#351 Reactive Hypoglycemia, Insulin Resistance and Why Nutrition May Not Be The Most Important Part of Improving Blood Sugar with Isaac Pohlman, RD, T1D (Part 2)

This week on The Less Stressed Life Podcast, I am joined by Isaac Pohlman for Part 2, talking about all things blood sugar. If you missed Part 1, be sure to check out last week's episode. In this episode, Isaac talks about insulin resistance and it's contributors, what causes reactive hypoglycemia, the importance of minerals, how stress affects blood sugar + more.

Be sure to watch for Isaac's new book, Have Your Carbs and Eat Them Too! Check out Isaac's website for free resources.

KEY TAKEAWAYS:

• What is insulin resistance?
• What are some classic signs that our blood sugar needs attention?
• Four top contributors to insulin resistance
• What glucose numbers should we be looking for?
• What is the benefit of blood sugar rising?
• Who are the people with the lowest glycogen levels?
• What is reactive hypoglycemia?
• The importance of eating earlier in the day

ABOUT GUEST:
Isaac is a dietitian originally from a small rural town in the Upper Peninsula of Michigan and is currently residing in Chicago.
During his formal education in undergrad and grad school, he studied human physiology and nutritional sciences and has since gone through a series of trainings, including internships to become a Registered Dietitian, mentorship programs under Josh Rubin and Morley Robbins, and independent research.
Despite his formal education, his personal experiences with health and working with clients 1:1 have been just as if not more valuable to his work. He was inspired to pursue nutrition after developing a series of health issues, including hypothyroidism, low testosterone, chronic fatigue, cystic acne, and type 1 diabetes, during his high school and early college days.
Isaac currently helps adults with type 1, type 2, and pre-diabetes improve their blood sugar control without cutting out carbs, in his coaching program, The Balanced Blood Sugar Roadmap.

WHERE TO FIND:
Website: https://www.isaacpohlman.com/
Instagram: https://www.instagram.com/isaacpohlman/
YouTube: https://www.youtube.com/channel/UC13UVlKgTCNG325KpiVxXHA

***WORK WITH CHRISTA***: https://www.christabiegler.com/fss

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife
Leave a review, submit a questions for the podcast or take one of my quizzes here: https://www.christabiegler.com/links

NUTRITION PHILOSOPHY:

• Over restriction is dead; if your practitioner is recommending this, they are stuck in 2010 and not evolving
• Whole food is soul food and fed is best
• Sustainable, synergistic nutrition is in (the opposite of whack-a-mole supplementation & supplement graveyards)
• You don’t have to figure it out alone
• Do your best and leave the rest

EPISODE SPONSOR:
A special thanks to Jigsaw Health for sponsoring this episode. Get a discount on any of their products. Use the code lessstressed10

Transcript

[00:00:00] Isaac Pohlman, RD: The stress ultimately drives reactive hypoglycemia. It forces the body to be more insulin reliant or insulin dependent, and as a result of that, we're overproducing insulin, we're overproducing insulin, we're relying on that, and over time, the bottom kind of falls out where we have no stability there.

[00:00:17] Christa Biegler, RD: I'm your host, Christa Biegler, and I'm going to guess we have at least one thing in common that we're both in pursuit of a less stressed life. On this show, I'll be interviewing experts and sharing clinical pearls from my years of practice to support high performing health savvy women in pursuit of abundance and a less stressed life.

[00:00:47] Christa Biegler, RD: One of my beliefs is that we always have options for getting the results we want. So let's see what's out there together.

[00:01:05] Christa Biegler, RD: So we talked about iron, we talked about mostly iron right there. I think we're coming into insulin resistance next. Let's talk about what insulin resistance is and contributors. I think we arrived here by looking at biomarkers around blood sugar. And then we went through, some of these Unassuming blood markers related to blood sugar, but now coming into insulin.

[00:01:28] Christa Biegler, RD: Insulin is a biomarker. So let's talk about insulin resistance in the body and what creates insulin resistance and what it looks like. 

[00:01:35] Isaac Pohlman, RD: Yeah, that's a great question. This is a big topic and I think it can show up for a few clients just a little bit differently, but I like to use this analogy because My dad is like a postal worker, so he works for USPS, and on the holidays he gets really busy they'll have lots of packages, and mail, and gifts, and care packages delivered, and so they have to hire temporary workers to take care of everything.

[00:01:58] Isaac Pohlman, RD: I almost compare the situations like insulin resistance, because what insulin resistance at its core is it starts off as overproducing insulin, meaning we are producing a hormone insulin that initially helps to lower blood sugar, but as we're overproducing it and overproducing it, the cells don't respond to it as well.

[00:02:19] Isaac Pohlman, RD: Meaning like you could have a healthy amount of insulin or even More than enough insulin to work with, but your body isn't responding well, and then as a result, your blood sugar rises. And going back to this postal worker example, like these people like my dad deliver mail to individual mailboxes, and you can think of them as being like the insulin, in a sense.

[00:02:41] Isaac Pohlman, RD: And then these temporary workers are hired on to deliver more and more of this mail. But, eventually we can only fit so much mail in those mailboxes, right? They get full and expanded and now we, they have to take some of it back to the postal office. And so that is almost like blood sugar becoming higher.

[00:02:58] Isaac Pohlman, RD: The letters, the care packages, the mail is like those carbohydrates, right? And those individual cells are like the mailboxes that we're delivering them to. So even though we have. All this all these mail, the postal workers to deliver this, these carbohydrates, it's still not working out. And as a result, that blood sugar ends up rising.

[00:03:17] Isaac Pohlman, RD: And it's not necessarily insulin issue. More or less, we're relying too much on insulin to regulate our blood sugar. And one researcher that really got me into this was Ray Peat, who we talked about earlier. And one of his quotes I found was just super fascinating around this. He talked about how basically insulin only provides 8 percent of the blood sugar lowering capacity of the body.

