Episode #12: Supplements

Summary

In this episode, Kyle Hulbert and Dr. K discuss diabetes and glucose control. They cover the different types of diabetes, symptoms, pre-diabetes, and testing methods. They also explore the concept of metabolic flexibility and provide diet and lifestyle strategies for managing glucose levels. Additionally, they discuss the use of supplements and prescription medications for glucose control. Overall, the conversation emphasizes the importance of maintaining a healthy diet and lifestyle to prevent and manage diabetes. The conversation covers topics related to weight loss medications, insulin management, and overall strategies for managing diabetes. The hosts emphasize the importance of using weight loss medications as part of a comprehensive plan that includes a high protein intake, regular exercise, and a clean diet. They also discuss the appropriate use of insulin for type 1 diabetics and individuals with high A1C levels. The conversation concludes with a reminder to prioritize vegetables, meats, and sugars in one’s diet and the importance of weightlifting for muscle growth and metabolic health.

Takeaways

• There are different types of diabetes, including type 1 and type 2, which have distinct causes and treatments.
• Symptoms of diabetes include frequent urination, increased thirst, and unexplained weight loss.
• Pre-diabetes is a precursor to diabetes and can be identified through testing, such as fasting glucose and A1C levels.
• Metabolic flexibility refers to the body’s ability to switch between using glucose and fat for energy.
• Diet and lifestyle strategies, such as intermittent fasting and meal timing, can help manage glucose levels.
• Supplements like berberine, Ceylon cinnamon, and apple cider vinegar may aid in glucose control.
• Prescription medications, such as metformin and GLP-1 agonists, can be used to manage glucose levels.
• It is important to work with a healthcare professional or health coach to develop an individualized approach to glucose control.

Chapters

00:00 Introduction

01:02 Overview of Diabetes and Glucose Control

03:03 Types of Diabetes

04:25 Symptoms of Diabetes

06:07 Pre-Diabetes and Testing

12:09 Metabolic Flexibility

19:42 Diet and Lifestyle Strategies

23:58 Supplements for Glucose Control

32:02 Prescription Medications

41:29 Using Medications for Weight Loss

44:26 Insulin Management

46:30 Summary and Last Thoughts

Sponsors

This episode is sponsored by Toxic Roots.  The optimal resource for online health coaching for optimizing performance and removing toxins. Click on the link below to get started on finding your toxic roots. 

Website: https://www.toxicrootswellness.com/

Instagram: @toxicrootswellness

X: @toxicroots 

Sources

People

Peak Performance 

• Website: https://peakperformancepodcast.online/
• On Instagram: @thepeakperformancepod
• On X: @PeakPerformPod

Dr. K 

• On Instagram @theosteodoc

Coach Kyle 

• On Instagram @toxinfreekyle

Transcript

Kyle Hulbert (00:10)

Peak Performance Podcast y’all. We’re here. I’m Coach Kyle.

Ben Kosubevsky (00:15)

And I’m Dr. K. Thanks everybody for joining us as we dive into diabetes and glucose. We’re going to talk about diabetes testing. What is diabetes? How is it defined? We’re going to talk about natural ways to manage your diabetes versus medication management. And we’re going to talk about, you know, effects that diabetes can have on you. And one last hidden gem, which is called metabolic flexibility. Let’s get into it.

Kyle Hulbert (00:40)

So Dr. K, is it diabetes or is it diabetes?

Ben Kosubevsky (00:43)

that the only person saying diabetes is cletus. Everyone else says diabetes.

Kyle Hulbert (00:48)

Well, not only diabetes, but really we’re going to start with the whole scale and then we’re going to dive all the way into basically just glucose control and start touching on metabolic health because it’s applicable to everyone. It’s not just those who have been diagnosed with the disease. Is that correct?

Ben Kosubevsky (01:04)

Correct. You know, there’s far precursor steps before you actually hit what’s classified as true diabetes.

Kyle Hulbert (01:13)

you want to start us out with explaining essentially what diabetes is

Ben Kosubevsky (01:16)

Diabetes is just a very general overview, too much sugar in your blood. And there’s different ways that happens. And you know, I know you said don’t go into the types, but that’s really the only way to explain what diabetes is, is the types. There’s type 1 and type 2. And honestly, the only thing that they have in common is that they’re both called diabetes. They’re wildly different things. Type 1 is an autoimmune condition where your body attacks

a certain cell in your pancreas and breaks it down. So your pancreas, you just don’t make insulin to break down sugar. Whereas type two is literally your body just becomes resistant to insulin. So it just takes more of it to break down sugar.

Kyle Hulbert (02:01)

Gotcha. So essentially, diabetes or glucose control or how your body regulates glucose starts with what you eat per se, if you’re not type one. What you eat, that causes your blood sugar to rise, which causes your body to produce insulin in order to shuttle that blood sugar into the muscles and the liver as glycogen. But over time, if you have too much blood sugar, it will…

be ineffective when the insulin comes out so your body will make more and more insulin until the system fails and that’s type 2. Okay so type 1 you said was an auto-immune condition when does this manifest or how does this appear for people?

Ben Kosubevsky (02:34)

Yes.

For most people, it appears by age 20. You can get it as an adult, but it’s much more common for it to appear in children and teenagers. What causes it? We don’t necessarily know what triggers the autoimmune. Nothing’s been proven.

Kyle Hulbert (03:00)

Could we say it’s toxins? Toxin overload? Is that a good theory?

