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Weight LossUnderstanding CGM Data with Paul Kolodzik MD
August 13, 2024 By
Leanne Vogel
January 25, 2025
Transcript
Dr. Paul Kolodzik
The reason increased muscle mass reduces insulin resistance is just that you have more effective insulin receptors on a higher level of muscle mass. So you’re going to be soaking up more insulin and soaking up more blood glucose.
Kevin Kraft
Welcome. This is Kevin, Leanne’s husband. Leanne has been sick the last week and lost her voice, so I’m taking over. But don’t be scared, it is just for today’s podcast Introduction in today’s episode, Leanne interviews Dr. Paul where they delve into a critical aspect of our health that often goes unnoticed until it’s too late. Metabolic health and using CGM data to understand metabolic health. Some topics they will cover include how CGM use can assist with reverse metabolic diseases such as hypertension, high cholesterol, prediabetes, GERD, sleep apnea, fatty liver disease, and more. Dr.
Kevin Kraft
Paul A pioneer in the use of continuous glucose monitoring for non diabetic patients. With over 30 years of experience in emergency medicine and a passion for preventive care, Dr. Kolowczyk has dedicated his career to helping patients achieve optimal health by addressing the root causes of metabolic dysfunction. From understanding the significance of glucose and fasting insulin levels to decoding CGM patterns and reversing insulin resistance through diet and exercise, Dr. Kolodzik brings a wealth of knowledge and practical insights. Stay tuned as we explore the numbers, the technology and the lifestyle changes that can transform your health. Enjoy.
Leanne Vogel
Hey, my name is Leanne and I’m fascinated with helping women navigate how to eat, move and care for their bodies. This has taken me on a journey from vegan keto, high protein to everything in between. I’m a small town holistic nutritionist turned three time international bestselling author turned functional medicine practitioner offering telemedicine services around the globe to women looking to better their health and stop second guessing themselves. I’m here to teach you how to wade through the wellness noise to get to the good stuff that’ll help you achieve your goals. Whether you’re seeking relief from chronic ailments striving for peak performance, or simply eager to live a more vibrant life, this podcast is your go to resource for actionable advice and inspiration. Together we’ll uncover the interconnectedness of nutrition, movement, sleep, stress management and mindset, empowering you to make informed choices that support your unique health journey. Think of it as quality time with your bestie mixed with a little med school so you’re empowered. At your next doctor visit.
Leanne Vogel
Get ready to be challenged and encouraged while you learn about your body and how to care for it healthfully. Join Me as we embrace vitality, reclaim our innate potential, and discover what it truly means to pursue Healthfulness. Hi, Dr. Paul. How’s it going today?
Dr. Paul Kolodzik
Thank you for having me.
Leanne Vogel
Yeah, of course. So today we’re going to be talking about CGMs. And I would love to know kind of how you got started with CGMs and why, why CGM is your thing.
Dr. Paul Kolodzik
Okay, so CGMs are continuous glucose monitors, the devices you see on the back of the arms of diabetic. And I think they have great utility for non diabetics because a lot of pre diabetics and non diabetics put a CGM on and they see their blood glucose physiology for the first time. And it can be very useful. And some people, I can even say that it can change their direction of their lives because if you’re pre diabetic, you can be pulled back from the edge of being diabetic. So I first got into the metabolic health business using CGMs because my background’s in the emergency department. I’ve spent 25 years in the emergency department. And what gets all the press in the ER is the gunshot wounds and the multiple traumas and the stabbings and the overdoses. But what emergency physicians see every day, day in and day out, all day long, is the disease processes associated with both obesity and vascular issues and blood glucose.
Dr. Paul Kolodzik
High blood glucose is the foundation of both of those. You know, we’re largely 60% of Americans are overweight, middle aged Americans are overweight. And I see all those problems in the emergency department that result from vascular disease, whether that be stroke or heart attacks or diabetic emergencies or kidney failures. So after being in the ER for a long period of time, I decided to kind of get proactive in my practice and started a metabolic health practice. And CGMs are just an amazing teaching tool for people to understand their physiology and then ultimately, you know, change their diet. So I know that we don’t want to be too restrictive or, you know, too focused on numbers, but once people see, you know, their CGM patterns on their app, on the phone that the CGM connects to, you really can’t unsee that, as many of my patients have seen. And it can be life changing.
Leanne Vogel
Yes, I totally agree. As somebody who never really tested high for glucose, and my insulin’s always been pretty good. Even still, I’ve learned so much by having a CGM periodically to just tighten in the reins and understand how my body is responding not only to food, but also fasting and working out. So there are a bunch of different tools within that too. Like it’s, it’s unlimited. And so, like, when should we be caring about this metabolic health? Like you’re talking about high blood glucose, probably insulin resistance. If somebody is in that area, that would make a lot of sense. But if we’re not even there yet, or there at all, is there still a place for CGMs to understand our body?
