#23 Should You Use a Continuous Glucose Monitor (CGM)?

Speaker 1: 0:02

Welcome. I'm Dr Moose Herring, Orthopedic Sports Medicine Specialist.

Speaker 2: 0:06

I'm Dr Rob Green, Sports Chiropractor, Coach, Trustee Sidekick. We are Lifetime Endurance Athletes. We are Eager Lab Rats.

Speaker 1: 0:13

We are Maker of Many Mistakes. We are Family-focused sports medicine docs that are balancing family work and fitness and are enjoying the ride While we are sports medicine professionals. This podcast is not part of our professional responsibilities. No doctor, patient or coach-athlete relationship developed this podcast. We have no financial support from any outside resources. The only support we get is from our fantastic wives that sit back and look at us in complete dismay.

Speaker 2: 0:42

Welcome to HubLife. Enjoy the show. Hublife. Welcome back. It's been a couple of weeks, moose, how you doing man Pretty good this busy time of year for us.

Speaker 1: 0:54

Every patient that comes in says you got to get me in because my deductible changes January 1. We're at the point now where we're like sorry, we just can't.

Speaker 2: 1:05

We're not going to change quantity for quality.

Speaker 1: 1:08

We are full go, but it's a busy time of year.

Speaker 2: 1:12

Yeah, there's nothing more you can do. You can't invent extra time. If you do like you said, that's a big deal. I don't want my surgeon kind of like burning the candle at both ends.

Speaker 1: 1:21

I am so happy that our racing season is in the spring and the summer and the fall, and then work is just crazy right now. So there's no work-life balance, but one takes over and there's definitely a flux of things.

Speaker 2: 1:37

Yeah, you're Yin and Yang man, your work, yang is pretty thick right now. So you're training right now, so thick.

Speaker 1: 1:44

Yin is done. But, trying to be consistent, my calf is better. I'm up to five. I ran this morning five times five one with no pain off the bike. So it's fantastic Deep into my road challenge and I'm just amazed how just absolutely absurdly hard rowing is. I did my first 2K road challenge to set my time trial last week and was super happy, but was smoked for like 24 hours yeah.

Speaker 2: 2:20

Smoked, which I don't think since we've had a couple of weeks away. I don't think we've talked about it, but there's been two incidents right. There's been a pickleball incident and there's been a rowing incident.

Speaker 1: 2:32

I think we talked about my calf.

Speaker 2: 2:33

No, I don't think so, man. I think, yeah, I think it's been that long. I think you and I have talked about it, but I don't think we shared it. But no, because it happened after last podcast.

Speaker 1: 2:43

I'm four weeks.

Speaker 2: 2:44

Yeah, so we missed three weeks. I think, wow, so we're not missed. I mean, we're trying to do it weekly but life happens. But after that podcast, you were going to be right family first. So what'd you do? Right After we had ran like two hours on the trails, right, and then the next day, what'd you do?

Speaker 1: 3:02

I rode two hours and 15 minutes doing low cadence, strength stuff, yeah, and then I did a little jog off the bike and was tired. But to spend some quality time with my wife I decided to go play pickleball and tore my medial head of my gastroc at the muscle tendon junction playing pickleball. And I may have said some few choice words around that incident. And then it really was a bummer because it took me out of marathon training and I'm just not a nice guy when I'm not running.

Speaker 2: 3:36

So how about how it happened, though? Right, you were all done. So how does that happen?

Speaker 1: 3:42

I was done. I was happy. I was sitting on the bench with my shirt on, ready to go, and they decided to play one more game.

Speaker 2: 3:48

Just one more, one more game. Hey, doc, I was feeling really good right up to that point.

Speaker 1: 3:53

That's why, on your intervals, shut down before you're absolutely smoked. So it's. I mean to go and do a plyometric type exercise with fatigue methanal legs is not the best, but the hub, the hub way is family first and I thought I was spending quality time with my wife. Now the worst ironic thing is she broke her foot the next week after playing pickleball. Oh man, and it's hard, hard for this kind caring, compassionate individual to have any any kind caring, compassionate words for her Cause I was linting around and you know she was in a boot. She broke her foot. We were a mess. So it's awful hard to hit those pickles.

Speaker 2: 4:35

Man, it's funny how those injuries happen. I don't know about you anytime and I'll share mine with you, but anytime we've done it it's kind of like I knew it, I knew it, I knew it and helps us. I don't know about you. We're better providers that way. Just for the fact that, like it, we go through not only the physical experience with all, but the mental side of it and the frustration and talk to patients all the time. Being injured sucks. This is part of is part of the deal and unfortunately it happens in the weirdest places. And you know if you, if you went back, you probably do the same thing. You just wouldn't play that last game. But but it happens. And what do you do with it? Right, you, you, you have that hits, you fit it first and then you get the other side of it and then you focus because you're you're already back and you're doing run, walk.

Speaker 2: 5:14

You got a nice good progression back. You're running pain free.

