Blood Sugar Regulation: Rational Wellness Podcast 247
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Cheri Bantilan discusses Blood Sugar Regulation with Dr. Ben Weitz.
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Podcast Highlights
2:48 A continuous glucose monitor (CGM) is a device that place on the back of your arm or your abdomen and it measures your glucose through the interstitial fluid of your body every 5 to 15 minutes. The two main companies that make these are Dexcom and Abbott.
4:50 The most important values to look at with a CGM are fasting glucose, average daily glucose, and postprandial glucose, which is after a meal, typically for two hours, and finally there is glycemic variability.
6:32 Fasting glucose levels should be between 70 and 90 for a healthy person and average daily glucose, which takes into account fasting levels, sleeping levels, and eating, is ideally below 105 for a healthy person. We would not want to be a flat line.
8:16 After a meal, ideally we would like these postprandial levels stay below 140 and we would like to see values come back to normal within 2 to 3 hours. If it is taking longer, this could be because there was a lot of fat in the meal, but having your glucose spike above 150 and stay there for 4 hours is not good and we need to make some changes.
9:38 Some Type II Diabetics can get their fasting glucose levels below 90 if they are properly managed
Cheri Bantilan is a registered dietician who works with Nutrisense, which is a company that helps patients to use a continuous glucose monitor and to interpret the data to optimize their health.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Dr. Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me. Let’s jump into the podcast.
Hello, Rational Wellness podcasters. Today, I’m excited that we’ll be having an interview with Cheri Bantilan from NutriSense, and we’ll be discussing the use of a continuous glucose monitor and how this tool can help us to better manage our blood glucose levels for optimal health. Obviously, this can be super important in helping to manage patients who are diabetic or pre-diabetic, but it can also be part of a program for optimal health, for longevity, as well. As we know, there’s many studies correlating lower levels of insulin and better managed blood sugar with less inflammation. There’s even some data that we’ve discussed previously on the podcast, linking it with potential lower risk of cancer. For longevity purposes, better managing your blood glucose levels is an interesting thing to take a look at. It’s one of the reasons why eating a lower glycemic carbohydrates and perhaps some of the specialized lower carb diets have been shown to have some benefits for overall health.
Our special guest today is Cheri Bantilan and she’s a registered dietician who works with NutriSense and NutriSense is a company that helps patients to use a continuous glucose monitor and to interpret the data to optimize their health. A continuous glucose monitor is a device typically worn on the back of the arm or on the abdomen that monitors your glucose continuously all day and night. When interpreted properly, can help you to learn how your blood glucose levels respond to eating certain foot foods, meals, timing of meals, activities, exercise, stress, sleep, and this fits very nicely into the functional medicine model with aims, not just outpatients with their symptoms, but to use the right testing to get to the root cause of their health issues. Welcome, Cheri.
Cheri: Thank you. Thank you so much for having me here. I’m super excited to be here.
Dr. Weitz: Excellent. Can you explain what a continuous glucose monitor is and which of the devices on the market do you find the most helpful or accurate?
Cheri: Great question. The continuous glucose monitor or CGM as we like to call it for short, is a small device that you basically put on the back of your arm or your abdomen, as you mentioned. It’s painless to insert there. If people are familiar with checking their blood glucose levels, they’re probably really familiar with glucometers where you have to use a needle and prick your finger and check your blood in that sense. No needles are involved. You basically insert the device on your arm and depending on the device that you have, it measures your glucose through the interstitial fluid of your body every 5 to 15 minutes. Therefore, you get this nice plotted line of continuous data, which is really nice. It’s pretty insightful. It’s like having real time data for yourself. As I mentioned, there’s a couple of devices out there.
The two main companies that make them are Dexcom and Abbott. There’s a FreeStyle Libre, which is what we use at NutriSense. Then, there’s the Dexcom. Then, there’s various different devices between those two companies but our company currently uses the FreeStyle Libre. Both devices are very accurate in assessing changes in real time for your glucose. Each company has their own calibration system. At our company, we do find that many members have a fasting glucose lab value or a glucometer home. We also have a feature where you can manually calibrate your sensor to those metrics as well.
Dr. Weitz: Interesting. When do you think of the most important times to look at for understanding our glucose levels? People often talk about the fasting level, which is when you get up in the morning prior to eating, the postprandial level, which is two hours after eating, other diabetics check it prior to eating meals. When do you think is the most significant, important times?
