Continuous Glucose Monitor Use by Nondiabetics to Guide Diet and Improve Health

Real quick, before we dive into this episode, I have a little sleep secret I want to tell you about. Look, sleep is crucial for your fitness, but it's crucial for just plain old everyday life and function. And I find I sleep great unless I have a migraine. And I've had more than my fair share since perimenopause all the way through postmenopause. My secret weapon was Blue Sky CBD sleep gels. Each gel contains 25 milligrams of CBD and 25 milligrams CBN for deep restorative sleep. Something about it helps to reduce inflammation, which I believe for me was key in helping me get to sleep. But the biggest thing is so many of the over-the-counter solutions, whether for sleep or migraines, can ruin gut health, and liver health. Neither one of those did I want to be problematic for me. So this option is recommended by healthcare providers worldwide and backed by thousands of happy customers, many of whom come from our Flipping 50 community. There is zero THC, so it's non-habit-forming. It's made by a trusted family-owned company that we all can feel good about. Third-party tested for purity and potency. And if you're interested, you too can try a sample for just $6. But even better, you can get 30% off forever with discount code FLIPPING50. That's FLIPPING50. Just go to flipping50.com/blueskycbd. We'll put that link in the show notes and you'll find it everywhere on Flipping 50 at My Favorites. What are you waiting for? Good night. Got questions about CGM use? We've got answers to your continuous glucose monitor questions in this episode. My guest wrote the book, and we have a tip-rich discussion about how you can benefit from CGMs and potentially change your life. If not you, potentially this will be of value for someone you influence. I'm Debra Atkinson. You're listening to Flipping 50, where I address your top struggles and concerns. I share what to how to move and how to change your mindset so you can have the energy and the vitality that you want, need, and deserve in this second and better half. My guest today is Dr. Paul Kalodzik. He's a board-certified by both American Board of Preventative Medicine and the American Board of Emergency Physicians. In a 30-year emergency room career, he has cared for many patients in crisis, has witnessed firsthand the failures of mainstream diets and the medical system overall. Which prioritizes medications and surgery over diet and lifestyle changes to prevent and reverse disease. In his metabolic health practice, Dr. Kalodnyk uses technology of continuous glucose monitoring, or CGM, previously once used only by diabetics, to help his patients achieve weight loss and improved health. In his recently published book, The Continuous Glucose Monitoring Revolution, Dr. Kalodnyk shares how he has helped thousands of people, patients, lose weight, prevent and reverse metabolic diseases such as hypertension, high cholesterol, prediabetes, GERD, sleep apnea, fatty liver disease, and others using CGM. In this book, he presents a comprehensive program for metabolic health success using CGMs. Dr. Kalodznyk graduated from the University of Notre Dame, completed medical school and residency at Wright State University, where he served as chief resident. He is a founding member of the Society of Metabolic Health Practitioners. And those of you who have known me, you've been here for a minute, know very well that for the last few years I've used CGMs myself. In fact, as we're doing this, I have— I'm wearing one. So I will share in the show notes the link to the one that I use, operates like this, just so that you go in with your eyes open. There is an annual membership. The benefit of this annual membership is every time that you order a CGM, and I generally advise order 2, you order 2, you're gonna wear each one for 14 days. So essentially you're covered for a month. We'll do that month and you can share your results for with me. Now if you happen to be in a group and we're doing a complimentary group at the time, you can get a little feedback and one-on-one commenting if you're kind of coming through it trying to figure out what you're doing. If you're working with me one-on-one in more of a a, what we call a fast flip because you're already in another program. We can actually deep dive and look at what's causing your spikes and what we do to experiment and know exactly what's going on and what suggestions we might make on type and timing of food or exercise and how your sleep and your stress might affect it. So lots of rich information here. It's that time of year, right? But no matter when you're listening, this episode is going to be beneficial for you. So let's get right to it. Dr. Paul, thank you so much for being with us today.

Thank you for having me.

I love this topic, and I, I love it because I've found these to be a very useful tool. First of all, it's selfish, it's all about me, but I'd like to try something. I like to have liked it trust it before I share it with our audience. And I found it very helpful for my clients as well, especially those ones who we can apply a blueprint and they can be doing the things, but to really see at a glance what's going on, it's been super helpful. So let's, first of all, let's dive into why are you doing what you're doing? Why is it that you are spreading the word about CGMs and their benefit?

