I am delighted to have Kara Collier joining me for the third time today. The last time we connected was in episode 285.
Kara is a registered nutritionist and dietitian. As the co-founder and Vice President of Clinical Operations at Nutrisense, she is the leading authority on continuous glucose monitoring technology for health optimization, disease prevention, and reversing metabolic dysfunction.
In our discussion today, we dive into the outdated history of dietitian recommendations, the problem with rigid nutritional dogma, and the need for dietary nuances. We look at scale-related phobias and how many individuals have become disconnected from their bodies, and we discuss the use of tools and data for better health. We also share signs of blood sugar dysregulation, explain what blood sugar spikes mean for your health, explore how perimenopause and menopause affect insulin sensitivity, and touch on the benefits of postprandial excursions and training, stressors, macros, and more.
I know you will love today’s invaluable and insightful conversation with Kara Collier.
IN THIS EPISODE YOU WILL LEARN:
How dietary advice must fit individual nuances and needs
The dangers of rigid nutritional dogmatism
Why the scale is not a reliable tool for monitoring health
The benefits of continuous glucose monitors for analyzing metabolic health
How attuning to body signals allows people to make better health decisions
Common symptoms of blood sugar dysregulation
How the menstrual cycle affects insulin sensitivity and blood glucose levels
The impact of various types of exercise on blood glucose levels
Will hormetic stress lead to optimal health?
The benefits of making protein a dietary priority
“Many people just regurgitate the standard recommendations of big pharma or government without thinking for themselves or using their clinical experience.”
-Kara Collier
Connect with Cynthia Thurlow
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Submit your questions to support@cynthiathurlow.com
Connect with Kara Collier
On social media: karacollierrd or Nutrisenseio
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of reconnecting for the third time with Kara Collier. We were last connected on Episode 285. She's a registered dietitian and nutritionist, co-founder and vice president of Clinical Operations at NutriSense. Kara is the leading authority on the use of continuous glucose monitoring technology for health optimization, disease prevention and reversing metabolic dysfunction. Today, we spoke about the archaic history of dietitian recommendations, why rigid dogma and nuance are important phobias around the scale and why they can be problematic, how to use tools and data for health outcomes, why we are so disconnected from our bodies, signs of blood sugar dysregulation, the significance of blood sugar spikes, how our cycle and perimenopause and menopause impact insulin sensitivity, looking at postprandial excursions, the role of training, hormetic stressors, macros and more. I know you will find this to be an invaluable conversation.
[00:01:36] Welcome, Kara. I think this is our third podcast together. So good to have you back.
Kara Collier: [00:01:40] Yeah, I think so. Excited to be here.
Cynthia Thurlow: [00:01:42] Yeah, it's interesting. Ironically, today I have not one, but two registered dietitians’ back-to-back with podcasts, and I thought it might be fun to start the conversation around archaic dietary advice or the things that maybe drive you the craziest. Now, both of us are trained in traditional allopathic medicine for full disclosure, but I think we have kind of gone beyond our kind of conventional training to think a little bit differently. And sometimes we take some heat for that, but more often than not, it forces people to think a little bit differently than how they originally trained. But are there particular topics or opinions that, as a registered dietitian, really drive you crazy?
Kara Collier: [00:02:23] Yes, there are a lot. [chuckles] Well, we'll try to narrow it to the top most frustrating. And as we were mentioning this is true for any field in healthcare, unfortunately. There are a lot of people who are maybe just regurgitating what are the standard recommendations that Big Pharma or government or whoever puts out there and not really thinking for themselves or using their clinical experience in front of them. When you work with real patients and if you're really using critical judgment, you start to see that some things don't work even if it is traditional recommendation.
[00:02:56] So I think a lot of it is just regurgitating like the classic, like my plate for everyone, where it's like a fourth of your plate should be whole grain carbs and a fourth of your plate should be lean proteins and another fourth should be fruit. And assuming that that works for everybody and the standard recommendation that 40% to 65% or whatever, the crazy percentages of our calories should come from carbohydrates for the average American, assuming that works well for most people is something that I've just seen over and over, is not true. Like when you're actually working with people and looking at the data and being open minded and curious and really critically thinking, you see quickly that that doesn't work. So I think that one frustrates me.
[00:03:41] I also get frustrated specifically in the metabolic health space when we're working with those who have metabolic dysfunction. So pre-diabetes, diabetes, any form of insulin resistance, and we're following the traditional, like small frequent meals that always have consistent carbohydrates. With that one, we're just throwing gasoline on the fire and we're making the problem worse. There are a lot of things that don't work in practice. I could keep going, but curious to hear some of yours as well.
Cynthia Thurlow: [00:04:09] Yeah, no. What's ironic is years ago, when my kids were in elementary school, I was co-leader of something called Real Food for Kids. And so we were actively working to have farmers bring in like fresh fruits and vegetable and meat into the schools and educate the community. And I just recall one of the teachers that was actually the teacher of one of my children was like, “Could you come in and talk about macros?” And so I came in and he said, “We just learned about my plate.” And I looked at him and I said, “Unfortunately, I'm going to not agree with my plate.” And some of the kids were really cute. I mean, they were young, like maybe third, fourth grade. And they came up to me afterwards and they were like, “What should I tell my mom?”
Kara Collier: [00:04:49] Yeah.