Cheri: That’s a really good question. There are three major trends that we actually like to follow. As you mentioned, one of them is fasting glucose value. I would also like to tag on average daily glucose value on that and kind of keep them in the same realm. Then, the next one would be, so that would be any, so fasting glucose would be anything without food or drink for at least eight hours. Typically, it’s in the morning for most people.
The next one would be postprandial responses, which is after meal responses. We like to look at what your pre-meal value was and then that two-hour period after you eat. We’re looking at all those metrics within that time. Then, the last one, which is actually very unique to wearing a CGM would be glycemic variability or standard deviation. You can actually only get this metric if you are wearing a CGM. If you have a glucometer at home, you can’t get your standard deviation just because you don’t have that continuous data, but those are the three metrics. The standard deviation is more of a metric that comes over time. It’s not like a one stamp time type of metric. It’s really useful for measuring your glucose fluctuations or swings.
Dr. Weitz: I’m pretty familiar with what we see as a good level or an optimal level for the fasting glucose. That’s typically what we measure when we do lab testing. How does that compare with average glucose levels? We typically think of somewhere between 70 and 90. I know there’s different ranges that people consider optimal for fasting glucose levels. Well, first of all, what do you consider optimal for fasting glucose levels, I guess for healthy person versus maybe a pre-diabetic or diabetic? Then, how does that compare with what we see as average glucose levels over the course of the day?
Cheri: Yes. We agree, for optimal values for a healthy person, we like to see fasting level values between 70 and 90 majority of the time. Obviously, we know that glucose fluctuates and there’s reasons why it may be higher or typically higher for some people, depending on various influencers but typically we do want to see them between 70 and 90 most of the time. Now, daily average glucose would be something that takes into the count your entire day. That would take your sleep average and the rest of the day. We like to see those values below 105. Just a little bit higher, you’re kind of taking into account the rest of the day while you’re eating. It’s very normal when you’re eating for glucose to go up. We don’t expect it to be a flat line ever. We don’t want that. Average glucose, we like to see below 105.
Dr. Weitz: Okay. What should be the highest level we should see glucose levels rise after a meal and ideally how long should it take to come back to the previous baseline level?
Cheri: Yeah, this is a really great question. This is one of, probably my favorite things to kind of look at and assess is different meal responses. It can vary depending on the meal content, meal timing, what you did before and after. It’s pretty interesting to see, but in general, we like to see, again, for a healthy individual, we like to see postprandial responses stay below 140 the majority of the time. Then, we also look at how long it takes for your values to come down. We like to see values return back to baseline or back to your pre-meal value between two to three hours. If it’s taking longer than that, there are nuances. Maybe you had a lot of fat in that meal. It’s just taking the glucose longer to digest and be absorbed. That fat is prolonging that response, but there’s different reasons why a response would stay longer. What we don’t want to see is having your values spike to 150 and staying up there for four hours. That would be something that we would be like, “Okay, let’s look at this. Let’s dive deeper into this because maybe there’s something else going on.”
Dr. Weitz: Would you say with the two type two diabetics that you manage, do their levels typically go back to fasting levels or is that sort of once they start eating, it’s always a little bit above that?
Cheri: It depends on their health history and how well their diabetes is being managed. If it’s pretty well managed, yes, we do actually see values come back down and whether that’s through lifestyle factors or medication, it’s being managed and you’re seeing those values in that normal curve that we like to see. For individuals who don’t have their diabetes managed that well, it takes a long time for their values to come back down. That’s when we would try to intervene through lifestyle interventions, with diet, exercise, sleep and stress levels, making sure all of those components are coming together to make sure that their body is working as efficiently as possible.
Dr. Weitz: What you’re saying is for a type two diabetic, it’s really not unreasonable for us if they’re properly managed, if they’re really taking care of all the lifestyle and other factors that we know can play a significant role that their fasting glucose levels should consistently be below 90?
Cheri: That’s tricky. I think that depending on where they are, it is very possible. It is very possible. I feel like a lot of the times when people come to us and they have a diagnosis of type two diabetes, they’ve been dealing it with for a long time, they feel like that is the end result. However, we can reverse this. We know that insulin-resistance can be reversed. It does take time just as it took time to have it progress. It takes time for it to reverse. It does take time, but it is possible.
