[INTERVIEW]
Ronda Nelson: If a patient came to you with fatigue and brain fog, anxiety, hormone issues, sleep problems, stubborn weight gain — all the things — what would you think? Well, you’d probably think thyroid, maybe adrenals, hormones, gut issues maybe. And you’d probably be right. But what if it was something much easier than that? What if it was just blood sugar? Because when this is off, everything is off. What we’re gonna talk about today is the impact of glucose dysregulation on the body, how it shows up, and of course how to fix it. Let’s go.
Welcome to the Clinical Entrepreneur Podcast. I’m Ronda, your no-fluff, tell-it-like-it-is business bestie for wellness practitioners just like you who want to build a practice you love, make a bigger impact, and a little money while you’re at it. So if you’re ready to ditch the overwhelm, attract your dream ideal patients, and finally run your practice with complete confidence, you’re in the right place. Each week we’re tackling things from programs to patient retention to marketing strategies that actually work — sprinkled, of course, with a little sass, a lot of heart, and the step-by-step strategies that will help you get there. So grab your cup of coffee, your notebook, or whatever keeps you going, and let’s build a practice you love and a life you love together.
Well, hello. Welcome back to the podcast. You know, as I was sitting down getting ready to record this podcast, I thought — I sometimes don’t pay attention. I just know what I wanna talk about, I write up my notes, and kind of make the points I wanna cover. And I realized, like, this is episode 298. I have to say — that’s pretty impressive. 298 episodes. You guys are awesome. You just keep listening and keep loving it. And as always, I don’t ever mention this, but do a girl a favor — go like, review, rate, subscribe, all the things. It really does help the podcast get found so that it gets promoted out there. But yeah, 298 episodes — we’re coming up on number 300, so exciting. We’ll see what the future holds with the podcast. You just never know. I might decide I’m gonna do something different one day. But for now, here we are, and I’ve got a great episode for you today.
We’re gonna talk about blood sugar. And you’re all probably thinking, yeah, yeah, yeah. But listen — sometimes we just need to go back to the basics. And there might just be a few little tidbits in here that might kind of wake your brain up a little bit and you go, “Oh yeah, I forgot about that.” You know how it is. We kind of get in our rut and we just sort of keep seeing things through the same lens all the time. I’m so guilty of that. And then something will happen, something’s not working, and I think, “Wait a minute — I kind of skipped over that part.” So I would consider blood sugar one of the foundational aspects that we always need to be considering. Because when we don’t address blood sugar, it’s sort of the foundation for everything else. And in part because it involves the adrenal glands, it involves obviously the pancreas, it also involves the liver, and then we’ve got cortisol — and then it can kind of start to be a little bit of a snowball.
Managing their diet, making sure that the patient has enough steady glucose throughout the day — and for brain function, you know, the brain needs 20% of the glucose but it only makes up 2% of our total body weight. So by weight, it’s the largest consumer of glucose in the body. In order for brain function to work — mental clarity and acumen — we’ve got to make sure that blood sugar is stable. When it’s stable, mood is stable, energy is stable, all of those things.
So here’s kind of the cascade, right? We all know this, but just for review. We eat something that’s high in sugar or high in refined carbs — you’re out and you’re gonna eat some bread, or you’re gonna have some ice cream because it’s a Friday night and it’s summer and we’re gonna go have a little treat or whatever. Blood sugar goes up, the pancreas releases all the insulin, then the insulin brings the blood sugar down. And if we don’t have anything to stabilize it, blood sugar goes too low — because it’s a short carbohydrate, right? It’s gonna burn up fast. Now blood sugar crashes. Now the adrenals get the 911 signal — “Oh my gosh, oh my gosh, what’s happening? We’re crashing, we’re crashing, what’s happening?” And then cortisol kicks in, and that stimulates the liver to release glycogen — too many G words in there — but we end up reaching for another refined carbohydrate. We get the craving like, “Oh my gosh, I need to have something else,” and we reach for another refined carb and the cycle just keeps going, going, going. So the adrenals are working overtime, we have high levels of cortisol, the pancreas is working overtime — and the patient, you, me — we don’t feel good because our blood sugar is so wonky.