Dr. Paul Kolodzik
A lot of people don’t know that they’re there or not. And, you know, the healthcare system is set up really that, you know, we kick the can down, down the road. You know, if your doc says to you, you know, your blood sugar is a little bit high, we should check that again in a year, keep an eye on it, then that’s really kind of code for your pre diabetic or almost pre diabetic. And because the healthcare system is set up as a disease management system rather than a disease prevention system, I think people need to empower themselves in terms of getting information that they can act on. And CGMs are great ways to do that. And, you know, to your point, I have a lot of people come into my office and they say, I just want to lose, you know, 20 or 30 pounds. And we put a CGM on them. And they realize that this is a much bigger issue than that with insulin resistance, as we can talk about that you mentioned, because basically high blood sugar gets converted to fat and it causes weight gain.
Dr. Paul Kolodzik
And I believe low carb. We’ll talk about it. I believe low carb, intermittent fasting and some strength training is the best way to counter that insulin resistance. And you don’t really know where you are until you get, you mentioned a fasting insulin level. It’s great that you had a fasting insulin level. I think fasting insulin levels should be as common as cholesterol tests, but unfortunately, unfortunately they are not. But the combination of a fasting insulin level to calculate your insulin level of insulin resistance and a CGM can be tremendously valuable. And you know, you can say, well, it’s for people that are overweight or people that have a family history of diabetes.
Dr. Paul Kolodzik
But, you know, the majority of Americans have some insulin resistance. And, you know, a trial run of a CGM can be very valuable to them.
Leanne Vogel
Yes, completely agree with that. So when you’re saying keeping an eye on it, you go into your doctor, they say, let’s just watch this insulin. Well, well, normally they don’t have insulin, but let’s just say they ran insulin. Let’s just watch this insulin. The fasting insulin. Let’s watch the glucose. What numbers should we be looking in our own blood work to be like, maybe I should probably start looking at this? Assuming that we have a fasting insulin and maybe even a fasting glucose, what are the numbers that should start to raise some red flags for us that we maybe need to get on this?
Dr. Paul Kolodzik
So first of all, I think you’re way ahead of the game when you’re talking about fasting insulin levels, because I’ve had a handful opinion patients come into my office in the last five years that have had a fasting insulin level. And again, I think they should be just as common as cholesterol levels, maybe more common than cholesterol levels, because I think blood glucose is a bigger threat to most people’s long term health than cholesterol is, though we’re entirely focused on cholesterol in this country. But to look at the numbers, an absolute fasting blood sugar of 100 milligrams or higher is considered pre diabetes. And then the other number to hang your hat on is a hemoglobin A1C. A fasting blood glucose measures your blood glucose that morning. And by the way, if you’ve got a CGM on, you get a fasting blood glucose reading every morning. So the other number to hang your hat on is a hemoglobin A1C. And people have probably heard that term, but what it is is the amount, percentage actually of glucose that’s attached to your red blood cells, your hemoglobin in your red blood cells.
Dr. Paul Kolodzik
And red blood cells live for 90 days. So it gives you a good reflection of what your blood glucose has been over the course of the last 90 days or so. And then the third number is a fasting insulin level. And usually a fasting insulin level needs to be done in conjunction with the fasting blood glucose, because if the fasting insulin level is a certain level, it should be pushing that blood glucose down because the insulin is the key in the lock to push blood glucose into your organs, let’s say your muscles. So you have those two numbers together and you can calculate an exact level of insulin resistance. The fancy term for that is homa IR h o m a dash IR if you want to look that up or you can find it in the book. But that’s homeostatic model of insulin resistance and it tells you exactly where your insulin resistance is. And if you’re overweight or you have a family history of diabetes, then that’s something I think it’s very important to pay attention.
Leanne Vogel
Yes. Couldn’t Agree more. And with the HBA1C, because it’s based on hemoglobin, would you say that anyone with anemias, because our hemoglobin is going to be living longer, that Perhaps a hemoglobin A1c, if it’s elevated, could be because you’re anemic? Do you find that that could play a role in anything?
Dr. Paul Kolodzik
Yeah, I think, by and large, I think it can play a role. I think there can be some variability there. But if you’re bumping, you know, 5.5, 5.6, 5.7 with the hemoglobin A1C, I would pay attention to that. I think American medicine is very nonchalant about numbers that we should be more concerned about in terms of progression to pre diabetes and then diabetes. And you know, for me, prediabetes is an emergency. It’s like you’re pre diabetic, you can reverse that, never become diabetic, or you can just progress and then be dependent upon diabetic medication for the rest of your life. So I think it’s really important, if you’re close to that range, to keep an eye on it. And a lot of metabolic health physicians feel that even if your blood sugar is not quite there, if your blood sugars, you know, your fasting blood sugar is 96 or 97, or your hemoglobin A1C is 5.4 or 5.5, then that means you probably already got some insulin resistance going on and you need to pay attention to that and act.