[00:03:41] Isaac Pohlman, RD: And so I found that really fascinating. I don't know if I have necessarily seen research to link that, but speaking from personal and professional experience, there are a lot more. Things that have to do with lowering blood sugar outside of just insulin in itself. And so when I see someone that is struggling with insulin maybe on a lab work where their insulin level is really high and their fasting blood sugar is high, what I tend to see is they're relying too much on that pathway to regulate blood sugar and not enough on things like in their diet or lifestyle to do that.

[00:04:13] Isaac Pohlman, RD: And so I titled this kind of the big four. There are big. The top four contributors to insulin resistance that I typically see that help somebody get that back into more of a balance. Now the thing that ultimately drives insulin resistance is some sort of stress, right? It's the thing that keeps our blood sugar high and keeps us more reliant on that insulin pathway to be able to regulate our blood sugar.

[00:04:36] Isaac Pohlman, RD: The reason that is the case is because when we look at stress What ends up happening as a result of stress is we break down our muscle and our fat tissue when that is, when stress hormones are being released and stress can come from variety of different parameters really can come from work, it can come from lifestyle, it can come from a family life, it can come from moves across the country, but like we talked about yesterday, it's like the perceived stress, are we perceiving that to be something that's really taxing.

[00:05:07] Isaac Pohlman, RD: Demanding us, right? And so if we do, and we have accumulation that over years and years, what ends up happening is as a result of stress, it breaks down muscle, breaks down fat tissue, which makes us more insulin resistant. It inhibits the insulin hormone from working correctly. And then it also is a diuretic.

[00:05:27] Isaac Pohlman, RD: And the thing that, why this is important is because. When we look at something that's diuretic, it makes you pee more frequently, right? And so when something is making you pee more frequently, it's not just water that follows that fluid outside your body, it's the water soluble vitamins and minerals that also do.

[00:05:45] Isaac Pohlman, RD: And so those vitamins and minerals often just happen to be the exact vitamins and minerals that play a huge role in blood sugar regulation. So potassium, magnesium, sodium, B vitamins, all water soluble. So it's a huge piece with the stress. And that's why it's one of the first things that I touch on with clients and anybody that I work with, because that's the ultimate Break that puts is placed on somebody that prevents their blood sugar from coming back down and continue to be reliant to insulin to regulate that, which we don't want to do.

[00:06:18] Isaac Pohlman, RD: We want to have multiple places, multiple variables. To be able to manage our blood sugar outside of just insulin. And so that's probably the first piece I'll look at the other pieces, things like sleep, huge contributor as well. When I look at clients that maybe don't get the quality of sleep that they're looking for, or.

[00:06:37] Isaac Pohlman, RD: Or if they don't get the quantity as well a lot of times their blood sugar will be higher in the morning and then continue on for the rest of the day where they're like chasing that down. So that's a huge piece. I see a lot of folks, I work with a lot of clients that are like, That have desk jobs and are like in sales or business, a very stressful desk jobs where they're not getting in a ton of movement.

[00:07:00] Isaac Pohlman, RD: They're not getting up from their desk every now and then, and that light movement, especially if you do it outside where you have access to light and sunlight. It can be one of the most effective things to bring down blood sugar bar none that I've seen. If I were to get a high blood sugar, let's just say maybe mine went up into the 200s.

[00:07:18] Isaac Pohlman, RD: I could easily get my blood sugar down to under 100 in like 30 to 45 minutes with a walk, right? It's that significant for some people like it is for me. So those are the pieces I look at first. A lot of people would say, Oh, insulin resistance, it's just a food thing. But the things that keep it high are often those things beyond just food.

[00:07:38] Christa Biegler, RD: You said top four contributors to insulin resistance, and I wrote down stress and sleep and what were the other two 

[00:07:44] Isaac Pohlman, RD: movement in light. And then I didn't get to the last one, which would be food, which I can get into that right now the food piece is interesting. Like I get a lot of clients and I don't know what your experience has been, Christa, but I get a lot of clients that aren't really eating.

[00:07:59] Isaac Pohlman, RD: They're eating fairly well, like good quality foods, grass fed, pasture raised meats they've learned some good things around nutrition so they might be eating quote unquote healthy in a sense but they may not be eating healthy for them. I call it strategic eating in a sense, and so With strategic eating, I look at in a sense of tuning your food and tailoring your food to how your body feels.

[00:08:24] Isaac Pohlman, RD: And I call that tuning into your biofeedback and biofeedback in my view is just the signs and the signals that your body's giving you, whether something is working or not. And the more that we do not pay attention to those signals that our body is giving us, the less results that we're going to get.

[00:08:43] Isaac Pohlman, RD: And I think from a nutrition perspective, we've been so taught to like, to get our information outside of ourselves, dietician social media, internet articles, books. And I think there's absolutely a time and place for that. There certainly is. But I think sometimes we focus way too much on that at the expense of ourselves.

[00:09:01] Isaac Pohlman, RD: And so we're not tuning into our own bodies. We're not making us a part of the process. We're just looking for external. Opinions on that. And so the more of that clients can tune into their own body in terms of how they're feeling, their mood, their energy, their digestion, their sleep, their stress, that helps them to be able to tailor this nutrition plan, the frequency of their nutrition plan, the balance of their nutrition in a way that actually ends up supporting their insulin resistance.

[00:09:30] Christa Biegler, RD: Before we move on from insulin resistance, when people come to you and have concerns about this, probably both sides, they're probably sometimes told they have insulin resistance and that's prompting them to see you and maybe you're finding it. What is it looking like on them, both from a biofeedback perspective and a biomarker perspective?

[00:09:47] Christa Biegler, RD: Or what are their numbers looking like? 

