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Treatment Options for Insulin Resistance with Dr Michael Jurgelewicz · Wellness by Designs - Practitioner Podcast

• 0:21
  Speaker 1: Welcome to Wellness by Designs.
• 0:22
  Speaker 1: I'm your host, andrew Whitfield Cook.
• 0:24
  Speaker 1: Joining us today is Dr Michael Jurgavich, who's a doctor of chiropractic and deeply involved in his clinical practice, but also head of research and design with Designs for Health USA.
• 0:37
  Speaker 1: Dr Mike, welcome to Wellness by Designs.
• 0:40
  Speaker 1: How are you Good?
• 0:42
  Speaker 1: Thank you for having me.
• 0:43
  Speaker 1: My pleasure, our pleasure.
• 0:46
  Speaker 1: Now can we start off?
• 0:49
  Speaker 1: Firstly, we're going to be discussing treatment options for insulin resistance today, both in men and women, may be favouring women a little bit because of certain fertility issues.
• 0:58
  Speaker 1: But can you speak firstly to some of the statistics, some of the significance of prediabetes and why these individuals should be seeking out nutritionists and naturopaths for treatment?
• 1:15
  Speaker 2: Sure, I mean specifically, if we're looking at the statistics in Australia, when you're looking at the self-reported diabetes, this has increased from around 3.3% up to 4.4% from 2001 to 2017 or 18.
• 1:32
  Speaker 2: And when we think about this more globally, it's estimated that one in two people living with diabetes are unaware of their condition, so there can be lots of complications associated with that.
• 1:48
  Speaker 2: And then also, just over 1.3 million people were newly diagnosed with type 2 diabetes between 2000 and 2021 in Australia, and this is an average when you're really looking at from a number perspective around 60,000 people each year.
• 2:06
  Speaker 2: And as one of the things you initially alluded to, when we're thinking about women, you have a subgroup of those within cylinder resistance with PCOS or polycystic ovarian syndrome, and that represents in Australia about 8% to 13% of women, which is about one in 10 women.
• 2:26
  Speaker 2: And when we think about some of these statistics, we have to think about, like, the expenditure.
• 2:35
  Speaker 2: So when you look at from 2019 to 2020, there was an estimated 3.1 billion of expenditure on the Australian health care system that attributed to diabetes, representing 2.2% of the whole disease expenditure.
• 2:54
  Speaker 2: And this can represent those with type 2 diabetes, gestational diabetes that's, during pregnancy and then other causes of insulin resistance, such as the polycystic ovarian syndrome, and, as you mentioned, with the significance of pre diabetes.
• 3:09
  Speaker 2: This affects about 3.1% of those in Australia, and why this is important is those that have pre diabetes have 10 to 20 times greater risk of developing type 2 diabetes.
• 3:22
  Speaker 2: And if you've been told you have type 2 diabetes, it's important to make those lifestyle and dietary changes, such as exercise, because one in three people will that have pre diabetes will end up developing diabetes, so that's about 30%.
• 3:38
  Speaker 2: And what's even more significant with that is there's an increase with with this opidemia.
• 3:45
  Speaker 2: So those with hyper high cholesterol levels or high blood pressure levels is significantly greater in those with pre diabetes than diabetes, because these are the people that are typically not getting managed with anything, and the problem is these people that are, you know, on diagnosed with it have that additional concern of developing, you know, other sort of complications, such as, you know, chronic kidney disease, issues with diabetic retinopathy and even suffer from a vascular perspective.
• 4:17
  Speaker 1: Yeah, I think one of the frustrating things, at least for me, is when you talk about pre diabetes.
• 4:23
  Speaker 1: It's not even acknowledged in Australia.
• 4:26
  Speaker 1: Try and get a fasting insulin done, or this is something that that concerns me.
• 4:33
  Speaker 1: If you asked a GP, an orthodox GP for a fasting insulin level, you would be knocked down and told that it's not approved.
• 4:42
  Speaker 1: Basically, if you, however, ask for a Homa IR, a Homa insulin resistance test that involves fasting insulin, but that's approved and it's kind of like this disconnective.
• 4:54
  Speaker 1: Do you know what involved is involved in that test?
• 4:57
  Speaker 1: So I'm I also wanted to catch myself out.
