Recording

Session Notes
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Topics Discussed:

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**Type 2 Diabetes and Osteoporosis**

* Dr. Doug emphasized the importance of metabolic health and its impact on osteoporosis. Elevated glucose and insulin levels can negatively affect bones and overall health.

**Glucose Metabolism and Insulin Resistance**

* The relationship between blood sugar and insulin was discussed, explaining how the body processes carbohydrates and the spectrum of metabolic dysfunction leading to type 2 diabetes.

**Insulin Resistance in Different Body Types**

* The conversation covered how insulin resistance can affect individuals with different body types, including those with smaller frames and those with larger bodies who have osteoporosis.

**Dietary Approaches to Osteoporosis and Blood Sugar Management**

* The impact of various diets, such as alkaline, vegan, and Western diets, on blood sugar and bone health was discussed. The focus was on the importance of a whole food-based diet and the potential risks of high-carbohydrate diets.

**Tracking Nutrition and Carbohydrates**

* The benefits of tracking nutrition, particularly carbohydrates, were highlighted. Breta shared resources in Slack, including meal plans and guides for tracking carbs.

* A study was mentioned where participants increased their fruit and vegetable intake to over 9 servings per day and saw improvements in bone markers. Concerns about the impact on blood sugar were addressed.

**Community Questions**

* Various questions from the community were answered, including topics on artificial sweeteners, optimal fasting insulin levels, hypoglycemia, and the effects of GLP-1 drugs on bone health.

Key Takeaways:

* Metabolic health is crucial for managing osteoporosis and overall health.

* Insulin resistance can occur in individuals regardless of body type.

* A whole food-based diet is recommended for bone health and managing blood sugar levels.

* Tracking nutrition can provide clarity on dietary intake and help tailor individual nutrition needs.

* Frequent eating may be beneficial for some individuals to manage hunger and blood sugar levels.

* GLP-1 drugs may have negative impacts on muscle and bone health due to their effects on satiety and food intake

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Transcript

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Breta Alstrom: I have not yet. I just jumped on.

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Dr Doug: Well.

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Dr Doug: so I'm just changing my name.

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Dr Doug: So Brett has been here before. Bretta is our gosh! What is your title now? Brett?

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Breta Alstrom: The Director of Marketing and Development.

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Dr Doug: There you go. But Brett is also a registered dietician, and has been with us from the beginning of the optimal human health optimal bone health world. So we're gonna play this a little bit differently as we try to figure out the best way to serve the number of people that are showing up to these.

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Dr Doug: So Brett is here. She's gonna help moderate and we're gonna figure out kind of what that means. But as people are rolling. In. What other announcements? Brett, I have a list.

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Dr Doug: What do you think of anything off the top of your head?

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Breta Alstrom: Yeah. So I know we sent out a survey on what time we were going to host Host Hsn. And this ended up kind of being the the best time across the board. So we're just gonna go ahead and keep it here for now, and we might reevaluate in like a few months and then for today, I'll I can outline the format of what we're gonna do today. But I can do that now, or I can do that in a second, wherever you want.

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Dr Doug: Why don't you go ahead and.

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Breta Alstrom: Awesome. So we are gonna be talking about type 2 diabetes and swung resistance all things blood sugar today. So we've kind of got a little bit of an outline for what we'll talk about. So then, as far as it goes, with asking questions. If there's a part of the conversation where you have a question that's really related to what Dr. Doug is discussing at that point. Clarity?

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Breta Alstrom: like a specific question about that, feel free to raise your hand, and then we'll go ahead and have you chime in. If you have other like broader questions related to blood sugar type, 2 diabetes, insulin resistance. Go ahead and put those in the chat, and we'll answer those at the end. And as we go, and then we'll reserve like 10 min at the end for just anybody to jump in and ask any question whether it's related to type 2 diabetes or not.

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Breta Alstrom: and if we don't get to your questions. We'll take everything back to slack. And I wanna make sure you guys can access all of the different channels. I know we've had a little bit of conversation about that in slack, but you can post those into like the specific channels based on your question. Hold on. Let me get the chat open up here. Sorry.

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Breta Alstrom: awesome. Okay. I love the questions coming in already. So thank you guys for putting those there. That's awesome.

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Breta Alstrom: But as far as accessing slack goes, on the left hand side of slack, and I will just

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Breta Alstrom: share this document here.

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Breta Alstrom: for you all. But this is how

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Breta Alstrom: this is a slack tutorial on how you can make sure you're in all the channels that you want to be in. So on the left hand side of slack. There's 3 little dots you can click on more and there should be a little like hash

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Breta Alstrom: tag that says channels next to it with like a little search button. And that's how you can view all the channels that we have. But I posted that link in the chat for you guys to access. It's also in slack as well. I'll repost it in our main feed in slack and that's all I have for right now until you want to get started. So Dr. Doug, if you have any other

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Breta Alstrom: announcements you want to make.

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Dr Doug: No, that's perfect. Thank you. The one thing I did want to ask and, Bredo, if it's

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Dr Doug: just well, it's just answer the question. So are we. Have we been updating the affiliate companies that we're working with in the affiliate section because we've had some new ones come in one. I think something that would be good for us to do is to like, keep an updated list of new ones so that I can just kind of walk through what they are.

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Breta Alstrom: Yeah, we do have those under the tools section on Hsn, and then we're working on getting all of your guys as accounts migrated over to our new platform. We just gotta work it out. So you guys don't get double charged. That's the only reason why it's taken a second to get you guys over there, but we'll get you over there, and then you'll be able to see the new platform access everything all in one space, and the tools will continue to be updated over there.

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Dr Doug: Yeah. So we'll do a better job of presenting the affiliate. So you guys understand what they what they are and why they're there. Cause they are all hand picked

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Dr Doug: so alright, so should I start talking about diabetes.

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Breta Alstrom: Well, I will start for yeah. Guide you here. So I do think it'd be really helpful if we could just start with like a high level outline of why, we're talking about type 2 diabetes, blood sugar metabolism, and how it's relevant to osteoporosis.

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Dr Doug: Yeah, great so it's diabetes is an area that I have a lot of interest in. One of the reasons why I even made a shift in my career is when I watched in through my wife's nutrition practice.

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Dr Doug: how she was able to reverse or put a remission diabetes, depending on how you look at it, and it just blew my mind because I was taught that diabetes is not reversible, that it's progressive, and it's a death sentence.

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Dr Doug: So I learned a lot about diabetes. I have coached a lot of people through that and helped my wife create the program around that

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Dr Doug: diabetes in relation specifically to osteoporosis is really interesting, because I'll give you a little bit of background. But diabetes

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Dr Doug: from a metabolic perspective, and I look at it as a metabolic dysfunction, and I'll explain what that means in a minute. But when you have metabolic dysfunction of your glucose metabolism and you have elevated insulin it will negatively impact everything, including your bones, including your muscle, including your heart, health, brain, health, inflammatory factors, all of it.

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Dr Doug: So metabolic health is one of the key things that we look at when we're doing an initial evaluation of our patients. And if we see elevated glucose a one C. And I'll explain all these things for those that don't understand it. But if you see elevated glucose, a one C, and fasting insulin, then that becomes probably our primary goal, even if they have severe osteoarthrit arthritis.

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Dr Doug: osteoporosis, and arthritis, because it's it's that important. It is one of the biggest risk factors that we could hammer down.