So my background is as an emergency physician. I spent 25 years in the emergency department, and what gets all the press in the emergency departments is the gunshot wounds and the overdoses and the traumas. But what emergency physicians see every day, day in and day out, all day long, is the vascular complications of disease, the kidney failure and the peripheral vascular disease and the congestive heart failure and the heart attacks. And after looking at that over a period of time, my belief is most of that vascular inflammation comes from the problem of high blood sugar and insulin resistance. And so about 7 years ago, I decided to get out in front of this and open a metabolic health clinic, which has been thriving since that time. And instead of being reactive in the emergency department to those disease processes, I'm proactive in helping to prevent my patients from ever having to need those emergency department services.

You remind me of a friend of mine, um, Dr. Alan Hopkins, who also comes from the emergency room and, and is also compelled or propelled to do something much more proactive. So there must be something to be said about having scare tactics light that fire, huh?

Yeah, I mean, I've loved the emergency department. It's been a, you know, a great place to spend a career, but now being able to see patients and, you know, kind of pull them back at times from the edge of those vascular issues, you know, they're heading one direction. And once they understand the importance of decreasing their blood sugar, reducing insulin resistance, it can be life-changing. And quite honestly, the CGMs are part of that. Because, as my patients have put it, you know, once I see those spikes on the CGM, I can't unsee those. They know what's going on now, and they're motivated to really change their path.

What a good mic drop. Once I see that, I can't unsee that. So now we know. Love that. And I want to talk about something that came up during the pandemic, and I think this was people who were diabetic and they were a little guarded because I think this is really when CGMs and their use kind of hit more mainstream. People were becoming more aware of it, it was more accessible, and then there was this whole little bit of a war like, no, you can't have that because I need that, and if you have one, you know, you shouldn't be doing that, you shouldn't be taking them out of the hands of those people who need it. Did you— were you privy to any of that conversation?

You know, I, I have heard that, yes, and I've, I've read that and I've heard comments about that. But, but I'll believe— to tell you the truth, I, I believe in these devices. I'm actually a little militant in my response to that. You know, you put a CGM on a patient that is pre-diabetic or maybe even diabetic and they don't know it, and it can change their life. So yeah, these are valuable tools for patients that are dosing their insulin, which is really what they were made for initially, but they can be life-changing for, you know, people with metabolic disease or prediabetes. And I would never apologize for using a CGM in a non-diabetic when it can change the course of their life and their health for the next, you know, 15, 25, 35 years.

Yeah, amen. And I'm so glad you said that, but I also didn't want to just step over it for, for listeners who are still maybe a little bit confused about who is that for or why would I want that. And so given that you're talking about who could this be pivotal for, I mean, we're really talking— we're hunting in the zoo, as a friend of mine used to call it. But I mean, we are talking to women going through perimenopause, hormonal changes, mid- mid-menopause transition and, and post-menopause who often are told you're pre-diabetic. And it's like a slap in the face quite often because even women who have been diligent feel like, I've been aware of my health, I mean, I'm trying to eat healthy, I'm trying to do the right things. Even they have come back and said, oh my goodness, this is where I'm at. So talk a little bit maybe about How do CGMs work? Let's just go back and maybe go to the beginning of the alphabet compared to— I know I can tap into you for so much more, but I feel like we don't want to leave any listener behind who still is a little unsure about how this works and how they're applied.

