Welcome to Episode 409 of The Intermittent Fasting Podcast, hosted by Melanie Avalon, biohacker, founder of AvalonX, and author of What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine, and Barry Conrad, actor, singer-songwriter, and creator and host of Banter with BC.
SPECIAL GUEST
Kara Collier is the co-founder and VP of Clinical Operations at Nutrisense, one of America’s fastest-growing wellness-tech startups. She is a Forbes 30 under 30 recipient, frequent podcast guest & conference speaker. Kara has made it her mission to help others reach optimal health using modern technology & expert coaching. Kara is a leading authority on continuous glucose monitoring (CGM) technology, particularly in non-diabetics, for health optimization, disease prevention, and reversing metabolic dysfunction. Kara is a Registered Dietitian Nutritionist (RDN), Licensed Dietitian/Nutritionist (LDN), and Certified Nutrition Support Clinician (CNSC).
Website | Nutrisense IG | Kara Collier IG
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TRANSCRIPT
(Note: This is generated by AI with 98% accuracy. However, any errors may cause unintended changes in meaning.)
Melanie Avalon
Welcome to Episode 409 of the Intermittent Fasting Podcast. If you want to burn fat, gain energy, and enhance your health by changing when you eat, not what you eat, with no calorie counting, then this show is for you. I'm Melanie Avalon, biohacker, founder of AvalonX, and author of What, When, Wine. Lose weight and feel great with paleo-style meals, intermittent fasting, and wine. And I'm joined by my co-hosts, Barry Conrad, actor, singer-songwriter, and creator and host of Banter with BC. For more on us, check out MelanieAvalon.com and BarryConradOfficial.com. You can submit questions for the show by emailing questions at iapodcast.com or by going to iapodcast.com. We would love to hear from you. Please remember, the thoughts and opinions on this show do not constitute medical advice or treatment, so pour yourself a mug of black coffee, a cup of tea, or even a glass of wine if it's that time, and get ready for the Intermittent Fasting Podcast. Hi, everybody, and welcome. This is episode number 409 of the Intermittent Fasting Podcast. I am here today with a very special guest. It's somebody who's been on the show before, and it's for a topic that we talk about all the time and which has a radical effect on people's health and wellness and fasting and all the things. And so that topic is continuous glucose monitors, also known as CGMs. And friends, like I was saying, you're probably familiar because I talk about them all the time, but continuous glucose monitors, which we will talk about, actually give you a picture of your blood sugar levels on a sort of like a 24-7 basis for quite a few days when you do a session of one. And it is so eye-opening because it actually gives you an in-real-time picture of how your food is affecting you, how your fasting is affecting you, all the things. It can be a game changer, especially if you're trying to just figure out where you're at with your health or if you're trying to break through a weight loss plateau or just really optimize everything you're doing when it comes to food and diet and lifestyle. So I am here with Kara Collier. She is a fabulous human being and the co-founder of Nutrasense, which is a platform which makes CGMs accessible to everyday people. And by everyday people, I mean you don't need a doctor's prescription in order to get one. And then Nutrasense also comes with an app which helps you actually analyze and understand the data and it is just so empowering, so helpful. And so Kara, thank you so much for being here.
Kara Collier
Yeah, absolutely. I'm excited to chat.
Melanie Avalon
So, I was telling you before, I have quite a few listener questions for you, but before diving into those, I actually have a personal question because I think last time we came on the show was a while ago and I feel like within that, well, it wasn't that long ago, but in any case, in that time period, I feel AI really like took off, like chat GBT, because I feel like there was like a pre-AI time, I mean, AI's been around for a while, but like it like rapidly escalated. And so I was just thinking before we started recording with Nutrisense and everything you're doing with CGMs, like the future of it and what you're doing now, has that had a big effect on the company and the future and everything that you want to do with CGMs?
Kara Collier
Yeah, that's a great question. So much has changed. I think we spoke maybe like a little over a year ago, when you reflect back of like all the things that change in a year, both in terms of technology advancements, but also just the industry, like a lot has changed within cgms and within our company. But with AI specifically, yeah, it is going to make analyzing, I mean, it already is making analyzing large amounts of data, super simple and easy, which is great for both businesses that function on data as kind of the main component. So now instead of just having maybe cgm data, it's going to be a lot easier for us to plug and play other forms of data and put it all together and give you something meaningful. And then it's also going to make it easier for the user, you know, we have the easy ability for you to export every single data point in that kind of like five minute intervals. And then you can kind of if you're savvy enough, you can use simple free AI tools to manipulate that data if you have certain things you want to look for or see that we aren't necessarily providing for you. So I think it just makes it a lot easier to use data for answers, because you don't have to be an analyst anymore to be able to kind of use these tools. So as a company, it's kind of helping us make it easier for making things digestible for people. And it's also helping us to make sure that our human support, which we're actually leaning on even more now in the forefront of AI is still having that human component, but it's helping to kind of augment them and give them the tools and support they need to do their job well.
Melanie Avalon
Oh, that's really interesting. So do you think you're temporarily leaning on them more or do you think ultimately, you know, it'll be all AI providing that support?
Kara Collier
Yeah, it's hard to predict what exactly will happen and what the gaps are going to be and how much adoption there will be across the board. You know, you still ask the average person on the street if they use chat GBT on a daily basis and most people actually are not. Like it's still really underutilized on just like an average person, but we've actually leaned more on the human component because of a demand from customers. Recently, you know, we used to just provide chat support access to our dietitian so that you could ask questions. And now we do kind of our long telehealth sessions that are reimbursed by insurance. And that really came from the demand of people wanting to turn these data insights into real behavior change. So it's kind of connecting that dot of how do I now turn this into a habit I can stick to? How do I, you know, adjust things when my routine is different? And for some people, I think it just depends on your personality type AI might solve that problem for you. And we're happy to kind of support that person in that way, where I think there is a whole separate group of people that need that human connection in order to reach their goals. So I think it really just depends on your personality type and like what motivates you.