Dr. Paul Kolodzik
And again, I think one of the best ways to act is to wear a CGM for a couple weeks and understand what’s going on with your blood glucose physiology.
Kevin Kraft
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Leanne Vogel
Get there, I have one more question just before we get into you mentioned a little bit about what a CGM is doing, but I really want to understand how it works and all of those things for our listeners. Why is this such a big issue? Why is metabolic health important? Why should we care for insulin resistant if it becomes diabetes and just going on a medication, what’s the big deal? If my doctor’s not concerned, why should I care?
Dr. Paul Kolodzik
Yeah, I’m going to go back to my time in the emergency department because insulin resistance and diabetes eventually causes heart attacks and strokes and dementia and peripheral vascular disease and kidney failure. So if you’re at all heading in that direction, you should really care a lot. I take care of patients every day in the emergency. I don’t work every day. I work just once a week now because I have my metabolic health practice. But you should care a lot because you don’t want to live that way. You want to have, you know, not only you want to not only age, but you want to have a health span as well where you’re very active into older age. And American set, American medicine now is set up to we’re going to wait until you have diabetes and then we’ll treat it.
Dr. Paul Kolodzik
We’re going to wait until you have hypertension and then we’ll treat it. And you know, the weight issue is another issue. People don’t like to be overweight. But insulin resistance is to a great degree the reason a lot of people are overweight. And with a cgm, you can begin to understand that physiology. I use the CGMs first diagnostically so people can see what’s going on. And then we use them therapeutically to help people guide their low carb diets.
Leanne Vogel
So what you’re saying is more like behavioral change, like you’re seeing the data and you’re making changes to your behavior to change the data in real time, basically.
Dr. Paul Kolodzik
Absolutely. So if I can tell you when people come into my office, what we do is we put a CGM on for a couple weeks. So CGMs are the devices you see on the back of the arms of diabetics originally used to dose their insulin. You put it on, it puts a little sensor under the skin. That sensor then picks up the blood glucose reading in the area and transmits it to your smartphone and you can literally 24, 7, see exactly what your blood glucose is. So I put a CGM on people and I say, don’t change your diet. Some people don’t come in with and they don’t have any issue. I don’t have any blood sugar issues.
Dr. Paul Kolodzik
I just want to lose 30 pounds. And then we put on a CGM. And then some people. I see, well, you know, actually you’re pre diabetic or I’ve even had people that come in and actually you’re diabetic because your spike in sugars over 222 30. So I tell them not to change their diet for a week. There’s going to be plenty of time to act. And let’s gather data because seeing the curves on the CGM can be life changing for people. They literally see that, they spike to 180 and then they drop to 70.
Dr. Paul Kolodzik
Then all of a sudden they understand why they’re so tired in the afternoon. So it can be life changing. And our goal then is to help them level those numbers out, keep them relatively low. Because if your blood glucose is a little bit lower, then that means your body will turn to fat as a source of energy and you’ll break down fats around the middle and that will help with weight loss and it also helps then reduce the amount of insulin resistance you have. You know, blood sugar sticks to everything. It sticks to your blood vessel linings. That’s why diabetics have kidney problems and other vascular issues. It sticks to your joints, your cartilage, and that’s why diabetics often have achiness in their joints.
Dr. Paul Kolodzik
I have a lot of patients, we lower their blood sugar and a lot of their joint pain improves out of proportion to the weight that they lose. So knowing where your blood glucose physiology is with kind of a diagnostic phase, using a CGM for two weeks and just seeing where you live on your normal diet, I think can be very valuable.
Leanne Vogel
And so what you’re saying is we wear the CGM and it’s constantly monitoring your glucose all the time, as opposed to a pin prick where you’re just testing your blood one time.
Dr. Paul Kolodzik
Right.
Leanne Vogel
Or every time you prick your finger sort of thing?
Dr. Paul Kolodzik
Yeah, it’s, it’s 24 7. You know, again, I think that they’re great tools for people to understand what’s going on with their physiology. And if you’ll allow me, I’m going to give you my simple version of insulin resistance physiology. Is that okay?
Leanne Vogel
Yes.
Leanne Vogel
Yes.
Dr. Paul Kolodzik
Okay. All right, so what happens is. And first of all, the origin of all this is, you know, we ate a DIET that was 25% carbs, 50% fat, and 25% protein until the food pyramid came out in the 1970s. And we were told that we had to decrease our fat because, you know, fat was evil. Cholesterol was public enemy number one. And so almost overnight, period of a few years, we switched our carbs from 25% to 50%. And of course, the food processing industry jumped on board with that because you can make foods with a long shelf life with just, you know, refined wheat, sugar, and inflammatory seed oils. So we increased our proportion of carbohydrates in our diet.