Cynthia Thurlow: [00:04:49] And I said, “Okay, well protein is good, healthy fats are good, the right types of carbohydrates are good. But most people, like most adults, and frankly, kids should not be consuming-- 50% of their plate should not be crappy carbohydrates. I think in many ways that's a huge one for me. I think the meal frequency piece for me is huge. And I think that on so many levels, so much of the dogma that I was trained in in the 90s and early 2000s, like most, if not all of it, like even my cardiology patients, I used to make them fear fat. Like, I remember the handout, I came across it a few years ago and it made me shudder, but it was bastardizing fat. Eat these tasteless, nonfat, low-fat things, essentially eschewing any types of healthy-- like don't use butter, don't use ghee, but oh, yes, use Brummel & Brown and Smart Balance and all these seed oil spreads.
[00:05:49] Or I think the other thing that finds so frustrating is as an example, a lot of our diabetics and cardiology, I would refer them to the diabetes educator, who sometimes was a nurse, sometimes it was an RD, sometimes it was another licensed healthcare provider. And a patient came back to me and I said, “Oh, did you register with a diabetes educator?” He's like, “Yes, it was fantastic.” And generally, that's not their reaction. [Kara laughs] They meet the diabetes educator, because in many instances there's a lot of recommendations that come along with that. And he said, “I've been eating bananas.” And I said, “Okay, well, how often?” He said, “everyday.” I said, “how frequently?” He said, “Oh, I have three or four bananas everyday.” And I said, “You're diabetic, you have a sugar handling problem.” Banana is the last thing you should be eating with any frequency.
[00:06:35] And so it just reaffirmed for me that a lot of the information that well-meaning providers are sharing with patients is stuck in really antiquated dogma. And so it's not suggesting that a piece of fruit's going to get you into trouble, but if we know if you already have a blood sugar handling problem and you're not metabolically healthy, eating a lot of fruit is not a good idea. So those are probably some of the ones that I find the most bothersome.
Kara Collier: [00:07:01] Yeah.
Cynthia Thurlow: [00:07:02] Kind of siphoning off of that is thinking about like rigid dogmatism. There's many camps if you're on social media. And I have to believe that it's well-meaning when people say, well, carnivore worked for me, so that means it works for everyone, or veganism or keto diet. I think that the degree of bio-individuality is so important. And I always say if something works for you, that's great, but it may not work well for everyone else. And actually, the last conversation I had today, we were talking about how the research on ketogenic diets, if it doesn't work well for someone, it is likely a reflection of inflammation and the state of their gut microbiome. And so it goes back to that bio-individuality piece. I don't know if you feel similarly like you're like, obviously ultra-processed foods we want to eliminate, but being rigidly dogmatic about a particular nutritional paradigm I think can set us up for disaster
Kara Collier: [00:07:55] A 100%. Like you said, there are some guidelines, rules, so to speak, that apply to pretty much everybody that are good general advice that we can say as blanket statements. But in general, there's a lot of nuance and nuance isn't what gets very clickbait. We don't have a lot of attention driven to, well this works for some people and not in this situation with all these asterisks and nuance. But that's where health professionals really should be focusing is working with the individual in front of them and taking that nuance into account. Because the same thing is not going to work for everybody, as you mentioned, and it might work for one person and not the other, but for the person it works for, it also might not work for them forever or at different stages of their life.
[00:08:39] So you as an individual are also going to change. So removing that rigidity from the patient or client's end is also important for them to understand that they too can change. And with a diabetic, we might need to really drastically reduce carbohydrates to fix that metabolic dysfunction. And if we fix that and we've really improved a lot of things down the road, we might be able to be a little bit more flexible with those carbohydrates and kind of change some of the original things that helped fix that situation. So it does shift a lot within the person as well. I think that's something, it's easier for us to stick to one rule or black and white thinking because it's like, “Okay, this is good, this is bad.” But very seldom are things truly that black and white, which is part of the reason that we use data as part of, you know, our approach to helping people. Because you see very clearly when you're looking at a little bit more objective information that we're not all the same. People do vary quite a bit and we have to kind of adjust appropriately depending on what's happening with the person.
Cynthia Thurlow: [00:09:46] I think this is so important because as someone who has prescribing privileges I just remember, we would get asked all the time by newer practitioners, “What's your favorite anti-hypertensive or blood pressure medicine? What's your favorite medication to treat diabetes? What's your favorite medication to treat lipids?” And I always used to say if I had 10 patients, it might be something different for every single patient. Because I've come to find that teeny, tiny, little old ladies need a lot less medication even if their blood pressure is insanely high. And sometimes you don't take into account that when a patient goes into an office, that might be the worst you'll see their blood pressure and then at home it's not nearly as bad.
[00:10:26] So if you hit them hard with medicines, not only are they going to struggle with compliance, but then they're not going to be happy with you and they may not come back to you and you don't want to devolve that. Now you're alluding to tools and data, which I'm a huge proponent of. And so I think it goes without saying, I think one of the most simple tools that we have at our disposal/problems in our society is the scale. What are your thoughts around overuse of scales, letting the scales, you know, govern your perspective for the entire day and the poor understanding of what the scale actually represents?
Kara Collier: [00:11:04] Yeah, it's a great question. It is very affordable, accessible, and everybody understands what that number means, which is why it's so widely used. And so that is valid. And like all things we mentioned, there's nuance to the scale in my opinion, some people should be weighing themselves more frequently and are just avoiding it. So with some clients, I might recommend weigh yourself weekly at the same exact time. We'll use that as a data endpoint so that we can monitor trends. But it's just one piece of the puzzle that we want to help guide us in our decision making and making adjustments. Because if we aren't measuring at all, it becomes that thing where slowly you add a pound here and there and it's really hard to notice it in the day to day, but by the end of the year you're 15 pounds heavier and you don't know what happened.