• 5:00
  Speaker 1: I just before, in the first question, said naturopaths and nutritionists and I should, of course, be including chiropractors and holistic doctors and all of those brethren of the, the complementary integrative medicine fields.
• 5:14
  Speaker 1: But yeah, what do you say?
• 5:17
  Speaker 1: What's the landscape in USA?
• 5:19
  Speaker 1: Because you're as opposed to Australia, because you've sort of dabbled in both.
• 5:26
  Speaker 2: Yeah, so I mean, obviously I wanted to provide everyone with some of the statistics in Australia, but in the US it's it's similar in the sense that individuals that have pre diabetes in that range are not really being told they have pre diabetes, because it's more of a dysfunction at that perspective and until they really hit that threshold from a fasting glucose or hemoglobin A1C, they're not going to really get managed with medication for their symptoms and disease management.
• 6:00
  Speaker 2: And why that frustration are challenging with that is when someone's in that pre diabetes range and they don't know it, that number one, that's probably one of the best opportunities to make the changes because they're in a more defunct dysfunctional state as opposed to that chronic disease state.
• 6:16
  Speaker 2: But in addition to the conversation about I think it's 10 to 12% of those with pre diabetes are actually told they have it, so the other 90% since they don't, that's, like I said, the perfect opportunity.
• 6:31
  Speaker 2: But in addition to, as a result, these individuals are not being told that they can change the trajectory of their dysfunction or disease state with dietary lifestyle changes or nutritional therapeutics, and it's really just we're going to keep an eye on things and not really any sort of game plan.
• 6:57
  Speaker 1: Yeah, it's almost like they've noted that women who have gestational diabetes have a higher risk of going on to develop diabetes themselves, same with their children.
• 7:08
  Speaker 1: But it doesn't seem like, as you say, to have a game plan to say we should be watching you, you should be under constant surveillance from there.
• 7:19
  Speaker 1: I'd also like to ask there, with these 90% of people that fall through the cracks, what should maybe they be looking for to alert themselves, to say maybe I should be seeking some help here?
• 7:34
  Speaker 1: Are we talking about the post-lunch crash, the post-prandial crash, or are there any other symptoms they should be looking for that might tweak their interest or their alert?
• 7:46
  Speaker 2: Yeah, I mean a lot of these individuals are going to possibly have some of the similar symptoms that someone that has on controlled diabetes.
• 7:56
  Speaker 2: They can start to notice they have frequent urination.
• 8:00
  Speaker 2: They may be waking up in the middle of the night going to the bathroom.
• 8:03
  Speaker 2: In addition, due to the dysglycemia or that imbalance in the blood sugar, you're right they could have different crashes throughout the day when they're eating food.
• 8:15
  Speaker 2: In addition to they may have some sleep disturbance because the whole regulation with blood sugar handling and glucose can impact those.
• 8:26
  Speaker 2: Things can crash and spike throughout the middle of the night and have some issues with that as well.
• 8:34
  Speaker 1: So do you advocate for these sort of people to maybe get one of these patches that can test your blood sugar on a continual level for two weeks or so?
• 8:46
  Speaker 1: Do you use these a lot to say, hey, listen, maybe we should be looking at this.
• 8:51
  Speaker 1: Or do you just go in with a fasting insulin or other tests?
• 8:56
  Speaker 2: Yeah.
• 8:56
  Speaker 2: So I mean that's a good point to mention with the insulin, because it's not just the fasting glucose, it's the fasting insulin many times that can increase first.
• 9:04
  Speaker 2: But to your point, at least here in the US, I mean we typically can have a fasting glucose easily tested with their metabolic panel as their annual check what they get with their primary often.
• 9:20
  Speaker 2: But the challenge is it's not really just looking at that blood sugar hint, that one-time snapshot in the morning where that can be normal, but to your point, they may have a high fasting insulin which is often not tested and they often do not get their hemoglobin A1c tested, so we don't really know what their average handling is.
• 9:40
  Speaker 2: So that's something that we can typically test relatively easily and even if it wasn't through insurance can do that pretty inexpensively here.
• 9:49
  Speaker 2: But so we can get some of that information.
• 9:53
  Speaker 2: I mean, I do think the continuous blood sugar man glucose monitors and things like that unfortunately are somewhat expensive, but there are ways to monitor stuff.
• 10:07
  Speaker 2: I think there are a lot more individuals in the last couple years that have become more interested in nutrition and I also think through some of the frustrations that they may have experienced in the traditional model with practitioners and maybe not really having people listen to them or spend time with them and really listen.