Dr. Paul Kolodzik
People don’t. You. A lot of people don’t understand that. They know sugar is bad, but they don’t understand that complex carbohydrates, pasta, bread, even potatoes, when it crosses, when those nutrients cross the gut into the blood, they instantly become blood glucose. So it’s basically complex sugar molecules that are all wrapped together that then get dissolved in your gut, and then your blood glucose goes up. So what happens is your blood glucose goes up, insulin is released from your pancreas, which is the sweet bread, and that is the key in the lock to force that blood glucose into your organs. So far, so good. Your muscles need energy to contract, so that’s good.
Dr. Paul Kolodzik
But what happens if you’re on a higher carb diet, which we have been since the 70s and 80s, with your blood sugar? Well, the blood sugar rises, it’s sustained at a higher level for a longer period of time. Eventually, those organs, like your muscles that, you know, have used that blood glucose source for energy, begin to resist the signal from insulin. And that’s what insulin resistance is. Just think of it as your organ saying insulin. I’m not going to listen to you anymore. Blood glucose has been high for a long period of time. We’ve already absorbed plenty of blood glucose. There’s extra blood glucose out there in the blood.
Dr. Paul Kolodzik
We don’t need any more blood glucose. We’re not going to listen to you. Insulin, extra blood glucose goes to your liver, gets converted to fat, and then deposited around the middle. So eating fat is not the reason for obesity in America. Eating excess carbohydrates are because that high blood glucose then gets converted to fat. Most of it gets deposited. A little bit of it might stay in the liver, causing fatty liver disease. So it’s an interesting fact that eating fat doesn’t cause fatty liver disease.
Dr. Paul Kolodzik
Eating carbs causes fatty liver disease. And so what you want to do on a lower carb diet is just kind of reverse that process, bring that blood glucose down. So those organs are now looking for a source of energy. And if the blood glucose is at a more moderate level, they’re going to start looking to those fatty acids around our middle, breaking down those fatty acids, and then that will become a source of energy. And when that happens, you lose weight. You know, it’s like the bear that’s forging in the fall for nuts and berries and roots and, you know, eating a lot of carbs and laying down all this fat. And then the bear goes and hibernates for five months. We don’t do that.
Dr. Paul Kolodzik
We keep going to the grocery store and our blood sugar levels stay high. So with, with a low carb diet, that’s what you’re trying to do. Lower the carbohydrate intake, decrease blood glucose, so your body’s going to burn fat. And then we also integrate that in with some other techniques, intermittent fasting and strength training, which also lower insulin resistance that we can talk about.
Leanne Vogel
So in the case of strength training, I would love to kind of delve a little bit deeper into there. And before I ask you more about CGM patterns and the numbers and sort of the data that we can collect from here, because we do know that when we’re working out, some individuals will have higher glucose as they’re working out. And also we know that as you build more muscle, you’re going to become less and less insulin resistant. Like, how do we manage the carbohydrate intake with strength training and make that all work? And do you see that it needs to change over time as we become less and less insulin resistant?
Dr. Paul Kolodzik
Sure. So, first of all, the reason increased muscle mass reduces insulin resistance is just that you have more effective insulin receptors on a higher level of muscle mass. So you’re going to be soaking up more insulin and soaking up more blood glucose. So that’s the reason that an increased muscle mass helps with insulin resistance. So I, you know, I’m a big believer in strength training. I don’t disbelieve in cardiovascular fitness, but I think that most people should be spending three or four times as much time on their strength training as they do on their cardiovascular fitness. And according to the American Heart association, if you can get your heart rate to 80% of your max, you can get your, your cardiovascular workouts done. In 75 minutes a week.
Dr. Paul Kolodzik
So if you got three or four hours to work out, then you can be spending most of your time on strength training. So that is basically the reason that that increased muscle mass can help with reducing insulin resistance.
Leanne Vogel
And so when we’re working out, if we’re wearing a CGM and we’re panicking because our glucose is elevated, what do we do?
Dr. Paul Kolodzik
You don’t panic because what happens is when you’re working out, you’re getting releases of adrenaline and releases of cortisol, and that releases blood sugar from your liver into your organs. It’s really a fight or flight phenomenon. And so you’re basically being given more energy because of the physiological stress you’re putting your body under. And that’s a good thing. If your blood sugar goes up when you’re working out, do not worry about that at all. It’s a good thing. So the important times to keep your blood sugar under control related to your diet are really the rest of the day.
Leanne Vogel
Okay, so we’re working out. We don’t need to freak out when our glucose gets elevated when we’re working out.
