February 28, 2024
In this session, special guest host Ashlee Williams discussed the use of continuous glucose monitors (CGMs) and their impact on metabolic health. She shared her personal experience with using a CGM and how it helped her identify the factors contributing to her symptoms. She explained that CGMs are a valuable tool for monitoring glucose levels in real time and can provide insights into the effects of food, stress, exercise, and other daily activities on blood sugar.
Ashlee described the process of using a CGM, including the placement of a small device on the back of the arm and the collection of interstitial fluid for glucose measurement. She emphasized that while CGMs are not a new technology, they have become more accessible and can be used for preventative monitoring and disease detection.
The main focus of using a CGM is to monitor glucose trends and patterns, including baseline glucose levels, postprandial glucose response, and glucose variability.
Ashlee explained that these metrics can provide valuable information about metabolic health and help identify areas for improvement. She also discussed the importance of maintaining metabolic health, as it can have a significant impact on overall health and the prevention of chronic conditions.
Ashlee discussed the accuracy and calibration of CGMs, the impact of different foods on blood sugar levels, the timing of meals and exercise, and the use of supplements to support insulin and glucose control. She also highlighted the importance of individualized approaches and experimentation to find what works best for each person.
Lastly, Ashlee emphasized the importance of continuous data tracking and the potential benefits of using CGMs in conjunction with other lifestyle interventions to improve overall health and prevent chronic conditions.
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Ashlee Williams RD: are newly using in the program, which is a continuous glucose monitor. Otherwise known as the Ctm.
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Ashlee Williams RD: So prior to joining. Oh, I practice in a small private practice space with the focus, of course, on root cause medicine, in depth, functional medicine testing, really identifying the cause of patient symptoms rather than treat the label that those the label and diagnosis of those symptoms were given.
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Ashlee Williams RD: and, like most providers, at some point in our own personal health journey, I kinda hit a wall with some symptoms. I was experiencing myself, and sadly and conventionally those symptoms were likely going to be labeled as stress anxiety. Maybe even normal side effects of having small children, which I can agree with to some extent.
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Ashlee Williams RD: But I knew something wasn't functionally optimally within me, so sought out a company neutral census, the name of that company
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Ashlee Williams RD: who made Cgm available direct to consumer and accessible to the public and created a fabulous platform that translated glucose data from a untraditional lens outside of diabetes.
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Ashlee Williams RD: that continuous glucose data and experience was how I learned that the intermittent fasting that I consistently did for years and years and years was no longer serving me types of exercise that I was kind of forcing myself to do, cause. I thought it was great for me. It was really contributing to my daytime fatigue, and with just a few tweaks, and you know the time of day that I was eating the composition of my meals.
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Ashlee Williams RD: Even the way that I exercised and moved it really and truly, completely resolved. You know what felt debilitating at the time, and just all with tracking and having this continuous data available.
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Ashlee Williams RD: So I later had the opportunity to do some part time work for nutrisense. And so that was a wonderful experience and really expanding my knowledge and experience with this particular tool and device.
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Ashlee Williams RD: So a continuous glucose monitor we also call these Cgm's are not necessarily a new technology whatsoever. They've been around since about 1999 and were developed as truly a lifesaving tool for diabetes. Management. This allowed for proper medication, you know, timing meal, timing, carbohydrate, counting things like that.
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Ashlee Williams RD: So we know that in the space of preventative medicine we are able to successfully reduce or even avoid major conditions and disease states through shifts in our diet and lifestyle.
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Ashlee Williams RD: But prevention really is a moving target. Especially with new advances and disease, detection and preventative monitoring. And as they emerge, this is where a Cgm device has come into play.
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Ashlee Williams RD: It is one of our only sources of continuous data that we have outside of, of course, are weight on a scale or heart rate, with particular you know, wearables like an apple watch or whoop. But other than that, when we look at biomarkers, there's still just a snapshot in time, you know, when we go and have our blood drawn. So this is one way that we can look at real time data in response to what we're doing each day.
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Ashlee Williams RD: So kind of digging into what exactly a Cgm is. This is a very small device. And I actually, I don't know how well you'll be able to see it. But I'm happy to when we turn off the presentation, show it again.
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Ashlee Williams RD: But just the size I have one with me today. It's a very small device that's worn on the back of our arm.
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Ashlee Williams RD: Typically in the kind of fatty as part of the back of our arm. Some devices are worn on the abdomen, and it has a tiny filament that is quickly kind of placed and shot in with a very small needle. It does not hurt truly it does not hurt, and into the subcutaneous space. And it's the filament that remains after the needle comes out, and it sits in a part of the body where it can sample something called interstitial fluid.
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Ashlee Williams RD: And this is the fluid between cells. So to just kind of clarify, we're not testing the blood itself. But this interstitial fluid and glucose moves throughout that
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Ashlee Williams RD: with the Cgm we spot patterns and trends by observing real time, glucose and response to not just our food, but our stress. And that was a big learning curve for me when I was wearing one initially our exercise, sleeping habits and sleep hygiene, and then just other daily activities.
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Ashlee Williams RD: I believe what a common question is about accuracy and calibration of a Cgm. If you've ever had any experience with doing a fasting fingerprint which is available over the counter. Any pharmacy will will let you do that for fasting glucose.
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Ashlee Williams RD: The accuracy lies in the trends so historically, nutrition, for instance, has used the free style libre. C Cgm. This is the dexcom. So they just recently added a dexcom as well.
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Ashlee Williams RD: but the accuracy will always vary some from a finger prick and over the counter fingerprint, and that's just due to the lag time between the interstitial fluid and the blood itself.
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Ashlee Williams RD: so we can calibrate nutrisens is one of the only companies and apps that allow you to calibrate, and a Cgm. Through their app, but just understanding that there might not always match that lag times a little bit different. But the trends that we're monitoring are are very precise.
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Ashlee Williams RD: and this just talks about so, so so happy for the diabetic community, you know. Imagine pricking yourself every hour on the hour. And now this is a glucose reading every 5 min with, you know, we're able to wear it up to 14 days when we use it outside of diabetes. It's really one of the first tools that we can use to close the loop between.