Sure. So, so, you know, historically CGMs were developed for diabetics, um, and generally now sometimes even only available with insurance coverage for diabetics that are using insulin, though we've been successfully getting approval for some of our patients that are not diabetic. They're a device that you see on the back of people's arms, puts a small filament under the skin when you apply them, doesn't hurt, stays for 2 weeks, and then you swap it out. And it gives you 24/7 glucose readings, so you know exactly what is happening with your diet in terms of its impact on your blood sugar level, how your activity and your exercise affects your blood sugar level as well. And so they're just very very valuable tools to monitor your metabolic health. The way I use them is first in a diagnostic phase. Patients come in and we put one on, and I ask them not to change their diet for a couple weeks. Let's just see where you live in terms of your blood glucose patterns. Um, you know, and, you know, there's an occasional patient that doesn't have significant blood glucose changes, but I see all kinds of patients that are spiking their sugars into a pre-diabetic range, 160, 170 or so. I have some that come in and they're spiking 230, 240. They're already diabetic. They blew through the pre-diabetic range and didn't even know it. And then once we use it 2 weeks diagnostically like that, we take that information and we formulate a plan to use the device therapeutically to guide their diet. And of course, that's usually with a low-carb diet and some other tools that we, we use to help get them where they need.

I love that. And same description. I mean, that's really the way I love to treat it too. And, and yet it's not intuitive. I find that we've forgotten 7th grade science, like where we change one variable at a time, but we don't change a variable until we know what status quo was, right?

Yeah, absolutely.

So if you're listening, I think often we want to target because we want to get to the finish line faster, and we have to remember, wait, we— to get to my finish line, your personal finish line, listener, you really need to know, wait a minute, what's true for me now? Let's not turn your world upside down potentially, but maybe there's tweaks we can make. So let's talk about that. Like what kind of tweaks? You did mention, you know, probably a lower carb diet, but what other tweaks? Some things like timing or changing the order of things. What, what are some great things that a listener who isn't even wearing one could put into action to help her even if she's not reading it?

Sure. Well, the 3 legs of the stool— so the issue with most middle-aged Americans that are a little bit overweight is generally insulin resistance. I know your readers are probably familiar with that concept, but it basically is that blood sugar has been too high for too long. The organs have as much energy as they need in terms of blood glucose, and now the organs— and use your muscles as an example of organs— are saying, you know, insulin signal, we aren't going to listen to you anymore. We got all the energy we need. So basically, that's what insulin resistance is. And unfortunately, then that extra blood glucose goes to the liver, gets converted to fat, and then deposited around our midsection. So that's one of the major reasons for metabolic syndrome. The, the best way to approach metabolic syndrome, being overweight with high blood, high blood glucose, hypertension, increased abdominal girth, I believe, is a low-carb diet. And, you know, maybe be a little bit of a conspiracy theorist here and that the food pyramid came in in the '70s and '80s and that's when the obesity epidemics and the diabetic epidemics took off. And I think the best approach to reversing that is a low-carb approach really. And this shouldn't be a radical concept. We're really just going back to the way that Americans ate for generations before we were told that we should eat more carbohydrates as a result the food pyramid. So the, the three legs of the stool in terms of actionable items are a low-carb diet, intermittent fasting to some degree or another, and you know, that can be 12 hours overnight. Some patients want to go a little bit longer. Some patients are into the one meal a day concept, but, but that's another item that drives down insulin resistance. And then the third is strength training, which I know— Amen!

Thank you, Jesus! Amen, right?

Yeah.

Yeah, I did not pay him to say that.

Yeah.

Okay.

No, it's just, I mean, strength training is so critical. You know, the physiology is again the reason most patients are overweight. And quite honestly, for most people, insulin resistance is a much bigger threat than what gets all depressed, which is your cholesterol level. But if you can increase the size of your muscle mass, you know, for women, obviously it helps with the osteoporosis issue. But if you can increase the size of your muscle mass, you're increasing the quality and the receptivity of the insulin receptors on your muscles. They're soaking up more insulin and more blood glucose. And so that's helping to reverse your insulin resistance. And you know, the key here, the physiology, without getting too wonky about it, is, you know, you drive down your blood sugar a little bit and those organs that were resisting insulin now are looking around for another energy source. And they look down at the middle, your middle, and say, oh, there's an energy source— fatty acids. We're gonna break down those fatty acids and use them for energy. So that's, that's really the, the 3 major components for my patients. It's low-carb, intermittent fasting, and strength training.

Love it. Talk to me a little bit about how low— how low-carb. You mentioned about 12 hours for intermittent fasting. We like numbers here. Okay, how low are we talking?

