 And so if you have that data that again is more intrinsically motivating because it's personalized, it's not me telling you to go on walks. It's not me telling you to lift weights. It's not me telling you to stop eating late at night. It's you seeing it in the data from your own body. It's motivating and it's real time. You know, we have this huge time gap from our behaviors and the consequences often. If I eat cake every night before I go to bed, I'm not going to see diabetes for 30, 40 years. That's not very motivating for me to stop doing the thing that's really fun and pleasurable today. Oh yeah, we like this episode so much. I'm going to do a huge giveaway on it because in this episode, we talk about CGM devices and how there's individual variances with how people respond to food. It's like a brilliant episode. So I want this one crush on YouTube. So here's what I'm going to give away. I'm going to give away the RGB bundle maps, anabolic maps, performance and maps aesthetic. All three programs I'm going to give away for free to one of you viewers. Here's how you can win. Leave a comment below in the first 24 hours that we drop this episode, subscribe to this channel and turn on notifications, do all those things. And if we pick your comment will notify you and you'll get free access to the RGB bundle. Also, we got a sale going on this month. Here's what it is. We have the starter bundle, which is maps anabolic maps prime and the intuitive nutrition guide. That bundle is 50% off and then we have maps split. This is a high volume bodybuilder style workout program. We're putting that 50% off. Okay, so if you're interested in either one, you want to get that 50% off discount. Here's what you got to do. Go to mapsfitnessproducts.com and then use the code may special for the 50% off discount. All right, here comes the show. Kara Dan, thanks for coming on the show. So I want to start out by talking about, I remember when I first heard about continual glucose monitors, I thought it was the coolest thing ever. Basically a device you could wear that measures your glucose response in real time. And now we've come such a long way. Let's talk a little bit about continual glucose monitors. Did I explain that right? Is that what they're doing basically and how does this help with nutrition and what are the applications? Yeah, absolutely. So continuous glucose monitoring, we can just use CGM from now on for ease of use is exactly what it sounds like, what you said. You're continuously monitoring your glucose values. And as you mentioned, this is pretty unique and interesting technology in the sense that we're not a lot of things that we can measure continuously. We can get one off labs, we can prick our fingers with a glucometer to get our glucose values, but there's not a lot of things that we can see the ins and outs of. And this device, which is just something you can put on at home on the back of your arm, you all have worn one. So you can attest to the fact that it doesn't hurt. That's always everybody's first question. I describe it as kind of like an easy button. It comes in a little applicator and you just push the button and it's on the back of your arm. They last for about two weeks at a time and you can shower with it, work out with it, do all your normal activities with it. And meanwhile it's gathering your glucose values in real time. And then you can just use a phone app to see what is happening in your glucose. Yeah. And it's like a tiny, it almost looks like a acupuncture size or like short, like little needle. Very tiny needle. Yeah. Like you don't even feel it. And that's literally measuring off your blood. Yeah. So what's actually happening is there's a needle for insertion. So when you're putting it in at home, the needle is putting a microfilament just underneath the surface of your skin. So the needle doesn't actually stay in your body. It's just for insertion, which is why it's so painless and comfortable. If you, when you take it off, you can, you know, hit the little microfilament and it's flexible and it's going just believe beneath the surface of the skin. And so it's actually measuring your glucose and your interstitial values, which is the space in between your cells. So it's not even going to the depth of your blood, which is why it's so shallow, so comfortable. But then you're able to measure glucose continuously in there, because our glucose values diffuse from the bloodstream into that interstitial space. So it's really the same thing, but it's just an easier way to be able to measure it comfortably and in that real time nature. Now, is it as accurate as the, the old traditional way with the pin prick? Yeah. The most accurate way to gather your glucose values would be to go to the doctor's office or order labs and get it from a blood draw. This is the same level of accuracy of when you're pricking your finger with a glucose meter. And so there can be a little bit of variability from that blood draw. But the good thing about the CGM is that it's extremely precise and that it's going to capture those changes in your glucose value. And that's what's unique about being able to measure it in real time constantly is that instead of a snapshot and image of your glucose values, you're getting a movie. So let's say you check it at eight a.m. and it was five minutes after you ate something and it's 80, it looks great. You're like, okay, that's excellent. But really in reality, what might be happening is it's about to spike really high and crash down. And that's why you got hangry and then grab for some more food. You know, it's that movie that's really going to tell us the whole picture of what's going on. Now this technology, was it developed primarily for people with diabetes? And then how did this then move into just accessibility for your average person? Yeah, absolutely. So this technology is originally for diabetics and really mostly insulin dependent diabetics. So this is type one diabetes or further uncontrolled type two diabetes, only about a third or close to a quarter of type two diabetics have ever even worn a CGM. So it's actually not even that common for doctors to prescribe it in the diabetes community either. But that is what this technology was developed for. And it's primarily been used between you and your physician. So your physician looks at the information, adjust your insulin dose, and then it's a medical tool in that sense. And so me coming from a background as a dietician working in the clinical world in the hospitals, I've worked with type one diabetics who use these, and it's an amazing powerful tool for them. But I began to realize that if we could put this device on anybody, then we could really solve some of those core problems that we're seeing in the healthcare is that we can identify some of these issues way earlier in people and actually drive meaningful behavior change. And that's when companies like ourselves started to use this hardware in a way that's more applicable to the everyday person. So what is, what is it showing when you see your glucose levels go up and you said crash? I mean, what are we looking at? And what does that mean? So let's say it goes up, we know that there's more glucose in the system, the rate at which it goes down, that's something to watch as well. Like what is it all telling us about somebody? Yeah, absolutely. So really, when we're looking at your glucose values, you can think about it, both what's happening in a fasted state and then what's happening after a meal. So in a fasted state, that's telling us how is your body self-regulating essentially, you know, when we don't have any food coming in, any glucose coming in, how is our body being able to find homeostasis in a sense. So just thinking about also measuring heart rate, you know, when we're just at rest, it's like your resting heart rate tells you a lot about your general health. That's what we can think about in a fasted state. So we want it to be usually somewhere between 70 and 90 milligrams per deciliter. It's okay if it's fluctuating a little bit, but if you're seeing big dips or large rises while you're fasted, that's a warning sign that maybe we want to dig in a little bit deeper and see what might be going on. And similar to heart rate, I actually like to describe glucose as a vital sign. Instead of a metric of do I have diabetes or not, which is what most people think of when they think of glucose, you can think of it like a vital sign as in it's reflective of your overall health. It's telling us how different variables and lifestyle habits are impacting your body. And so then we can move to what's happening when you eat. And so when you eat, you might expect your glucose to go up, depending on the composition of the meal. You know, if I eat chicken and rice and broccoli, my glucose is going to go up and that's okay. I think one misconception is that people expect a flat line glucose. And if it budges at all, they're like, what's wrong? What do I need to do? And we expect glucose to go up, but it's how high does it go? And does it come back down to normal afterwards? So we really want to avoid glucose spikes above 140 is kind of an upper threshold for a non diabetic. And then we usually want to see it return back down to pre meal values within two to three hours of eating. That's a good signal that, okay, we're processing this meal and we're getting back down into that more fasted state. So those are the general trends we're looking for. And then we can also look at, and in our app, it'll tell you all of this information. And you know, if it's good or bad, so you don't have to memorize it. But we can also look at a more macro view. How is your average glucose overall? And how big are those swings? Okay, so how does it, so why is this important? Like, what is it telling us about our health? If our glucose, first of all, let's go back to the fasted. You said you don't want to see it go up and down when you're fasted. Where's this glucose coming from? Is your body releasing it from your liver, from your muscles? Like, why would it go up in a fasted state? Yeah, so there can be a variety of reasons, but