110. Continuous Glucose Monitors (CGMs), Nutrisense & Lifestyle Factors that Affect Blood Glucose | Catherine Staffieri, RDN

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Our guest today is Catherine Staffieri, a registered dietitian who currently works as the nutrition manager at Nutressense, which is one of the fastest growing health tech startups aimed to help you understand glucose management. It's one of the programs that allows you to transfer your glucose data over to software and then helps you with insight as far as what different types of lifestyle factors are affecting your blood sugar. Catherine has counseled over thousands of clients and she's reviewed over 750,000 hours of glucose data and recording meals in the process while recommending nutritional adjustments to improve her client's metabolic health. She holds a master's in nutrition education from Columbia University and completed her undergrad work at University of Pennsylvania. In this episode, we go over what CGMs are. You may have heard of those three letters. It stands for Continuous Glucose Monitor. We talk about how they work, what they measure, and who should be using them. We'll then delve into the specifics of Nutressense, how the app works, how the program works, and how the coaching works. Last but not least, we touch on the effects of different lifestyle factors on glucose, such as sleep, exercise, stress, and nutrition. All right, time for the episode. Catherine Staffieri, thank you so much for joining Medicine Redefined. How are you today? Thank you so much for having me, guys. Absolutely. I'm really excited. I know Altamash is as well to talk about CGMs, Continuous Glucose Monitor, talking about diabetes, and talking about, I guess, somewhat of a newer trend. I know they've been around for some time, but more and more people are starting to use Continuous Glucose Monitor and we're really excited to delve into the data, see what Nutressense has to offer, as well as how these monitors truly help from an optimization standpoint, but also from a lifespan longevity health standpoint. But first, why don't you take us through your journey, because as we talk about offline, this is not really your first career, so take us through the weeds. Sure. Absolutely. So, I feel like I've come to Nutressense, I've been there for almost exactly two years. I started two years ago last week. It's been an incredible journey, never did I think I would end up at a tech startup. My undergrad work was in economics and math, was not my intention to end up in health, but so happy that I did. I worked in finance, the alternative asset management, you know, hedge fund industry decided that that was not really where I wanted to see myself long-term and ended up going back to school to get my masters in nutrition education at Columbia, and then wore many different dietary hats after that. As many, if you've ever been a dietitian, they generally do like nine different things. And so I worked outpatient at a hospital, I had a private practice, I did community outreach, I've done a lot of different stuff. And eventually I was like, I really would love to be able to reach a wider population, and that's where Nutressense came in, because what they do is they take this incredible hardware, they pair it with some really sweet technology, and they give you a dietitian, a real person who's super smart on the other end to help you achieve your fitness and health goals. So I feel super lucky to be a part of Nutressense, and it's been a great experience so far. So we briefly touched on, I think the difference between a dietitian and a nutritionist, I think we're familiar with this being in the healthcare field, but those who may be listening who aren't, can you help discern the two? Yeah, so register dietitian, RD, we actually have sort of co-opted, take it back, the nutritionist moniker. So that's why I have an RDN, a registered dietitian nutritionist, but a registered dietitian is someone who is accredited by the Academy, and we have taken a national exam. We've gone through a one-year internship, we've done all the requirements, and a lot of times we work in accredited hospitals, and we work very closely with physicians. Certainly, I'm sure you guys have seen them throughout your rotations, I tend to think that we know a lot more than people give us credit for in the clinics. When I work with some really phenomenal dietitians in the hospital, nutritionist can be a little bit more of a Lucy Goosey term, and anyone can kind of get a certificate sometimes, and call themselves a nutritionist. We like to really be evidence-based at our job. We do have CNS's certified nutrition specialist, and they also have gone through a rigorous training and just sort of a separate but equal pathway along with the dietitian. We really, really try to make sure that everything that we're talking to our members about is evidence-based, science-based. We like to make sure that everything we're talking to them about has some real scientific backing. Yeah, I totally agree with the fact that our doctors will use RDNs to our advantage as much as we can, especially Ultima and I being a rehab setting, where nutrition is so critical to get our patients to become fully functional. The amount of times I just want people to understand and realize how much really goes into a dietary plan, right? When somebody who can't even have a full diet talking about thin liquids, regular diet, they might have a pure diet, so really try to even figure out, based off their weight, we might have to get them up to 10 pounds to their baseline. How do we figure out the macros, the micronutrients, all that sort of stuff really goes into that. I've definitely been using dietitians about whatever I can just to really learn as well, because there's a lot of things we don't learn in medical school from a dietitian standpoint, so definitely just want to give you guys the plug there as well. I am curious, though. How did you transition into neutral sense? Was there a reason why you didn't want to work at the hospital or did you think that neutral sense was really the best fit for you? I truly think that wearable technology and I think using these kinds of tools, it started out with just tracking calories on the apps on your phone, things like my fitness pal, lose it, all of these apps have been really helpful in people taking control and really learning what's going on with their own nutritional intake, right? What's happening now is that they're taking it to the next level. Using something like a CGM can really help you dial into where you are currently and help you get to where you want to go. That to me was so exciting. I was like, oh, it's nice to meet with my regular clients and do a lecture here and there, talk about, do a support group or some education, but we are reaching hundreds of thousands of people. We are helping people on an individualized basis and we're using some incredible technology to do that for them, so it's like, what a cool job for someone like the dietitians. And frankly, we work with, I think some of the most brilliant, I've got this army of colleagues that are so freaking smart all over the country, I'm so lucky to be able to work with them and we all just feed off of each other like, oh, I read this study or I saw this or I worked with this doctor and they recommended this and so it's just been fascinating. Yeah, and I think there are very few people, if any, left who aren't wearing some type of wearable, right? I mean, I don't go anywhere without my Apple watch or really anything and he's got his boot on all the time and I have multiple other ones, right? So, let's dive into CGMs. We brought it up a couple of times and I think still people don't really understand how they work or what they are. So as we've said before, continuous glucose monitors, so a little bit implicit what they might do, but talk a little bit about the technology aspect of it. How do they work? What is it? Do the people wear it on their wrist like a watch? Like, you know, somebody might have never seen it, but if you could go into that aspect of it? Totally. So the continuous glucose monitor is a sensor, it's about the size of a quarter, it's pretty thin and it has a tiny little filament in the middle of the circle and what you do is you attach it to the back of your arm and so it lives there, the life of the sensor is about two weeks. So it lives on the back of your arm, it sticks there. We put a little bandage over it to cover it. You can wear it in the shower, you can do anything you want, sleep with it, everything it just stays there for two