Ben Kosubevsky (03:04)

It definitely could be because something triggered, you know, in my personal belief is a lot of autoimmune diseases are literally just toxin overload So it’s a valid theory. They actually did a study TACT2, T-A-C-T, the number two or TACT2trial.org That was the chelation study and they found that you know as they chelate people their need for insulin dropped this was in type 2 diabetics, but

I guess the logic still applies that, yeah, toxins are triggering some of that overload.

Kyle Hulbert (03:37)

Yeah. I’ve, I mean, I’ve seen that in my personal journey. Um, when I started with you, I was pre-diabetic and we’ll get into that. and now my glucose control is absolutely perfect. So we have type one, which is an autoimmune condition that usually manifests early in life, where the body’s immune system essentially attacks the pancreas, limiting how it controls and regulates insulin. Is that a good summary of that? And then type two is basically a.

kind of a lifestyle malfunction where too much blood sugar is too elevated for too long, causing the body to become insensitive to insulin. thus creating the issue of diabetes type two. Okay. So what are the symptoms of diabetes?

Ben Kosubevsky (04:17)

Yes.

the very general symptom is someone who is peeing non-stop and eating like crazy, but can’t gain a single pound.

Kyle Hulbert (04:32)

Okay. So that is, there was that type one and type two.

Ben Kosubevsky (04:35)

Yeah, they have a similar initial presentation because what happens is regardless of what’s causing it, the blood sugar gets really high. So what happens is the body makes you really, really thirsty because it’s trying to dilute that sugar and because you’re really thirsty, you’re gonna be peeing all the time.

Kyle Hulbert (04:53)

Okay. Yeah, that makes sense. And then what about the weight loss? Cause I’ve seen a lot of people struggling with weight gain when they have insulin insensitivity.

Ben Kosubevsky (05:02)

Insulin insensitivity, sure. And I think part of that is people are overweight to start with and that’s one of the triggers for diabetes is being overweight. You don’t necessarily have to be overweight to get diabetes but it’s a good trigger for it. The problem with weight gain is your body can’t effectively break down the glucose to utilize it for your body and store it.

Kyle Hulbert (05:28)

Okay, so this is well and good, but I guess a lot of our listeners don’t have diabetes. So how is this applicable to most people? Because I believe there’s a stage before diabetes that we call pre-diabetes. What does that look like? And maybe we can start going into testing a bit.

Ben Kosubevsky (05:43)

Yeah, so pre-diabetes, so the problem with the modern American diet is a lot of the foods we eat are really high on what’s called the glycemic index. So glycemicindex.com is one of my favorite websites. You can type in pretty much any food you want and they will tell you what is its level of glycemic index and what that level means is how close is it to pure sugar in your body.

And so, you know, all these things that the modern diet involves, bread and rice and complex carbs, your body doesn’t utilize properly. It ends up getting broken down into sugar. And the more sugar you eat, the more your pancreas has to work to break it down. So you go through insulin spikes throughout the day. And the longer your insulin stays spiked, the harder your pancreas has to work.

Every time you eat sugar, it has to squeeze to produce the insulin to break down your food and it can run dry and that’s where type 2 diabetes comes in. So the way that traditional medicine will test for diabetes is one of two things. They will do either what’s called a hemoglobin A1C and this is a marker on your red blood cells and it’s actually an average over the last three months. So it doesn’t matter what you ate today.

Well, you ate today, cannot throw off your test. Let’s get that very clear. But it’s averaging that marker over the last three months. And if you’re over a certain percent, you have diabetes. That percent being 6.5, or pre-diabetes is over 5.7%. And then it goes all the way up to 15.

Kyle Hulbert (07:22)

So, yeah, so that’s a very important distinction because I’ve seen a lot of people that have been diagnosed with pre-diabetes without an A1C reading and just with a fasting glucose reading. And that might not tell the full story because if they had their kid’s birthday party the night before and they ate a bunch of cake or ice cream or something the night before that test and they had the test first thing in the morning, their insulin or their glucose could be high the next morning.

Ben Kosubevsky (07:52)

I mean, could it be? Yes, but honestly, if that’s happening, that probably is a good market for pre-diabetes. You should be able to, if you’re really healthy and your pancreas are in really good shape, you should be able to eat a pound of ice cream and your glucose still stays low because it’s not normally in that position. So whatever that need happens, it can spike really fast and break down all that sugar.

Kyle Hulbert (08:13)

So that’s like peak function, peak pancreas function. Okay. So does pre-diabetes have a glucose, a fasted glucose measure that you would fall in? I do believe it’s 100 to 125, if I remember correctly.

Ben Kosubevsky (08:15)

Correct.

It… it does. Do you act- do you know the number?

yeah, it is. It’s a 100 to 125. I had to actually look it up. so anything, anything over a hundred, and this is not necessarily even fasting, but random, if you’re, you’re just getting over a hundred, more than an hour or two after you’ve eaten, that’s probably.

Kyle Hulbert (08:48)

Yeah, yeah, so blood sugar management is kind of the quick read of diabetes or metabolic health, but the A1C is the 90-day snapshot. So hypothetically, would the A1C show a better, is a better predictor of prediabetes or diabetes or where you’re headed?

Ben Kosubevsky (09:01)

Yep.

A1C is just a much better overall marker than random glucose.

Kyle Hulbert (09:16)

Okay. So when people go get tested and they want to test their metabolic health, they want to test their, how they function with their blood sugar and insulin, they really want to make sure they get a glucose test, a fasting glucose test, as well as an A1C, hemoglobin A1C. Okay. So, and then once again, that’s on a percentage basis and the lab will show the breakdown of where you might land based on your percentage.