[00:09:50] Isaac Pohlman, RD: Yeah, yep. So biomarkers, I typically see a high blood sugar. So when I say high blood sugar, something above 100 the higher it is above 100, the more significant the insulin resistance typically is. And then I will also see, and this is, this comes in two, so it'd have to be two.

[00:10:06] Isaac Pohlman, RD: Their insulin will also be high, meaning typically above seven. I see a lot of clients with 17, 20, 30 a lot of clients with PCOS history as well. But that suggests that they're relying way too much on the insulin pathway to regulate their sugars when they looking at these other variables would be really impactful for them.

[00:10:26] Isaac Pohlman, RD: And how that physically mentally presents. I see a lot of clients that tend to store weight around their abdomen. I think I talked a little bit about that yesterday where they might have like really skinny limbs. I see this a lot, really skinny limbs and then their abdomen or their trunk is like very thick.

[00:10:42] Isaac Pohlman, RD: And I see that quite a bit. I see clients that struggle with fertility often. I see those that, especially after eating like something carb rich, they're feeling like they need a nap, they need to crash they need something to pick them up in a sense. So I see that quite a bit. I also see when they connect the dots between Carbohydrates might be causing their blood sugar to really fluctuate.

[00:11:06] Isaac Pohlman, RD: They become more fearful of that too. So a lot of food fear around consuming carbohydrates, going out to eat, eating socially which kind of goes into like tracking. So they might be more and more obsessive with tracking, get into CGMs and get really hyper focused on blood sugar which is more of the mental health side of things, but typically I do see it in terms of Anxiety, brain fog, and then energy, and then sometimes digestion, where they might bloat more with carbohydrate containing foods as well.

[00:11:37] Christa Biegler, RD: When you say blood sugar above 100, you mean fasting blood sugar above 100? 

[00:11:40] Isaac Pohlman, RD: Yes, yep, exactly. All 

[00:11:43] Christa Biegler, RD: right. So you just mentioned CGM a couple of times, probably some people come to you and they're tracking their blood sugar because they're supposed to write what the glucometer handled glucometer. But right now, continuous glucose monitors, they look a couple of quarters or something stuck to your, like a sticker stuck to your arm have become pretty popular on your note.

[00:12:00] Christa Biegler, RD: One time I tried one of these. It was probably three to four years ago, actually, now. And I remember I had gone on a retreat with some dietician friends, and I was enjoying all of the foods and eating a lot, and my main takeaway, I was trying to determine, there was a couple things I wanted to determine. I just wanted to see what people were saying.

[00:12:20] Christa Biegler, RD: But I also wanted to see did stress increase my blood sugar. I remember one morning when my kids were being crazy, I just thought I'd go up like a 10 or 15 points, within those 10 minutes. But the main takeaway from my trip, the girlfriend trip to Arizona was I was eating all the things and I could do that.

[00:12:36] Christa Biegler, RD: And no matter what with the walking, my blood sugar was so awesome with the walking, right? Because I was just such a subsection of that to emphasize your point already. Like the answer to your blood sugar might be a nice walk after lunch. 

[00:12:50] Christa Biegler, RD: And I were talking yesterday before we jumped online that sometimes the CGM movement can be a pain in your side, especially as people become obsessive.

[00:12:58] Christa Biegler, RD: So tell me a little bit about your feelings about your clients tracking. Do you ever have clients that are not diabetic track? And how do you handle tracking in your? 

[00:13:08] Isaac Pohlman, RD: Yeah. Yeah. It's a really good question. And I always look back at the client cause CDM can be a great tool for the right person, but be the worst tool for the wrong person.

[00:13:17] Isaac Pohlman, RD: Yeah. I think it depends on the person and sometimes we have to evaluate their history. I have some clients that have like maybe an eating disorder history and or like a disordered eating sort of history. And so those are the few people that may be a more so hyper, fixate on things like blood sugar and for a lot of those folks, I find that it's actually not beneficial unless they can support that relationship that they do have with their blood sugar.

[00:13:42] Isaac Pohlman, RD: And so if they're one to obsess and fixate and hyper focus on blood sugar at the expense of everything else, then I typically will not suggest to track at least at first. Now, if a person can take their But sugar with a grain of salt within consideration of all the other things that are part of health because it's not just blood sugar.

[00:14:02] Isaac Pohlman, RD: It's digestion. It's energy. It's how you sleep. It's how you feel from a mood perspective throughout the day. If they're able to take blood sugar within consideration of that, then it might actually be, quite supportive to them. So it ultimately just goes back to the person. Now the reason why I have sometimes an issue with cgms is because I think whether it's like the internet, social media, or maybe some influencers, I don't know who, but I think we've created the expectation that just should be a straight line, like all throughout the day.

[00:14:31] Isaac Pohlman, RD: And I think that's really setting up people for failure and the wrong kind of expectation when it comes to blood sugar in a healthy expectation at that too, because even if we were look at someone who's metabolically healthy, meaning that they don't have any blood sugar issues, they will naturally see a bump in blood sugar up after a meal.

[00:14:50] Isaac Pohlman, RD: And I think we have to distinguish what is a bump versus what is a spike, because I think We lump them all one in the same. If we see any variation with blood sugar, it's like a spike. What is a spike? I would consider a spike anything above 140, one to two hours after a meal.

[00:15:07] Isaac Pohlman, RD: So if it's going to 200 yeah, obviously that's not good. But if we're going to maybe 100, 110, 120, 130, even that's very natural. And if we look at any health measurement in the body, nothing, it stays in a straight line. If you look at. Blood pressure, heart rate, that's always varying to some extent.

[00:15:26] Isaac Pohlman, RD: And, if we look at heart rate, for example, if it was a straight line, we'd all be dead. Like I wouldn't be talking to you on this podcast. So there's a reason why they vary. And if I were to be doing like. Like jumping jacks right now, my blood pressure and heart rate would both go up. Now, if we put that in a vacuum and say blood pressure and heart rate going up isn't that a risk for cardiovascular disease?