[00:11:49] So when we completely don't track anything, I think that we lose accountability to some of those things that matter. But then on the flipside, there's the person that's weighing themselves three times a day and is doing anything at all costs in order to see that number go down without regard for the other data endpoints that are appropriate and important to consider. So for that person, I might be like, let's take a month off with no scale where we focus on a different metric that I know if they improve that metric, their weight's probably going to go down. But we're taking a break from the hyper focus and obsession with the weight because weight does fluctuate. It doesn't tell us the whole story. It doesn't necessarily tell us how healthy you are on the inside. Even though it's a correlation to that of overall health, it doesn't tell us your body composition, muscle mass versus fat mass. So it doesn't say everything, but it is important to keep track of it, I think overall for most people. Because there's the other camp that's like we should never use a scale, we should never weigh ourselves. And I think that can get us into dangerous territory as well.
Cynthia Thurlow: [00:12:57] Yeah, that's such a good point. To your point about looking at fat free mass versus muscle mass, this is when it is blaringly apparent what you're looking at. And I would highly encourage anyone that's listening, a lot of doctors’ offices, healthcare providers offices now have bioimpedance scales, get one of those or get a Bod Pod. You can't hide the data. It is blaringly apparent. I have very transparently shared with my community that I just did a bioimpedance reading about a month ago and I've lost some muscle mass. Not surprising given the stage of life I'm at, even though I do all the right things. And so my functional medicine doc looked at me and said, “This is what I would like. I'd like you to gain 5 pounds of muscle.” And he said in doing so you will probably lose 7 pounds of body fat. But I don't want you focused on the body fat because that will naturally happen as you're building muscle. And it was just very objective.
[00:13:54] There was no judging, it was just this is what it is and you can look at those numbers and you can impact those numbers. And so I think that is valuable. But I think I have plenty of friends that have spent their entire life being obsessive about what their weight is in the morning. And I go by how my clothing fits. That's usually my objective, like do my clothes feel tight or do my clothes feel comfortable? And that's kind of where I exist. But I think some degree of checking in with yourself, whether that's once a week, once a month, using a tape measure, measuring your waist and your hips. I mean, whatever works for you, I think is certainly reasonable. But we definitely are a society that is fixated on numbers.
[00:14:37] It's interesting, I interviewed a personal trainer a few weeks ago and she said for some reason, the number 120 is what every woman tells me she wants to weigh, even if it's not wildly unrealistic 120 pounds appears to be the number that makes everyone happy. And I said, “Isn't that funny.” That it could have been the weight you weighed when you were 15 years old. But I think when we're talking about weight and numbers, so much of it is not even particularly realistic. I don't want to weigh what I weighed when I went off to college because I was just skinny. And so I think these bioimpedance scales and being thoughtful and meticulous about how you use these tools, I think is really important.
[00:15:18] Now, obviously, you and I are both fans of tracking glucose, continuous glucose monitors. When you're working with your patients and clients, when do you introduce this tool? Do you do it upfront or do you wait until they've done some foundational work to be able to be motivated to utilize the tool effectively?
Kara Collier: [00:15:37] Yeah, great question. So a lot of our customers that are working with us and coming to us are already at the stage where they're eagerly seeking out the continuous glucose monitor. So usually, the reason they've come there is because they've already done some basic learning and education on nutrition fundamentals, like they know what macros are for the most part. They've maybe checked their finger glucose every once in a while. They might be getting labs annually and there's some sort of trigger that's making them want to take that next level to get a deeper analysis into their metabolic health and glucose levels.
[00:16:11] So maybe a common story is they're just on the prediabetes threshold or they just entered into that diabetes threshold, or their parents died from diabetes at the same age that they're now hitting, or they're going through menopause or they're entering retirement, some sort of life shift that's causing them to really double down and want to make sure that they're in the best health they can be. So we also have clients that are coming to us just to start with our dietitians. And so for them, when we think they might be ready for that continuous glucose monitor is something similar. So we have a good understanding of some basics, maybe we've started to track and then there's a good reason for us to dive deeper. Although with that being said, I do recommend that everybody wears at least one. I do not think that everybody needs to wear them for three months, six months.
[00:17:00] Most people, if they are in some sort of pre-contemplation stage of change, are very applicable and will learn a lot from wearing one for the 14-day period and learning a little bit more about their health. For those individuals it's about that awareness step. Kind of like you mentioned with you and your weight, you go off of how you feel, how your clothes are fitting, how you're looking. But a lot of people are missing that basic kind of self-awareness and tuning into like really how they feel and how they look and how they're performing. A lot of people aren't that into their body signals and how they feel. So sometimes we find that data can really reinforce that and bring that connection to how they're feeling and how different things are changing a little bit stronger which can enhance them their ability to go on without the data but in a better, more self-aware process.
Cynthia Thurlow: [00:17:55] What do you think contributes to the lack of self-awareness like when people don't feel themselves in their bodies? Because I've started noticing that when I talk to friends or even clients or patients and I'll ask them about bodily awareness, I would say it's easily 60:40, 60% of people are like, “I have no idea, I eat whatever, I'm not attuned to my body.” It's not that I don't choose to be, I just don't, I don't notice those little, you know how I feel on a discretionary level versus when I do different things. So I'm just curious what your opinion is. I have some ideas but when you brought it up I was like, “I just find that a lot of people are very disconnected from their bodies.”