Ben Kosubevsky (09:29)

Yes. Yep.

And then.

Yes, that’s exactly it. You know, 14 to 15% is horribly uncontrolled diabetes. They’re probably about to go into what’s called DKA, which is just dangerous. You’ll probably end up in the ICU if you reach that point. Most people who have diabetes, their goal is to sit between seven and 8%.

Kyle Hulbert (10:01)

So that’s pretty good effective management of type one or type two diabetes.

Ben Kosubevsky (10:05)

Yeah, diabetics actually don’t want to be too low because their problem is that they eat food with their sugar spikes and then they take meds and their sugar drops. And if they’re constantly dropping too low, sure they’ll have a really low A1C, which isn’t all that good because it means they’re going through periods of hypoglycemia, which is also dangerous.

Kyle Hulbert (10:23)

Gotcha. So hypoglycemia, can you explain that real quickly for us? And then I’ll explain some of my anecdotal experience with hypoglycemia.

Ben Kosubevsky (10:32)

Hypoglycemia literally just means low blood sugar. When your blood sugar drops too low, things stop working. Your body runs out of fuel to do things, so your brain starts to shut down, your organs start to shut down.

Kyle Hulbert (10:45)

I have had this happen to me in the past where I’ve been hypoglycemic pretty badly. And I literally had trouble forming words. I was like, I couldn’t like effectively speak. It was kind of scary, honestly.

Ben Kosubevsky (10:57)

Yep. if you are doing things that involve glucose regulation, my personal tip, you know, most diabetics know they keep hard candy in their pockets just in case for a quick sugar spike.

Kyle Hulbert (11:08)

Yeah, that is a good tip. So we have diabetes one, which is an autoimmune. We have diabetes two, which is basically lifestyle induced diabetes. We have pre-diabetes, which means you’re on the way to diabetes two. So what is, so like we take a step back and if someone is healthy, like you said, optimal function is, you know, you can eat kind of crazy food, crazy sugar, high food, and your body still is able to regulate it.

So that touches into a concept called metabolic flexibility. Do you want to speak on that or do you want me to take that?

Ben Kosubevsky (11:44)

I’ll let you take that but, I want to point out a couple more lab tests before we deviate away from that. There are what’s called C-peptide, pro insulin and insulin levels. so C-peptide is the breakdown of, so when you use insulin in the body, you start with, pro insulin, it’s the precursor, and then as it turns into insulin, you get an offshoot called C-peptide.

Kyle Hulbert (11:49)

Okay.

Ben Kosubevsky (12:09)

And so when we look at those numbers, if you’re starting to climb in those numbers, your glucose may be fine and your A1C may be fine. So those numbers climbing can tell us that you are predisposed to diabetes years in the future. And so that gives you a giant window of time to do some lifestyle management changes so that you never end up with diabetes. Because once you have diabetes, you basically have diabetes for life.

If you can avoid it before it starts, then you can avoid getting it. And your pancreas will function better throughout the rest of your life than once you hit that point in diabetes.

Kyle Hulbert (12:49)

Gotcha. So if you want comprehensive lab testing for your metabolic health, you should go in and make sure you at least have a fasting glucose, an A1C, hemoglobin A1C, a C peptide, a insulin, and a pro insulin test. And that’ll give you the largest window of depicting, you know, if you’re straying towards diabetes or pre-diabetes or just metabolic dysfunction. Okay.

So that’s a pretty good lab test stack for people to look at. Is this something that you would put on your comprehensive lab testing when patients come see you?

Ben Kosubevsky (13:21)

That’s absolutely part of it. I also, whenever I check for diabetes or sugar markers, I check thyroid as well, just because they’re so common.

Kyle Hulbert (13:30)

Okay, so what does the thyroid have to do with your blood sugar?

Ben Kosubevsky (13:34)

my view is that if you’re at risk of one auto immune condition, you’re at risk of others and thyroid being one of the most common auto immune conditions in America. I just always check them both.

Kyle Hulbert (13:44)

So yeah, if there is issues with glucose disposal or insulin sensitivity, there might be a chance that you’re developing something like Hashimoto’s thyroiditis.

Ben Kosubevsky (13:54)

And the second logic to that is if you’re struggling with things like weight gain, weight loss, it may not be sugar, it may be thyroid. So why not hit two birds with one stone? You’re going to do blood work anyway.

Kyle Hulbert (14:06)

That makes a lot of sense. Anything before we move on to metabolic flexibility? Okay, so metabolic flexibility. You know, the way I would break it down is there’s actually like one step in between truly metabolically flexible and pre-diabetes. So like on this scale, I would say there’s, you know, type one diabetic, which is autoimmune, type two, which is lifestyle induced, pre-diabetic, and then a…

Ben Kosubevsky (14:10)

That’s all I’ve got now.

Kyle Hulbert (14:35)

normal functioning human. And how I would classify this as normal functioning humans, you know, especially in the Western world, they burn primarily glucose as fuel in their daily lives. So it’s a very carb based heavy diet, which doesn’t necessarily mean they’re metabolically flexible. And what I mean by metabolic flexibility is the ability to burn either fat via ketones or glucose and able to switch back and forth between these two.