[00:15:48] Isaac Pohlman, RD: If we look at the context of this situation it's not because it's serving me, because if I didn't have blood pressure and my heart rate increase when I'm doing jumping jacks, blood flow and oxygen are not going to get to my tissues and my brain. And if they're not getting there I'm going to pass out doing jumping jacks.

[00:16:04] Isaac Pohlman, RD: So there's a reason why those increase and it's important for those to go up. Now, the question now becomes that might be true for blood pressure and heart rate, but what about blood sugar? What could be the benefit of blood sugar rising? There is a really big one. It's often not talked about enough.

[00:16:19] Isaac Pohlman, RD: So let's just say someone has a bump up. I have a bump up in blood sugar to, one 20 or one 30 after a meal. What happens? There's something in your body known as the liver, which absorbs that extra glucose, a sponge would. And I compare your liver to a carb pantry, if you will.

[00:16:37] Isaac Pohlman, RD: So Christa, I don't know how you grew up, but like in my house growing up, we had. All sorts of carbs in this pantry and potatoes and rice and cookies and fruit and all the good stuff, right? Your liver is like that. It's a future storage place for carbohydrates and it is really important that we have that.

[00:16:57] Isaac Pohlman, RD: The reason being is because it helps us to activate hormones like thyroid hormone. Because if we look at thyroid hormone, most of it is not coming out active, meaning it's not usable by the body just yet. Okay. in the main site of that activation is actually in the liver. Now that activation does not occur unless we have carbs in the liver, meaning glycogen.

[00:17:19] Isaac Pohlman, RD: So I must compare it to if you have a supplement bottle and you have that little seal on top, you need to rip it off to get access to the capsules. That's what's happening to thyroid hormone in the liver. So In essence, we need to have bumps up in blood sugar to be metabolically healthy, especially from a thyroid perspective, because otherwise, if we don't, we're impacting trillions and trillions of cells because every single cell in the body responds to thyroid hormone.

[00:17:46] Isaac Pohlman, RD: And if we don't have enough of that available, or if we're not using it, It's not activated. For many people, that's going to have huge consequences from mental health, like anxiety and depression, physical health, like energy digestion and sleep, even lab work, like cholesterol and blood pressure and even blood sugar, right?

[00:18:05] Isaac Pohlman, RD: And so making us less metabolically healthy if we're not able to store carbohydrates in the liver. Now here's the kicker. Who are the people with the lowest glycogen levels? It just happens to be those with blood sugar issues and diabetes, right? And so if we're not getting a bump up in blood sugar, or if we're not consuming a healthy level of carbohydrates or finding a way to improve our body's ability to tolerate those, we're setting ourselves up for many health issues in the future.

[00:18:36] Christa Biegler, RD: So important to stop and reflect on this. I love liver stuff and it's like liver, the home of a lot of things related to blood sugar and a lot of things related to thyroid, which massively affect your energy and how you function and your mood and throughout the day. 

[00:18:53] Isaac Pohlman, RD: Absolutely. 

[00:18:54] Christa Biegler, RD: You mentioned numbers.

[00:18:57] Christa Biegler, RD: You specifically mentioned that you like the postprandial post meal glucose to stay around 140 or below. We mentioned insulin levels, which you would test at a lab under 10. Yeah. And do you have any feelings about a one C or any other numbers that you're normally monitoring? 

[00:19:16] Isaac Pohlman, RD: Yeah. This is a good question.

[00:19:17] Isaac Pohlman, RD: I didn't mention this just yet, but with the a one C it's an average of your blood sugar over the course of the last three months. And so depending on the client, this may or may not be the most accurate measurement to use. If a client is, for example, having low blood sugar in high blood sugar, their a one C might show like smack dab in the middle and be.

[00:19:37] Isaac Pohlman, RD: perfectly okay, and you might not even capture those low or high blood sugars because they're a one C is averaging that out. Now, the measurement that is helpful to take in mind, especially if you're one that has like diabetes type one or type two is a measurement called time and range. And basically what it refers to is the amount of time that your blood sugar spending in your destinated target range, right?

[00:20:01] Isaac Pohlman, RD: So if my designated target range is 70 to 100 before a meal and less than one 40. after a meal, it's that percentage of how long my blood sugar is staying within that range. And you can calculate that from a CGM. Like I use Dexcom and they generate reports on that. And it's a helpful number to have around, especially if you use something like that.

[00:20:23] Isaac Pohlman, RD: So if someone is having like up and down blood sugars, that's probably one of the most effective Ways of measuring because the a one C or fasting blood sugar check or glucometer check will not capture the scope of that blood sugar trend. 

[00:20:38] Christa Biegler, RD: I have to go back to insulin resistance.

[00:20:40] Christa Biegler, RD: I did a bit of a flashback. You were talking about the picture of abdominal adiposity and skinny limbs. I worked in a dialysis unit for eight years and I saw that constantly there. And the other thing I would see is just people having their insulin increased. Their exogenous their medication, insulin increased and increased.

[00:20:58] Christa Biegler, RD: And it was like continuous insulin resistance. So that's I don't know if you have any comments about that, but that's just how I saw it handled all the time. And I was like, there's something not okay here, right? Of course there was many things not 

[00:21:12] Isaac Pohlman, RD: okay. Yeah. And I had a rotation in the renal clinic for, I think about.

[00:21:17] Isaac Pohlman, RD: Almost two months and it was really interesting for me to see that too. I saw very similar things as well a lot of people with diabetes But yeah, when we think about there's of course other factors and some of those renal patients I think are you know may not understand maybe even what a carb is and that's okay if you're at that place I think my population I take on many people that may have a little bit More of an understanding of what nutrition is and what a carb is and what is fat is and protein.