• 10:31
  Speaker 2: There's more people that are because because many times with the insulin resistance it's not just really looking at blood sugar and insulin.
• 10:38
  Speaker 2: A lot of them may have other metabolic dysfunction around dyslvidemia and other issues and they're often aware of that.
• 10:47
  Speaker 2: And I think more and more people just do the side effects with certain medications and things are seeking natural alternatives and they're coming to either integrated functional medicine practitioners or nutritionists.
• 10:58
  Speaker 1: And so, with regards to dietary factors, obviously this is a huge issue.
• 11:04
  Speaker 1: I've run across patients who at no stage in their whole diet ever do they eat fresh food.
• 11:11
  Speaker 1: Every 100% of their diet is processed fast foods, including drinks, by the way, you know, it's the sugary drinks.
• 11:21
  Speaker 1: There is nothing healthy about their diet.
• 11:23
  Speaker 1: It seems to be burgeoning.
• 11:25
  Speaker 1: I've seen so many.
• 11:27
  Speaker 1: I shouldn't say so many, but I've seen more and more.
• 11:31
  Speaker 1: Whereas this didn't exist when I was nursing, now I see it more and more, particularly in younger people.
• 11:36
  Speaker 1: Are you seeing this real shift?
• 11:37
  Speaker 1: I thought we'd move away from it.
• 11:39
  Speaker 1: I thought we'd realize the error of our ways.
• 11:43
  Speaker 2: Yeah, I think I mean for the most part you're right.
• 11:46
  Speaker 2: I mean when I, when I, obtain a seven day food diary because you can ask someone, you know what their diet's like, and if it's just something verbally, we may think it's better than it is, but when you really see them write it down, and it's not just the food itself, it's really like what's their activity level like throughout the day, what time are they going to bed and waking up, and so what's their water intake for the day.
• 12:11
  Speaker 2: But, to your point, many individuals are eating products and not not real food, and simply by making those changes alone and getting rid of beverages that count towards calories and replacing it with water, you know, we have to understand sometimes these people, they're not going to make this dramatic shift in 24 hours or in a week.
• 12:34
  Speaker 2: It's more about, you know, trying to move some of the things because eventually it's not going to be a diet, it's going to be more of a lifestyle and we have to kind of coach them and guide them.
• 12:45
  Speaker 2: But really a new way of eating and some people just don't really know how to, you know, prepare their food.
• 12:52
  Speaker 2: But to your point, I mean, it's really comes down to cutting down the processed foods, because they're the ones that are.
• 13:01
  Speaker 2: They're not nutrient dense, typically, they're high in calories and they have lots of sodium and things that are just going to work against them from a metabolic perspective and just contribute to further weight gain and metabolic dysregulation.
• 13:18
  Speaker 1: Let's talk further about what type of diet you recommend.
• 13:21
  Speaker 1: There's so many diets on the offer, on the platter, for us to offer.
• 13:26
  Speaker 1: Yeah.
• 13:27
  Speaker 2: Where do you start with?
• 13:28
  Speaker 1: change with these people.
• 13:30
  Speaker 2: Well, I would say, if we just think about some of just some of those dietary factors, sure, there's lots of different like food plans or diet type templates we could essentially recommend.
• 13:44
  Speaker 2: But I mean, I will say there is some pretty strong research, even though we see a lot of trends with intermittent fasting and everything and time restricted eating, typically eating breakfast or getting a good amount of protein with breakfast tends to improve the metabolic rate and it tends to, you know, you get this satiety from that added protein.
• 14:07
  Speaker 2: And well, and then when we think about some of the things that people are consuming from a beverage perspective, many times things that are promoted as being diet related or weight loss, have a lot of artificial sweeteners that can contribute to insulin resistance because, although they may be nonchaloric, they still have to pass through the gastrointestinal tract and exert that effect on the microbiome which can, you know, play a role with, with certain peptides and things, and negatively influence that.
• 14:42
  Speaker 2: And then we also have things such as like food sensitivities that people may have that contribute to inflammation.
• 14:48
  Speaker 2: So it's the dietary patterns, you know, and medication that they could be taking and their exercise habits that can contribute to that.
• 14:57
  Speaker 2: But then when you think about what, what really we would recommend from a dietary perspective, and it's there's not like a perfect diet that I found that is a one size fits all and it's more.