And a lot of times people are kind of not pre-diabetic, but they might be headed that way because of their fuel primarily being glucose from carb consumption almost around the clock. You wake up, you eat a bowl of cereal, you eat your normal meals in the day right before you go to bed, you have some Chex Mix or something or a sweet right before you go to bed. You’re fasting for only eight hours, you wake up and you have more cereal. That kind of come that constant feed of carbohydrates or sugars going into your blood.

Metabolic flexibility would allow you to skip a meal with no blood sugar crash. You can skip a meal, your body’s going to switch over to burning fat or ketones, and then your body would just be able to adapt. And ketones are usually a preferred fuel for the heart and the brain. So being able to be metabolically flexible is very important for heart and brain longevity. So that’s why intermittent fasting kind of took off recently.

because it was able to address some of these metabolically inflexible problems that are popping up. Now, I don’t necessarily recommend intermittent fasting for a lot of people. I think it depends on the situation. I found it’s very, very effective with overweight males. On the flip side of that, I think it has actually done a lot of damage to women, because if you…

do meta, if you do intermittent fasting for too long as a woman, your body starts to regulate hormones in a different way. It’s caused a lot of cortisol and a lot of stress on the system. I think it comes from like an evolutionary perspective. Like if you think about how we lived thousands of years ago, you’re looking at like, you know, the males were typically the hunters. And so when, when guys were starving, they needed to be sharp.

they need to be able to go out and hunt and kill. And the females were typically more the caretakers or the gatherers and everything in a female’s body is generally regulated for remaining fertile and reproducing the species. So they’re not necessarily tuned to be sharp and active when there’s a period of, extended period of lack of food. Yeah, so.

Ben Kosubevsky (17:19)

Interesting.

So you’re telling our audience they can’t have cereal and pancakes for breakfast anymore, and they can’t have cake after dinner anymore. What should they do?

Kyle Hulbert (17:31)

So cereal and pancakes. let me start by saying there’s nothing wrong with having a good breakfast once in a while. Good, you go out, you have the pancakes, you have the waffles, there’s nothing wrong with that. It’s the habitual consumption of these foods throughout the day constantly where you’re always feeding yourself glucose. That’s the real issue. So I mean, when it comes to managing your glucose, there’s a few strategies that really, really can move the dial pretty quickly.

And the first one, I hate to say it’s intermittent fasting, but it kind of is intermittent fasting. So, but it’s a very light version. So stop eating a few hours before you go to bed and eat your breakfast a couple hours after you wake up. Try to get about 12 hours. That allows the system to kind of reset itself, works towards starting to build your ketone levels in your blood and start to build that metabolic flexibility. Again, if you’re a woman, I wouldn’t push that, I wouldn’t push that window more than 12, 14 hours.

If you start to get to 16, 18 or 20 as a female, you still have issues with your hormone regulation. Guys can too, but usually there’s a better, there’s a little more wiggle room with that. So that’s that strategy. Number one, managing your glucose is just don’t eat carbs all the time.

That’s kind of like where we start, but there are a lot of nuances in terms of diet and how we can approach it and lifestyle things that can actually modify your metabolic flexibility and your insulin sensitivity. Do you want me to dive into those or?

Ben Kosubevsky (19:06)

Before we dive down supplements, let’s do this. Let’s say you go to your doctor and they say, hey Kyle, you are pre-diabetic. I want you to start taking medication, probably metformin. What do you think about that?

Kyle Hulbert (19:23)

Well, if you’re asking me what I would recommend for my clients as to what I would do, it’s two different paths. So I’m the bio hacker guy, I like to experiment. There’s a lot of research out there on metformin. I’m pretty confident in its safety profile. So I take metformin, Extender Release, kind of regardless, but I wouldn’t start there with a coaching client. I wouldn’t recommend my coaching client go talk to their doctor about getting metformin off the bat. The first thing I’m gonna do is approach it with supplementation and lifestyle.

And the first, the very first thing is what we discussed. Have it have that overnight window about 12 hours. The number two is, is really your movement post meal. So if you can, what you want to do, if you get a carb heavy meal, either, it could be in front of the meal too. but post is probably optimal. once you eat your meal, you get up, you go for a 10, 15, 20 minute walk and it’s activates the muscles in your legs.

which then helps shuttle the glucose out of your bloodstream into your muscles where it should be. Very effective for clearing glucose. And it’s really an enjoyable lifestyle strategy. You eat your dinner, you go for a walk with your wife or your husband or your dog or whoever it might be by yourself, enjoy the solace. It’s a great lifestyle strategy. So that would probably be the second lifestyle strategy I would put in. And then we can get into things like meal timing.

So it’s very interesting if you approach one meal, so say you have a baked potato, a steak and some broccoli. So it’s a pretty balanced meal. You’ve got protein, you’ve got fat, you’ve got carbs. but if you eat your broccoli and your steak before you eat your baked potato, that will actually control your glucose spike much more than if you ate the baked potato first. So. Yeah. So when, when you eat carbs.

Ben Kosubevsky (21:14)

I don’t know why that is.

Kyle Hulbert (21:18)

and they go in your gut and it comes in first. They’re quick digesting and the glucose makes their way into the bloodstream very quickly. But proteins and fats and fiber are very slow digesting things. So if you put those in your gut before the carbohydrates, it will slow down the whole absorption process, limiting that glucose spike. So I mean, that’s a change that basically anyone can make at any time. You really don’t have to change what you’re eating per se, just change the order in which you’re eating it.

Ben Kosubevsky (21:37)

Interesting.