You know, I tailor this to the end, what the individual can do. I will tell you, you know, the typical American American diet now, you know, with the processed food we eat, is often 250, 300, and 350 grams of carbs a day. Um, and so what we do generally, um, is, is move people to a lower range fairly quickly. I have just found that if you go slow— oh, we're going to move you to 150, then we're going to move you to 100, then we're going to move you to 75— it's just too slow a process. People don't get the positive feedback in terms of feeling better and weight loss. And so usually what I do initially is jump people to 50 or 75 grams a day. And then generally I like my patients to settle in long-term in the 35 to 50 gram range. I have some patients that want to go keto. I myself cycle into a keto range periodically, but I don't think you have to be doing less than 20 grams chronically to get where you need. If you want to go, you know, just in a low-carb range, not a keto range, I think that's very acceptable as long as you're doing and the other things that we talked about.

All right, every listener out there is begging me to ask this question because there's thinking, oh, okay. And, and I'm also thinking someone who's not been, been doing this or tuning into it has no idea, may have no idea that they're getting upwards of 250 grams of carbs a day, or what 50 or 75 might look like. So can we tell them? Could you give me an example of eating through a day that is between 50 and 75 grams of carbohydrates?

Sure. So, so one good rule is always start your day with protein. So, you know, look in the morning to start with some eggs, maybe even some meat. You know, again, I, I focus on making sure the carbs are low enough, making sure the protein is high enough, and I really don't worry that much about the fat. Content. You know, we do teach patients over time to gravitate toward good fats as opposed to bad fats, but start your day with protein. You know, if you're doing some intermittent fasting, for a lot of my patients, that means that, you know, they maybe often are not eating until 10 or 11. They'll have eggs in the morning, maybe some sugar-free yogurt, maybe some nuts, and then often they will not eat again except for maybe a snack of, you know, some kind of protein, a jerky, maybe a protein shake with their workout until the evening. And then in the evening, basically, if you eat a meal associated with, with some source of protein— chicken or meat, fish, steak— and then you add appropriate vegetables to that, you know, cruciferous vegetables that are generally high in fiber— the asparagus, the Brussels sprouts, the broccoli— then you actually probably will have some room to spare and you can have that piece of dark chocolate, you know, for dessert. So that is a general outline of what things look like. And, you know, I tell people related to the intermittent fasting, you know, you fast during the week, you want to go out with your family for breakfast on, you know, Saturday, do that. You have a special event, a wedding or whatever you're going to, Do that and enjoy yourself, but just keep this basic framework in, you know, your lifestyle, integrated into your lifestyle. And what I find is people evolve in this way to this kind of diet and they never look back. You know, they've seen those CGM spikes and what the carbs are doing to them, and they just adopt this lifestyle and it's not really a burden to them. You know, they know they can have an occasional dessert for a special occasion, but they adapt the lifestyle and they move forward and they feel so much better that they want to embrace it.

So good. What is it that made you write a book about CGM? I mean, how, how were you kind of compelled to do that?

Well, you know, I've had the metabolic health practice and I just saw the way these devices can impact people's lives. I mean, a 21-year-old pre-diabetic, overweight— this, this happened to be a male who has, you know, diabetes throughout his family— you know, lose 70 pounds and be on a different path for the rest of his life. You know, the people you pull back from being pre-diabetic, you know, I think pre-diabetes is just, you know, lights and sirens should be going off. It's an emergency because you can reverse pre-diabetes. But once you're diabetic, you're always going to have some insulin resistance. So pulling people back from that edge and helping them redirect their lives and CGMs during that 2-week trial when they see what's going on with their blood sugar and then, you know, long-term monitoring their health with the CGM is life-changing. You know, and I, you know, I mean, it sounds trite, but I've had countless patients that, you know, with this type of program and with this kind of device that their life is literally changed. And that disease that I see in the emergency department frequently isn't going to happen to them because they've learned how to manage it and avoid it. So it's very satisfying from a clinical standpoint when patients do very well like that.

You know, I'm going to take a real side path here, but as we were talking back, I have this little doodles here on my notes. We were talking about, you know, what happened with the Food Guide Pyramid and that being kind of the birth of, you know, it's been an obesity epidemic since then. What's being done with CGM use with children? Anything?