If it’s the foundation of everything, let’s talk about what the symptoms are — the signs that you can suspect blood sugar is an issue. How it shows up in the body. There are a variety of ways, and these are the ones I kind of made note of. There’s probably more, but I would call these the low-hanging fruit. The first one is just energy crashes. If they’re going along fine, fine, fine, and all of a sudden — boom. Or they need to eat every two to three hours. Or you know, 30 minutes, an hour, two hours after they eat, that reactive hypoglycemia kicks in. They get yawning — yawning is a big sign. I didn’t even put that in my notes, I just thought of it. Someone eats and then they start yawning. Why? Why are you yawning? You have a full belly and you didn’t eat too much, but you’re yawning. You’re yawning because we have unstable blood sugar. So obviously the signs of shakiness, irritability, hunger — you know, those are all looped into the same thing. But really, our energy just starts to tank.
The second one is cravings. When glucose starts to get low, of course a very well-balanced body is going to send a signal that says I need fuel. And when blood sugar is in kind of a crisis state — in other words, it’s starting to precipitously drop and the adrenals are getting involved like, “Oh my gosh, 911, we need some help over here” — what do we reach for? We’re not wired to think, “Oh, I better stop and make myself some meatloaf.” Said no one ever. Because we need fuel right now. And so what often happens is even a healthy patient will reach for an apple. Okay, yes, the apple has fiber, fiber’s gonna prolong the life of glucose in the bloodstream, but it’s still pretty high in sugar. Not that I’m opposed to it — but what if it was an apple with some almond butter? At least now we have some substance with it. We’re gonna address the craving but we’re also gonna stabilize that blood sugar. Like if someone reaches for crackers — I mean, I’ve done that. I reach for like blue corn tortilla chips or something like that and I’ll just sit and eat those. And I think, “Okay, why didn’t I have some cheese with this? Or some salsa? Or why don’t I grab some chicken and have some chicken with this and make myself some nachos or something?” But if I’m hungry, I don’t wanna stop and have to get the tortillas and grate the cheese and then get the chicken and cut it up and put it in the oven and wait for the cheese. No. I’mma just reach for something fast. And everyone else does the same thing. We all kind of do that.
So cravings, sugar cravings, sweet cravings — if they tend to be needing to eat all the time and they’re not making good choices, that’s a sign of unstable or dysregulated blood sugar. And just that feeling of “I can’t think straight, I need food and I need it right now” — that’s kind of a 911 blood sugar issue.
Also, waking up at night between 2 and 4 — this is a big one. Because blood sugar does drop in the middle of the night. And when it drops in the middle of the night, the adrenal glands pick up the signal, they release cortisol, cortisol spikes up to compensate. But when cortisol spikes up to compensate, what happens? We wake up. And then we can’t fall back asleep. So if it’s between 2 and 4, you can suspect there may be some blood sugar dysregulation going on. And it might just be as easy as getting them to eat — I always say a protein, a fat, and a fruit or veggie before bed. And my secret hack is adding a little bit of AF Beta Food. Now I know if you’re listening and you’re a Standard Process hater, fine — you can still do you. But I have just found this trick to work. A little bit of AF Beta Food, couple of two or three, because what it does is it takes the food that you have in your stomach and it promotes the storage of glycogen. We should have about two days’ worth of stored glycogen in the liver. AF Beta Food helps to promote that storage. It shuttles the glucose from the protein, the fat, and the fruit or veggie that we just ate right into the liver, and then the liver stores it.