it's primarily the regulation from your liver. So your liver is doing a lot to kind of self regulate. It can stimulate the breakdown of glucose. So glycogen stores, if it thinks we need energy, or it can create new glucose through gluconeogenesis, or it should be able to halt those processes if it realizes we have enough energy. And when those messages get gunked up, so to speak, that's kind of when we're starting to see some insulin resistance or metabolic dysfunction, because that communication, that crosstalk in the body is starting to get a little dysregulated. And as we know, insulin resistance and good metabolic health is sort of the core of which all good health stands. We can't prevent diabetes or cardiovascular disease or dementia or cancers unless we have good metabolic health at baseline. So this is giving us a unique insight into that metabolic health and how our body is able to self regulate. So is this, could this predict like, oh, if you're not managing this properly, or the fact that it's going up and down your fast and the fact that it's reacting the way it is when you eat, is that a somewhat good predictor to say, if we stay down this path in three, four, five, 10 years, you're going to be, your likelihood of getting diabetes or of dementia is increased. It's a lot higher. Yeah, absolutely. And that's where we describe it so much easier and more important to be able to capture yellow flags and early warning signs than to wait until we've gotten to a disease state. By the time you get a type two diabetes diagnosis, over 60% of the beta cells in your pancreas have been damaged or destroyed. That's where insulin is produced. And so do we want to wait until we get a diagnosis until we're starting to cross those thresholds? Not really. You know, if we do not to say that once you have diabetes, you can't do something about it, you absolutely can. But the earlier we can catch these deviations and do something about it, the easier it is to fix it. Okay, so this is a question I've been meaning to ask actually someone like you. So there's this debate in the fitness space over whether or not insulin is the main driver of fat storage or no, you need to eat more calories in your burn, which we know that to be a fact, although that's somewhat general, I think it's a little more complex than that. If you eat more calories in your burn, you'll store body fat. Where does this, your glucose, your health, the health as indicated by your glucose responses play into that? Is it because now it's showing that your insulin response may be off or is it more a behavioral thing? Because I know when I tried wearing one, I noticed that when I would look at my chart and I saw my glucose do things that, you know, maybe not so ideal, I would feel not as great or I'd feel hungry. I'd notice I get cravings when it would drop. So what is it? How is this help in terms of like people who are just interested in fat loss or body composition changes? Yeah. And there's always the debate of, is it insulin and hormones or is it calories? And I think it's absolutely both. I don't think we can isolate these things to say that calories don't matter. I think is ignorant and incorrect. And to say that hormones and insulin don't play any sort of role in your health journey, I also think is missing the picture, which is historically the route we've gone is down playing the metabolic side of things. So I think it's both. And it becomes more important to pay attention to your insulin levels and glucose. So essentially in a nutshell, when glucose rises, insulin usually follows. So measuring glucose is a good proxy for understanding kind of what's happening with your insulin levels. And to be able to track that is important because an estimated 90% of the population doesn't have optimal metabolic health. And so if you are insulin resistant or on the way the path towards insulin resistance, then it's going to be harder to just calorie count because your hunger hormones are going to be off. You're going to have that dysregulation and communication within your system where, you know, maybe I'm eating, but my body isn't putting the energy in correctly. So essentially the more insulin resistant you are, I think the more you need to get glucose and insulin under control to be able to manage your calorie intake effectively because of the things like you're saying like cravings, that's going to make me eat more, which at the end of the day is higher calories and that's what's driving the weight gain. But I can't reduce my calories effectively and in the long term until I've understood and mastered the metabolic side of things. People who say hormones don't matter. It's silly because you could, the studies will show you could take someone, put them on exogenous hormones to change their profile and you'll see a body composition change. Even if their diet doesn't change, a guy will build more muscle and lose more body fat with more testosterone and you can see this with growth hormone and other hormone profiles. Yeah. Have you, what are some of the, because you're working with people who, and not only you're working with people, but you're also watching their charts. So you can see what's happening throughout the day. What are some of the behaviors or feelings people are getting that are correlated to these rises and these drops and what's some of the craziest variances too in terms of person to person, what you've seen so far. Yeah. To touch on behaviors, like you mentioned, you don't realize that mind body connection often until you have the data to back it up. And so a lot of people are like, well, I think I know when I'm hungry or I probably know when my glucose is high. And then you start to actually see the data and correlate it with your subjective experience. And you're like, oh, that is actually what it feels like when my glucose is high and then crashes. What does that normally feel like to people? What are they saying? Yeah. When it's high, people often feel jittery, nervous, kind of like anxious. Interesting. And then a lot of times, so this is the concept of reactive hypoglycemia, which is extremely common even in non-diabetics is let's say you just did a hard workout. So you're in a really insulin sensitive state. And then you chug some juice or something really sugary. Your glucose probably going to shoot up really quickly. And then it's going to dip down super low, kind of below that 70. So reactive hypoglycemia, meaning you've created this state in your body where you're hypoglycemic because of the spike, the initial spike. Yeah. Because of that quick flood of easily digestible energy you just gave it, we kind of see that spike in insulin to chase that glucose. And we've overcorrected a little bit because the body would rather process that and try to fix it later than not deal with it, anything with it. So we see that reactive hypoglycemia a lot. And that dip is then often stimulates cravings, hunger, because your body is like, I don't have enough energy. I'm in this low glucose state. Now I need to eat more. And so a lot of people will notice this behavior. We see this even in desk jobs. So skipped breakfast, didn't eat all day, got lunch around one, and you're drinking your caramel frappuccino while you're waiting for your meal to be ready. And then you're seeing this big jump and then this big dip afterwards. And you're feeling really crappy. And then you eat your meal and you're hangry. Low glucose, when that drops down, do you get tired and crabby? Yes. Okay. You know what's funny? You're talking about post workout in our space, especially the, I don't know, the part of the space I don't like so much, like the bodybuilding fitness space. Bro space. Yeah. They'll be like, oh, you got to have super fast adjusting carbs afterwards to replenish glycogen. And they'll literally recommend dextrose. Like, you know, gummy bears or candy. Pop tarts. Yeah. And then it'll pop tarts. And then people will be like, yeah, I don't, I'm so tanked after my work. About an hour later, I need to take a nap. And they think it's the workout, but it could be what you're talking about. And that's not a great thing. No. And it's like, I'm sure you guys can speak more to the need of how quickly you need to replenish glycogen stores. Yeah. I was going to say, I don't really think that's very important. And you're probably compromising your overall goals by doing something like that as well, because now you're most likely going to overeat. Or yeah, you feel crappy. It's not setting you up for success. I try to say this all the time, how you feel will dictate your behaviors, your behaviors, then we'll dictate your results. We have to look at that. We can't just look at everything on paper and say, eat this and eat that. Because if you feel crappy or you have lots of craving, eventually it's not going to be so, so, so effective. Yeah. So in terms of actually using it, it has to bring a lot of like weird insight into some people's behaviors. Like in terms of like some foods giving you a crazy spike versus others that you'd never even anticipate. So are there some like examples of that you guys have found through all the data you guys sift through? Yeah, absolutely. And that was one of the most eye-opening experience when you start working with clients with this data is just how different each person is. Like I guarantee you, if all of us in this room eat the same exact thing right now, we're going to have a different response. And even with myself, so I've tested just about every fruit that exists to see how I respond to different fruits, you know, same portion size, same setting, same time a day and consistently the glucose response that is lowest is to bananas, which is a higher glycemic index. You would think bananas would let you be a spike. Just the variation between predicted glycemic index and your actual individual response is all over the place. You know, glycemic index is an average of the population. So maybe 50% of the people will respond a certain way to bananas, but there's going to be all of those people who deviate from the average. And that's what we see day to day is that, you