Dr. Weitz: Okay. That should be the goal. We shouldn’t like say, “Well, because you’re diabetic, if you get it to 105, fasting, that’s probably the best we can do.” I mean, we might have to accept that after a period of time, but.
Cheri: Yeah. Depending how long they have been dealing with this and how long it’s been unmanaged. There may be nuances where maybe we may never see it go below 90, just because there is a history of damage there physiologically, but that doesn’t mean that you don’t try for optimal. It doesn’t mean that you can’t achieve something close to it.
Dr. Weitz: Right. There’s something that most people have heard of called the glycemic index or the glycemic load. This is basically a measure of how quickly different carbohydrate foods are going to cause your blood sugar to spike. Of course, this is an average. The glycemic index is based on a 50-gram sample. That’s why it came out with a glycemic load, which maybe is more going to reflect the amount of the carbohydrate that somebody might eat in a meal but from your experience working with hundreds, maybe thousands of patients, how much variability is there in the glycemic index when we see that say, sweet potatoes are low glycemic, how often is that, how often do you see patients respond differently to different carbohydrates…
Cheri: Yes. It’s fantastic.
Dr. Weitz: … than we would expect from the glycemic index?
Cheri: Yeah, absolutely. It’s quite impressive at how everybody has a unique response, truly. People often use a glycemic load or glycemic index as maybe like a first next step just maybe they’re just trying to get used to navigating a low carb diet or whatever it may be but I always say to test it out. Everybody has their own unique response. Don’t guess, just test, that’s our little slogan that we like to use because it is so true where everybody has a unique response. Yes, people may have different health backgrounds and different situations where other factors may come into play but it’s really very fascinating to see how one food, for example, for me bananas, they spike me. I can’t eat a banana without spiking me, without a huge, huge spike, but for a colleague of mine, she eats bananas and it’s totally fine.
Dr. Weitz: Hey, I heard her say that.
Cheri: Yeah, and it’s totally fine.
Dr. Weitz: I think [crosstalk 00:14:14] Dr. Ruscio’s podcast.
Cheri: Yes. I’m jealous. No, it’s fine. It’s really, it’s not a big deal but it’s just shows it’s very interesting how there’s two people who are around the same age, very similar backgrounds that we just have different responses.
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Dr. Weitz: I don’t know if you’ve looked into this, but do you think or have you seen that the way people eat and/or digest your foods matters? If you eat quickly, maybe you don’t have good digestive enzymes, hydrochloric acid function. Maybe you’re not going to break it down as quickly or somebody who chews their food for a longer period of time in a more relaxed manner, have you seen that that makes a difference in glycemic response?
Cheri: Yes, absolutely. It’s actually very interesting. If somebody, for example, rushes through their meal, we tend to see or I have tend to see a lot of people actually have higher responses because it’s rushed. They’re not relaxing during their meal. Maybe it’s more of a stressful environment. They tend to have just more, I don’t want to say aggressive, but just larger response to this versus someone who’s taking their time, having a relaxing moment and similar, this is maybe [crosstalk 00:16:53].
Dr. Weitz: Do you think that’s more likely related to say, cortisol levels or stress or is it have to do with how much you’re breaking down the food as compared to not breaking down the food particles?
Cheri: I would say that in that moment, if someone’s rushing, it would probably be more related to stress. If somebody has a history of any GI issues, maybe dysbiosis inflammation, that would be something that’d be related to more on that side of the spectrum where it’s maybe a little bit more physiological versus, well, stress is physiological too, but something that’s a little bit more physical in the terms of something else is going on in your body versus a stressful moment and it’s more acute.
Dr. Weitz: What about GI motility? Would we expect patients with SIBO, for example, to have a higher glycemic response or would we expect SIBO patients with diarrhea to have a different glycemic response than SIBO patients with constipation?
Cheri: Yeah, that’s a good question. We do know that there is some research out there that indicates were GI issues such as SIBO does have an impact on glucose. Typically, with issues like this, it does end up being where glucose levels are higher and they have higher responses. Again, that’s just more of an issue with malabsorption or things that should be regulated and working efficiently and it’s not. Yes, all of that comes into play, it’s very, yeah.
Dr. Weitz: Like with slower GI motility mean they’re going to… I have seen some data that correlates SIBO with constipation or IBS with constipation with gaining weight, because of the slower motility, you absorb more of the calories from the food. Would it be the case that you also absorb more of the carbohydrates and see more of a blood sugar spike?
