Ep.94 The Continuous Glucose Monitor for Non-diabetics: Harnessing Data for Metabolic Health and Weight Loss

Unlock the secrets to a healthier life with Dr. Paul Kolodzik, as he shares the life-altering benefits of continuous glucose monitoring. This isn't just for those managing diabetes; it's a revelation for anyone grappling with metabolic health. Throughout our conversation, we delve into the insidious effects of high blood sugar on vascular diseases and dissect the dietary choices that could make or break our health. Dr. Kolozdik, with his unique blend of emergency and metabolic health expertise, gives us the lowdown on how simple changes in nutrition and lifestyle can forge a path to overcoming insulin resistance and optimizing overall well-being.

Ever wondered why some people struggle with insulin resistance despite not being overweight? Dr. Kolodzik illuminates the subtle signs of this condition and explains the crucial differences between visceral and subcutaneous fat – knowledge that could redefine your approach to health. Our discussion takes a turn into the inflammatory nature of common dietary oils and how making smarter choices in the kitchen could significantly reduce health risks. The transformative potential of continuous glucose monitoring becomes crystal clear as Dr. Kolodzik walks us through the practical steps for early detection and management of blood sugar irregularities.

We do a deep dive into GLP-1 mania, the benefits, and the downside of these medications. There are nuances to using GLP-1s responsibly and effectively, and Dr. Kolodzik shares his must-haves for patients to not only be successful but for his patients not to be on the drug forever. 

The episode wraps up with a strong focus on the power of strength training – particularly for the legs – as an essential tool for maintaining mobility and independence into our later years. Dr. Kolodzik's practice not only embraces the latest in telemedicine but also offers actionable advice for finding healthcare providers who can support your journey to metabolic health. And for those looking to get a leg up on their health, Dr. Kolodzik's personal fitness regimen and his approach to strength training serve as a testament to the importance of a holistic health strategy that you don't want to miss.

To find a metabolic/CGM health provider near you:
https://www.lowcarbusa.org/

You can find Dr. Paul Kolozdik at:
https://metabolicmd.online/
https://www.instagram.com/metabolicmds/

His best selling book can be found on Amazon
The Continuous Glucose Monitor Revolution: Lose Weight, Look Great, and Live Longer with Continuous Glucose Monitoring

I'd love to work with you! Let me help you reach your health and fitness goals.
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This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.

Transcript

Michele Folan: 0:08

Health, wellness, fitness, relationships and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, michelle Fohlen, and this is Asking for a Friend. The Constant Glucose Monitor is one of the most powerful tools in modern medicine. Especially with the increase in metabolic disease, it can be an essential tool people can use to take back control of their health. The beauty of this technology is that I'm not just speaking of diabetics. Non-diabetics may still have struggles with metabolic syndrome. Dr Paul Kolodzik is a double-board certified emergency and metabolic health physician with 30 years of experience. He has used continuous glucose monitoring to help thousands of patients lose weight, prevent and reverse disease. In his first book, the Continuous Glucose Monitoring Revolution, Doctor Kolodzik presents a comprehensive program for metabolic health success. Welcome to Asking for a Friend, Dr. Paul Kolodzik.

Paul Kolodzik, MD: 1:21

Thank you for having me, Michelle.

Michele Folan: 1:23

It's nice to meet you and I did get to review your book and it was fun for me. As you know, I have a diabetes background of sorts. I was in that arena for about 12 years, so it brought back a lot of great memories and lots of great information that actually I forgot. So I appreciate that very much. I would love for you to just provide a little information, fill in the holes, what I didn't get to in your introduction.

Paul Kolodzik, MD: 1:56

Okay, thanks. Well, I'm certain you helped a lot of people when you were in the diabetes arena, so thank you for that effort. My background is in emergency medicine have worked in the emergency department for 25 years, still pulling a shift a week in the emergency department because I still enjoy closing the door and sitting down with the patients. But it is in that career, in emergency medicine, that I saw a lot of vascular disease, peripheral vascular disease, congestive heart failure, strokes, heart attacks, diabetic kidney disease, et cetera. What gets all the press in the emergency department is the overdoses and the gunshot wounds and the multiple traumas. But what emergency physicians see every day, day in and day out, all day long, is the complications of vascular disease. That means inflammation of the arteries in your body and ultimately, them getting clogged up to cause those problems that we talked about.