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Ashlee Williams RD: The, you know, immense amount of nutritional misinformation that we have access to, or just some universal recommendations that we're allowed to take our style of eating and see what's happening to our individual bodies in real time.
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Ashlee Williams RD: And one of unfortunately, what it's looking at is glucose. So this is the main metabolic substrate that has huge implications for overall health, and we know that metabolic disease and metabolic dysfunction leads to conditions like insulin resistance, of course, type 2 diabetes. But furthermore, cardiovascular disease, and even early cognitive decline.
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Ashlee Williams RD: A big reason that a lot of high, you know, executives and adults with demanding jobs. You know, we'll use continuous glucose monitor at least once or twice a year is simply from a cognitive decline prevention standpoint. Knowing that it really keeps our brain healthy to have metabolic flexibility.
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Ashlee Williams RD: This is a better picture, since I'm not really able to show the one I've got in front of me. 2 up close. So this is what the sensor will look like. Nutrisens and other companies do send waterproof bandages that go over the sensor. The sensor itself is waterproof. Some common questions is.
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Ashlee Williams RD: Yeah, are they waterproof? How do I shower? How do I swim? If I'm doing this in the summer they are, and completely waterproof up to 30 min, in a depth of 3 feet or less, without a waterproof bandage. That's just with the sensor alone
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Ashlee Williams RD: with a waterproof bandage. You're you're pretty much just good to stay in the water, and it has not been tested in sea or salt water, so kind of best to avoid a beach trip at that time, while you're wearing one and another common question is, can you fly? I absolutely can fly. It won't set off. You know, any of the routine sensors. You can also always ask for a manual
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Ashlee Williams RD: metal detector, you know, if you're worried about it, setting it off
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Ashlee Williams RD: imaging. I thought that'd be helpful to highlight in this group. You know what I've got a dexa scan coming up. I've got an MRI, I've got an X-ray, and we do have to remove them prior to any imaging. So that is, don't you want to plan your Cgm around those things.
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Ashlee Williams RD: So these are just outside of carbohydrates, right? Other things that can cause our blood sugar and our blood glucose to increase
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Ashlee Williams RD: dietary choices, of course, is the first thing that comes to mind, but also really intensive exercise. Trauma, severe infections, certain medications that if we have to take those long term, can cause
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Ashlee Williams RD: blood sugar, dysfunction and regulation at the same time as control glucose levels can help reduce over stimulation of the pancreas and really, positively impact chronic inflammation.
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Ashlee Williams RD: So we're gonna kind of dive into how we use it to do that.
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Ashlee Williams RD: This is.
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Ashlee Williams RD: I hope that's I know that writing is very small, and I'm happy to send this out when we send out the recording. But this is just a big overview of 42 different factors that impact our blood glucose. So really trying to shift our thinking in our mindset that it's carbohydrate and take alone
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Ashlee Williams RD: some of the things on this list, of course, under food is going to be carbohydrate, but also fat and protein. Can delay digestion and actually improve glucose metabolism. Alcohol is one of the primary reasons, and a person who is non-diabetic to be hypoglycemic, so have low blood, glucose.
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Ashlee Williams RD: and activity. So, too, intensive exercise for too long can cause some metabolic dysfunction, or not moving enough. Of course we know sedentary lifetime style can contribute as well
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Ashlee Williams RD: stress and environmental factors.
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Ashlee Williams RD: We will actually have an increase in glucose. While we have sunburn, for instance, always found that kind of fascinating our bodies just in recovery mode, apparently sending resources to that to that injury if you will.
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Ashlee Williams RD: So I look. Why, glucose is a common, you know we are looking at. Why are we testing glucose? And why are we not looking at things like insulin or other metabolic markers from a tech space alone. We're not yet able to have real time continuous data on things like insulin being a hormone, but because glucose is a metabolite, it's, you know, just simply easier from a technological perspective to measure than a hormone
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Ashlee Williams RD: glucose. When you think about it as well, is really the central point of our metabolic health and metabolic health to me is the foundation of good health, that other things are built upon.
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Ashlee Williams RD: If we take things like chronic cardiovascular disease, even dementia, other neurological conditions, a lot of those stem from unaddressed chronic metabolic dysfunction.
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Ashlee Williams RD: So if we can get that metabolic health and good control which glucose is really the fuel system that our metabolic engine, so to speak, runs off of, we can see this big ripple effect in preventing a lot of those common chronic health conditions.
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Ashlee Williams RD: And
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Ashlee Williams RD: of course we know America is not one of the healthiest countries around. Right now, it's an estimated 12% of Americans are considered metabolically healthy or metabolically optimal.
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Ashlee Williams RD: What that means is we look at what determines if we're metabolically healthy or optimal.
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Ashlee Williams RD: this is the process of building up and breaking down anything that drives energy in our body. And so the most obvious things about metabolism that come to mind, of course, is when we eat and we're fueling the body with those building blocks, and then we can break this down through a pretty complex metabolic system and use all of these different components for energy.
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Ashlee Williams RD: Obvious energy, like the ability to sprint or lift something heavy. But it's also you know, resurfacing different cells, growing new bone, repairing damaged injured joints, from prior injuries, and all of that is centered around our metabolic health being able to create the energy required to do those day to day processes.
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Ashlee Williams RD: Here is a
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Ashlee Williams RD: quick snapshot at different values that the dashboard or the home screen when you're wearing a Cgm. Will show you. So when we are monitoring glucose, we're looking at 3 primary trends.
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Ashlee Williams RD: First and foremost, is our baseline value. This includes both our fasting glucose and then our average glucose throughout the day.
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Ashlee Williams RD: and we definitely look at both of those things. Second, would be our post prandial glucose, which this is after we eat.
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How high is our glucose increasing, and how do we modify a meal for a better glucose response.
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Ashlee Williams RD: and then a third is probably the most important, which is a glucose variability. And this is the swings in our glucose that happens throughout the day.
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Ashlee Williams RD: A higher variability is where we have higher disease, risk
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Ashlee Williams RD: and so that's less than 14 is optimal.