Kara Collier: [00:18:35] Yeah, I see a similar thing that disconnection is the norm. Maybe not the majority, but certainly a high percentage minority of people are completely disconnected to how they feel. Theories on why this might be, I think A, is that it's never been prioritized as important within traditional society or even in healthcare. Most physicians, practitioners are not asking like how do you feel though? How do you feel after you eat? It's more like here's your number, here's your medication, here's your thing very transactional. So we haven't had that ability to think about it. Sometimes when we're asking people, “How do you feel when your glucose rises? Or how do you feel when you've gone this long without eating?” They really have to sit and think and then they can answer it. But they've never done that reflection. They've never even thought about thinking about it.
[00:19:29] So I think that there's just a lack of importance in our society and it's not a norm to have that reflection. And I also think when you feel a certain way for so long, it's not noticeable. Like if you have a killer migraine for the first time ever, you're going to notice it. But if you kind of have a dull, aching headache every day and sort of feel low energy levels every day, you don't notice it as much because it's almost the norm. So I don't think people reflect on those things that are more habitual in nature.
Cynthia Thurlow: [00:20:00] I think that's such a good point. And I think for a lot of people, they make assumptions just based on what life stage they're in. People who have young kids, they assume they're tired because they maybe don't have as much ability to have flexibility in their schedule. Maybe they're not getting the same quality of sleep they used to get. And the flipside, I think about people that are at my stage of life who just make assumptions that aches and pains and brain fog should be the norm. And that's just a normal experience, therefore, shared by everyone therefore not normal or therefore it is considered to be normal. And yet I would argue that if you are aware of how your body feels, day to day, week to week, it can allow you to notice those subtle shifts.
[00:20:41] And it's not being self-absorbed. It is just again that self-observation, that checking in with yourself. I think for so many people, I'm an introvert, so I'm always kind of taking information and processing it. And I think because of that, for me personally, I'm just very self-aware. How do I feel in time and space? What feels right, what does not feel right? And I acknowledge maybe not everyone has given themselves the permission to be able to feel all of that.
Kara Collier: [00:21:07] 100% agree. Yeah, even outside of health and wellness and your physical body, I don't think being self-aware and reflective is the norm in general about all things. Yeah, so there's a lot of factors going on there, but it's certainly very common. I also think that we haven't historically weighted somebody's subjective experience about anything as important. So our feelings have been downplayed, where it's an important metric to take into consideration from a health perspective, like how you feel after a meal. And those subjective experiences are equally important, in my opinion, as the objective experiences.
Cynthia Thurlow: [00:21:47] What are some of the common symptoms your patients and clients will report? And we'll use the example postprandially. So after a meal, that clue you in that they may have some degree of blood sugar regulation issues?
Kara Collier: [00:22:02] Yeah. So after a meal, some of the common subjective symptoms might be kind of that jitteriness, think of it as like a sugar high after you're eating followed by a crash. So that need, that overwhelming urge to take a nap after you've eaten is a very big warning sign that something's going on with your glucose. We probably have a little bit of a roller coaster happening after you're eating. So if you feel like you truly can't focus, like you get back to your desk after lunch and it's like brain fog, like lack of concentration, like irritable, all of those are very clear symptoms that there's probably something going on. You should feel like your energy levels are relatively stable throughout the day whether you're eating or not eating.
[00:22:48] Then for some people, if we have that crash after they eat, they can get those hypoglycemic symptoms as well. So they might feel anxiety. So a lot of people will have true feelings of anxiety after they eat. And little did they know it was because they were triggering these low glucose values after meals. It might be like shakiness, kind of jittery, and you might even be sweating. Those are a little bit more extreme. But we see those even in non-diabetics, very common symptoms that your glucose is kind of plummeting after you eat.
Cynthia Thurlow: [00:23:19] Well, and it's interesting because one of the things that I've noticed is that when you see that hypoglycemic curve, sometimes people will then say, I know I just ate a meal, but now I'm hungry again. It's their body's way of intrinsically trying to get some food in to raise their blood sugar. And generally, they're not craving the healthy things. They're not going for like, a piece of steak and broccoli. They're very likely craving cookies, ice cream, something like a processed carbohydrate that's going to raise their blood sugar quickly so that they kind of move away from the symptoms that they're experiencing.
Kara Collier: [00:23:50] Absolutely, yeah. That's a great point. It's very common if maybe an hour after eating a real meal, if you feel hungry, then we're most likely having that roller coaster effect because it's triggering in your brain a survival response. Your brain is thinking, I don't have enough energy. You need to eat something sugary really quickly to regain normal energy levels, when really you have plenty of fuel. You're just kind of having a difficult time processing it. And back to your first question about pet peeves and the common dietetics industry. [Cynthia laughs] That's another one of like small frequent meals where we're doing like the hundred calorie packs of like, I don't know if you remember all the hundred calorie packs of like mini-Oreos or mini pretzels or whatever it was, where we're trying to control our calorie intake by eating these hundred calories every hour or two. But what's really happening with those is your glucose is going up and down all day and you're probably eating more, which is actually going to lead to weight gain because you're not ever feeling satiated or really giving your body the fuel that it needs.