Speaker 1: 5:16

You got a goal of, by December, to be 60 minutes back and you, you do what you can and yeah, so, so, so really, you know exactly you do what you can, and so we kind of set this goal and so this will go back to you as we set this goal. If I can't run out, I'm going to try to row again. So last winter we set a row challenge and kind of a national standard is 2k and so you you can look on online and see what the national, national averages for all age groups for 2k time trial on the ERG too. So I decided I was going to set that again. I've been working, been working, working toward that and I did my first 2k challenge last week. It is amazing how hard rowing is.

Speaker 1: 6:01

So it was shocking that I did a 2, I did a 2k row challenge and my max heart rate? I hit a max heart rate I hadn't seen in two years. Yeah, Wow, Two years, yeah. And in the last three minutes of that 2k row challenge I was well above zone 27. It was insane and I'm sure the people that were like what's going on.

Speaker 2: 6:24

Yeah, and it's good to get that heart rate mat. You wouldn't do it every day, but it's a missing component, especially when we do long core stuff and we don't. And how many, if you look at it, and the amount of muscle recruitment that is done in a row. Yeah, but now that leads to like I've had a rowing incident, like so I, we've done this, we're fragile.

Speaker 2: 6:43

Oh man, and it was. I mean, it's classic. So maybe we put out there there's a really fun row challenge to do, and and heed some advice on my part, because I've I've used a rower before, but I have not used it, you know, from other than just every once in a while. And so I went into a deep dive of technique because I started the row challenge. I was doing it. It was like you know what I'm going to get into, this too, moose is great and and so I didn't kind of know exactly what I was doing, but I know how to row it. And then we were looking for time. So I went in a deep dive and formed to figure out, well, how do I improve on my form? And like anything that's new, I was like, well, crap, I'm doing it totally wrong. Right, I'm sort of that classic guy that was making a basically a polling exercise rather than a pushing exercise. So it changed that flip, that paradigm of like you know that, that slow recovery and then really kind of like press the machine, like you're trying to push it across the room and then finish it off with the poll.

Speaker 2: 7:40

And so I came in Monday morning. I came in before work because we have a rower here at Hub. And you know, I did. I practiced for one K. I practiced this new form and it was like a game changer. I was so excited. I'm like, oh, dude, I finally got the catch, I got the rhythm. My pace went way down. I'm like, oh, I can't wait to see what this looks like.

Speaker 2: 8:01

And then the next K I sort of built into it and built into it and built into it and was just like my 500 meter pace went down, so much that I just got so damn excited, right, and I overreached as I was getting fatigue on that like drawback, and I did exactly what we teach people not to do flexed in the spine, yeah, and then pressed in the machine and from a flexed lumbar spine started to push back and click, pop. And that's to me. It's like, if I'm listening to this podcast, I wish I could just rewind 15 seconds, absolutely, because that was my disc, yeah, and I was like, oh, no, no, no, no, and came into my office, was on my back, pretty sure, I texted you pretty quickly into it. It was like, hey, might need you to write me a script for some anti inflammatory. Yeah, was lucky, lucky, lucky, lucky that there is no nerve involvement. So I had five days of significant downtime and then second week back into it getting my range.

Speaker 2: 8:56

It's what I will. We do for rehabilitation of my own good patient, yeah but. But there's been a pickleball incident, there's been a rowing incident. So get into the road challenge, look at technique and just be mindful as you get excited. Right, don't be a knucklehead, maybe that's I'll give you a lesson from knucklehead earlier. Is, you know, always perfect form failure never, never, outkick your form.

Speaker 1: 9:18

Yeah, and I think if you're interested in the road challenge, you know here here's the deal Don't compare yourself with others.

Speaker 1: 9:26

Make sure you look at technique, because technique is critical.

Speaker 1: 9:29

Critical and be warmed up before, before you, before you start doing anything aggressive on the road, cause here's a ton of force across your low back, there's a ton of force across your legs, but you know, looking back on my notes from last year, what it taught me and what I learned from it is being able to tolerate a high heart rate.

Speaker 1: 9:49

It's amazing and for me, for my training, I don't get into much high heart rate and I tend to run really low, but for some reason, the rower, within several minutes I can be through through the roof and me and me being able to tolerate. So just set a goal. So if you, if you, row a 2K, our goal is you row a 2K and then by February we're one, you, you row a second 2K and that change is your progress. It doesn't matter what your 2K time is, it doesn't matter what it involves, 2k, but, but, but you're just looking for for progress and I guarantee, if you row and you row hard, your tolerance and your and your tolerance for high heart rate and fatigue will change yeah.