• 15:12
  Speaker 2: It really needs to be somewhat.
• 15:13
  Speaker 2: We can give a template.
• 15:14
  Speaker 2: It should be more personalized.
• 15:16
  Speaker 2: But essentially what we have to also look at is what types of foods do people enjoy eating that are healthy, and then tailor it that way a little bit, and some types of things may work better than others, and some examples of that could be when you really look at some of the interventions that have been shown to either prevent type two diabetes or have evidence for correcting that.
• 15:44
  Speaker 2: I mean, obviously, you see, like a Mediterranean diet, right, there's gonna be anti-inflammatory, rich and extra virgin olive oil, your essential fatty acids, et cetera.
• 15:53
  Speaker 2: But then there's also things around the intermittent fasting that I alluded to before, where there's that time restricted window where, simply, if people are only eating over an eight hour window, they're most likely in a lot of instances only gonna be able to consume a certain amount of calories, and then it also gives the body a break from putting out the insulin and the glucose throughout the day.
• 16:18
  Speaker 2: And then you have other things such as like a low fat diet that has some research, low carb diet, high protein diet, and then you have some of these really low total expenditure diets where they're really low calorie and so I think, and you have the ketogenic type diets.
• 16:35
  Speaker 2: So I think it's a matter of really trying to figure out like protein has always has to be a moderate macronutrient that is in there, because that's gonna be really essential for you need the proteins as essential amino acids just for practically everything that you do, from maintaining your muscle mass, lean tissue, et cetera.
• 16:57
  Speaker 2: But you can't eat a lot of all of the macronutrients, so you can't just stuff your face with all the protein, all the carbs and all the fats.
• 17:07
  Speaker 2: Where you're gonna have to get more manipulative is really looking at like the carbohydrates and fats and if you're gonna balance them, make sure there's portion control or manipulating one to either extreme to some sense, but essentially doing that around a whole food beast diet.
• 17:28
  Speaker 1: Portion control is obviously big one, particularly for those people, those more obese people who are.
• 17:34
  Speaker 1: Their stomach is distended, they can fit some of them, super obese, can fit a loaf of bread into that stomach.
• 17:40
  Speaker 1: It extends down to their left iliac crest.
• 17:43
  Speaker 1: So when you're talking up to patients with, let's say, weight issues that they'd like to control and then we'll move on to the thinner people later but with the larger people, what sort of strategies do you employ about to help them reach a state of satiety?
• 18:02
  Speaker 1: Is it fats, good fats like, for instance, shotting olive oil?
• 18:07
  Speaker 1: So you know, 60 mils of olive oil or something like that.
• 18:10
  Speaker 1: What other?
• 18:10
  Speaker 1: What strategies are available to you?
• 18:12
  Speaker 1: What work?
• 18:14
  Speaker 2: Well, I mean, I think, number, there are a couple of things that I think can be helpful.
• 18:19
  Speaker 2: Obviously, you wanna make sure that they're increasing their water intake enough, because most people just are not drinking enough water and, with that being said, sometimes they're confusing hunger with thirst and sometimes, if they really make sure they're getting like they're half their body weight announces they may drink a glass of water or so and then realize they're not hungry or they'll eat less.
• 18:44
  Speaker 2: I think also, what can really help from a huge perspective, you know, even after they eat, is going for like a 10 to 30 minute walk, because that can help with the insulin sensitivity and it will help with the weight loss and so, and that will help with, you know, kind of curbing that appetite a little bit later.
• 19:11
  Speaker 2: But I think what's?
• 19:13
  Speaker 2: I think we really have to make sure, you know, if we're not guiding them from an exercise standpoint, really trying to partner or work with someone that's either a personal trainer or find something they're compliant with, because ultimately, you know, I may like lifting weights, but that person may not, and we really have to find some sort of format exercise that they enjoy.
• 19:40
  Speaker 2: So they may like walking or they may have access to it, doesn't have to be going to a gym.
• 19:45
  Speaker 2: They can do simple bandit stuff at home.
• 19:47
  Speaker 2: But it's about really moving and I think there's been so much research lately with combining the two that it's all.
• 19:57
  Speaker 2: It just speeds up the process of everything.
• 20:00
  Speaker 2: And you know, we just know, that muscle is basically an organ and it has to be stimulated for our function, and so those are some of the things.