So then — and this is magical — in the middle of the night, when blood sugar naturally drops, the adrenals go, “Hey hey, problem, problem,” and they talk to the liver, and the liver says, “I got this, no big deal.” It releases a little bit of that glycogen into the bloodstream, blood sugar is very happy, it stays stable, and you don’t wake up. So for nighttime wakening, think liver and think cortisol. If the adrenal glands are tired or dysregulated themselves and they can’t produce the cortisol, that’s often when we can’t go back to sleep — or it’s just too much of a response in the middle of the night. So think liver and adrenals as well. We often think, “Oh, I’ll just give some Glucose Sugar Balance from Doctor’s Research, or I’ll do Diaplex, or whatever you’re gonna use.” And that’s great, but you have to address the adrenals, and we probably need to make sure that we’ve got enough glycogen stored in the liver.
Next one: anxiety that doesn’t make sense. And here’s what I mean by that. Sometimes you will be doing what you know to treat anxiety, to support an anxiety-type response — maybe it’s a Gaia product, or maybe it’s whatever you’re using — and they say, “Well, you know, I’m better, but I still am anxious.” That’s classic for blood sugar right there. The symptoms look similar. If blood sugar drops on a consistent basis and the adrenal glands are dysregulated — you know, that HPA axis is off — the symptoms can mimic anxiety when really it’s blood sugar. That feeling of “I feel unsettled,” maybe fears, a sense of dread, shakiness — a person could translate that as being anxious. But it’s not psychological. It’s metabolic. So if you have someone with anxiety, I’m not saying in every case, but just keep that on your radar. Because you might find that if you manage blood sugar — what if 50% of those anxiety symptoms the patient is interpreting as anxiety just go away? And now really you just have very mild anxiety that will be handled with like ashwagandha or something. So just kind of keep that on your radar.
Another symptom is brain fog. That’s pretty obvious, because again, that brain consumes so much of that glucose. If there’s not enough glucose for the brain to work, it gets foggy, it’s not clear, it’s cobwebby. “I can’t remember, I can’t think, I can’t form my words, I can’t focus on things.” Because blood sugar is low.
Another one that’s big — in fact, we just talked about this in a live Q&A inside Clinical Academy just a few weeks ago. We had a big long conversation about stubborn weight loss. Women who cannot get the weight off — it is so many times their blood sugar. Now that doesn’t mean there’s not also adrenal involvement, and maybe there’s some liver there, and maybe they need to really increase protein. You know, protein is like putting gas on the metabolic fire. When you get protein in someone — and you gotta make sure their upper digestion is working, of course, we don’t want to throw protein into the stomach of a person who’s been a vegetarian forever, those parietal cells are not going to keep up very quickly, sometimes you have to warm up the engine a bit — but when you get that blood sugar stable and you get the right kind of protein in there, very often the metabolism starts to pick up and speed up and that weight will drop right off.
But remember that insulin and cortisol are both fat storage hormones. So you can eat a good diet, but if we have too much insulin or too much cortisol, the fat is gonna stay on. The patient’s not gonna be able to get it off. So we have to balance the blood sugar, get the HPA axis working, and then maybe look at protein in the diet.
And then the last thing I jotted down was hormonal issues. Estrogen is also a fat storage hormone. And when we have unstable blood sugar in women, it drives cortisol — which we’ve talked about, that steals progesterone. Inflammation goes up, estrogen metabolism is disrupted, and then thyroid conversion suffers. When there are hormonal issues in women, you’re thinking it’s hormonal, and it may very well be. But what if it’s blood sugar? Because the blood sugar instability — we have blood sugar up and down, up and down, up and down, then we have cortisol up and down, up and down, up and down. And with that high cortisol, we have that pregnenolone steal — remember, the pregnenolone is gonna drop down that cortisol pathway for cortisol, at the expense of the sex hormones. Inflammation’s gonna go up, estrogen metabolism is gonna drop and change, and then that affects thyroid hormone conversion. It’s just a little bit more complicated. We have the pancreas, we have the adrenals, we have the sex hormones, and we have the thyroid. Blood sugar that mimics itself as hormones can be all of those things. It can be hormonal and blood sugar.