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Ashlee Williams RD: You'll see. I don't know if I can. If I zoom in well, we'll it will go over. This. In A. QA. Average is less than 105 is kind of optimal for an average.
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Ashlee Williams RD: We want our glucose variability to be less than 14. We want our Max glucose, or how high we are spiking after a meal to be below 140,
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Ashlee Williams RD: 180 is a little bit of a cushion. It would, it would surprise everyone. And we can talk about that. What kind of traditional medicine or that traditional space considers optimal for some of these glucose levels. And it's pre-diabetic is what it is. And then fasting averages between 70 and 90.
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Ashlee Williams RD: And so we can kind of review those those values as well.
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Ashlee Williams RD: this is another
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Ashlee Williams RD: kind of component of the app. And what we're looking at when we're monitoring glucose, and outside of the data averages every day. One of my favorite things that the app gives you is a meal score. So this will really break down every single thing, and that we're eating throughout the day, and how our body is responding to it from a metabolic health standpoint.
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Ashlee Williams RD: The meal score will give us a score based on the 2 h window that we are eating. So it's gonna look at how high we spiked.
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Ashlee Williams RD: And it's gonna look at how quickly we recovered. So within 2 h we should be back to baseline glucose. If we're not, we've kind of you know, gotta work on some increasing insulin sensitivity or better, glucose control.
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Ashlee Williams RD: It's also gonna outside of the meal score. It allows us to look at glucose response to exercise.
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Ashlee Williams RD: With exercise, our glucose can increase to a peak of about 1 60. And that's completely normal. And okay. And we would start to be concerned, and we'll see this in some endurance athletes or some cross fit folks if we're hitting above 180 pretty consistently throughout the week around exercise. That is where we can see some of that vascular damage. Let's, you know, start to occur.
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Ashlee Williams RD: depending on our energy state.
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Ashlee Williams RD: The glucose can come from different sources during a fasted workout, and this is where our liver and our muscles are likely breaking down what we call glycogen to provide some immediate energy for that workout.
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Ashlee Williams RD: If we have recently eaten and had a little, you know, pre-workout snack, we're gonna be using the food that we just had for energy instead, sometimes a mix of the 2, of course, depending on that meal.
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Ashlee Williams RD: we will typically see a higher glucose response with exercise that is, high intensity and anaerobic. because the current energy available, whether we ate or we didn't need is just not enough to meet those energy demands.
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Ashlee Williams RD: Zone. 2 training or steady state cardio. We typically see, a gradual decrease in glucose during that activity because the energy demands are close to the energy that's available.
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Ashlee Williams RD: Stress has a profound impact on our glucose levels. When our body is under stress, it's perceived as a threat, and the body copes with threats by doing 2 different things, we increase glucose output typically from the liver. And then we reduce our insulin sensitivity.
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Ashlee Williams RD: What that means is with with those 2 things combined. More glucose is going to stay within the bloodstream, not be brought into the cell by that insulin, and which is, you know, an important strategy for our bodies if we actually need that energy to fuel. Our response to that threat. Say, a lion, you know, if we're needing to run because something's chasing us and our body kind of shifts that metabolically and allows us to have that energy.
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Ashlee Williams RD: That response is pretty evolutionary and incredibly important. But the type of stressors that we have today are not lions and don't necessarily require that additional fuel. So over time. This is where we're seeing some increase in visceral fat or body fat percentage with a high stress individual.
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Ashlee Williams RD: This is a screenshot of what that meal card looks like within the app. So it's showing you that 2 h window?
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Ashlee Williams RD: The 4 metrics that are measured around a meal again, is that peak glucose? And we aim for 1, 40, or less.
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Ashlee Williams RD: The exposure is the yellow part there. That is what we consider the area under the curve, and this looks at how much time our body is exposed to an increase in glucose after that meal.
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Ashlee Williams RD: and there's no perfect score with the area under the curve or the Auc. But we the lower the better, you know, we certainly want that amount of time to be limited.
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Ashlee Williams RD: Stability. Is the third metric. This is also known as their delta, and that shows the amount glucose changed during the 2 h around that meal. So, for example, if we started our meal and glucose our baseline glucose was a hundred, and it
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Ashlee Williams RD: peak to 135. That's a delta of 35. So we actually want to aim for a delta of 30 or less. And so that's where it kind of gets individual for going into that meal, not at 70, but at 100, you know, it's kind of specific to we. We only want that small minimal bump.
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Recovery is a big portion of metabolic
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Ashlee Williams RD: health and metabolic flexibility, and that re that compares your glucose at the start of your meal to your glucose 2 h later, and will show us how well our body recovers or returns to baseline glucose. After our meal.
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Ashlee Williams RD: I mentioned in some earlier slides that glycemic variability was the biggest contributor to different disease States, particularly cardiovascular disease, vascular damage, and early cognitive decline.
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Ashlee Williams RD: So this is showing us. The green in the middle
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Ashlee Williams RD: is what we want an ideal glucose curve to look like throughout the day, and our app and our dashboard will show us a nice curve of what our metabolic health is doing all day when we have big peaks, followed by big dips, followed by more big peaks.
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Ashlee Williams RD: We kind of refer to this as the tennis game between insulin and glucose, and it's just back and forth all day long which eventually causes that insulin resistance. And then we've got some metabolic health dysfunction.
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Ashlee Williams RD: Peaks again, can be not just from food. So now we're looking at stress management or changing the time of day that we're exercising.
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Ashlee Williams RD: you know. For instance, one of my favorite things to do to improve a a spike on stress is cold water therapy or cold exposure. So if it's like today in 30 degrees in Oklahoma, and I'm stressed, go outside just kind of that, like brisk.
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Ashlee Williams RD: cold, fresh air really helps our nervous system respond to stress in real time. And I'm actually gonna do some experimenting and and share it either on my socials, or on our page with
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Ashlee Williams RD: showing kind of a stressful situation while I'm wearing this text calm in real time, then going outside doing some cold water exposure and and seeing it come down.
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Ashlee Williams RD: it's kind of fascinating
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Ashlee Williams RD: course. Cold plunging, Dr. Dead, that's his preferred cold water therapy.