Paul Kolodzik, MD: 2:57

What I realized over that career is blood sugar. High blood sugar even I think and we'll get into this even I think, sometimes much more importantly than cholesterol is really what causes those issues for people. Then, of course, blood sugar also leads to the increased rates of obesity that we have. I researched this and determined that, and we will talk about this in detail. I imagine as well that really the best way to approach both weight loss and decreased vascular information for the majority of overweight Americans is a low-carb diet with some other tools like intermittent fasting and strength training that lower insulin resistance, because the key issue is insulin resistance. I started my metabolic health practice about seven years ago. I've treated thousands of patients since then and it's been very satisfying to be able to prevent these problems as opposed to just react to them in the emergency department.

Michele Folan: 3:59

One thing that I think is worth noting is that you don't have to be obese or even overweight to have insulin resistance. Would you say, then insulin resistance is the precursor to having full-blown metabolic disease.

Paul Kolodzik, MD: 4:17

Yeah, insulin resistance comes first because it starts well before your blood sugar test tells you that your pre-diabetic or your hemoglobin A1c tells you that you're pre-diabetic. Insulin resistance can be ruined for years before then and people should be aware of this, especially if you have risk factors, which is primarily being overweight or having pre-diabetes or diabetes in your family. I think it's important for people to be proactive to prevent those problems Before you end up down the road, because you can get to a point, for example, when you can't reverse diabetes. Pre-diabetes is generally reversible, so I think that's a very important period of time for people to be addressing these issues. So what you want to do is try to address these with diet and activity prior to the time that some of the problems are irreversible.

Paul Kolodzik, MD: 5:11

And a lot of this disease is reversible. Pre-diabetes is reversible. With decreasing insulin resistance and weight loss you can reverse sleep apnea, you can reverse fatty liver disease. You can lower your blood pressure. You can even lower your cholesterol with a low-carb, high-fat diet, which is a little bit counterintuitive, but we'll talk about that. So this is an opportunity for people, and one reason I'm doing this in my practice is because I've been able to help people basically change their path in terms of long-term health issues, both in reversing disease and preventing disease.

Michele Folan: 5:46

When you are sitting down speaking to a patient for the first time. How much does heredity come into play? Because I guess it's kind of the chicken or the egg, right? Do we inherit the propensity for insulin resistance and obesity, or do we inherit the, maybe the lifestyle or the habits?

Paul Kolodzik, MD: 6:09

Yeah. So there's no question. There is a genetic component, because certain ethnic groups, even if not overweight, have a tendency to have insulin resistance. For example, south Asians have more insulin resistance even if they are not overweight. But for the majority of Americans it is lifestyle issues and I have a certain philosophy about this.

Paul Kolodzik, MD: 6:31

It is my belief that we were eating OK for generations in this country, and even our ancestors before that, when we had a balanced diet that was not heavy in carbohydrates. And then we were told in the 1970s to follow the food pyramid. There's like a circuitous way that happened in terms of fat is evil and you have to avoid fat at all costs and you should get away from red meat. And of course, what happens once we follow that advice by the US Department of Agriculture? We've had epidemics of obesity and diabetes. So when we talk about low-carb diets, we're really advocating just going back to the way we ate for generations.

Paul Kolodzik, MD: 7:12

You know, you look at a movie or a photograph from the 30s, 40s and 50s. You don't see the rates of obesity that we have today. So what happened was when we were told to increase our carb intake to 50% of our diet overnight when the food pyramid came out in 1972, what happened was the epidemic of obesity took off and, as predicted, insulin resistance rose. So 10 years later, the epidemic of diabetes took off and now, subsequently, we're seeing the fruits of that with the vast the rates of vascular disease that we see. So the answer is there is a genetic component, but a majority of this, I think, is lifestyle driven.