Dr. Paul Kolodzik
Absolutely not.
Leanne Vogel
Let’s talk a little bit about. We’ve put on the CGM with your advice. You’re saying like for the first two weeks, just kind of see, I do this with my clients also, like just wear it. And we’re just going to look at the data after two weeks and kind of see what we’re going to learn from what you’re doing. I totally agree with that. Just so you can understand. And earlier you said seeing the curves, the spikes and drops, connecting that with the tiredness, what do we then do with that information? Like, what are the common things that you’re seeing people you know have.
Dr. Paul Kolodzik
I just think there is such a tremendous educational tool. When you see these curves or you see these high levels, people all of a sudden understand their doc may have been telling them their blood sugar is a little bit high or you’re risking diabetes or whatever, and it doesn’t sink in. But when you see the data on your smartphone, then it seems to all make sense. Last chapter in the book is cgms Change Lives. Because I had people see that data and the way they put it is they can’t unsee it once they see it. And then we move into a therapeutic phase where you use the CGM to guide your diet, to keep your carbs low. And I generally recommend under 50 grams a day. And then people kind of self correct.
Dr. Paul Kolodzik
And I think, as you probably know, Something happens in your mind when you go through the evolution to a low carb lifestyle. It’s like you, you, you look at some foods you used to think about eating in the past and you just don’t eat them anymore. You don’t desire them anymore. So it can be a very reinforcing process to have a CGM on and see the benefit and the stability in your blood sugar and the lower numbers.
Leanne Vogel
Long term, I think too, the gamification of health really does go a far way. Like, I wear an OURA ring and I bought it for Steps. It’s a terrible step tracker. But since wearing this thing, my sleep has gotten so much better. I wake up and I’m like, what’s my score? How can I make it better? And it’s really the same thing with a cgm. You just, you see real time data and it makes you make different decisions. Like it just, it just causes a behavior change.
Dr. Paul Kolodzik
Yeah, I mean, you just, it’s not a burdensome behavior change. It’s not like you’re restricted. I can’t eat that. And I’m not, you know, people can, you know, have a, you know, special occasion meal with their family and whatever, but you just don’t think about foods that sometimes you used to crave in the past. It can just be very, very valuable over a period of time to get that guidance. And, you know, I really feel that a low carb diet is the way to go because I don’t think calories in, calories out is sustainable for a lifetime. But with a low carb diet, you can always eat something. And so what I usually do with my patients, then we put a plan together.
Dr. Paul Kolodzik
You know, carbs under 50 a day, protein over 100 a day. We quite honestly, I know this is going to sound strange coming from a doc, but I don’t worry about fat that much. We talk about good fats and bad fats and we do some education there. But I really focus on keeping your carbs low and your protein high. Integrate that with some intermittent fasting and getting your strength training in.
Leanne Vogel
So what should we be aiming for? Because you’re talking about spikes and drops. Like should we be looking at a change in a certain amount of milligrams per deciliter in a meal? Or should we be more looking at the patterns or like how do we use this data to make the changes?
Dr. Paul Kolodzik
So we look at averages and patterns, but it’s different for different people. It’s very individualized data driven on an individualized basis. So if I have A patient that comes in and they’re spiking to 220, they’re going to have an initial goal that’s going to be different than somebody that is spiking to 160. So when I work with patients, we look at their individual situation, and that usually boils down to how high are your spikes going and what is your average level? And then we talk about targets. You know, if you’re 220, let’s, let’s for the first month get you down so you are not spiking higher than 170. And let’s get that average that is 115 down to 107. But if I have somebody come in and the highest they’re spiking is, you know, 150 or 160, then those numbers goals are going to be lower early on. You know, let’s get you to consistently under 130.
Dr. Paul Kolodzik
Let’s get your averages under 100. So it’s very, very individualized but progressive because once you reach a certain goal, then we move the goalposts and we lower it a little bit further. And that’s ultimately how people get to optimal health. And it’s also how they go through this mental change related to their lifestyle.
Leanne Vogel
The moving of the goalpost is very unsettling for people that are used to the allopathic level of care. Because I know, like, with my clients, when I’m taking them through certain things, I’m like, okay, the goal has changed. They’re like, no, no, no, wait. Like, but we were doing good here, but why are we changing this? And it’s really hard to wrap your mind around because this is a new concept for a lot of people. Would you agree with that?
Dr. Paul Kolodzik
Yeah, yeah. It’s just, you know, I mean, to borrow a term from industry, it’s continuous quality improvement. I mean, you’re, you’re basically, you know, but. But what it is, is success. You’ve achieved success at a certain level, and now you’re going to achieve success at a higher level. In this case, lower blood sugar level. But, you know, it’s, it’s basically means you’ve been successful. Congratulations.