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Ashlee Williams RD: Just briefly with glucose and bone help. So how are those tied together? How are they correlated, monitoring our glucose levels? But more
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specifically metabolic health as a whole is very beneficial for bone health.
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Ashlee Williams RD: We see that chronic high blood, glucose or hyperglycemia can directly suppress bone formation, and then it promotes fat. Of course, accumulation and some marrow cavity which then leaves our bone more susceptible to fracture.
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Ashlee Williams RD: Some providers in the traditional space will even advise that those patients with metabolic dysfunction, not diabetes, just metabolic dysfunction, and take steps like anti diabetic medications to limit their risk of developing osteoporosis. They know that alone controlling their blood glucose will help with preventing that diagnosis down the line.
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Ashlee Williams RD: Of course, our objective is weight training of protein, forward diet, hormone optimization, and addressing this from a root cause perspective.
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Ashlee Williams RD: and some other metabolic factors. That influence bone health, of course, is hormone health. We talk about that all of the time in the program and balancing and optimizing our hormones.
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Ashlee Williams RD: Insulin resistance. Ha! Is associated with an increased risk of osteoporosis.
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Ashlee Williams RD: chronic because of that chronic high blood sugar interfering with bone information and then chronic inflammation, and from metabolic dysfunction, of course, can contribute to accelerated bone loss.
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Ashlee Williams RD: Okay, I think that's
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Breta RD OHH/OBH: that's the end of the slides. Do I stop sharing now, Breno, or keep them up to reference if we need, or yeah, spotlight?
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Breta RD OHH/OBH: If you guys have any questions to be would be thinking about those. I've got a couple here, and there's just something I wanted to touch on. That Janina had put in the chat at the very beginning, and she asked, what's considered underweight for being at risk of a fracture and osteoporosis bone fractures.
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Breta RD OHH/OBH: She's been eating a carnivore diet for a year, and she's down to 116 pounds. And because this ties into that last thing that Ashley was just talking about, you know, it's not just gonna be about your weight, but it's gonna be, how metabolically healthy are you? You know how much muscle do you have so really have to like zoom out and take that big picture to our weight. There, Ashley, would you add anything to that?
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Ashlee Williams RD: Yeah, I mean. So if we're utilizing a Cgm, specifically to look at that we would be potentially just looking at. Are we having too many frequent low, you know, blood glucose as as a component of our of our diet or of our weight of overactive metabolism, so we would be able to highlight and see if that's a part of the equation.
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Breta RD OHH/OBH: which I think lead us to into like. Since I know everybody here is very interested in hormones as well, how blood sugar impacts, hormone levels whether it's too high or too low, like, what kinds of things would we see and impacts like from having altered blood, glucose metabolism on our hormones?
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Ashlee Williams RD: Yeah.
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Ashlee Williams RD: lot lots of different impact. So of course, insulin is a hormone and so when that is dysregulated in response to poor glucose metabolism similar to cortisol being able to dysregulate our sex hormones so can insulin. So it's really a way to address all of our hormone and metabolic health from a root cost perspective
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Breta RD OHH/OBH: some.
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Breta RD OHH/OBH: And
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Breta RD OHH/OBH: I have a few questions that were submitted that I wanna make sure that we get to and I think we can just rapid fire a few of these. So do you have any perspective on which Cgm is the most accurate.
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Ashlee Williams RD: Yeah. So the FDA has not identified a particular. Cgm, they have approved Cgm's as a full for an accurate way to measure real time blood glucose levels. And it's simply about the trends, though, you know, right? So it might not, even with a serum, level glucose, reflect in real time. But it's just back to that different lag time with interstitial fluid levels in glucose.
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Ashlee Williams RD: There's not a ton of difference between a freestyle and a dexa or dexa, a desk call phone help and not, you know, not a lot of difference at all, and so I think one of them, I believe, was mentioned. They're just a little bit more resilient, you know. Stay on arm better. Their adhesive is preferred amongst some. And so it's really but yeah, accuracy wise. They're pretty comparable.
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Breta RD OHH/OBH: awesome. And
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Breta RD OHH/OBH: one of the other questions that we got was just asking about like sugar intake for the day. So this person does one tablespoon of molasses, one fig. 6 prunes and their blood sugar test comes back about 90. But I think that's from like a fasting. So what other like things would you be looking at just like from a practical level on, I know, is our blood sugar healthy
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Ashlee Williams RD: around those particular carbohydrates. Do you think that's the yeah. So a good experiment would be. And you can actually do an oral glucose tolerance test. You know, something that we typically will do in prenatal patients, but you know certainly not in a doctor's office as well while wearing a Cgm. So 75 grams of carbs. And then we monitor that glucose and recovery response. So with that is, you know, a
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Ashlee Williams RD: pretty dense, quick sugar line up that list right there. So it would be interesting to see if you go into that meal at 90. How high does that spike you? And then can we modify it a little bit with some protein? First, this is called meal sequencing. Having even 10 grams of protein 5 or 10 min before the carbohydrates would improve that glucose response as well.
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Ashlee Williams RD: It it gets so precise but individual, which is what we're aiming for?
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Breta RD OHH/OBH: Yeah, I think using the Cgm's right, is that like individual tools really helpful? Which we do. I, if you guys are like, kinda curious about a Cgm, now, in your products and tools. Section on the website, or like on the Hsn portal side of things. There is a link for nutrisense there. And then Julie can actually put the link in here as well. But if you're an annual member for Ob or Oh.
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Breta RD OHH/OBH: we have special membership rates on those things. So just reach out to your dietition or your coach. If you're interested in doing a Cgm, if you're part of our 12 month program. So
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Breta RD OHH/OBH: something else, I think, is super interesting is glucose response and sleep. So somebody had asked, you know what? Why, they they have a Cgm. Already, and they are getting like these huge spikes when they're sleeping. What's happening?