Cheri: Yeah. I’m not sure on the specifics on that particularly. SIBO in itself is like another, a whole another ball game I feel like and the different types of SIBO, right?
Dr. Weitz: Right.
Cheri: There’s different, like hydrogen-dominant, methane-dominant, hydrogen sulfate, right? There’s so many different types. In general, if they’re not able to break down, I guess what your question is, if they’re unable to break down their food, would that cause a higher response? Is that [crosstalk 00:19:32]?
Dr. Weitz: If they have a slower motility, would they absorb more of the carbohydrates from the food?
Cheri: Yeah, that’s actually a good question. I haven’t really looked into that specifically, but from what I’ve found working with SIBO patients, I will say more that they tend to have higher glucose values. The actual mechanism, I’m not too sure, but yeah it’s a good theory.
Dr. Weitz: When eating a meal, does it matter what part of the food you eat first? If you’re having a meal with protein and vegetables and maybe some starchy carbs, I’ve always eaten like the protein first and then the vegetables and then the sweet potatoes thinking that I want to get the good stuff in there first but do you think that affects the glucose response?
Cheri: Yeah, absolutely, 100%. We’ve done numerous experiments with this with our own numbers. Then, even on top of that, there’s a ton of scientific articles on that, where meal timing or meal content does matter. Having your protein first, and then maybe having, like you mentioned, your non-starchy vegetables or something, maybe with fiber and then your carbs. We tend to tolerate carbs a lot better as a second or third thing to eat in.
Dr. Weitz: Cool. Let’s talk about glucose changes that occur with working out. Let’s say, I go to the gym and I have a pretty intense workout for an hour, mostly lifting weights, how does that affect my glucose levels?
Cheri: Yeah. It’s very common to see a lot of people they’re exercising pretty intensely. You can see your glucose spike an increase pretty high, actually. Sometimes we see levels all the way up to 160 and it can be completely normal. You really only [crosstalk 00:21:26].
Dr. Weitz: Are you’re talking about during the workout or after the workout or when?
Cheri: During the workout.
Dr. Weitz: Okay.
Cheri: During the workout, we’ll see a big spike and completely normal. What we want to avoid is any, we don’t want to frequently hit levels above 180 because that’s when you may be actually causing vascular damage, but if it’s spiking to anywhere below 180, and it’s a pretty intense workout, very, very common, it’s likely, what’s happening is it depends. If you’re working out in a fasted state, liver and muscles are likely breaking down glycogen to provide better energy for your workout. If you’re working out in a fed state, you’re likely using that food that you just ate for your energy instead, but it in general if anytime you see a spike from a very intense exercise, it’s probably twofold. It’s probably just overall the stress on your body, but to your energy demands are exceeding energy availability so your body is just using those mechanisms in place to provide that energy needed.
Dr. Weitz: It’s actually a good thing because you have these stored carbohydrates, your muscles need the glucose right then to function. It’s mobilizing that glycogen. It’s getting into the bloodstream. That’s why you’re seeing this spike, but then the muscles are utilizing it, so over a longer period of time, that’s a good thing, right?
Cheri: Yes, exactly. We’ll see that transient increase during exercise, but then overall a lower pattern for the remainder of the day. Just a side note on that, when we see these exercise spikes, it’s not the same mechanism. It’s not the same mechanism, I should say, as a glucose spike from food. The majority of glucose spikes and the glucose disposal that we see from exercise is noninsulin-mediated, while with food, we do need that, the insulin. It’s a little bit different mechanisms there as well.
Dr. Weitz: Potentially, that’s beneficial because while all peptides, hormones are complicated and have probably beneficial and negative effects, in general, you don’t want a lot of insulin around because it tends to be inflammatory?
Cheri: Correct. It’s one of those things where you want enough of it to get the job done, but you don’t want too much of it. Correct.
Dr. Weitz: Right. Right. How do different forms of exercise affect glucose levels? Let’s say, we have heavyweight lifting, we have high intensity interval training, we have lower intensity cardiovascular training.
Cheri: Great question. Typically, for any type of zone two training, thinking about this is something like a walk, something that’s pretty leisure, we may see glucoses either stay the same or have a slight dip. Think about anything low intensity, that’s kind of what you’ll see, a level or maybe a little bit of a dip for strength workouts. That’s something that’s a little bit more intense.