Dr. Paul Kolodzik
Now it’s time to look around for your next challenge.
Leanne Vogel
Yes. I couldn’t agree with you more. So we’ve talked a lot about the elevation of glucose, but what happens when we say, enjoy that meal and our glucose goes up really high and then tanks and drops lower than where we started? What’s going on there and how do we correct.
Dr. Paul Kolodzik
Yeah, the physiology there is you eat Carbs, your blood sugar goes up, the pancreas releases insulin, but it’s not an exact science. And your insulin sometimes overshoots the mark and drops. So you can have people, you know, spike to 170 and then 15 minutes later be at 75. So part of the goal with the diet, with a low carb diet and a diet that has some fiber in it, because there’s some nuance, nuances to how quickly you absorb those carbs that you just ate related to the amount of fiber in your diet. So the goal is to level that out. So rather than this, you’re seeing this leveled out. And I have some patients that come in and they don’t have that much variability, but they’re too high. So we just look at getting that a little bit lower.
Dr. Paul Kolodzik
Because again, the goal is take out that variability, lower the numbers, your organs start looking around for another source of energy, which is those fatty acids. Acids.
Leanne Vogel
Would hypoglycemia kind of fall in line with this or is this a totally different conversation when it comes to the hypoglycemia?
Dr. Paul Kolodzik
No, I mean, we’re talking about blood sugar levels. So hypoglycemia is a consideration. But I’ll be honest with you, I don’t see a lot of hypoglycemia. You know, in my career in the emergency department, somebody took too much insulin, sure, certain medications can sulfate. Some medications called Sulfony reals can lower blood sugar and that can be dangerous. But I’ll tell you, in my patient population that is not on blood sugar lowering medications, I really don’t see any kind of dangerous hypoglycemia. And I have people that will, you know, they’ll drop into the 60s, even the high 50s in the middle of the night. And I haven’t had any patient that has had a problematic outcome related to that.
Dr. Paul Kolodzik
You know, I think, you know, the body is set so that you aren’t going to drop it into that low range unless you’re on some exogenous substance like insulin, etc. So I’m not saying symptomatic hypoglycemia can’t happen in a normal person, but it’s exceptionally rare. And in my career in the emergency department over many years, I probably only saw a handful of those cases. So I wouldn’t, in general, I wouldn’t worry about blood sugar getting too low.
Leanne Vogel
Yeah, I’m definitely in the camp of low blood sugar. That’s always been my issue of like my CGM will be like, you are Way too low.
Dr. Paul Kolodzik
Are you symptomatic when you have that though?
Leanne Vogel
If I get too low when sleeping, it will wake me up.
Dr. Paul Kolodzik
Okay.
Leanne Vogel
Yeah. So I have to be very strategic with what I eat before bed and I’m one of those people that has to have a snack before bed, usually protein and fat. And if I combine both of those two together, like walnuts and a meat stick, that is my before bed snack. And that will keep my glucose totally good. Whereas other individuals that might be more hyper, that might not be for them, but for me I will sleep better if my glucose is regulated, which for me is making sure it’s high enough.
Dr. Paul Kolodzik
Yeah, I understand. So there are some people that affects and the CGMs have a tendency to give you low readings. You probably recognize for the first 24 to 36 hours you have them on. So we actually don’t pay that much attention to the data in those first hours. But then the sensor seems to settle into the environment and give you more accurate readings.
Kevin Kraft
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Leanne Vogel
Leanntosave I love that you brought up potential issues with CGM because I do know that sometimes the monitors don’t self correct and they’re just not right. So that does happen. And have you used the there’s like a setting where you can do a pin prick and like recalibrate. Do you find the recalibration works or have you run into any issues just overall with using the cgm?
Dr. Paul Kolodzik
Yeah, I’ll tell you quite honestly I I have found we use the Freestyle Libras and I found the manufacturer to be very responsive. If you know one of the great things about CGMs and this is valuable to some people, they know somebody else is looking at their data. So there’s a little bit of Big Brother stuff going on there and I’m not saying it motivates every patient, but there is an occasional patient that it motivates so we can look at that data remotely and we can say, yeah, this monitor looks like it’s not really working well. And I found that the manufacturer of the Freestyle Libre Avid is real responsive. When people call, they usually are overnighted a new monitor. You know, sometimes Abbott likes to collect the old sensor to make sure that, you know, there was nothing wrong with it or as part of their data set. But usually I don’t have people do a lot of calibration. Usually they just, you know, swap a monitor out.
Leanne Vogel
So my understanding is that these CGMs will be more wildly available pretty soon here. Yeah, that’s pretty exciting. Like you could just go and grab it and use it and learn.