Speaker 2: 10:32

And it's we'll talk about in sometime in the future, about cross training and the winter time. Just do something different, make it fun, challenge about it, be different and and like Dr Harry said, like do some diligence, learn how to use the piece of equipment. I did that as well and I would take. Take a lesson for me Something that we preach in in in movement correction all the time too is slow is smooth and smooth as fast. I had just I was rowing is new to me and it's a new skill and I had developed the technique, but what I hadn't done was trained the ability to do it over sustained time, so I did the old too much, too quick. You know, hindsight's 2020, if I went back, I would have done exactly what I did, but I would have been slower in the progression of power until I really mastered good, consistent techniques.

Speaker 2: 11:19

So slow is smooth, smooth is fast. Go slow, focus on good technique, add a little bit of of intensity to it, slowly, progressively, until perfect form failure and over time, you're ramping up and you can start to deliver a max heart rate and know that you're formed to get sloppy, because I was about 600 meters into a 1k effort and I just I rushed it before I had earned the right to be able to do it. My technique got sloppy. You can do it right 99 times and wrong once. In that one will put you on your butt, like it did for me. So slow is smooth, smooth is fast. Get the technique down. Practice the technique slowly, build up, start easy, go into this sort of steady to mod, hard, mod, hard to hard. So get that down before you just blast into it. And that is from personal experience. So so try not to do that and hopefully we'll save you from a big injury. Awesome. So what's happening? Man, you had some current events that were out there. You were talking about some NCAA women.

Speaker 1: 12:21

Yeah, so I have to admit I've got some crushes out there. There's two women runners that I've been falling for years and years and they are Phenoms. Caitlyn Tuey from NC, nc state and Parker Valby from Florida have been the top collegiate runners for the last three, two or you know two or three years Now. If you follow collegiate running, you know their names. If you don't, I would ask you to look them up, because they are incredible, and today is the NCAA cross country champs where they're going head to head.

Speaker 2: 12:58

Yeah, and that's it. That's not far away, charlottesville. Yeah, so we've got an interview coming up with Kiera that we're super excited about Kiera DeMotto and we were going to do it this weekend, but she's actually at those races which is a rock star American runner, but yeah, to be right up the street, that's pretty incredible.

Speaker 1: 13:17

I want to give you a little history on them, just to just to tell you why I have a little bit of a crush on them. So Caitlyn, who goes to NC state, last year her 5K time 1570. Oh my God. Okay, in the fall of 2021-22, in the cross country championships, she came and put down the most most incredible last mile to catch Parker Valby. Parker Valby when these two girls race, they race with different strategies. Yeah, the Caitlyn Tui she tends to run strong and steady and then at the end she just crushes her dreams. She's amazing at the end and Parker Valby, as soon as it goes off, she folds her ears back and just dashes. She's like a pre-fontain. It's ridiculous.

Speaker 1: 14:10

And so last year in the NCAA cross country championships, parker Valby went out like she normally does and put probably 20 seconds on the field 20 seconds and Caitlyn was running with the pack. And the last mile, which was up this steep, steep hill, she put in one of the most ridiculous miles you ever see and caught her for the finish. And they finished one too. And then in the winter, in the spring, valby had an injury, caitlyn Tui had an injury. They were kind of back and forth.

Speaker 1: 14:40

And then the opening race this year for cross country, parker Valby won by 15 seconds. So today was the showdown and my new PA is out on the course and he just sent me a text Parker way out front. So she folded her ears back in and dashed and ended up winning by four to five seconds. And Caitlyn was running with the pack and I think she folded back to fourth or fifth. But it has been one of the greatest collegiate competitions between two people that they've ever seen. It's amazing. So it's a huge salute to women's running. It's a huge salute to women's collegiate running. But just phenomenal athletes and I might be a little bit of a stalker on both.

Speaker 2: 15:31

I just yeah, but does it count if you at least say it out loud? But how cool is that for them to? I mean to have a standout like that, but to have a competitor that pushes you into have two different styles and see those compete against each other, that's really pretty cool.

Speaker 1: 15:45

So they had a conference yesterday and they were they were interviewing the racers about their, their ideas and her, her, caitlyn, should we say. She focuses on day to day, she workouts and rest with intention, yeah, and she really looks after the team, yeah, to make sure all the girls are doing very well, yeah, so here's a girl who's one of the top collegiate runners she, she will go pro she hasn't already gone pro whose focuses on day to day, workouts with intention, she rests with with intention and she's also around with the team approach.

Speaker 2: 16:23

Yeah.

Speaker 1: 16:24

It's great lessons to learn. We know all learn from that, yeah. The second thing is I don't know if anybody else follows it, but for your past USAT Membership you got an outside plus membership as well for free, right, oh, yeah, yeah, so you got to read outside magazine. Well, that relationship has split and you need to check because there was a there was a yearly Update. You probably got charged 95 bucks as soon as you update your USAT phone, usat membership Outside. If you hadn't unchecked that box may have charged you 95 bucks, sketchy, right. So there's there's some upheaval there.

Speaker 1: 17:06

Yeah so if you're not using it outside and you get a $95 charge, you need to met somebody, know. But the relationship between USAT and outside is done.