Michele Folan: 7:52

You know I had a guest on the podcast not too long ago and we were talking about added sugars in foods and that the new American Heart Association limit for women was 25 grams of added sugar. So that doesn't count fruit and the foods, that where sugar is naturally occurring, 25 grams of sugar, added sugar is not a lot, Right? If you look at what a Coke is, what 39 grams. A 12 ounce can of Coke is 39 grams.

Paul Kolodzik, MD: 8:25

Absolutely, that's an issue, and you know what happened with our change to increase carbs, and you know I'm a capitalist, so I'm not going to demonize the food processing industry. They're just have a business model that's profitable, even though I don't think it's in the best interest of the majority of Americans. But the way to make good tasting food is to mix sugar with refined flour, with seed oils, and that's what we get in our processed food, and so we're just not aware of the amount of sugar that they're getting.

Paul Kolodzik, MD: 8:58

And I'm going to throw a little thing in here about fruits. The fruits that mom told us to eat, when she told us to eat all our fruits and vegetables, are not the same fruits that are out there today. They're now genetically engineered to have high fruit dose contents, which is sugar, and so you actually have to be careful with everything you eat. So again, I'm just advocating going back to the food processing industry. I'm just advocating going back to the days when we had less processed food, when we had less refined, we had less sugar added to our food and basically lower your blood sugar so that you can reduce your insulin resistance, which helps to lose weight and we may get into the physiology of that.

Michele Folan: 9:40

Okay, you brought up seed oils, so I'm going to ask you a question about that, because I think there needs to be some clarification around what oils are okay for us, which are inflammatory. Can you talk a little bit about that?

Paul Kolodzik, MD: 9:54

So I got to be careful, because you're in Cincinnati, right In the Cincinnati area the home of P&G and basically anything that's made from a seed oil to a greater or lesser degree is inflammatory. So again back in the 70s we were told that you can't eat butter. You should eat margarine, which is obviously made from corn oil or one of the other seed oils. So generally the best oils for cooking and the best oils for consumption are the Omega 3 oils, which are olive oil and walnut oil and avocado oil. The other oils are seed oils and you know there's soybean oil in pretty much every processed food that you end up purchasing.

Paul Kolodzik, MD: 10:37

And what the reason I'm trading lightly is on the P&G thing is that the history is. This is that the seed oils were initially produced by P&G for industrial lubricants machines that needed oils. And then oil started bubbling up out of the ground in Pennsylvania in what the 1880s or whenever it was, and there was no longer a need for those seed oils as industrial lubricants. There was a cheaper way to produce machine lubricants. So P&G again, good business. People said we got to find some other need for these seed oils and they became food.

Michele Folan: 11:14

Crisco.

Paul Kolodzik, MD: 11:15

Yeah, the Crisco. Even just regular old corn oil you know my mom cooked with for years. Seed oils in general are pro-inflammatory. Try and gravitate toward olive oil and avocado oil and walnut oil, and seed oils are almost in every processed food, so you got to be careful of that. And then, of course, fast food that is fried is fried in seed oils as well.

Michele Folan: 11:41

All right, so we talked about insulin resistance. You don't necessarily need to be heavy to be insulin resistant. When would you suggest a patient start wearing a constant glucose monitor?

Paul Kolodzik, MD: 11:54

Okay. So the normal variables to assess for a presence of a blood sugar problem are a fasting blood sugar Over 100 is pre-diabetic. Over 125 is diabetic. The other parameter that your listeners may have heard about is hemoglobin A1C. Hemoglobin A1C is the number of glucose molecules, the percentage of glucose molecules that are attached to red blood cells so hence the word hemoglobin and A1C is the amount of blood sugar that is attached to it. So those are traditional numbers. Now, unfortunately, sometimes, even when those numbers are a little bit elevated because the way our healthcare system is set up, now People here from your doctor or medical provider is like oh, your blood sugar is a little bit high. We should keep an eye on that, and what that means is you're pre-diabetic or approaching pre-diabetes. So that is a time when you should pay attention and I believe it's a time when you aggressively should assess what's going on physiologically with your blood sugar. The best way to do that is to fold One is the continuous glucose monitor, but I'm going to throw in another option to help assess your level of insulin resistance.