know, it's all over the place. Yeah. And this is the real value of it because you're absolutely right. There's a huge individual variance. I knew this is a trainer and I wouldn't have objective tools. I would have loved something like this when I was a trainer, but it was all feel. Yeah, we have to ask a lot of questions. You have to be really like in tune with your body and how I feel. And I did notice a while ago, we talked to a good friend of ours, Rob Wolfe. And he was one of the first people to use these CGM devices back when they first kind of came out. And he had some of his friends use them and stuff. And he talked about how weird it was that some people would get this, this glucose response to a food that like had mostly fat and proteins in it, right? And he's like, what's going on? His theory, and I'd love your opinion on this, his theory was that they must have had some kind of a low level immune response to that food, which is the individualized, you know, the kind of the difference between people. So in other words, this person ate an avocado, which is mostly fat and some fiber, but because they had a kind of like low level immune response, but maybe an intolerance, their liver spit out a bunch of, you know, glucose and they got a spike. Is that, is that? It can happen. Yeah. And we had this instance recently with somebody to macadamia nuts, which is like the most like perfect keto food. And they kept getting a glucose spike to macadamia nuts and then ended up having an intolerance moving that and all was good. So sometimes it can be that inflammatory immune response happening to a meal. And sometimes there are some secret ingredients in there that is also eye opening. For me, a personal example is Costco rotisserie chicken has a bunch of dextrose in there. Who knew? But I kept getting glucose spikes to the rotisserie chicken and I was like, what the heck is going on? Oh man, we're going to run. Even as a dietitian, you forget to look at the actual label, you know, and see what other ingredients are in there. So that can be another part of it is just being able to objectively identify what your go to food foods are doing to you. Back to, you know, addressing things early, yellow flags versus waiting, it's okay if you have a glucose spike every once in a while. Like I want to make sure that's normalized is if you have a glucose spike once a week or once a month to something you enjoy, it's not a big deal. But if it's your go to breakfast and you're eating that every single day and you're having a massive glucose response to that and you don't realize it, those are the sort of feedback loops, consistent habits that are going to lead us towards this negative downstream. Josh, I would have killed for this when I was a trainer because it would take me months or years with clients to figure some of this. I remember one lady in particular used to have, she would get lots of anxiety in the kind of late morning and couldn't figure out what was going on and we did the work out and her diet was what I thought was good. And you know, she had to kind of treat herself with some medications for some anxiety. And then I remember reading that high glucose spikes and cause anxiety. And so I said, you know what, for breakfast, let's just have like a fat and protein meal, like no carbohydrates whatsoever and see what happens. And tremendous response. She felt so much better because she didn't get that. But it took me I think it was like a year of training her to kind of figure this out. So you're seeing this right there real time. Here's what's happening. Yeah. And I would say two of the unexpected results we see often is that people have a much better mental health or, you know, states of anxiety after being able to adjust their meals to improve their glucose responses. And the other is better sleep. So there is a strong connection between sleep and glucose levels as well. It's actually a bi-directional relationship in that if you're going to bed with high glucose levels, your nervous system is on alert. Your body is in more of an active metabolic state. It's harder to get into those deeper states of sleep. And then the same goes the other direction of if you're not sleeping well, if you have poor quality of sleep, poor quantity of sleep, you're putting yourself in basically an insulin resistant state the next day. And so those are the factors where we need to be able to be malleable in our, in our habits. If you know, I got a crappy night of sleep last night, maybe I'm going to adjust my breakfast to be something more low carb or more fat heavy because I know I'm in a little bit more of an insulin resistant state today as my body is just didn't get the repair needed last night. Right. When usually we do the opposite, we get a crappy night of sleep. And then we're like, I just want the Pop Tarts and cereal or some sort of cravings. So I was just going to say, so what kind of, so you see cravings go up when the glucose drops down low, that's when the cravings start to kick in and people then want to eat more foods that raise glucose. So you're stuck in a cycle of the up down, up down. So are people more, so okay, I've noticed this after a night of drinking or, you know, you hang over the next day, like what do you want? You want the worst food of all time, which then causes a spike in glucose, which then will cause the crash again. And then, like you're saying, you get the spike. So insulin resistance is this, this is when your, your body continues to produce too much insulin and it starts to react less and less to it. Yeah. The way I like to describe it sort of like the boy who cries wolf, essentially it starts with that high insulin levels because for some reason, maybe it's your diet, maybe it's your lack of exercise and there's a variety of factors that can cause that where you're pumping out more insulin. And at first your body is responding well to that, you know, the boy who cries wolf cries the first time, second time, third time, everybody's listening, but eventually they start to ignore him because that signal gets dulled. And that's when our insulin sensitivity starts to drop. So we're pumping out more insulin, but it's not as effective as it used to be, which results in then high glucose levels, which is the hallmark of eventually type two diabetes. Are you seeing any, because I know what the data says generally speaking that if you build muscle, it's a very effective way to make yourself more insulin sensitive. And muscle itself is an insulin sensitive tissue plus you can store some glycogen in muscle, not as much as the liver, but it's kind of like another additional kind of storage bank, if you will. Are you seeing this in the people that you're working with, where if they start to build muscle, you start to see better responses? Absolutely. Yeah. So when we think about controlling glucose levels, I talk about it as four pillars to think about. There's nutrition, exercise, stress and sleep, and all of those are going to have an equal impact on your glucose levels. And when it comes to exercise, the two most important thing is building up lean body mass, that skeletal muscle, and you can actually store more glycogen in your muscles than your liver. If you think about just surface area, your liver only has so much space. We do not want our liver to get bigger than it's supposed to be. That is not a good thing, but we can make our muscles bigger. And then there's more room for that glucose to go. Our skeletal muscles are actually the largest sink for glucose. So 80% of circulating glucose usually goes to the skeletal muscle. So the more muscle we have, and the more we're using it, moving around, just literally five minutes of walking. If you're standing all day of a desk job, if you can break it up with some body weight squats, whatever you've got to do, any sort of movement will help pick up some of that circulating glucose. I was just going to ask, so what are the most effective forms of exercise that you see for this? So you mentioned building muscles, so I'm assuming strength training. Yeah. And then you just said something very interesting. You said kind of activity throughout the day. Does that seem to be more effective than like, for example, would a 10-minute walk after breakfast, lunch, and dinner, which equals 30 minutes, would that be generally more effective than one 30-minute shot of cardio type of deal? Yeah. If you had the opportunity to break it up and be more consistent throughout the day, that would be the preferable option. Being able to just move your body throughout the day is going to stimulate that glucose to be taken up and by the muscles, and it's going to have a better result in your overall glucose values. With that being said, any movement is better than no movement. So if all you can figure out is the 30-minute walk, do what you got to do. But, you know, the mistake a lot of people make, I think, is going hard at the gym for an hour and then sitting the rest of the day. So really prioritizing that movement in any way, shape, or form, just as much as you would prioritize making time for the gym. Excellent. I think we've been right then, Justin. Yeah, we're getting it right. Yeah, I wanted to bring in the business end of it a bit, and I know, Dan, you've been sitting here nice and patient, but in terms of incorporating nutritionists and dietitians and being able to actually coach people through all this data, first of all, how did you get involved in continued glucose monitors, and where did you see the opportunity there? Yeah, the one thing I'll mention is the food that impacts me or gets a drink, coffee. Every single person, we've seen, say, people have an increase in coffee, some people a decrease, and some people have a flat line, and I think that's something super interesting that people forget about that coffee is such a different impact. I have a rise, and I think it's because coffee comes from beans, and I may have some kind of immune response to it. So I can have caffeine, but if I have coffee, I feel I'll get the crash, and I'll feel crappy. So that's me. Very interesting. Oh, coffee helps me. It's like a