• 20:09
  Speaker 2: But as far as fat, I mean, for sure that's gonna help with satiety, but I think it's important from a fat perspective, you're probably gonna be safer eating, like you know, a half an avocado with a meal or a handful of nuts, or, you know, using a tablespoon of extra virgin olive oil with a salad, as opposed to sometimes where things get out of control a little bit is people are using a lot of vegetable oils that get marketed as being healthy on like their salad.
• 20:38
  Speaker 2: So they may have a salad with chicken and if they're having like several tablespoons of that, those calories can get away.
• 20:47
  Speaker 2: So when you think about, like you know, 15 or 16 grams of fat per tablespoon, it's gonna be much harder for them to kind of exercise that kind of caloric excess off.
• 20:59
  Speaker 2: So we definitely wanna make sure that they're getting those healthy fats.
• 21:04
  Speaker 2: But it's not too uncommon that sometimes people try to eat healthy and they may not preparing something and then they go have a salad out somewhere and they don't realize, like when they start adding to dressings and other stuff they're trying to do the good thing with having the salad and then just the calories from the other stuff just adds up too much.
• 21:26
  Speaker 1: When we're talking about walking after a meal, versus that concept of sympathetic versus parasympathetic, nervous simulation.
• 21:38
  Speaker 1: How brisk should that walk be?
• 21:40
  Speaker 1: Is it just a leisurely relaxing walk where you're just chilling, or is it like hey, let's go yeah absolutely.
• 21:47
  Speaker 2: Yeah, I don't think it's, and it's not like the second.
• 21:51
  Speaker 2: You're done eating, right, I mean, you're gonna you wanna have that mindfulness when you're having the meal and you wanna, you know, digest that meal, but I would say anywhere from.
• 22:02
  Speaker 2: Like you know, after that digestive process started, you completed your meal, maybe like 15 minutes later or so you can definitely, you know.
• 22:12
  Speaker 2: Just, I would be doing more casual work.
• 22:15
  Speaker 2: I mean, no one's gonna do some sort of like high intensity interval training or intense cardio session on a full stomach like that.
• 22:24
  Speaker 2: I'm talking about in that case, more of just like if someone's going to walk their dog, for example, and it's just to kind of move that way.
• 22:34
  Speaker 1: Yeah, and so to nutrients.
• 22:36
  Speaker 1: Favorite nutrients, can I ask you?
• 22:38
  Speaker 1: You know we've got, for instance, myoenosatol available to us now in Australia.
• 22:43
  Speaker 1: It's been available for a while now, but I see dosage issues with a lot of products.
• 22:49
  Speaker 1: Can we talk about a few of your favorite nutrients and perhaps look at the relevant dosage for people with, you know, insulin resistance, diabetes and especially polycystic ovarian syndrome?
• 23:00
  Speaker 1: I see myoenosatol employed quite frequently here.
• 23:06
  Speaker 2: Did you want to talk about myoenosatol first, or some of the other stuff?
• 23:11
  Speaker 1: No myoenosatol, please.
• 23:12
  Speaker 1: Yeah, and relevant dosages.
• 23:15
  Speaker 2: Yeah, so I mean you know what I would say in general about myoenosatol is inosatol in general is gonna occur in nine different isomers and you typically the most common in the supplement industry is the myoenosatol.
• 23:33
  Speaker 2: And when you think about what is the average food derived intake of myoenosatol, it's about 900 milligrams a day that we would get from the diet.
• 23:44
  Speaker 2: And what's, as you mentioned, you know what's exciting about it is that the myoenositol has been shown to mitigate some of the symptoms and some of the underlying dysregulations of people with insulin resistance, including those with PCOS, and it's believed to work by reducing insulin resistance as well as mitigating metabolic syndrome.
• 24:12
  Speaker 2: So when you think about, like whether you take a supplement form of it or you get it from the food that you're eating, it's going to compete with glucose for gut absorption and intercellular uptake, and so it's estimated that our endogenous synthesis of the myoenositol from the glucose is about 2 to 4 grams per day.
• 24:38
  Speaker 2: But the problem is it's impaired by high glucose levels and it's a component, it's a second messenger essentially to thyroid hormone insulin, so it's a component and precursor to intercellular signaling of insulin action, and so what happens is in these individuals that have metabolic issues or insulin resistance.