We expect to see a slight increase in glucose for something that’s high intensity depending and it all depends on the duration as well, but for something that’s short, high intensity, we do expect to see maybe more of a moderate to large spike and then anything that’s really long and very high, for example, maybe like a 45 minutes and above type of workout. It depends on the person. It depends on what type of fueling they did before.
I usually recommend for people to just test what they usually do out, and then we look at the glucose data and then we can kind of adapt from there and figure out meal timing from there because what we want to do is make sure that for these long workouts, their energy is sustained and they’re able to have these quality workouts. They’re not as bonking, so to speak, but we’re also not overfueling as well, right? It’s always that tough balance.
Dr. Weitz: Right. Typically, when glucose levels go up due to a higher intensity workout, how long do they usually take to come down?
Cheri: It’s actually not very long at all. It almost looks like a meal response. It’ll typically come down. It’ll peak maybe right at the peak of their workout and it’ll come down within the next hour or so. It doesn’t last long at all. It looks very similar.
Dr. Weitz: An hour after they finish the workout, it’s probably back to normal?
Cheri: It’s probably back to normal, I would say like one to two for the-
Dr. Weitz: One to two hours?
Cheri: Yeah. For the CGM, there is like a, because it measures interstitial fluid, there is a little bit of a delay between actual blood glucose, usually 15 to 45 minutes. It’s like to give that-
Dr. Weitz: Interesting, 15 to 45-minute delay.
Cheri: Yeah. There is a little bit of a delay. We’ll always like to give that buffer, but in general, yeah, it comes back down fairly quickly. If it is prolonged, I would probably look deeper into maybe recovery, maybe the recovery tips or whatever they’re doing for recovery isn’t as they need to kind of tweak that a little bit.
Dr. Weitz: Right. Let’s talk about stress and glucose levels. I know one of the things I’ve seen sometimes working with some diabetic patients is sometimes they’ll see their fasting glucose levels higher than they should be based on everything they’re doing in terms of their diet and sometimes stress will be a factor.
Cheri: Yes, absolutely.
Dr. Weitz: We’ve correlated it sometimes with the bigger increase in cortisol levels in the morning.
Cheri: Yeah. That’s often referred to as the dawn phenomenon where you see this rush of hormones, cortisol, adrenaline, all these kind of things. It’s kind of like your wake up hormones, but for individuals who have diabetes, what happens is those hormones are released, it causes a release of glucose, but then it just stays elevated. That is very common in the diabetic community, but stress does play a huge role in anyone. It can have a huge or very profound impact on your levels. The body copes. If you think about what the body is doing when it’s under stress, it’s increasing your glucose output. It’s releasing all that from the liver. Then, at this same time, insulin sensitivity is also reduced.
These two things combined cause glucose to stay in the blood and it’s very important if we’re running away from like a lion or something, but we were not really doing that anymore. We’re kind of sitting at our computers as maybe we have a stressful meeting, but we’re not running away from anything. It’s helpful, but acutely, it doesn’t have too much of an issue. There’s not much things that we can do about it, but what we get concerned about is those chronic stressors because that’s when it’s just, it can get dysregulated.
Dr. Weitz: Right. What have you found are the most beneficial ways to deal with that sort of issue?
Cheri: For more chronic stress, we really rely on creating a really good stress management plan for many people. For example, I work with a number of surgeons and obviously they have a very high stress job. It’s really interesting to see that every time they go into surgery, they’ll note it and you can see that when they start the surgery, their glucose levels will go up sometimes by 30 points and it’ll stay elevated for several hours. Then, as soon as their surgery is done, it’ll go back down. While, again, one of those things where they can’t [crosstalk 00:29:24].
Dr. Weitz: Somehow, I can’t see all these surgeons popping cortisol manager capsules before or during their surgery.
Cheri: Meditating during their surgery, exactly. Those are more edge cases where it’s very acute and we know what the stressor is. Oftentimes, it’s taking away the stressor, that’s what’s the biggest, the most helpful thing. However, it’s their occupation. A little bit of a different case, but for most people it’s figuring out what the stressor is and trying to find some type of technique, whether it’s breathing techniques, meditation, yoga, going outside, going for a walk, it works. Something’s different for everybody. Whatever sticks is what’s going to be helpful long term.
Dr. Weitz: What about when people sleep? What is typically their glucose pattern?