Justin drinks it all day. Yeah, yeah. In terms of business side, my background's in healthcare consulting. So my job was basically to optimize profitability for hospitals, medical device manufacturers, and insurance companies. Not the, it's a fun job, but not the best for the world, as you can imagine. I always tell people a fun fact that if you ever do need to go to hospital, look at the CEO. If the CEO of the hospital is a former doctor, the chances of you having good outcomes are actually much higher, because a lot of times in hospitals, the CEOs are actually like former finance people, accounting people, and they're just looking at numbers and like, how do we cut cost? Oh, interesting. If there's a doctor knows like he was in that room for a decade before, and so they are aware of how to actually, you know, understand numbers are not just old results. There's more things that matter besides numbers. So I was in those a lot of meetings, and I saw this trend that you guys all know that people could be getting sicker and sicker and sicker. We all know that. But the side I didn't see was that we keep spending more money per person in the hospital setting on these people. And so how does it keep happening? We keep spending more money. Yeah, people keep getting sicker. So I wanted to do something about it, but I didn't know what frankly speaking. And so I was in a healthcare conference in San Francisco, and I ran into one of my friends who was wearing one of these devices. And I said, why are you wearing this? Are you diabetic? And he said, no, I'm not. I'm just trying to understand how to improve my glucose control. And he said, do you know anything about it? I said one from professional perspective, I do. But also my sister's type one diabetic. And so she's seen these devices from day one till now. And so I've been around it. So it happened to kind of be an expert in this industry. And he said, Hey, I'm thinking about starting this company. Are you intrigued to help me? Because I don't know the business side. I understand the engineering side of things. That's not sure. I quit my job two weeks later and launched it. And about two and a half years later, we have 120 people on the team and helped tens of thousands of people now. Now they used to only be available by prescription. It still is only by prescription. Oh, I didn't know that. So what we do is this is where the business side gets kind of complex. We write digital prescriptions in all 50 states, because every state has different regulation, different laws. So you have to every time somebody submits a form, they fill out a health questionnaire. And then we send it to the state they're in, and that doctor reviews and decides if they're approved or denied. They're approved, they send it back to our pharmacy partner. And the pharmacy then sends it out on our behalf. I didn't know that. Now, why is it by prescription only? Is it because it's considered invasive because the tiny little filament thing that? It's a good question. We're still trying to figure out. I mean, Canada doesn't require prescription. It makes no sense to me. Mexico, Europe, no prescription. It's pretty arbitrary. The FDA just decides this is a medical device because you can buy a glucometer over the counter, which is even more invasive. You think about it, you're drawing blood, but that's, it's a little arbitrary. That's crazy. That's crazy to me. So, okay, but anyway, it's an easy process because if we went through the process, it would be fast. And that's what people only realize, there's prescription in the back end. But we, I mean, we found that, you know, having a hardware itself is nice, but you need the software as well to help you kind of track all this data, because objectively, you don't want to sit there and write things out by hand all day, every day. And you have, you know, you stress, you have to track your sleep, your exercise. And even then, unless you're an expert, like you guys, it's very difficult for the average person who's an accountant or a marketer or something of that nature to sit there and figure out like, okay, I have these data, what do I do with it? There's so much data. It's an overload, right? And a push notification by itself on your phone telling you, don't do this, don't do this is also not enough. And having a human being on other side, which in our situation is a dietitian, we've seen that drive a lot more improvements. And so combining the hardware, the software and the dietitian together has really been the playmaker for us. Yeah, full disclosure, we've had companies come to us and approach us, but the reason why we liked you guys is because of that, because people, because we know, look, we train people. That was the missing component always. Yeah, I'm like, this data is not going to help anybody if they don't have coaching along with it, because you could go on Google and learn all kinds of stuff about exercise and diet, and that doesn't help anybody either. So it's that coaching component. I want to ask Kara about that coaching component. How do you use this to coach people? Like what does that process look like? Yeah, so as Dan mentioned, all of our members get a one-on-one dietitian that they communicate with through the app. And as a dietitian, this is also a game changer in that you have data, objective data to work on with your client. You no longer have to rely on incomplete food logs. You no longer have to rely on memory when you're only meeting once a month or once, you know, every couple weeks. What did you eat then? How has this been feeling? You get to talk real time with that client. And then from the member's perspective, the customer, they also get to communicate in real time. You don't have to wait for, you know, your specific visit. You can say, I just had a glucose spike. I'm feeling really crappy. What can I do next time to prevent this? And so it's an async texting type of communication that we use with our customers. And the dietitian is, of course, getting to see all of the data that they see. They're getting to see their food logs. They're getting to see whether they logged that they had a stressful day or if they got poor sleep. We also sync data from a bunch of other wearables. So data from your Apple watch, from your Aura ring is going to get... Also you can connect sleep, activity, all that stuff. Yeah. So they're able to see all of that as well and kind of point them in the right direction. It really depends. Somebody might be really healthy and they're just there to learn as much as possible. And they might just nerd out with the dietitian about what this means, how they can optimize their health, or maybe somebody has PCOS, they're overweight, they're going through menopause. And we're just going to be taking baby steps based off of what the data is telling us. So it really varies. Yeah. How do you identify, I guess, like intolerances or somebody, you know, you're trying to interpret that data. And then also you're trying to kind of troubleshoot with them. Like how does that all kind of work this way out? Yeah. So the unique luxury we have had is that we've now seen thousands and thousands of data sets. So the more you've seen it, and then we can train new dietitians on the experience we've had, the easier it is to quickly identify patterns. And so you just get used to it. Like I can look at a glucose data set and probably predict exactly what happened without even knowing the context because I've just seen it so much. But a lot of times it's looking at those four pillars. You know, what is it that you have eaten at that meal or what was the meal before that? What is your sleep like? What is your stress like? And what has your exercise routines been like? And those are the variables you kind of want to think through as you're trying to understand why you might be having a certain response. Yeah. You know, you just reminded me, I had a client once who, he had just become diabetic and because he had just become diabetic, he's like super motivated to work out hard. And I remember he came in and he worked out really, really hard. And then his blood sugar went through the roof. It spiked. It was a stress response. A lot of people don't realize that that other factors will influence you because you would think working out hard would cause it to drop, but it actually went through the roof and he was so confused. He's like, I just worked out. I worked out real hard what's going on. Let's talk about all these other things that can affect your glucose. I have nothing to do with food because I find that so fascinating. Yeah, absolutely. And like you're mentioning, the really intense workout can spike your glucose. And you could think about that as a supply to demand ratio. If you're doing steady state cardio, you don't have a really urgent demand for energy and your glucose will probably either stay even or go down a little bit. But if you're lifting heavy, if you're sprinting, if you're doing a hit workout, you might see a glucose spike and that's because you have a really intense demand for energy. Your body's releasing it, but it's a lot different than if you just drank a soda and your glucose spiked. Your body's like, I don't really need this energy. Thanks for that. But in the exercise, you're using that energy immediately. So it's not necessarily a bad thing. And again, that's why it's really important to have a human on the other side who can reassure you know, it's good to work out. Please keep doing that. But we'll just need to tweak some things. So mental stress or non-exercise stress can cause spikes in glucose. Absolutely. And that was another really surprising thing when we started to see so many people's data is often people who are relatively healthy, eat a relatively, you know, whole food, clean diet is that some of their highest spikes of the day are from stressful moments, not food at all. You know, they're like, I'm having this huge spike at nine a.m. every morning. I have no idea what's going on. I'm fasted and you dig a little bit and you're like, Oh, it's when you're commuting and your boss is calling you and you're trying to, you know, answer