Paul Kolodzik, MD: 13:06

It's a fasting insulin level. It's not done very often in American medicine, but a fasting insulin level along with a fasting blood glucose can give you your exact level of insulin resistance. So the physiology is that when you eat a carb of any type, your blood sugar rises and then your pancreas releases insulin. So insulin is the source of the signal to drive your blood glucose into your organs to use for energy, for example. Your muscles need to contract, so insulin drives that blood glucose into your organs. But if your carb intake has been high for a long period of time, like it is for most Americans, then your blood glucose is going to be persistently high. After a while the organs, like your muscles, stop listening to that insulin signal. The pancreas doesn't get the message. It keeps pumping out insulin, but the organs don't listen. That's what insulin resistance is. Your organs are resisting the signal from insulin.

Paul Kolodzik, MD: 14:08

Blood sugar is toxic. It causes inflammation in our joints, inflammation of our blood vessel line. So something has to happen with that blood sugar. So it goes to the liver and gets converted to fat and then it gets deposited around the middle. That's the reason that increased carbs cause increased weight for the majority of people Also causes a problem called fatty liver disease, again because blood glucose is getting converted to fat.

Paul Kolodzik, MD: 14:33

So the best way to assess level of insulin resistance that I have found is that you should check and fasting insulin level, which I think in terms of inflammatory issues, can be just as important or more important than a cholesterol. And then the other thing I do is I have my patients wear a two-week continuous glucose monitor so they can see what is happening with their blood sugar in real time. So these monitors are the devices you see on the back of the arms of diabetics. They give you a 24-7 blood glucose reading. So, with my patients, during their initial evaluation, we do a fasting insulin level and then I put a CGM continuous glucose monitor on them for two weeks and I say don't change your diet, just keep eating where you're eating and let's see where you live in terms of what's going on with your blood sugar. And then we follow that for two weeks as well.

Michele Folan: 15:24

Now, do you have them keep a food calendar or food log so that you can look and see where those spikes are and what they eat?

Paul Kolodzik, MD: 15:34

Yeah, people get pretty good at this, pretty quick in terms of realizing what spikes their sugars and what does not. So, yeah, there's actually a mechanism right within the app, the monitors on the back of the arm. You scan it with your phone, you get graphs of your blood sugar over the course of the day. You get an immediate reading of what your blood sugar is at that moment and you can also add what your food was. Because there is individual variability from person to person, food that you eat may affect me differently. So, yeah, people can get a great handle on what is spiking their sugars and what is keeping their sugars high.

Michele Folan: 16:10

Thank. You brought up visceral fat and I would love for you to explain the difference between visceral fat and subcutaneous fat and why visceral fat. You did talk about the insulin resistance with visceral fat, but what are the long-term ramifications of carrying around too much of it?

Paul Kolodzik, MD: 16:27

Yeah, so visceral fat is the fat that's actually within the abdomen. So it's not actually just under your skin in the area of your abdomen, it's within the abdomen. And, of course, when you have an increased amount of visceral fat, you're going to have higher levels of cholesterol and higher levels of triglyceride. So visceral fat is pro-inflammatory. Now, historically, that fat has been there to help us through times of famine or when, for example, ancestors, the only means they had for food supply was honey. So it had its purpose way back in the day. But for those of us now that have food at our fingertips 24-7, it is not as helpful and is pro-inflammatory. So my goal is to work with my patients to reduce visceral fat, and the way you do that is you reverse the process we just talked about. So we want to lower your blood sugar, decrease your carbohydrate intake not only sugars, but other complex carbs like pastas and some fruits bananas, for example, are very high in carbs potatoes, rice, etc. So what happens then? When you're taking in less carbs, the organs and again let's say, your muscles are looking around for more energy and they notice that the blood glucose is lower. So they're saying we need energy here somehow. What are we going to use for energy? The blood glucose is lower, but you're denying those organs that persistently high level of blood glucose. So they got to look for an alternative. What do they do? They look down, they look around the middle and they see that there's a source of energy there and that source of energy is fat that is broken down into fatty acids. That then serves as a source of energy. So basically that's what we want to happen, because that's when we lose weight.