Cheri: Yeah, sleep is pretty interesting. We do know that poor glucose control or elevated glucose values impact sleep, and it’s a bidirectional relationship. Poor sleep also impacts glucose values unfortunately. Poor sleep could be from anything, right? It could be from chronic stress. It could be from maybe not getting enough sleep, maybe it’s disrupted sleep, like you having more fragmented sleep. Those are all stressors that can impact an affect glucose values. Again, it’s one of those things where you have to, there’s things that we can do from a nutrition perspective where it’s worth timing, right? Meal timing and so if we find that your values are elevated overnight, and that’s what’s causing you to have poor sleep, let’s play around with the macro NutriSense content of the meal, let’s move the meal up earlier. Let’s do things like maybe go for a walk after your meal so we can get those glucose levels down.
If it’s more of for other reasons, sleep hygiene tips are always helpful and implementing that is always helpful. We can, we often discuss that with our members just to make sure they have a good wind down and sleep hygiene routine. It’s all these things are cumulative effect. I feel like a lot of times people undermine sleep and stress, but it has such a huge impact. Really taking the time to dive deep into these is best for longevity, not just your health, but for longevity.
Dr. Weitz: Sometimes if you’re working with, say diabetics, especially diabetics who are taking insulin, whether they’d be type two or type one, sometimes the glucose level’s going too low during sleep is a problem as well.
Cheri: Yeah, absolutely. At our company, we actually don’t take any members who are actively taking insulin, but absolutely we do have a lot of members that aren’t on insulin, but have issues with hypoglycemia at night. Again, so it’s kind of the flip side, right. We’re working on, again, same things, macro content, meal timing, and how we can make those levels steady so you’re not waking up at night. There’s a lot of people that don’t realize that they’re waking up because their glucose levels are low. We see both sides, yes for sure.
Dr. Weitz: How does drinking a glass of wine affect blood glucose levels?
Cheri: That’s a great question. Yes, it’s not uncommon for people to, of course, have a glass of wine on a Friday night. Oftentimes, when they do that, the next morning their values are elevated. They’re very surprised about that. I always like to remind members that it’s completely normal. It happens. Basically, your body, in a nutshell, your body, there’s no place for your body to store alcohol. It’ll always prioritize breaking down alcohol before other substrates. It’s very common to see elevated values the next day with any type of alcohol that you drink [crosstalk 00:33:08].
Dr. Weitz: But you’re saying the next day, right?
Cheri: Typically, it depends. Yeah. Typically, it’s the next day.
Dr. Weitz: Right? Because I think what’s in common thought patterns out there, what I hear people say is, “Well, alcohol turns into sugar.” I think they’re thinking that you’re going to get this rapid rise, but it turns out alcohol, I mean, unless the alcohol you drink can contain sugar, it actually doesn’t turn into sugar. It gets metabolized differently, right?
Cheri: Correct. If you’re having something typically like wine and anything, that’s hard liquor, we do actually see a dip in glucose. Then, we see those elevated levels of that the next day. For things that are like sugary cocktails, because as you mentioned, there’s actual sugar and things added in there that would impact your glucose very quickly. We we’ll sometimes see like those higher levels and then the dip and then higher levels but it depends on the type of alcohol. Wine is very common. One that we see people drink or beer is very full of carbs. Typically, beers also drinking with other high carb foods like beard pizzas are very common combination. You’ll see elevated values probably right after the meal and overnight and into the next day,
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Dr. Weitz: Now, explain physiologically why you would see elevations in glucose levels the following day after drinking a glass of wine with your dinner?
Cheri: Great question. As I mentioned, it depends on the alcohol that you’re drinking but many people will see that glucose elevated because your body is basically prioritizing down that alcohol over normal glucose production. The studies that we have on this show that alcohol temporarily impairs the normal functions in the liver to moderate normal glucose levels. It balances that insulin and glucagon. It appears that what happens is when you drink alcohol, it temporally interferes with liver gluconeogenesis, which is making more glucose and glycogenolysis, which is breaking down stored glucose. What happens is the liver prioritizes breaking down that alcohol over other normal homeostasis functions because the alcohol doesn’t have a place to be stored in the body.
Dr. Weitz: This has been described in some articles as drinking a glass of alcohol prior to a meal reduces postprandial glucose response as possibly a positive thing but you’re saying it’s actually a negative thing?
