything to do with sugar and carbs. Ultimately, type 2 diabetes is a disease of excess calories. So now the caveat to that, of course, is that if your diet is very high in donuts, brownies, cookies, biscuits, they're of course very high in calories, hypercaloric as we might call them, and hyperpalatable. So if we're eating foods that do contain a lot of sugar and we're highly likely to overeat on, that will contribute a lot, of course. So that is the personal fat threshold. So it's not caused by sugar for anyone who's listening. There we go.
SPEAKER_01I just want to touch base on the ethnic group that you spoke about, because obviously, if they're on obviously a lower body fat and lower body weight, then where what's driving that then for them to get type 2 diabetes? And does it help with things like exercise and what's important for that population?
SPEAKER_00Yeah, so that's why for black Africans and uh South Asians, the BMI thresholds are lower.
SPEAKER_03Right.
SPEAKER_00So have you noticed how uh the BMI threshold for someone who's white or Caucasian is up to 24.9, so it's up to 22.9 for people who are African or South Asian, and that's because their fat stores will spill over at a lower body fat percentage. So that that's totally genetic. It's not really got anything else, it's just their predisposition as a cultural or ethnic group. At say, so for me being a white man, it might be 30% body fat, my subcutaneous stores will start spilling over into visceral. That would probably be my personal threshold. Whereas for someone who's South Asian, their genetics determine at a lower body fat percentage, their subcutaneous stores will reach capacity and it will then start storing in visceral. So it means at a lower body fat percentage, they will start storing fat in and around their organs. And that's where you get, you know, naffldy, non-alcoholic fatty liver disease within the kidneys and things like that. So they will store fats within their organs at a lower body fat percentage. So they will, chances are if they start accumulating body fats from too many calories at a young age, 20s or 30s, they will become diabetic earlier at a lower body fat percentage.
SPEAKER_02I'm interested to know if there's obviously you say it's an it's an issue with excess calories. I know obviously this is probably going to be completely different for everyone. It's not a number we can really pinpoint, but do we know sort of around about like by how much is someone overconsuming that puts them at higher risk of potentially developing type 2 diabetes?
SPEAKER_00Yeah. Um, so uh I mean in in terms of age, we've got people who are 18 on the program um with type 2s. Um if you put it down to rate of body fat accumulation, I mean the average intake in the UK is three and a half thousand a day.
SPEAKER_02Is it actually the average intake in the UK? I didn't know that.
SPEAKER_00In in in the USA it's three eight a day. Yeah.
SPEAKER_02Oh my gosh.
SPEAKER_00So if you think about the average man, uh realistically the government it the government guidelines aren't that accurate in terms of two thousand a day. That's why really do you gain most people aren't aware of, so that you didn't gain weight. So if you think about the average intake is let's call it three and a half thousand a day. Say I'm quite short, I'm only five nine. Say I need fifteen hundreds, that would put me into a two thousand calorie surplus a day.
SPEAKER_02Wow.
SPEAKER_00So daily, that would be two hundred grams of fat storage a day, just by that metric alone. So, you know, say someone's on two, two and a half thousand again, that's one thousand calorie deficit a day, which is over a pound. So eating 50 calories a day in a surplus over your maintenance will lead to half a stone a year of fat gain. So if you overeat by, you know, half a slice of bread a day, and I don't want to be fear-mongering here, this is just that people need to be very aware of what they're eating. But that's what a lot of people aren't aware of, and our food environment does not help, of course. But a lot of people are not aware the very slight overconsumption of calories long term will lead to quite a lot of fat gain long term, which is the difficulty. And then you get to, you know, 40 with two kids, you've gained three stone. How do you get it off? And it's quite hard.
SPEAKER_02And it's probably more dangerous if it happens slower, right? Because we don't actually see changes, obviously, day to day. So it's just like slow and steady, and then all of a sudden you're like, oh my god, I've gained three stone. Like what like you just don't notice it going on.
SPEAKER_00No, no, you don't notice it at all. And you know, it happens all the time. I as you say, it's quite a good analogy that you use in terms of, you know, the slow change, you know, the flowers, the sun, the weather. You don't notice things if they happen.
SPEAKER_03Yeah.