Cynthia Thurlow: [00:24:51] Yeah. I think it's such a good point that just building awareness around, putting your macros together, what's going on with your blood sugar. Now, I know that blood sugar spikes are a hot topic because in some ways we want to avoid overt and prolonged blood glucose excursions. Having said that, I know that if you eat a meal, depending on what you've consumed, you're going to see changes in your blood glucose. Obviously, fat is going to have a more negligible impact than carbohydrates. But we do expect your blood glucose to go up in response to a meal. For you personally, what number do you like to see? Like, let's say you start at 90 mg/dL before you eat and then you go up to 150. That's a 60-point increase. I know that you probably like a tighter control, but what is your prevailing thought process around blood sugar spikes?
[00:25:47] Like when should patients be concerned? When do we need to not stress about it? Because the other thing that I've started seeing is people proudly showing online like their blood glucose has literally gone up by like 10 mg/dL all day long. I'm like, “Well, I don't think that's the intention.” That's not what we're advocating for because I think that's entirely unrealistic for most people. But where is your comfort level when you're working with clients talking about those glucose spikes in a way that this is pathologic and this is non-pathologic?
Kara Collier: [00:26:17] Yeah, great question. The number one glucose myth that I'm always trying to reiterate is that your glucose has to be a flat line as you mentioned. That is not the goal. And it doesn't mean if there's some variability or some increases and decreases that you're unhealthy or that something is wrong. And I think that sets people up for failure and it starts to then become an emotional number like the scale is. And that is not what we are trying to create. I have so many influencers or people I'm talking to that are like, “Well, my glucose rose 10 points, so I did something so it only rose 5 points.” And it's like, “That's actually not the goal.” And if we're trying to teach that to people, then they're going to get really upset if they have some metabolic dysfunction and their glucose rises 80 points and they're really, really far away from that.
[00:27:03] So with that aside, what I do look for is how high, like the absolute value, the max value, it went. And then what is that difference, like you said, that jump from baseline up, and then how quickly do we kind of return back to normal levels? So generally, for a nondiabetic, we are aiming for that max glucose value to be under 140. That's a good rule of thumb. However, if somebody hits 150, 160, I'm viewing that as an undesirable but likely metabolically normal response. If you first thing in the morning, chug some juice and your glucose goes to 155, I'm not going to be worried necessarily that you have severe insulin resistance. We're going to say that probably wasn't the best choice. That was a high glucose spike. You most likely didn't feel good. Let's think about how we can adjust that response and change what you're eating.
[00:27:55] However, if you have that juice in the morning, your glucose goes to 220, 230. Your body's likely having a really hard time processing that appropriately. And we probably have some insulin resistance, metabolic dysfunction that we need to heal in order to have better responses. So we want to aim for under 140 for the best optimal health outcomes. But 150,160 doesn't necessarily mean you have a problem. For the optimal health outcomes, we want to see kind of a jump less than 40 for that more stable glucose levels kind of 30 for some research articles are mentioning but again it's newer information, especially in the non-diabetic space. So I see a lot of people cherry pick where there was one research article that was maybe questionable methodology that said, “Oh, it was normal for people to have a 20 point increase. So then they're like nobody should ever jump more than 20 points. I think that's an unfair extrapolation of the data. So 30 to 40-point increase is probably normal, especially if you're not doing it every hour or two.
[00:28:55] If you're doing it two to three times a day when you're eating perfectly normal, if your glucose jumps 80 points but you stay at that 140 threshold, that's a pretty big increase and that means that you're jumping quite a bit that big area under the curve. And then lastly, we do want to see your glucose levels kind of return back to normal about two to three hours after eating. So for sometimes when we see early signs of metabolic dysfunction it might go to 140, but then it takes seven, eight hours to get back down to that normal range which is going to bring your average glucose levels up because you're never really kind of getting back down to those normal levels. So that would be another kind of clear indicator that maybe we have some healing work to do.
Cynthia Thurlow: [00:29:38] Yeah. So big takeaway for anyone who's listening. If it's a one-time event, do not stress about it. But if you're noticing you've got a prolonged period of time where your blood glucose remains elevated after a meal beyond that two-to-three-hour window, it might have been the meal you ate. But if it's happening with some frequency, it may be that you are heading in the wrong direction in terms of metabolic health. Now I'm sure you probably with all the data that NutriSense has, you probably see a lot of trends around women's menstrual cycles. Obviously, we know we're more insulin sensitive in the follicular phase, we're less insulin sensitive in the luteal phase when progesterone predominates. Do you find that to be the case with your clients when you're working with them as well?
Kara Collier: [00:30:20] Yeah, absolutely. We do see these differences during the menstrual cycle in some women it seems more pronounced than others which goes to show the bio-individuality. Some women, you really can't notice much of a difference and some it's pretty dramatic, pretty noticeable. I happen to be in the more dramatic group, so I can experience this firsthand where during that luteal phase when we kind of have lower estrogen levels, we tend to see those higher glucose values and you're in a more insulin resistant state. So during that time, you might just want to be more aware of your carbohydrate intake, especially kind of what you're eating, when you're eating. It also, unfortunately tends to be the time when we have more cravings for things like that. So I do find that awareness is that first step kind of helping women become aware that this could be a factor, actually really helps to reduce the cravings.
[00:31:12] Just the acknowledgement that, “Okay, this is a normal physiological change. This might be why I'm feeling this way.” It empowers you to make different decisions if you are aware of this rather than just being like I'm craving something, so I'm going to do whatever I want and not kind of understanding why it's happening or the implications of that. But yes, we do see a little bit of that shift in kind of insulin sensitivity at those different phases of the menstrual cycle.