Paul Kolodzik, MD: 18:20

If you are on an aggressive low-carb diet, you carry that a little bit further and you produce ketones when you're breaking down that fat, and that's where the word keto diet comes from. But basically we want to lower blood sugar, so the organs have to use fat as a source of energy and that results in weight loss, reversal of fatty liver disease. Usually blood pressure drops with that. This is interesting. Triglycerides drop like a rock on a low-carb, high-fat diet. And again, that's because blood glucose is converted to triglycerides in the liver and if you lower blood glucose, less of that conversion is taking place and, quite honestly, I don't see cholesterol altered a lot. Again, people are put on a low-carb, high-fat diet. Yeah, your cholesterol may go up a few points, down a few points, but it usually doesn't change a lot.

Michele Folan: 19:12

I would like to talk about keto just for a second, because I know lots of people who have done keto and they gained their weight back, and what you're talking about is just a lower-carb diet which, in my opinion, my humble opinion, seems way more sustainable and realistic.

Paul Kolodzik, MD: 19:38

I agree. I do have some patients that embrace a keto lifestyle. I don't push my patients in that direction. So you know the numbers. The cutoff is keto is usually less than 20 grams of carbs a day. My patients are usually at 35 to 50, just so you know, the typical American diet can be over 300 grams of carbs a day, but usually I get my patients to 35 to 50, which is very sustainable, I think, much more sustainable than the calorie deficit model.

Paul Kolodzik, MD: 20:09

The cut- your- calories model is just burn more energy than you eat. Just basically it's an energy balance model. But I think weight loss is more complex than that. It's a hormonal issue, the star hormone being insulin. So I encourage my patients primarily just to go low-carb because I think it's sustainable and, quite honestly, once they see the results, this kind of becomes a lifestyle thing, as my patients have put it, with the continuous glucose monitors it's like once I see what that donut does or that candy bar does, or even that big bowl of pasta does to my blood sugar, I can't unsee it and you naturally gravitate to a lifestyle where there's a lower carb intake and it really sometimes without thinking about it a lot subsequently.

Michele Folan: 20:58

You know I was laughing because when you said you know you keep your patients within 30 to maybe 50 grams of carbohydrate, obviously your patients aren't having the venti Starbucks lattes, are they? Because they blow it all in one trip through the drive-thru.

Paul Kolodzik, MD: 21:16

Yeah, or blow it twice in one trip through the drive-thru Oops, oh gosh.

Michele Folan: 21:23

I think this is a great time to talk about the GLP ones, because I would assume this now is kind of part of not just the glucose monitoring, but then, okay, some people need that little jumpstart of with the weight loss. Where do you stand on the GLP ones and how are you implementing those into your practice?

Paul Kolodzik, MD: 21:48

Okay. So of course the GLP ones are the Ozembics, the Wagovies, the Mongeros, the Zepbounds dark names semi-glutide for Ozembic and terzipotide for Mongero. So these medicines, you know, are gaining great popularity. You know a lot of the movie stars are on them. When I first work with the patient I want to do that full metabolic health assessment first. We figure out what their level of insulin resistance is. We talk about their CGM patterns and then, if they want to, either out of the gate or if they get a stall during the normal process of not using medicines, then we talk about sprinkling the medicines in a little bit.

Paul Kolodzik, MD: 22:33

These medicines have downsides and the big downside is weight regain when you stop using them. My preference would be the somebody comes in and I am not committing them to a lifetime of being on medicines. That we're talking about lifestyle changes first. In those lifestyle changes are not only low carb, but the other Important components are intermittent fasting and then strength training, because it all strength training also decreases insulin resistance and maybe we can get back to that more than cardiovascular training. So we want to go ahead, build those lifestyle changes in. That being said, then I go ahead and can I trade in lower doses of these medicines. So the way I believe they should be used in lower doses, not maximal doses, but lower doses with lifestyle changes for limited periods of time, so that we can get somebody through a plateau or maybe get them a jump start.

