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About Brian Mowll, DC,CDE,IFMCP
Dr. Mowll is the founder and medical director of SweetLife® Diabetes Health Centers and serves clients worldwide as The Diabetes Coach. He is a certified diabetes educator and was one of the first doctors to be certified to practice functional medicine by the prestigious Institute for Functional Medicine.
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02:12 Prevalence of Diabetes: Diabetes is a global pandemic. The western diet, stress, and living sedentary cushy lifestyles has spread throughout the world and has set us up for diabetes. A study done in 2015 published in JAMA (Journal of American Medical Association) that said that 50% of the US population has diabetes or prediabetes.
05:06 Assessing our Blood Sugar: We should all have a glucometer and be testing our blood sugar. Dr. Mowll recommends the Precision Neo by FreeStyle. The most important time to check your blood sugar is after you eat. It is postprandial blood glucose levels which are the ones that are most dangerous. It is a test of glycation or a form of oxidative stress that ages us faster and causes the diabetes complications. We can have these complications without having diabetes. Extra sugar floating in our system caramelizes or sugar coats the proteins around nerves and the endothelium of blood vessels, the brain, kidneys, and in the small blood vessels in the hands, feet and sex organs. The glycation damage is ultimately what will lead to dysfunction in the body: sexual dysfunction, dementia, poor circulation, and neuropathy or nerve issues. Normal blood sugar is about 83. If it is up into the 90s or up into the 100s, you need to be paying attention.
09:38 Blood Sugar Thresholds: From a diabetes diagnosis standpoint, blood sugar should never go over 200. Post meal blood sugars, in Dr. Mowll’s opinion, should stay within 20 to 30 points of your before meal blood sugar. Exercise, stress and other things may elevate blood sugar. Check your blood sugar before and about one hour after you eat your meal. Testing 2 to 3 hours after a meal lets you know how your body is recuperating and glucose control. If your blood sugar remains elevated two the three hours after a meal, it could be sign of glucose intolerance, another form of prediabetes. It is a problem. Your blood sugar should be back down to baseline within 2 to 3 hours. Diabetes is not just high blood sugar; it is also how you regulate your blood sugar. You can use the pre and post blood sugar check to determine what foods work best for you. Some “healthy” foods may not work well for you. If you have normal blood sugar metabolism and you eat a good low carb or ketogenic style meal, you will see no blood sugar elevation. It may even decrease. That is optimal.
14:12 Fasting Blood Sugar Testing: Some of us have the Dawn Effect or Dawn Phenomena where our morning reading is the highest. That needs to be addressed. If this is the case, a better time to get a baseline is just before dinner. We need 4 hours of no food consumption. Compare that test number to the result in the morning fasting reading. A morning rise is not your baseline. It would be from a hormone influence. If we start our day at a fasting blood sugar rate of 110 or 115 and your blood sugar rises 30 points with a meal, you are in the danger zone.
16:23 Type 2 Diabetes Subtype Type O: The Subtype O, about 50 to 60% of people with diabetes, is typically overweight, and highly insulin resistant. The dawn effect is a possibility for this subtype. They have high insulin levels throughout the day. It will not come down to where they can burn fat effectively. Fasting and a ketogenic style diet can bring it down.
18:24 Type 2 Diabetes Subtype Type I: The Subtype I is a thin type 2 diabetic. It is similar to type 1diabetes. Subtype I differs from Type 1diabetics in that they maintain a lower blood sugar without external insulin and the Subtype I diabetic still has beta cell function, so they can still produce insulin. They do not make enough insulin for their diet. Due to the lack of insulin, they are thinner. Often with Subtype I diabetes, there is an autoimmune component with damage done to the pancreas by the immune system.
20:05 Type 2 Diabetes Subtype Hormone Type: These diabetics have adrenal fatigue, adrenal dysfunction on the low end, low cortisol production and low thyroid function. This has a huge impact upon the metabolism. If we are not burning blood sugar, it can raise blood sugar, triglycerides, and free fatty acids in the blood, hypothyroidism. That can cause insulin resistance. The hormone imbalance is the driving force. About 30% of Dr. Mowll’s clients have hypothyroid and may be taking some synthroid, but their thyroid levels are not optimized or stable. Often the thyroid component of diabetes is ignored.