Speaker 2: 17:14

Yeah, I can't imagine. I mean the magazines and outside of. How are they surviving in the world of, like online stuff? I mean, who's sort of paying for that stuff? It's all online. Yeah, I had no idea. I haven't renewed it yet, so I'll keep an eye out for that.

Speaker 1: 17:27

Keeping out for me and just make sure, sure, sure, when you do renew it you don't get charged extra 95 bucks from outside that because relationships split. Yeah, and then the next thing is if you Looked on on slow twitch, Try bike transport. We've all used to transport a bike is in a cash crunch. Yeah, and as of November 13th Four days ago they're no longer transporting bikes.

Speaker 1: 17:54

Yeah but there, there, there are some people in flux because what happened is? They're there. The bikes from a Spain Trafflon are being held by this carrier because tri bike transfer owes them $70,000. Yeah, so, so what Ironman did that? They came in and putting cash to pay for the transport for nice Latte tea, which is a 70 point point, three worlds, but but there's still a Cargo little bikes.

Speaker 2: 18:28

Yeah, it's being held and some coming back from Kona, I think too, or like they were concerned, they're being being held, yeah, so.

Speaker 1: 18:35

so if you've used, if you've used tri bike transport, I want to be aware, but but apparently the number is that they up to $300,000 in debt. Yeah, further for their transportation.

Speaker 2: 18:47

That's. That's sad man, because, like, I don't know about you, but that's a luxury, I mean it's. It was expensive and I can't imagine how much more expensive. Imagine that escalated very quickly the cost of transporting the bikes Over, since and they yeah, so they. They made up. You know a management error, but but using them it's a luxury. You take your pedals off, you drop your bike, you pick up your bike. It never gets disassembled.

Speaker 1: 19:09

So I don't know if they survived, but I, but I man, I would really hope they do and because you and I both know we, you know, last year we went through the stress of figuring out our new bike bags and, yeah, transforming that's stressful, it is, man, oh my god, I'll pay somebody to take my bike and to have a system where I pick it up. Oh man, but that's, that's gonna know.

Speaker 2: 19:29

If there's, I'm sure there are other bike transport, but but something that's been been kind of ingrained in our sport, yeah, is gone and you know, the other thing I've read in that too, that would stuck out for me too, is is Ironman has been getting in rightfully so a lot of hard time about stuff lately. They stepped in, I mean, they, they have skin in the game on it, they're they're racers, bikes but they did step in and financially, yeah, you get them out of it. I'd be curious if Ironman ends up buying right, try bike transport, I don't, I wonder, but, but they did step in when the athlete was in need, and whether there was some self-serving without. Either way, they came to the table with money. So I think they should be padded on the back for that.

Speaker 1: 20:08

That's a big deal, yeah and the last thing is I'm in. I'm in. Florida was a couple weekends ago. It must have been a freaking perfect day. Yeah if you look at the times, holy cow. Yeah, rudy von Berg went 734. Yeah, the top 10 were all sub eight. Oh wow, so you, you had to go sub eight. Even there's one guy who went sub eight and got no money. That's crazy.

Speaker 2: 20:35

Yeah, no money.

Speaker 1: 20:35

It was up eight yeah so and then sky much one when the women's at 822. But all the times you know the age group are times, the pro times. It must have been super fast day. Yeah, run was cool, but you know bike ride.

Speaker 2: 20:49

But not windy on the bike, cool run. That that's a crazy. The swim can be slow out there with the open water, ocean swim but it's wet suit, but no, that's a crazy. It's a crazy fast course on a good day. And there's what. There's been Florida days where it's like 40 and raining, which is crazy for Florida, and there's the other ones where it's just been like scorching hot. Yeah yeah, that's pretty awesome, man, I mean day.

Speaker 2: 21:11

But yeah, yeah, good, good, good job to them you know, I still haven't, and maybe I do a little bit of a deeper dive Between PTO, between Iron man. I feel like they. I don't know if they're playing a game of chicken with one another, who's gonna announce first, but I feel like they. They. What's going on for next year? Who knows?

Speaker 1: 21:28

Yeah, I don't. I don't Because because we talked about on podcast. You know a couple couple months ago that PTO is gonna come up with an age group series. Age group champion.

Speaker 2: 21:39

October.

Speaker 1: 21:40

October yeah haven't seen in November, right, yeah, I think Iron man came out, so they're gonna have a pro series. It's gonna be up to 1.7 million dollars in prize money.

Speaker 2: 21:49

So my conspiracy theory is they both have it. They're just waiting for the other one to announce first so they can come in behind it and like, make some, make some calculated decisions and but but no, I'm eager to see what next year looks like, because I don't know about you. I don't. I don't really have a Hardcore plan. I know I need something. This year was a little bit of an off year, like you, for you we would. Penn State 73, yeah, yeah.

Speaker 1: 22:15

I think. I think I mean, and an interesting thing is, if you look at USAT Nationals, for us it's within driving distance. Where's that? Atlantic City? I don't think. I saw that four hours away.