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Breta Alstrom: Yeah. And so for a lot of people here, if you maybe don't know or you haven't been formally diagnosed with type 2 diabetes

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Breta Alstrom: that doesn't necessarily mean that you have healthy, glucose metabolism, so that blood, sugar, metabolism. And so how is this

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Breta Alstrom: conversation, like also relevant to those people who don't have a formal diagnosis of diabetes.

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Dr Doug: Yeah. So when we look at when we look at glucose metabolism, and we can even like put the term diabetes on the shelf for a second, and just talk about glucose metabolism. What happens when your body consumes carbohydrates?

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Dr Doug: There is a spectrum of dysfunction all the way from normal normal metabolic function which would honestly be. There was a study published a couple of years ago that showed that if you look at these specific parameters from metabolic health. About 10% of the Us. Adult population actually is metabolically healthy. So probably within this group of however, many people are here 55 people on this call, probably 5 or 6 of us actually are metabolically healthy.

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Dr Doug: which is pretty amazing. Now, this might be a special group, because this is a subset of the population, but still it's probably not as many as most think. So there is a spectrum from metabolically healthy all the way to type 2 diabetes.

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Dr Doug: and there's a lot of people that fall somewhere in between. And early on we see it in our labs this early metabolic dysfunction. Most doctors aren't looking for it until you have hit the threshold of diabetes. Maybe pre diabetes. If your doctor is really looking at the labs closely. But most people have metabolic dysfunction way earlier. And we can.

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Dr Doug: We can intervene much earlier. And and it's so much easier. And you really start to see the negatives of that metabolis function again much earlier than a diagnosis of of diabetes.

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Breta Alstrom: And I think

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Breta Alstrom: I'm excited because we can get into like the nitty gritty. And I think this group really thrives with that. But can we break down the relationship between like blood, sugar and insulin? And just kind of like, talk about that on metabolic level? So everybody has a basic understanding of like, what's happening in their body.

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Dr Doug: Yeah. So glucose metabolism is is really interesting. And it's funny. I wasn't taught, you know. Brett was taught this in her training. I was essentially taught none of this in my training. So whenever you like, I hear these complaints all the time about. Oh, my doctor didn't ask about this or that. It's like they didn't. They don't know it. They don't know what to ask. They don't know what they don't know.

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Dr Doug: So when I started learning about it. It was really, you know, surprised to to learn 2 main things. One is that your body is making glucose all the time.

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Dr Doug: and your body does need glucose, but it doesn't necessarily need to consume carbohydrates. And this is a big misunderstanding of what is required in a diet. So we can. And this is why people can survive on a Ketogenic or carnivore diet, because your body's always making its its own glucose. Whether or not that's enough

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Dr Doug: different conversation, but your body can make it, which is really interesting, and then we can consume it right? We can consume carbohydrates. And so when you consume carbohydrates, or when your body makes

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Dr Doug: glucose, it all gets broken down into glucose. It doesn't matter if it comes from a sweet potato or a skittle, it's gonna become glucose. Right? Fructose is a slightly different topic. But we'll just stick to glucose for now.

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Dr Doug: So when glucose goes into your body, it goes into your bloodstream as this simple sugar, and your body has to do something with it, because if your glucose level is just rose, rose, then you would have the complications of diabetes, which is, when things start to not function well, so your body has to do something with it, and the hormone insulin which comes from the organ. Pancreas

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Dr Doug: hormone insulin is secreted in a response to to glucose going into your bloodstream, and it's really really sensitive to it. Like, if you just sort of sniff for people that are really insulin sensitive. If you just sniff sugar, your body will make insulin right. And I saw a question about low blood sugar. And that's actually a component of that really too sensitive potentially but your body makes insulin and insulin goes out into the bloodstream, and it tells your cells to bring that sugar

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Dr Doug: inside. And so it's essentially telling your body that you have adequate fuel. You need to store that fuel. So insulin is a storage hormone. And so when we consume carbohydrate, or what we're making on a low basis, you require some level of insulin to to then take care of that.

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Breta Alstrom: Yeah. And when

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Breta Alstrom: we use the term insulin resistant.

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Breta Alstrom: can you just explain that on like what we're talking about when somebody becomes insulin resistant.

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Dr Doug: Yeah, absolutely so, just like

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Dr Doug: almost all hormones, insulin should be used and should be seen only when it's needed. Right? So if you were to consume, say, 3 meals a day, even if they were high carbohydrate meals, you would consume that meal. Your insulin would go up. You would dispose of your glucose appropriately, then your insulin would come back down. It would go away

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Dr Doug: like so many things in our society, when something hits you all the time, whether it be the news or your 2 year old screaming, or whatever the stimulus is, whenever something is being presented to you all the time, then you get accustomed to it right. Sometimes something will turn off, and you're like, Wow! I didn't even know that that thing was on. But, man, that was loud like, it's so much quieter now you get resistant to it.

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Dr Doug: So same thing happens with hormones when the hormone is present. All the time the cell receptors actually get resistant to it. And then you need to, because you're still getting the signal from glucose. You need to start putting out more and more insulin. And that's something that we can measure in blood as we'll see people's insulin levels start to rise. And so, instead of a normal level, you know, fasted of like a single digit. We can actually see fasting levels start to rise on the double and even triple digits.

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Breta Alstrom: Yeah, I think of like,

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Breta Alstrom: just as like a simple like analogy when your body breaks down carbohydrates or your liver produces that glucose that goes into your bloodstream. You need that insulin to unlock the cells, to use that sugar is energy in your body, and

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Breta Alstrom: when you constantly have, you know all that sugar coming in, and your cells become less sensitive to it, they become insulin, resistant. The insulin then takes the extra that it can't get into the cells, and or if you're saturating your system with extra sugar, and then it will store that as fat, too. So.

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Breta Alstrom: being mindful like how everything is connected. And then how like. Let's also talk about a little bit about how blood sugars can actually influence our vascular and cardiovascular health. Since that, I know is a big topic in this group as well, and a lot of times we separate the 2 on like diabetes and heart disease.

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Dr Doug: Yeah, well, and that's why I think metabolic disease is so important. And so for those of you that in here that are patients you've you've heard me talk about this because I talk about it every time, which is, we always wanna look at our bone health through the lens of health span. And that's why our report is what it is. That's why we have a metabolic health section and a cardiovascular section and a brain health section.

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Dr Doug: Because we have to. They're all connected. We have to deal with it. So metabolic health will impact everything. So when blood sugar is elevated, it is when it's too high, it is toxic to specifically in nerve endings. But it's also toxic to the endothelium, the lining of the little arteries. So anything that has

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Dr Doug: little arteries going to it, which is most things. But the things that are most sensitive would be like the eyes. And really, if you just think the list of the complications of diabetes. Right? It's it's the eyes, it's the nerves in the hands and the feet. And it's because in those areas we have in the kidneys it. In those areas we have the most small vessels and the small vessels just they. They basically become toxic with sugar. And there's some fancy words there. But basically they stop working.

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Dr Doug: So once those small vessels stop working. Then you get the kidney stuff, then nephropathy. You get the eye stuff. You get the peripheral neuropathy. And I saw this when I was practicing as a foot and an ankle surgeon. People complain all the time I have this peripheral neuropathy, and nobody can understand why. But their fasting insulin is over 10. Their A one C is, you know.