Melanie Avalon
I'm so interested by this, and it's also interesting that you point that out about, you know, not everybody using chat GPT and things like that. Actually, yesterday, the guest I had on the show, I just like brought up chat GPT, I was talking about it, and they actually hadn't, like, they didn't know what I was talking about. And I was like, Oh, like, because I'm so saturated in it, it's like, I use it so much. I forget that everybody's not using it all the time.
Kara Collier
I know I'm currently trying to get my mom to use it more for like basic things. And it's, it's an interesting experience to walk through somebody who's like the learning curve is like, it's not intuitive to them in the same way of like how I would use it for all these different applications. But as soon as like I pointed out, she's like, Oh, that's amazing, but wouldn't have thought of it herself. So I think there's a lot of people like her.
Melanie Avalon
I use it for for everything. It's so it's so helpful. It expands beyond just things like this, but the entirety of health care like will we always want a final human, you know, overseeing everything, especially like surgeries and procedures and records. Do you think there's a future where we're comfortable? I know you're talking about personality types, but do you think there's a future where it's all just automated?
Kara Collier
I think so. I think a lot is going to change. I think we're at the start of exponential change, you know, where it's, we're at that bottom of that exponential curve where I think it's going to be almost, it's going to be very challenging to even imagine what things are going to look like 10 years from now. Cause I think they're going to be so different than even what has changed, you know, in the past 10 years. So I think everything is going to look different eventually. I just don't know when that will happen. Like what is the pace of which this is going to occur in a, which we're all very like normalized and we trust some of these systems. Cause the other thing is, you know, right now there's still the issue of kind of the quality of data you put in is what you get out, but it's, that's going to be less of an issue as things just get more and more intelligent. I think there's going to be time where we trust data a lot more than humans.
Melanie Avalon
It's so interesting. And on a similar note, so the actual technology itself, and it's interesting when I was asking for questions, one of the first comments I got, it actually wasn't a question, but it was a clarification, which I find really helpful from Lisa Marie. And she said that she's a type one diabetic here. She said, please know that CGM tests the interstitial fluid and not the actual blood like blood glucose monitors do. I've heard other podcasts mistake this. It will be interesting to see what questions pop up here. And then Stacy wanted to know how accurate are CGM's. And the reason I'm leaning off of both of those is kind of tying it into this concept of the evolution of everything in the future. So the actual technology of the CGM, because like Lisa Marie was saying, it's not actually measuring our blood sugar levels. It's measuring this interstitial fluid. Is the technology itself, like has it evolved or changed? Is that still how it works? Do you think it will change? And then as far as the accuracy, like how does that tie into the evolution and how the technology might be changing?
Kara Collier
The, that is correct. So the, the CGM they are measuring your glucose in your interstitial fluid, which is just kind of like the fluid in between your cells. So you can think of it as kind of like classic diffusion that we learned in science class. So when your glucose changes first in the bloodstream and then diffuses into the interstitial fluid. So the biggest difference between the values in your blood glucose level and your interstitial fluid is that there's usually a little bit of a delay as it diffuses and the more intense the change. So if you suddenly dump in a ton of glucose into your bloodstream, the faster it's going to diffuse into the interstitial fluid. So the more rapidly it's changing kind of the quicker you're going to see that appear, but if it's a slow change, it will diffuse slowly. So it is an, and one thing that is important to think about though, is that that glucose in our interstitial fluid is still like, you know, it's a part of our body. Like that is like real glucose that is also important to know. So it's not that it's irrelevant. It's just that it's a slight difference from your blood levels. This is especially important for type one diabetics, which are the, you know, the patient population, the audience that these CGM were first created for, and that they're most critical for this audience because they cannot, you know, they type one, type one diabetics do not make insulin. And so they rely on exogenous, you know, injected insulin in order to maintain glucose levels and to live and survive. So those minor fluctuations are really important to be on top of in a type one diabetic. And their glucose swings are much more dramatic typically because, you know, that normal process that a non-type one diabetic kind of naturally has. So their swings might go from 200 to 50 in the matter of, you know, 30 minutes. It's especially important in that group, whereas if you're a non-diabetic, the minor differences, it is important to kind of know that absolute value, but it's the trends and information that you're gaining from like the way your glucose is changing. And that is most useful. So coming to the question then of accuracy and precision, what tends to be very correct, so to speak with the CGM is the precision. So the amount that glucose is fluctuating at different times. So if you compare your overnight average on your Sunday versus Monday, kind of how you're seeing how much those are different between two days is very accurate in that precision. But what might be off is the absolute number. So it could be reading that your glucose is 90 right now, and then jumped up to 120 when in reality it was 80 and jumped up to 110. So we do allow people to calibrate in our app, which means if you know your glucose at that moment, because you recently got a fasted glucose level or your finger pricking is 80, you can adjust it to match that. And then you can kind of see that in real time, a little bit more accurately. But if you don't have that number and you aren't calibrating, you can see that my glucose jumped 30 points and it took four hours for it to come back down to what it was before I ate.
Kara Collier
You can see those trends and variability in your glucose levels, whether the number is exactly on or not.
Melanie Avalon
Oh my goodness. Okay. So many, I have so many thoughts and questions. I'm just trying to think in all the conversations I've had about CGM's. I don't remember learning that about if it's a bigger change or a faster change that you see it faster on the CGM. That's, that's really, that makes sense though. Okay. Some, some questions there. Well you mentioned just to provide some clarity for listeners about the numbers they actually should be looking for. Andrea had a really good question. She said, what is the optimal blood sugar spike for a given meal? Should your blood sugar never go over X amount or is it more about how quickly your blood sugar returns to normal? I heard someone say your blood sugar should basically stay between 80 to 130 no matter what you've eaten. So can we, um, just kind of clarify for listeners, what numbers they actually should be looking for?