weeks. And what that little sensor is sensing that's inserted in your skin is the amount of glucose in your interstitial fluid. Now this technology is really interesting and it's been basically only worn by diabetics in the past, right? And that's, it's wonderful, you can do sure, insulin off of it and you might have seen ads for it. We use the Abbott Freestyle Libre, you know, they advertise on television. So it's not our hardware, right? But what we've done is we've taken that hardware, neutral sense has taken that hardware. And what you do is when you scan your sensor, it downloads all the data that has been collecting and it downloads it into our app so that then you can use that data to analyze what's going on in your life. So we think it's super interesting for non-diabetics, you can, you know, be a type 2 or maybe pre-diabetic. We think it's interesting basically for anyone to use this kind of data to see how they're responding to their meals, how they're responding to sleep, to exercise, to stress all of that stuff we can interpret through your glucose data. So it's super exciting and really applicable to everyone. Why two weeks, can the filament not stay in longer? Oh, that's a good question. I don't know the life of the device, I don't know how Abbott manufactured it. Some of them I think are going a little bit longer. Gotcha. And then again, just to kind of recap, most of the medical providers or healthcare providers are familiar with the role of insulin, right? So any time glucose goes up at some point, which variations are normal after any time you eat a meal or unless you have some pathology, it might be at other times fasting and stuff. Insulin comes along with the right, right? And we have talked about, well, we've talked a lot about nutrition, but we've talked also about the carbohydrate insulin model. And I think that's one of the things that maybe is worth plugging in here that lately, the interest has gone up because of this carbohydrate insulin model, which again, it's not really new, but I think it's really taken mainstream, it's over the last three to four years, right? Would you say that's fair? I feel like Jason Fung, one of his first books, the obesity code, I think that's what it was called, and maybe some of the other people when they were talking about it, that's been really a lot of the media started to grab attention and that's when they became popular. And I guess maybe the next question is, you brought up diabetics, particularly type one diabetics who have poor glucose control. What are some other patient populations, if even patient populations, healthy individuals, or types of people that these work well for, essentially who is it for? Well, we can, we think it's for everyone, 18 and older, but truly, I think, you know, it can be a recent diagnosis, right? It could be a pre-diabetes or a type two diabetes diagnosis, right? We do get a lot of people like that that say, I don't really want to be a metformin or perhaps I've been on metformin and I'm sick of it, I'd like to get off. A lot of times it can be women who have had gestational diabetes and know that they are at higher risk for developing diabetes later in life. They want to prevent that to happen. We get a lot of women that are going through perimenopause. They are having all sorts of hormone fluctuations and as you guys know, the hormone systems, whether it's insulin, estrogen, progesterone, they are all intricately related. And so we get a lot of women that are like, you know, help, I'm going through this crazy change in my life. I need some, I need some advice, I need to know what's going on inside. We get a lot of endurance athletes. We get people that are super into their fitness, perhaps they're returning from a recovery or they have upcoming races. They are really dialed into how their body is training, how they can optimize that and clearly carbohydrates are necessary when you are training for any type of athletic event. So it's really fascinating for them to be able to dial into their fueling, pre-imposed workout. We get a real range of people. We also get weight loss. Clearly, that's something that's on a lot of people's minds, first and foremost, and is tied in with many chronic diseases. And so we do get people that are looking for the use of the CGM to help them towards their weight loss goals. Yeah, I think it's really interesting. I think the thing that comes to mind for me is all the populations you described have a goal. And I think every human living on this Earth has some sort of goal when it comes to either health related activities or just trying to reach a certain weight. So everyone almost belongs into that special population. You did mention 18 or older. And I kind of wanted to delve into the normal variation of glucose before we kind of delve into CGMs, apparent numbers and what people may do for that. Can you just go through what maybe on a day-to-day, even decade-to-decade for life when we talk about aging, what glucose numbers should look like? That is such a great question. And when you look at the adolescent teenage, I mean, their bodies are just these well-functioning machines. I mean, you can throw Coke and Doritos, and who knows what at them? And it's like, ooh, they're just so well-run, everything's functioning so much faster. And they tend to have a lower fat mass and higher lean body mass on average. It's just that as we get into older age, obviously, as you know, things start to break down, things start to sort of function not as fast, not as great. And we've put longer wear and tear on the system, right? So as we know with type 2 diabetes, it can be a real, you know, sort of a marathon, not a sprint to get there sometimes, and it can really be decades of that really high, high, high churn of insulin and eventually, you know, the burnout and the insulin resistance and the lack of sensitivity, if you will, to insulin in the cells. And that takes a long time to get there. So that's really why we see more of the older populations, older decades, having much larger incidences of insulin resistance and type 2 diabetes in that way. And I would say in general, we don't really differentiate in terms of our member population in terms of optimal glucose control. We try to meet everyone where they are depending on your health and your medical background, your own personal health history. But generally, we like to see people's glucose to be anywhere between 70 to 140. If you are type 2 diabetic or, you know, along that health route, we will extend that up higher to like a 180 cap or 200, just depending on where the person is. But that's what's so great about what we're doing is that not really conventional medicine. We're not trying to fit anyone into one certain box and saying, you must, you know, we're looking at you at one moment in time. You know, we all get our annual fasting glucose at the doctor and that's, you know, that's Tuesday. Well, what did you do Monday night? You know, is that a really good capture of who you are and what your health is? So that's the other big plug for the continuous glucose monitor. As physicians, you guys know, you got a blood panel. Some of it is retrospective, like an A1C or something like that. Maybe that gives you a glimpse of the past three months. Your fasting glucose is one point in time. I mean, maybe they weren't really fasting. Maybe they had gone out on a bender the night before we don't really know. They went keto for like three days to look really good. So, you know, you can't really tell what someone's doing. They can kind of game this system, right? So what you can see with the glucose, the continuous glucose monitors, how someone's doing 24, seven day after day. Our patients, our clients love sharing this information with their doctors and their doctors are saying, oh my gosh, this is so helpful. I can see the deviations. I can see what you're doing on the weekends versus the weekdays. It's an incredibly, it's an incredibly, incredibly powerful tool and data load that you can really extrapolate trends from. That's interesting. Well, I think a point worth highlighting is the higher numbers you were mentioning in 140, 180. That's the post-prendile, right? I think somebody's in the fasting range at that point, then we're certainly concerned. Yeah, the point about physicians using this data and seeing the trends over a period of, I guess, two weeks, I can see why that would be important and actionable, right? And for that's exactly one of the reasons I think that you guys are providing them coaching so they actually can digest the data and make it actionable. But I'm also wondering is