Dr. Paul Kolodzik
They’re supposed to be over the counter come later this year, you know. And that’s one reason I wrote the book that to help people since they’re going to be more widespread, people can get a hold of them, which is I think, a great thing. People are going to be able to see their physiology. But the reason I wrote the book is kind of a step by step guide to people that decide that they want to dip their toe into this pool and learn exactly what’s going on with their blood glucose physiology.
Leanne Vogel
So I think this conversation wouldn’t be complete without just touching on GLP1s and leptin and ghrelin and kind of what’s going on there, because it’s just such a common conversational piece right now in this realm of metabolic health and glucose regulation. What are your thoughts on GLP1s?
Dr. Paul Kolodzik
There’s a mania out there right now related to GLP ones and I think unfortunately a lot of times they’re being prescribed not in the context of a comprehensive program. So we didn’t talk about fasting a lot, but you know, I think a comprehensive program is low carb intermittent fasting and strength training. And the strength training is a huge component because when you lose losing weight on these medicines, you’re also losing some muscle mass. Anybody that’s thinking about these medicines or on these medicines should definitely be strength training. So to talk about the medicines, I mean, they are going to be the most prescribed medicines in the history of the world. Okay. They’re, they’re found to be effective for, for diabetes. They’ve moved on to found to be effective for obesity.
Dr. Paul Kolodzik
There are now indications, new indications that are coming out frequently. You know, a couple weeks ago, patients with heart disease have a decreased risk of a second heart cardiac event if they’re on the medication, if you have fatty liver disease, it looks like they help reverse fatty liver disease. So they are going to be used frequently. I just think they need to be used in the context of the right kind of program. And I personally believe that lower doses and limited periods of time are the most prudent approach to using these medicines. Not just to take a shot and then be dependent upon the medication for life. So it’s an opportunity to make lifestyle changes. And I have patients that, you know, I want them to work out, but they can’t work out, they’re too obese to work out.
Dr. Paul Kolodzik
So we use the medicines to help give them a jump start and get to that situation. The other time I use the medicines, I usually like people to come in and make the lifestyle changes first and then if they have a stall, maybe use prudent doses of the medicine for a limited period of time. But I also have patients that come to me and I know they are laser focused on, they want to be on this medicine. And I think, you know, I’d rather have them working with me, you know, not to be derogatory, but then just getting the medicine off the Internet, not in the context of any kind of program. So I work with people to help set up those lifestyles out of the gate. But the goal always is to begin with the end in mind. And the end in mind, I believe, is to use the medicines prudently. Maybe they should be used wisely, but they should be used prudently with the intent of, you know, eventually getting off it.
Leanne Vogel
I’m so curious. The type of clients that you’re getting, are they more in the area of they’re eating too much and need a handle on what they’re eating and how to manage it. And that’s why they’re dealing with obesity, because many of the ladies that listen to the show, they’re not eating enough and then they’re wanting to get on GLP1s and my understanding is like, that’s not going to help if you’re not eating enough because generally the GLP1s will just make you more satiated, which will stop you from eating as much. And so if your issue is obesity because you’re eating too much, then they could be useful. Thoughts on that?
Dr. Paul Kolodzik
Yeah, there is, there is definitely something to getting adequate. I usually don’t count calories, but getting adequate caloric intake to lose weight. But you really should be focused on making sure that whatever that diet is is the right mix of macros. And I have all my patients Count their macros. And we played less attention to fat and less attention to calories. But in utilizing the medication, you’re going to have to be, for example, you’re going to have to be eating more protein because you’re going to be losing muscle mass if you are not doing that. So along with those strength training become comes, you know, getting adequate protein in. But people, I think can be successful.
Dr. Paul Kolodzik
You know, it’s. It’s really an individualized plan. You know, are you going to start with the medicines right out of the gate or you’re going to add them later? You know, what does your macro mix need to be? You know, what is your workout routine going to be? You know, I have patients that come to me and they have never lifted a weight in their life. You know, I can’t just send them to the gym and say, be comfortable next to, you know, the meatheads that are lifting. Totally. Yeah. So we start with bands. We get them a set of bands and maybe a five or seven pound weight and let’s work through that.
Dr. Paul Kolodzik
But, you know, don’t let perfect be the enemy of good. Just get started. 30 minutes, three times a week to get started. I’ve had patients that have never lifted a weight in their life and, you know, they have found to embrace it and enjoy it. And especially for women, and most of my patients are women because women are smart enough to appreciate their vulnerabilities as opposed to us guys who, you know, think we’re going to live forever until that crisis, that heart attack occurs. So we really need to just, you know, help guide people along as part of that prudence process.
Leanne Vogel
Yeah, I couldn’t agree with you more. I think where we get really stuck is when we get motivated. We want to do everything at once and just get it all done and get it achieved as quickly as possible. What I’m hearing from you, and I’m in the same camp, is like this process took a long time for you to get into this. It’s going to take us a little while to unpack everything and get your behavior shifts. And what I’m hearing also from you is that the CGM is a great way to start those behavior changes. And that diet, fasting and strength training really all go hand in hand to beginning and supporting the data that we’re getting from the CGM to start shifting things.