• 25:03
  Speaker 2: There's this increased nutritional demand for the anositol and this may be caused by having too much carbohydrate intake.
• 25:16
  Speaker 2: There could be excess urinary loss of anositol.
• 25:20
  Speaker 2: There can also be genetics and obviously that metabolic dysfunction they have that can exacerbate that issue.
• 25:28
  Speaker 2: But why?
• 25:30
  Speaker 2: I think anositol is good and we'll talk about some other therapeutics as well but it's naturally occurring in our physiology but it's often deficient in those with insulin resistance.
• 25:43
  Speaker 2: So if we supplement with myoenositol it can satisfy this metabolic demand to really address this critical metabolic dysregulation which is characteristic of insulin resistance as well as metabolic syndrome PCOS.
• 26:02
  Speaker 2: But it's also going to upregulate the production of these myoenositol mediators and address some of that impaired glucose transport.
• 26:16
  Speaker 2: And so when you're talking about what the dosing is, well, from what I've seen, most of the dosing is going to be between two to four grams per day, typically in a twice daily dose.
• 26:35
  Speaker 1: When we're talking about things like magnesium, for instance, we've got to also consider the ligand that it's joined to as pertaining to how it acts, how fast it acts, where it gets.
• 26:46
  Speaker 1: For instance, magnesium orate, much more useful for the heart.
• 26:52
  Speaker 1: Magnesium citrate the Germans love the citrate.
• 26:56
  Speaker 1: They say it's best, the better form of magnesium for everybody.
• 27:00
  Speaker 1: You've got the bisglycinates or the glycinates.
• 27:03
  Speaker 1: That I find very fast magnesiums.
• 27:06
  Speaker 1: How do you choose what sort, what type of magnesium to use in insulin resistant individuals?
• 27:13
  Speaker 1: Do you look at something like aspartate that might go on to the inner lining of the cell, or do you just look at a fast magnesium that's going to get in there and do the job?
• 27:26
  Speaker 2: Yeah, I mean I think you can definitely get into the nuances and bias things a little bit.
• 27:32
  Speaker 2: But to your point, when you're looking at like magnesium in general and you're trying to increase intercellular levels for that specific application and getting more in the red blood cell, I mean from my perspective I wouldn't see any issue doing like a mag bisglissinate or your magnesium glycerophosphate or even the magorotate, because they're all good biavailable forms of magnesium.
• 28:02
  Speaker 2: I mean, obviously in the natural nutrition space we tend to stay away from like the magnesium oxides, just because, although there's some research on them for certain things, they're not that well absorbed.
• 28:18
  Speaker 2: And the other forms.
• 28:20
  Speaker 2: I mean you mentioned that the orate with the cardiovascular health.
• 28:24
  Speaker 2: We have to also think that these individuals tend to have, you know, with metabolic syndrome and insulin resistance.
• 28:32
  Speaker 2: They don't just typically have the insulin resistance, a lot of times they have the dyslidemia as well.
• 28:37
  Speaker 2: So I think you know any of those three forms can be good together or even separate, and it's really just about getting that like around 300 to 300 to 500 milligrams a day and some individuals may satisfy, you know, really getting that level up for them.
• 28:58
  Speaker 1: Anything else that we should be considering.
• 28:59
  Speaker 1: For instance, just the other day, speaking with a patient and it seems like cortisol.
• 29:06
  Speaker 1: They had a high pressure job and cortisol was driving everything.
• 29:11
  Speaker 1: So I said, look, we can put you onto some things that might look at your blood sugars now, if you like, or your dyslidemia, your insulin resistance type symptoms now.
• 29:21
  Speaker 1: But unless we address the stress, we're never going to make any moves.
• 29:27
  Speaker 1: How do you unravel that web of where you should be attacking the cause?
• 29:36
  Speaker 2: Yeah, I mean in that case, if you can't, I mean you can try to have them do other things like yoga or meditation or exercise things that are going to help with that.
• 29:47
  Speaker 2: But if they have certain stressors that they can't really address that underlying cause of it, I mean they can obviously do certain adaptogens that may help at least manage things.
• 30:01
  Speaker 2: While they have that, in those cases I think it's more of them doing different lifestyle type things in conjunction with maybe some of the adaptogens.
• 30:13
  Speaker 2: The reason you know, lipolycacic can also be beneficial.