[00:21:43] Isaac Pohlman, RD: And so for those individuals, like maybe basic stuff might be helpful. But when we look at like the by product of that, if we're losing muscle, if we're stressing our body out to an extent where it's eating up. Our muscle. There's less of that less of a surface area to store those carbohydrates away.

[00:22:01] Isaac Pohlman, RD: There's nowhere else to go. It's going to go in that tissue. And it's going to either going to stay in the bloodstream or go there. And if there's less surface area for us to store that and liver or muscle glycogen. That means automatically we're going to either gain more fat or it's going to stick around in the bloodstream.

[00:22:16] Isaac Pohlman, RD: I think that's certainly a big piece of it. And, is a huge piece why I think for those that are getting older Or even young now, starting now with like strength training exercise, even if it's something very simple and light and only for a few minutes, because that allows you to preserve some of that capacity moving forward so that you have, if you find yourself in a blood sugar situation that you have an ability to store some of those carbohydrates away versus some of those have aged quite a bit.

[00:22:43] Isaac Pohlman, RD: They've had the stress of That ongoing blood sugar imbalance. Now they have nowhere else to put that. It just goes in fat or it stays in their bloodstream and they have to rely on insulin therefore to regulate things. 

[00:22:55] Christa Biegler, RD: One more fringe topic here, which I was thinking about this and you're talking about the livers, natural rules.

[00:23:03] Christa Biegler, RD: And I was thinking about, I was rewinding my brain to 2016, 2017. When I was first seen, there was a nephrologist, a kidney doctor. He's from Canada. And. I don't remember his name. Jason Fung. Does that sound right? Maybe? Oh, 

[00:23:18] Isaac Pohlman, RD: yeah, I know. Yep. Yep. 

[00:23:19] Christa Biegler, RD: And he was really big into using keto for his renal and diabetes patients.

[00:23:24] Christa Biegler, RD: Talk to me about how that comes into, how often that gets talked about in your practice. 

[00:23:30] Christa Biegler, RD: Probably one of the most underrated nutrients I use in practice is potassium. Low potassium can be a huge factor in energy, relapsing gut issues, thyroid function, and even regulating blood pressure. Now your blood test for potassium will look normal most of the time. Otherwise you'd feel faint and maybe like you're going to pass out, but your tissue levels of potassium will decline with an increase of the stress hormone cortisol.

[00:23:56] Christa Biegler, RD: Big picture. I find it's just really hard for humans to get enough food based potassium in their diet, unless they live in a tropical place. And I'm usually recommending my clients get at least 4, 000 milligrams of food based potassium per day. That's why I really commonly recommend Jigsaw's Pickleball Cocktail to help my clients.

[00:24:14] Christa Biegler, RD: It's one of the only electrolyte products on the market with a hefty dose of potassium at 800 milligrams per scoop. When most electrolyte products only have about 200 milligrams. Making it really hard to reach those high doses of food based potassium I recommend per day. Plus, it's automatically the best choice if my client is dealing with swelling, which can be related to imbalances of sodium and potassium in the tissue.

[00:24:40] Christa Biegler, RD: I'm a potassium evangelist, and Jigsaw's Pickleball Cocktail is one of my most used tools of the trade. You can get a discount on any of Jigsaw's amazing products, including Pickleball, at JigsawHealth. com with the code LESSSTRESSED10. That's three S's, LESSSTRESSED10.

[00:25:01] Isaac Pohlman, RD: Yeah, it's huge. It's huge. I have a lot of clients that have had history of keto or fasting. I want to say he does some fasting maybe to Jason Fung. Okay. Okay. Yeah, I've either clients that have experimented with that already or ask me questions around that.

[00:25:16] Isaac Pohlman, RD: So it definitely comes up quite a bit. And I would never want to bash somebody for doing something like that. It certainly doesn't align with my way of thinking like long term, but it allows somebody to find like stability with their blood sugar and it allows them to feel good great.

[00:25:29] Isaac Pohlman, RD: That's what we're after at the day is that person to improve their control and improve their metabolic health so that they can feel. Like themselves and age well I think the problem sometimes comes into into play. I won't say sometimes a lot of times because I'm getting clients from this area a lot is fasting in a sense, many times has a lot of benefits at the beginning, right?

[00:25:50] Isaac Pohlman, RD: I see clients with mental clarity and better energy and weight loss and better insulin sensitivity and drop in blood sugar and weight loss, like all these things are just great. The problem is those in my experience tend to flip. After the fact, where they flip to the complete opposite, where maybe that person, is starving now and is ravenous and is, has to eat a ton of food to feel satisfied again.

[00:26:14] Isaac Pohlman, RD: Maybe they've stalled in weight loss. Maybe they actually gained some weight back, right? Maybe their insulin sensitivity is now going the opposite way. Maybe they're seeing a climb up in their blood sugar. I've had clients try keto and been on keto for a long time and now their blood sugar is slowly starting to rise, right?

[00:26:29] Isaac Pohlman, RD: Okay. Bye bye. Because the thing is with these protocols is that over time they're increasing stress in the body, right? A lot of clients when I hear this they'll say well carbohydrates are not essential to the body there's a difference between essential and optimal because the thing that we maybe don't I don't quite always either understand or fail to recognize is that what the body has to do if it's not getting the nourishment it needs, and if it's not getting carbohydrates, it's going to get it from somewhere.

[00:26:55] Isaac Pohlman, RD: It's either going to get it from your diet, or it's going to get it from your muscle tissue by breaking it down. And so when that happens over a series of long years, or even months for some people, they'll start to notice their hormonal health is off because, going back to stress, it impacts insulin, it impacts thyroid hormone, it impacts progesterone, right?

[00:27:15] Isaac Pohlman, RD: So there's so many pieces that I think we don't consider as a result of keto and fasting, and it's all focusing on, okay, what is the outcome that we're getting? Maybe the outcome is weight loss, or maybe the outcome is improvement in A1c or blood sugar. And I think it's fine to focus on that.