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Dr Doug: pre-diabetes threshold, and they don't have diabetes. So. Oh, it's not from your diabetes, because you don't have diabetes, but it's because they're already seeing complications of high blood sugar. So it's high blood. Sugar is toxic to everything, and that's why your body will continue to push, insulin out, to try to get it under control. But insulin at high levels is also toxic. So then, you're in this sort of like, back and forth, where now you have both things that are toxic, and that's why diabetes is so catastrophic, and it is such a quick, downward spiral.

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Dr Doug: Yeah.

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Breta Alstrom: Like. You know that you can only put so many things in your blood like we. You know, there's the more insulin you have, the more pressure it puts on your vessels. It's like the same like issues as high blood pressure. The more sugar you have in there, the more pressure it puts on your vessels so really important to just kinda take like zoom out and take like a whole big picture approach here. Alan did ask a really good question, though, on Howma Irs factored into the equation of all of this, and how you use that.

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Dr Doug: Gosh! I would have to go back and look at the actual equation of Homa. Ir. Do you know it? Off the top of your head, Brett.

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Breta Alstrom: I don't know the equation.

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Dr Doug: On, my.

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Breta Alstrom: We don't use it.

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Dr Doug: A while. Yeah.

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Dr Doug: But essentially, Homa Ir is looking at insulin resistance. So I forget what goes into it, Alan. But cause we don't. We don't use that specific lab value anymore. But that's sort of what they're trying to game that system and give you a number that's more clear to understand.

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Dr Doug: because most doctors aren't looking at fasting, insulin.

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Dr Doug: That makes sense.

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Dr Doug: I saw a good question.

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Dr Doug: Yeah. Well, let's not get into that yet.

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Dr Doug: Where do you want to go from here, Brian?

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Breta Alstrom: So now let's talk about the 2 types of people that I feel like we get in our osteoporosis camps. We either have people with osteoporosis and clear insulin resistance issues like elevated weight, or people who and then we have, like a separate group of people. It's maybe more like our classic presentation of osteoporosis, where

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Breta Alstrom: they are wanting to gain and maintain weight. And so I just wanna talk about some of the similarities and differences. But first, like, I think the biggest question is, do you see people with those smaller frames, smaller bodies who are struggling with insulin resistance and blood sugar, dysregulation.

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Dr Doug: Yeah, it certainly happens. And this is where people assume that being overweight or being obese, to take it to the extreme is protective of osteoporosis, and it's not true.

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Dr Doug: We see. I wouldn't say it's

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Dr Doug: I wouldn't say it's the majority, by any means. It's a minority still, but we do see people that struggle with weight and obesity, and they they do have osteoporosis. And there's a lot of potential reasons for that. So we again, we have to keep our eyes open for that. And that's actually kind of a challenging problem, too, because people that want to lose weight and build muscle and bone. Those are not complementary goals.

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Dr Doug: But let me just take us a moment to talk about that, for those that haven't

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Dr Doug: heard this this principle around insulin insulin resistance and weight cause. I think it's it's so critical. When my wife built her company she really built it on this premise of the the hormonal theory behind obesity. And essentially, it goes like this, we've already established that carbohydrate consumption increases your insulin levels. Right? So insulin levels goes up. It's telling your body that it's in a fed state, meaning that there's adequate nutrients.

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Dr Doug: and it wants to drive those nutrients, then into both your muscle cells, other cells that need nutrients, and especially your fat cells. So insulin tells your fat cells that, hey? We've got nutrients out here in the blood. You need to bring those in and store it so it'll turn them in fat. They're really good at that. We're really good at that as a species.

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Dr Doug: and insulin tells us that signal.

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Dr Doug: Once you have elevated fasting insulin, then your fat cells are always getting the signal. Hey? There's abundant nutrition, even if there's not.

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Dr Doug: and we need to be in the storage mode which is to keep all of this energy in one place. So, even though somebody might be eating inadequate calories, they might be intermittent fasting, exercising, doing whatever. If their insulin level is high, they will not burn fat, they can lose weight through burning muscle, and they can break down muscle, which is going to make it worse, but they will not lose

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Dr Doug: body fat without lowering their insulin level, and that's why it is so strongly connected to obesity. and weight loss. You really have to have that approach lots of ways to get it down topic for another day. But that's the that's where this is connected.

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Breta Alstrom: Yeah. So then, one of the biggest questions for this population I feel like is, how do we balance eating enough to grow our bones.

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Breta Alstrom: and keeping our blood sugars down.

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Dr Doug: Yeah, well, and I think this is a, it's a really interesting it's an interesting challenge. But it's we are so poised well poised to do this because we and we also have a deep understanding of too much insulin and weight loss

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Dr Doug: as a goal. So we can really balance this out, and if I if I if you were to say Hey, I want to put on as much muscle and as much bone as possible, then I would look in my body building friends and be like, let's do what they do, which is to eat 500 grams of carbohydrates, 300 grams of protein and 4,000 calories, and you will put on weight

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Dr Doug: right now. I don't think anybody in here can eat that much food, myself included. But that's just an example of how our bodies will do that if we push it to, but you will gain weight. Now you would gain muscle, and probably bone, too, you would do nothing but eat, which is what they mostly do.

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Dr Doug: So it's a balance. We don't push carbohydrates really heavily, because I'm sensitive to metabolic dysfunction, knowing that most people have some metabolic dysfunction. That's one of the reasons why we push protein the way that we do get the amino acids that you need.

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Dr Doug: and get the the right amount of carbohydrate for you. My wife coined this term. I don't know if she made it up, or she's the first person I heard say it, but the idea of carbohydrate tolerance, meaning that we all have a unique tolerance to carbohydrates. Mine happens to be pretty low bread is is quite a bit higher, right?

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Dr Doug: But we, because of our different activity, level different histories of metabolic function, like, if I get over a hundred grams of carbohydrate. I just feel fluffy. I don't feel good, but if I get too low I don't feel good either. Some of my athlete friends delete 200 grams of carbohydrates in a meal. Right? So they're getting 600 800 a thousand grams a day. Everybody's different. So we need to find that for our patients, too.

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Breta Alstrom: Yeah.

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Breta Alstrom: I think that's the biggest thing is like getting specific. And then looking at what you're doing. And I think one of the things we can touch on later, too. And you guys can always go back and listen to the the talk that Ashley did on continuous glucose monitors. But that can be a really great way to find your unique carbohydrate tolerance level.

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Breta Alstrom: So then, on the flip side of that, we do also have people who would maybe be like the less conventional presentation of osteoporosis, and they have a larger body. They have Osteo process. They might be trying to lose weight they and and it feels like, really, I think, in conflict with the you know, the stereotypical person who has osteoporosis. So what myths do we need to be

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Breta Alstrom: really trying to dispel about osteoporosis and body type, and I know you kind of touched on that. But what what should we.

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Dr Doug: Yeah, I mean, I think the biggest thing is, don't don't assume that because somebody's overweight or obese that they don't have bone metabolism issues. It makes sense to me actually that if they have

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Dr Doug: glucose metabolism issues, that they could have bone metabolism issues, too, and just having the especially the belly fat. That visceral fat is just inflammatory by nature, and we know inflammation is so closely tied to osteoporosis. It can be such a cause of osteoporosis, so you could imagine. Somebody especially who is obese has been chronically dieting their entire life. They're under fed, they're undernourished.