21:20 Type 2 Diabetes Subtype S: This diabetic is stress driven. They tend to be type “A” personalities. You would not guess that they are diabetic. When they are diagnosed, they are embarrassed. The stress is mental, overworking, being overwhelmed, poor sleep, gut dysfunction, chronic muscular-skeletal pain, and chronic blood borne infections like Lyme disease, Epstein Barr, gut infections, parasites, or candida. Dr. Mowll’s Subtype S patients are generally already on a Paleo or low carb diet, they are exercising and doing all of the things they should do, but their blood sugar does not come down.
23:56 Hemoglobin A1C Biomarker: Triglycerides, glucose and hemoglobin A1C are the first three things Dr. Mowll looks at.. The hemoglobin A1C is described as a 3 month average of your blood sugar, but it is more of a surrogate marker for blood sugar. It tells us how much damage is being done by high blood sugar to the red blood cells. If damage is being done to red blood cells, there will be damage to your large blood vessels, small blood vessels, your nerves, your brain, your kidneys and other organs. Optimal A1C is between 4 ½ and 5 1/2. Five and a half is a little high. Most healthy people test at about 5. The American Diabetes Association says that 7 is good enough. Research shows that for every point you are adding, you are adding about a 15% to 18% greater likelihood of complications like blindness, kidney failure, and cardiovascular issues like heart attack, stroke, neuropathy, sexual dysfunction, or dementia. You want that A1C under 6 and preferably around 5.
22:44 Triglyceride Biomarker: The Triglyceride test tells us if we have been eating too many carbs. We could look at an organic acids test, mitochondrial function and detoxification, advanced lipid markers, but triglycerides are simple, easy, and cheap and give us a lot of information. If triglycerides are high, above 70, it is an indication that our metabolism is not working well. You are not burning fat effectively, depending upon glucose rather than burning fatty acids. It means that the free fatty acids form a triglyceride, a glycerol and 3 fatty acids and the fat is building up in your liver, spilling into your bloodstream. It is like blood fat. Now your blood vessels and organs are becoming fat coated as well as sugar coated, causing insulin resistance, which causes diabetes, issues with weight, belly fat and more. We should seriously look at a good ketogenic diet or a good low carb diet where we cut out most starches, sugars, fruit and other forms of carbohydrates except for fiber. This will encourage your body to burn fat. When people are overweight and they begin burning fat more effectively, triglycerides may rise temporarily.
32:54 Effective Therapies: The process starts with a very thorough functional medicine assessment. The patient’s story, condition, subtype and testing determine the treatment. For many of us, healing the gut is the highest priority. For those of us with stress driven diabetes, dealing with stress is the highest priority. Adaptogens and herbal formulas can help, but you cannot medicate a bad lifestyle and make significant change. It starts with the basics. It starts with a good low carb or ketogenic style diet with a goal of under 50 grams of carbs per day. Eat quality food, clean meats, healthy fats and focus on vegetables. Dr. Mowll thinks that our diet should be 75% fibrous above-ground vegetables. Vegetables are important for those of us with a blood sugar imbalance because they do not raise blood sugar and contain fiber and phytonutrients. Drink lots of water and healthy fluids.
37:26 The Importance of Physical Activity: Most of us do not move enough. Try to keep moving all day and move as much as you can. Try to walk for 20 to 30 minutes after every meal.
38:21 Stress Management: Meditation, journaling, healthy baths and relaxation techniques like HeartMath heartrate variability training, should be incorporated into our lives to reduce stress. Quality sleep is crucial.
38:36 Nutrient Repletion: Make sure that we have the right vitamins, minerals, and nutrients that we require. If we have not had the best diet over the years, we may need to replace missing nutrients.
39:58 The Importance of Breakfast: Skipping breakfast is not intermittent fasting. Skipping breakfast can shift our circadian rhythm. Since our first meal is at mid-day and our second is at supper, our third or incessant snacking is in the evening. Eating in the evening is not good for our metabolism. Intermittent fasting should be done only after our metabolism has been shifted to effective fat burning mode. Eating breakfast within an hour of waking up revs your metabolism. Protein first thing is a good thing. It could be something small and simple.