Paul Kolodzik, MD: 23:31

But Steven Covey said in his seven habits for a highly effective people book twenty five years ago begin with the end in mind. And the end in mind is that you want to be able to get off these medications over a period of time, and the way to do that is to use them as a crutch. Basically, if I sprain my ankle, using a crutch for a few weeks is a fine thing to do it all me to heal but then not necessarily be committed to having to get around on crutches for the rest of my life. So the way I kind of distinguish my practice from, I think, what's going on out there with this GLP-1 mania Is a lot of people are just seeking the medicines there, internet programs where they're just giving people medicines brief intake, here's your medicine. Good luck see in six months. These medicines should really only be used in the context of a comprehensive program with the plan to eventually get off the medications.

Michele Folan: 24:29

Okay, I'm really glad to hear you say that, because, doing this podcast, I've talked to quite a few women who have been on them and they have gained the weight back. But more importantly, they've lost a lot of muscle. So with with that weight loss, they naturally lose muscle and I love what you're saying. So the weight training is so, so important, but also the nutrition counseling, making sure they're getting enough protein right absolutely so.

Paul Kolodzik, MD: 24:59

You know you teed me up there. So the great thing about strength training is it also reduces insulin resistance and the physiology there is. Just your increasing the quality and the receptivity of the insulin receptors on your muscles. So your muscles are soaking up More insulin as they get a little bit better. So can I, more blood glucose, so you're reducing insulin resistance.

Paul Kolodzik, MD: 25:22

If you're on GLP-1, you have to be strength training and getting adequate protein Absolutely critical because you're losing muscle mass in. This is huge for everybody, especially as you get into middle age and older, cause we're all losing seven percent or more of our muscle mass every decade as we age. So and for women it's just a big, even bigger deal because the degree of muscle mass you have relates to your degree of osteoporosis. So if your muscle mass is decreasing and that means your risk for osteoporosis is going to be a lot greater. So the three legs of the stool for my programs are low carb with adequate protein we always emphasize adequate protein Some intermittent fasting I usually have people do just fourteen to sixteen hours or so.

Paul Kolodzik, MD: 26:09

If you want to fast, do a day long, fast little, you know. Once in a while that's fine, but I really just recommend fourteen to sixteen hours and then add the strength training and then again, in a minority of patients, we sprinkle in the medicine you know, no one would want to be around me if I fasted for more than fourteen hours.

Michele Folan: 26:27

Trust me, you've seen the snickers commercials. Yeah, yeah, hangry oh you, you have no idea. So just so you know, this girl here is not fasting for twenty four hours at any time in my life. Do you have patients, though, that they want to stay on the GLP-1 Do they ever strong arm you?

Paul Kolodzik, MD: 26:49

Again. So the way these men let's talk a little bit about these medicines specifically and how they're used. So they have three mechanisms of action and that is they slow gastric emptying, which means they keep your stomach full for longer period of time. They lower blood glucose. They were originally, you know, found to be effective for weight loss and non diabetics, because they lower blood glucose but they don't drop blood glucose into a low range. So the drug companies used initially for diabetics and then found out people lost weight on and then read studies on non diabetics and the weight loss was evident as well. So that's why they became popular weight loss medications Branded as what would go V and that bound. And then the other mechanism of action is that they have a direct hypothalamic effect on the brain. So lowering blood glucose basically just means there you give you an opportunity to burn more fat, like we talked about in. The third mechanism of action is on the hunger center in your brain. So they're effective for those reasons.

Paul Kolodzik, MD: 27:50

When they're used there titrated up, you've probably heard these medications have side effects, the biggest one being nausea. You start them at one dose and use the same dose for four weeks and then you tie traded up a little bit and use the same dose for four weeks and then you continue that process. You can continue that process, bringing levels up the dose up for four or five months. I usually try and get to a maximum dose after about three months and then the goal should be don't go to maximum doses because again you want to tie trade down.

Paul Kolodzik, MD: 28:23

You asked about people not wanting to come off the medications, so we have that. But you know, if you've done these other lifestyle changes, your position in yourself to be able to come off the medications and I have had some patients that we tie trade back down and we keep on low doses for extended periods of time and, quite honestly, a couple things happens then is that is that you know fewer side effects, you can maintain the weight loss and it actually decreases the cost when you're on a lower dose as well.

Michele Folan: 28:54

Oh, I would think so, because they're not, they're not inexpensive.