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Dr Doug: They're chronically inflamed. They probably have dysfunctional, you know thyroid as a result of obesity and dysfunctional sex hormones, why wouldn't they have osteoporosis?

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Dr Doug: So I think a lot of doctors won't screen these people either. And so these these women are. Even if, as they're going through menopause, probably not getting screened for osteoporosis, because they assume if they're overweight, then they're not going to have that issue. So if you know anybody, we don't. I don't see that many.

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Dr Doug: I don't see that many faces around here that have that problem. But if if you know anybody that is in that camp, I would certainly encourage them to get some kind of a screening.

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Breta Alstrom: Yeah, like you said, like, there's so many underlying causes of higher weight that could also be contributing or like underlying causes of osteoporosis, too. So

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Breta Alstrom: making sure we're taking that comprehensive approach. But then, what for? Like our intervention? And we'll might have to break down some of the terminology here. But I I think for our typical interventions for Osteo process, we're trying to promote this like anabolic state, right? But weight loss requires this catabolic or like energy breakdown state. So when we're trying to manage

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Breta Alstrom: both of those, I think it's like the exact opposite problem of somebody in a smaller body with higher blood sugars. But you know, how can we manage osteoporosis and that healthy blood, sugar, metabolism.

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Dr Doug: Yeah, I yeah, I think it's relying on the things that we know aren't gonna have as much of an impact on blood sugar. So focusing more on getting adequate protein rather than pushing carbohydrates. Because I can make you gain weight with carbohydrates, too.

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Dr Doug: right? Like we we could eat a lower protein diet, probably still gain muscle effectively, and just push carbohydrates, and you would gain weight. You would gain more fat in your glucose. Metabolism would be worse. So I would say, most of our patients. Hmm, I don't know not to look at the data. I'd be curious to see how high a carbohydrate diet our patients are shifting into. Or if because we're talking about eliminating processed foods, if they actually end up more carbohydrate restricted. Do you know cause you were seeing patients with Corona for a while.

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Breta Alstrom: Yeah, it depends on the person and what they're right and and which kind of camp they live in. So just like a breakdown. And a actually, we're gonna transition into talking about like specific diets for managing both of these things and some common things to a process, and how it influences blood sugar. But this is why tracking is really important is you can see where you're at and what you're getting. And you know, potentially where you need to go. And then

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Breta Alstrom: this is that our internal monologues of do we track total carbs? Or do we track net carbs? And generally for people who are aiming to lose weight. We're gonna track

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Breta Alstrom: total carbs, which means we're counting all the fiber and stuff like that in there. But for people who aren't trying to lose weight. You'll you might have a little more flexibility, and with all that fiber and some different things there, and it gives you a larger scale. So we might be tracking net carbs then. And the net carbs. It's just total carbs minus how many carbs are coming from fiber. And then that gives you your total

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Breta Alstrom: for some people we might be factoring in artificial sweeteners. It just depends. But we can. I have a question about that, too, for later, so we'll keep in there.

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Breta Alstrom: So when it comes to diets, I do think, and I know this will be a fun topic for you to talk about. I think some common osteo process diets, and how they influence blood sugar but also bone health. And so let's start with the alkaline diet and Vegan diet. And so

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Breta Alstrom: first is, do you think people would see an improvement in their blood? Sugars.

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Dr Doug: Again, it depends on the starting point.

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Dr Doug: So I think that in in general, if we look at somebody who's eating a standard American diet. And this is the argument from the Vegan community, and I know we have some plant based individuals in here. So I'm not. I'm not being negative in any way. I'm just

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Dr Doug: telling you my experience.

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Dr Doug: if you're starting with a really terrible starting point, switching to a whole food plant based diet, you likely actually could see some improvement employee, sugar and metabolic factors. So we hear people like the Mayor of New York City likes to talk about how you reverse diabetes with a Vegan diet.

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Dr Doug: I want to know what his starting point was.

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Dr Doug: because a plant-based diet is going to be by definition a higher carbohydrate diet so depending on, you know, if you were starting eating, you know Hamburger French fries and milkshake 3 meals a day. Then that's going to be a much better diet.

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Dr Doug: but we see so often is that people have gone on to a plant-based diet

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Dr Doug: to try to improve the alkaline nature of their blood, which I'll talk about in a second. And then, as a result, they're consuming more carbohydrates, and they come in, and they have prediabetes or early diabetes, and they didn't know.

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Dr Doug: And it's just because they're consuming so many more carbohydrates, and especially in a protein, poor diet, because you can get adequate protein and a plant based diet. But it's hard. You have to be extremely intentional about getting adequate protein, and then you kind of limit it in your sources. So so that's what we see coming in

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Dr Doug: the alkaline side. You guys have probably heard me talk about this, and either the bone foundations course or Youtube video or something, but

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Dr Doug: the

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Dr Doug: I. I really dug into this because it it was counterintuitive to me that we could have the capacity through food to change the alkaline nature of our blood, our Ph balance of our blood. And so I was raised again in this, like do Osteopath environment, where, like we talked about alkalinity. So it was a different environment than a traditional medical school, but it never made sense to me. And then, as I got into, you know, working in the Icu, and in the or taking care of really sick people. And we're measuring blood. Ph.

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Dr Doug: I learned that you really, we have such a capacity to affect Ph through our breath, through our muscles, through our blood itself, that our Ph is very tightly regulated, and it does move up and down a little bit. And there's different impacts of different things. So to think that eating a single meal is going to significantly impact our Ph is

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Dr Doug: is just not true. If you look at the research and I've gone down every single rabbit hole possible, because I've listened to. You know the plant-based advocates

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Dr Doug: try to sell this point to people. And when you look at the studies that they're talking about, they are cell-based studies and petri dishes. They're animal studies with fixed diets that don't apply to the real world.

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Dr Doug: and none of it applies to a human eating a real diet.

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Dr Doug: And so I don't think that we can significantly change the Ph with a single meal potentially, if you were to eat bad food all the time, could you actually change your Ph, maybe, but probably because you're causing some other dysfunction in your kidneys, or your lungs, or whatever.

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Dr Doug: So I think that the Ph. Argument kind of goes out the window. And the reason why this it just makes sense is, if you look at the people that are talking about it when they say avoid things that are acid causing, and they'll almost always talk about meat.

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Dr Doug: But if you look at the acid causing foods, it is all meat, all dairy, but also most grains, sugar, and alcohol. So you don't hear those same people saying, avoid eating bread, chocolate, and wine

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Dr Doug: to be alkaline, they say, avoid eating dairy meat and eggs.

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Dr Doug: so I think you can clearly see the bias in their argument.

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Dr Doug: So then, if you remove all of those great sources of protein, and you only eat an alkaline diet. Then you're likely going to be eating a plant-based diet.

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Dr Doug: If you look at the literature on people who eat a plant-based diet versus people who eat either, even an omnibor diet, and we don't know enough about carnivores to know the answer here. But if you look at omnivore versus plant based, even knowing that the omnivores are generally going to be eating a more processed diet just because it's the standard diet. The rate of fracture in the plant-based community is significantly higher

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Dr Doug: than it is in the on the war community. So in the real world that doesn't actually pan out.

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Dr Doug: Yeah. And I think.

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Breta Alstrom: I think that kind of leads us right into

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Breta Alstrom: the like, the topic of the Western diet and its impact on blood blood sugar, and simultaneously phone health. So.