SPEAKER_00And then the biggest contributors to weight gain are having kids, that's in the family. Weight Watchers did a survey a few years ago, and it's not really that surprising, is it? You know, that having kids, moving house, changing job, being made redundant, although hopefully having kids would be nice, I should say that, but very stressful. Those factors are the biggest contributors to weight gain. And then people say, I need to be more disciplined, which is another problem. You know, discipline does not overrun your biology. So if you're struggling, your discipline is not the problem. But yeah, it happens throughout life. And then, as Em touched on exercise, you then get to a point where your five stone heavier, the exercise hurts, you don't want it. What do you do? Um's got a great solution to it at the moment.
SPEAKER_02Yeah, it's hard, isn't it? And I think as you pointed out, people just aren't people are just not aware. They're not aware of how much they're consuming day to day. We're not, I don't think we get enough education through sort of just like unless you're looking for this kind of stuff. You're not it's not just it's not obvious to us, right? You have to actually seek out this kind of information and people just don't. People like to live in ignorant bliss until it happens it's too late. Yeah.
SPEAKER_00Just to touch on that point in terms of the lack of education. So I'm not that close to the stats. So hopefully the viewers will not abuse me for this.
SPEAKER_02They'll know much less than you on the stats, I'm sure.
SPEAKER_00Hopefully, we hope. Um, so I think the statistics are I think it's over 25% of primary school children are now overweight or obese by BMI. So while and then you start questioning it. So you think, you know, this is why I always say it's my patients, because they say, Oh, you know, it's my fault, I let myself go. And and you know, again, if you break it down to biology and genetics, right? So if you combine an appetite that is more or less designed to make us overeat, again, you know, in the middle of human evolution when we evolved from apes, we didn't know where our next meal was coming from. Yeah. Could have been an hour, it could have been a day, it could have been a week. So as humans, if we are designed to overeat, that is an enormous survival advantage. Enormous. So if you know, got whoever next to you who does not overeat, you know, a million years ago, and they didn't store excess body fat between meals, they'd probably die. That's the reality. And again, I'm being a bit of a nerd here, but people are totally out of touch with their evolution and they therefore don't really understand that and they therefore blame themselves as well. So if you combine that evolutionary-driven biological drive to overeat with from the age of three, kids being exposed to chocolate bars, sweets, things that are designed to be overeaten on. So those are the two main mechanisms. So it's an appetite that designs us to overeat, and an environment that's designed to make us overeat. That's not a good combination, really. So it's again, it's not really that surprising that you get people gaining weight and struggling to lose it.
SPEAKER_02Yeah, I always say, so I am someone that could literally eat and eat and eat. Like I just don't have an off switch. Like I'm not, I'm not ever full. Like I love food. So I know that I have to track my calories every single day. Luckily, I it's such a habit ingrained in me now that I actually enjoy it and I'm very aware of like I know where my maintenance is. I know if I overeat by a little bit, then I'll gain weight. I know some days maybe if I've gone over my calories, I need to pull back. But if I didn't have that in place, if I didn't have that structure in place and that data, I would I would probably be much heavier than I am now. And as you said, then that coupled with our environment is literally working against us. So I think it's important to note that, yeah, sometimes people will blame themselves and be like, oh, there's something wrong with me. Like I just can't, I can't do it. Like I'm not destined to look a certain way or be a certain way. Like this is my life. I just have to, I have to deal with it. But actually, a lot of things have been set up to work against us. And I think it's important for people to know that even though this is the case, like the power is still in their hands, like they can make that change.
SPEAKER_00To some extent, I wouldn't entirely agree in terms of the power is still in their hands. So with with some people, so you know, to get into emission, you know, 10% body weight loss gives you about a 50 to 60% chance of emission, 15% body weight loss from your original starting weight gives you about seven in terms of the biology, and this is where it's interesting, you know, some people can just lose weight. I have people where I just give them quite generic diet advice and then they lose 40 kilos, which is, you know, seven stone. And then other people they just can't lose weight. You know, I I have people who are 25 stone and you know, they're almost in tears on the phone to me because they can't lose weight. So every day they are, you know, e trying to exercise, eating their, you know, 50 plants a week, eating their protein, but their appetite is so high, which is where which is where the weight loss medications come into this, which we can chat about. Um their appetite is so high that they're almost in tears on the phone trying to lose weight, and they can't reduce their calories because the appetite's so high. So in terms of the field that you guys work in where the appetite's lower, what you said is probably true to be fair. You know, if you are 70 kilos and you want your six pack to be a bit leaner and a bit more visible, then it's probably down to discipline in that case. What you said is probably true in that scenario, whereby their appetite's not that high, it is more down to habits and behaviour change at that point for sure. But yeah, I think that's the difference with the genetics, really. Yeah.