So what are we gonna look for in a lab? Let’s talk about testing. You all know fasting glucose. The lab range is up to 100, but I like to see it around 85 — that’s kind of my sweet spot. And I’m not saying that someone with a 92 glucose is necessarily pre-diabetic. But if it’s over 90, the dog ear goes up. I’m just thinking, keep an eye on that, let’s not let that get any higher. Because what you’ll notice, if you look at labs over time, a lot of times that glucose just starts to slowly increase — it goes from 92 to 94 to 95 to 97. Well, at what point are we gonna call this a problem? It’s going the wrong way. If it’s going from 92 to 89 to 87, I’m really happy with that. That’s a well-regulated glucose. So just watch fasting glucose — it can also be normal even when they have unstable blood sugar, because remember, blood is just a snapshot. It’s not a movie. We’re not getting the whole day. So maybe that fasting first-morning glucose just happens to be fine, but they’re not fine. So you gotta look at some other clues.
Another one is the A1C — you all know this. It’s a 90-day average of basically the stickiness of the blood cells. If I pour sugar in water, sugar becomes sticky, makes the water sticky, and whatever I’ve put in the water is gonna start to kind of stick together. You can get like a sugary film or coating, and they’re not gonna bounce and slide around like they used to — they’re gonna stick together. And that’s what the A1C tells you: how much glucose is in the plasma, the blood fluid, how much stickiness is there that’s causing those red blood cells to stack up on one another. So we really want to see it down close to 5.0. I’m okay with 5.5, but I’d like to see it under that a little bit if possible.
And then there’s fasting insulin. The lab panel I use from Professional Co-op Services doesn’t automatically come with a fasting insulin, but I’ll often add it because this is the one that’s really valuable. And I’m gonna give you a calculation here in a minute. If you’re not ordering fasting insulin, you really should — because you can have normal glucose on a blood test with an elevated insulin. And what that means is the body is working overtime. The pancreas is working harder to try and keep glucose within a normal range. It’s really a sign that insulin resistance is sort of developing — kind of starting to come along, coming to the party, but it hasn’t quite showed up yet. So always, if you suspect any of those things going on — brain fog, fatigue, afternoon crashes, all the things we talked about earlier — make sure that you’re adding a fasting insulin.
Now there’s a calculated marker called the HOMA-IR. HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance. So now you know why we say HOMA-IR. And it’s just a calculated value — all it does is use glucose and fasting insulin. Super easy. So if you’re somewhere where you can write this down, write it down. Otherwise you can look it up online if you want. But in the US, our glucose is measured in milligrams per deciliter. All it is: fasting insulin times fasting glucose, divided by 405. That’s it. And that gives you the number. We want that number to be pretty dang low. If it’s in millimoles, you’re gonna divide by 22.5, but you probably don’t need to remember that. You just need to remember the 405.
The last one is triglycerides and HDL. When you see high triglycerides and low HDL, that is metabolic dysfunction. Some of the lab tests will come back with a ratio — a triglyceride to HDL ratio — and it should be under 2. But you could just generally look at it: if triglycerides are high and HDL is low, you know there’s a metabolic problem. That’s just a good sign right there. So that’s how you can test it.
Okay. So what are you gonna do? The first thing I would do, after you’ve tested and you’ve decided there’s some kind of dysregulation in the glucose handling system, is some supplemental support. My favorite at the moment — the one I’ve been using a lot of — is Glucose Sugar Balance from Doctor’s Research. I like it because it’s got gymnema in it, so I don’t have to give more than one thing. It’s got chromium in it, which the pancreas needs. It just works good and it seems to get blood sugar stabilized pretty quickly. I dose it at two twice a day — that’s kind of my dose. I think the recommended dose is three, but three is hard to manage. I’m like, just do four and you’re fine. So two twice a day.