Paul Kolodzik, MD: 28:57

No, let's talk about that for a second. So right now, limited. There's limited coverage for actually let me back up even further. If you're diabetic, usually you have access to Ozembic or Monjuro one of the two but you got to be a bona fide diabetic meeting the lab criteria for that. If you are not diabetic, the medications we go to Zepbound, semaglutide or Tirzepatide, and there's very limited insurance coverage for that. Now, because you know over a thousand dollars a month and you know a lot of employers just I mean, can't afford that. This is a bigger issue economically, with 60% of Americans being overweight and potentially have apical use of these medications. But that is hundreds of billions of dollars yearly If everybody would be covered for them. So again, why you know some guardrails need to be put on the use of these in terms of being involved in a program related to this and if you don't have insurance coverage, the out of pocket is generally over a thousand dollars a month, which you know of course nobody can afford.

Paul Kolodzik, MD: 30:05

There is a compounded medication that is produced in compounding pharmacies and we provide this to our patients, certain providers that have special relationship with compounded pharmacies. Compounding means you mix it with another substance, such as vitamin B12, to help control nausea, and that is available in kind of a generic form. It's not exactly a generic but it's very similar, so in available at about a third the cost. So we do do that with a number of our patients that don't have access to the brand name medications because it costs, and it's a good alternative. The medications are safe. Compounded medicines, I should mention, are not FDA approved but they are produced in state licensed pharmacies and we've had hundreds of patients on that compounded medication and not had issues.

Michele Folan: 30:53

About a week ago I heard on the news that maybe Eli Lilly is looking to partner with telehealth, basically so they can get these medicines into more hands. And I sit here and I listen to all the work you do with a patient to ensure their success and I just think, uh, it just made my skin crawl, you know. And I think, oh, these patients are going to miss out on all the other things of the coaching and the diet recommendations. And I just got to think that that's just a bad, bad idea.

Paul Kolodzik, MD: 31:33

Yeah, well, think about the model. I mean, an Eli Lilly sponsored program is not going to be anxious to titrate you down and off the medication. So yeah, I think that's why I love. You know, I'm an independent private practice. I'm not working with the health system or another big group. You know I'm just doing this because after that emergency medicine career I became passionate and it's very satisfying. I don't want to be trite or overstate this, but even without the medicines, you see, I had a 19 year old that lost 70 pounds. Her, her parents were overweight, her parents were diabetic. She understood that she didn't want that to be her future, and so we were able to redirect her again low carb, CGM guided diet, intermittent fasting, strength training and she's never going back.

Paul Kolodzik, MD: 32:23

She's made these changes and she's not going to have the problems that her parents have, one of which was on dialysis. So it's very satisfying to do that. And the majority of my patient population is actually I think, your, your listenership middle aged women. Women I don't know if we talked about this, but women have a tendency to get it a little bit better than men. I mean, women seem to understand that we have physical vulnerabilities.

Paul Kolodzik, MD: 32:47

Us guys would rather just stick our head in the sand and wait for the crisis in the emergency department, but the majority of my population is middle aged women. They come to me because they're overweight, so I have a selected population in that regard, and so they seem to understand that they need to do something, and sometimes they'll drag their husband along in this process as well. And even if they don't, when they have success, their family around them sees why they have success with this type of program and they will join in and they will pursue a lifestyle change as well. So the reason I'm so passionate about this is because everybody wins here. Patients get healthier, they avoid long term complications. Their overall health care costs are less, they get to avoid trips to the emergency department, and I get the satisfaction of seeing the changes that they're able to make.

Michele Folan: 33:44

I think that's fantastic, and we all know that obesity is a huge weight on the health care system, and if we can just get more people aware and proactive, I think we'd be so much better off as a country Just be healthier and happier. I do want you to tell the listeners, though, where they can find your practice in your book.

Paul Kolodzik, MD: 34:15

Thank you. So my practice is in the Dayton area, but the majority of my practice is now telemedicine. This is a practice that lends itself to this kind of interaction, and so I see patients in Ohio, where I'm licensed Ohio, Indiana, Florida and Arizona we can do entire visits by telemedicine. We can call the Continuous Glucose Monitor prescription into the patient's pharmacy. If they're on medications we can call that into the pharmacy, or we can have their compounded soma-glutide delivered directly to their home and the CGMs can be called in as a script as well. So this lends itself to telemedicine.