you guys have been around for a couple of years. Are physicians routinely using this in their practice and then changing management time and time again? The challenge that I see is, well, as we've talked about, medicine is somewhat of a business and you need to be able to put different codes in, you need to assign the values and then you need to be able to bill for them so the insurance company is starting to reimburs. Considering this is an adult pocket expense for healthy individuals, how are they integrating that and using that to make decisions? Is that question make sense? Yeah, and I wish I could say everyone's doing it. Everyone should be doing it. All I can say is from feedback from our members, obviously when they are a physician or we get a lot of nurses, a lot for them is learning just their own, again, you can study all you want, you can read it in the book, you can take the test, you can look at someone's chart, but what is your own body and you're testing it on yourself and seeing how it's really fascinating. And when you're working with your own data and seeing that, I think it turns a lot of lights on for people. We do see it a lot with physicians that are working and nurses that are working night shifts. Their glucose values are very different than people who work on the regular shirt of circadian rhythms. So in terms of professionals using this for themselves, it's eye opening. In terms of them integrating it into their practices, I think it's a huge opportunity for, I think, really any physician, if you're an endocrinologist, if you're a family physician, you know, OB-GYN, all of this kind of stuff is so key to helping your patients have their optimal outcomes. Be it prevention, you know, they're edging into those higher ranges of whatever they're blood workers saying, or they're already there and you're trying to get them off some medications or you're, you know, they're really trying to improve their health outcomes. Yeah, I suppose the next question to ask is, aside from pediatric populations under 18 and pregnant women who I don't think it's approved for, right? Who is this not for? What's the person who you would say, see James not for you? I will say it can be triggering for those who have a history of disordered eating. So this can be a difficult thing to face and it can bring back perhaps old habits or unhealthy habits that could be binge eating, that could be, you know, any of the spectrum of eating disorders. So we do find that if you are struggling in that area in your life, this probably isn't the right time for you to use something like this. Let's maybe go a little further down that rabbit hole, right? I think I don't want to make this to a disordered eating pathologic, binge eating disorder, anorexia, all that kind of stuff. But at the same time, I do understand just from my brief reading of that. There are a lot of eating disorders are under diagnosed or just misdiagnosed, right, in the general population. And I suppose the challenge is, you know, I think about a company that I've referenced time and time again because I think do great work, precision nutrition, and they have like these annual surveys with their patient, with their client that they publish out. And time and time again, the number one thing that the surveys show from people who struggle with weight loss or their health goes body composition, etc, is because they have emotional eating or stress eating, right? We all struggle with that. Maybe my medical roommate was like probably a robot or as close to one who didn't like chocolate or desserts, but aside from that person, most of us when we're stressful, we have a poor night's sleep or working night shift, we want something sugary salty. I suppose a long way of asking is, how do you tease out like actual binge disordered stuff versus somebody's just having this natural emotional response and just stress eating quote-unquote? So, you know, it's a great, it's definitely something that we are hyper aware of. And we do ask when you are signing up to a test that you are not currently, you know, going through one of these, one of these eating disorders. So that's one step, although it's easy to skirt that and you know, perhaps not be totally honest. But there are red flags along the way that we've all seen, we're all pretty seasoned dieticians in terms of counseling with people. You know, we can see when someone's oh mad and they just really aren't eating, you can pick up on things that they say, you know, oh, that's too fattening for me or I've never eaten that, that makes me feel so terrible afterward. We also are really, again, this tool for us and our approaches, everything is allowed, right? We're not, we're not trying to proselytize and commit anyone to a specific diet plan. We're here to help you, Darsh, and you ultimately to find out what works best for you, because it's not the same for anyone, right? So we're not trying to put anyone into a certain box. So when we do find that people are really avoid, they avoid change, they avoid having sort of an open mind, testing things out. These are all kind of red flags to us that maybe this person's struggling on a deeper level. But, you know, we do also see a lot of people that say, you know, we can see in their glucose data, right? You know, Friday night, Saturday night, you know, huge swings, lots of stuff happening, you know, what happened and they were like, oh, it was a huge night out. I went overboard or it's Sunday night and watching the game and I was out of a sports bar and I just went totally crazy. I mean, most people are honest and they will tell you, you know, that was a one-off or that's my weekly indulgence. And so you can kind of test, you can get a good idea of where people are approaching their food. But it is it's rampant. And I think the term orthorexia is certainly getting more headlines lately. People being very aware of healthy eating and how that can lead into other unhealthy eating patterns. Right. Yeah. Now, I love the the concept you're talking about. There's nothing restrictive about this at all. I think that a lot of people will say that especially the first couple of weeks, maybe even months of using device, the amount of insight that you get is probably the most powerful thing. Would you say this case? And then, you know, afterwards depending on, I guess what you're baseline understanding of nutrition and macros and all that kind of stuff and how your body responds to that, then, you know, becomes an extremely powerful behavioral tool. And I think that that's the part that that excites me the most is because despite being on this health train and stuff like, I got a toddler at home and these got these little peanut butter things called bombas. I don't know if you guys have heard of them. They're asleep. And I told my wife, I was like, we can't have them because she never gets to eat them because I just finish them all. I guess so anyways, besides the point. But, you know, and especially when you have these challenging days, and so I think they're just having that little thing there and then seeing what type of response you might get, if nothing else, it's an accountability tool. And I think that's the part that I love the most. You know, I suppose somebody who I respect a lot and I've been listening to this person's podcast for a long time, E. C. St. Kowski. She's a really good nutritionist and she had a podcast way back when on C. James I'm talking about it. She uses interesting analogy. Didn't think that they had a lot of merit for a lot of the people because the knowledge of use was kind of like, let's just say you're the CEO of a company, right? And if you're trying to operate the business and you're getting day in and day out and inundated by every single expense and rather than a profit and loss statement at the end of the month, you're getting, okay, you know, the toilet seats cost this much and then this was the next expense and you're just kind of getting throughout the day every single expense. That's it's going to make very challenging for you to do your job. And the way that it related is like if you're getting all these glucose spikes up and down after you have a couple of raisins or, you know, if you have an apple in the morning and stuff like that, at the end of the day, if you're not accounting for quantity, right? And you're only looking at your spikes and you're trying to normalize your spikes for the day, but maybe you're still eating more and you're, you're not maybe measuring your weight and stuff like that. Does it even matter, right? If weight loss is your goal or if long-term metabolic health is