Kara Collier
Yeah, absolutely. And I love this question because I think there is a lot of misinformation around this. The first myth I always like to point out that I think we've discussed is that like an absolutely flat glucose line is not necessarily the end goal. Like zero variability in your glucose is not superior to normal amount of variability. So if your glucose moves because you just ate, that is normal physiological response to eating. But we want to make sure that it's moving in a way that is not too high and it doesn't take too long to get back to normal. And then we also want to put it into context. And this is where kind of either AI detection to put it into context for you or a human to kind of point this out and talk through it is important. Because if you eat something that is just protein and fat, I'm not expecting your glucose to go up too much if there isn't any carbohydrates in it. So it might be ideal if your glucose was starting at 80, if it goes up to a 90 or 100, and then comes back down to 80 within two hours, that's pretty expected. But if you have some carbohydrates, let's say you have half a cup of sweet potato with that same meal, it might be completely normal for it to go up to 120, 130, but then come back down within two hours still. So you do want to take into context like what did I eat to make sure that it's an expected response. But at a high level, we really don't want glucose to go above 140 in an optimal manner. And we want it to kind of come back down to those pre-meal values within two hours of eating. But as I mentioned, if you're following a low carbohydrate diet, if it's just kind of mostly protein and fats, then I really don't expect it to go much above 120, kind of at any point in time with meals. But one last clarification I'll point out is that there's a difference between what is optimal for good long-term health and kind of what is the goal range, which is below that 140, and being metabolically unhealthy. So there are responses when I look at someone's meal response that I would say, this concerns me that maybe there's some metabolic dysfunction, potentially some insulin resistance. And then there are responses where I'm like, this makes sense given the context, but it's not a healthy or ideal response. So to give two examples, you might eat a piece of steak and half of a sweet potato, and your glucose goes up to 140. It takes four hours to come back down to normal. And it's like, I wouldn't have expected it to go that high, and I would have expected it to come back down sooner. This could be something to look into, get your insulin level tested, kind of try some other foods. It might not be a good sign of normal metabolic response. And then there's somebody who maybe drinks an entire Gatorade and their glucose spikes up to 150 and comes back down in an hour. And that response doesn't indicate to me that you have metabolic dysfunction, but it doesn't mean we want to see that response because it's not necessarily good for your body. Does that make sense?
Melanie Avalon
Yeah, no, that completely does. And actually, so to that point, and so this is me asking, and then Andrea actually had a follow-up question that is kind of similar. But my question would be, if we're not expecting to see that many fluctuations on like a low-carb diet, a keto diet, maybe even a carnivore diet, is there benefit to using a CGM on that sort of diets? Or is it really just for people who are eating carbs? And then I can tie in Andrea's second question, but maybe I'll start with that.
Kara Collier
Yeah. I definitely think there is still benefit. Usually people who are following a lower carbohydrate diet don't need to wear them for as long to get some insights, but some examples of things you might learn are the impact of meal timing. So sometimes everyone kind of responds differently, but eating later at night versus earlier in the morning, like how does your glucose respond? And then there's also giving you a better picture of what your average glucose levels are because a hemoglobin A1C, which is trying to capture your average glucose, isn't always super accurate. And so this wearing a CGM is another way to kind of see at a broader view, what are your average glucose levels overall, which is really important for overall health. I mean, kind of seeing like, does it come back down to lower values while I'm sleeping when I'm fasted? And then that's kind of the third component is seeing the fluctuations in your fasted glucose levels, which can be impacted by a lot of factors outside of nutrition and carbohydrates. So often we'll see people who are under a lot of stress and those fasted glucose levels are really high, which brings their average glucose levels up and they're not eating any carbohydrates. And the thing they really have to work on is stress management. That could be a similar type of thing for sleep quality or sleep quantity. So there's all these other variables that can impact your glucose levels that a CGM just provides much quicker and more meaningful insight into that are worth at least assessing, even if you're following a low carbohydrate diet. So maybe you wear one sensor for 14 days and everything looks good. You might be good to go and maybe you only wear one once a year to kind of check in where somebody with more of a variability in their diet might need to wear them a couple more to even kind of understand that baseline.
Melanie Avalon
So that actually does tie in really well to Andrea's second question because, so basically she's trying to figure out why her fasting blood sugar is consistently around 100, whereas like she said two years ago, it was always low around in the 80s. And she says she's been taking berberine for a long time. She says she's tried eating higher protein. She avoids processed foods, seed oils, refined sugars and grains. She takes a bajillion supplements. And so she's struggling to figure out why her fasting blood sugar is high. And her two questions here are, one, can high protein cause a higher fasting blood sugar somehow? She said she feels healthy otherwise. Good energy, good muscle mass, very little visceral fat. And then her second question, it's not really a question, but I'm turning it into a question. She said, I'm considering getting a CGM again, but I, oh, this is just a note. She says she thought that the numbers were consistently about 15 millimole difference compared to her finger stick. And since her main concern is now her fasting blood sugar and not the spikes, will it be helpful? So, and her fasting insulin was 4.7 and she's considering metformin. But to recap the questions here, so I guess there's three questions. One, which is what is similar to what we were just talking about, if she's just concerned about her fasting blood sugar, not the spikes per se, would a CGM be helpful there? Maybe we can start with that question.
