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Lauren Bongiorno discusses Type I Diabetes with Dr. Ben Weitz.
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Podcast Highlights
5:53 Some of the most important variables that we need to manipulate for type I diabetes are nutrition and exercise. With respect to exercise, there is the type of exercise, the time of exercise, what your insulin sensitivity levels are, and what kind of food you have before exercise. With nutrition, the combination of macros, timing of macros, and the timing of insulin are all important factors. Also important are your relationship to food, your mindset to diabetes and your acceptance of it. Your hormones, including the menstrual cycle, and cortisol are other factors that are probably more important for type I diabetics and all these factors have to be juggled at the same time.
7:30 Monitoring glucose levels. Lauren monitors her glucose with a continuous glucose monitor (CGM), the Dexcom, but this technology is not accessible to everyone, since it may not be covered by insurance and it is somewhat costly. Ideally every type I diabetic should have access to both a CGM and an insulin pump. On the other hand, some people are perfectionist and they may obsess too much on getting their numbers perfect and using a CGM may drive them crazy, constantly living on their phones, watching the arrows and trying make decisions to control the numbers. It’s also important to get to know your body’s patterns and to know what a higher or lower blood sugar feels like.
11:17 Maintaining blood sugar overnight. Lauren does not feel that there is one way to help type I diabetics to maintain stable glucose levels throughout the night while sleeping. Some diabetics do well with a high carb, low fat approach, while others thrive with a keto style diet. Some do well eating some fat in the evening to keep blood sugar even, while others do better having a carb snack in the evening.
Lauren Bongiorno is a health coach, a diabetes influencer, and the founder and CEO of Risely Health. Lauren has dealt with type I diabetes since she was 7 years old. She is challenging the current healthcare system and the world of diabetes management through her company’s innovative health coaching programs and online educational classes.
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 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 and let’s jump into the podcast.
Hello, Rational Wellness podcasters. Today. I’m excited to be talking about type 1 diabetes, which is not a topic we’ve spoken about very much on the Rational Wellness Podcast. We’ve had a number of conversations about type 2, but type 1 is a very important topic and type 1 diabetics need a lot of help from nutritional perspective that they often don’t get.
What is type 1 diabetes? Most of us in the functional medicine world see a lot more patients with type 2, and that’s because only about 5% of diabetics are type 1, but type 1 diabetes used to be known as juvenile diabetes, but it’s probably better described as insulin-dependent diabetes. In this condition, the pancreas produces little or no insulin. Insulin is a hormone that signals the muscles to pull sugar from the bloodstream, to enter the cells used for energy. It’s generally understood that type 1 diabetes is an autoimmune origin, and while usually develops during childhood or adolescence, it can develop in adults. The cause of type 1 diabetes is controversial and we’re not going to go into all the possibilities, but there’s discussions about gluten and dairy and a bunch of other issues that may contribute to the causation of type 1 diabetes.
To lead the discussion this morning is Lauren Bongiorno. She is a health coach, a diabetes influencer, and the founder and CEO of Risely Health. Lauren has dealt with type 1 diabetes since she was seven years old. She is challenging the current healthcare system and the world of diabetes management through her company’s innovative health coaching programs and online educational classes. Lauren, thank you so much for joining us.
Lauren: Thank you so much for having me. I’m looking forward to this discussion.
Dr. Weitz: Great. Maybe you can start by telling us a little bit about your journey and when you just first discovered that you had type 1 diabetes.
Lauren: Yeah, absolutely. It’s interesting, now, in our practice and in our health coaching company at Risely, we see people getting diagnosed with type 1 diabetes at 40 years old, 50 years old, 60 years old, but like you said earlier it is very more well-known that children get diagnosed. I was one of those children. I was …
Dr. Weitz: Wait, by the way, why do you think more people are being diagnosed later with type 1?
Lauren: Yeah, you know what? I think that in the past a lot of doctors have misdiagnosed adults as type 2. It just took a longer amount of time to get them the correct diagnosis, but COVID also, we saw a huge spike after and within the past two years of diagnosis after COVID and the stressors of either getting COVID and then having it afterwards, or just the life stressors with things changing in your routine and people dying in your life that maybe have potentially triggered it.
Dr. Weitz: Interesting. There’ve been some discussion about viral triggers. You’re saying SARS-CoV-2 virus and/or possibly the vaccine may have triggered an autoimmune process that’s leading to type 1 diabetes?
Lauren: Yeah. There’s more research coming out now about it. I think it’ll be something that over time, will have to be looked at, but there is definitely some kind of relation between it.
Dr. Weitz: Interesting, interesting. When it gets diagnosed later in life, it can be confusing because there’s a type 1.5 diabetes, this latent onset, right? Diabetes that’s different than type 1.