your goal. Now, I suspect I know we're going to go with that, but before you do that, I also love this fact that and maybe you could address this is that you also brought up that you guys have dieticians who are coaching at least for the first month for people, right? Is this correct? And at previous, some research that I've done, people have accessed them 24-7 during the week at least, is that unique to you guys or other companies who offer the similar service also provide that coaching at least for a brief period of time? So the best of my knowledge, we are the only ones out there to offer a complimentary month of dietician support when you sign up with NutriSense. And I truly think that that is what helps us be the best, right? You can download the the Libre app and just check on your own. You can take 1,000 finger sticks a day if you want to and record your own, you know, blood glucose data, but to have a professional there that can offer you actionable items, ways to improve, help you reach your goals and offer you things that you might not even know about research on caffeine, research on alcohol, research on all kinds of things. And we've been there, we've done it, we've seen it ourselves. That kind of buddy, that kind of partner, that kind of, sometimes, you know, tough love to get you back on track when you've gone off a little bit, can really be helpful. We think it's a really incredible tool. And I do think to your point about the spikes, and I think I'm answering the right question, but please correct me if I'm wrong. We get a lot of people that wear this and they say, well, my glucose looks great. So what? How is this going to help me, you know? And you know, I didn't go over 140 ever. I look pretty good. My standard deviation is exactly where it's supposed to be. We can, there's always ways to optimize. There's always something that you can work on, perhaps it's body composition. Maybe, sure, your glucose looks great, but you have very little lean mass, right? So let's work on that. Let's figure out ways to fuel your body so that you can increase your protein and increase that, that great storage space, because that's where the muscle, you know, the body loves to store glucose and the muscle. We know, obviously, you guys know how important muscle is on the body, and how we lose it as we get older. So even if, you know, in your stats, it looks, you know, pretty good. There's always something to work on. And we find the CGM, I compare it to like a window inside of your body, right? So you can see, you know, what's, what's happening? Maybe you have GI issues. You can see some of that inflammation, maybe of cortisol, you're spiking your cortisol all the time. We can see all of that. And it's fascinating how you can make small little changes with the help of your dietician to really improve some of that inflammation in your body, lower your risk for heart disease, help improve your GI system. If you've always been struggling with that, there's so many ways to apply this data. Love that. Yeah. I mean, we talk about all the time. Muscle is just a metabolic sink, right? So more, where you can put it on that, as you're talking about, one of the reasons adolescents and, you know, even a lot of people in their 20s can get away with things up to 30, depending on what you're training background is, you do have a lot of muscle, but also your hormones, right? The turnover of the metabolism, all those kinds of things. Although some recent data suggests that metabolism doesn't necessarily tend to slow down more activity and that kind of stuff, but you brought up this caffeine. And I want to take the side word for a minute, because what I do know, we talk about when people are talking about fat loss supplements and just from a fat loss endpoint, a supplement caffeine is very potent, right? Increases your thermic effect and increasing metabolism in that regard. It's also contributes a bit to insulin resistance from what I understand. And I always have a challenge reconciling those two things, whether from a metabolic health, if it's a good thing or a bad thing. Can you help me figure that out if you are familiar with that type of data? Well, you bring up the idea of the thermic effect of food. And that recent ish study that was I think last summer about kind of proving that metabolism is what it is for many, many, many decades. And there really isn't a whole lot we can do to alter, even if we get pregnant or anything like that. Yes, agreed that there have been studies that have shown that caffeine can increase the thermic effect. But when you're looking at the total impact of your calorie expenditure, your basal metabolic rate, it's a very small portion of it. So even if you were to increase your caffeine intake by a huge amount to really increase that, it's not going to drastically alter your basal metabolic rate. I would also say that particularly, again, specifically to glucose, we see a ton of caffeine spiking your glucose because it's spiking your cortisol levels. So the tradeoff of, yeah, like, you know, maybe there's a small increase in terms of how much you're burning, but you're like wired and uncomfortable and then you're going to crash later on as well. And I also think that a lot of people are sensitive to it and some people aren't. So some people might be taking in a lot of caffeine, but they're not actually as sensitive to it as others. So when we see the caffeine coming into the system, sometimes we see a pretty big spike and then a crash. And then these people are exhausted. They need more caffeine. They have the mid-morning snack. You know, it sort of, it begets the cycle of snacking and eating and snacking and eating for them that is not helpful at all and offsets any of that potential minor increase that you could see from it. Okay. That's interesting. Two-part question. Are there some sources of caffeine, maybe green tea, black tea, other source tea that are gentler when it comes to that cortisol spike just from the data that you've seen. And then also when people who are high caffeine, let's just say coffee consumers, right, they over time will get desensitized and that adenosine receptor over time when it's desensitized is primarily, I think, in the brain that that's happening, right? But do you know if it's uniformly getting desensitized or is it desensitized only in the brain? So you have to consume more to get that neuro-cognitive effect, but metabolically you're still getting the jacked up cortisol, which is affecting your glucose. That's a super interesting question. I don't know the answer to over time, in terms of over time, five years, ten years, you know, what changes in terms of the receptors. I will say particularly with women things crossing over the blood brain barrier, particularly during the perimenopause and menopause stage, they can try to increase their caffeine intake because of the brain fog. And really it's actually more of estrogen and the estrogen receptor. So I think a lot of times people are using caffeine to help in a way that is not actually the right path of physiological way to help what's what they're feeling physiologically. Does that make sense? I think caffeine is a tricky one. I know there's a lot of mixed stuff on Yerba-Mate, which has some, you know, which is a caffeine-based plant supplement, but I don't have the science behind dosages and what the what what the literature says on it right now. For sure. And I think it would be interesting, right, as far as having a CGM and seeing that if you're trying to Yerba-Mate, I mean, I have green tea, white tea, the oolong, I do black coffee, I do the Yerba, so that'd be pretty cool to kind of see. What I'm interested in understanding is from your perspective as the dietician with neutrosense and let's say I'm the patient, I go ahead and buy the CGM putting it to the back of my triceps, can you tell me the interaction from your perspective of what you're looking at from day zero of when, you know, I get this, I now am inputting my meals, my blood sugar is being tracked, tell me what you're looking at from day zero all the way up to, you know, day X. Absolutely, that's great. So we get notified that we have a new member, a new person that, you know, me as a dietician that I get to follow, I get notified that Darsh has activated his sensor, so I'm super excited. And what I get is a long, I shouldn't say it's not long, but I get a questionnaire that you've filled out that gives me your goals. And that really sets the stage for how I am going to approach you. And I'm going to know that, oh, Darsh's goal for this is to promote longevity. Or his goal is