Kara Collier
Yeah, I still think it's very insightful because you can start to see trends a little bit easier than the finger pricks. And like I said, in our app and in some apps, you can calibrate and some you cannot. So it sort of depends. But if you know, okay, it's consistently 15 points higher, you can kind of just do that mental math in your head that, okay, it's reading 115, but it's actually 100. But it's useful to get that sense of what days are my fasting glucose even higher or lower and like what is driving those changes potentially. Typically, we don't see people have the same exact pattern every single day. And to that point, then kind of bleeding into potentially a second question, is there are other variables that we tend to look at really closely if it seems like the fasting glucose is the thing that is driving up. So I mentioned stress tends to be the top thing for people usually if they have a higher fasting glucose level, but everything else looks good, because that kind of chronic cortisol pulsing that chronic elevated cortisol is going to stimulate the liver to be making glucose. And that tends to drive up our fasted glucose levels. So sort of assessing stress levels, and kind of any form of stress is a good place to start. The second thing tends to be sleep quality and quantity. So kind of looking at that and making sure that you're getting adequate sleep, because that can definitely impact your fasted glucose level. And lastly, in terms of just really common factors for people is the timing of your last meal. Some people seem to be much more sensitive to this than others. There seems to be like a genetic variance to how sensitive you are. But for some people, if you eat later at night, it will bleed all the way into kind of the next day, next morning and impact your fasted glucose levels. So that's another thing to play around with. And as we've kind of mentioned, the benefit of the CGM is that you can experiment with something and get insight quickly. So you could try adjusting that meal timing and see what happens and pretty much assess within one day, if that is making any difference or not. Similarly with adding in a walk before bed or in the evening or after your dinner, you can have a very quick yes or no of what type of impact that had, which I think is one of the main benefits of the CGM is just that quicker learning feedback.
Melanie Avalon
Yeah, I could not agree more and it's hard to really emphasize just how profound it is until somebody's actually done it, but that in real time data and that really ability to see quick changes, I just think is so, so powerful. So her question about the protein, actually before that, I want to comment on the liver piece. I also love that you brought that up because I think a lot of people think fasting, you know, their fasted blood sugar level is primarily driven by like the food they just ate. But so much of it is the liver actually, you know, producing this glucose, which I think a lot of people don't realize. So her question about can high protein cause fasting blood sugar to be higher? Have you seen that with CGM's?
Kara Collier
Yeah. And to touch on the liver piece, just to emphasize that more, like your liver has unlimited ability to keep making glucose. Like there, there is no upper limit, you know, it's like you can keep making it and making it. Because I think a lot of people under emphasize the amount of stress they're under and how much of an impact that has, but related to protein. So this is something that I get asked quite often. And I have very rarely been able to see a direct link between, okay, we really increased your protein and we saw that fasted glucose go up or we really decreased your protein and we saw fasted, flat, fasted glucose levels drop. So I can't say with certainty, because I haven't done like a, you know, completely randomized controlled trial. But anecdotally, I haven't seen this to make a big impact. I think that the upper threshold of how much protein you have to eat in order for that to start impacting your glucose levels is pretty high and higher than what most people are doing. So it's not to say I don't think it exists. I just don't think it's a common variable that most people are probably needing to deal with. It can, you know, provide the substrates for your liver to make more glucose, as we've mentioned. But again, most of the time I don't, see this direct correlation and it's not usually something that I'm having people worry about too much. Usually I'm having people eat more protein than what they're currently doing.
Melanie Avalon
I tend to err on the side of encouraging more protein rather than less. And we've actually, especially when we have a new co-host now, but Vanessa Spina was our prior co-host and we talked about protein all the time on the show and it's still an ongoing debate. Like it's weird to me that we still don't know that there are still conflicting opinions about if you're eating excess protein, whether or not it becomes glucose or not. Like there's people still debate that.
Kara Collier
Yeah, they do.
Melanie Avalon
I'm like, how do we not know? I feel like this is testable.
Kara Collier
Yeah, I feel pretty good about recommending like higher protein is typically better. And there's like very rare instances where I'm like, that's a lot of protein you're eating. Like usually I'm like, yeah, more protein, please.
Melanie Avalon
It's shocking the amount of protein I eat, but I also don't add a lot to it. I don't think I could eat the amount of protein I eat and also have a ton of carbs or fat as well. This is a random question I just thought of. Have you seen, I'm trying to remember, I don't remember the brand or what it was called, but a company reached out to me and they were making an app that was supposed to show you your blood sugar levels, but it didn't actually test them. Do you have thoughts on that concept? I was very hesitant. I immediately just said no, because I was like, how does it know? Like you could be telling people wrong information.
Kara Collier
Yeah, I would definitely be skeptical of that. And that, that brings to a question I think you had earlier that I might not have finished with just like new technology with measuring glucose levels. What is being tested and I think has a lot of potential, but is not ready for like full market adoption consumer use is kind of detecting your glucose values through like optics and lasers. So, you know, similarly to kind of how we're detecting heart rates from like a wearable or like a watch. I think that there will certainly be a possibility where we'll be able to wear something like that, that is kind of able to detect the glucose levels like in from your, you know, your veins and your, your blood vessels. There's also the ability potentially to detect it in like your eyes. So the small amount of those tiny blood vessels that are in your eyes and kind of similar type of functionality. I haven't seen anything yet that has been that is credible and verified and ready for like market use. So I would say if you have something right now, like anybody out there, like they're seeing an ad for something, I would be skeptical, but I definitely think we're going to have much better technology in the future.
Melanie Avalon
Yeah, I was going to circle back to that. I'm so glad you brought that up again at Nutrisense. Are you actively looking at expanding if there is new technology like that in the future, or I'm just curious about like the company in general. And actually related to that, Anna said, are they available over the counter yet? I had heard a like a rumor or a whisper that maybe that barrier was going to be broken anyways with CGMs. Do you know about all of that?
Kara Collier
Yeah, absolutely. So from a company perspective, we don't make the hardware. We work with the companies who do make it. And then we do the software. So the app and then the services, the nutrition dietitian support on top of it. So we're always looking for like what, and we're not hardware specific, where we only work with, you know, one person, one type, we work with several different ones. And now we also have a better related to the over-the-counter option. We have a better what we call like BYOS, bring your own sensor, because they are available over the counter now. Oh, are they?
Melanie Avalon
Did I miss that?