So, so, um, CGMs in kids are primarily only used by type 1 diabetics. That's really not the patient population that I work with, but you know, you have now insulin resistance and prediabetes in 14-year-olds because of the obesity issues. And I have had a number of teenage patients, you know, in conjunction with their family, in conjunction with the blessing of their pediatrician, coordinate a low-carb low-carb, gentle intermittent fasting, appropriate strength training approach. Because the, these kids, when they get into adolescence, are not immune from the potential lifestyle issues that can impact their health and head them down the road to prediabetes and diabetes. So I think working with that population is very important with the teenage obesity epidemic that we have.

Yeah, and I think, you know, it's been a few years, this isn't new news, but I remember, you know, when it was first stated that this could be the first generation that outlives their kids, you know, and that being a statement that we've got 4-year-olds that, you know, are obese, and we were seeing, seeing youngsters like second graders reaching puberty because of the body fat.

And it's diet. Diet is what does that. Processed foods, you know, the fructose and, you know, the sodas, and quite honestly even the juices. The diet— you mentioned the food pyramid— the diet was different. You look at the '50s and '60s, you look at a movie or, you know, a set of photographs from that period of time, you don't see obese people. You know, it's when, you know, we went from 25% carbs in our diet, you know, almost overnight when the food pyramid came out, to 50% or more carbs in our diet, and we reduced our protein intake. So really, this is approach of just really trying to get back to the way we ate for generations.

Yeah, so love that. So love that. How do you when you're working with a patient, how do you use CGMs? I mean, are you putting it on or using it continuously for 3 months? Are you using it for a month, having them apply what they've learned, maybe coming back and checking it? Is there a preference for you?

Yeah, so that 2-week period is important, a trial period where they're eating their normal diet. And then after that, we use the CGMs to guide diet, and then The use of them subsequently is variable. I usually work with people for about 6 months during that period of time for them to adapt these habits for a lifetime. During that period of time, they use the CGM most of the time. We take a break, call it a CGM holiday. You're going on vacation for a week, then take a break, or you just need a mental break for a little while, that's fine. So it's variable. Most patients will use it for most of that 6-month period of time. You know, I actually have had patients that have put one on the back of their arm and quite honestly never want to be without one again because they feel that the information they get from it is that valuable. But usually it's intermittently for a 6-month period of time. And then long-term, you know, patients often manage their diet without them, but, you know, often circle back around and will want to use them for a couple weeks every, you know, 3 or 4 months.

Great. I'd love to hear that. And I also wonder if we could end with some very tactical things that— I think it's an interesting experiment when people are wearing their CGMs. What I noticed in a small group that, that we've run is that they're shocked to find, no, wait a minute, I had this food and last week it it didn't spike, but now it is spiking. Talk about a few other factors besides just the food itself that could impact the fact that it might elevate blood sugar levels.

Sure. So there are a lot of variables. You know, the, the big one is stress, because when you get— when you're under stress, either physiological or emotional stress, you get cortisol release, and you know, that is your fight-or-flight phenomenon. So that's gonna bump your blood sugar. If you're anxious, anxiety releases adrenaline. That also can bump your blood sugar. I have found when patients, if they have a carb load, sometimes that blood sugar can have a tendency to stay up for days. If you get a spike, yeah, you know, it actually can have an impact for an ongoing period of time. You, I think, alluded to the order you eat your food in. You know, it spikes one week, but it doesn't spike the next, but maybe that's because you had adequate protein and fiber before you ate the carbohydrate component of a meal. So there are all these variables that you can play with, with the CGM to understand the impact on you personally. And that's why these are such great devices, because you get to see what's happening to you, not what in general happens. Happens to people, but what happens to you and, and your physiological system.

Yeah, I love that. With women who might be listening who are still in early perimenopause and, and may not actually even know it yet because things have not gotten changed enough for them to know, if they're still cycling, do you see with women who are still cycling variability in their numbers based on what week they're in?

Yeah, they actually, um, in, in just before menses, um, the numbers have a tendency to be a little bit higher. Um, and then, um, as menses start, uh, they settle down, and generally they stay in that pattern until the next cycle. Um, but it's not a huge change. Um, it's usually, you know, 10 or 15 milligrams per deciliter, you know, normal blood sugar. Fasting blood sugar is less than 100. You know, the highest I like to see people generally, um, when I'm managing them on a low-carb diet is in the 130 range. So they get a little bit of an impact, but it's not tremendous.