that he's running a 10k and he wants to make sure that he's feeling properly for it. Or, oh gosh, Darsh, unfortunately, got, you know, a diagnosis recently. And he's hoping not to take any medication for it. So that's really the initial jumping off point. And I just want to emphasize how individual it is, right? I'm not jumping in there with my set programming for you because I don't know what you want to get out of this, right? I don't know what your job is. Maybe you work night shifts. I have no idea, right? So it's that initial goals questionnaire and health questionnaire that I get to know who you are and what you want to get out of this program. So then we start by doing just the basic analysis of what's going on with your glucose. And we love to get that baseline value. We tell our initial members, just do your normal thing. Like you do you for a couple days, because let's see where you are before we start to make tweaks or changes, and we can identify maybe where those problem areas are. So we're going to basically look and just see how are you in range, right? We have a basic range of 70 to 140 milligrams per desk leader. And it's just shown in a green band on your screen. And you can just see very easily how often are you staying in that range, right? Are you frequently going up and down? We're looking at just those basic trends, right? And the app gives you a thousand metrics. We slice and dice your data seven ways to Sunday. I mean, it's it's incredible. But the dietician will reach out with those kinds of just basic understanding of your goals. And then let's start to just see a general idea of what's going on with your trends to get to get started. Catherine, do you guys collect data from patients, either prior A1Cs or maybe people if they do get their glucose like daily glucose with just fasting glucose over the last, you know, people sometimes will check the the finger stick on our daily basis. Do you guys get that type of data ahead of time? Because I think about the Hawthorne effect, right? Even though you ask people, Hey, don't make any changes. Just the fact they know they're quote unquote being monitored. They're going to make changes, right? This is well documented. So is that something that you also look at? Absolutely. So again, within that questionnaire, you are able to input any recent labs. You can send us your labs. A lot of people will send us lab lab work to be reviewed. We take a little bit longer to go through that and we're not going to make any large judgment calls on that. But we can certainly take a look at a recent lab work that you've had done. And there is room in the app to add in if you're measuring glucose on your own with a finger stick on a daily basis. You can also add in ketone measurements if you're taking ketone measurements on your own. There's lots of different extra things you can add onto it. And absolutely, people are like, no, no, this is totally how I eat when all of a sudden they're moving more. And they also tend to not log things. But you can see it in their data. You can be like, well, what happened last night? So a huge spike in people are telling me like, oh, well, you know, I ended up having more dessert or it's just sort of like, oh, I didn't realize how much I had been snacking last night. Then they really realized. So nothing happened. The sensor is faulty. It's faulty. Right. I must have bumped it. Oh, actually, that brings a question. Is that I do think this is the one, right? Like you have to in terms of some people said that the data is you see aberrant data if they're sleeping on their arm or something like that. Is that affected as well? Correct. Yeah, it's a, you know, pressure. When there's pressure on the sensor, it can cause a false dip. We really only tend to see it, you know, at night, if you're if you're wearing it and you're a side sleeper or something like that, you can see kind of a false dip sometimes, but usually bumps right back up as soon as you roll over. Okay. Okay. So it's only a dip. It won't go the other way. Like it won't be a spike. No, that's that's determined by other factors, exogenous factors, things like, you know, what you ate than I before, how late you ate, stress, hydration, so certainly want to come back to that in terms of, you know, tactics and strategies that you learned in your time, kind of looking at this stuff, but I want to talk a little bit more about the sensor. I understand that some people, I think that you said the freestyle librae is the one that you guys are using, and I think a couple other companies will use that as well, but the other very popular one in terms of from patients that I see the insurance companies is the DEXCOM, right? I think G6 is probably the most up to date one. And from a like a medical grade standpoint, I think although I did have a patient yesterday who had the librae as well, but no more, more the, you know, the medical grade ones or the ones endocrinologist who prescribed are going to be the DEXCOM. And I think one of the reasons people say in terms of a calibration issue with the librae thing is that like what can you say to that and maybe even elaborate on it specifically what that is because I don't think I did a good job telling people what the issues might be. Yeah, so actually when it comes to calibration, you know, those those apps like the librae app is calibrated slightly different than ours because people are dosing insulin off of it, right? So they have to really be, they have a lot more sensitivity around lows because someone could be dosing insulin off of it. So we, you can calibrate on our app, your sensor. And we do that to a fasted glucose either from a finger stick that you're taking at an at home, you know, glucometer score or a recent lab draw something within the last three months. So you can calibrate the sensor within our own app. And it is slightly different than what you would see on a librae from the from the librae app because of the dosing of insulin and just the sensitivity around it. But was there specific reason you guys chose to use the librae instead of the DEXCOM? Oh, good question. Perhaps before my time, I'm not sure. And I don't know about the integration right now with our app and DEXCOM. It could be something they're exploring on the product side. Got it. I want to come back to a term used earlier. You talked about orthorexia. I think that's an all-time. I think really anything with respect to health and wellness. And I don't know, Darshan, maybe we're guilty of contributing to that. It's kind of an all-time high rate sleep, right? The good that that Matthew Walker has done by putting his book out by people becoming more aware of their sleep. In my opinion, certainly outweighs the bad. But there is certainly some bad to talk about, right? We've talked about this with Dr. Jayde, who a couple of times before where people are hyper-focused into their insomnia and their sleep, and that's only contributing to further pathology. So the term orthorexia that you're talking about, people being hyper-aware of their eating patterns and just healthy eating in general. What concerns do you have with this just kind of movement going towards more CGM, more towards nutrition, and then CGM's contributing to that? Like I know we talked about somebody who has true pathology and disorders that it's not the right thing for them, but just coming back to the general population, where the basics are what's going to drive 90% of the change for them, right? Like how do you have that conversation where you're like, you know what, you're not there yet, because you aren't offering that dietitian support. You're seeing that, right? So you're having a conversation with these people, you just say, look, you know what, you need to focus on maybe just like the ABCs before this data, because this is only confusing you and actually backfiring. Yeah, I think, you know, again, we are highly trained dietitians in terms of, you know, clinical thing. We've all gone through a dietetic internship. Many of us have worked in highly specialized clinical situations, either diabetes or just, you know, within hospitals and stuff. But there's also a huge element of counseling and that, you know, MI, those MI skills and really hearing someone and learning what their ultimate motivation is. We can pretty easily identify someone who's having, you know, kind of struggling. And a lot of times we do see women and some men that are under-eating. And so that's, that's one of those sort of triggers of the, you know, they think that they're doing all the right things and they're exercising a lot and they're just not taking in