Lauren: Mm-hmm (affirmative). Exactly. Yeah. There’s many different types of diabetes. There’s more than type 1 and type 2. I personally live with type 1, which is an autoimmune disease. My body doesn’t produce insulin, which is basically the thing that helps take the sugar out of the bloodstream. I was diagnosed at seven years old. Your whole entire life from in that point is changed in the way that you’re living. You hear from a very young age, if you don’t take care of yourself, hear all the terrible things that could happen to you. As a child, you’re like, “Oh, that’s so far away, right?” But it sneaks up on you. I’m going on 22 years of living with it. I’ve been through many stages of living with my diabetes. It’s way more complicated than just eat less carbs and exercise.
Dr. Weitz: It must be pretty traumatic for a seven-year-old kid to suddenly have to start pricking your finger to measure your glucose levels and injecting insulin.
Lauren: Yeah. I’d actually argue that it’s more challenging for the parents than it is for the child a lot of the time. I know that my parents and we also work with a lot of parents in our family coaching program at Risely, they went through the newborn stage already with their child or multiple children. This is kind of that like second wave of having a newborn because you’re waking up multiple times in the night to check your child’s blood sugar. You’re constantly focusing on all these hyper decisions that need to be made that you shouldn’t have to think about as a parent, but you ultimately do when your child’s diagnosed.
Dr. Weitz: What are some of the most important variables that we need to manipulate to help manage patients with type 1 diabetes?
Lauren: Yeah. Like I alluded to earlier, many of what we, much of what we understand type 1 management to be is around nutrition and exercise. Just within those two categories, there is about 20 different factors that influence your blood sugars, right? There’s the type of exercise you’re doing. The time of exercise you’re doing, how long you’re exercising for, what your insulin sensitivity levels are, your resistance levels, where your starting number is at, what kind of food you have before it. Then, with the nutrition, it’s the combination of macros, timing of macros, timing of insulin, right? All of these are different factors. That’s just one part of already what we know, but under the surface, there’s all these other levels. You can think of it as an iceberg, right? On the top of the water, you can see that most obvious things that you have to be looking at to manage your type 1 diabetes, but beneath the surface, you have things like relationship to food and your mindset to diabetes, how your acceptance level of it, right? Your hormones, your background, cortisol levels, or for females, your whole entire 25, 26 to 34 day cycle that’s having, give or take, depending on your particular hormones but that impacts your blood sugars, right? There’s so many of these other factors where type 1 diabetes is not like type 2, where you can take Metformin, you can take a pill and it helps the majority of the symptoms. We’re very much juggling all these factors at any given time.
Dr. Weitz: Interesting. How do you recommend monitoring the glucose? I’m assuming you probably recommend one of the continuous glucose monitors available today.
Lauren: Yeah. They’re the two main leading glucose monitors are the FreeStyle Libre and the Dexcom G6. I believe the G7 just came out. This is for people with type 1 diabetes, the most popular, I wear, the Dexcom. The thing is that it’s not, the technology is not accessible to everybody. You always have the option to be finger pricking for you to see what your blood sugar is. I wish, and it should be that these technologies and insulin pumps as well are available to everybody, but it’s just not the case, but it does make your life so much easier because you can just look down at your phone, in my case, on the Dexcom, see what the blood sugar is and make a decision based off of that.
Now, on the flip side of it, you have people who are highly perfectionist, who you’re never going to get your numbers perfect, and if you attach too much to it, it’s going to drive you crazy because if you’re constantly living on your phone, watching the arrows, trying to make the decisions, you’re not going to be living in the present moment. I think it’s really important to balance that this is a long marathon and it’s not on a sprint and you have to develop sustainable habits with everything, with food, with nutrition, with mindset, all of it.
Dr. Weitz: The worst thing you could do is get too stressed out over and have an increase in your cortisol levels, which will raise your blood sugar. Then, we also have to keep in mind that as high tech as these insulin, as these glucose monitors are, they’re not perfect. For example, both of these monitors that you mentioned, the FreeStyle Libre and the Dexcom, they’re measuring interstitial fluid, which is not exactly the same as the glucose levels in a bloodstream. It’s close, but it’s not perfect.
Lauren: Yeah. That’s a really good point. I think at the end of the day, what it comes down to is being able to know your body’s patterns and first without the technology, have a good relationship with what a higher blood sugar level feels like. Right now, when people are getting diagnosed with type 1 diabetes, you are a lot of the time getting put on a CGM right away. For me, I was diagnosed at seven, I didn’t have a CGM for 15 years. I slept through the night, given my mom checked my blood sugar maybe once or twice in the middle of the night for the first few years, but there wasn’t that amount of data that we have today. It was beneficial, in my opinion, because I now can look at my number and instead of just giving food for a low blood sugar that the CGM is saying, or giving insulin for a high that it’s saying, I can say, “You know what? That’s actually not the case. That’s not really what it is.” I can test my blood sugar on a finger prick, and then I can say, “See, that’s the right thing and I knew I was on the right track there.”