Cynthia Thurlow: [00:31:38] Yeah. I would imagine that women in perimenopause and menopause, it's probably even more exaggerated, especially because what you get away with in your 20s and 30s, you can't per se, get away with in your 40s and 50s and beyond. And so one of the things that I see is as women are losing muscle, so this degree of sarcopenic obesity becomes an issue. As they're losing muscle mass, they're also further, losing insulin sensitivity. And this is why I love using CGM so much, because it will objectively give them information that allows them to make better decisions. Because that's ultimately why I think these tools are so valuable, is allowing people to objectively see the information, discuss it with their healthcare practitioner, and be able to say, “Okay, well, I actually can't eat plantains.” I think I talk very openly about this on the podcast. I can eat a lot of starchy carbs, but plantains, it doesn't matter how I eat them, what I eat them with, they spike my blood glucose so significantly that I'm like, “This is so sad. I love plantains, but they don't love me.”
Kara Collier: [00:32:40] Yeah, 100%. And this is an area where we see pretty consistently all women in perimenopause, menopause see that change in their glucose values, unfortunately. It's a true physiological change that is happening where it's kind of that more dramatic and prolonged effect that we see during the menstrual cycle. So of course, we're having real hormonal changes and this changes our physiology and the way that we're able to process some of these more carbohydrate foods and our ability to remove glucose from the bloodstream. So we do kind of see this across the board where women tend to be less insulin sensitive, so their total carbohydrate threshold or how much they can eat and still maintain good glucose values decreases.
[00:33:24] But as you mentioned, we see variability between women and the biggest factor that determines that variability is their level of muscle mass, which does, as you mentioned, decrease throughout this stage. But the women who are actively working on maintaining or adding muscle mass, they fare much better throughout this. Like, so that's the number one thing, and I know you feel similarly that we recommend over and over is to really prioritize strength training, building that lean body mass and prioritizing enough protein to fuel that muscle mass production. Because we also have increased turnover of our proteins during this time, which means we need even more protein than we might have needed at different stages of life.
[00:34:07] So it is a big change in our glucose levels. But there are things you can do to make it a lot better. As you mentioned, there's also the things that are going to be unique to you, like plantains you know somebody else might not have that response to plantains and it might be something else that they find is just the food thing that doesn't work for them. That's the food source that matter how they adjust it, how they kind of mitigate the response, they just always have big glucose responses to it. And so part of the data is empowering you to know what works best for you. And I also find that then it's a lot easier to stick to those recommendations or habits once you've seen it with your own eyes of kind of your data and your body's responses.
[00:34:51] Whereas if your healthcare professional tells you, you really need to exercise more and cut out all carbohydrates or reduce your carbohydrates by half. It's like, “Oh, I feel like I'm being forced to do something I don't want to do.” It's kind of like, “Meh, I don't know if I want to do that.” Which makes it hard to stick to. But when you see, “Okay, I can have this many carbohydrates under this circumstance, but not this one in particular.” But when I strength train, it's much better. When you find out those variables that really work for your body, then I see that women particularly are much more empowered to stick to that. And then that's what helps them get the long-term results that we really are looking for.
Cynthia Thurlow: [00:35:30] Yeah. It's so interesting because it's human nature. We oftentimes want to fight against what we perceive is not sustainable. And so that's why I think having devices allows us to kind of objectively look at the information. Like, yes, I love plantains, but I don't love them enough to watch my blood glucose spikes go. And it was substantial. It was like 60 points. I mean, not something that I ultimately want to recreate for myself over and over again. But there are plenty of other alternatives that are out there that don't impact my blood glucose quite so significantly. What are your thoughts around training?
[00:36:03] So especially things like really intense exercise like sprints or high-intensity interval training, or not so much endurance work, I guess, because so many people that listen to this podcast are largely women north of 35, so perimenopause and menopause, so there's a lot less long-term endurance work going on. But when women are seeing significant increases in blood glucose related to specific physical activities, even like hiking, I'm thinking about you being in a very warm desert like conditions, and I'm sure if you're doing a lot of hiking at an intense level, that could also free up some additional glucose.
Kara Collier: [00:36:41] Yeah. What's important to realize is that during exercise our glucose might have a specific response and that is different than the potential overall impact exercise is having on our glucose levels. So during exercise, depending on the intensity level, our glucose can be stable, it can decrease or it could actually increase. A lot of people get confused on this point, so I always like to emphasize it. If you're having intense exercise so like you said, kind of hiking, especially in hot weather, doing HIIT training, sprints, maybe heavy weight lifting, you might actually see your glucose levels spike during that exercise. But that's a supply and demand thing. So your body is saying, “I need a lot of energy, this is intense exercise.” And then your body is supplying it to fuel that exercise. So that's a lot different than if we're just sitting on the couch and we drink that juice and our glucose spikes and our body doesn't actually need that energy.
[00:37:37] So if you see a spike while you're exercising, don't worry about it, that's completely physiologically normal. But exercise is one of the most powerful tools we have in the long run to improve our metabolic health, improve our ability to decrease and dispose of those glucose responses and improve our insulin sensitivity overall. So the exercise I really recommend the most for that strength training again, the more we can build up our muscle mass, the more storage area we have for glucose to go, because it can go on our muscles and it can also go in our liver. And our liver only has so much space. So the more muscle we have, the more ability we have to dispose of that glucose. And then when we're using our muscles, when we're exercising, we're also freeing up some of that glucose. So we're using it to fuel our energy and we're making sure we're having good turnover of that storage space so they don't get too full and then there's nowhere for that glucose to go.