Kara Collier
Yeah, so it's very recent change. So yes, they're available over the counter, which is a huge change in making them more affordable, more accessible. So we're working directly with those companies as well, to kind of integrate those sensors into our ecosystem to make it even cheaper to our customers as well. And from their perspective, they are still hardware manufacturers that don't really want to play too much in like the consumer side, even though now it's direct to consumer or the software side. So, you know, they're, they want to kind of like stick in that wheelhouse. So it works well to be able to either you can get the sensors directly from them and then use just our app in our dietitian services or kind of still get it through us, but using their hardware because it's continuing to make it cheaper and easier for everybody.
Melanie Avalon
Wow, when did that happen? Do you know?
Kara Collier
I think it was August or September.
Melanie Avalon
Okay, in the fall. Okay. I find it really interesting in the medical community in general, where the barriers are, and where they aren't. Like what we're like allowed access to, and what we're not. I just, I'm, I find it intriguing.
Kara Collier
It is. The whole thing has been interesting because, you know, it's in Europe, they've always been over the counter, same companies, same, you know, manufacturers are allowed to sell them in Europe over the counter. And then in the US, we just kind of, you know, had like an arbitrary rule, but they are still their cgms that they make for so like, you know, the Libre you're familiar with is still a prescription device for diabetics, technically. And then they have their over the counter variation, which has like certain, it has to be like a different sensor, technically, in order to get that approval. So there's still some weird rules and like, things that we're having to go through. But I think the whole landscape is changing. And we're only going to move towards more accessibility, cheaper prices, better technology as things continue to change.
Melanie Avalon
Awesome. Wow. That's really interesting about the, like the lasers or the eye. And I want to say non-invasive, but putting a CGM on for friends, if you've probably heard me talk about this before, some people can be intimidated because it, there is like a needle that sticks to your skin, but I promise you, you don't, you like don't even feel it. It's so easy to put on.
Kara Collier
Yeah, it's so easy. And if you do any sort of at home finger pricks, that's way worse just like to put it into context way worse.
Melanie Avalon
There's like no comparison.
Kara Collier
Yeah, I hate finger picking now.
Melanie Avalon
Okay, as far as actually lowering blood sugar levels, Amy had some good questions. She wanted to know about some specific different things. So she wanted to know, to help regulate blood sugar, is it better to go on a walk right after a meal? Or if the morning blood sugar is high, is it better to walk before the first meal? So that's the first one she asks about. So walking, and you mentioned walking earlier, so I'm glad she's talking about it. Is the timing of it, do you see a difference?
Kara Collier
Yeah, in general, walking is a great tool. The more you can do it and the more you can kind of get these like micro walks in. So 10 minutes here, five minutes there versus like a really long walk is better. So if you have the ability to do a 10 minute walk in the morning when you wake up and the ability to do 10 minutes walking after each meal, like that's ideal. But if you're like, I'm only going to do it once, I would say right after a meal is the best.
Melanie Avalon
And then another one she asked about when is the best time to take berberine?
Kara Collier
Yeah, I'm also curious to see if you if you have a preferred time, but in general, I see it best with meals. So I tend to recommend if you're kind of splitting it up, like if you're taking it twice a day, kind of taking it with with your biggest meals as the most optimal time, but I recommend taking it consistently. So as opposed to kind of taking it here and there, the more consistent you are, we see I see better benefits, but curious your, your thoughts. 1
Melanie Avalon
Yeah. Well, first of all, have I sent you my berberine?
Kara Collier
I think last time you did, yes, yes, you did, because it's in the beautiful glass bottle. I love when they're glass bottles and not plastic.
Melanie Avalon
Me too. Yeah, no, huge Burberry fan here. It's interesting and I'm glad you asked that question because the majority of the research I've seen on Burberry does dose it around meals. That said, I do a daily fast. I fast every day and I eat one meal a day at night. So I actually just personally, I do take it in the morning and then I take it before my meal as well. I just, that's the way I do it.
Kara Collier
Yeah, makes sense. And I think the main recommendation from my awareness of taking it with meals is because sometimes people have GI side effects and they tend to be lessened with with meals, less so of like effectiveness. So if you don't have any sort of, you know, GI issues with it, then I don't think it matters as much.
Melanie Avalon
That's a good point. Yeah. It's also astounding because I think a lot of people think about berberine and they focus on the blood sugar control aspect, but there are so many studies on the other benefits of it beyond that. So helping with cholesterol, it actually, there's a study on showing how it activates AMPK, also microbiome effects. That's why I thought about it. So yeah, it has a lot of potential good benefits, which I love.
Kara Collier
Yeah, absolutely. And just like general like suppression of chronic inflammation, those like natural stress pathways. Yeah, absolutely. And it's so low risk, like we don't really see any sort of issues with it.
Melanie Avalon
Yeah, it's great. How about fasting? So I'm going to modify her question a little bit because she's wanting to know, actually before that, since we're talking about blood sugar levels, she wants to know what is the best time to drink apple cider vinegar for blood sugar. She said she's seen 15 minutes before a meal and also right after a meal, does it matter? Do you have thoughts on apple cider vinegar?
Kara Collier
Yeah, I typically see the best benefit with this if it's right before a meal. So just drinking a little bit, diluting it with water if you want to. I know there are also apple cider vinegar supplements, but honestly, just kind of drinking it, taking a quick shot, diluting it into a beverage. A lot of people will dilute it into a plain sparkling water if that's your preference and kind of drinking it right before the meal, I tend to see the best, best impact.
Melanie Avalon
Awesome. Do you personally use any? Well, I know we're brain. Do you use apple cider vinegar?
Kara Collier
I don't use it consistently. I have used it in Burberry or not Burberry apple cider vinegar is one of those that you can sort of use more randomly and see just as much of an impact versus like needing consistent use to see the benefit. So if I know like I have maybe an abnormal meal coming up that's like higher carbohydrate or kind of something going on, like I'll try to incorporate it. Like I'm like, Oh, a mental note to do it, but it's not a part of my daily routine.
Melanie Avalon
And then Amy's last question was the fasting schedule. She wants to know for blood sugar, is it better to do a long fast or to fast daily for X amount of hours? What might people find with fasting and CGM?