Dr. Weitz: Yeah. Interesting. I just wanted to comment, one of the things that happens when you do podcasts is sometimes you have weird things happen with lights. I remember having one interview where the person I was interviewing had the light coming in through the tiny beads and you have shades that you use to block out the light on your window and there’s tiny holes and the light was coming out and going across his face. I see your [crosstalk 00:10:55].
Lauren: Well, because my window, I’m backlit over here. You would not see me if I didn’t have a ring light over here.
Dr. Weitz: I know. I have a ring light too, and sometimes it shines off of the frame on picture behind me. It’s all those things you have to deal with.
Lauren: All of [crosstalk 00:11:14].
Dr. Weitz: It’s interesting. Anyway, but you brought up something that people who don’t know about type 1 diabetes have no clue about and people with type 2 diabetes generally don’t have to worry about. I think this is a good time to talk about that is worrying about making sure that your blood sugar doesn’t drop too much during the night. Normally, with type 2 diabetics, all we’re concerned about, or mostly what we’re concerned about is that fasting glucose in the morning, we don’t usually worry about problems with their glucose during the night, even though sometimes they can have problems there too, but for type 1 diabetics, it’s really crucial that their glucose, in particular, doesn’t drop too low during the night. Do you have a strategy for trying to keep the glucose from dropping too low during the night? And this is sort of starting to our discussion of diet. I did have one discussion with another guy who was a health coach who talked about eating some healthy fat in the evening before bed. He actually has some product with a bunch of nuts and things like that in it. What do you think about the best strategy to keep the blood glucose fairly even during sleep?
Lauren: Yeah. Look, I’m here to change the narrative, I think, around a lot of what we’ve heard that is the best for anything, right? What’s the best strategy or way to eat for this or for that? There really is no best way and I’m not just saying that, right? You could have somebody who thrives on the keto diet, somebody who thrives on high carb, low fat, who thrives on this, vegan, whatever it is, but the truth of the matter is, you have to find what works best for your pattern in terms of what’s sustainable, but also for your blood sugars. There is no one size fits all. It’s actually the main issue with the healthcare system is that they view too much all type 1s as a here’s what’s were going to work for all of you and that’s just not the case. You have one guy, I don’t know if he was talking about type 2 or type 1 or whatever.
Dr. Weitz: He was talking about type 1. Yeah.
Lauren: type 1, okay. You have somebody who’s saying that increased fats before bedtime are going to help you sustain without having a low, I can give you 20, 25 case examples in the next 20 minutes of people who would not benefit from that, right? Because increased fats in their diet are going to actually sustain a higher blood sugar number over bed. It’s not exactly what is one size fits all, but hey, what happens to my blood sugars overnight? If it’s they’re going too high, they’re going too low, what needs to happen beforehand? I can give you a personal example for me. If I had fats before bedtime, my blood sugars would be running high because that fat acts like a buffer and help and creates a little bit of resistance to my insulin, my basal insulin that’s coming overnight. For me, it’s actually more beneficial to have a carb snack if I want something for dessert. Let’s say a bowl of berries or an apple with maybe just a little bit of peanut butter, something like that because I can then give insulin for it. I know how it’s going to, what it’s going to do with my blood sugars in those two hours and there’s not going to be a prolonged effect on my blood sugars in that two to eight-hour span, which happens when you add some facts in.
Now, it depends on the amount of fats, the quality of the fats, all these different factors, but all to say in the end that it’s like, look at what’s happening to your blood sugars overnight and understand what certain foods do to your specific blood sugars and then make informed decisions based off of that.
Dr. Weitz: Right, but I wanted to point out that, where is type 2 diabetics until a point at which they get to having to take insulin, the big issue is their glucose being too high and type 1 diabetics have to worry, not only about it going too high, but also about it going too low. I think the idea of using fat was to keep it from dropping during the evening.
Lauren: Right, and I think that where the misconception is, and really understanding is so with type 1 diabetes, we have insulin that goes in our body 24/7 in all these different rates, right? Especially if you’re on an insulin pump, you have different insulin, every two hours it can be for different rates. Technically, if I didn’t eat for 24 hours, my numbers based on those insulin rates should actually stay stable and should not drop. Now, if you’re on shots, which might have been the case for that past episode guest that you had on, that could be possibly a, well, I can’t change my insulin rates overnight time, so I have to use fats because my natural tendency is to drop. In his case, of his bio-individual body, those fats could be helpful for him.
Dr. Weitz: What percentage of type 1 diabetics are on insulin pumps?