[00:38:31] So strength training is a big one. Then I think HIIT exercise or kind of some of that more intense exercise can be a really good helpful tool as well for utilizing some of that energy improving insulin sensitivity. And then walking, just kind of like steady state movement, lots of movement throughout the day, is a really, really powerful tool for glucose management. So that's often if exercising is intimidating or you're not used to working out and maybe you're working your way up to that, just making sure you're getting enough movement throughout the day is a really good place to start because it makes a really big difference in our metabolic health and glucose levels.
Cynthia Thurlow: [00:39:08] Yeah. It's so interesting because that need, that non-exercise induced thermogenesis. I'm like if you do nothing else, just keep track of like how many steps you're taking during the day. This past week we were with my son at his parents’ weekend at college and he was telling me that he did a lot of walking on campus. And I was like, of course, you're a college student. Well, by the end of the day we had walked seven miles kind of traversing back and forth across the campus. And I looked at my husband, I said, “He's walking quite a bit.” [Kara chuckles] He was actually completely correct. But by the end of the day, we were like, “Wow, that was a lot of walking.” But not in a bad way. It was more of just like that bodily awareness.
[00:39:45] But on days when I'm not walking around a college campus, I try between dog walking and just running errands and doing things like trying to make sure every hour I'm getting up, it really does, as you said, make a huge difference and walking after meals in particular. I used to make fun of the families that did that and now I've become one of those people that would walk. Oftentimes the adults would walk in the evening. I'm like it's a great way to dispose of glucose for sure. What are your thoughts surrounding things like hormetic stressors like cryotherapy, cold plunges, infrared sauna, etc., in terms of impact on blood glucose excursion?
Kara Collier: [00:40:24] Yeah. Again, with these nuance is also important and kind of looking at each person individually, especially when we're talking to a health conscious female crowd, sometimes we can do too many things. That is a very real thing. So each thing individually in isolation are usually helpful tools. So cold therapy and heat therapy are both proven to improve glucose levels and insulin sensitivity overall. So they can be really good tools for multiple different health benefits. Similarly, kind of some of the other hormetic stressors, like maybe extended fasting or kind of some other things that put your body in that stress state, they can be really good things in isolation where we start to sometimes see issues. I rarely if ever see this issue in men, so I'm really talking to females primarily here is when we have stacked too many things and our cup is overflowing essentially.
[00:41:20] So if you think about your ability tolerate these stressors as a cup that has a limit, we can overflow it. And when that happens, you're actually adding true physiological chronic stress on your body, which then we actually see your glucose levels increase over time. So especially if you're already kind of lean, if you're already a normal weight, relatively low body fat, the more we add these on top of each other, the more we might see it become too much. So a very classic example I see are the very well-intended, health conscious women who are a normal body fat percentage. They're doing a HIIT workout class every single day and then they're doing the cold plunge and sauna and then they're only eating one meal a day, maybe two, and their glucose levels are kind of all over the place. They're in a very stressed state.
[00:42:10] They also tend to be women who have more just kind of like stress levels in general. They tend to kind of be type A, hyperfixate, perfectionist. That may be just kind of have a little bit of chronic stress as a baseline. So when they eat their one meal a day, we see their glucose levels stay elevated for 12 hours sometimes, we can see their glucose levels spike from just kind of daily stressors eating when they're fasting. So again, there is a little bit of nuance here where too much of a good thing can be a bad thing, but overall, each thing individually can be helpful.
Cynthia Thurlow: [00:42:44] Well, and it's so interesting to me. I was interviewed on another podcast a few months ago and the first question that was asked was, “What are your thoughts on hormetic stressors?” And I said, “It's like many things.” Before you start adding additional hormetic stressors, like, what are your macros like? Are you sleeping through the night? Are you physically active every day? Like thinking about the micros instead of thinking about the macros, the ones that have the largest net impact on our health and wellness outcomes. And so when I was asked this question ahead of us talking, I thought to myself, this is in many ways what-- it's like the big squeaky wheel. It's the thing that gets attention because we see all these influencers getting in cold plunges. And by no means am I being critical. I'm just saying sometimes people decide they want to do that instead of cleaning up their nutrition and focusing on sleep.
[00:43:34] And so you're right that hormesis is so much about the right amount at the right time, whether it's time in your cycle, time in your life. I get plenty of hormetic stress from a cold shower. I don't even need to do a cold plunge. And I think there's even genetic susceptibility to this. I always prefer being warm over being cold. Do I do the cold therapy? Of course, but I would never get in a cold plunge because I think I'd probably have a small heart attack. Not literally, but it would be way more stress than what my body needed. But I think for people that are listening, I feel like well-meaning, well-intentioned influencers, wellness professionals talk about these extremes that they do. And really that's like the icing on the cake. Meaning if you're already doing all the other things, then add one of those in. But don't feel like at the expense of eating a more nutrient dense whole foods diet and moving your body and sleeping it, what the message is we want you doing infrared sauna and cryotherapy over the macros, which are the most important.