• 30:18
  Speaker 2: But I think what's good about like the amasthol and the magnesium and some of these micronutrients is because there are other botanicals out there like berberine and stuff that you see people use for helping with insulin resistance and blood sugar control.
• 30:35
  Speaker 2: But a lot of times when people are in that prediabetes range or dysfunction, we typically want to give them the cofactors that are going to help them metabolically first, before we kind of have some of those other botanicals.
• 30:53
  Speaker 2: And you know, even if someone has diabetes and when you think about like metformin that they often get put on.
• 31:00
  Speaker 2: It was interesting because they had a study showing metformin combined by itself at like three grams a day and then they combined it, they cut the dose in half of the metformin.
• 31:10
  Speaker 2: So now the person's able to reduce their metformin dose in half and what they added was two grams a mile anasatol to it with lipoic acid and the metformin group had a reduction in their body mass index by 15 percent, where the metformin with the myoanasatol in the ALA went down 28 percent and it also lowered their total testosterone.
• 31:35
  Speaker 2: So like the testosterone came down like 33 percent with the metformin, but it came down 75 percent when they added the metformin to the myoanasatol.
• 31:43
  Speaker 2: So it's not only great for those individuals that have the dysfunction, but it has a synergistic benefit with their medication and it's not going to interact with their medication and so especially for those people with PCOS.
• 31:58
  Speaker 2: So I really like that.
• 32:03
  Speaker 2: I mean.
• 32:05
  Speaker 2: But the thing is, when people have these metabolic issues, they have increased nutrient demands often and metabolic demands and inflammation that they typically require some nutritional therapeutics.
• 32:23
  Speaker 2: Now, obviously we can't just out supplement the poor diet, but they often have lower levels of, I would say, sulfur.
• 32:34
  Speaker 2: So things like glycine can be helpful, that you can get from collagen and vitamin C can be helpful, because they often have low plasma levels of C just because of those metabolic demands.
• 32:45
  Speaker 2: So, besides giving them like a broad spectrum multivitamin that's going to cover some of those cofactors, like their zinc and their maybe a little bit of the vitamin C, adding the things like the anasatol and the magnesium, and then if they're at a point where they're in that higher end of the pre diabetes range, then they at that point they could consider something on top of what we talked about, like a berberine, because interestingly enough there's been.
• 33:24
  Speaker 2: Berberine is almost like an analog to metformin when you think about its act, its benefits on blood glucose.
• 33:31
  Speaker 2: But what it has, that or what has been shown with berberine that you don't typically see with the medication, is you see a reduction in waste circumference as well as the benefits on on reducing the LDL cholesterol and the triglycerides that you don't typically see with metformin and there's also some research on it.
• 33:55
  Speaker 2: You know being safer for for the liver than than metformin and some of these individuals that may not tolerate it.
• 34:03
  Speaker 2: And it's interesting because there's all these mechanisms with berberine on, like the AMPK activity.
• 34:10
  Speaker 2: But we also have to think about how berberine can modulate the gut microbiota as an antimicrobial agent.
• 34:18
  Speaker 2: So some of these people typically may have dysbiosis in their gut from like the foods that they've been eating and because of that dysbiosis they can have some populations with like their fremicid reduced to bacterioreal ratios where they may have a higher caloric extraction from food the bacteria than the others, and they can.
• 34:38
  Speaker 2: So you take a lean person and an obese person who may be eating somewhat of a same diet but having a different result from a weight loss perspective.
• 34:47
  Speaker 2: So you can see a benefit with berberine.
• 34:50
  Speaker 2: So I do feel like when I have people that have the dyslidemia along with these high insulin, I should say the dysglycemia, it can really help jump start down from a weight loss perspective.
• 35:10
  Speaker 1: Awesome point that's so important.
• 35:13
  Speaker 1: There seems to be this.
• 35:14
  Speaker 1: It's almost like a backwards flip with Burberry and going oh, we shouldn't be using it too long.
• 35:19
  Speaker 1: Hang on in, these people who are dyslipidemic.
• 35:22
  Speaker 1: They've got an issue that you need to be addressing with the microbiota, so it's a really good point you make there, mike.
• 35:28
  Speaker 1: Mike, there are so many points I'd love to cover.
• 35:32
  Speaker 1: I wish this podcast could go on for three hours.