Lauren: It really comes down to the accessibility issue that I said earlier. I would say that, I would have to guess a lot of people who have the option of doing, being on pump therapy or on CGMs, they choose to do that, I think it’s a larger percentage and the people who have the option based on insurance, and then say, I don’t want to go on. I just would rather be on shots. I don’t know the exact percentage, but I don’t know if it’s 50/50, I’m not really sure.
Dr. Weitz: It’s based on cost and insurance coverage.
Lauren: Cost insurance coverage and then of course, preference, right? A lot of people, there’s three leading pump companies. Two of them have wires, one of them, doesn’t. The Omnipod and that’s the one I’m on. If somebody doesn’t want to be on a pump and have something extra on their body, that’s another reason why they might not choose it.
Dr. Weitz: I’ve really been enjoying this discussion, but I’d like to take a minute to tell you about a new product that I’m very excited about. I’d like to tell you about a new wearable called the Apollo. This is a device that can be worn on the wrist or the ankle, and it uses vibrations to stimulate your parasympathetic nervous system. This device has amazing benefits in terms of getting you out of that stressed out sympathetic nervous system and stimulating the parasympathetic nervous system. It has a number of different functions, especially helping you to relax, to focus, to concentrate, get into a deeper meditative state, even to help you sleep, and there’s even a mode to help you wake up. This all occurs through the scientific use of subtle vibrations.
For those of you who might be interested in getting the Apollo for yourself to help you reset your nervous system, go to apolloneuro.com and use the affiliate code, Weitz10. That’s my last name, WEITZ10. Now, back to the discussion.
Dr. Weitz: Let’s talk about diet. You already set up the discussion by saying that you’re here to prove that or make everybody understand that there’s no one best diet for type 1 diabetics, but given that, how should we figure out what to eat if you’re a type 1 diabetic, or how should we decide what to recommend if you’re coaching somebody who’s a type 1 diabetic?
Lauren: Yeah. It’s a great question because we can’t just look at it and say, “Oh, well you have type 1 diabetes. Just eat whatever you want and don’t worry about the blood sugar strategy. Don’t worry about the insulin strategy, right?” There has to be some thought process to it. Kind of my rules in how I like to think about this is, first of all, what I love about coaching is my job is not to replace a dietician, a nutritionist, a doctor, a certified diabetes educator, there is a place for all of us and where the coach fits in is really by putting the client and the type 1 diabetic in the driver’s seat and saying, “You know what? I have all this information coming at me, but ultimately I have to decide kind of what works best for me.” What you’ll see a lot of is people who look outwards to follow specific diets, and then they do it and it’s not sustainable. I think the number one rule is find something that’s sustainable for you. Is it sustainable for you to never eat bread again? Probably not, right? Are you going to set yourself up for failure if you say that and then feel like, “Oh shoot, I can’t be successful,” and kind of go through that restrict binge cycle. That’s not good, right? It has to be sustainable. The second thing is obvious, it’s what’s good for everybody, which is lead with whole foods, right? Lead with real whole foods, less processed ingredients, less inflammatory foods for people who have celiac, obviously less gluten. I think all type 1s, there’s been a lot of research on the benefits of drastically reducing dairy. That’s the case for a lot of people. What benefits people who are type 1 and not type 1. I would say that’s the second piece. Then, the third piece is knowing that there’s an emotional component to food, right? That there’s a pleasure element to food. It doesn’t mean we’re having pizza every day, but to find a place for the foods that you love, that are part of your culture, part of your family, part of your enjoyment, and figuring out a way to have those foods and also be able to have the insulin strategies to meet it so that you don’t have to compromise blood sugars.
Dr. Weitz: Of course, when you say we’re trying to eat foods that are going to lower inflammation, there’s many, many different thoughts about that. There’s a thought and some data to show that maybe animal products and saturated fats are going to raise inflammation. There’s thoughts and some data to show that lots of fruits and vegetables, anything with seeds, anything with lectins, grains, legumes, that’s going to cause inflammation. Foods that you have sensitivities to, are going to cause inflammation. I’m used to, I’m not sure it’s so easy to know what is going to reduce inflammation.
Lauren: Right. I think that you’re exactly right. There’s controversial opinions on what is the best diet. You can find books written on lectins being terrible and having certain fruits and vegetables that have those and being inflammatory and exactly like what you said about opposing theories. I think ultimately, what it comes down to, is how does your body feel when you have those things? I know that when I have dairy, the next morning I wake up, my hands are literally swollen. I know that I’m never going to fully cut out dairy, but it’s not beneficial for my body. I’m puffy, I’m sluggish. I don’t like the way it makes me feel. It doesn’t help with my blood sugars. That’s enough data for me to make an informed decision versus having to go out and read all the research studies on if dairy is good or bad and then decide based on that. It’s really combining the inner wisdom with the outer wisdom.