Kara Collier
Yeah, and this is one of those topics where I think wearing the CGM and experimenting is going to be your best option because I see so much variability between people of what what is kind of their optimal sweet spot for fasting. Like as I mentioned, I think there's some good general rules of thumb of like, you know, don't be grazing all day, like make sure you have at least, you know, a little bit of time between your last meal and going to bed, having some sort of fasting window throughout the day. And then beyond sort of the basics, I just, I just see so much variability between what works for people. What you're kind of looking for is what does your glucose look like when you break a fast, so kind of just being mindful of what is the first few bites of food you put in your mouth, please don't start straight with carbohydrates, you'll probably especially the longer you've been fasting, the more important this is of like how you're breaking that fast. And then kind of when it comes to the right timing, you just sort of experiment with different times. And then that fasting window, I think also experiment. I know you you mentioned you do OMAD, and I think it works really well for some people. And then for some people, it doesn't. So I think just kind of testing that out for yourself. And usually the factor that I see of when it doesn't work is if they have a lot of other stressors stacked up in their life. And there's one too many stressors happening. So if you have a very stressful job, and you don't have your stress management under control, and you kind of are doing other things that are putting stress on your body, sometimes the positive stress of fasting and some of these other things like, you know, sauna cold plunge can tip that scale into too much stress. And then we see glucose levels go up fasting glucose levels, postprandial responses, average glucose levels. And so usually it's kind of what which of those things can we adjust so that we can normalize. And then with some people, we see their glucose levels dramatically appear dramatically improve when we add in more fasting than what they're currently doing. So again, I think it's contextual. And I think you have to experiment. But you know, I do recommend kind of the basics of doing some type of fasting window. So you're not eating 24 seven and trying not to eat like right before you go to bed. And then being mindful of how you're breaking that fast is super important.
Melanie Avalon
Yeah, I just like you're saying, it's so individual. And it also can change, you know, through time, like one thing that's working for you now might be different later. Like I know for me in the past, I went through a period of time where I was very low carb, almost carnivore, and I would have higher fasting blood sugar levels doing that. And then when I actually added in some carbs, I actually started having lower fasting blood sugar levels. And so my theory there is that, you know, my liver was probably like overcompensating, putting out glucose, and then it's actually just brought in, you know, endogenous or exogenous carbs. I feel like it wasn't keeping my levels high all the time. Things just can really change. So if you had to, well, Susan wanted to know what's the best way to lower blood sugar, and we literally just went through so many different ones. But so maybe I'll modify her question a little bit. If you had to, you know, have somebody start somewhere, because that's so many lifestyle factors, like where should somebody like, where should they start? Because it can be a little bit overwhelming, I think.
Kara Collier
Yeah, it definitely can be. And that's again, why I think a CGM can be helpful is because you can kind of identify like, oh, this one meal is like really not working for me. Let me just adjust this thing versus kind of you get a high A1C and you're like, what do I need to do to bring this down? Like what do I, like it feels overwhelming. So it can be helpful to have just like more information so you can pick one thing at a time that you know is working. But if you don't have that, you're like not really sure and you know, your, your glucose is elevated. I would start with just being mindful of your carbohydrate intake. You know, it sounds simple, but that's a good place to start. I think one of the biggest myths out there that I'm sure your audience is a little bit more aware of than maybe the average person is just that like half of your calories should come from carbohydrates. And that's a lot. And like for 98% of people, it's too much. Sometimes I see it work fine for people if they're like athletes usually is pretty much the only bucket that, that amount tends to be okay. And so really just being kind of mindful of that total carbohydrate amount and prioritizing your plate to be more about protein, non-starchy vegetables, if you tolerate those well, and then kind of the carbohydrates are more of a nice to have small amount. So that can make a big difference. And then if you're consuming any form of like liquid carbohydrates, try, try to cut those out and that, cause that makes a big impact. You know, even if it's sort of quote unquote natural juices, that's still a very concentrated form of carbohydrates, any sort of sweetened beverage, sweetened coffees, Gatorade, you know, checking the sugar content of like electrolytes. So trying to just be mindful of that liquid sugar is another really kind of like big place to start kind of auditing your sugar intake.
Melanie Avalon
I'm pretty sure I think we talked about this before. I'm so fascinated by this question. So I'll re-ask it. How do you feel about the recommendation people make to add fat to your carbs to slow down the absorption of the carbs?
Kara Collier
Yeah. So it is this concept of kind of like no naked carbs, which I do think has validity to it. But what I see work a lot better than just kind of coding carbohydrates and fat is eating some protein before you have any form of carbohydrate. So back to that kind of point of how you break a fast, if you are in a fasted state and your first bite of food is like a banana, you're probably a piece of steak and then some non-starchy vegetables, like you're doing Brussels sprouts or whatever it is, and then like banana is your dessert or whatever, however you're arranging that. It's probably going to be a much more blunted glucose response, which is going to have a less of an impact directly on kind of your blood vessel health and that endothelial tissue and those things that kind of cascade from a dramatic glucose spike. So it is beneficial to first prioritize eating protein before you have carbohydrates and not eating them by themselves. But that doesn't mean that trying to think of a good example. If you're eating potatoes, that putting a bunch of olive oil on top of them makes them significantly better. That's kind of where we're headed. Instead, I would say eat a piece of fish and then have a few bites of potatoes if you want them and see what your glucose does.
Melanie Avalon
Yeah, I feel like my take on it is a little controversial, but I actually, I don't know. I just feel like if you're having carbs, adding fat to that just seems like a bad idea to me. Because then you're, I love the idea, basically for carbs, I would say add what you just said, protein or like green veggies. Because then you're gonna slow the absorption, but you're not gonna be adding in a competing fuel source. Because when you're adding in the fat, then you're just encouraging a situation, in my opinion, of energy toxicity. Because now you have like, you're adding a lot of calories, you're adding two fuel sources of fat versus carbs. It just seems, I don't know, compared to if you add in the protein or the veggies, but not adding in the fat, you can still be using that glucose and those carbs as fuel, the protein will be slowing everything down. I don't think it'll be running into this like conflicting fuel option.