• 35:35
  Speaker 1: Can I ask you though, maybe as a last question and I'll try and stop myself but you mentioned something there about, you know, the metformin and the combination with myoenocetol and lipoic acid.
• 35:51
  Speaker 1: When you're talking about utilizing these therapies Burberry, for instance it could be an issue.
• 35:57
  Speaker 1: What nutritional therapies do we have to be cautious of during pregnancy?
• 36:02
  Speaker 1: Because you know some of these women, they're infertile, their fertility is addressed, but then they go on to become pregnant.
• 36:08
  Speaker 1: Then they've got the risk of gestational diabetes.
• 36:11
  Speaker 1: How can we help these ladies?
• 36:15
  Speaker 2: Yeah.
• 36:15
  Speaker 2: So when you look at a lot of the like natural medicines databases that have the uses and the dosing and the safety that the challenge is, when you look at pregnancy, when you're dealing with the micronutrients that are based upon the daily value or the recommended daily allowance, once you get outside of that range, there is basically insufficient research and we're supposed to avoid using at that time.
• 36:45
  Speaker 2: And then the same thing happens with like botanicals or your neurotransmitter precursors, et cetera.
• 36:51
  Speaker 2: So what's typically safe with pregnancy is like, obviously, like your multivitamin, your fish oil, your vitamin D, your amino acids, protein, some probiotics.
• 37:01
  Speaker 2: But where anacetol is great, you know specifically the myoanacetol is.
• 37:08
  Speaker 2: They studied this in pregnant women for gestational diabetes up to four grams per day.
• 37:14
  Speaker 2: So normally with other nutrients, if you said I'm gonna go above the daily value for that nutrient per day, there's gonna be typically an issue.
• 37:26
  Speaker 2: But because this is such a gestational diabetes is such an issue with pregnancy and obviously you don't wanna cause any harm with side effects of having non-serious adverse reactions with botanicals and things, there's been quite a bit of studies like back from starting from 2017 through now that have shown the safety with these doses so comfortably as like a manufacturer.
• 37:55
  Speaker 2: Well, you know, we could say, and even a clinician, that you know we will be comfortable with that because the studies are there and, knowing that this is an endogenous compound that's in our physiology, it's not like you're putting something into the body that's foreign, that we have to worry about, like, oh, what's that gonna do?
• 38:17
  Speaker 2: And there's the safety with it.
• 38:18
  Speaker 2: And the whole point is, if we, you know, I would even say you know, a lot of times in some of the research it shows that there's the benefit of supplementation in those that are at risk in their first trimester.
• 38:36
  Speaker 2: So I would almost be thinking about if someone is already a little bit overweight or they have some dyslipidemia, or they've had some dysclisemia issues but they don't really have, they're kind of trending upwards that they may have a risk or there may be a family history.
• 38:56
  Speaker 2: There's no harm in starting these individuals in their first trimester, along with their prenatal, with this, because, again, we don't wanna be reactive when they get to the third trimester and they have this issue.
• 39:08
  Speaker 2: Giving to this as a preventative standpoint can help, you know, reduce that which is definitely gonna reduce, you know, the risks of, you know, any sort of, you know, complications later in the pregnancy.
• 39:23
  Speaker 1: Absolutely, dr Mike Jojkiewicz, thank you so much for sharing your knowledge with us today.
• 39:29
  Speaker 1: I wish we could go longer.
• 39:31
  Speaker 1: There are so many issues that we can dive into here, so many things that you've got me thinking about, and thank you so much for taking us through the safety aspects as well.
• 39:41
  Speaker 1: I mean, it's obviously you're a dedicated clinician who knows their stuff from the patient's perspective, about trying to work with them to change their lifestyle there and eventually their outcome.
• 39:51
  Speaker 1: But I thank you also for your you know, really diligent research and developed us say, yes, this is safe.
• 39:57
  Speaker 1: No, we can't do that.
• 39:58
  Speaker 1: We should be looking at this.
• 39:59
  Speaker 1: Well done to you and thank you so much for joining us on Wellness by Designs.
• 40:03
  Speaker 1: No problem, thank you for having me and thank you everyone for joining us today.
• 40:08
  Speaker 1: Remember you can see all of the other podcasts and the show notes on the Designs for Health website.
• 40:14
  Speaker 1: I'm Andrew Whitfield Cook.
• 40:16
  Speaker 1: This is Wellness by Designs.