enough to help them meet their goals, whatever it is. And we really help counsel people to take small steps, you know, perhaps to broaden their macronutrient profile, maybe they're fat phobic, you know, they've been so worried to have any fats. And we help them explore that and we give them, you know, they get to see in real-time data that it's not hurting their body, right? That, that maybe their performance, you know, at their hit class is even better when they're fueling before they work out. And so we really try and broaden people's nutritional profile if we feel like perhaps they've been too restrictive in the past. And we try and help them down a path of more food acceptance and, and, you know, really seeing that it's helping their body, not harming their body. So in that sense, this is a great tool to show someone, hey, look at all this progress that you're making. Look at how great your body is doing with the different types of foods that you're eating. How do you extract that information out of them, right? I feel like a lot of people might be reluctant to kind of go with that information and feel like I'm being very reluctant. Are you interacting with them and then trying to extract that just through coaching tactics or do they feel out of questionnaire as well as the weeks go on? Yeah, I mean, one of our questions in the beginning is what's your style? What kind of coaching style do you want? You know, you tough love, you an educator, you want a friend. So we, you know, we take that into consideration. I love it when I get the tough loves because I'm like, I'm going to, I'm going after you. I'll hold you to it. But yeah, so there's that. And if someone's not logging or, you know, missing a lot of scans, they're just not really into it. You know, we have some ways of trying to engage them again, but sometimes you just have to understand that they're just not ready to make a change. They're just not on that, you know, they're not in a state of change yet in their minds. And maybe they're just going to use this as a tool to help them make that change down the road. And all you can do is offer them some information, some insights, some encouragement, you know, point out, hey, looks like your breakfast yesterday was really well tolerated, you know, whatever you had, you know, it looks terrific, you know, try that again later tomorrow. And it's really kind of a, we try and be a motivators for healthy behavior changes. I love that. I think so often we quickly go into coaching mode without asking how they want to be coached, right? And I mean, that's the, that could be 80 to 90% of their way of getting to success is just like asking them, what's your coach? Like, what's your learning style? So I absolutely love that. While staying on this topic, you did mention how, from the questionnaire, people will have different goals, whether it's a 10k, whether it's longevity. How are you coaching through those goals? Like, what are you looking at specifically when it comes to glucose monitoring in order for individuals to reach their goals? Yeah. So, you know, if it's longevity, a lot of times that's just minimizing your glucose spikes because we know that chronic high glucose fluctuations can lead to inflammation. And obviously, we all know that the inflammation cascade can be detrimental in the long run. So it's kind of explaining how their day to day choices might be influencing their ultimate goal of promoting longevity. Again, we never want a flat line of glucose. That's not really sustainable nor manageable in the long run, but it's helping them to understand what's going on in their bodies so that they can attain those goals. And again, many times it's not even food related. I know we touched on this before, but you know, your goal might be longevity, but you lead an incredibly stressful life and you're not sleeping or, you know, taking care of your well-being and it's showing up in your body. So it's, I think that can also be very eye-opening for people. And they also think that they have, they might have one goal, but using this data, they ultimately see down the road that maybe it's something else that they truly want to work on. Following up on the piece of change and being ready for change, you mentioned that whenever somebody signs up, the minimum amount is one month. Is that correct? Correct. In your experience, what's the average time I understand there's individual variability, but just kind of looking, you know, a big picture here. Do you feel like one month is enough for change? You know, for people to say, okay, look, I have the information that I need and I think I'm ready or like to be able to, to buy, establish that report, the therapeutic alliance to, to steal a phrase from Dan Pope is one month enough time? Or do you feel like that's, you know, the success rate is lower in that end? I can give you my marketing answer, which is absolutely not a 12 month. 12 month is the ultimate is the best one you could purchase. No, I'm joking. I think I hate to go back to individual, but you know, it could be someone, you know, we've all heard those people that they do a five day reset, right? Or they're training for one race and they, they institute this amazing workout policy for three weeks. And then, you know, after the race, they don't go back to it. So personally, I think one month allows you to see within, you know, think about a month of your life. What do you go through? You probably go through a couple cycles of work, maybe some downtime, maybe some busy times. You go through some social events with your family. You have an opportunity to see all different aspects of your life. You have the opportunity to play it really straight now. You have the opportunity to fall off the wagon a little bit. I think one month shows you a lot of data. I don't think one month allows you to see true behavior change and true long term adjustment to your blood glucose statistics, right? I think you need to see that more on like a three month basis to be able to see a really true reduction in like a fasting glucose or something like that. I think it just takes longer in order to really build muscle to maintain a lower baseline glucose. Yeah, you could prompt some muscle in a month, but I think if you instituted a decent strength training program, it probably takes about three months to really build up a lasting, you know, store muscle. So I think in general, three months, you're going to see the changes, but within a month, at least you can see where your baseline is and get a really good read of where you are. So Catherine, you also mentioned, you know, rightfully a lot of people listening are going to correlate and think about sugars and glucose monitoring with food, right? Think about insulin spikes, insulin resistance, all that, but you made it an important point that being highly stressed can, you know, definitely influence that as well as your sleep. I mean, there's a bunch of lifestyle factors. Do you mind going through some of those lifestyle factors? Let's touch on sleep or exercise and the impact that they have on glucose and the tips and tricks that you would use with your with the clients in order to get that glucose more stable? Absolutely. Yeah, I just I was invited to do a presentation for Rivian a couple of weeks ago and this was exactly what we talked about, which was, you know, kind of that that basic what we call the four pillars of health. You've got nutrition, but you've also got exercise sleep and stress, which are really, really incredibly important when it comes to not only your glucose management, but just obviously, you know, longevity health over time. So what we like to talk about a lot with movement is again, what do you feel comfortable with? What are you doing currently? We've got endurance athletes. We've got marathoners. We've got crossfitters. We've got people that haven't moved since 2016. So there's a like we, you know, we get a whole spectrum and listen, a lot of it depends on your lifestyle. We all leave incredibly busy lifestyle. So when it comes to movement, we give them there's a recent study published not that long ago, March February, glucose improvement better with 10, 10, three times 10 minutes a day versus a 30 minute chunk, right? Nice to have the science behind it. We all kind of move that anyways, but we love to send that out, right? Who doesn't have 10 minutes? You're probably scrolling ESPN or Facebook or something for 10 minutes anyways, like get up do something, walk around, do some squats, do something. So we love to use that as a motivator for people that aren't super active in terms of using up your