So good, so good. Thank you. And I know you've written a book. Would you just kind of give us a, a tour as if we were looking at your table of contents? What are we going to find in there? What kind of resources might help a listener who still wants to kind of absorb a little bit more information and know it and herself better?

Sure. Um, so it's basically a bible for continuous glucose monitor use for non-diabetics. The title is The Continuous Glucose Monitor Revolution for Non-Diabetics. Um, and, and basically we start with talking about why metabolic— what metabolic health is and why it's important. Um, and I am going suggest that the healthcare system right now really isn't set up to help people address these issues. We've kind of evolved to a disease management pharmaceutical model, um, where, yeah, if your blood sugar's up, let's give you a pill for that. Um, so we— I talk about the importance of, you know, lifestyle changes in terms of managing potential disease and disease as opposed to, you know, just taking more insulin, for example. So we start there, um, why, you know, we are able to focus on spending a lot of time with people on these lifestyle issues. And, and then we go through, you know, the CGM trial period, how a CGM is used to guide diet, talk about the components that you and I have talked about here, you know, what are the intermittent fasting options, what are the options for working out, and in my belief, the, the, the much higher importance of, uh, strength training in comparison into cardiovascular fitness. I tell my patients I'm a doc that, you know, is a little bit out of the ordinary because I'm gonna tell you I'm not gonna worry that much about the fat you're eating, and I really don't want you spending a lot of time on the elliptical machine. I want you in the weight room. So we walk through chapter by chapter like that, and then the last chapter is CGMs change lives because I've seen CGMs change lives, and, and I I think people that want to try this technology and possibly embrace this technology, if they've struggled in the past to lose weight or reverse their insulin resistance or decrease their joint pain, these devices can help. So the book is meant to be a Bible to guide people on the use of CGMs.

So good. You opened up really a whole lot of other reasons why someone would want to take a look at this, you know. In addition to, you know, I think what really gets a lot of women's attention is belly fat, you know, not being able to get rid of that. I have to tell you, oh my gosh, I have to be careful about how loud I speak, but right now I have a small cleaning company here working in another room, and one of the women saw me in the kitchen and said, "You help women lose weight?" And she's speaking Spanish and I'm not, so understand this was not as smooth as I'm describing, but she's like, "Can you help with this?" And of course she grabs her belly, and so it's funny. But then also aches and pains. So I hope some of you heard that because it is connected, and yet it's not often the first place you would go to think, right, oh, this, this is another cause.

Yeah, yeah, the joint pain, it's an inflammatory response. People think that, oh, my knees hurt because I weigh too much. Well, well, it may very well as much be because your blood sugar has been higher than it should be for a long period of time. And just like your blood vessels get inflamed with high blood sugar, your cartilage in your joints do as well. So patients, you know, they, they reverse their insulin resistance, and that helps an awful lot with the aches and pains as well.

So good. All right, would you please do me the honor, let it— let me know let all listeners know where can they find you, follow you, and get their hands on your book, which I'm guessing is available wherever books are sold, but you can say so otherwise.

Yeah, again, the best place to find the book is, is on Amazon. And my medical practice, I'm licensed in Ohio, Arizona, Indiana, and Florida, and I see a lot of patients by telemedicine. In, in those various states. I mean, telemedicine works great for a practice like this. I don't know what your listeners' experience has been, but you know, it actually is, is not a distant thing. It's, it's can be fairly intimate and I can work with people well. But I'm on Twitter @DrKoloMD, on TikTok @DrKoloMD as well, and the website is metabolic practice website is metabolicmds.com. And then again, the book is, is available on Amazon.

Fantastic. Well, it's been a delight to have you here and very insightful. So thank you on behalf of me and my listeners. And listeners, now it's your turn. So if there was a question that I try to cover you all the time, but if there's a question that I did not ask you, wish I would You can reach me and the show notes will be at flipping50.com/answers to your CGM questions. And what are you waiting for? Let's start flipping 50 today.