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Ashlee Williams RD: Hey? Yeah. So
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Ashlee Williams RD: we'll have a little bit of both with sleep. Sometimes we'll have big dips. And you know, honestly, some of the dips, more specifically are going to be called pressure dips. This is, if we're sleeping on our sensor. So if you do wear one and you freak out because of the morning, it said you went to 20. That's likely a a pressure dip we were, you know, sleeping on it, and increasing glucose would be
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Ashlee Williams RD: poor meal timing close to bed. So either we're eating too late, and this is, gets very specific with how our metabolic health is right. So either we're eating too late or eating the wrong macro distribution of that meal potentially too much fat going into bed, because that will prolong that glucose response. Keep it in our bloodstream a little bit longer, and kind of having a higher amount at night time, of course, is gonna disrupt our sleep and fasting through the night, you know, around 8 h optimally, the best sleep we
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Ashlee Williams RD: defined as around 75, 80, someone sleeping, you know, consistently through the night, having really good quality sleep, anything above that is going to be kind of bringing us out of rem sleep and contributing to poor quality. Sleep
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but we would be able to see
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Ashlee Williams RD: from that mail score card you know, if we have bad recovery. And that's kind of the component that contributes to to bad nighttime values.
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Breta RD OHH/OBH: And since most of our clients are so data driven too, you can definitely take your data from like through loop or your aura ring and looking at your sleep quality, and then like, sync that up and just align it with. You know, what were your glucose levels doing at those times like, what did you eat? So then you can kind of pair those things together to really optimize your sleep as well, cause I know that's huge for a lot of you guys, we had a lot of sleep questions early on, too. So yay, some questions coming in in the chat here, though, is
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Breta RD OHH/OBH: one really big one, is exercise and eating when is the best time to eat for exercise, and then
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Breta RD OHH/OBH: let me look here.
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Breta RD OHH/OBH: is there an optimal time to exercise, to like, avoid damage to your metabolic health? And with that I would say, I would also ask if you have any perspective on like
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Breta RD OHH/OBH: pre menopause and post menopause in those ideal times. So it's kind of like a combo question. However, you answer that.
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Ashlee Williams RD: Yeah. So I'm kind of going back to the endurance. Higher, you know. Intensity exercise. What I find is if we go into those completely fasted. And you know, back to my kind of intro and story. That's what I was doing. A lot of first morning completely fasted. I would fast until about noon or 2 in the afternoon, and have really high intensity workout during that time, and
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Ashlee Williams RD: not only was that a stressful scenario for my body. But that's what led to some. You know, your cortisol will start. It's a process called gluconeogenesis, you know, really converting non-carbohydrate foods into glucose. Because I'm getting too low, and I don't have enough readily available energy for that exercise that I was doing so. Then we have cortisol and balances that don't feel good. And so, depending on the exercise. Right? If we go into
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Ashlee Williams RD: zone, 2 kind of steady state exercise, we can get away with a small meal. You know, ideally small source of carbohydrate for a little bit of energy before that. You know. Source of fruit or some Greek yogurt going into a steady state zone. 2 exercise. Now, if we are going to go run 1520 miles.
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Ashlee Williams RD: we're gonna need a little bit more carbohydrate glucose energy on board. Otherwise we're gonna start seeing some metabolic dysfunction from just having a poorly fuel, you know, workout with menopause. Specifically, of course we're gonna have.
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Ashlee Williams RD: See, unless there's hormone replacement therapy on board just some lower hormones. So there would be
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Ashlee Williams RD: Just I feel like a higher need to properly fuel those exercises so that we don't further imbalance those those kind of delicate moments at that time so always protein, of course, little bit of before. Even more important after this is for exercise across the board, and then carbohydrates. Gonna be very dependent on your current metabolic health. How well you're tolerating carbohydrates, which is completely
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Ashlee Williams RD: different person to person. And we know this by using a Cgm.
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Breta RD OHH/OBH: and then yeah. So there'll be more dependent around how you utilize those carbs. Yeah, I think that's really important, too. Like when we talk about fueling, even though we're talking about continuous glucose monitors which generally like has us thinking about carbohydrates. It's about the protein, the fat, and the carbs together, and like in Combo, they have a big impact overall on your metabolic health. So playing around with some of those things to figure that out. And if you're
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Breta RD OHH/OBH: like interested in, just like what is zone, too, if you're not like tracking or anything like I wear a loop, and that will tell me kind of what zone based on my heart rate, that is but just like a good rule of thumb for zone 2 would be if whatever activity you're doing, it could be walking. It could be weightlifting. Where you could talk to somebody, but you can't sing. That's kind of a good example of like what it feels like to be in that steady state energy. Expenditure. So yeah.
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Breta RD OHH/OBH: next up, let's talk about carb sources and basically like
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Breta RD OHH/OBH: the theoretical low glycemic products like Stevia agave fake sugars and acts that and how they actually impact blood sugar levels and what you'll see on a Cgm as well. And I would just like to throw in there. I wouldn't probably not consider agave a low glycemic product. It does have less sugar per like more sweetness per like unit than honey does. But I wouldn't.
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Breta RD OHH/OBH: That would still be considered like a sugar.
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Ashlee Williams RD: But anyway, yeah, yeah, so interesting enough. Artificial sweeteners, of course, were intended and created for our community of metabolic, you know, Li unhealthy individuals, pre-diabetic, diabetic, you know. Unfortunately, we were telling these patients in a clinical setting. You can not have Jello, but you can certainly have as much sugar free jello, as you ever could want and that was our, you know, kind of
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Ashlee Williams RD: healthy approach at that time, but
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Ashlee Williams RD: we won't see a huge glucose increase. So that is correct with some of those artificial sweeteners. Again, there could be some individual variability there, but for the most part we won't see a big spike. However, what we've seen over time is.
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Ashlee Williams RD: I consider, the artificial sweeteners to be like the boy who cried wolf. We're constantly eating something sweet. Your brain knows that sweet. So it's gonna tell your body and your pancreas to release insulin. They're eating sugar when there's no sugar there. You know it's an overtime over and over and over. Why, why, it's send insulin at that point there's no real sugar there. So then we, you know, down the line. That's where we see some of the problems. If we have a high
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hi
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Ashlee Williams RD: intake of artificial sweeteners, we're more likely to have some insulin resistance, and not to mention a lot of those things are pretty hard on our gut, too. So in moderation, they can be great, you know, if it's a favorite protein shaker of protein powder that we're having once a day, and otherwise our diet is pretty low sugar and not okay. You know, we have to. Just take what we can with some things, but I wouldn't recommend having it as part of the daily drink snack.