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Dr Doug: Yeah. So I, this is, if you look at our diet today. And I, I talk a lot about this, and we struggle even even in our household, you know, with our kids, what do our kids eat?

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Dr Doug: our new and over the last 50 years diet of

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Dr Doug: everything is processed, and even when we talk about, when I talk about highly processed food.

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Dr Doug: I'm referring to like things in bags and boxes and wrappers in general. Right? But if you look at what's happened with our food over the last, really 50, 60, 70 years, we have had to commercialize food in order to feed the population. It was a necessity.

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Dr Doug: Early on. We're, you know, we're adding preservatives. We're making things last longer so that we can literally get food to people.

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Dr Doug: So I don't think that this was a nefarious thing out of the gate.

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Dr Doug: but what's happened is, we didn't know the consequences of what we were doing, you know when you add certain things that the body doesn't respond to when you change our grains to be hardier, but higher in gluten when you like, you make all these little shifts to make new. You know, Franken foods, and we don't understand what that's doing to the body. So now we are seeing, of course, higher rates of autoimmune disease, cancer, early heart disease, like across the board.

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Dr Doug: and it is impossible to prove it. But I can't help but think that our food supply is a major cause of that

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Dr Doug: right? I look at what my, especially my kids, are. 1110, and 5. I look at what their peers are eating.

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Dr Doug: and I hear it every day because we talk about it, my poor kids, but they they feel restricted because they can't have at every meal, cheetos and a cupcake and orange juice and a coke, and like all of these non foods.

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Dr Doug: And so we go through this big process of like, all right. What's a real food? But if you look at what happens when you eat highly processed food in general, it's going to come with a high level of carbohydrate because it's processed. It's going to come with generally artificial oil seed oils

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Dr Doug: that are inflammatory, and you're going to put all that in your body, and you're going to generally also pair that with dietary fat in the form of potentially some not great fats. So you're getting a high carbohydrate high fat diet which is going to be inflammatory. It's going to provoke obesity. It's going to provoke insulin resistance. It's going to provoke inflammation, and that is the root of every chronic disease.

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Dr Doug: So I can't help but think that our diet

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Dr Doug: across the board and this is global. It's not just us now, globally, our diet is the cause of probably every bit of chronic disease that we see.

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Breta Alstrom: Yeah, definitely, making that shift to to real food is great. And that's what we recommend as part of our optimal bone health nutrition protocol. So,

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Breta Alstrom: I I know you're not normally giving the recommend the nutrition recommendations, but I do think it's interesting to point out what we do a little bit differently. And why? It's nice to either one. Get really specific on what your needs are, or 2 work with a team that can help you, because it does provide a lot of clarity and like what your nutrition needs are cause right now, now, you're hearing. Okay? Well, maybe I should need very many carbs. What if that causes me to lose weight?

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Breta Alstrom: And how much protein do I need to eat? And then, if I eat more protein, my lipids go up. And so when we put that all into the context of like, we have some really good, like guiding principles for our nutrition protocol. And the first thing is like, eat real food.

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Breta Alstrom: and I did share in slack in the chronometer channel. So make sure you have access that to that channel. Our optimal bone health plate for both a moderate carb and a low carb plate, and then our Osteo process meal plan, which is based on the low carb version, but it's super easy to scale up with more carbs. So check that out. But

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Breta Alstrom: we are able to do this and tailor these things based on their labs. So we can make changes to your nutrition based on your blood sugar labs. We can make changes to your nutrition based on your cardiac labs, and you know your genetics and things like that. So what do you see as being the real benefit of like our approach when it comes to both. I already kind of outlined the benefits for

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Breta Alstrom: cardiac and blood sugar, but on bone, health in our approach as we like. Look at that.

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Dr Doug: Yeah. And I think this is so important. And it's not just. You know, this is not a pitch to work with us. But whoever you're working with, make sure that you're kind of following some of these principles, which is

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Dr Doug: we we put out there. You know, this is the ideal way to eat, but it is so vague intentionally, because I can't tell you. You know, Sir Deval versus Michelle Thompson, what your needs are without looking at your labs without understanding your history, without knowing what your family is like, and really looking at your genetics, and we don't always look at genetics on everybody. But it's helpful. Because I can predict how some food is gonna react for you.

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Dr Doug: So I think that you need to have somebody that is looking exactly at what you're eating, tracking for at least a short or moderate period of time, so that we can really understand. You know what food is going in, and then what the impact of that is I see so many times. People say, Oh, you know I don't. I don't eat very much, or like. I don't eat, you know too much car. I don't eat too many carbohydrates, and then they actually track for a while and tracking will change what you eat.

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Dr Doug: so don't get me wrong, but they'll come in. They'll say I really like I don't not getting any carbohydrates. I don't know why my a one C is so high, and then you start looking at what they're eating. I'm like you ate 300 grams of carbohydrates for lunch.

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Dr Doug: Right? You just don't know. You don't know what a carbohydrate is. You know, you're thinking it's one thing, and it includes others, and that's not necessarily bad. It's just knowledge, or they just need the knowledge. And so working with somebody who can really point out those things, help them, then, to identify probably a path forward. But then, just like we do in the forearm method like you have to recheck, you have to get new labs. You have to monitor progress. You have to probably look at body composition. So just like we're doing with bone health, we need to do the same thing with nutrition.

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Dr Doug: When my wife built out her program for weight loss. And she is like all like she is narrow, focused on weight loss. So she built it out so that they have, you know, at least weekly, if not more than weekly accountability. Coaching right like their coaches are on them. They're by their side. You can call your coach, or literally, from the grocery store be like, Hey, I'm having a hard time making a decision between these 2 products.

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Dr Doug: because it takes that kind of accountability for a lot of people that don't have the knowledge to get to a point where they can actually start to put together the pieces and then stay super consistent and for weight loss. Consistency is really key, I think, for growing bone and muscle. It's probably not as critical because you can slip up a meal by missing it and not getting enough protein.

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Dr Doug: and you won't have as big of an impact of like if you were to splurge any 5,000 calories in a sitting on weight loss. But it's the same thing where you just have to like every day has got to just be, you know, marching up that ladder, getting adequate protein, getting the micronutrients that you need, getting the calcium that you need through diet, and then like.

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Dr Doug: be washing your hands at the end of the night and doing it again the next day.

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Dr Doug: So I think that's that's how it relates to bone health for me.

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Breta Alstrom: Yeah. And since we're talking about tracking, we have some questions about tracking here. I I do think this is really important, and I as many things as there are to do, and and I personally, as like a person, I hate tracking. I think it's most tedious thing, but it is also, I think, one of like

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Breta Alstrom: the single biggest drivers of sustainable nutrition changes for people in our program, because you can see exactly what you're getting and where it's coming from, which helps you realize the foods that you're eating. So if I just ask you what you're eating, you know, you can tell me. And you. You might leave some things out. You might be like, well, I just have like a little bit of that. But when you're actually tracking it, and and specifically in chronometer, you at the end of the day

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Breta Alstrom: you can go back and you can highlight the carbohydrates, button and click on that. And it'll tell you your major sources of carbohydrates, and it could be so simple is like we. Maybe you do better with cutting that food out. Maybe you just have to adjust your portion size. You know, even when we're looking at things like

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Breta Alstrom: saturated fats for some people the the simplest thing to do, instead of being like, oh, I've gotta make all these huge changes. Well, sometimes we can just look at that and say, you know, the only days you go over your saturated fat limit is when you eat a chick-fil-a. So those are, you know. Really, it provides a lot of clarity there.