Dr. Weitz: Still when you’re working with, by the way, you mentioned how a health coach is different than a dietician versus a doctor, I’m a little confused about that. What exactly is the difference between a health coach and a dietician? Don’t they both put people on recommended foods and, I’m a little confused. What is the difference?
Lauren: Yeah, it’s a great question. I think that the coaching industry in general, now there is, I’m a nationally board certified health coach and we are the National Board is under the medical board of examiners. This is something that is new in the past few years and even when I first became a coach, I’m coaching people in 2015 was very like, what is health coaching, right? At the root, health coaching helps people prioritize themselves and get unstuck by helping them develop the tools and the strategies to become aware of what their blocks are, what their patterns are so that they can move towards the vision that they have for themselves. It ultimately pushes them in the, it puts them in the driver’s seat and helps them tackle behavior change more than just giving them a plan to follow. Where when you see a dietician or a nutritionist, they’re going to say, “Okay, here’s how to balance your meal at lunchtime and here’s the plan. This is your goals to have eat exactly this, do exactly that.” We’re more of the mindset, behavior change, helping you identify your patterns of what’s working and what’s not.
Dr. Weitz: Interesting. Okay. Let’s get back to, what are we going to tell this type 1 diabetic that’s coming to see you today, what they should be eating for breakfast?
Lauren: Yeah. If they were to come to me and say, “Hey, my blood sugars are high after breakfast. What should I be eating?” My role is to not tell them, this is what you should be eating because then that’s saying that I know their body better than they do. Instead-
Dr. Weitz: Well, I know my body works great when I eat frosted flakes and I pour some extra sugar on it.
Lauren: Well, then they [inaudible 00:24:31], right. Then, they wouldn’t come to me and say that there’s a problem with it. Then, there’s no reason that they’re here. They’re here and while we’re working with them is because they’re saying, “Hey, this isn’t working what I’m doing. I need to figure out what is.” Likely, the conversation goes, “I’m having Frosted flakes in the morning. I don’t know why my blood sugars are going high after.” Then, I can say, “All right, well tell me a time that you did have stable blood sugars after breakfast. What did you eat that was different?” “Oh, you know what? I had eggs and toast.” “Oh, interesting. You had carbs, but you also had some fat and protein. What does that tell you?” “Oh, it tells me maybe I had to have to add some fat and protein to my frosted flakes.” “Okay. Would you like to try that?” “Yes, I would.” “Well, let’s get curious and let’s see what happens after you do.” Right? That’s how the conversation starts and where it goes from there.
Dr. Weitz: What would you recommend to eat for breakfast, if you’re a type 1 diabetic?
Lauren: It’s something that’s pretty much, I mean, like I said, it’s not as specific-
Dr. Weitz: Let’s say I came to you and I said, “Look, I want to be perfect. I’m a type 1 diabetic. I want to live a long life, which I’ll eat anything. I don’t care. If you tell me to eat dried hamsters with strawberries on it, that’s what I’ll eat.”
Lauren: It’s not my role to tell them what to eat.
Dr. Weitz: Okay.
Lauren: I’ll stand by that, but what I will tell you is that I can give you one client that eats 70 carbs for breakfast of fruit and has perfect blood sugars after because they’re on a high carb, low fat diet, just a lot of fresh fruits, fresh vegetables. Then, I can have somebody who has stable numbers after breakfast and has eggs with two pieces of avocado, toast and have stable numbers. It’s not about the food, it’s about that person’s body, how they metabolize it, how their insulin sensitivity levels and weigh more than just what the food that they’re eating is.
Dr. Weitz: I do think that there’s a trend, especially in a functional medicine world, that diabetics, whether type 1 or type 2, should both be on a lower carb approach, but from reading some of the blog posts on your website, I think that’s something that you don’t agree with.
Lauren: Yeah. I think that there’s people who, for sure, thrive on a lower carb diet. It’s definitely easier, right? When you take carbs out of the equation, it’s a lot easier to not see that initial blood sugar spike, but what you see and this isn’t my opinion, this is research and science fact, when you have a higher fat diet, there is a higher A1c correlated to that and a lower percent time in range due to insulin resistance. There’s plenty of research that shows when you have a higher fat diet and you’re eating carbs at the same time, you’re going to have a little bit more elevated, than, if you’re eating even kind of moderate levels of everything, a little bit more moderation, there’s also tons of research that shows when people have a high carb diet and I’m talking 400, 500 carbs per day and a super low fat under 20% diet, they can have great A1c’s too. You can find the support, the research to support either one.
Dr. Weitz: Yeah. I’ve talked to other coaches. I interviewed Cyrus Khambatta and Robby Barbaro, do you know them?
Lauren: Yes. I know both of them.
Dr. Weitz: They have Mastering Diabetes and they basically told me the same thing. I personally have not ever noticed that. Quite patients that I work with who have elevated hemoglobin A1c, I’ve never seen anybody who followed a low fat, high carb diet lower their hemoglobin A1c.