[00:27:32] Isaac Pohlman, RD: But, I think we put blinders on to what are the consequences of not nourishing yourself in a way that's sustainably supportive in the long term. And if we fail to recognize the interconnections that carbohydrates have or with nourishing yourself in a sustainable way for many people, they might improve their blood sugar or lose weight, but it's going to come with 10 different strings on the end of that.

[00:27:55] Christa Biegler, RD: Yeah, I, too, get people from that realm happily because usually adrenals and thyroid have taken a The brunt of that, like you said, sometimes when there's a lot of, let's say there's blood sugar dysregulation, et cetera. They go through a process, like you said, they use up some of that kind of overfed undernourished resources.

[00:28:20] Christa Biegler, RD: And then once they use that up underneath of that is not a solid foundation. And so I find that. If there's something that declines, as you said, stress or adrenal function, it's going to affect you, all of those hormones from the adrenals, which are going to affect everything blood sugar wise, of course.

[00:28:38] Christa Biegler, RD: So that's my feelings there. It's pretty cool how it's all interrelated. It's just that, keto, like the sales tactics for that, which whatever I worked for a fasting program. That's how I am well aware of what this looks like. But. The sales tactics there is you can fit it in a sentence pretty easily.

[00:28:58] Christa Biegler, RD: It's do this and have all of these benefits, but 

[00:29:01] Isaac Pohlman, RD: yeah, 

[00:29:01] Christa Biegler, RD: sustainability, 

[00:29:03] Isaac Pohlman, RD: right? I think there's also, 

[00:29:04] Christa Biegler, RD: and I don't know, I don't have strong feelings about this, but I think as humans, we tend to, if we have those addictive personalities or a little must be, if a little is good, then a lot must be better.

[00:29:15] Christa Biegler, RD: And I think, There's probably more intelligent ways to go about this with carb cycling, but I think it's missed somewhere, I don't, I think there's potentially a lot of education, so around that. All right, so we covered insulin resistance, covered some numbers, we covered some CGM stuff and tracking.

[00:29:32] Christa Biegler, RD: The one thing we haven't really covered is reactive hypoglycemia. Talk about that, tell us about it, tell us how people show up to you with that, and then what do you do? 

[00:29:43] Isaac Pohlman, RD: Yeah. Yeah. Reactive hyperglycemia is an interesting thing. I'm getting more and more clients from that area. And I don't know if that's just referrals or just the way that things are progressing, but I'm seeing that a lot more.

[00:29:56] Isaac Pohlman, RD: And reactive hyperglycemia, if you're not, Quite familiar with it. It's low blood sugar that typically happens a few hours or soon after somebody eats and they might eat again and it might temporary fix some things and their blood sugar comes right back down again, and so they have challenges with keeping their blood sugar up and are riding this like Blood sugar roller coaster all day long and that's what their energy and their mood feels like too It falls right along with that.

[00:30:23] Isaac Pohlman, RD: And so they're very depleted very exhausted dead I find it can vary from like a minor annoyance where they just have to eat very often. And they know that and then it can vary all the way up to those that can't drive and can't work because they can't think and they're concerned about when that next episode will happen.

[00:30:42] Isaac Pohlman, RD: And if it happens when they're driving it's going to be very severe to the point where they could hurt themselves or somebody else. And it can be for a lot of. And it's like very debilitating and miserable if they are in that situation because they feel like they can't go out. They have to be chained to the kitchen and food and bring food with them everywhere.

[00:31:01] Isaac Pohlman, RD: They don't feel comfortable going out with friends or family or eating at gatherings because they're always in the back of their mind is like, when is that next episode going to happen? And I feel for them. It's a tough one. The thing is with reactive hypoglycemia it's really interesting.

[00:31:16] Isaac Pohlman, RD: Going back to the insulin conversation a lot of them are at the beginning stages of insulin resistance. So if we look at a progression, typically it's going to go hypoglycemia slash reactive hypoglycemia. Maybe a mix of hypoglycemia and high fastings, insulin resistance, pre diabetes type 2, it varies, the spectrum goes up.

[00:31:37] Isaac Pohlman, RD: For these individuals, if they continue to have low blood sugar, what it will actually cause is a rise in stress, and therefore a rise in blood sugar over the course of time, that, where those lows now become highs, right? If we can catch this early, it can prevent the progression of diabetes, but it can also stabilize their blood sugar so they can live a normal life again.

[00:31:57] Isaac Pohlman, RD: love working with these clients. Cause you know, a lot of times if you get to the root of these, like I've had clients, basically be completely stabilized in three to six months, which is shocking because a lot of these clients come to me and it's they've been having these lows for five, six months.

[00:32:12] Isaac Pohlman, RD: 10, 15, like even 30 years, I had a client with 30 years of chronic low blood sugar. And I just, that, I think that speaks to just a lack of information or lack of direction from what they were getting. And it sounds like too, they had well meaning resources, but I just don't think that there's quite an understanding on that.

[00:32:30] Isaac Pohlman, RD: With reactive hyperlipidemia, it is very interesting. I find stress is a huge player with these individuals, maybe some trauma, mental health trauma in the past for these individuals. But a lot of times they're in understandably, so their focus of their life becomes so negative and so consumed with their blood sugar that.

[00:32:49] Isaac Pohlman, RD: They don't do the hobbies. They don't focus on the things that they've enjoyed. And so it almost it feels like it takes the life out of them in a sense. So one of the first things that I work with them is not even about food. It's about how can they set up their day in a way that's a little bit more supportive to them.

[00:33:04] Isaac Pohlman, RD: And so I have them kind of document their day and say, Hey what is your day just on average kind of look like? And, maybe in the flip of that How could you make it maybe a little bit more ideal? What would you change, realistically? Not saying you have to quit your job or ignore your kids, but what could you do to make that just a little bit more supportive than it is right now?