work emails. It's these stressful moments or it's flip flop sometimes depending on a person's life. But their glucose levels could be really high during the week when they're really stressed out, they're working and then it's low in the weekend or it might be vice versa depending on your personal life. But often we see these variances just because of stress. Okay. So with the coaching, obviously you'll focus your dietitian, you work with nutrition, but you're also coaching them through this other stuff. Have you seen improvements in people's numbers from stress management exercises? So it's like, okay, you get the spike at nine a.m. because you're in traffic every day or whatever. Obviously there's nothing we can do with exercise or diet in that moment. Have you seen improvements with people doing things like meditation or awareness or whatever? Like pair like a calm or something like an app where it's like, yeah, you can get some kind of meditation guidance. Does it make a big difference? Definitely. It does. And really the first step is awareness. You know, if you don't realize the impact that stressful moment is happening, then it's hard to change it. And a lot of people are so stressed out and running so, you know, on red line all the time that what's normal feels normal, even though it's not normal. You know, they're like, I always feel like this. I'm fine. And then you see the data and you're like, well, okay, maybe I need to do something about this. Maybe stress is actually something I need to take more seriously. You know, maybe I'm meticulous about my diet and exercise, but I haven't cared about stress because it's hard to quantify. And so when you can see that and it's clear that it's impactful on your health, then it's much easier for people to insert those habits. And that's where I think the CGM is a really powerful behavior change tool. Whether it's for stress, exercise, sleep, you know, whatever your Achilles heel is, when you see that in real time and it's personalized to you, it's not somebody telling you, Hey, I think your stress is out of control. You see it yourself objectively. It's much more intrinsically motivating to do something about it and to experiment, you know, maybe you try meditation in those moments and you can't get it to work. And maybe it's not for you. So then maybe you try deep breathing instead and that does work. It's much easier to speed up that experimentation feedback loop as well. When you have the data to see like that works, that didn't work, what's realistic. You got the feedback. So do you have an example that you can, you can tell us about? Obviously you can't give us names, but you have an example of someone who implemented like a stress management tool and you see this improvement just from that. Oh yeah. I mean, we see this all the time. The examples of people commuting and having those glucose spikes are very real. That's common. Yeah. I mean, it is stressful. And so maybe instead of doing that, you, you instill some sort of mindfulness habit during that. So let's say you're in an Uber and you're all stressed out because you're going to be late or whatever. Instead it's taking that time to put your AirPods in and use a mindfulness app. You know, it's can be simple things that are extremely effective. They make a big difference. Oh, absolutely. Like how big of a difference do you see with this kind of stuff? I mean, you can get your glucose back to just being flat in those moments if you can mitigate mitigate the stressful effect. Cause what's happening in those acute stressful moments is your body is essentially having that surge of cortisol, which tells your body I need energy. And so if you can prevent that surge of stress, you can keep it even. Are there any supplements or nutrients that you've seen an impact that can impact glucose? Like I know alphalopoic acid I've seen in studies can help with glucose or insulin. Is there anything like that you see people will supplement with and then you see like a positive. Yeah, I've seen the most success with berberine. Oh, really? And is that before you eat or right after? Yeah. A lot of supplements, you know, the supplement industry is a whole mixed bag, but there'll be a lot of berberine supplements that are targeted towards like carb manager and it's like eat this right before, but I see the most success with berberine if you take it consistently. So if you're seeing high glucose levels and you've done a lot of the right lifestyle habits and you want to try supplements, I would say take berberine daily for a couple of weeks and see how it impacts. Okay. So rather than the acute effect, take it regularly and then you start to see improvements in when it comes to acute effects. If you want something for like a specific meal, apple cider vinegar, it's the way to go. It actually works. People always say like, does that work? You know, there's certain things where it's kind of a gossip. Doug saw that. Doug used apple cider vinegar and saw an improvement. It really works. Yeah. So, okay. Here's something that I saw with mine. I think, I want to say Adam did too, maybe Justin, you wear it all night and I would see spikes in the middle of the night. I'm like, what's going on? Am I having a bad dream or whatever? And I think maybe, and I don't think my wife told me, I snore sometimes can, can like snoring or that kind of stuff produce spikes in glucose as well. It could if your sleep is just disrupted because of it. We often see that people have these high glucose values while they're sleeping. And the most common reason for that is usually a late dinner the night before. So it's typically the timing of your evening meal. This is one of the most common, yeah. That was a bad idea. Yeah. So our insulin sensitivity and our ability to use processed glucose and kind of keep glucose levels even works on a circadian rhythm, similarly to other hormones. So most familiar, most familiar is melatonin. You know, it peaks in the evening to get us sleepy and then it's really low during the day. Our insulin levels are opposite of that. So insulin and melatonin are actually antagonist in that when melatonin is high, our insulin sensitivity is at its lowest. So if insulin's high, you're not going to produce enough melatonin. Yeah. So as a good general rule of thumb to kind of keep those glucose levels even while you're sleeping is to try not to eat when you think your melatonin levels would also be high. So daylight hours as a good general rule of thumb, trying to avoid food at least three hours before bed. Again, I know everyone's routine or schedule is sometimes not suitable for that. So if your meal time in the evening with your family, the only thing you can do is nine PM, which would be pretty late, but who knows. Then trying to make that a little bit lower carbohydrate, a little bit smaller in portion size, not the time when maybe you're also having a bunch of desserts or snacks, which is the most common, of course, because we're in a naturally decreased decrease insulin sensitivity state and that is evening hours. And it's also inversely related to growth hormone, right? Insulin goes up growth, okay. Small meals, do you see better results with people eating, because bodybuilders for years have done the whole like eat every three hours versus big breakfast, big lunch, big dinner, or is there an individual variance there? There's an individual variance and I think both can work. And again, it's more what's most realistic for your lifestyle. What is actually, are you going to be able to stick to? There's so many people who are like intermittent fasting is hot right now, so I must do it even though it really doesn't work for my schedule. So it's kind of like figure out what's going to work best for you. What I would recommend not doing is being very mindful of grazing and snacking. So maybe you're eating every two to three hours, but having bites of food in between that, we really don't want to do that. Because then you're never giving your body that ability for glucose to go back down in between meals. So you don't generally see a difference then between eating five meals versus eating three if the calories are somewhat equal? I think both can work. The problem I see for the everyday person, I think a bodybuilder is very disciplined and they can stick to their calories and eat every two to three hours. You're talking like a trainer now, I agree with 100%. But the everyday person is like, oh, I'm going to eat these smaller, more frequent meals and they end up just eating more. Yeah, or they eat bars because nobody pretty. And so I think the everyday person, two to three larger meals and trying to avoid snacking in between is usually a better option, but it's going to depend. Now, most of your career, you did not work with CGM devices like that. You worked in hospital settings, whatnot. Is it much more effective now at getting people to lose weight because you have this data that you can point to and work around or does it not make that big of a difference? Like let's talk about weight loss. Yeah, it makes a huge difference. And a lot of that is just the motivation that comes as a behavior change tool. I liken the CGM as similar to calorie tracking. At first, it's about awareness. Most people are totally off in their assumptions. If you're going to, somebody's never tracked before and they're going to guess how many calories and protein they're eating, it's totally off. Same as going to be if you're trying to guess what your glucose response is, you're going to be off. So the first step is awareness, gaining knowledge, gaining insight, and then it turns into behavior change. You're not learning as much after a while, but it's helping you stay accountable and consistent. And we know that that's where results really happen is being consistent and accountable. And so if you have that data that again is more intrinsically motivating because it's personalized, it's not me telling you to go on walks. It's not me telling you to lift weights. It's not me telling you to stop eating late at night. It's you seeing it in the data from your own body. It's motivating and it's