Lauren: Yeah. They’re master in diabetes, Cyrus and Robby are great examples of that, where they’re saying, “Hey, we’re going to show you a different way to do it.” I have ate their diet before, and it’s not sustainable in my opinion, but there are plenty of people who it works for them and you can’t fight the results, right? They speak for themselves. You can’t fight the results of somebody lowering it by removing carbs. You can’t fight the results of people lowering it by increasing carbs and having super, super, super low levels of fat. That, to me, you’re taking out oil, you’re taking out a lot of those that macro that helps other things of the body, like your skin and your hair and your nails and all that type of research, right? There’s controversy in so many different areas, but the point is, is that if it works for somebody, we can’t knock it, right? It’s a possibility.
Dr. Weitz: I guess one of the concepts is that increased levels of either fats or saturated fats, or I have even heard people claim that animal proteins increase, decrease insulin sensitivity.
Lauren: Mm-hmm (affirmative). Yeah.
Dr. Weitz: Which of those? Do you think all of those or do you think it’s just saturated fats or [inaudible 00:29:19]?
Lauren: Yeah, for sure. For sure, what we can see and we have let’s say 800 people that apply for our coaching programs per year. We have a lot of data in terms of type 1 diabetics and food and what works and what doesn’t for the majority of people. What we can tell is the higher the dairy and the animal fats, I don’t know, specifically saturated, [crosstalk 00:29:40]…
Dr. Weitz: Yeah, and animal fats. Okay.
Lauren: … animal fats, it’s contributing to the higher levels of insulin resistance. Now-
Dr. Weitz: You’re measuring that by hemoglobin A1c?
Lauren: Yeah, by hemoglobin A1c and also time and range. Time and range, I think, is even a better indicator than A1c.
Dr. Weitz: Okay. What is time and range?
Lauren: When you wear a CGM, oftentimes the doctor will say, your time and range, we’ll set your goal between 80 and 180. It’s how much, what percentage of the time are you staying between those numbers? You want that number to be higher.
Dr. Weitz: Is that what the range is, 80 to 180?
Lauren: Yeah. Pretty much. You can change it. [crosstalk 00:30:21].
Dr. Weitz: 180 sounds kind of high, huh?
Lauren: For a type 1 diabetic, no. It’s not because it’s very unrealistic to say that for a type 1 where your body literally doesn’t produce any insulin and you’re in charge of monitoring every single thing, the expectations right, would drive people crazy if it was any lower than that.
Dr. Weitz: Wow. Okay. Interesting. What about coffee for type 1 diabetics?
Lauren: Interesting question. In the morning time on an empty stomach, you’re going to see most likely, depending on somebody’s tolerance for caffeine, how much they’re drinking it, frequency, all of that, you’re going to see blood sugar rise from coffee, even if there’s no sugar and there’s no cream, anything in it. That’s something that happens to me as well. I actually have to give insulin for black coffee.
Lauren: Now, when you make a small shift of eating something before you have black coffee, a lot of people will see a decrease in their blood sugar response due to just that little switch.
Dr. Weitz: Interesting. I wonder what about, have you looked at people who have more of a response from coffee or less of a response? I know there’s certain genes that correlate with that. Is it more because people get a bigger response from coffee, get more of an increase in adrenaline cortisol and that’s what spikes the sugar?
Lauren: Yeah. In my opinion, what I have seen and what I’m seeing is that your cortisol levels are higher in the morning time period, right? They taper off [crosstalk 00:31:54].
Dr. Weitz: They’re supposed to be, right.
Lauren: Yeah. They’re supposed to be, exactly. If you’re adding caffeine on top of it when you’re waking up and you’re already a little bit dehydrated and you’re not, let’s say, drinking water and you don’t have any food in your system, there’s just a higher blood sugar response. Sometimes I say, you don’t have to know the why, you just have to know the patterns. Whether that has to do with their, how frequently they’re drinking it, if it’s caffeinated, decaffeinated, all these different factors, if it’s happening, there likely has to be insulin being given for it.
Dr. Weitz: For type 1 diabetics, are you recommending small frequent meals? Are you recommending any periods of time where they don’t eat as you know, one of these strategies for longevity these days is intermittent fasting.
Lauren: Yeah. In our years of working with both men and women, we’ve seen more men benefit from an intermittent fasting than women have. I think it has a lot to do with relationship with food, with hormones, depending on where they are, in terms of what age they are. I think it can be beneficial for certain people and depending on what their goal is.
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Dr. Weitz: What about alcohol, like a glass of wine? How does that affect diabetics?
Lauren: Yeah. Interestingly enough, let me ask you, do you think that alcohol raises or drops blood sugars over, let’s say a six-hour period?