[00:33:24] Isaac Pohlman, RD: And we build on that over the course of time, but the reason why that's important is because stress ultimately drives reactive hypoglycemia. It forces the body to be more insulin reliant or insulin dependent. And as a result of that, We're overproducing insulin, we're overproducing insulin, relying on that.

[00:33:41] Isaac Pohlman, RD: And over time the bottom kind of falls out where we have no stability there. And a lot of that does come down to minerals. One of the things that I mentioned, I think yesterday was around like the blood sugar ratio calcium to magnesium. And so for most clients if it's a part of their package, I will run like an htma on them and nine times out of ten I will see this calcium to magnesium ratio be high.

[00:34:05] Isaac Pohlman, RD: And the reason why that's significant is because calcium is a signal for insulin to be released. And so if someone is very high in calcium, ultimately that means they're going to be more and more reliant on insulin. And at the same time with this ratio, calcium is high, magnesium is low. And so when magnesium is oftentimes low, that often prevents them from having like stable blood sugar or tolerating carbs very well.

[00:34:33] Isaac Pohlman, RD: So they'll spike up. insulin will have to be released and then they'll drop down. So both of those minerals are super, super important to have in balance. Otherwise they're going to be continuing to be stuck in this cycle of low blood sugar and ways that you address that as through stress management and bonding and more supportive routine, but also with balancing out their meals, looking at maybe some minerals supplementation as well.

[00:34:59] Christa Biegler, RD: I'm thinking about your client that had this for 30 years. And I think about how sometimes when you have things for over a decade, sometimes it takes a little bit more time to correct it. And I also think about people who don't have mineral testing and resources at their disposal yet. I was thinking about what they are driven to.

[00:35:20] Christa Biegler, RD: I. Understand the entire feeling as you do when sometimes it's at the end of the day, it's minerals caused by stress, but if they don't have that as part of their toolbox, I wonder what are some of the other integrative approaches to hypoglycemia besides reducing stress and improving your intake.

[00:35:42] Christa Biegler, RD: So it's more consistent throughout the day. I wonder what other big ones pop up. Is there anything else that comes to mind? 

[00:35:48] Isaac Pohlman, RD: Yeah, I've had clients that have taken like a lot of supplements a lot of them will go to like functional doctors and get a lot They'll be on like 10 20 different supplements. So I will see that quite a bit.

[00:36:00] Isaac Pohlman, RD: I will see Typically like a low carb dieting history Paleo keto, but a lot of times low carb for sure trying to think if there's been other ones I hear sometimes they dabbled into pro metabolic. And again, I don't know what that term means anymore, but it's I hear that term a lot or repeat the repeat diet I'll hear a lot.

[00:36:20] Isaac Pohlman, RD: And I think for each person that looks a little bit different, depending on who you talk to, but those are typically the. The things that I see and a lot of times it's just been, they've worked with their doctor or maybe a functional practitioner, but typically in my experience, they haven't looked at minerals.

[00:36:36] Christa Biegler, RD: Cool. Just curious what else popped up. All right. We've covered a lot today, Isaac. Let me run through the list here. I think you did a good job covering stress in some capacity. We may round it out with that. We talked about. 

[00:36:48] Isaac Pohlman, RD: Sure. 

[00:36:48] Christa Biegler, RD: When things are nutrition related, not nutrition related. On our first episode, we got a little bit into minerals nuances.

[00:36:55] Christa Biegler, RD: They're looking at some of those biomarkers today. We talked about reactive hypoglycemia, CGM, markers, insulin resistance, anything else you feel like we missed on our list? Cause we were pretty comprehensive. 

[00:37:06] Isaac Pohlman, RD: Yeah, we were. I'm just looking over if there's anything else I have in my. Notes here.

[00:37:14] Isaac Pohlman, RD: I do have one thought on how clients sometimes structure the day a bit and that I think that feeds nicely into stress a little bit too. So I could cover that then. 

[00:37:24] Christa Biegler, RD: Yeah, go for it. 

[00:37:25] Isaac Pohlman, RD: Okay. I see a lot of clients that start with me too and this is part of their routine or structure or schedule of the day.

 I'd be curious of what you see too, Christa, but I see a lot of folks that start off the day, like in chaos and stress where they, right from the get go that they wake up, it's like they're taking care of everybody else except themselves. And so there's. Rarely any time for them to, have a meal or to step into the day, ease into the day.

[00:37:53] Isaac Pohlman, RD: I like to say and it starts, from stress, from right from the get go where they're in go mode, from that. Perspective on until probably the evening, I would say until things start slowing down. And I think that's where they start like feeling those hunger signals come back and they're starving and they eat a lot and they might overeat and that's when they time they have the most time for themselves and they might settle into doing something relaxing and they protect that at all costs.

[00:38:22] Isaac Pohlman, RD: And then sometimes I find That kind of feeds right into them not getting good sleep, or they're going to bed late, and then the cycle continues where they have to sleep in order to get the sleep that they need, and then their morning is chaotic and stressful, they don't have time for themselves, and then they basically back load all of their nourishment, time for themselves, their food at the end of the day, which only they need.

[00:38:44] Isaac Pohlman, RD: reinforces this cycle. And the reason why that's important for somebody with trying to regulate blood sugar is I find for a lot of folks, the their fasting readings, their morning blood sugars are their sometimes their most highest, blood sugar of the day. And if you're backloading all your food and nourishment at the end of the day, that's going to show up in the next day's morning blood sugar, right?

[00:39:04] Isaac Pohlman, RD: So if I were to eat this, my biggest meal, right before I went to bed. I would have a high blood sugar, in the morning, even if my insulin dosing is on par and my lifestyle is great, like that will contribute to a high morning reading. And so when I see clients that have all this nourishment, meaning time for themselves and food at the end of the day, that's typically a sign that they're not setting up the routine in the center or in the beginning of the day in a fashion that's supportive for them.