Paul Kolodzik, MD: 34:56

The other thing I was going to say actually was labs can be done locally and then we can get the results of that. So my office is in Dayton and the website for the practice is MetabolicMD, so the word metabolic, and then MDScom, and basically I have a great staff. If people want to make an inquiry on the contact form there, then my staff will call and talk to them and explain a little bit more what we're about, answer questions, including those about cost of our programs. But Ohio, Indiana, Florida and Arizona.

Michele Folan: 35:27

Do you have any suggestion, Paul, about if someone is not in one of those states, how they can find a doctor like you that can help them with their metabolic disease?

Paul Kolodzik, MD: 35:41

Yeah, we're a little bit of a rare breed out there right now. So there is a group called Low Carb USA that has a provider directory. So if you just Google Low Carb USA, the guy that runs it is Doug Reynolds. He is a great guy. He's not a clinician, he's just a great guy that has a passion about how this type of approach can change lives. So you can go to the medical provider directory at Low Carb USA. But I will say that finding practitioner in this area is it can be a little bit difficult. I actually am a little bit gratified that I have a few patients out of Chicago and they drive into Indiana to see me. So the medical board rules are that the patient has to physically be in the state where the provider is licensed. So I have had people you know, are they vacation in Florida? So we do that. But if I can't help people then I would look on the Low Carb USA site.

Michele Folan: 36:38

Okay, I think that's good advice. I appreciate that. And then how about your book?

Paul Kolodzik, MD: 36:43

So the book which I will shamelessly plug here the continuous glucose monitor revolution has been out for about six months. It's the bestselling book on CGMs on Amazon. It is focused on use by non-diabetics and pre-diabetics to get the kind of information that we talked about here and that I think can change people's lives. My patients have said again once they see those graphs on the phone, they can't unsee that. And so I marched people through the program about how you can use a continuous glucose monitor to change diet, why strength training isn't important, how intermittent fasting can add to that process. And then we do talk for a chapter about the medication Semaglutide as well. So it's the continuous glucose monitor revolution for non-diabetics on Amazon.

Michele Folan: 37:32

Very good, and I will put all that in the show notes. One last question is there a pillar of self-care that you practice for yourself?

Paul Kolodzik, MD: 37:42

So this goes back to my emergency medicine. If you mean, are you talking about a single item or a program Until? I practice what I preach.

Michele Folan: 37:53

Oh my God, we could do another half hour of Paul's self-care.

Paul Kolodzik, MD: 37:59

Yeah.

Michele Folan: 37:59

Really, I think, is there something that you do for yourself every day that you think has made a difference in your health?

Paul Kolodzik, MD: 38:05

It's not every day because you got to give yourself rest days, but I think strength training is huge for middle-aged and old Americans and some of that harkens back to my time in the emergency department as well, and it's this. So I'm actually going to be even more specific Strength training, but strength training involving the lower body, leg strength. I have seen countless people over the years that lose their mobility, can't get up and around in their own home, have to go into a nursing home, not because they have a joint problem or a neurological problem, but just because they don't have adequate leg strength. They don't have enough strength in their legs to stay mobile. So I've become kind of passionate about that.

Paul Kolodzik, MD: 38:54

And so strength training and especially I don't know if you know this phrase don't skip leg day. Don't skip leg day. Don't wear baggy pants around the gym so nobody can see your little skinny legs is what the old joke used to be, but don't skip leg day. So I try and do legs at least twice a week, just because I want to maintain my mobility. So if you ask me for a pillar of my own health, it is I want to maintain adequate muscle mass in my lower extremities. So as long as I'm healthy, I'm able to get around, and I think that's very important for people.

Michele Folan: 39:31

Amen, that's one of mine too. So, dr Paul Kalosik, thank you so much for being here Appreciate this. This was extremely informative and I think our listeners are going to come away with some great information.

Paul Kolodzik, MD: 39:46

I really appreciate you having me on Michelle.

Michele Folan: 39:52

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