SPEAKER_02Yeah. And then obviously, then we can nicely segue into that's where GLP medication probably really helps.
SPEAKER_00How very convenient, yeah.
SPEAKER_01So, what is your thoughts behind GLP ones? Do you have do you have an opinion? Obviously, I'm sure you do.
SPEAKER_00Uh yeah, yeah. Um, I'm massively in favour of them, as you may expect. So there are benefits outside of appetite alone. You know, they will probably be the biggest drugs from the data I've looked at since cancer drugs. So, you know, in terms of what they actually are, doing your I hadn't looked into this until recently. I wrote an article for the NHS on it. So those drugs were originally developed for type 2 diabetes. So those GLPs, glucagon-like peptides, they're actually produced naturally in the intestines. And they were isolated in the 70s or 80s, I won't say, because they were found to increase insulin production. So that's why they were they have been used, you know, in the past 10, 20 years or so for diabetes. But they've been found more recently to be very powerful appetite depressants. So that's why so many people are going on to them. A lot of the patients that we work with are on them, but the medical teams and the patients don't know how they work or how to use them, is the main problem. So, so yeah, there's there are a few coming through. So the main one people would have heard of is probably a Zempic, of course. Um Mounjaro is more recent, that's Tesepitide. So a Zempic is what we call a single agonist, so that's just GLP. Teseptide, also known as Mounjaro is a dual agonist, so that's a GLP and a G I P. So they now have new drugs coming through that are quadagonists. One of which, if you guys heard of retrotrudides, yeah. Yeah. So retrotrutes coming through, starts a quad agonist.
SPEAKER_01That's that's not been approved yet, has it?
SPEAKER_00That's I think that is a very good question. I don't think it has. They're normally approved in the US first.
SPEAKER_01Yeah.
SPEAKER_00Yeah, is an NHS problem because drugs are often approved, you know, at least two to three years in advance in the US.
SPEAKER_01Yeah, I think there's it's talk of the UK in 2027.
SPEAKER_00Sounds about right. Yeah. Yeah. And then there's I'm I'm gonna completely butcher the saying of this, but it's something like Oligopron, which I think is Eli Lilly, I won't say. Oligopron. Yeah. That that's a pill. Are you familiar with that one as well?
SPEAKER_01Yeah, I know of it, but I don't know that's as far. I just know that they're bringing out some sort of oral medicine.
SPEAKER_00So the benefit of that is that a lot of people don't like needles and you only take it once a week. I think it's a once-a week tablet. Uh the one that's coming through in research is called Bim McGroomab. And I don't know if either of you two have heard of that.
SPEAKER_02No.
SPEAKER_00But that has the same benefit of weight loss in terms of the GLPs and the GIPs, but it also enhances muscle growth. That they have well, I say they, very, very clever, wonderful people in this world, have not been able to recreate with exercise is muscle growth. You've always had to resistance train, have your protein XYZ. But that drug, I think, is going through phase two or three clinical trials, and it is the first widely studied drug that will be able to reduce body fat, and it's it's a marginal increase of in fat mass, so people shouldn't get excited. Sorry. Lots of fat mass, marginal increase in muscle mass.
SPEAKER_03Okay.
SPEAKER_00So that could be very, very game-changing because it would, of course, increase the metabolic rate.
SPEAKER_03Yeah.
SPEAKER_00So that is the first studied drug that's progressing through clinical trials I that I know of. There may well be others, people can tell me if I'm wrong, that will significantly reduce fat mass and also marginally increase muscle mass.
SPEAKER_01Do you think then people will go, well, I don't need to go to the gym then because I'm getting like I'm getting my gains from this tablet?
SPEAKER_00Yeah, but I think that's good if they're 25 stone.
SPEAKER_01Yes, 100%. Yeah, yeah.
SPEAKER_00Again, you have to think, who are we working with here?
SPEAKER_03Yeah.