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Ashlee Williams RD: you know, convenience, snack, protein, bar that sort of thing
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Breta RD OHH/OBH: awesome while we're on the topic of kind of different food products. And how those impact your blood sugar? How do you factor in like the naturally occurring sugar content of like fruits and vegetables? And how do those contribute to your daily sugar intake?
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Ashlee Williams RD: Yeah. So there's still, you know. Of course, there are going to be a host of benefits when an apple as opposed to a cup of ice cream.
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Ashlee Williams RD: And so they do still, of course, count for that total carbohydrate. But it's very fun to do experiments with tolerance of carbs, and how they differ not just in each person, but for instance, I tolerate fruit really high glycemic fruit bananas, for instance. You know really really well.
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Ashlee Williams RD: But my sister who wore one with me, you know. It was almost like she had a full piece of cake with a banana you know, absolute different response to that tired glycemic fruit.
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Ashlee Williams RD: Sometimes patients can tolerate even whole grain breads, lots of fiber, or you know, but on the verse fruit might really spike their blood glucose and not so much a bread or a grain. So it's very specific. And that's why I really recommend a lot of my patients every well visit that you have even if it's just once a year, you know. Throw one of these things on. They last 14 days. That's plenty of time to get a really good read on where your metabolic health is.
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Breta RD OHH/OBH: Yeah.
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Breta RD OHH/OBH: And I mean, I was Cgm last month, and it was super super helpful even for telling you, if you're not eating enough. So I would highly recommend that, too. And on, you know, back to the macros of things. How quickly are we available? Is each protein carbs and fat like, how quickly are those available for energy? Slash like? What would that
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Breta RD OHH/OBH: glucose response be? Maybe the more like practical question is, is, how can we blunt our in or our insulin and glucose response after eating like a less than ideal like meal?
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Ashlee Williams RD: Who? Yeah. So we always
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Ashlee Williams RD: meal sequencing works really? Well, so that's eating your protein first. If I've got
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Ashlee Williams RD: you know, grilled chicken and a baked potato and a salad on my plate. I'm gonna finish. Not just a portion of that grilled chicken, but eat all of that 5 or 10 min before consuming the rest. One. This does help with satiety. We see we're not as likely to eat the whole baked potato, cause we've, you know, consumed that 4 or 5 ounces of chicken, and but it really helps mitigate the spike, you know, from that baked potato as well.
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Ashlee Williams RD: Fat can prolong our glucose response, but we use high fat, of course, in a weight loss space, because it also helps us feel full or longer. Slows down digestion, you know, doesn't have us on on the carb train, where we high carbon. Then we dip, and we're starving and ravenous again. But if we have a 1, 61, 65 spike. And then we, you know, kind of
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Ashlee Williams RD: also include high, fat content food. At that time it is going to prolong that spike, and you know, not be optimal. So I would say for post, and not so optimal meal. It's not so much how. What can I eat to fix this? It's what can I do?
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Ashlee Williams RD: You know, we've seen things. Just like a 5, 10 min walk. Drop our glucose by 1015, even 20 points.
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Ashlee Williams RD: you know, after a high carb, content meal, apple cider vinegar has been shown to be very helpful. If our glucose is high and kind of utilizing that free, flowing glucose and getting move levels reduced. So not so much kind of what to eat to fix that response. But different lifestyle factors.
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Breta RD OHH/OBH: Yeah, I think that's super helpful, like some good takeaways there, and if your Cgm. Is showing like that consistent metallic dysfunction, I know we kind of touched on this with like the on one of your slides? But will that likely show up in your fasting insulin levels on blood tests, or like, what's that correlation there. Yeah, not unless it's pretty chronic.
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Ashlee Williams RD: So that's you know, we're missing so much in in that blood work. And thank goodness, our program, you know, it's very thorough, and we're checking all of those markers, not just even once a year, twice here. But you know, traditional traditional, primary care won't even ever do a fasting insulin. They might do a one C every now and then, you know. Glucose there, if it's fasted, that's great, it's not always imperative. So this is really kind of how to stay ahead of the curve in that preventative space
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Ashlee Williams RD: before you know a doctor kind of slam slam to the face with a metabolic dysfunction. Or
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Ashlee Williams RD: you know different diagnosis because it's been so chronic and unaddressed.
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Breta RD OHH/OBH: yeah, just such a good tool to kind of get ahead of it. And you, I think it's also interesting, too, to just see like how your blood sugar and those fluctuations might be impacting things that you didn't even think were related. Like, maybe you feel like you're having a hard time focusing, or you're having a lot of stress at work, or just like with life, and then, you know, you check your blood sugars, and make some changes with what you're eating, and you can see how that can be reduced, and then, in addition, I mean, like that, the inverse of that where your stress can also provoke that response. But it's not
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Breta RD OHH/OBH: always so clear cut unless we have the data.
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Breta RD OHH/OBH: I
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Breta RD OHH/OBH: also wanna just just on some of these questions, too, relating to like
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Breta RD OHH/OBH: what to eat and how much to eat we are gonna do a full like chronometer training to kind of give you guys a good idea of like how to to track those things and how to look at your carbs and your macros to make sure you're getting enough, or you know how we're thinking about those things for health and how to set those things up. So stay tuned for that. Next time Dr. Doug is out of town we'll be trying to get that set up. So you guys have all of that in
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Breta RD OHH/OBH: a little bit more on the practical side with Cgm's
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Breta RD OHH/OBH: john has asked within nutr sense. There's an option to calibrate, but when she does a finger stick sometimes there's a big discrepancy sometimes not, but they never match, so she ends up doing 3 finger sticks and taking the average, and puts that in the calibration after 48 h of a new Cgm.