Speaker 2: 22:28

So it's a T national, so that's all. These be in Milwaukee, mm-hmm and that's so. Pto sort of took over the Milwaukee and then USA to, so is USA T long course. That's different than what the PTO is. It's not long course.

Speaker 1: 22:40

It'll be Olympic national on Saturday and Sprint national on Sunday. Gotcha, that's something to think about.

Speaker 2: 22:46

Yeah, I know people went to Milwaukee and had a great experience. It was fun. It's a great event.

Speaker 1: 22:52

But and it'll be interesting to see if, see if PTO tags on to that, yeah, who knows? But just I, you know, looking at maybe some trail racing, looking some local racing with kinetic multi sport, I don't know. But you're right, I need common Norstar because there's Saturday mornings when you get up, you think. I really want to get on a trainer, yeah two hours.

Speaker 2: 23:14

I struggle January, february or especially January in the trainer on the trainer probably trails this trails man. So no, interesting man. A lot of cool stuff going on Local. Local women's championship is right down the road. I'm in Florida. Try bike. I hope you survive. Yeah, usa team might be drivable next year, so yeah welcome to holiday time, right?

Speaker 2: 23:46

All right, miss, I got something for you maybe on this podcast that you Got me into. We were at Kona and we had met with the group at Super Sapiens and for those that don't know, especially in Europe, super Sapiens is is a continuous glucose monitor system and A patch. Probably seen a bit different races, they're not approved here in the FDA, but but you got a chance to have the patch on and got to see your blood sugar and the monitoring that for us as endurance athletes and man I was, I jealous. That was really pretty cool. We've we've talked to them about you may be teaming up, especially with the metabolic testing and things that we do here, but now, after the back incident on the rower and I'm Not as active as I want to be right now, and so what do I do? You can write you, you focus on things you can and nutrition for me, right. So nutrition, especially in the wintertime, I'm like you know what. This is a time for me to hit the reset button, focus things I can do. Let me tighten up my nutrition. I tend to eat pretty sloppy around this time of year and just kind of get away with it, because you're usually training a decent amount.

Speaker 2: 24:51

And one of those things was to get a continuous glucose monitor. And I went to primary care here in US you have to have a script for it and she was confused. She was like so what do you want? I was like I just need. I did the research. I ended up getting a dexcom g7 and I told the reasons why and she was like that's a great idea. Like so she was a big fan of it. But she that's first time that she had come across somebody who's healthy you think of somebody who's diabetic and monitoring blood sugar. And so I was diving into it and I've been using it and I thought it'd be really cool, because I know you did a deep dive, you used it in real time and I thought it'd be really cool about, like, what was your experience? What can I learn from it? What can others learn from it? And then you know if you're interested, it's not that hard. It's a bit expensive if you're gonna do it in the US To get a CGM.

Speaker 2: 25:42

And well, again, cgm being that continuous glucose monitor. So I thought I'd bring that up to you and be like hey, moose, I got my, I got my CGM. And man. I've already seen some decisions. I was like, oh crap, right, we all sort of know and most I would imagine most people out there know good health decisions, they know what they should be doing, right. But reality is like test on guests. When I see the graph I'm like, oh, that was a bad decision. And then there's some assumptions that I made from before that you know in theory how my body should react to it, and my body reacts different Sometimes than I. What I thought it was. So like we'll start where you want to start. But my thought process was bring it up to you With your, with your medical background and your personal background, and be like dude, how was it for you, what can you share with me? And and figure out where we go from there.

Speaker 1: 26:32

That's great. So when I got involved in the super sapien research project probably six weeks before Before Kona last year so it was right after Mount Tremblant and and before before Kona and I wrote that road in I got involved in this project and I wore this monitor through Kona and probably I took two weeks off After Kona and then then wore it for a month or so running trails just as an experiment and and during that time and recently you and I've been talking about it I've done kind of a deep dive research, looking at what it's supposed to mean, what it's not to mean, and it's interesting what the true science tells us and we can talk about that. Yeah, so a Continuous glucose monitor, cgm what it does, it's a device you wear, it's about the size of a dollar coin that goes on your skin. It's inserted with a monofilament that goes in the interstitial space. And that's important to understand because You're you're not tapping the blood, you're tapping the interstitial space. And what does that mean? There's a space between your skin and your blood vessels that holds fluid and that fluid is a it's kind of a secondary Representation of what your glucose level is. But because you're testing the interstitial fluid, not the blood, there will be some delay and some effect in the measurements. Okay, so it's important to know what the monitor is now.