Dr. Paul Kolodzik
Right. And those three things lower insulin resistance. We didn’t talk about the fasting, but the same thing. You don’t have to start fasting and fast for 20 hours if you haven’t fasted before. Let’s do 12 hours overnight. Let’s maybe try then 14 hours. So again, it’s something that can be incrementally worked into. And even a moderate amount of fasting is going to have a great benefit in lowering insulin resistance.
Leanne Vogel
Okay, so behavior shifts to kind of like wrap up this part, because I know we’re running out of time and I want to give actions to those listening. So behavior shifts. You’ve talked about the diet, low carb, under 50 grams for fasting. You’ve talked about the incremental, you know, starting off with maybe 12 hours, then 14, 16, 18, strength training. You mentioned three times a week, 30 minutes. Anything that we missed in the behavior change and shifts that you want to make sure that listeners walk away with, like some tips and strategies on how to start those behavior changes, you know.
Dr. Paul Kolodzik
To start them again. Get a hold of a CGM and see what your data looks like and use it for a couple of weeks diagnostically, maybe not changing your diet just as you have done in your practice, and then use it therapeutically. And I’ll tell you that some people, I have had patients that once they have a CGM on their arm, they never want to be without a cgm. And I’ve had patients that, you know, they’re good after a couple of months and they might want to use one intermittently after that. But understand the data. When you understand the data, your mind again will go through a mental evolution which will support the behavioral changes that you want to make there. I mean, and you probably know how it is. There are certain foods that you just don’t look at anymore.
Dr. Paul Kolodzik
You don’t even think about eating anymore. And it’s not like a burden that this new diet is a burden to me. It’s like my new life. And I feel so much better in my joints because they don’t have glucose attached to them. Feel so much better. And I’m avoiding the long term risk of vascular disease by doing this. And you know, with a lower carb diet, the brain fog and the lack of variability, the brain fog goes away and the energy is often better. So there’s all these different benefits, but you can evolve to this with it being part of your life and a lifestyle as opposed to it being a burdensome plan to follow.
Leanne Vogel
Yes, completely. So your book is the Continuous Glucose Monitor Revolution. Lose weight, look great, and live longer with continuous glucose monitoring. I hope I got that right. Right.
Dr. Paul Kolodzik
Yeah, I stuck the word non diabetics in there because diabetics use these to guide their insulin dosages. But this is the use of the continuous glucose monitor. The continuous glucose monitor revolution for non diabetics. So you know, for people that just want to know where their blood glucose physiology is, how to construct their diet, maybe to assess whether they’re pre diabetic, maybe to avoid going on to becoming diabetic.
Leanne Vogel
I love it. Where can people find more from you? I know that I will include a link to your book in the Show Notes today. Where else can people connect with you?
Dr. Paul Kolodzik
So the book is on Amazon. It’s the best selling CGM book on Amazon and you can find me in my practice. I’m licensed in Ohio, Indiana, Florida and Arizona@metabolic mds. So the word metabolic followed by mds.com.
Leanne Vogel
And I will include that link also in the show note. Dr. Paul, thank you for coming on today.
Dr. Paul Kolodzik
It’s been a pleasure. Thank you.
Leanne Vogel
Thanks for listening to the Helpful Pursuit Podcast. Join us next Tuesday for another episode of the show. If you’re looking for free resources, there are couple of places you can go. The first to my blog healthfulpursuit.com where you’re going to find loads of recipes. The second is a free parasite protocol that I’ve put together for you that outlines symptoms, testing and resources to determine whether or not you have a parasite, plus a full protocol to follow to eradicate them from your life if you need to. That’s available at healthfulpursuit.com parasites and last but certainly not least, a full list of blood work markers to ask your doctor for so that you can get a full picture of your health. You can grab that free resource by going to healthfulpursuit.com labs. The helpful pursuit Podcast, including show notes and links, provides information in respect to healthy living recipes, nutrition and diet and is intended for informational purposes only.
Leanne Vogel
The information provided is not a substitute for medical advice, diagnosis or treatment, nor is it to be construed as such. We cannot guarantee that the information provided on the Healthful Pursuit Podcast reflects the most up to date medical research. Information is provided without any representation or warranties of any kind. Please consult a qualified health practitioner with any questions you may have regarding your health and nutrition program.
Hi! I'm Leanne (RHN FBCS)
a Functional Medicine Practitioner, host of the Healthful Pursuit Podcast, and best-selling author of The Keto Diet & Keto for Women. I want to live in a world where every woman has access to knowledge to better her health.