[00:39:32] Isaac Pohlman, RD: So what I would. We really like to see is like a client that maybe their smallest meal of the day is actually dinner or maybe One of their smallest meals of the day is actually dinner because that tells me that they have gotten enough food throughout the day To feel satisfied so they don't have to catch up At the end of the day with that type of huge meal.

[00:39:52] Isaac Pohlman, RD: So I see that quite a bit. And so a lot of things that I work with clients is slowly starting to edge up some of that food into some of their snacks or having an earlier breakfast or having an earlier lunch or having a snack between breakfast and lunch. And what that does is it really provides that stability in the morning where many people need it.

[00:40:10] Isaac Pohlman, RD: As a result, they tend to feel more satisfied during that, even those evening hours, and then as a result, their blood sugar looks better. better the next day and the next day and the next day. So it's a huge piece, not just with blood sugar, but how you feel. Because if you're going on empty during those morning and afternoon hours, and you're only getting food at the end of the day you're not taking advantage of your nutrition plan as best that you could.

[00:40:34] Isaac Pohlman, RD: And for many people, they're going to have issues in the way that they feel as a result, just because they're lacking that during the times where they need it the most. 

[00:40:42] Christa Biegler, RD: Yeah, I couldn't agree more. I see that same pattern, and I've been that same pattern, so I understand it. And I can say that when you're ravenous, when you haven't eaten enough, you're inhaling your food, right?

[00:40:54] Christa Biegler, RD: And you're pretty unconscious of your satiety signals. You're not chewing it up. You're not digesting it. So there's a lot of other things that can then come all from that. I would say, it's such, I don't know what you would, I, like you, say, it's waking up being reactive instead of proactive.

[00:41:12] Christa Biegler, RD: And then, but you said, Hey, it follows you the whole day. It's like everything gets, it's just, it's like a, I don't know. You just push things. And then there's a mountain at the end of the day. I don't know. It almost needs a name because it's so common. And I think when we talk about, How does a person tactically reduce stress?

[00:41:30] Christa Biegler, RD: That is like such a good example for how to flip that upside down. It's like really right there. And I bring this up every once in a while in 2020, I had this mentor and I think it was early 2020, maybe it was late 2019. And I remember she said, how will you know if you're successful? And the question was, and the answer for me was if I go to bed and get up early.

[00:41:53] Christa Biegler, RD: Go to bed early and get up early because, I've, we've all been there. It's if you get revenge bedtime stuff, and that'll happen, especially with, I know women of young children are just, and like we start to build habits and it's better, but then you don't, and then you don't feel good.

[00:42:07] Christa Biegler, RD: So it's like front load your day with awesome. Basically, it'd be a great tagline. Something like that. I like that. 

[00:42:12] Isaac Pohlman, RD: I like that. I like that. You said revenge bedtime. Is that what it was? Revenge 

[00:42:16] Christa Biegler, RD: bedtime is a term. 

[00:42:17] Isaac Pohlman, RD: I love that. I love that. For women 

[00:42:19] Christa Biegler, RD: who like put their kids to bed and then they feel like they didn't get anything for themselves.

[00:42:23] Christa Biegler, RD: So then they're going to stay up late with their whoever and watch Netflix. Whatever TV. And then I find like with bedtime TV, at least at our bedroom is I'm not watching Yellowstone before bed. This is awful. And I know, fortunately we don't have to watch that anymore, but it's I don't need to raise my cortisol.

[00:42:41] Christa Biegler, RD: How is this not raising your cortisol? I'm trying to, I'm going to, I would like to go to sleep now. So it takes time for that cortisol to come back down. So 

[00:42:48] Isaac Pohlman, RD: it does. It does. Good 

[00:42:50] Christa Biegler, RD: stuff. Isaac, I think you have a good pulse on these real things of in a real empathy around the stressors that these clients have.

[00:42:59] Christa Biegler, RD: So thank you for that. 

[00:43:00] Isaac Pohlman, RD: Yeah. Thank you. 

[00:43:01] Christa Biegler, RD: Where can people find you online? 

[00:43:04] Isaac Pohlman, RD: A lot of my content on Instagram. So you can just find me in my Instagram handles. Just my name, Isaac Pohlman. I also have a website that has all sorts of free resources. No matter where your blood sugar is at or, what goal you're trying to achieve.

[00:43:17] Isaac Pohlman, RD: Do you improve with blood sugar balance? Like we touched on today. I think it can help anybody, no matter if you're trying to just improve your numbers or the way that you feel or hormonal health or lower stress. So I have a few guides that you can download if you'd like to. I do have it, if you're wanting to learn about all these topics that I talked about today, a little bit more in depth, I do have a book coming out in the next one to two months, depending on how quickly my book team can get it out there.

[00:43:40] Isaac Pohlman, RD: And so it's title is have your carbs and eat them too. And it's basically it's a person with type one diabetes lens, right? But it can certainly benefit those that want better blood sugars. And if they have type two diabetes or PCOS or just want to feel their best, certainly can be something that can be helpful because it's all design and how to use.

[00:44:01] Isaac Pohlman, RD: Be less reliant on insulin, which can help, in a variety of different ways because it supports blood sugar, it supports hormonal health, it supports the way that you feel. Basically being able to eat carbohydrates while keeping your blood sugar really steady. So that's coming out. It's only going to be about five bucks.

[00:44:15] Isaac Pohlman, RD: If that's something you want to learn more about. Great. And then on my website, I just hired two more co coaches. Taking on more and more one on one clients. So if it's something, again, you want to learn more about don't hesitate to reach out. 

[00:44:27] Christa Biegler, RD: Cool. Thanks so much for coming on today.

[00:44:29] Isaac Pohlman, RD: Yeah. Thanks Christa.