That makes a lot of sense and that’s probably gonna be one of the most helpful tips we give people off of this podcast because they don’t change a thing about their life.

Kyle Hulbert (21:56)

Yeah, I mean, it’s really that easy. Just eat your fat, protein, and fiber first, then eat your carbs. So, I mean, and along with that goes the actual structure of the meal. Like, you don’t want to have a meal that’s just purely carbs. Unless you’re like an Ironman athlete and you’re glycogen loading and you’re doing insane amounts of exercise, and that’s a different topic altogether. But for most people, you don’t want to have meals that are consisting of

only carbohydrates. You almost always want to have some kind of protein, fat, and fiber along with your carbohydrate intake. So that would be kind of the third or fourth step. Going from there, we can get into further strategies like supplementation. So there are quite a few supplements that can help manage or dispose of glucose. And these are

Ben Kosubevsky (22:32)

extents.

Kyle Hulbert (22:51)

It’s kind of a little bit tricky how you use them. So I would recommend working with a health coach or someone who knows how to use these supplements and how to advise you on them. this is also a good time for me to say I’m not a doctor and Dr. K is a doctor, but we are not giving medical advice in any way, shape or form. Please talk to your, your practitioner or your health coach for implementing any of the strategies that we recommend here today. So in terms of supplements, Really there’s, there’s a few that can really move the needle. And the ones that come to mind are.

Berberine, Ceylon cinnamon, and apple cider vinegar. Ceylon cinnamon.

Ben Kosubevsky (23:23)

What was that second one?

Okay, I was just making sure it’s clear because you kind of mumbled it.

Kyle Hulbert (23:30)

Yeah, Ceylon cinnamon. So it’s a specific type of cinnamon.

that helps, dispose of glucose in your bloodstream after a meal.

Ben Kosubevsky (23:36)

gonna ask because it’s not as simple as just you take a berberine in the morning and then you’re good for the day.

Kyle Hulbert (23:41)

Yeah. So the strategy here is usually to take it with your meal. and this is pretty important because what you don’t want to do is take it after your meal, especially a few minutes after 15, 20 minutes after, because what will happen is when you eat your meal, your glucose will spike up. And as it’s falling is it, if you take your berberine or your ceylon cinnamon, then it will drive your glucose even further down, causing possible hypoglycemia. So you want to take it right before.

or as you’re enjoying your first bite of your meal. And dosages of that vary widely on how you wanna do it.

Ben Kosubevsky (24:16)

Yeah, do you want to give an overview on how to dose these things?

Kyle Hulbert (24:20)

Yeah, the, I don’t really want to get into specific dosing recommendations too much because it’s so personal. What I recommend here is testing. So the gold standard here is a continuous glucose monitor. So this is a little thing you put on the back of your arm and click it on. And it measures your glucose all day. And so you can see what I would recommend people do is put it on.

You can see how your body reacts to certain foods, how high glucose spikes. I would implement the lifestyle strategies we talked about before. And then if you need further glucose support, I would play around with dosing, berberine, apple cider vinegar, and ceylon cinnamon. I would probably start with a shot of apple cider vinegar before the meal because the effect is much weaker than the other two. If that is not regulating your glucose effectively, I would try cinnamon.

And if that’s not working, I would then try berberine, because berberine’s the most powerful of those compounds. Dosages vary widely, so I don’t really wanna get into that too much. I just wanna make sure that people are working with a testing method, or someone who knows what they’re doing to help them regulate this, because I don’t recommend people just start wolfing down handfuls of berberine.

Ben Kosubevsky (25:41)

So you mentioned the CGM’s continuous glucose monitors. There’s a bunch of different brands out there. I’m guessing they’re not all made equally.

Kyle Hulbert (25:49)

there’s actually very few brands of CGMs. so there’s like two or three manufacturers of the actual product. There are a ton of providers, that offer these CGMs as a service. I use levels as one. there’s a, there’s a bunch of them. there’s one that I really like. I’ll have to get the name. We’ll put it in the show notes. I’m forgetting it off the top of my head, but it’s actually a CGM and they.

The CGM readings are accompanied with food logs, you log what you ate, and then a nutritionist, a dietician is on the other side giving you advice weekly on how you should tailor your diet to maximize the metabolic flexibility. So that’s, yeah, that’s a pretty good option. Now, CGMs are rather expensive. So they cost about $200 to run for two weeks, or $160 bucks is probably as low as I’ve ever seen them, sometimes $250 on the upper side.

Ben Kosubevsky (26:26)

interesting.

Kyle Hulbert (26:41)

the other thing you can do is just, go get a glucose measuring machine from like CVS, Walgreens, Walmart, wherever it’s a pinprick little blood spot test. the key there is just, you’re going to have to do it a lot of times per day. You’re going to do it before meal. You’re going to have to do it, you know, 30 minutes after your meal, an hour after your meal, and really just start to understand how you do it because those data points, you really want it spread out. You don’t want to just wake up and test it. That’s not going to tell you too much.

as opposed to seeing how you actually react to certain foods. So those are the main testing strategies for your active glucose levels. Did I cover that pretty comprehensively?

Ben Kosubevsky (27:22)

So I think that’s pretty good. OK, so let’s circle back to something that we touched on previously but didn’t get into, which is type 3 diabetes.

Kyle Hulbert (27:31)

Type 3 diabetes? What is that? I thought there were two, we only talked about two.

Ben Kosubevsky (27:35)

Well, so now there’s a new one that they’re in the process. I don’t think it’s been officially named, but they’re in the process of working this out. so you want to get into that.