Speaker 1: 28:12

Why was the monitor developed? The monitor was developed for diabetic control, mainly type 1, so that those patients that have Pancreas cells that do not respond to insulin is supposed to help them with their control, because their control when it, when you have diabetes and you eat your insulin, does not respond and you have too much blood glucose in your system and that wreaks havoc on everything from Kidney, liver, eyeballs, you know everything so so so the good idea there for for this continuous, continuous glucose monitor was to have diabetics have a real-time time number that Back to their, their control and now their their insulin monitors that are directly Connected to this continuous glucose monitor that helps them keep their, help them to keep their glucose level. Okay, so the continuous glucose monitor was aimed for diabetes Type 1, type 2, but now there's interest over the last three or four years in the endurance or sports population and there's a there's some really good science going on. There's a lot of really marketing blogs going on, but the science is getting to be pretty clear.

Speaker 2: 29:38

Yeah.

Speaker 1: 29:39

So there are a couple of key things. So what they recommend to you is that you validate the monitor with bloodsticks. So if you're diabetic and you're wearing one of the diabetic monitors, they tell you machine's not really validated unless you do bloodsticks to calibrate it. Okay, and if you look up, there's a super sapient literature which I have. There's no, there's no statement on accuracy.

Speaker 2: 30:10

Yeah, so we don't really know what the accuracy is.

Speaker 1: 30:13

So if you're, if you're wearing a monitor and you're making decisions based on that, that accuracy, that may or may not be a great thing. The other key thing is there is a delay in your glucose response to what the monitor is telling you. That's one thing I didn't understand when I was, when I was running with it last fall, I was like this is awesome, I can, I can look at my run and I can see at an hour my glucose was dropping a little bit and I was testing different gels to try to figure out. You know, you know what? What? We are not getting arrested, yeah, don't panic.

Speaker 2: 30:49

It's not covering it. It's like I started checking my pockets. I'm like do I have anything in there?

Speaker 1: 30:53

So so you, you got to be careful when you're saying you're making a decision on what you're doing, because there is a delay in the interstitial glucose level compared to your blood glucose level, and it's about 15 minutes, okay. And the other thing that I just found out about is there's a one day equilibrium in the system every time you change your monitor. What they're telling people is if you, you, you, you change, change, change your monitor, it lasts about two, two weeks or so, right, so? So so if you, if you change a monitor that first day, it means nothing because there's an inflammation response around.

Speaker 2: 31:33

So that that's the thing with, like the G seven that's come out. That's where it's. It's different in the US, so that was a super sapiens one. I'm curious and I don't know the answer to this. But with this new G seven they say it's a hour's calibration. So now they've cut it down because their monitors are 10 days. So, like where super sapiens was 14 days, the monitor for the one I'm using is 10 and apparently it's come down and they'll talk about. You're taking the finger prick, especially if you see they validated about how I want to say maybe 5% as far as error, but if you ever get any sort of abnormal readings to to draw and, just you know, validate the fact that it's pretty close, but but that seems to be down a little bit. But but no, it's definitely something to be aware of.

Speaker 1: 32:16

So the accuracy, the real time accuracy, is not there yet.

Speaker 2: 32:21

Yeah.

Speaker 1: 32:21

Right, and we can talk about that. As far as wearing a monitor to race or train, and 15 minutes isn't that bad, though.

Speaker 2: 32:29

I mean you're looking at like two hours of how your body's responding to sugars that are in it. So it's as long as you know it, Right.

Speaker 1: 32:36

So I was listening to this, this, this podcast, talk about it a couple of days ago and he was saying can you imagine the elite level marathoners wearing it? So by the time they get their number, they're 5k up the road. So they're making decisions at the 15k mark on numbers. They saw it at the 10k mark.

Speaker 2: 32:59

Well, that's why you'd hope they'd be using it in training, to make training decisions and see it retrospectively.

Speaker 1: 33:04

That's exactly right, so that's key is having a purpose, exactly what you're using it for. So the interesting thing when you look at this is the only thing it does is it looks at your glucose stability. That's the only thing it does, right? It tells you, rob Green, which what your glucose stability is, and our whole goal is to try to blunt out those spikes and valleys. Yep, that's your whole goal. So, if you have good glucose control, that's the goal. So you can look at response to training. You can look at response to eating before, during and after. How that?

Speaker 2: 33:52

goes.

Speaker 1: 33:54

So the blood is basically a conveyor belt to deliver glucose to the muscles, right, that's supposed to be what it does. That's all it does. And so the average fasting glucose is between 80 and 90 value. Right, we think there is a performance zone. We don't know how to define that, right, because your performance zone, your glucose level, may be 80. My performance zone, my glucose level, may be 60. We just don't know.

Speaker 2: 34:22

It's like a heart rate, where it's sort of like everybody can be a little bit different, truly variable.

Speaker 1: 34:26

That's why it's so important you gather your own data and you look at that data as it compares to what you eat, how you train, the effort you're training and all that stuff. So you have to use that as a trend, not as an exact value. Okay, so we all have about four grams of carbs in our bloodstream, right, and so the body has an amazing ability to maintain that. You're been scientific studies that show you can maintain three to four grams of glucose in your bloodstream with multiple days of starvation, right, so it has to do with how your body responds, right. So I think it's going to be very interesting to see.