real time. You know, we have this huge time gap from our behaviors and the consequences often. If I eat cake every night before I go to bed, I'm not going to see diabetes for 30, 40 years. True. That's not very motivating for me to stop doing the thing that's really fun and pleasurable today. But if you could see real stuff happening every day. Yeah, exactly. Our brains are absolutely hardwired for that immediate gratification. And we don't get a lot of opportunities for immediate gratification in traditional nutrition fitness world. Oftentimes it's the opposite. The first time you start working out, it's not very gratifying. You're like, I'm sore. It kind of sucks. And so being able to have a positive reinforcement to the behaviors that you actually want to stick to is like really, really helpful. So as a coaching tool, it's just brilliant. I would, I totally see this because when I first heard about these, I'm like, how's it going to help anybody when they just have the data? But when you combine it with the coaching, here's something that really occurred to me. One of the best strategies for a trainer or coach to be effective is to be able to figure out how to get your client to be honest. It's very challenging to get someone to be truly honest with their dietary habits and their feeling, especially if they're reporting it, you know, you're meeting with them twice a week. But sometimes even less than that. It's like, what happened on Monday? What happened the day before? And they're kind of trying to report it or getting someone to write something down right in that moment. It's very challenging, but you see the data right now. So it's like, they're forced to be Hey, what happened at 2pm yesterday or what's going on here? And so right away, are you finding people like right away or just like, oh yeah, I'm honest because there's no way to lie. Yeah, there's like nowhere to hide. We're in this, we're in this together, I guess. Yeah, that's exactly the mindset is it's extremely difficult for people to be honest. And even if they're well intended to be honest, it's hard to remember like you're saying, or it's hard to write everything down, you end up summarizing and then skipping the bites here and there are the little things that actually matter and add up. So being able to have that data capture it objectively is so helpful. And in being able to help somebody effectively, you really can't help somebody reach their health goals if you don't know the whole picture. And being able to do that behind a screen, I also think is really helpful because there's a little bit of a barrier between the difficulty of being honest sometimes of like, yes, I had, okay, not one glass of wine last night. Yes, I drank the whole bottle last night. Well, it's interesting. We see sometimes we see people who are like Olympic athletes, professional athletes, and these folks are fit. And yet you look at their glucose responses as atrocious. And you sometimes have people who are a little bit overweight, and they're super healthy. And we have a stigma around the way we look is connected to our metabolic health, which is not completely accurate. No, you're right. Because in fact, if you look at the data of diabetes, so type two diabetes and heart disease, a substantial minority, and I say substantial because it's not insignificant, it's something like 15 to 20% is non obese individuals. So there's it's millions of people who get heart disease who are not obese. Now majority are obese, but there's a percentage who aren't. And how would you know, if you're one of those people, you know, I have a friend of mine whose uncle, you know, is late 40s got a heart attack, the guy worked out all the time, whatever, you know, how would he know if he didn't have something giving him kind of objective measures, because he looks in the mirror, he sees his performance in the gym, and everything feels, you know, totally great. I want to go back to the calorie counting and just how difficult that is as a coach to be able to to get that kind of information and data from your clients. And in terms of there's been other my fitness pal, there's been like other types of apps out there that have tried to be able to make that process easier and try to catalog everything and be able to upload pictures to sort of make that simplify that process a bit more like, what were some of those challenges in terms of the actual user experience? Like how did you make those decisions and create that? So it was more valuable to the coach and the client. Yeah. And this is what's fascinating about this with my fitness pal, you have to track every single thing because there's no feedback loop to you. Right. With this, we realize everyone has a different methodology of tracking, not everyone. Some people will track every single ingredients, every single Mac or every single like calcium zinc they had. But some folks, they just want to just maybe take a picture and that's it move on, or they maybe want to even just like type in yogurt. And because that is always tagged to actual data, you can actually then realize what the feedback loop is on what. So it makes it much more flexible. And even if you like take a picture of something and you don't have the macro breakdown, because there's a human being on the other side, they can tell approximately what it is. Right. They don't need to know it's three bananas, they could seeds bananas. Right. And so I think that ability to let people just put much more flexibility around tracking helps. And some people also will, interestingly enough, the only track when they only see negative events. If it's if you're eating some healthy, do you really need to write it down? Right. Probably not. Right, right, right. Are you, how often are the dieticians in communication with the people using the CGM? Yeah, close to daily. So it depends again on the person. We'll always respond within a day maximum to something somebody is sending us directly. But if you don't know what to ask, you don't know what you don't know, the dietician is going to reach out usually every two to three days in the beginning, while you're figuring things out to kind of point things out, guide you along your journey. And then once you get a rhythm going, it might be more like every five days that we're checking in on your goals and you can send a message anytime in between then. So some people want much more frequent contact. And some people are like, I got my plan, we're on a good path, check in with me weekly, hold me accountable. So it's flexible again to what the person. If I was training again, I would 100% get clients to do this because you guys are handling that side. And I would just be able to look and see what's off of a trainer's back. You guys have people who work with trainers who then contact you guys and work with you guys as well. So everybody can kind of work together. Yeah. And right now that's in a more beta phase where we do it a little bit manually where, you know, we can give them access to see their data so that we're all seeing it together. We're all working together, but we are working on a platform that will make it easier for people to work with where, you know, their clients are working with us and they're seeing it. And they're getting maybe more of a high level report so that they don't have to be the person who's an expert in looking at the data either. I'll say there's one point I find interesting is that we try to reach out to members all the time and we had a one member we reached out over and over. His glucose was really, really high. He's always athletic, healthy, and we kept reaching out to him. He was not responding. Three days later, he was finally responding to us. We're like, you okay? Well, what's going on? You're in diabetic range for like 10 hours. And his response was sorry I was getting married. So high. He like couldn't respond, but it was just like he felt the pain. Do you see glucose? Because I've read how fast digesting protein, like protein powders can cause spikes in glucose. Do you guys see that? Sometimes I see it. We get a lot of keto people who are worried about getting glucose spikes from too much protein, you know, the obsession with that. And what I actually have seen is that it takes a lot of protein for it to result in a glucose spike. And so usually you're probably not overdoing it on protein. Most people are underdoing it on protein. But sometimes that fast acting, we can see a little bit of a glucose bump, but it's not anything where it's concerning or it's out of normal ranges. So most people who are afraid of that, I think it's okay. How big is the individual variance here? Because we know that we generally would think a low carb diet would cause better glucose response. And I've worked with clients who have gone vegetarian and felt great and others that just was terrible for them. There's of course, we were talking about the software, there's, you know, carnivore diet, which I believe to be just really good elimination extremes in the spectrum. How big is the individual variance? Like, do you see people doing the same diet and you're like, this is working for you and this is terrible for you? Is it that big? Yeah, it's pretty big. There's the basics, you know, it's always master the basics of nutrition, whole food, nutrient dense, as much as possible, of course, maximize protein. And then from there, it's, there's a lot of variation. That's why I always say with nutrition, it's, I can't tell you what to do besides the basics because it's so personalized. You have to have a mindset of being open minded to like, what's working for one person is not necessarily going to work for you. We always have people who come to us and they're like, well, my sister lost 80 pounds on keto. And it's, but I'm gaining weight on keto and like, well, it might not work for you. And even just the variations of what low carb is, somebody's carbohydrate threshold where they're going to feel good and have good glucose values, isn't going to be the same as somebody else's. Now you were a dietitian for a while before you started working, doing this. Did you go in with some