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Breta Alstrom: So when people are tracking. And when we're tracking carbs, this goes back to if we're doing net carbs or total carbs, which is totally based on you. But you do technically count vegetables in your carbohydrates.

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Breta Alstrom: and

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Breta Alstrom: depends on the person depends on your goals. Normally, what I would recommend is like non starchy vegetables. So anything except for like peas, corn and potatoes and things that are related to potatoes. You kinda get for free like as many as you want. If you go over your carbohydrates because, you know, you're eating, I'm trying to think of something that's like nobody's gonna get mad at me for here. But like just as excuse me, example. Like broccoli like nobody's gonna be, you know.

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Breta Alstrom: you might have other health issues from that. That's your problem. If you have gut health issues. But you know that's not going to be driving your insulin resistance. So just

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Breta Alstrom: kind of factoring that in and and just taking some time to track and then seeing where you're at and what those problem areas are, instead of trying to be like. Oh, well, I've you know, had 40 grams of cars, or I just need to count up everything and just stay with these really strict numbers like, find out where you are, and then make adjustments based on where you are.

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Dr Doug: I find, too, that helps to

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Dr Doug: a limit how much, how drastic are the changes that we need to make.

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Dr Doug: But just like you said like it might just be one simple thing that they may not even really enjoy. They're like, Oh, well, actually, I just go there with my office.

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Dr Doug: you know, colleagues, because that's where they want to go. I don't have to go there at all.

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Dr Doug: That was another point I wanted to make. There.

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Dr Doug: I forgot. Anyway. Keep going.

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Breta Alstrom: Yeah. So I think, when it comes to tracking that there. And

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Breta Alstrom: I I I just think we wanna use that as like a driver, and I feel like a lot of carbs. Hold on just checking in on some of the comments.

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Breta Alstrom: yeah, that. So if you're looking at specific foods. See how much do I like? Look at your total carbs overall and then check it. Don't just say I've gotta cut out this this and this like, go from where you start. The last thing on nutrition before I dive into all of your guys questions that you sent around this, which I have some great questions today. Is the Scarwell fair study. So, Audrey, yeah. Audrey posted this in slack.

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Breta Alstrom: and I think it's really interesting. But there were some questions around this study in particular, which I don't know if you had a chance to read it. But basically the focus of the study is that these people have increased their fruits and vegetable intake to over 9 servings per day, and they saw positive improvement and bone markers. But people are concerned with what that means for their impact on their blood sugar, metabolism.

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Dr Doug: Yeah.

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Dr Doug: yeah, I it's been a while since I looked at it. Can you? Did you read it?

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Breta Alstrom: Yes.

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Breta Alstrom: so I I think the really, that's it. Like they had, like some control groups. And the people that saw the positive improvement had over 9 servings per day. I don't think they made any other changes, and I think the biggest. It's not that like, Oh, you have to follow this because I this actually probably aligns with more that, like vegan and alkaline diet. I don't think that they made any changes to people's protein intake. They just increase their.

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Breta Alstrom: you know, fruits and vegetables, which is like great. But there's definitely lower carb options that you can choose for fruits and vegetables, too.

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Breta Alstrom: and you can apply this. And you know, eating more fruits and veggies doesn't have to impact your protein intake either. So those are my takeaways from it.

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Dr Doug: Yeah, I mean, I. So I remember when I reviewed it.

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Dr Doug: I think my takeaway was basically like they're eating a whole food

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Dr Doug: based diet

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Dr Doug: right? Like they're eating real foods, probably more nutrient, dense. They didn't affect their protein intake. I don't even know if they track their protein intake.

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Dr Doug: Yeah. And so we don't. We don't really know. And then you know what other confounding factors were present in this particular study, you know. Was it blinded, obviously not cause. They knew that they were doing that. Were they then doing other things as a result of that? So all these potential variables, that work into that. So like is this the best diet for Osteo process? Well, I think it's an approach. But there's a lot of variables in there that we don't know. And and so I think it's just. It's interesting data. But all it tells me is that we should be eating a whole food based

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Dr Doug: diet which we.

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Breta Alstrom: Yeah, I agree. And I think if you guys you can search this in slack, too. But even like Audrey, she posted her results about this, and her Ctx. Dropped from 1,160 in last August to 240 which is awesome. But she also, you know, eats 130 grams of protein, and she's lifting weights, and she's increased her weights from 2 kg to 18 kg.

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Breta Alstrom: and so she's, you know, doing a lot and putting in the work in all the different areas to see those changes. So I think the other thing, too, is.

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Breta Alstrom: I would be really like curious to know if any of you guys know, if you're eating over 9 servings of vegetables per day, because outside of those being vegetables and being good for you. It's a lot of food. And one of the things I feel like we see is just people chronically under eating highway or low weight, like people are chronically underneath under eating. And if you want to build bone, you have to have things to build bone out of.

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Breta Alstrom: Yeah.

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Dr Doug: Yeah, I let me just a note on that, too. I just see, I was just looking. I've got 2 patients right after this.

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Dr Doug: and one. Both of them actually have chronometer data, and both of them are around like 1,000 to 1,100 calories a day.

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Dr Doug: you know, and we see this

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Dr Doug: the time. You know, people that are consuming 1,000 calories a day. And I think it's just part of our culture, especially for women

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Dr Doug: to chronically diet, you know. Lower, less food is better, less food is going to be the answer. Less food is going to get me the body I'm looking for. And so what we have really been doing, and I love talking to my wife about this.

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Dr Doug: So even for people that have been on a weight loss journey for a long time. The first time I heard the term reverse dieting I was like, what what does that even mean like this doesn't make sense to me. But now I get it, it's really refeeding right? We're we're like teaching the body to to absorb nutrients again. We're bringing that basil metabolic rate back up. And that's the only way that you can get to start eating to start eating enough. But then to to actually build muscle. So even with me, you know, as a 200 pound 6 foot tall guy I was

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Dr Doug: for the most of the last 25 years a 175 pound guy eating 1,500 1,800 calories a day.

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Dr Doug: So now I'm eating

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Dr Doug: almost 3,000 calories a day.

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Dr Doug: and I'm leaner than I was then, and obviously 20 plus pounds heavier, but mostly through muscle mass.

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Dr Doug: And so I had to reverse diet myself to get back to eating an adequate number of calories. So me on a bigger scale doing the same thing. And that's what we do in our patients.

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Breta Alstrom: Yeah.

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Breta Alstrom: I, yeah.

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Breta Alstrom: think that's like, if you take nothing away from this, eat more and eat a whole more.

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Breta Alstrom: Yeah. Oh, okay. I have some community questions. Some from slack, some from the Channel. If we don't get to them, I'll post them in slack with some answers for you guys there, too. But our first one is just talking about the effects of using artificial sweeteners, and to a varying degree like the sweeteners in question. Here are monk fruit. All you'll lose. And Stevia. And if they have, this is like a 2 part question. So

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Breta Alstrom: anything you're aware of on the impacts of those sweeteners and bone health.

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Dr Doug: Not not specifically in bone health. I'll tell you. My! Here's my what my gut no pun intended. What my gut says about sweeteners is that it's we're trying to use something, even if it's natural, like alulos is a a real sugar that has no calories. You know, monkfruit is a real sweetener that comes from monkfruit but clearly like, if I get a bag of alulos, that's a pound right, and it's like I can scoop it into my smoothie, or whatever which I used to do.