42:26 The Second Meal Effect in Diabetes: Our blood sugar will rise less after the second meal of the day than the first. It is as though it primes the insulin release from the pancreas. Insulin/blood sugar metabolism works better at the second meal, so a small breakfast prepares our bodies for a larger lunch.
43:16 The Importance of Sleep: Sleep is overlooked in diabetes care. We go to bed too late. On average, we should go to bed early, but 10 pm. At about 10:30, cortisol levels begin to rise again. We should go to bed and wake up about the same time every day, even if we stayed up late the night before. Research shows that unstable sleep and waking times causes insulin resistance, makes us hungry, causes us to retain weight, and throws cortisol levels out of balance and effect blood sugar. Sleep hygiene includes staying away from computer and phone screens in the evening. Morning and evening rituals/routines are important. Parents know that children do better if they have a routine. We do too. This will let our brain know that it is time to shut down. It could include dimming the lights, lighting candles, relaxing, reading, praying, meditating, breathing, or a bath, making it the same every night.
48:43 Supporting Supplementation: Recent research shows that people that take melatonin at night helps to normalize blood sugar. With melatonin, more is not necessarily better. Dr. Mowll recommends no more than 1 mg of melatonin. There is evidence that taking more can suppress your natural production. For blood sugar health, berberine has metformin-like effects in the cell, but with less known toxicity. Metformin can cause GI distress and it depletes vitamin B12. Berberine is a plant compound, but that does not mean that it is completely safe to take in large quantities. Dr. Mowll recommends cycling on and off berberine at 6 week intervals to rest the liver. Minerals like chromium and vitamins like biotin have been shown to improve glucose tolerance. Apple cider vinegar seems to help just about everything, and it can help blood sugar as well when taken before a meal. Ceylon cinnamon can be very effective at reducing blood sugar and improving lipids when taken in higher doses, at the 8 to 10 gram per day range, about 2 teaspoons. Gymnema sylvestre is an effective herb to help preserve beta cell function in the pancreas and regenerate beta cell function in the pancreas. It improves insulin resistance. When you open a capsule and put a little on your tongue several times a day, it can reduce sugar cravings.
54:11 Dr. Mowll’s Morning Routine: Dr. Mowll has 4 kids and sees clients, so a morning routine is very important. Dr. Mowll awakens about 6 a.m. He has an hour or a little more to pray and do mindfulness meditate for about 5 minutes, consume a double shot of espresso and 6 days a week he gets some exercise. Research shows that caffeine improves lipolysis or breakdown of fat during fasted exercise. Sometimes he does yoga or something relaxing, but often he does some sprint/cardio and 10 minute blood sugar burners. They are body weight exercises like squats, lunges, pushups, and pullups.
58:12 Dr. Mowll’s Favorite Nutrient: Dr. Mowll loves green drinks. He throws a scoop of greens into his smoothie or even just a glass of water a few times a day. It is energizing. He also likes chlorella. He will chew 5 or 10 chlorella tabs throughout the day for immediate energy and wellness.
01:00:03 One Health Tip for America: As a culture, we need to take health seriously. We have lots of big issues: poverty, drugs, healthcare reform (disease care reform), homelessness and immigration. Rarely is there a focus on health. That is where it all starts. Very few of us take our health seriously. It is not just about preventing disease, it is about optimizing performance and potential. The healthier you are, the better you are eating, the more you are exercising, the better you are managing your stress and sleeping well, and everything is better. Your relationships are better. You feel better. Your mind is clearer and you make better decisions. You are a nicer person. Taking our health seriously would have a profound positive impact upon our culture and the other big issues.
01:02:30 Diabetes Summit 2016: Dr. Mowll interviewed Mike about gut hormones and the gut. He interviewed athlete Ben Greenfield and he also Dr. Robert Lustig about sugar. Dr. Mark Hyman discusses consuming fats. There is a discussion about gestational diabetes. There are interviews with unconventional dietitians about low carb/ketogenic diets. Dr. Sarah Gottfried discussed hormones. Sleep and sleep quality was discussed with Dr. Sarah Ballantyne, Paleo Mom.
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