preconceived ideas and then were you surprised by anything? Yeah, I was. I think I went to extremes where, you know, when you're first clinically trained as a dietitian, which our training is not as good as it should be. It's a little bit archaic in some aspects, whereas more like, okay, carbohydrate counting, consistency, small frequent meals. And then I saw all of these people in the hospitals with diabetes and complications. And I was like, everyone should be lower carb. Like this is not helping us. And then swung the other way with the CGM where it's really like, oh, it depends. It varies. And it also might depend for the individual person, depending on where they're at in their life. We have so many menopausal women who come to us. They're like, what was working before isn't working now? I'm sure you've seen this. And estrogen drops when you're going through menopause. We see this in a minor way during just normal monthly menstrual cycles. But during menopause, you're having this massive change in hormones. Again, back to hormones matter. Suddenly, you cannot eat the same as you were before. And most likely you're going to need to be in a little bit more of a carbohydrate restricted state during and after menopause, because you're just not as insulin sensitive. But then again, going back to the importance of strength training, the women who have the most success through menopause and maintaining good glycemic control are those who are still being really physically active, making sure that they're doing strength training, eating a lot of protein, but their needs have changed now. So it's also a variation of what stage of life you're in, what you're doing personally, and then between person to person. My ego feels great because a lot of the data that you're seeing or that you're explaining is a lot of what we learned through trial and error, through training people. And oftentimes, we were at odds with quote unquote experts because they would talk about studies and data. And from that perspective, we'd say, well, no, I've worked with a lot of people that this year. I haven't always seen that to be the case. At the end of the day, the clinical experience is the most important. It's like what you've actually seen work with real human beings. Research is great and important, of course, but it's a sterile environment usually, and it doesn't take into account all of the variations of real life and real humans. A lot of times, this research on glucose, they're using oral glucose tolerance tests, so they're having people drink pure glucose. That's not very realistic of real life. So it's important as a guide to understand the research, but you have to be able to be willing to adjust things with your client's experiment, trial and error, like you're talking about. Have you worked with people where they'll go on hormone therapy, like either testosterone replacement therapy, or some women will go on hormone therapy, and then you see a big impact and change in how that affects? Yeah, and same also with thyroid. So we have a lot of women, specifically, who come to us with Hashimoto's or hypothyroidism, and their thyroid levels are not optimized yet. They're not in a good place. And once those get stabilized, we see much greater improvement in good glucose control. So thyroid, female hormones, testosterone, all of those are going to have a really significant impact. This is the most effective. I've been very vocal on the show about this. I'm not a big fan of wearables, typically. I don't think that they're going to move the needle. I think they're cool, and I like fitness fanatics are going to like it, but I never thought that wearables would make an impact to the average person until we started talking to you guys, and the coaching aspect through the data, that's what makes all the difference in the world. What is the adherence rate? Are people sticking with you guys? Because that really tells a lot, right? How long people are able to stay consistent? They've lost weight, they've been able to keep that off. Do we have numbers or do we know what that looks like? So we have internal numbers, but we decided to take a next level. So we actually started to work in University of Wisconsin, and one of their leaders is from an MDPHG from Mayo Clinic and about quantifying this and doing a research clinical research study about this. We've noticed that historically, the research institutions are about 20 years behind clinical settings as we talked about. And so we said, let's go to the research universities, work with them, provide this data. All this data has never been existence before and try to quantify this with a stamp of approval from the old school. So that's where we're trying to get to. Again, Kara has way more and what she's seen, but again, we want to make sure there is a scientific backing of this information. In related to the awareness first and then behavior change next, what we see a lot of people is they'll do it for three to six months in the beginning consistently where they're wearing it every day. They're gathering that data. They're coming up with a plan. And then from there, there's a group of people who want to keep wearing it forever as that behavior change tool. And then there's a group of people that are like, can I just stay with my coach while I implement some of this? Interesting. And then I'll come back and wear the sensor periodically. Because unlike an Apple Watch, unfortunately, it's disposable in the sense that last two weeks and then you have to throw it away and then you have to use another one. You can't just wear it forever and just have a one-time purchase. So what we're seeing a lot of people then will do it on a quarterly basis or every six months as sort of a check-in. Again, related to calorie counting, I think a lot of people will be like, okay, I'm good for a while, but then I need to revisit it to make sure everything still looks good, to hold myself accountable. So I think that periodic use is very interesting, but a lot of people are wanting to stick with the coach throughout that. Well, it's interesting, too, because you're thinking about how people change over time as well. And some foods that you may have done really well with initially may not serve you quite as well in the future. It'd be interesting to just periodically put it back on and just to check up again. Yeah, but what you're saying makes perfect sense, because you can get, data can become stressful. What I should say to be more clear is, people who track, if you become obsessive about the tracking, that's a hard way to live all the time. So it makes perfect sense that people would do it long enough, get the awareness, kind of have an understanding. I feel like this when my glucose is high, I feel like this when it crashes. Now you connect feelings and cravings to those things, and then you can kind of self-monitor a little bit, but along with the coaching. So that makes a perfect sense. Are you seeing way more success with this than you were without? Oh, yeah. It's night and day. So it makes you hopeful? Yes. I feel very optimistic. Anything that surprised you two about using this, about yourselves, or anything that you changed about your lifestyles, your workouts, or your diets? Me probably more than Kara. My job was traveling and eating. And again, I thought every day for breakfast, I would have orange juice, because I was like, oh, vitamin C, right? I'm spiking my glucose every day. Like I'm eating bananas, I'm like potassium, getting all my vitamins out today, right? I don't need multivitamin. I'll just eat healthy, right? And every single day, banana, orange juice, what else, bagel, and like a protein shake. That was my breakfast for like a decade. And I, the whole time kept thinking, I'm beyond believe healthy. Look at these other people eating McDonald's. And every day, like, noon, I was just crashing. And I was like, man, something's wrong with me. And the first I just swapped some of those things out. What do you do now? Now I eat cottage cheese instead of banana. And even if I have a little honey, but again, I'll put honey and I'll eat it maybe after or mix it with something else, where I'll have the protein or the fat first instead of having a carb. And it's funny enough, I'll actually oftentimes eat some kind of meat as well. So I mean, it sounds like I'm kidding. I'm not. But it made a difference with your... I mean, dramatic, dramatic difference, right? I think the order of food, this is meal sequencing that Kara taught me, personal dictation of mine now, really dramatically helped me to understand how to eat. Or even, I mean, this is going to sound silly, but like, you know, people always eat dessert in the afternoon or evenings. But like, theoretically, desserts are better in the morning. So if I'm gonna have a cheat meal, and this is probably not the best they do, but I'll have them cakes for breakfast once in a while, the rare occasion, right? But it's just healthier, right? Because you're, you have better ability to control insulin and glucose at that point. Well, it's funny. I was just thinking about you're in the land of deep dish pizzas. Yeah. To really test the limits of like, you know, we're going to spike out. Justin's like, it might go straight with deep dish pizza. What about free self-care? Did you change anything or have to come here? Yeah. And I think for me, I was just figuring out what my optimal carbohydrate sources are, as I mentioned with even testing the fruits. I love bananas, but then I was like, oh, they're too high glycemic. And it's like, okay, they're perfectly fine. So understanding those go-to carbohydrate sources. So for me, white potatoes are better than sweet potatoes. Wow. My glycemic response. And I actually like them better. That's a surprise too. Yeah. So a variety of just figuring out which carbohydrate source, as Dan mentioned, always protein first when possible before the carbohydrates. That actually makes a really big difference. I knew that the walking after meals is important, but I'm much more likely to stick to it now than I ever was before. How big of a difference does it make in glucose? Oh, at