glucose. And I think a lot of times people don't even understand how exercise and glucose work, like they don't quite get it. And it, I mean, it's simply like, you know, burning up the fuel that you might have taken in and or the glucose that has previously been stored in your muscles gets used. It gets taken out of your muscle. We sort of call muscles like, you know, our cubby holes takes out, you know, taken out, used up. And then you have now storage space at the next time you eat your glucose can go into your muscles. And it's not floating around your bloodstream, right? So we sometimes you have to just explain those basics to them. And sometimes it's just a motivation of like, you got to get out there, you got to walk around after your meal, you have to use up what's coming in. And then we also talk about the importance of muscle, which I touched on earlier. In the sense that obviously it's one of the first places, you know, it goes to the liver, your body will store glucose in your liver, it'll store it in your muscle. And if those are all filled up, it'll probably store it as fat. So we really want to make sure that they are building muscle. This is pretty key for women. Men are like, oh, sure, sure. No problem. Women are a little bit more tentative to start a strength training program, although that's starting to change. But it's really just a matter of encouraging someone to get some dumbbells or, you know, doesn't have to be a whole rigorous progress, a process of starting a, you know, massive deadlifting practice. So we really, again, we meet people where they are, but for exercise, that's really it. When it comes to stress, it is incredible when people see it in their data. I have a lawyer who goes to court, I think like two or three times a week. Every time he goes to court, it's like, it's up and it stays high and it stays high. And then when he leaves court in the early afternoon, it drops right back down, right? The guys eating a great breakfast, you know, clearly it's a clear stress indicator. I've seen it, you know, someone has a stressful phone call, someone has an argument with their partner. Their glucose goes up purely in response to the cortisol spike. So it's really interesting. I think people are fascinated by the fact that their body is physically adapting to these higher stress situations and it's happening on a constant basis. So we can work on some of those in the moment, stress techniques, breathing exercises, encouraging someone to think about starting a meditation practice or just being in nature, you know, whatever kind of works for them to lower that parasympathetic nervous system reaction. So another really interesting, one of the fourth pillar, if you will, that besides the nutrition and the stress and the exercise is sleep. And it's fascinating to see in someone's data after a poor night's sleep, not only is their baseline generally a little bit higher, but generally their ability to process carbs in their their reaction to certain carbohydrates can be different. So we think it's super interesting to look at that. You can do some comparisons and a lot of times someone will say, you know, I'm meeting the same lunch I had the past three days. Why does it look so different today? And, you know, you can kind of go through a couple different things. But then we always say, you know, how did you sleep last night? And people are like, oh, actually, it was terrible. I was up a bunch or whatever. And it's really fascinating how the body compensates for that kind of poor sleep stress state that it's in the next day. And how it processes the the incoming energy. You know, you mentioned exercise and how it's not insulin dependent. I think that it's worth highlighting because when I think about all those four pillars, of course, individually, it's going to matter. Every single person is going to be different in terms of how much is going to move the needle. But if I had to make a general statement, I would say activity by far exceeds every single one of them in terms of how it affects your glucose response. And for those who don't know, right, insulin is the key that's going to open the lock to the glucose is going to go into a certain organ, whether it's the liver, whether it's going to be, you know, in the muscle, whatever it is. But exercise is unique in the sense that it opens the key without the need for insulin. And everybody's heard probably events that at this time. And, you know, hybrid and salineemia, some people will say is the canary in the coal mine, right? That's what's leading to metabolic ill health down the road, which leads me to my next question and getting your thoughts about OGTTs. And maybe I'll just briefly explain it for those who don't know an oral glucose tolerance test, right? And so if you've ever been pregnant, and you've had good care throughout, you've certainly familiar with this. But basically, what it is is that you take about 75 grams of this drink. A lot of people say that, hey, glucola, but when I did it, I actually liked it. That was pretty good, some lime flavor that I had. And then within 30 minute intervals, you're going to get your glucose checked. And what you're looking for is an appropriate spike. And then over time, it comes down. And then I think within two hours, it should be back to baseline. Is that did I explain it correctly? Yep. What some who are proponents of the carbohydrate insulin model or just really insulin as a significant contributor to obesity epidemic will say, well, we should also be checking your insulin response. Because again, that and hyperinsulinemia over time is what's causing metabolic ill health. I don't remember those numbers off the top of my head. But again, similarly, insulin shows spike. And then within an appropriate time in about 60 to 90 minutes, you should be coming, you know, somewhat close to baseline. And if that stays elevated for prolong periods of time, that suggests that you are in this hyper, you know, insulin resistant stage, as the name suggests. My question for you is, what are your thoughts about that test and periodically doing that? Because, you know, the insulin response is almost more meaningful to me than the glucose spikes up and down. What do you think? I told, I love it when we have members that are like, let's do it. Let's experiment. Because I'm like, let's do the at home OGTT. Because those are, you're right. It's so fascinating, right? You maybe, maybe many men have probably never even done this. But you can do it at home with honey. You can do it with white rice. You can do it with any type of, you know, popsicles and whatever it is, 75 grams of a simple carbohydrate. And you just kind of sit there for two hours. You kind of have to block it out of your day. But because we, you know, we don't want the confounding factors of, oh, well, then I got up and I went running or something, you know, or as at work or moving around to town or something like that. So it does take a little bit of forward planning, but it's absolutely fascinating. That is exactly what we're trying to see. You take in the glucose. How does your body respond to it? That's 100% the name of the game when we're, when we're really trying to test out and see what your body can do. And we do use, we have a metraconclycemic variability, the standard deviation of your data. And we do use that as a proxy a little bit for how your body is responding to insulin. So a lot of people say, well, you know, how can I, how can I use this? Or what if my baseline is off? How can you tell me, is this really, am I really a fasting glucose of 92? And we say, you know, regardless of calibration, regardless of that, let's just look at what your response is to your carbohydrates. And we see that in your standard deviation metrics, right? We can see how you do when you go out for sushi. We can see how you do after you have four beers. You know, we can see how you do when you have these higher carbohydrate meals. How well does your body respond to that carbohydrate? And therefore, how well does your body responding to the insulin that it's producing? So absolutely, we have to use the CGM as a proxy, but that's exactly what we're getting at. Awesome. So Catherine, as we come to a close here, I want to ask you about, we started off at the outside talking about how wearable, you mentioned how one of the reasons you got into it was because you believe wearable is kind of the future. I think we probably agree again, we're all wearing one, which actually I meant to ask you, were you wearing a CGM prior to coming on board for neutral sense? Or did you have any experience with