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Dr Doug: We're still synthetically driving our driving, our cravings for sweetness. We are encouraging our bodies to consume sweet, and we're just pushing this lever over and over and over again, so that when we consume foods in their natural state they don't taste so sweet.

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Dr Doug: Now this isn't nearly as bad as like the sugar alcohol sweeteners, or some of the truly synthetic sweeteners like sacrin. If you wanna go back 30 years. You know those are like thousands of times sweeter than sugar, but still aulose, monkfruit, Stevia. They're sweet, you know, when you consume them by themselves, like they're super duper sweet. So my preference is. And I I get criticized for being

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Dr Doug: to what was I recently called militarily disciplined, or something like that. But anyway, point was, I get criticized for being too disciplined. But for me, I don't consume them at all. My kids have Stevia. My wife likes Alulis so like it's in the house. But I think for people that struggle with cravings.

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Dr Doug: the more you can eliminate it the better as long as you can tolerate that socially, is it going to negatively impact bone health. I think only with the research that looks at the potential impact of sweeteners on the microbiome.

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Dr Doug: maybe. But then we're in a really murky space.

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Breta Alstrom: yeah, and I, the there there was around this an article shared which didn't share with you, but it's about all you'll lose kind of acting like a glp. One inhibitor

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Breta Alstrom: But I just wanna say, like the study they were doing oulose injections. And it was in mice.

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Breta Alstrom: Yeah.

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Dr Doug: Oh.

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Dr Doug: I don't know about that. I can answer a couple here. There's one it actually is a good follow up to the a one C, and we didn't really talk about labs that much on on glucose about a one C being elevated.

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Dr Doug: When it doesn't seem like it should be, and this was from Diane's is right out of the gate, Diane. So

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Dr Doug: the question is, basically, how is it possible for a one C to increase as you cut carbs. She's finally on carnivore at less than 20 grams of carbs a day. How can my, a. One c. 6.2.

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Dr Doug: Such a great question. So here is the secret that a lot of people don't know otherwise wouldn't be a secret so when you are getting the a one C. Biomarker. So A. One C stands for hemoglobin, a. One C. It's essentially looking at the amount of glyco glycolysis is that a word? The amount of glucose attached to the red blood cells during their lifespan. So red blood cells will live on average 90 days.

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Dr Doug: And you can look at that ninety-day average of glucose by looking at how much they've been affected by the glucose and the blood. So that's what a one C is.

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Dr Doug: So it is an estimated 90 day average of your blood glucose. But if you go, carb restricted, extremely carb restricted, your red blood cells will live longer.

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Dr Doug: I don't know why, but they do. And so when your red blood cells live longer, they're going to be impacted by glucose more than would be expected by the the 90 day lifespan of red blood cells. So for people on a car restricted diet, their A one C will be falsely elevated.

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Dr Doug: And that's the power of using that Cgm device that actually talked about because a Cgm will tell you your actual glucose over time. So then you can backwards calculate your A. One C, so I fit in this group, too, Diane. So I my, A one C kind of lives around 5, 6, 5, 7, 5, 8, you think like, gosh, this guy eats 40 to 80 grams of carbs a day. How's that possible? And it's not because my, A one C is really there. When I use a Cgm a. One C lives around 5, 2, 5 0.

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Dr Doug: It's just because it's falsely elevated.

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Dr Doug: So a one C is not a great biomarker and people eating a standard American diet. It works. It's easy, it's cheap, but that's why we get fasting insulin as well.

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Diane K Miller: Okay. Thank you.

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Breta Alstrom: Yeah. And I think that answers david's question as well about you know his other labs look really great. Why is his? A one C elevated and I think that would answer that. And I also think it's important to to point out that

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Breta Alstrom: you still use insulin to process. Protein like to utilize protein. And so when you are eating like a high protein diet, you still are going to be using, you know, insulin. So you might have some of that. So there is like a little bit of a balance to play there, and the insulin is also gonna hang out in your bloodstream a little bit longer, because proteins digest it more slowly. So.

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David Callen: What about the effective way protein may have on your.

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Dr Doug: So I'll answer that in 2 sections. So one thing I wanted to say is one of the things we've learned also through my wife's program. With her experience with people from weight, loss, with protein. She used to be more restrictive in protein because her concern is so much about the insulin impact. And if we if we're raising insulin even through protein consumption, it's gonna slow down weight loss. And it does. But

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Dr Doug: the secret to maintaining weight loss is to maintain your muscle mass as much as possible. And so we have now pushed that up quite a bit. But I will still say for people where I've struggled to help them lose weight like you. Remember, Brad, on my surgeon friend from Ohio.

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Dr Doug: so like we like you and I both were like banging our heads against the wall like, how is this guy not losing weight? He must be lying to us right? So then he goes to work with my wife, and she cuts his protein by, you know, even point 2 grams per pound, and all of a sudden he starts losing weight like clockwork. And so there is an impact, especially for weight loss. Because you are, gonna see a rise in insulin. It's not nearly as as much of a spike as with glucose, but it is certainly present.

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Dr Doug: Sorry. What was the second part to that question.

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Dr Doug: David, what was your.

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David Callen: the way protein does it.

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Dr Doug: Yeah, yeah, thank you.

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Dr Doug: Yeah. So so whey protein is gonna be absorbed essentially the same. If you were to consume it like in solid form, but nobody eats solid way. Right? So we we have a powder, and we put it in a smoothie, and we drink it

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Dr Doug: whenever you drink protein like that, like whatever is coming in in liquid form. This is why we tell people in general like, Try not to drink your calories. It's gonna be absorbed much faster. So my guess is, you're probably gonna see a bigger spike in insulin. As a result of that, there's gonna be a different metabolic

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Dr Doug: impact of drinking your protein versus eating your protein. It's gonna get absorbed much slower if it comes through, like, you know, actually eating dairy or eating. You know, animal protein.

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David Callen: So more meat, less less.

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Dr Doug: But but there's also I mean, there's a convenience factor to that, too. Right? So like I would rather you get the protein and consume. You know, one shake a day where I struggle is when I see people. I just saw a patient recently and and literally this is a friend of a good friend of mine's wife, who's a patient of ours.

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Dr Doug: Everything she eats is either in like a shake or a bar, like a hundred percent of her calories.

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Dr Doug: And so I was like, you've gotta eat real food like number one thing, you just gotta eat real food and it's she's like, well, but I'm on the I'm in my car all day long. And it was like, Okay, you're gonna meet with one of our dieticians. They're gonna talk to you about how to prep food. And we're gonna like we can do this. You put a cooler in your car.

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Dr Doug: So anyway, it's all possible, eating whole foods, if possible, but you know I'd rather get the food than not get the food.

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David Callen: Thank you.

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Breta Alstrom: And on the lab side of things. What would be your optimal fasting, insulin level.

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Dr Doug: Yeah, you know, I used to be again. Overly, overly militaristic. No, I used to think that like lower was better. But I there is a threshold at which I think we can be too low. I mean, we do need insulin. We do need to have healthy metabolic function. So I think right now, our reference range is what 4 to 8. Something like that. It's definitely single digits. I do. There is some concern like if it starts dropping into like the 4, 3, 2, one like

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Dr Doug: you'd actually, that's not healthy, either. And that's somebody probably who's been, you know, on a strict Keto diet for a long time, and then they're actually losing metabolic flexibility in the other direction.