Kyle Hulbert (27:45)

Yeah, so type three diabetes is the, as of now, the colloquial term for Alzheimer’s, because there is such a strong correlation. I’m not sure if they prove causation yet, but it’s so strong that it’s showing that if you have metabolic dysfunction and insulin insensitivity, it leads to a degradation of your brain health, which in turn could lead to Alzheimer’s. So they’re saying that is the type three diabetes.

Ben Kosubevsky (28:13)

So, but hold on, I thought that they were saying that having low cholesterol after taking statins was causing Alzheimer’s.

Kyle Hulbert (28:21)

They’ve also said beta amyloid plaques are causing Alzheimer’s and that was just proved wrong by a scan recently on a research paper. So I would answer, we don’t really know still. We’re not a hundred percent sure, but I would say that glucose is a main driver of what could cause it, along with toxins and other things that just hurt brain health in general. Is that your read of what’s going on?

Ben Kosubevsky (28:32)

Yep.

That’s pretty much it. I think the real thing is that there’s a bunch of different things that cause Alzheimer’s, with the thing in common being anything that promotes degradation of brain matter. So sure, things like concussions and traumatic brain injuries, they’ll break down your brain matter. Having low or high blood sugar will probably eat through your brain matter. Not having enough cholesterol so your brain can’t repair itself will lead to Alzheimer’s. So these are all things that lead to Alzheimer’s.

Kyle Hulbert (29:14)

Yeah, so, but now they’re pushing to call type, or Alzheimer’s type three diabetes because of the such strong correlation between if you have diabetes, chances are your brain is going to be degradated over time and get worse and worse that could possibly lead to Alzheimer’s.

Ben Kosubevsky (29:30)

And so what I don’t know, and this is what I wonder, I don’t know the incidence of Alzheimer’s in other countries that aren’t America, but in America it’s becoming more and more prevalent, I think, because of our diets and medications.

Kyle Hulbert (29:43)

Yeah, I would totally agree. Diets, medications, toxins. I believe the majority of lifestyle, chronic diseases, you know, just could be avoided. Most of them are completely avoidable, with clean diet lifestyle. and just taking care of yourself really. So I do want to, before we move on, I do want to cycle back to, the diet thing. Cause I just remember one more strategy that I, that I implement, with some of my clients who I talked to.

and that’s the consumption of protein. So along with the consumption of protein at every meal, if you aim for a gram of protein per pound of body weight, it’s going to make it that much more difficult for your body to get insulin insensitivity and generally promote good muscle development, nervous system adaptations from the amino acids, et cetera, et cetera. So having a high protein diet is a good prevention technique for something like…

metabolic dysfunction.

Ben Kosubevsky (30:42)

Good tip.

Kyle Hulbert (30:42)

That’s, yeah, that was my little point there. So we’ve talked about type one diabetes, type two diabetes, the type three diabetes, pre-diabetes, a normal person and true metabolic flexibility. We’ve talked about diet and lifestyle strategies to prevent it and to maximize your metabolic flexibility. We’ve talked about some supplements. anything else on any of those before we move to drugs, prescriptions?

Ben Kosubevsky (31:09)

I think that pretty much covers it.

Kyle Hulbert (31:12)

Okay. So let’s move on to drugs or prescriptions. So you mentioned metformin. You want to give us a synopsis on metformin?

Ben Kosubevsky (31:18)

Yeah.

Well, let’s go over drugs as a general overview first. So there’s a few different ways to get your sugar down, or your insulin up, or some other variation of them. You can basically force your body to just be able to intake less glucose from the foods you eat. So there’s medications that prevent just intake of carbs and sugar. There are medications that force your body to use more glucose with everything it does. There are medications that

affect hormone markers in your pancreas to make insulin more effective. There are medications that force your pancreas to make more insulin. I think that’s about the four categories. Did I miss one?

Kyle Hulbert (32:03)

I think you’ve got it.

Ben Kosubevsky (32:07)

well let’s talk about the, I can only think of one I believe is called Acarbose is the one that prevents you from being able to absorb glucose. I mean the unfortunate side effect of that is diarrhea because your body has to, when there’s a bunch of sugar in your intestinal tract and you’re not able to absorb it, your body will try to dilute it.

And so it’s gonna flush a bunch of water into your intestinal tract. Yes, so that’s not a very commonly used medication anymore because it has more side effects than benefits. So it’s kind of fallen to the wayside.

Kyle Hulbert (32:33)

which could also lead to dehydration

Yeah, so I try to generally avoid anything that drastically messes with digestion, with a few caveats there, but if it’s messing or blocking specific macronutrient, I don’t think it’s a good long-term strategy because there’s also medications that block fat for weight loss and things like that. They lead to terrible digestive symptoms. So I would generally recommend to avoid things that block entire macronutrients.

Ben Kosubevsky (33:09)

Yep. Okay, so the next category is ones that, and correct me if I’m wrong, but metformin basically forces your muscles to use more glucose.

Kyle Hulbert (33:20)

Yeah, I believe the function is it actually opens it up and shuttles it into the muscles more effectively. I’m not sure if it affects the actual use of the glycogen in the muscles. I think that might be associated with the use of muscles and workouts and muscle tissue and things like that. But it effectively gets it into your muscles. It pushes it there.

Ben Kosubevsky (33:41)

Correct, because there’s different ways for your body to utilize glucose, there’s glycolysis, there’s gluconeogenesis and a couple of others, so I believe that metformin just uptakes your glycolysis.