SPEAKER_00If you're 15 stone and, you know, again, there are can you afford the gym and all those different aspects? There's a lot going on there. But if if you are capable and you have the opportunity and the means to go to the gym, then I completely agree with you. You know, because there is benefit in going rather than probably just using a medication. Um, but yeah, in terms of those medications, I'm massively in favour of them for the right people, and that's where the difficulty comes in because GPs and nurses and things don't always know about them. Um, specifically in terms of how the nutrition applies. So, you know, I'll get patients saying, Oh, my GP's put me on Mountjaro or something, and they'll just not eat for a week.
SPEAKER_03Yeah.
SPEAKER_00And that's quite a big problem. Um, so and again, in terms of you guys as coaches, and for me, and in terms of a lot of people I speak to, they say, Oh, well, if people are on GLP ones, they don't need any help. And I think it's the opposite. I think they need more.
SPEAKER_01Yeah, I agree with you. So I've actually got I've got quite a few clients at the moment on GLP ones. And um, when they first come to me, they are eating probably around 400 calories per day. Like, so they are minimal amounts of food consumption. You are looking at near to nothing in protein and it sucks. Literally, it's uh it's a I guess a piece of toast, that kind of vibe. And they are just not and they're on very high dosage, which is wild because if you look at that as someone that's consuming 400 calories a day, you go, well, instantly their dosage is probably a little bit too high for their body right now. And they have been prescribed that, and that is what they are writing at.
SPEAKER_00Are they getting it from the GP or privately?
SPEAKER_01I would presume they are getting this privately through prescription, but not through a GP service. Interesting. Um, but there's communication, because I know that because I have spoken to a couple of my clients that um are very early on in their journey, but they are on high dosages than I would have expected them to be on where they currently are earning it.
SPEAKER_00Interesting. Yeah, because the issue that we see, you know, then it becomes well, the main issue is deficiencies, of course.
SPEAKER_03Yeah.
SPEAKER_00But, you know, it's it's really quite risky in terms of going on it. And again, this is an educational problem. And I I've I've mentioned GPs and nurses being at fault a couple of times, and I say that with the best will in the world because I feel I have a lot of sympathy for them because they're expected to be an expert in every area, which is totally unrealistic. So I do have a lot of sympathy for them. But in terms of getting, excuse me, the right information to patients, how we've come to a point where we're just for 90% of people just giving them these drugs that are absolutely fantastic, but if they're leading to people not eating, it's not good. So, you know, people need to eat more frequently with them because of the nausea and things like that, and hopefully they do provide a lot of benefit. But yeah, how we um because you know, once you're coaching them, it's okay, but most people on them are not being coached.
SPEAKER_01Do you know what I find wild at the moment? I don't know if you've seen it, but there's a TikTok like sort of influencer trend with them where people are selling them on TikTok, like it's casual. They promote them, they sell them through a prescription that they deal with, they get a percentage back. So just like an affiliate brand, but for peptides. Yeah.
SPEAKER_00Oh peptides as well.
SPEAKER_02I've seen this with the I've seen this with the peptides with an influencers basically just like selling peptides for commissioners.
SPEAKER_01Use my use my code, get toast them off. Yeah.
SPEAKER_02Crazy.
SPEAKER_01They're doing it with GLPs as well.
SPEAKER_02Yeah. See, I know, like within sort of not with people I coach, I have a couple of girls on GLPs, and really it's just about reminding them to eat and structure their meals and making sure they are getting in enough protein and actually drinking enough water as well, and just like getting on top of all those basics. But people in sort of like my social sphere, I know people that have essentially been lying about their BMIs to get these prescriptions online when they actually are a very healthy BMI, they probably don't need a GLP to assist them to lose weight, and then yeah, they just end up eating nothing, losing probably more muscle mass than body fat because they didn't have a lot of body fat to lose in the first place. And that's yeah, that's sort of the issue that I that I have seen. I feel like for the right population, as you say, they are absolutely incredible and life-changing. But I think it's celebrities and like the skinny trend has made the opposite side become more trendy, or like more people are looking for now. And that I feel like is not it's not a great path that we could potentially be down.
SPEAKER_00Yeah, well, that's where the difference between medical necessity and sanity comes into it though, which is the difficulty. And that's the problem that they're having, where you know, supply is somewhat limited still at this point. So, and I mean I don't know what the percentage of people who are getting it privately and uh through public health is or GPs or anything, I've got no idea. But that is that was a bit of a problem when they were first made. The people who could afford them were getting them to lose a stone, and then the people who need to lose 10 stone therefore couldn't get them. But yeah, that's the importance of resistance training, of course, with that is that you will lose muscle mass at a greater rate on a GLP than you would normally. So that is a benefit, of course, of both type 2 diabetes in terms of glucose disposal that we can move on to as well. The benefits of resistance training for both.