The second thing I’m gonna do is make sure that they have enough protein in the meal. Because that protein is gonna stabilize any carbs, it’s gonna slow glucose absorption and maintain that steady blood sugar. It’s when we eat just an apple, or just some cookies because we’re hungry or got the munchies or whatever — I would rather someone eat two handfuls of cashews than grab just some crackers or something. Part of it is preparation. You just have to think ahead. Over the weekend, you gotta cook your protein for the week. It’s a hassle, but we just have to do it. So they have to do the same thing. You want to make sure there’s protein at every meal. A palm-sized portion of protein is a pretty good indicator. Breakfast is a good one — some people are fasting, you know, they’ll do some intermittent fasting, and that’s fine. But whenever the first meal of the day is, make sure there’s protein there.
I was just recently talking to someone who is a type 1 diabetic — she’s been type 1 for 20-some years. And she said that all of her type 1 diabetes specialists and doctors managing her insulin and all the things tell her that a perfect breakfast in the morning is oats. So every morning she has oatmeal for breakfast. I about fell out of my chair. I said, “Really?” And she said, “Yeah, I just eat oats and I feel fine.” And I said, “Yeah, how much insulin are you using?” And she goes, “Well, I usually use quite a bit in the morning, and then it kind of peters off during the day.” And I said, “Well, what do you eat the rest of the day?” “Oh, well, you know, then I’ll eat some chicken a little bit later, or tuna or something like that.” I said, “Yeah, and you don’t need as much insulin, right?” “Well, yeah.” I said, “Because oats is what we feed horses. This was not meant to be human food.” This was a little bit of a brain-bender for her. She said, “I literally have been told this since I was a little girl — that oatmeal was good for breakfast for a type 1 diabetic.” No. No, we gotta get protein in here. No breakfast cereal, no Pop-Tarts, none of that. We need to make sure they’ve got some good protein.
No naked carbs. I always tell them, no carbs by themselves. If you’re gonna eat an apple, add some butter to it. If you’re gonna have crackers, put some cheese with it. If you’re gonna eat out and there’s bread and you just can’t help yourself, make sure you have a ton of olive oil with that bread, just so that you can slow down that glucose.
And then another tip I always tell people is just make sure you’re eating on a regular schedule. Try not to snack — eat well enough that you’ve got some satiety, and then you’re not tempted to snack. It’s when we start the snacking train that then we snack and snack and snack, and that creates a whole other cascade. Not only disruption in blood sugar, but we disrupt the MMC wave, you get sleepy earlier, there’s gonna be more nighttime wakening, the liver doesn’t have a chance to store the glycogen. There’s a lot of things that happen when we’re snacky. So you want to just teach the patient how to eat until you’re satisfied — not stuffed — and then wait at least three hours before eating again. And you’re gonna have to make sure there’s enough protein and fat in the meal so that satiety can happen.
And then intermittent fasting — you know, some people do it and they really like it, they’re happy, they feel good when they intermittent fast. I’m okay with that, as long as it’s not intermittent fasting where you’re only eating during a three-hour window during the day. Because when that pancreas doesn’t have a chance to exert its muscle, we’re basically not stressing the system with food. When we stress the system with good food — protein, fat, fruit, veggie, all those things together in a meal — the body gets to do its job. We don’t wanna starve it. I’ve seen a number of people who will just say, “Oh well, I’m fine, I just eat once a day.” They’ll lose a whole bunch of weight, they’ll pack a bazillion calories into that one two-or-three-hour period, and then they don’t eat again until the same period the next day. What happens is as soon as they go back to eating normally, they’ll put all that weight back on. So I think fasting is a bit trendy to some degree. For someone that has dysregulated blood sugar, I’m not sure that intermittent fasting is the best recommendation. I think for some women, intermittent fasting can actually make things worse — and I think that has to do with our sex hormones. So if you have a woman with stubborn weight gain, maybe don’t think about intermittent fasting. Maybe just think about getting her to eat protein regularly throughout the day, and none of this restricting — because the body’s gonna think of it as restricted calories. You want to stabilize her blood sugar throughout the day so there’s zero chance she’s gonna be up and down, up and down on those blood sugar bombs. You know, she’s grabbing quick bites of cereal from her toddler’s tray, or she’s eating a donut or a scone or something like that — avoid all of that. I always say, if something goes in your mouth, there better be protein with it. If you’re eating a piece of cheese, there had better be some turkey behind it. Because you can’t just eat one thing and not have some protein. Protein is super important.