Kyle Hulbert (33:52)

Yeah, yeah, I do believe that’s how it works. Which could be an effective strategy in conjugation. This is kind of biohacker left field-ish. It could be an effective strategy in terms of like carb cycling and making sure your athletic performance stays high. So you can have carbs night before, along with something like metformin to make sure that your morning workout, even though you’re not eating before it, you’re still glycogen loaded.

Ben Kosubevsky (34:19)

So metformin does have an unfortunate side effect. It does also cause diarrhea, usually only when you first start it I think it probably does shuttle some glucose into your intestinal tract. And so same effect as the acarbose is you end up having to dilute that intestinal tract. So most of you, you do have to taper into it where you start a lower dose for a few weeks and then up your dose.

Kyle Hulbert (34:41)

It’s been hypothesized that it has a major effect on the microbiome, the gut too. And so that can cause other effects. For me, it was nausea. When I started, when I started taking metformin, it was like, I was on the lowest dose that people prescribe extended release. It was one 500 milligram tab a day. And I was just so nauseous. but it went away.

Ben Kosubevsky (34:51)

Interesting.

Kyle Hulbert (35:05)

Honestly, and if as I kept running it, I stepped at the dose and I don’t have any issues and I’ve taken up to two grams a day, one gram a.m., one gram p.m. Now I take one gram p.m. And I don’t have any GI effects whatsoever.

Ben Kosubevsky (35:22)

And then as a side note, Metformin is considered an anti-aging medication just in the sense that if you keep your blood sugar low, low to normal, your body essentially works hard and sugar just generally does cause aging and inflammation and all that stuff. So I know plenty of people that take Metformin not because they have any issues at all with sugar but just so that they can keep their inflammation levels down.

Kyle Hulbert (35:44)

That’s the camp I am in currently. So my journey is I started, when I started with you, I was pre-diabetic. I employed a lot of the diet and lifestyle strategies along with taking Metformin. And now my A1C, last time I checked, was 4.7%, which is nearly perfect.

Ben Kosubevsky (36:03)

That’s probably better than mine, honestly.

Kyle Hulbert (36:06)

It’s my average glucose the last time I checked it, which includes all day, including post meals on a CGM was 97. Yeah. So I don’t have any issues with glucose now. And if I want to go eat ice cream, I can go eat ice cream and I don’t really have to worry about the effects. But I still take metformin for a, like I said, glycogen loading perspective to help it get into the muscles and also for a longevity effect with limiting blood sugar overall.

Ben Kosubevsky (36:14)

That’s perfect.

Okay, perfect. Okay, so let’s get into the buzzword medications, Ozempic, Majara, Wagovi. I think there’s a couple others out there now. Victoza, et cetera.

Kyle Hulbert (36:49)

Yep. So for people listening, ozempic is semaglutide. That’s the generic name of it. Manjaro is tris-zapatide. and there’s one more that’s actually in the FDA pipeline called red atrutide, but we probably won’t hit on that. We might do an episode on, GLP-1 agonist overall. but in terms of glucose and metabolic health, they work a few different ways. Do you want to start this off or you want me to take this? Okay.

Ben Kosubevsky (37:13)

This is all you.

Kyle Hulbert (37:16)

So they work a couple of ways and there’s two main functions they have in terms of how they affect your blood sugar. One is the slowing of digestion. So you’ve probably seen in the news stomach paralysis from these drugs, it’s a possible side effect. Usually it’s because people are taking mega doses for way too long. And…

In my use of these agents, I usually keep the doses well below half of the maximum dose. Rarely do I go over half. Sometimes I do if I’m doing an intense cut, but I never approach the full dose because I don’t want any risk of vastly limiting the ability of your stomach to empty out. So what it does is it slows down your digestion. It holds the food there for longer. And naturally because of that, if the food is not being digested as quickly, it’s not entering the bloodstream to be turned into glucose.

as fast, so it is a slow bleed, so it doesn’t cause a spike, it just will cause one of these, and then it’ll go back

The

way they work is they actually stimulate your body to produce more insulin. So overall, your insulin levels will be up, and it will be driving that glucose down kind of perpetually.

Because of the long half-life on these medications, it is an increased level of insulin and a decreased level of glucose around the clock. Now, you’ll probably pick up if you were paying attention earlier that if your insulin is increased for a long period of time, you become insensitive to it. And that is one of my main concerns about these medications, is that if you’re on a high dose of these things and it’s jacking up your insulin to a high level for a long amount of time

you’re going to become insensitive to that insulin. So these things will work less and less effectively over time at managing your blood sugar, which then in turn will lead to very, very difficult glucose regulation when you go off it. Or eventually if you stay on it for a long time, it’ll just start to get worse and worse. Is that your read of these medications?

Ben Kosubevsky (39:22)

Yep, pretty much. One more thing I want to point out, there’s a ton of side effects popping up about these pancreatitis and stomach pains and this and that. So these medications, they’re designed to be a short-term tool to help people lose weight, to have an end to lose weight. But the important part to take these medications is a change in diet. I think a lot of the side effects are happening because people are not changing your diets. They’re still eating McDonald’s and candy and sugar. They might be eating less of it, but that’s all they’re eating.

whereas you need to really be on a super high protein, one gram per pound body weight, you need to pretty much avoid carbs while you’re on this medication. Don’t give your pancreas anything that needs to work to break down.