Speaker 1: 35:13

And I think also one thing is crucial for us and one thing we stress is the energy source while you're exercising is different, right. So at low intensity, your ratio of fat versus carb burning is going to be higher. Right, it should be. It should be Right, it should be higher. Yeah, your ratio, as your intensity or time goes up, it is going to switch more toward carbs. It is never 100% one versus the other, right, so you can train that Right, and you can speak to that. You can train your ability to burn fats longer, to be able to maintain that glucose level longer, but it is truly an effect where your energy source is the most important thing.

Speaker 2: 36:03

Yeah, yeah, no, totally, I mean it's. You know that's especially even doing metabolic testing where we can see how you partition the fats and the glucose. You have some people that go straight to glucose very quickly and it has a lot to do. So not only do it for sport, but really for long term health. I mean, blood sugar control has a lot to do not only with diabetes but in the environmental factors and the things that you do to your body. For long term health, especially in today's world where things are so carb dominant and seeing those spikes going up and down is not only not good and you could, you can have skinny people developing type two diabetes because you burn out your insulin but but just long term health is is trying to keep those spikes down and have good blood sugar control. And I think that's probably my bigger motivation right now is just general health as opposed to performance, and then, as you start to, you know, get more cardiovascular active, seeing how my body is is adapting and where, like, kind of my performance zone might be. But but yeah, we see a lot of people that you know cause when I was younger and dumber. Right, if you burn the engine hot enough, you burn the oven hot enough, you can throw anything in there, right? And that's just not the case. And as you get older it becomes more apparent. So, like I think it's incredible, I mean to have a device that is showing me how my body is utilizing and I've seen some trends and maybe we'll get into that what you, from a practical standpoint, what you picked up on, and seeing the data kind of go up and then right back down and seeing those spikes, made me realize I'm like, oh, I actually had an effect on what I did and I'm more mindful. And now that I see that there's a, there's a, this invisible effect, that not invisible anymore, that I've made better decisions. Now you know what's that mean.

Speaker 2: 37:50

Do I wear all the time? For the rest, I would say that you know I would this, this CGM that I'm wearing. I'm probably going to wear it for maybe, I think, three months and get myself in a good spot, and then maybe once a month, every six months or something like that, just to recalibrate and keep myself accountable. I don't know. And that's part of what you know, now that we sort of know the science. And what do you do with it, right, what do you do with it and what did you do with it and do you? Did you make any changes? Did you see any things that that helped you? Did you think it was a waste of time, like where, where?

Speaker 1: 38:21

No, I don't think it's a waste of time. I mean, I think the biggest, the biggest concept for up, I mean the biggest concept for me was training and racing, right. And so I mean I'm truly interested in metabolic efficiency or metabolic flexibility, truly interested. If I'm going to be an endurance athlete, how long can I, can I, how I'm sorry how intense can I keep my body from going to my glucose stores? Yeah, right. So I think that we can test and tell you, yeah, and to do a metabolic testing event and where the glucose monitor and see how it correlates, yeah, right.

Speaker 1: 39:05

Because we basically know that that your, your, your body's initial response to exercise is your, is your, is your, is your body's initial response to exercise. Glucose level goes up, yeah. The reason for that is your body's going to use the muscle glycogen first yeah, but it sends a signal that you need more glucose, yeah. So the liver breaks it down and stick it in the bloodstream. So it was fascinating to me to look at my workouts and say what's going on. I'm starting to run or ride and my glucose is going up. But now we know the body uses that muscle glucose first. It tells the liver to start releasing more glucose, you have to have more in your system. So as long as you know that, that's fine. But then immediately it goes up, it comes back down.

Speaker 2: 39:52

Yeah.

Speaker 1: 39:52

Right. So there's a system there where you use the body's muscle glucose first, liver, you know, liver glucose next. But if you can wait and be more metabolic efficient, you're going to be more efficient athlete, yeah Right, and so I think I think that's the most interesting thing to me is how we can use our metabolic efficiency testing and correlate that to the 24 hour glucose glucose monitor to tell us what we're doing pre-race to put glycogen in your muscle cells during the race to prevent that depletion of that, and post-race to destroy that glycogen in the muscle cells. To me was the most important thing.