Dr. Weitz: I’ve done a little research into this recently and it’s common for people to say alcohol gets converted into sugar, but the reality is alcohol gets processed by the liver and it’s a long route until it gets converted into sugar. A number of studies show that alcohol reduces glucose response with the meal.
Lauren: Yes, exactly. I was so curious if you knew that if you were familiar with that because a lot of people think exactly like you said, that it just raises blood sugar. Now, there’s certain types of alcohol, that if it has sugar in it, and you’re adding creamery [crosstalk 00:35:32].
Dr. Weitz: Like a mixed drink that has added liqueur or something like that.
Lauren: Right, right, right. Exactly. Your blood sugar is going to rise from it likely, but over time, over the next couple of hours, they’re exactly what you said is happening with the liver, you’re likely to see low blood sugar. It’s why doctors are very, very careful of telling kids before they’re going to college if they have type 1 diabetes, if you’re drinking, you have to have a plan in place for definitely eating before you’re drinking, and also being mindful of your numbers overnight, because that can become a really dangerous situation.
Dr. Weitz: If the glucose drops too low while they’re sleeping.
Lauren: Yeah. It’s a big source of type 1 deaths, where-
Dr. Weitz: What do you think is the critical level that should not drop below?
Lauren: I mean, I’ve seen more-
Dr. Weitz: Sixty?
Lauren: No, no, no, no. No, no, no. I mean, of course, yeah. Technically on paper, it shouldn’t drop below, let’s say 75, but I’ve woken up in the middle of the night with numbers in my 21 years of living with diabetes, I’ve woken up at 35, right? It’s not that it’s, the threshold is a little bit lower than 35 before you’re in kind of a danger zone, but yeah, you don’t want to, the goal is to not get anywhere near there.
Dr. Weitz: Okay. Let’s discuss exercise for type 1 diabetics.
Lauren: Okay.
Dr. Weitz: Generally speaking, when I’ve worked with type 1 diabetics, recommended that the most important thing is to do approximately the same amount and the same intensity of exercise every day, if possible.
Lauren: That consistency?
Dr. Weitz: Right.
Lauren: Yeah. I think, type 1 thrive in routine. We thrive with consistency, with everything across the board, from workouts to sleep patterns, to nutrition, but is it realistic? Maybe not always, but as close as you can, especially I think for exercise, the more consistent you are with your exercise, the more you’re going to know what your body’s pattern is. It also goes to say, if you want to do a workout on Monday and a yoga class on Tuesday and a 5k run on Wednesday, it doesn’t mean it can’t be done, right? It’s just, you have to know what your body’s patterns are for that and you might need insulin before one of them. You may need 30 carbs with a snack before another one, just based on the anaerobic versus aerobic, whatever type of workout you’re doing because they have different blood sugar responses.
Dr. Weitz: In general, maybe you could address that. What about the blood sugar response in the average type 1 diabetic with resistance exercise, with high intensity training, with longer distance cardiovascular training?
Lauren: Yeah, that’s a great question. Generally speaking, exercise, that’s very start and stop like if you’re sprinting or if you’re doing heavy weight lifting, those are going to be things that are going to more likely increase your blood sugar than to drop it. Things like a steady state run or a, let’s say swimming or playing soccer in a soccer field, that’s probably a combination of anaerobic and aerobic, but more of that where you have your heart rate at a lower rate, but for a longer period of time, you’re going to see more of a steady drop but it also depends on how much insulin you have on board, right? That’s a key factor as well, but that’s generally what you’ll see for the patterns there.
Dr. Weitz: It’s not unusual for say somebody doing an hour workout of resistance training to see their blood sugar go up immediately after the workout?
Lauren: Yeah, exactly, but knowing that, how can you get ahead of that? I’ll give you my personal experience, right? Everybody listening, if you’re type 1, don’t do this for your body, because this is my specific pattern, but when I do weightlifting in the morning time, I will give myself insulin beforehand because I know that my blood sugar is going to go up. Normally, if I didn’t do that, my blood sugar would rise, but maybe if I do that, my blood sugar is actually not going to go up because I was able to counteract it.
Dr. Weitz: Right. Now, my understanding of this, this is another thing I read up a little bit about recently is that that’s because you’ve used up the glucose in your muscles and now your muscles are sucking up glucose, so the body’s trying to produce some more glucose to give it to the muscles. Maybe you don’t want to take insulin then and decrease that. Maybe that’s just a normal response of the muscles and it’ll settle down in a little bit.
Lauren: Right. For me, my main priority is not going high because I don’t want to have to go high afterwards and then go into a breakfast meal where I’m already starting off high, then I’m going to go higher. You don’t feel good. You feel more lethargic. I cannot perform in the gym as well as if I’m high, than if I’m in range. For me, my priority is always having that lower blood sugar and keeping it stable.