Kyle Hulbert (40:04)

Yeah, I a hundred percent agree with that. That I think is the only logical way for anyone to use these medications, to use them as a quick hack to lose weight without changing your diet is really shooting yourself in the foot. Because when you go off them, you’re going to gain the weight back and then some. Because the weight you lose is often half fat, half muscle, further reducing your metabolic rate. So it’s even harder to get out of the hole when you gain it back the second time. When…

The overall strategy for these things, Dr. K mentioned it, but really it’s high protein intake. You need to get in the gym. You need to lift weights to maintain your muscle mass when you’re losing weight. You know, make sure your diet’s pretty clean overall. And then don’t go to the maximum dose. If you can avoid it, try to only step it up to half at max and then cycle it back down and three or four months maximum.

Ben Kosubevsky (41:01)

Oh, he points out a good point. Cycle it back down. Don’t just stop it cold turkey.

Kyle Hulbert (41:07)

Yeah. If you stop at cold turkey, what happens is all of a sudden your insulin is not being stimulated, which drops your insulin, which skyrockets your glucose. And you’ll have very difficult time digging out of that because you’ll be starving all the time. And then you’ll be super high glucose and super low. And it’s just a roller coaster. So it’s a cycle up, it’s a maintain and then it’s a cycle down. That’s the appropriate way to do it. And even the manufacturers, you know, they say.

You know, you don’t just stop this medication. You have to cycle off. And that’s very smart and people need to know that. That’s the basic strategy on these. In terms of recommendations for these, again, talk to your doctor. make sure you go at it with a good plan. Like if my clients who I’m working with want to go to their doctor and ask for these medications, I highly advise them to not, until they have strung together at least two months.

of being in the gym consistently weightlifting and two months of the protein goal intake. Then I say, okay, I now think it’s time if you wanted to use these agents, you can go talk to your doctor and ask for them.

Ben Kosubevsky (42:14)

You have to be mentally ready to do this. If you’re not mentally ready, nothing’s gonna happen. You’re gonna be frustrated. You may end up gaining more weight because you’re gonna be forcing yourself to eat because your body’s gonna be confused about why you’re not eating. You’re just gonna lead to a bad road.

Kyle Hulbert (42:28)

Yeah, so I always advise my clients before you go on these things, you know, have your lifestyle and diet changed beforehand so you don’t have to worry about doing it while you’re on the medication. You can maximize the effectiveness of the medication. Medications are just tools, but like all tools, you know, I wouldn’t try to cut a board with a hammer. So you want to use it correctly. You want to use it in the best way that we know how to. It’s pretty clear that we know how to do these now, and that’s the strategy I laid out a few minutes ago.

Ben Kosubevsky (42:55)

Yeah. Okay.

Kyle Hulbert (42:57)

I don’t think we’ve talked about insulin yet.

actually taking insulin.

Ben Kosubevsky (43:00)

Do you want to get into that?

Kyle Hulbert (43:01)

I mean, you can give us a brief synopsis if you want to. I mean, that’s basically the management technique of people who have diabetes.

Ben Kosubevsky (43:11)

I mean, yeah, insulin, you know, if we’re probably not the experts on insulin, insulin at this point, modern medicine has got down really well and the chronologists have a firm handle on it. Insulin only applies to two types of people. One is type one diabetics who just don’t make their own. There’s no other medications that they can take. And you know, the other part is anyone with an A1C of over 10%, you need insulin. Your body just can’t keep up with producing enough on its own.

You can get off insulin if you’re a type 2 diabetic, through diet, lifestyle, all that. Your goal with insulin is pretty much take as little as possible and maintain a very tight glycemic control. Insulin as a rule is just, it is toxic to the body when it’s given externally. So unfortunately, every time a diabetic has to give them self insulin, it does hurt their nerves, it hurts their body. So these tips and advice, they apply to diabetics that are on insulin as well.

Kyle Hulbert (44:10)

Yeah, I like that. In the bodybuilder world, and this is kind of the off-label type use of things that are kind of sketchy, but the biohackers talk about this. They usually use IGF-1, insulin-like growth factor one, which ends up spiking their glucose, and then they also use it in conjugation with insulin for maximum muscle growth. That is a terrible longevity strategy.

Ben Kosubevsky (44:34)

that’s probably one of the worst things I’ve heard. That is worse than testosterone.

Kyle Hulbert (44:38)

Yeah. Oh yeah. it’s a terrible strategy. but you know, when you’re a bodybuilder, you only care about one thing. How many pounds of muscle is on my body? Not am I going to live to 80? So we’ve covered the whole spectrum of diabetes. We’ve covered diet and lifestyle strategies. We’ve covered supplements. We’ve covered drugs. We’ve covered the buzzword drugs. any last thoughts Dr. K?

Ben Kosubevsky (44:49)

Fair enough.

Eat your vegetables first, then eat your meats, and then eat your sugars.

Kyle Hulbert (45:09)

There we go. Last thing I want to say is make sure, because we didn’t touch on it too much, make sure you go to the gym. Lift weights two to three times a week, one at minimum. And if you lift weights two to three times a week, that’ll build your muscle, giving more places to store glucose, giving you a less percentage likelihood of developing metabolic dysfunction.

That’s all we have folks. Well, thanks for joining us. I’m Coach Kyle. You can find me on Instagram at @ToxinFreeKyle.

Ben Kosubevsky (45:38)

And I’m Dr. K on Instagram as @TheOsteodoc. Thank you everybody for joining us and we’ll see you next time.