Kara Collier: [00:44:34] 100%. It's a really good point where we can't skip over the basics and do the supplemental items. Similarly with supplements, they're called supplements because they're supposed to be supplemental. I'm sure it's a question you get a lot of, “What is your favorite supplement? Or what do you recommend? Or what supplement can I take to improve my health?” And while I do think they have a time and a place, they are supplemental to doing the basics first. You can't replace a bad diet with any sort of supplement or cold plunge or sauna therapy or whatever it is. Those basics, like you can't skip exercise and just do a cold plunge instead. And I understand why people want to gravitate towards it because they're easier things, right? It's five minutes of this or it's one pill to take. It's less overwhelming than thinking about fixing your sleep or fixing your stress levels. But we will get it much further by focusing on those basics first kind of that 80:20 rule. Our exercise, our diets, our sleep and our stress are going to be the things that we have to focus on first before we start kind of fine tuning and optimizing all the other little levers.
Cynthia Thurlow: [00:45:42] No, such a good point. I think for people that are listening, really understanding that we want to focus on the big things first before we worry about the minutia. Last in terms of topics that I think is really important. When we're looking at macros, so obviously we're both proponents of protein. I know a lot of women are confused about whether or not they should eat more carbohydrate or they should eat more fat. Many women are told, don't eat fat and carbs together because it'll make you gain fat. What are your prevailing thoughts and how do you help women navigate these choices?
Kara Collier: [00:46:17] Yeah, great question. As you mentioned, first, I want to focus on protein. So instead of what do we limit, what do we remove, what do we not do? We want to focus on the things that we do want to do and get there. And I naturally see, usually if we focus on protein and we're super prioritizing that, we're tracking our protein, we're making sure we're getting enough, we naturally tend to fix the other areas a little bit better because there's not as much room for other things if you're actually getting your protein needs and you're making your meals big enough so you feel satiated, you're tuning into how you feel, you're kind of stopping when you're comfortably full, not stuffed.
[00:46:53] So if we're paying attention to some of those body signals like we mentioned, and really focusing on protein, the other stuff tends to improve a little bit naturally. So we'll start there and then if we've got protein down, we're doing a really good job. We'll decide on carbohydrates based on your glucose levels. So we really kind of want to adjust that carbohydrate threshold based off of what the numbers are telling us. And that's usually, we can start at a different starting place depending on where you're kind of at in life. If you are an overweight female going through menopause, I'm going to probably start your carbohydrates on the lower end and we'll adjust. Maybe we actually can add a little bit more and maybe it's just a different balance of different types at different times a day.
[00:47:36] Whereas if you're my 25-year-old bodybuilder male, you probably can consume a decent amount of carbohydrates and you might actually need those if you're working out multiple times a day. So you're going to have a much higher threshold. So that threshold does kind of depend. And then we fill in fat with the rest and really prioritize from a baseline whole foods. So even if you're not sure how much fat to have or how much carbohydrates to have, we want to focus on food that's in the most original state as possible. So usually that means that there is going to be some natural fat present and that's not something that we need to be scared of or that we need to excessively limit. And we definitely don't need to avoid carbohydrates and fat together.
[00:48:18] These three macronutrients exist in nature. It's okay to eat all three of them at a meal time. Nothing's going to happen. What tends to be a problem is with the hyper processed, hyper palatable foods tend to be a combination of very refined carbohydrates and very refined fat, which make it delicious and addictive and very caloric and very easy to overeat and wreak kind of havoc in our bodies from a cellular level and just from an overall ability to maintain our cravings and our satiety. So if we're focusing on whole foods that are in the most, whole unprocessed state as possible, then we don't need to worry about fat and carbohydrates together. Just really thinking about satiety and prioritizing that protein as the first two rules to think about.
Cynthia Thurlow: [00:49:05] Thank you for that because I feel like I field that question almost daily. And I think it really comes from well-meaning people. You'll hear this prevailing theme. I know these people are well intentioned, well meaning. But then it makes nutrition even more complicated. And to your point about the athletic teenagers, I have a very, very-- well, both my boys are very athletic, but one in particular is very interested in like building muscle. And so he tracks his protein and carbohydrates, that's all he worries about. And the amount of carbohydrates this kid eats is unbelievable. And he's super lean and he's very healthy. But it cracks me up it's like two cups of rice with a big load of protein.
[00:49:48] My kids make these rice bowls and I'm like if I ate that, I would feel entirely differently than you did. But you go and you enjoy that because you have so much more muscle mass on your body to distribute all of that glucose disposal. Please let listeners know how to connect with you on social media. How to learn more about NutriSense and your continuous glucose monitors.
Kara Collier: [00:50:08] Yeah. So to find NutriSense you can just go to our website, nutrisense.io. So we offer the continuous glucose monitor programs as you mentioned, but we also offer the ability to talk to dietitians that have been trained by me and are kind of that 10% or 5% or whatever percents they are that are really going to look at the person and take a more functional approach. So we offer free consults if you just kind of want to start there. We also have a blog and a newsletter if you want to learn and kind of see what we're thinking about in the metabolic health space. On social media you can follow me, @karacollierrd and then NutriSense account is @nutrisense.io, both of which we're putting out tons of information, on glucose, metabolic health, nutrition, all of the things.
Cynthia Thurlow: [00:50:52] Well, thank you so much for all you do. It's always a pleasure connecting.
Kara Collier: [00:50:55] Yeah, always fun to chat.
Cynthia Thurlow: [00:50:58] If you love this podcast episode, please leave a rating in review, subscribe and tell a friend.
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