SPEAKER_02Yeah, I guess that does lead us nicely into the importance of building muscle.
SPEAKER_00Indeed. In terms of resistance training, I think that a lot of people are put off. You know, we speak to so many people who say, Oh, you know, are you doing any exercise at the moment? Say, Max, I'm not going to the gym. And, you know, within 10 seconds, that is the are you going to do any exercise conversation almost over. So just to be clear to people, in terms of exercise, doing as much as you can of anything is great. Now, the higher the intensity, the duration, the frequency, the better. That is normally the three points I go by. But resistance training is the gold standard for everything, right? It's the reality. So, in terms of diabetes, how it would apply, so your muscles are basically enormous sinks of glucose or glycogen, as we would call them more accurately. So the bigger the sinks of muscle that you have, the more glucose you can pour into them and store without causing fat gain. Technically speaking, the more resistant you are to type 2 diabetes. So now that only reaches a certain point, because at some point, if you develop enough fat mass, you will become insulin resistant. So that's something that people need to be aware of because we I I do speak to people who say, you know, I used to be a rugby player or I used to resistance train a lot, but I've gained weight recently. But I don't understand how I've developed type 2 if I'm so fit and healthy. So those are decide different points. But yeah, um the more muscle mass we have, the more resistant it will be to blood sugar elevations because we both have a higher metabolic rate, of course, the number of calories that we expend in a day. And a lot of people say they have high and fast and slow metabolisms, which you know, if they have hypothyroidism or anything would be a slight issue, but it's not as big as most people think. But the more muscle you have, as I say, the higher metabolic rate, so you can over-consume calories without excess storage of fat. And if you go out for a meal, a big pasta meal, you're going to store more of the glucose, glycogen in your muscles compared to someone who does not have that. So resistance training from an early age is very important to prevent type 2 diabetes and metabolic syndrome, um, which is really important for people. Yeah, guessing more people exercising, resistance training is something that we could do a bit of work on, really.
SPEAKER_01As that as a preventative as well, I guess. So if we start at a young age training, resistance training, that will be our benefit to if we can't control our environment, we can't control the foods that are around us as much as we'd like, then at least we can control the muscle mass that we have on our body at a young age.
SPEAKER_00Yeah, absolutely. And you know, that's also got other benefits of being around people who are, you know, a bit of bias there, around people who resistance train. You know, if people spent the day with us three, they're probably less likely to, you know, go and snack on things because of our environments and things like that. But yeah, getting people training from an earlier age is quite a big factor, which people are put off by, which is a shame. They don't want to do it. But yeah, trying to find a way to get more people resistance training from an earlier age is something that would really benefit the large population.
SPEAKER_01We've been blessed, I think, because we definitely you were in the gym from a young age, weren't you, Tosh?
SPEAKER_02Not super young. Well, actually, yeah, probably like in comparison to most people. I started, I was like first intro about 16, 17. And I was so lucky that I had a at my school, we had a um like an in-house PT and he taught us like how to actually move properly. And because we would go in and run on the treadmills, and he was like, Girls, that's not how you're gonna build your bodies, you need to start lifting some weights. So he taught us that, and that that was kind of like my segue into it. So yeah, but it honestly it's like, I mean, we say this all the time, like lifting weights changes your life, not just from like the aesthetics point of view, but in terms of like actually how it shapes our personalities and what we value in life. Really, it's so important.
SPEAKER_00Absolutely agree. I think it's a good point.
SPEAKER_02CGMs, shall we touch face? Yeah. Do you know what? I think when you when we were saying about uh how there was a bit of a like a the supply of GLPs and GIPs and all of these drugs is not meeting up to the demand. That's a similar kind of thing happened with CGMs. Am I correct? In saying that they became quite trendy and people that didn't need them were being sold them and purchasing them for basically for their to tell them that actually their bodies are just normal.