that? Or were you wearing any other wearables technology? I'd only ever worn like an apple watch. But I'm wearing a CGM right now. I love it. It's like my favorite thing. And I was super jazzed to work for neutral sense. Yeah, because of that, you know, I have friends that wear the aurora ring, friends that wear a woop band, but for me, I've gotten way more out of the CGM because it shows me that bigger picture, right? The woop band might tell me I need to get up and move more, like sure, fine. You know, the aurora ring might tell me that I'm not sleeping. That's great. Fine, fine. But I can see all of that in my CGM data. Get more bang for your buck. What do you mean? How do you see the sleep stuff and activity stuff and strain scores? But how do you see that in the? Well, sorry, I shouldn't say it's not the exact metrics, but I can be told that I'm not moving enough through my CGM data. I can see that I'm not sleeping well enough through my CGM data. So in my, in my opinion, I get the fuller picture with my glucose levels than just getting the one reading, sort of the siloed readings from the other things. Interesting. Yeah. Now, you know, I mean, because it's all those are secondary signs, right? But I think it would be really hard to disentangle if you were having a lot of life stressors, i.e. newborn, and then you're also not sleeping well, which again, you can extrapolate. But then if you're also stressed at job, but then identifying which stressors are the ones that spike that cortisol response, like the lawyer told us, because you know, diverting your energy to, to certain places in times of maybe when people feel time poor, I can say this because, you know, my kid is a lot younger than yours, and I feel that although you have three, so I don't know who gets to win that one. But I let's talk a little bit about the futures of CGM. There are more and more companies popping up that are offering these services. I think once you go on to, I did take that the quiz, the, you know, about what type of learner, is it learner, what type of support do you want, and all that kind of side, I fill that out. But once I think it did that, then of course, every part of my Instagram, feed, Twitter, everywhere I'm getting bombarded with different companies who I've never heard of. And so more and more popping up is if I said to say, what do you think that CGMs are going to be a couple of years from now? Like is it, what are you most excited about in terms of the technology evolving in terms of data? Like, what do you think? I think it's fascinating. I'm hoping that it becomes more mainstream. I'm hoping that it becomes more acceptable in terms of medical practices that this is just a part of your routine annual physical. This is just a routine part of taking care of yourself and, you know, life, just longevity and just making sure that you are a healthy individual. I'm hoping that it becomes routine in a workplace to offer this, you know, through like a health and wellness program. That's my hope. I also think though, you know, there's a lot of talk about the AI and the chat GPT, and is that going to take the place of doctors? Is that going to take the place of medical professionals, you know, of all stripes? And I'd like to say absolutely not, right? We offer the human perspective. There's nothing wrong with a little AI saying, hey, that banana spike do fine. I'll give it to the computer, right? But it's the nuance of the coach. It's the nuance of the dietician. It's the experience. It's the knowledge. It's using different decision trees that AI can't do, right? And that doctors can't do. You have to have that one-on-one relationship with your patient, with your with your person. And that's where the technology can't stand alone, right? You can't just have a robot doctor. You can just have a robot dietician. You have to have someone, you know, with some empathy and some real thought behind it, creative thought. And I definitely agree with that. I'll take the other side of this. I mean, I'll talk about this all the time. I'm very, I guess I'm pro AI, but I do think there is going to be a time where it's going to weed out a lot of the health professionals, especially from the empathy standpoint, right? And I know a lot of the medical schools now are requiring a test that will allow them to see how, I guess, flexible a student can be in terms of their social intelligence, emotional intelligence, looking at ethical kind of things. So it's definitely going to be an interesting next couple of years. I was actually just listening to Lex Friedman as well. Interview Sam Altman about the future of chat GPT and kind of where he thinks it's going to go. So definitely a lot to talk about, follow up on in that regard. Okay, then overall, I just really want to say thank you. CGMs to me have always kind of been this great area where, you know, I knew what they looked like, I knew what they did, but I never truly understood its true potential. And obviously we have a lot of patients coming in now wearing them. And I think, you know, this last hour or so has really helped me to understand how to better support my, my patients, I come into with it, but also those who may not be wearing one and who are looking for that potential solution to understand, as Altman said, which life stressor is it? That's really, you know, bugging me out and causing me this quote-unquote headache throughout the day. So thank you for that. I'll let no where can our listeners find you and where can they find neutral sense on socials? Absolutely. We are, yes, I think we're all over the socials, even if I'm not. But our website is www.neutersense.io. And I need to give a plug for our blog, we call it the journal. And even if you're not sure that CGM is right for you right now, it is an incredible resource with great evidence-based articles, bite size. You can really get a sense for how this technology can help you. And maybe if you have an issue, how does that relate to your glucose and to your blood sugar? So I definitely recommend everyone go, at least for our website, to check out our articles. They are fantastic. But you can also find us on Instagram. If you just say our name enough times your phone will pick it up. But it's, we're at Neutersense.io and I'm at C. Staffiary underscore our DN. So you will find us, I'm sure, I'm sure your listeners will find us. And I hope you guys take the plunge and put one on. Sure, absolutely. And I will say I think it's not only just for patients, but also providers to learn from whereables, as we just talked about these last 10 minutes, are definitely the future. I think they're even coming out with now blood pressure monitoring for 24 hours. So definitely a lot to look forward to. Katherine, our last question here that we ask all our guests is how do we add the health back to health care? Oh, the health back to health care. That's a tough one. I mean, I think it's really right now in this day and age and people are so I think really stressed about themselves and there's a lot of sort of inward thinking. I think taking care of who you are making sure you have a supportive community. It could be your doctor, it could be your family, it could be friends. But that really helps promote a better lifestyle overall finding those people that care about you, that care about your health that want you to be the best person that you are is a motivating factor for your own self improvement. So I say look around you, make sure you have a supportive community and people that are rooting for you. Love that. Thanks so much, Katherine. Thanks, Katherine. Thanks guys. This is great. I appreciate it. Thanks so much for listening to that episode. If you are interested in tracking your own glucose and seeing what type of lifestyle factors are affecting it, make sure to check out the NutriSense website, make sure to reach out to Katherine and even check out their social medias. Also, be sure to check out the medicine, redefine, Instagram, TikTok, as well as Twitter. We are posting tips, tricks from all of our episodes right there so that you'll never miss a beat. As always, our medical disclaimer, everything in this podcast is for educational purposes only. It does not constitute the practice of medicine and we are not providing medical advice. No physician patient relationship is formed and anything discussed in this podcast is not represented views of our employers. We recommend that you see the guidance of your personal physician regarding any specific health related issues. And thank you to our team, Ethan Jew, and Rita Yehpori for the production of this podcast. See you next week.