least 20 to 30 points for me. Wow. Just a 10 minute walk? Just a 10 minute walk. It doesn't have to be, you know, a long- So crazy. We've been talking about that just out of our own experience. Same exact thing. You feel better too. And you're less likely to overeat. I think if you're like, oh, I'm going to remove myself from the area and go on a walk rather than just kind of like lingering in the kitchen forever. And then trying not to eat past. For me, 7pm is kind of a cutoff that I have where I see my glucose values go much higher at night. I actually have the genetic variant for the melatonin receptor, which almost a third of the population does that makes you even more sensitive to that effect we talked about where your glucose will be higher if you're eating later at night. So I noticed that quite a bit in my data. And then there's some situations like I play beach volleyball late on Monday nights. I don't get home until 10 and I eat dinner at 10.30. I'm still going to eat because I just worked out for like five hours straight, but I'm just going to have protein and not carbohydrates at that time. So tweaks you can make depending on your situation. And now throw food combinations. If I just eat a food that I have a high, you know, glucose response to and I add protein to it or fats, do we see, I mean, that's what we're taught, right? That you'll see a better glucose response. Is that you normally see? Yeah, it definitely helps. If you combine it, what helps even more is if you can eat the protein first, it actually makes a big difference. So I've been teaching that too. That's why they're telling people, but not because of that. It's just because, you know, most people under eat protein. So I'm like, yeah, it helps with satiety. It's a win-win across the board. And that's small things like if I'm out to eat and they usually bring you carbs first. So chips and salsa, bread and butter. Now I want, I will wait for those things until my entree comes so I can have some protein first. Little things where it's like, I probably wouldn't have thought about it beforehand that now you just feel more empowered by actually knowing. Do you guys see any glucose responses to non-calorie containing foods like artificial sweeteners or anything like that? Yeah. And as Dan mentioned, it's kind of a mix up of how somebody might respond to coffee or caffeine, even if there's nothing else in it. It's probably related to genetic variants, or like you said, it might even be kind of bean intolerances as a variety of reasons. But similar with artificial sweeteners and stevia, it's a toss up. Some people seem really sensitive to it and will have a glucose response and some people seem nothing. That's fascinating. I wonder if it has to do with the perception of sweetness that make, I don't know. It's possible. I have a feeling we don't know the answer to that one. Yeah. Well, we definitely don't. Yeah, we definitely don't. There's probably some sort of microbiome component, I would guess. Do you ever see any changes with the probiotic supplementation with people? Yeah. No way. Yeah. And there is a probiotic supplement on the market that is specifically designed to lower your A1C. And we have seen people use that and it actually works. And so there's a variety of probiotic supplements out there that we've actually seen quite an improvement with. And even the gut health connection to everything is prevalent, but it is also connected to glucose, of course. And so if somebody, and there's actually really interesting research on this, where if you take a lean individual and you transplant their microbiome over. Yes, people transplants. Yes, people transplants over. That's a, the nice way to say it is to give it to them, but. It's a poop transfer. If you put it in a metabolically unhealthy person, somebody who has type two diabetes, you will see their glucose values improve overnight from just having that microbiome switch. So there's certainly that connection. And so the more that we can kind of optimize our health from all aspects, the holistic view, it's going to have those ripple effects. Generally speaking, from your experience, obviously there's a huge individual variance. We've already covered that, but generally speaking, what are the best and worst foods for glucose responses for people? Well, there's the obvious worst foods where it's liquid sugar, I would say is like the worst you could do. So soda, juice, dance orange juice. A lot of juice. Caramel Frappuccinos. Gatorade. Also not a good like electrolyte replacement. I don't know if you guys have ever gone on the, okay. We work with a company that does electrolyte, but there's no sugar that way. So any liquid sugar is going to be the worst thing you can do. And then, you know, the more processed foods, the worse it is where it's like the more whole food you can do the better. Generally you see that. Generally. Even if the macros are similar. Yeah. Even if you think about the level of processing within the same ingredient. So I've done this experiment personally of same portion size, same total carbohydrates of instant oats, rolled oats, steel cut oats and overnight oats. What's the difference? Dramatic difference. It is, it was pretty impactful. I was really surprised actually, even in myself of how much of a difference it made where the instant oats, it was like, I was spiking to 160 coming from a baseline of 70. Wow. Pretty dramatic increase. Whereas steel cut oats that then cooled overnight and eat in the next day. So a little bit of resistance starch in there. It was like a 10 point increase. So like 70 to 80. Wow. Yeah. So resistance start. This is because it literally develops starches that don't get broken down into carbohydrates. Right. Which is even also feeds the gut back, gut bacteria even more as well in that resistant starch state. So anything. Oh, it's oatmeal. What's the difference? Yeah. Yeah. And the instant ones are like kind of pre-digested. So that makes it a faster absorbing. Essentially. Which is similar to again, talking about liquid sugar, oat milk. Can we just end the oat milk craze for once and for all? It's basically liquid sugar. How do you milk oats by the way? Because it's already been processed. Not milk. It's like instant oats in liquid form. You know what I think is a kind of fascinating. So I used to travel quite a bit for my work and when I would eat the exact same foods in year versus US, I'd have a way worse response in US. And I don't know what, what the processing is, what it is, but the exact same breads, the milks, the orange juices. I've heard that with grains specifically. It's like way worse response for foods that eat in US. I've anecdotally noticed that. I have family in Italy. So I go over there and I eat the foods there. Same thing. And I feel like it is because I'm more relaxed here. Like what's the deal? But no, I'd bring food over and I'd notice that I feel different. So I mean, my guess is it has to do with the, because we have different regulations here on additives, whether it's coloring or preservatives or even glyphosates. Residues are higher in a lot of our food. So I, that's my guess, but it is very strange. Anecdotally speaking, I've had lots of people tell me that. That's really, really weird. So how many, how many people does a, does a dietitian typically work with at Nutrisense? Like is it one versus, you know, assigned to so many people? Yeah. So you'll be assigned one on one with someone so that you can develop that relationship and rapport with someone. And then they're usually working with somewhere between 80 to 100 clients at any point in time. Okay. And then how many people now are signed up and working with the company? Do you know how many members? Yeah. So like historically, it's been over like over 40,000 people so far. Wow. But here's a fun fact. Last time I looked, something like 12%, don't quote exact number, but 10, 12%, are folks actually healthcare workers? When I say that, I mean, doctors, pharmacists, other dietitians. That's a huge percentage of people that one. I mean, a lot of folks go to medical school and don't ever take a single dietitian course. Wow, that's remarkable. Nutrition course. And then so like, they, you know, they always say like doctors are unfortunately taught to prescribe medicine and cut in U.S. in our system. They're not worried about preventative health and, you know, Interesting. Like, a lot of times you go to a doctor like, Hey, I have an issue. They say, work out and eat better. Yeah. And then come back a year later. Did you work out and eat better? Doesn't look like it. Yeah. We real about that all the time. I know I asked you about supplements earlier, but creatine, have you seen any changes in glucose with creatine? I've read studies that show that it's got a positive impact, maybe indirectly because it helps build muscle, but have you seen anything? Yeah. I haven't noticed anything where it's like a stark impact with the supplements. As we mentioned, berberine seems the most effective for lowering glucose, but then there's also, if you have a deficiency in certain nutrients supplementing with that or bringing it up with food supplements, whatever you got to do, you'll see a dramatic improvement in glucose, but then usually supplementing beyond that, we won't see that. And most common for that is vitamin D shocker, which most likely you are deficient in. So bringing that up, magnesium, chromium, and zinc are the other ones that are really closely related to glucose metabolism. Do you generally see differences in meat, like beef versus chicken versus fish? Or is that not really a big... Not a large difference unless you're having some sort of intolerance. Got it, got it. Awesome. Well, this has been really cool, very fascinating. And like I said, we've had companies approach us and we've said no, but we worked with you guys because of the coaching aspect. I feel like the data combined with the coaching makes it super effective. And if you take one away, obviously loses its effectiveness. So appreciate you guys coming on. Yeah, thank you. Thanks for having us guys. Appreciate it. Yeah, it was great.