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Ashlee Williams RD: yeah, that works that, you know, doing that calibration that way absolutely works. If it is on the higher end. That's more likely to that lag time. You know you're testing in real time your blood glucose. And so there's a little bit of lag time between that and the interstitial fluid. So if you are, what I would recommend is also
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Ashlee Williams RD: doing your finger prick and then scanning your Cgm. Kind of 15 min later. It should align a little bit better at that time. But the calibration feature is great, you know, if you want to just tick that glucose, level up a few points to to match that finger, stick it still, you know whether it was 70 on the finger sticker 120. I get back to those trends. That's really what is the most important.
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We have to scan a Cgm, every.
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Ashlee Williams RD: So at least 8 h, or we'll have some flat line data, so that I do encourage patients. And because we don't want to miss any data in our trends, knowing that that's really what we're monitoring to make sure and routinely scan your sensor. And so we don't miss out on any data.
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Breta RD OHH/OBH: Yeah, perfect, I think. And we're talking about this the other day. Nutr sense is one of the is the only, if not one, of few companies that actually lets you calibrate so definitely nice feature.
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Breta RD OHH/OBH: And to just get really clear on this, too. So just for clarity, you recommend, eat protein, first, carb second, and fats last.
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Ashlee Williams RD: Not so much fats last.
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Ashlee Williams RD: That is going to be dependent on how carp heavy that meal is if we want the best recovery. So if it is a pretty low carb meal, you know, protein for sure. But fats, fat protein go really really well together, fat and carbs. If we're trying to work on satiety, I suppose. Maybe doing some long term fasting, maybe. But yeah, if we're routinely having 3 meals a day. We we don't want it.
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Ashlee Williams RD: Have a large carp source with that fat source. But yeah, with for meal sequencing protein first 5 min and consume the rest
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Breta RD OHH/OBH: perfect. And I think one of the our favorite topics within, like the Hsn group, overall our supplements. So tell me a little bit more about like supplements, like general supplements that you feel like would help with insulin and keeping insulin or glucose level steady throughout the day.
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Ashlee Williams RD: Yeah. So first and foremost, we use a lot of antioxidants. Surprisingly so, we think, you know. Of course, things like cinnamon or apple cider, vinegar, chromium are more
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Ashlee Williams RD: you know, more often discussed on blogs and and different sources. But antioxidants, especially Ala affiliate acid.
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Ashlee Williams RD: and has been studied extensively for its benefits and improving insulin sensitivity, and then, of course, reducing oxidative stress.
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Ashlee Williams RD: Chromium is another mineral that plays a role in insulin signaling and glucose metabolism. We actually see that chromium is most effective in therapeutic in individuals with a chromium deficiency. So if they've been supplementing, if they're on minerals already, it's not necessarily something that would impact the glucose or metabolic health the most. But if they have not been you know definitely an avenue to try.
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Ashlee Williams RD: Of course, magnesium. We talk about this in the program all the time is involved in pretty much every reaction of our body and in every system. So it's involved in glucose metabolism and insulin signaling as well. Fiber. Can, you know, slow down the absorption of glucose and improve blood sugar control. So
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Ashlee Williams RD: I always we know we kind of talk when we're doing some Carb source experiments swapping out a low fiber car for a higher fiber car. And we see far better, you know, glucose response to that particular carb. And that's you know, when we look at carb quality, cinnamon can help with some insulin sensitivity, and by enhancing, glucose, uptake into the cell. This is not.
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Ashlee Williams RD: I think when we look at some of the studies, you'd have to eat a lot of cinnamon for that to be considered therapeutic. So we typically go. The other route of using minerals, magnesium, and an accident
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Breta RD OHH/OBH: awesome. And it.
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Breta RD OHH/OBH: Okay, the science might be iffy. But if you're looking for a good food tool, or like what I call like a functional new, like nutrition product. There's actually a brand of sparkling water called good idea, that has chromium in it specifically to help with blood sugar. So if you can find that near you, it's actually pretty good. And I would recommend giving that a shot if you're already like having something like that with your meals, anyway?
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Breta RD OHH/OBH: And then can you talk about you mentioned apple cider vinegar? How you feel like that's impactful for blood sugars, too, cause I feel like that's just a really big topic in the health space in general sensitivity and utilization of glucose a little bit better.
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Ashlee Williams RD: Of course it also makes our digestion a little bit more acidic, and so we're able to improve digestion from an overall standpoint as well. This can be used going into a meal any you know, anywhere between a teaspoon. A tablespoon is sufficient.
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Ashlee Williams RD: It is very acidic, you know. So being cognitive of our enable on our teeth. And typically it's recommended to either do some gummies or capsule, or if you're drinking it, of course, diluted in water and use a straw if it's something in your day to day to day. And so yeah, or can be used after to help just utilize the high glucose in the moment.
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Ashlee Williams RD: It's very, very helpful helps with protein digestion. If we're, of course, very high protein protein forward, just feeling like, we're little stuffed while we're trying to make those protein goals. That's another
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Ashlee Williams RD: implement and implement a tool that I'd like to use.
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Breta RD OHH/OBH: Yeah, super simple, super, easy, affordable, great tool. And then I'm just gonna read this comment or this question from the chat really quickly, can water affect glucose levels or cause health issues. I've been drinking an equivalent of mountain, valley, spring water and noticed lime scale in my clear tea kettle. Google says, lime scale contains calcium, and could cause kidney stones.
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Breta RD OHH/OBH: but it says it's not harmful to the human body. What are your thoughts about glucose monitoring and water consumption?
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Ashlee Williams RD: I don't know about that particular water in the whole. Yeah, that would concern me, too. I'd be looking that up. But of course hydration status would play into metabolic health and glucose control. If we are dehydrated, you know. Of course, we're gonna have
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Ashlee Williams RD: not so optimal metabolic and glucose control. If we are maybe essentially over hydrated. But technically for me, that just means we don't have enough electrolytes. That's also going to contribute to metabolic dysfunction. So it's a nice fine line always, you know, if you can add electrolytes to that water really helps with utilizing that hydration and getting it into the cell.
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Ashlee Williams RD: And yeah, potentially not have to drink as much if we're if we're utilizing that water a little bit better.