Kara Collier
I agree. And I think volume matters. Like what the quantity of food definitely makes an impact. So it's like, you know, if we start to get where the quantity of food is more than your body needs, then it's it is going to start kind of kicking that in. But if it's like smaller amounts, it doesn't matter as much. But what I always recommend is that focusing on protein versus fat, because I also don't see fat blunt the glucose response nearly as well as protein or fiber does anyway. So it doesn't seem to have as powerful of an effect in that. And it is like, fat is extremely calorically dense. I am not fat phobic. I'm pro fat. But that doesn't mean that we want to like I maybe this is controversial, but I am not in the camp of add more fat to everything. Like the butter coffee is not my vibe. Because what I see often of what this actually turns into of people what people actually do with that is they're eating carbohydrates and they're putting butter in their coffee. And now we've just added 300 calories of butter for no reason. And like they're not any more satiated. They're not eating any less. They're not in ketosis. They're just adding more fat in random places. And that's not helpful.
Melanie Avalon
Yeah, I actually I'm on I'm on the same page there, because I feel like that's such a common recommendation. Add fat to your carbs. And it really should be add protein to your carbs. Like that would just be such a better recommendation, I think for for people.
Kara Collier
And usually the fat source people are adding that situation isn't necessarily like nutrient dense either, it's not like adding a lot of value.
Melanie Avalon
Yeah. Yeah. So true. So we're talking a lot about using a continuous glucose monitor for blood sugar levels. And I think we're kind of focusing on, well, actually we haven't even really defined this. So blood sugar levels and how it does relate to metabolic health in general. So that's me asking you, like, what are your thoughts there? Stephanie wanted to know, does glucose have any relation to heart health or cholesterol? Would her general practitioner give her a prescription if she asked? That's a good second question. Okay. So a few different things there. So general health, do the blood sugar levels, how do they affect our metabolic health? Does it relate to heart health? What are your thoughts there?
Kara Collier
Yeah, absolutely. So metabolic health and metabolism in general, I think of as like this whole bucket of all the processes our body is doing in order to turn food into usable fuels. So thinking about digesting, absorbing, processing, transporting, excreting, it's all of the different processes required to utilize the energy that we're putting into our system and the energy that we've stored in our system. So that's like metabolic health and metabolism as a whole. And then glucose is one of those main fuel points, right? So we have glucose, we have fats and fatty acids, and those are our two main fuel sources. Of course, there's also ketones. And so by monitoring that, we have a good idea of kind of how that metabolic system is working. And typically you don't have glucose. It's not usually like if you keep going down a certain path of metabolic dysfunction, that you're only going to have one issue, that you're just going to have glucose issues and never lipid issues, or you're just going to have lipid issues and never glucose issues. So typically, like if we have metabolic dysfunction, that means our energy processing, transporting, all of those different systems are not working as they're designed to be working. And so you can kind of see that by watching how your glucose levels change and react and how they fluctuate. There's definitely a correlation with glucose levels and cardiovascular health, heart disease risk. And that's where tracking glucose levels tends to be easier than tracking lipids because we have the technology to monitor it in this 24 seven way. So usually when we improve glucose levels, we tend to kind of improve metabolic health as a whole, which then has that kind of ripple effect bleeding into improving lipid levels and kind of those other areas. But it doesn't just start with cardiovascular health. One thing I always like pointing out is that it also has a direct impact on kind of the sort of brain function side of things. So both risk for conditions like Alzheimer's and dementia, but also kind of your day to day ability to concentrate cognitive function memory, because that, you know, our brain is very glucose dependent and very insulin sensitive organ. So that's kind of another major area that by monitoring glucose levels and optimizing them kind of having that big impact on long term and short term health.
Melanie Avalon
Awesome, yeah. When she asked about would her general practitioner give her a prescription, if she asked, I'm curious if she's asking about like for her blood sugar levels or if if he would give it to her based on her cholesterol. But either way, do you find doctors are open to prescribing them to people?
Kara Collier
Yeah, historically, not so much, which is why we decided to do it ourselves. You started your company. Yeah, so we traditionally know, and I think part of the resistance here is that they're not trained on what to do with the information. It's like, okay, if I give this to a non-diabetic, and they come back and tell me, look at my glucose levels, how was it? They don't know because the only... And I really can't blame them for that because the only thing they've been trained on is maybe managing the diabetics levels, which is honestly very, very different. So part of it is, how do they help somebody if they do give it to them? And then the other is, it's not anywhere in traditional guidelines that this is a use case. So traditional medical triaging, an intervention for somebody, this is nowhere in the standard recommendations that it might be a useful tool. So unless you get somebody who's maybe more of in the functional medicine space, it's probably unlikely that they're going to, unfortunately. But yeah, that's sort of why we exist. And now that things are moving a little bit more over the counter, you can kind of bypass that all in general. So I would kind of go around them if they're resistant.
Melanie Avalon
Yeah. And I don't know the, obviously I don't know the technicalities of the medical system and how it works, but I would imagine, I know for doctors, there's a lot of pressure about what they can and can't prescribe and there's codes they have to follow. And so I would imagine it's probably not the easiest for them to prescribe a CGM without like a verified you are diabetic or pre-diabetic like code to put in the system.
Kara Collier
Definitely like insurance won't cover it and so usually weren't they're not typically thinking about things if it's not in a classic like insurance coverage route
Melanie Avalon
And so, glad we're talking about this, to clarify, so when people use Nutrisense, what is the setup? How many CGM's do they get? How does it work with the app? What is that experience like?