Dr. Weitz: You use an insulin pump?
Lauren: Yes. I use the Omnipod insulin pump to administer insulin. Correct.
Dr. Weitz: Does that administer the same type of insulin all day? Okay.
Lauren: Yeah. There’s this background drip that’s called basal insulin, that’s for 24 hours giving me different rates of insulin based on what I set it to. At, let’s say 12:00 a.m., it can be giving me 0.4 where at 3:00 a.m., it’s giving me 0.55, and then I give insulin that is also for giving corrections to correct a high blood sugar number and to also give insulin before food.
Dr. Weitz: Okay. Now, there’s another strategy where people will use a longer-acting insulin at certain times and a shorter-acting insulin at other times?
Lauren: Yeah. That’s if you’re on a, if you use shots and you’re not on a [inaudible 00:41:28], so you have your long-acting, your Lantus, your placebo, whatever it is and then you have your fast-acting, let’s say Humalog. They have different release times. For the long-acting insulin, you’re giving it either once in the morning or a night, or you’re giving it a split dose of it. Then, you’re just giving the fast-acting every time you eat. It’s just a different strategy of how you’re administering it.
Dr. Weitz: Have you found any nutritional supplements to be helpful for managing type 1 diabetics?
Lauren: I don’t know if I can directly speak to direct correlations, but for me, and for everybody, sleep is really, really, really important in terms of your blood sugars the next day, in terms of curbing your sugar cravings and carb cravings the next day, and sleep is a priority. I take magnesium sometimes before bed and that helps my sleep. It almost like, that’s one that I can say for myself indirectly has helped my blood sugar control.
Dr. Weitz: What type of magnesium do you take and what dosage?
Lauren: Oh, goodness. Now, you’re testing me.
Dr. Weitz: No. No. I mean, you know people-
Lauren: It has a purple top.
Dr. Weitz: No. I’m not trying to put you on the spot.
Lauren: No, it’s okay.
Dr. Weitz: It’s just, you know.
Lauren: I would say, I don’t, maybe you can tell me what, I can see the bottle, it’s G-Y, G-Y-L.
Dr. Weitz: Glycinate, mag glycinate.
Lauren: Glycinate. Yes. I take and that is the one that I have. I believe it’s a thousand milligrams.
Dr. Weitz: No, it’s a hundred.
Lauren: No? A hundred milligrams? All right.
Dr. Weitz: Okay.
Lauren: I was one zero off.
Dr. Weitz: Unless you’re taking 10 of them. Any other nutritional supplements? What about berberine? What about cinnamon? What about lipoic acid? What about other nutritional supplements that are known to help with insulin sensitivity or managing glucose?
Lauren: Yeah, I think that those are really popular for more of like type 2. You can see more direct correlations with that. type 1, because of the nature and it’s just different. There’s not anything that I can say that is directly correlating to lower blood sugars or that at least I know of or I have seen and I can speak to.
Dr. Weitz: Now, what about any new nutritional supplements that can decrease your risk of chronic diseases? We know that patients with type 1 diabetes may have an increased risk of chronic diseases like heart disease?
Lauren: Yeah, absolutely. There’s a lot of comorbidities that happen.
Dr. Weitz: I’m thinking of things like fish oil, vitamin E.
Lauren: Yeah. To be honest, this sounds even more of your zone of genius or a dietician, or like you could probably speak to this way better than I can, but I would say the biggest thing is understanding what your deficiencies are and advocating, because you’re most likely seeing your endocrinologist and they might not be looking, doing a full blood panel workup, things like that. It depends on what diet you have. I’m a pescatarian.
Dr. Weitz: Yeah. Your endocrinologist is not testing you for nutrient status. I can tell you that.
Lauren: Yeah. Exactly. Exactly. I’ve been a pescatarian for 11 years now. For me, there are certain supplements like B12 that I take that overall health, going to be more helpful and yeah, I think it’s individual.
Dr. Weitz: Okay. That’s great. I think that’s a wrap for today. Thanks for sharing some useful information, helpful information for us. How can listeners, viewers find out more about your programs and get ahold of you? I understand you have some courses, both for laypersons and for practitioners, is that right?
Lauren: Yeah. We worked primarily with people that have type 1 diabetes and also families of children that have diabetes. We have coaching programs and courses and ton of free resources. You can connect with me on my Instagram, which is just my name underscore in between the first and last name. Lauren_Bongiorno or find Risley Health on Instagram, R-I-S-E-L-Y health.com also is the website. We’re everywhere. You can pretty much find us, but if you came from this podcast, definitely shoot me a note and I’d love to connect with you.
Dr. Weitz: Okay. That’d be great. Thank you, Lauren.
Lauren: Thank you so much.
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 new nutritional consultations for patients at my Santa Monica White Sports Chiropractic and 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.