And then of course movement — you all know how that is. It just helps to burn that glucose that’s in the bloodstream. Even if it’s just a short 10-minute walk, it’s great. After a meal, just go walk. Walk in your house, walk outside, get on a treadmill, whatever you have to do. Just enough to get some movement, get those muscles moving, so that those muscles can use up some of that glucose. Other things you could consider would be alpha lipoic acid, berberine — that’s great for blood sugar — cinnamon. I add cinnamon to my smoothies every day when I make them. There are a lot of different supplements out there that you can use. My favorite is Glucose Sugar Balance from Doctor’s Research. That’s the one that I really love.
Alright. Now how are we gonna wrap this thing up? I think I would say: don’t underestimate the impact of glucose. When you have patients that come in with symptoms you might otherwise attribute to thyroid, or adrenals, or poor sleep, or high stress — sometimes we’re so quick, and this is kind of how I started this episode, to put on blinders and think, “This is the problem, I’m gonna go down this road. I’m gonna treat this like an adrenal case.” And it’s not an adrenal case at all. It’s a blood sugar case. It’s blood sugar dysregulation. And so then we go marching down the road, we give the adaptogens, ashwagandha, whatever it is that we’re using for the adrenal glands, but they’re not getting a lot better. They’re complaining, “I don’t feel — it’s maybe 20% better.” Because it’s blood sugar. So don’t neglect blood sugar. You can’t just work on the adrenals. You can’t just work on the thyroid. You can’t just work on the sex hormones. We’ve got to figure out how to factor in blood sugar. And even if there’s anxiety like I talked about — it could be blood sugar.
[CLOSING]
Ronda Nelson: So if you’re wondering how to put all this together, I do have a free resource for you. It’s called the 5 Clinical Non-Negotiables. These are the five things that I look at with every single patient, every single time. In my mind, I go through the list of five things and I think, “Okay, check — have I done that? Yes. Is that good? Yes. Is this okay?” And there are five things, and you can go download it — it’s free. Go to rondanelson.com/nonnegotiables. That’s where you’ll find it. Just type in nonnegotiables, all one word. You can download it and use it as a checklist. It kind of describes each one — obviously blood sugar is one, adrenals are one, liver is another. All my top five. I think it will help you because it’ll give you a reminder. If you don’t know where to start, you don’t know what to do — and I hear this all the time from the practitioners inside Clinical Academy, that’s why they’re there — this is right here. Five non-negotiables. That’s it. You’re just gonna start with the non-negotiables. It buys you time, it gets the foundational aspects kind of fixed. You’re addressing blood sugar, you’re addressing adrenals, you’re addressing the liver, you’re getting all the foundational stuff fixed. And a lot of times, if you fix their diet, you fix their blood sugar, you get their cortisol back online, give them a little bit of liver support — you know, if you’re gonna do a detoxification or something like that — you do those things. I’ve always said that lots of times they’re gonna be 50, 60, 70% better and you never had to go chase some symptom, because you started by making sure the foundation was right.
So I’ve just always kind of thought that way. And sometimes I get out in front of my ski tips and I forget, and then it bites me in the butt, and then I have to come back and go, “Oh shoot, I did forget that part.” So I have to explain to the patient that we have to go back and do a basic thing — and then it fixes and it’s all better. So go grab the free resource. rondanelson.com/nonnegotiables. And if you’d like to join me in Clinical Academy, I’d love to have you. It really is the practical — it’s the how for the what. When you have all the clinical knowledge in the world and you want to know how to actually implement it with patients, that’s where it is. rondanelson.com/clinicalacademy. Thanks friends for hanging out with me this week. I’ll see you next week on the podcast.
[END]