SPEAKER_00Yes, indeed. Yeah. Yeah, so I I think you're right. As far as I know, again, I I I don't have necessarily anything to point to for it. Um, but yeah, there's a guy called Patha Carr who runs the type 1 diabetes program in the UK with the NHS. Um, and part of the aim of his project is to get everyone onto continuous glucose monitors with type 1. And I think they have had a problem with supply. So I think you are right. Um, in terms of CGMs, continuous glucose monitors, of course. So there's DEXCOM, they've had the G5 and G6, there's Freestyle Libre. I'm not that up to date with the brands and stuff these days, but yeah, with type one, of course, they are crucial, and that's really what they're designed for. Because if their sugars go too high, they need the insulin, of course. So they're very, very important for that. But in terms of type two, I'm not entirely sure they provide any benefit, really. Nicola Guess, I'm not sure if you guys have heard of her, heard of her work. She's a senior diabetes dietician. She, as far as I know, she runs the trials out of Oxford University. She's got a really good Substack, if people want to look at it, basically dispelling myths. She's got a very long article, myth busting the glucose goddess, if people want to read it. If there's if people need more evidence than that, I don't know where to point them. Um so basically, yeah, in in a healthy individual, sugars will go up and down, as I said in my Instagram reel. Without the ability to break down carbohydrates, absorb the glucose, fructose, whatever it may be, our sugars to spike, go into our blood, absorb the energy and go back down, there would be no life on earth fundamentally. So it is such a crucial part of energy partitioning that we have to be able to consume carbohydrates, break it down, and absorb it into our cells. Um, this is a conversation I have with people every day where I say, this is how it works, this is why our sugars are spiking. And unfortunately, they're not aware of it. But then you get the glucose goddess saying that, and you know, I I'm not entirely sure what the purpose of her work is. I'm not sure if you guys can tell me. And I had a look, and I think she's being quite clever with it because she doesn't say the specific purpose of what she's doing or who it can help or what problem it would solve. So she's just generally putting out information saying, you know, if you put raisins in your granola, it will spike it more than normal granola, and I'm like, right. And what's the issue with that, you know? Yeah. I don't know. But I was debunking one of her posts, and it was actually quite hard to debunk because she didn't say why people should balance their sugars or what benefit it would provide. But if you then ask, so her website says helping you to balance your sugars. Firstly, what does that mean? I have no idea. It's an incredibly vague statement, which I suspect may be intentional, because legally that would help her out, shall we say. But in terms of the benefits it provides, you know, I think it's marginal at best. You know, is balancing your sugars going to help you with your energy levels? Potentially, but the reality is that getting a bit of sunshine and being hydrated is going to help a lot more. Um so the main point, of course, that unless you have type one or quite severe type two, her work is going to provide very, very little benefit to you.
SPEAKER_01I don't know her. Is what what's she selling? She's selling a product, her own programming or I honestly don't know what she's selling. She's got a book, doesn't she? How is she?
SPEAKER_00She does have a book, but she also started selling supplements to reduce your glucose.
SPEAKER_03There it is.
SPEAKER_01There we go. There we go. No, so yeah, she's got to take my supplement 30% off with COVID.
SPEAKER_00Exactly. Exactly. Um, so yeah, she's she's a French biochemist. This is her Instagram bio. Um, and yeah, it says balance your sugars for better energy levels and all this stuff. And and again, you know, if cutting your sugar intake and having a more balanced diet helps, fantastic. I'm all for it. But the majority of her work is on reducing glucose spikes, then frankly, that's useless to the majority of the population. And as we've said, to actually reduce so you know, is she just helping people with reducing glucose spikes? Is she helping people get into remission? I don't know. I I have no idea. But for the general population, there is almost no purpose at all. And I actually posted a meter analysis on my reel saying that in healthy individuals, there Is no known benefit to reducing your sugar spikes.
SPEAKER_02And her audience, like, let's be honest, is going to be general population. It's going to be probably women our age, she's early 40s, who are probably already quite health conscious, have seen this account and are very impressionable to probably the way that she uses her language. She's very much good at telling a story, coming across very authoritative. And then we'll be like, okay, well, that we need to do that. We need to buy from her. But actually, it's just wasting our money.
SPEAKER_00Yeah, I was just gonna have a quick look at the supplement that she's she's selling. If if you two haven't seen it.
SPEAKER_02Um, I haven't seen. I've not seen the supplements. Uh she did recently go on Stephen Bartlett's podcast.
SPEAKER_00Well, well, that that's we could do another podcast on that podcast, couldn't we? So oh wait, oh, we've got cookies. We've got cookies. There we go.