Cheri: Yeah, it’s a funny. I have seen things like that and I have seen people thought processes in that way as well. I will say that everybody has a different alcohol threshold. I wouldn’t use drinking alcohol as prior to a meal, as a technique or tactic to [inaudible 00:37:36] your values but some people get away with it.
Dr. Weitz: Now, the reason why the glucose levels go up the next day is because it took that long to process the alcohol or it’s because it wasn’t processing the carbohydrates until later?
Cheri: Yeah. Basically, everything is pushed back, right? Your body is prioritizing the alcohol, it’s breaking that down. Then, you have all this leftover glucose in your body from eating, whatever you were eating, maybe you’re eating pizza. You have all that leftover glucose in your body. It’s just hanging out there. That’s what we’re seeing, right? Your body’s just wasn’t able to prioritize that because it was prioritizing alcohol.
Dr. Weitz: In a functional medicine world, and I’m sure, a lot of consumers as well, we often use specific nutrients to help with the management of glucose insulin levels like berberine, cinnamon, chromium, vanadium. Have you seen, looking at patients with a continuous glucose monitor that any of those specific nutrients have a particularly beneficial effect?
Cheri: Great question. The one that I, the supplement that I have seen have the most impact would be berberine for sure. I typically, if individuals are pre-diabetic or they’re having really high values, and we’re doing all the lifestyle factors and they just need that extra push, we discussed that with their physician as well to see if they’re a good fit but that is the one that I see to be most effective majority of the time. There are some studies that show that like cinnamon, ALA, chromium, things like all that, all those things, bitter melon is another common one. There’s less studies on that. I haven’t seen, also probably like a dose factor. A lot of people, the effective dose of cinnamon for impacting glucose people probably aren’t consuming. You have to kind of keep in mind-
Dr. Weitz: Right. Meaning, maybe some of the studies show two to three grams and people are probably consuming milligrams.
Cheri: Yeah. They’re probably sprinkling it on their coffee. They’re not eating a ton of it.
Dr. Weitz: Right.
Cheri: The other one that people do often, and I have seen it’s kind of a mixed bag but this one is apple cider vinegar. Sometimes people will use that as a tactic in their salads. It’s common. It’s easy to add. That has shown some impact as well for some people, but it’s not, the most effective one that I’ve seen consistently is berberine.
Dr. Weitz: On the berberine, can you comment about dosage and frequency?
Cheri: Yeah, absolutely. Therapeutic dose would be about 500 milligrams, two to three times a day. The most common, majority of the studies on berberine are done in type two diabetics. I always like to make sure that the member who is doing it is aware of that. The most common symptom with taking berberine is just some GI upset. If anyone ever experiences that, that means just it’s a sign that you just need to back up a little bit on the dosage and you should be taking it with food as well.
Dr. Weitz: Do you recommend before or after the meal, with the meal, and do you ever go to a 1,000 milligrams or higher dosages and have you seen a beneficial effect with that?
Cheri: Yeah, that’s a good question. I typically only recommend staying around that 500 milligrams, two to three times a day, just because of the GI issues that a lot of people do experience with higher dosage and yes, always with meals. It doesn’t matter if it’s before or after, as long as you’re not taking it on an empty stomach.
Dr. Weitz: I’ve seen studies that show that A, that berberine has a similar effect to metformin. I’ve also seen studies showing that taking berberine with metformin actually enhances the effects. Can you comment about that? Have you had any experience with type two diabetics who are taking metformin also taking berberine?
Cheri: Yeah, that’s a good question. You are completely right that the mechanisms are very similar. Berberine has very similar mechanisms to metformin, which is why it seems to work so well. Also, a side note on that, sometimes if anyone is taking it out there and they’ve been taking it for a couple days, sometimes it can take a couple weeks for it to show any type of effect. With that being said, I always, always double check with the member that they’re touching base with their physician, if they’re taking metformin and berberine just because it’s two medication/supplements that have the same effect. We want to make sure that, we want to have glucose levels manageable, but we don’t want it to be dipped too low as well. I always refer to the physician in terms of medication and if it’s okay with them, and they can take berberine at the same time, then I’m all for it but I never recommend taking it at the same time without touching base with their physician.
Dr. Weitz: [inaudible 00:43:04] the same, of course, we always want to check with their physician and patient should always check with their physician before taking any supplements, even if their physician doesn’t know anything about them. Sometimes, I’ll include a paper that they can [crosstalk 00:43:25] their physician.