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Breta RD OHH/OBH: and this hasn't come out quite yet. But coming up in the next like week or so. Dr. Doug is gonna have a special, an extra special discount for you guys on Dr. Ashley, his wife. She's created like a really wonderful blend of electrolytes as well. So if you're thinking about incorporating some electrolytes, just keep an eye out for that discount coax, it'll be coming soon. We love
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Breta RD OHH/OBH: having electrolytes, making sure all our patients have electrolytes and are staying hydrated. So that's huge. If anybody. Now, in the last of minutes would love to unmute and ask any final questions for Ashley. Now click the perfect time, or you guys can keep submitting things to the chat. I feel like we've covered a lot of ground here today. And II know we're always looking for more information. So if anybody wants to chime in, or has any comments.
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Breta RD OHH/OBH: Now's the perfect time.
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HELEN: Well, II was wondering about how available food is before exercise always sort of took a day for it to get through you in the right way. So I'm surprised. Obviously it doesn't. It's important to be a little bit before you
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HELEN: exercise. I mean, you give it some time. But
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Ashlee Williams RD: yeah, yeah, no, it's very that energy is readily available. Course we have. You know, our our bodies are very proactive, and they're always going to work really hard to maintain a certain level of balance or homeostasis. And so.
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Ashlee Williams RD: you know, stored energy kind of the shuffle there, if we if the food we just ate is it yet readily available? It's gonna start kind of pulling and shuffling from stored energy in our muscles and then shuffling what we just ate, you know, in the form of that glycogen as well. But yeah, essentially
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Ashlee Williams RD: 5, 10 min. And you've you've got some some glucose available for that exercise. That's where those little packets you ever seen people that are doing triathlons and biking and running. They've got little gel packs that they'll use for immediate energy while they're doing those long, long endurance training in in sports.
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HELEN: but breaking down the the protein and
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HELEN: fats takes a little longer, so that it's the ones that break down into the sugars that's are the most quickly re available like potato. Probably.
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Breta RD OHH/OBH: Right? Yeah. But on the flip side of that on the end of your exercise. And I mean even before. So if you eat like a little bit of protein before, that's actually gonna give your muscles more metabolic support to rebuild. So we always recommend to that like a post workout snack, because you're especially for women. Within that 30 min window after you've done some strength training, getting in a good amount of protein because your muscles are ready for it. So it'll break it down. And then it'll package all that stuff up. So
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HELEN: thank you
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Ashlee Williams RD: what's the fire pit analogy bread, I, do you remember that from that's dieticians love. This like the coal or the bark, is the fat that's just, you know, just stays and burns long, and the yellow part of the fires protein and the blue is that quick car?
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Ashlee Williams RD: Yeah, I think so. Yeah, yeah. And that's I've been doing a whole bunch of research on some sports nutrition training for people and just kind of following Dr. Doug's research trial for him, too. So that's definitely a huge component is making sure that you're eating enough and eating enough of the right things.
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Breta RD OHH/OBH: including like what we call branch chain amino acids. So there is a branch chain amino acid called leucine, and that is really like that pro muscle building amino acid that we wanna make sure that we're getting in. And so most commonly it's found in way, protein. But if you don't tolerate dairy or way that's totally fine. There's branch chain amino acid supplements that are super helpful. Take them every day and it really helps.
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Breta RD OHH/OBH: So what's happening in your muscles is they can either be in muscle, protein synthesis or muscle protein breakdown, and the Leucine, with a few other things really helps them stay in muscle protein synthesis for longer, which allows you to utilize that protein. Better?
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Ashlee Williams RD: Yeah, interesting. Yeah.
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Breta RD OHH/OBH: Any other questions we have about 5 min left, but there's no more questions. We can always wrap up early, or any just questions, comments for Ashley.
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Nancy Mandowa: I have a question about the leucine, or any or any amino amino acids
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Breta RD OHH/OBH: my my previous understanding was that you needed to take them separately from the other proteins in order to have much effect. Is that correct? So actually with Leucine, it's best to have it with your protein source, but you can take them on their own too. So either way should be fine. But say, you are really trying to to build up muscle, having some leucine with your protein, which is why, you know that way. Protein already has some of the leucine in there could be really effective for that. But again.
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Breta RD OHH/OBH: a lot of our patients don't tolerate dairy, and there's plenty of other options if you don't tolerate dairy.
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Nancy Mandowa: Thanks.
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Breta RD OHH/OBH: And the question here in the chat is, do you need to take Vca's close to a workout.
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Breta RD OHH/OBH: you definitely can, and utilize them in that way. I personally like to take them in the morning, and then, depending on what kind of workout I do. But yeah, it's it's really up to you. And I mean, it will also depend to on like your performing schools. We might get a little more dialed in if you're like really training for something. But if you're focused on like health span and wellness, getting super nitty, gritty doesn't necessarily
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Breta RD OHH/OBH: make the biggest difference.
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Ashlee Williams RD: I like to use them a second time. If I'm super sore as well they can help with recovery. If you kind of overworked yourself. You know a day of the week. You can always use them again later in the afternoon, or close to the evening time to help with soreness.
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Breta RD OHH/OBH: Yes, 100%. And just to clarify thanks for calling us out here. Bca stands for branch chain amino acids. So it's a particular component that makes up proteins, and all proteins are made up of a different combo of amino acids, so sometimes they have branch chain amino acids. It just depends on the protein source.
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Breta RD OHH/OBH: Wonderful. Well, if there's no more questions which will stay on for another 4 min, but I think we'll go ahead and wrap up today. Thank you. Guys all for coming we had a great turnout today. And II really enjoyed Ashley's presentation. I hope you guys got a lot out of it. We'll finish up the recording, maybe edit out the first few minutes where we are doing some tech check, and then we'll get that uploaded to Hsn for you guys to review. And something exciting is we're really working on the Hsn education vault content
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Breta RD OHH/OBH: and glucose metabolism and Cgm's are going to be a whole deep dive Mini series within the vault, too. So keep an eye out for more questions on, or more education around this. And if you guys have questions, put it in slack, and we'll collect those things and make sure we answer those in those deep dives for you, too.
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Nancy Mandowa: Thank you.
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Ashlee Williams RD: Yeah. Have a wonderful day. Everyone great to see everybody.