SPEAKER_02Anti-spike formula. Okay. I mean, it's got five-star reviews.
SPEAKER_00Must mean it's good, eh? So yeah, that says reduce your meal's glucose spike by 40%. It does say lower fasting glucose and reduce insulin resistance. She's saying to increase GLP as well, or she's gonna get done for that. Oh dear. So, yeah, so it says reduce your meal's glucose spike by 40%, which I don't know how possible that is. Reduce lower fasting glucose. I don't see how you can achieve that. Reduce insulin resistance and increase GLP. Big claims. Big claims.
SPEAKER_01And for what cost is that? How much can you buy yourself a jar of glucose's goddess supplement?
SPEAKER_00So it seems to sell 30 pounds a month full price.
SPEAKER_01I mean, that's a bargain, really. When you think it's a pound a day.
SPEAKER_00A bargain that's absolutely useless.
SPEAKER_02So nothing, yeah, exactly. You're just I'd rather save that 30 pounds and spend it on coffee or something, you know.
SPEAKER_00A quick piece of public health advice for everyone to get your sugars down, lose a few pounds, and buy a multivitamin. There we go.
SPEAKER_01But I've been sat in a science, like a lesson here. I've been like, mm-hmm. Yeah. No say no quite a bit.
SPEAKER_02We've we've learned so much, and this has been this has been a really yeah, very interesting conversation. As I said, it's something that we need to know more about as well. Um because yeah, we just don't we don't know enough about it. And I think in general, especially as we've said, like in the in our industry, like in the fitness space, we don't we're not we don't deal with this on the day on a day-to-day basis. Like as you say, the the kind of people that we work with probably already relatively fit, relatively good shape. They just want to get a little bit leaner, gain more muscle, and look sort of like more above average. So actually, yeah, this has been really, really eye-opening and very, very, very interesting for us. And I know that the listeners will definitely get a lot from it as well. Is there anything is there anything that you feel like we haven't covered that we should cover that you feel like people should know?
SPEAKER_00The two things just popped to mind, which I can cover quite briefly because we are short time. So the first thing in terms of remission, of course, is when people go to GP, they're told to cut out carbs. Um, and they swap that for fats. Now, with carbs and protein being four calories per gram and fats nine, that's probably going to cause weight gain. So the first thing is please, to anyone listening, don't swap all of your carbs for fats because it will cause further weight gain, which will worsen insulin resistance. Focus on reducing your calories. If you want to eat nuts, you can eat them, that's fine. But it needs to be within your calorie deficits. And in terms of PCOS, I did some research on that today, which probably don't have time for now. We can cover another time if we want to. But interestingly, from the research I did, people with PCOS have 400% greater chance or four times increase in type 2 diabetes. Oh wow, that's insane. Which I didn't know.
SPEAKER_02I I knew that obviously there would be uh risk, but I didn't realise it would be that high. Yeah.
SPEAKER_00So with um endometriosis, it's not as high. I think it's 20 to 50%. And I can't remember the mechanisms. I'd have to go back and look. I think it's to do with the androgen receptors, but with PCOS, it does vary, but yeah, it was about a fixed increase in risk of type 2 diabetes, and then with menopause as well, which we can do another time, as you progress through perimenopause and postmenopause, there's quite a linear increase in type 2 diabetes development as well.
SPEAKER_03So interesting.
SPEAKER_00Again, that's to say to people that if you have PCOS and you develop increased sugars, again, not your fault. There are things that you can do, and it's a good idea to see the GP. So there we go.
SPEAKER_02Yeah. And then we should we should definitely have you back on to discuss sort of PCOS, anopause, and how to really like shape your life to prevent getting type 2 diabetes. Because I think that would also be a very interesting topic that people would love to hear. But for right now, uh, we don't want to take up too much more of your time. But thank you so much for coming on. Genuinely, it's been a pleasure, and we've learned we've learned so much.
SPEAKER_00Yeah, thank you very much.
SPEAKER_01Max, where can people find you on your socials?
SPEAKER_00So, my Instagram is max your health underscore no spaces.
SPEAKER_01Amazing. Thank you so much. I love it. Thank you so much, guys. And I hopefully you guys enjoyed listening today as well. And we'll see you in the next episode.
SPEAKER_00Enjoy the sun.
SPEAKER_01Thank you so much, my darling.