Cheri: About what it is.
Dr. Weitz: Okay. Let’s see. I think those are the main questions I had. I often use berberine as part of a longevity program as well because metformin’s often used off-label for longevity purposes as well.
Cheri: Yeah.
Dr. Weitz: Can you explain a little more about what your company does exactly?
Cheri: Yeah. NutriSense is a company that where you can get CGMs from. Basically, historically, CGMs are only used in the diabetic population, but we have found that it’s a very great tool to be used for optimizing health and for preventing progression of specifically insulin-related diseases as well.
Dr. Weitz: You’re saying for the average patient out there, they can’t just buy one at the pharmacy?
Cheri: Correct. You cannot get this over the counter. You do need a prescription. What our company does, it takes care of that prescription for you. You go to our website, there’s a form that you fill out to make sure that you meet certain criteria. Our team looks at that. Then, we take care of that prescription for you. The CGM is sent right to your door. Every person, every member that has a plan with us, will get a dietician, a complementary dietician for one month. And so you have to [crosstalk 00:44:54].
Dr. Weitz: Do you have to have blood sugar problems or pre-diabetes or diabetes to get one?
Cheri: Nope.
Dr. Weitz: Okay.
Cheri: You don’t have to have any of those … We have exclusion criteria, which is basically you can’t be actively pregnant. You have to be over the age of 14. You can’t have actively be on any type of cancer treatment. Those are the basics of the exclusion criteria but other than that-
Dr. Weitz: Right. Biohackers qualify.
Cheri: Yeah. Biohackers, if you are interested in wanting to, I don’t, there’s a lot of people that are interested in meal timing with exercise, enhancing their exercise performance and they don’t have any type of health history. All types of people we work with.
Dr. Weitz: That’s cool.
Cheri: That’s fun.
Dr. Weitz: Okay, great. How can our listeners and viewers find out about your company? I don’t know if you want to give them your contact information as well.
Cheri: Yeah, absolutely. To sign up, you can just go to www.nutrisense.io and all of our plans are listed on the website. You can definitely choose one. Then, from there you’ll fill out the form. It’s pretty self-explanatory and it’ll be shipped right to your door and you’re paired with a dietician. Of course, if you want to work with me or want to work with somebody that you’ve heard of, [inaudible 00:46:17] you can always request that as well but other than that, it’s pretty easy. The website’s pretty easy to follow and you can-
Dr. Weitz: Yeah. How does your company interface, say, with functional medicine practitioners?
Cheri: Yeah. Great question. A lot of the dieticians that we have, have a functional background. In fact, I want to say majority of them have a functional background. We are very-
Dr. Weitz: What about functional medicine practitioners who don’t work for your company?
Cheri: Yeah, absolutely. We do have affiliates and we do work with them. If that’s something that you’d like to provide like a code for your members or for your clients, we can definitely set that up for you and we can get a code for you. We can touch base with our marketing team and get that for you and your clients.
Dr. Weitz: How would that work out exactly?
Cheri: We would just give a code. At checkout, it would be probably like your last name and then that when they check out they get like a 20% discount or something like that. It depends on what it works out to be, but-
Dr. Weitz: Would we be involved in the recommendations that they get?
Cheri: The member or the client has always, if they want to share it with you, they can definitely share it with you. Then, if they want, as far as like the dietician working with the functional medical practitioner, we don’t have an interface with that at the moment, but usually what happens is the member or the client is that medium between the two.
Dr. Weitz: Right. Yeah. You might consider that in the future.
Cheri: Yeah. Yeah.
Dr. Weitz: Okay, great. Thank you Cheri, for joining us.
Cheri: Thank you so much for having me. It was really fun.
Dr. Weitz: Yeah. I had a good time too. I’ll send you links to the podcast when we posted it in a few weeks.
Cheri: Okay. No problem.
Dr. Weitz: Hopefully, you can share that with your followers.
Cheri: Yeah, absolutely.
Dr. Weitz: Thank you.
Cheri: Absolutely. Thank you so much.
Dr. Weitz: Have a nice day. Okay.
Cheri: You too. Bye.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple podcast and give us a five star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. I wanted to let everybody know that I do now have a few openings for nutritional consultations for patients at my Santa Monica, Weitz Sports Chiropractic in Nutrition clinic. If you’re interested, please call my office (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.