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Breta Alstrom: Yeah, and then what about like on the flip side with hypoglycemia and someone feeling like, they have to eat every 2 h. And they want to eat more fruit, but it makes them crave more sugar.

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Dr Doug: Yeah, this is such an interesting thing, and I don't have a I don't have a solid answer other than I think some people actually do better eating more frequently.

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Dr Doug: And like this patient I'm about to see. She's she's currently doing intermittent fasting.

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Dr Doug: you know, and I think intermittent fasting got super popular, and even the people that were really pushing it, you know, 5 years ago have really stepped their their conversation back. And they're not pushing it like they were. There's a role for intermittent fasting, but I think the human body does better eating more frequently.

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Dr Doug: and this drives kind of like hurts me to say this, because for a long time I've been a big fan of fasting, and like having time in between meals. But I'm seeing this in my kids where one of the approaches that we're taking now is to feed them more frequently, because that time in between, as much as I hate to say it like it is stress. Now, it's good stress in some ways, but it is stress.

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Dr Doug: Take somebody who was really stressed out especially in this for my next patient. She's a postman, a puzzle woman. She's dealing with a lot of, you know, emotional, you know. Work stress she has inflammation. Add all these things up and then try to fast on top of that. And it's not gonna work well.

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Dr Doug: And so it's probably Ok to be eating every couple of hours, if that's what your body tells you that you need. Now, if you're eating a bunch of fruit and you're eating naked carbs, as our dieticians would say.

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Dr Doug: then you're probably gonna get like, an up and down. And so then you're gonna hit this like compensatory low. It's gonna cause more cravings. And then you're just on this roller coaster. But if you're truly hungry and you're eating, you know some fruit with a protein source, then you can hopefully ride that for potentially longer. If you're getting dietary, fat protein and carbohydrate all the same time. But you might just need to eat every 2 h. Don't eat overnight, though.

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Breta Alstrom: Yeah, yeah. And yeah, making sure that you're pairing things together, not just getting the carbohydrates will make a really big difference and eat more at each of the times, too.

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Dr Doug: Yeah, if you if you can. And we run into that issue as well. Yeah.

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Breta Alstrom: I think that's like a a really common thing to when people get really busy during the day, they feel like they're binging at night, but really like it's more compensatory eating because you just enough during the day. So then you feel out of control around food at night, so eat more more consistently, and then you'll be able to check in with your appetite better as well.

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Breta Alstrom: which

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Breta Alstrom: we had a question about you eating more, and if you eating more, if you, you feel like you have an appetite, if it's like a struggle to eat more, and your experience with that.

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Dr Doug: So I used to. I used to look at my metabolism as such. Like a.

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Dr Doug: It was like a penalty. It was something I was born with. That's like broken. But now I look at my capacity to consume massive amounts of food as such a gift.

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Dr Doug: because I really can. I can sit down, and I could eat 20 to 30 ounces of protein in one setting, and not even think about it. So one of the things that I've had to do, and this is the the value in me like I weigh out. Usually I weigh out most of what I eat, because for me I could eat so much more than I need to, so I have to cut myself off at 8 ounces, whereas most of you are probably trying to push up to, you know, 4, 6, or 8 ounces.

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Dr Doug: so I have pretty much a never-ending hunger.

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Dr Doug: I don't get full, and I probably have some kind of

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Dr Doug: glp, one dysfunction from burning out my metabolism from eating a fat, free diet which my parents thought was the right thing to do when I was a kid.

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Dr Doug: Whatever I don't get, I don't get full.

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Breta Alstrom: Yeah.

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Breta Alstrom: I. I also think to the more often that you eat the easier it is for your body to eat, like if you're constantly in a fasted state. You're not gonna feel hungry like your body's not gonna make you suffer. So you're just not gonna feel hungry. So it's just a little bit of training there. But time for one more question, and I think this is a great one to end on. But how does mojaro impact bone health.

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Dr Doug: Now. Gosh!

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Dr Doug: So I'm doing it Mandy

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Dr Doug: glp ones. So for those that don't. Mujaro is Mondaro and Ozmic, and we go. V, and there's a couple of others in there. So all of these new glp, one drugs that are designed originally for diabetes. But they found, of course, that they provoke weight loss. So now there's the huge weight loss, craze, and glp. Ones have been around for a long time, but they really picked up recently because the FDA approved one of them for weight loss. So now they can't make this stuff fast enough.

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Dr Doug: and I can tell you, because my wife runs a business that refuses to use glp ones, that it is certainly impacting the the way that people are losing weight. Right now, I just just on a call with

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Dr Doug: a physician group that does telehealth visits, and they are processing over a thousand of these scripts a day just cranking out glp one scripts.

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Dr Doug: So people are on them.

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Dr Doug: What we know very clearly from the research. And I'm doing a talk for my wife's company next week on this topic.

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Dr Doug: If you look at the research, one of the things that is obvious is that when people lose weight they lose weight mostly through muscle mass.

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Dr Doug: So somebody is getting lighter, but fatter.

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Dr Doug: And so for most people, that's not what they want. Actually, I would argue for anybody. That's not what they want, right? Because if you're losing muscle mass, your basal metabolic rate will go down, you will be able to consume less calories. It'll be harder for you to maintain your weight loss. So I think what we're gonna see is we're gonna see this huge shift of people losing weight with gop ones. You can't take them forever. I mean, I guess you could. But they're pretty darn expensive. So you probably don't wanna take them forever. And then we're gonna see the obesity rate just climb. We're gonna see this little dip, and it's gonna go nuts.

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Dr Doug: So how could that affect bone health? Well, if you're losing muscle mass, sarcopenia, which is loss of muscle and osteoporosis go hand in hand. So I think we're gonna see it get worse. And it's so hard. I I went on Ozimpic intentionally, because I was thinking about prescribing it, and I do occasionally, but when I was on it I could not eat

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Dr Doug: animal protein.

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Dr Doug: because the the dietary fat in it, the protein. It is so satiating. You get so over satiated when you're on a Gl. P. One, and and you'll hear this with people that are on it. They're like, I can't eat a steak. I can't eat, you know. They certainly can't binge, and this is why, like you'll binge on a Gl one once, and you'll feel so miserable and probably end up throwing up that you you won't do it again. So you're not gonna get adequate protein. So would that impact your muscle and bone? Absolutely. Yeah, I think these drugs are really bad idea.

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Breta Alstrom: Yeah.

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Breta Alstrom: awesome. Well, thank you guys so much for coming in today. That's I think, all we have time for. So we'll wrap up so Dr. Doug can go see some patience. And and you guys know how you thought this format way? I've all your questions saved. If they weren't answered. We'll bring them over to slack, and maybe try to find a way to answer things in in bulk where it's more like it might not be your specific question, but your question will be answered by a video or a

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Breta Alstrom: written description. So just stay up to date on slack, and if you don't have slack. Feel free to reach out to Hsn. Support at Ohhhmdcom, and we'll get just set up and squared away. But have a great day. Everyone.

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Dr Doug: Awesome.

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Michelle Thompson: In place.

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Dr Doug: Brother, yep.

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Breta Alstrom: Bye.

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Dr Doug: Bye, everybody!

‍

April 17 Insulin Resistance

Recording

Session Notes‍

Transcript

Session Notes
‍