Kara Collier
Yeah. So each CGM lasts 14 days. So kind of our minimum order is to do two CGM's or like a month supply. And that's a great place to start if you're not really sure, if you just kind of want to check it out, or if you're generally healthy and just want to see some of these additional like insights that we talked about. So if you were to just do the one month, then you would get those two CGM's shipped to your door. You just kind of sign up on our website online. It's super simple. You fill out a quick health questionnaire, and then we'll ship it to your door. And then you have access to the app, which is where you'll see your glucose data. Once you put the sensor on, you can log your meals, you can kind of sync with your wearables. So any data from like your Apple watch or your or ring will sync on there. And that's also where you can schedule and book calls with our nutritionists and where you can kind of connect with them. Like I mentioned, now we offer full video consults, which again, for some people using the app, looking at the data, reading our blogs, talking to our kind of like chatbot that has all of our information might be enough. But then for other people, there was this big issue of kind of like what now or what does this mean, or what's most important to take away from here. Being able to kind of connect with that human helps people really turn the data into actions and change. And so then we also offer three months, six months and 12 months subscriptions. So you can change to those plans at any time, but it gets cheaper, kind of the longer the commitment term.
Melanie Avalon
Awesome. And yeah, this will be a good time. So I will give listeners a link, because we do have a discount code for you guys. So thank you so much for that Kara. So people can go to Nutrisense.com slash if podcast. So that's n u t r i s e n s e comm slash if podcast and use the code I have podcast that will get you $30 off and one month of free nutritionist support. So definitely check that out. I'm super curious just like a day in your life, Kara at Nutrisense. Like what's a day in the life? I mean, I know we're like podcasting right now. But you know, where's your focus? What are you doing? Like was what's it like being at the company?
Kara Collier
Yeah, that's a great question. It's all over the place. I would say one thing that is always true is that a one day never looks the same as another day. But largely, so I'm responsible, really paying attention to our dietitian services. So everything that our dietitians touch and making sure that they are, you know, adequately staffed, trained, supporting our customers in the right appropriate way. And then anything that kind of requires knowing anything subject matter expertise. So I'm working with product a lot to make sure our product is really good, and scientifically sound and also useful and actionable. And then kind of external facing activities like this that require some of that more knowledge about kind of the nitty gritty of what it all means.
Melanie Avalon
And two more personal questions. One, how often do you wear a CGM?
Kara Collier
Well, I'm actually wearing one right now. So pretty often, I think when I first started wearing them, I wore them pretty much 24 seven, where now I probably tend to put one on every, I don't know, maybe two or three months, sometimes I'll wear them more often, if just there's like something happening in my life that I'm trying to pay more attention to. But in my normal routine, it's it's Yeah, maybe once every quarter. So
Melanie Avalon
This is actually really inspiring me because I haven't worn one in a while and I have one. So for me guys, so I'm going to I'm going to put that on like really soon. And what are you most excited about in the future with all of this?
Kara Collier
Yeah, similarly to what we've talked about, I think we're really at a cusp of a lot of positive change happening. So I'm excited about all of the technology advancements that are going to be coming, but I'm also really excited in terms of kind of the switch to the over-the-counter sensors. Because I think they're going to become more normalized. More people are going to be wearing these. They're going to be cheaper, which is going to make it easier for a lot more people to use them. And they're just going to become better technology that are easy to understand, easy to wear. They're going to last longer. And just like my personal goal, the reason I got in this in the first place is because I really, truly believe that if everybody wears even just one CGM, we will be healthier as a nation. So that is my big picture, moonshot goal, is that everybody wears at least one. Honestly, we still have a lot of improvement to make in our health as a society, but I'm optimistic that we'll at least be heading in the right direction, hopefully.
Melanie Avalon
Oh my goodness. Now I feel like I'm plagiarizing because literally that is how I open my conversations of CGMs. I always just say, especially for people who aren't familiar, I'm like, if everybody could just wear a CGM, like once, even just once, it would change the metabolic health of our nation. Like, hands down. Hands down. That's incredible. And it's really good to hear because I was curious when I first heard that, yeah, CGMs are going to become more accessible or maybe not require prescription. I was wondering how it was going to affect companies like you. Like, would you see that as, you know, a threat because you're providing CGMs, you know, and now people can get them over the counter. It's good to hear that you're all about the more access and the abundance. Because even if you get one over the counter, that is not going to help you analyze that data, make sense of it. I think so many people, you know, they get a CGM and then it's like, now what? You need something that helps you to understand everything. And Nutrisense, the app, and everything that you're doing is just so, so valuable for that. So, like, thank you. Thank you. Thank you.
Kara Collier
Yeah, absolutely. And it's definitely synergistic. You know, if I love that they're going to be, you know, cheaper and easier, but it's also they are not they're not good at making apps or accessible data. So it's definitely synergistic of what we do and what the hardware manufacturers do.
Melanie Avalon
So again, for listeners, cannot recommend enough getting a CGM, go to Nutrisense.com slash I have podcast use the code I have podcast to save $30 and get one month of free nutrition and support. So well, this was awesome. I would love to just keep having you on annually if you're down because I, I just think this is so so helpful for people and I just can't thank you enough for all you're doing. So so thank you so much for everything that you're doing.
Kara Collier
Yeah, absolutely. I would be thrilled to make it an annual change and honestly, so much changes in a year would be fun to kind of do at that cadence.
Melanie Avalon
I know. It's really exciting, especially like going back to what we were talking about in the beginning. Like just so much has changed even from last time we talked, so. Awesome. Well, thank you so much. Enjoy the rest of your day and we will have to talk again soon.
Kara Collier
Yeah, absolutely. Thanks Melanie. Bye.
Melanie Avalon
Thank you so much for listening to the Intermittent Fasting Podcast. Please remember, everything we discussed on this show does not constitute medical advice, and no patient-doctor relationship is formed. If you enjoyed the show, please consider writing a review on iTunes. We couldn't do this without our amazing team, editing by podcast doctors, show notes and artwork by Brianna Joyner, and original theme composed by Leland Cox and recomposed by Steve Saunders. See you next week!