Speaker 2: 40:35

Yeah, and so the zone two that a lot of people know and is very valuable. We know that to usually be where your max efficiency point is and where you can burn the most amount of fats. But here's the rub with that and doing the testing we have plenty of people, and plenty of fit people, who have that max efficiency point before zone two. They have it in their warmup because they're not. When we say metabolic efficiency, that means how well are you partitioning your fats and your glucose? As you go lower intensity, you want to lean on the fat stores, more and less on the glucose, and as you go a little bit faster it's going to start to kind of transition a little bit, but it's not going to skyrocket to where it's heavy on glucose. And the max efficiency point is really where those two cross over. Where is it like a 50-50? And the further to the right, as we like to think about it, further into your aerobic zone, the better. And so if a lot of times people have it underneath their aerobic zone and then that's not metabolic efficient, you're going straight to sugars and sugars gets a bad rap. You need to use sugars. It's a scarce resource. Fat for all intents and purposes. It's not endless, but it's endless for our purposes, for what you have. So it's a much more efficient way to carry yourself through a long course because you're going to supplement glucose, but it's a scarce resource. How many grams can you tolerate per hour? How many grams are you losing per hour? And you can have a better race longer. But here's a rub with it, right, a lot of people know zone two. They train zone two 25% of your trainability. If you want to retrain your metabolic efficiency, 25% of its exercise. So knowing where your true zone two is and training at zone two, 75%. Now say that again. 75% of that is your nutritional choices. So you can exercise zone. I know zone two, but if you're not doing the right nutritional choices and you're spiking yourself quite a bit, you can train at zone two. In reality is you might be one of those efficiency people who have that number lower. So 75% of that is due nutrition. And if test, don't guess, you can train the right way. But if you're hitting your energy stores and you're having a lot of, like, high sugar meals, more so in your protein levels aren't high enough to help slow that, and we'll talk about some simple ways to help you with the blood sugar. But I would just like to emphasize that nutrition is three quarters of being metabolic efficient. The exercise isn't. So just that you say I train zone two.

Speaker 2: 43:06

I had a guy. We did a metabolic efficiency test with him last week or the week before no, it must have been the week before, because I was I'm gonna back the before that and he came in and he said all the right things on paper I train zone two, I do X, y and Z. And we put him up and and he was really really, really bad and we were like, dude, you might be doing all the exercise stuff, what's your nutrition? And diving into that nutrition, he was good for nutrition like a week before his event, but beyond that he sort of didn't tighten up and it's like that's not how it sort of works, I know you. And then he went back into the explanation of what he's doing and why it should be working. I'm like dude, I get what you're trying to say, but I'm gonna. I'm a data guy, here's your data. So like that's crazy important the nutrition part.

Speaker 2: 43:53

And for me the CGM helps me make better decisions. So that way, the exercise that I do and put myself through. Is that effective? But not enough people know that the dietary choices you make. I've got a trainer in in clinic. He's fantastic, he's our, he's our strength and conditioning and exercise director and he's like no training can out kick a poor diet and I was like man, that's actually kind of beautifully said he's like you just can't out train that. He's like you. Maybe when you're young you can get away with it, but that's going to catch up with you and it's, it's so true.

Speaker 1: 44:29

So I think I think, with this continuous glucose monitor, you have to understand the science right how your body uses glucose. Are there other stores that can use better? And what that number means for you. That's, I think, that's that's all it tells you and and I think for you and I that are very data driven, I think it can be fantastic Because you really got to go in and look at your.

Speaker 1: 44:57

You know, you have to look at your glucose monitor and say, well, it nine o'clock, eight this and 10 o'clock my blood sugar went to there, that, that, that, therefore, that was a bad. You know, that was a bad response. Or my glucose going into this two hour ride was this and it quickly dropped off. Why? Yeah, right. So I think you have to look at the trends and I think you're right. It can teach you to eat. You know to eat, eat better. But you have to look at this glucose curve with a lot of other factors. You have to look at your diet, your sleep, your stress, the meals, the timing of the meals and actually the composition of the meals.

Speaker 2: 45:37

Yeah.

Speaker 1: 45:39

And and, and we know I mean some of the things I looked at when I was wearing it was I was adding MCT to meals because that's medium chain fats right, because I saw the, the addition of fats, smooth my curve out in the morning. So I, you know, eat open on the morning. There was a eating oatmeal, there was a glucose spike and a relatively pretty good drop after and I found that just simply adding MCT oil to that process, adding fat to that carb load, extended that glucose curve.

Speaker 2: 46:14

What did, what did it spike to when you, when, before you, did the MCT? What a spike for you. What did you consider a spike you remember?

Speaker 1: 46:19

I can't remember. Yeah, I can't remember, but I mean it was a curve. It was a curve I was looking at, it was sharp. It was a sharp curve. And so I would go to work and be like, why am I so tired 10am? Well, it's because I was getting a glucose spike. I was superman until 10, and then from 10, 11, 30, I was exhausted until lunch.

Speaker 2: 46:36

Yeah.

Speaker 1: 46:37

Then at lunch I would eat and then have the same same kind of kind of spike.

Speaker 2: 46:40

And eating, quote on quote, healthy, like it wasn't a bad. It wasn't like you ate like a, like a donut for breakfast.

Speaker 1: 46:46

No, it wasn't a Twinkie, I mean, I thought it was a healthy, but but just adding MCT oil to that extended that curve. And there's there's. There's some other things you could do. Well, you know one there's some people that are eating vinegar before, before meals.

Speaker 2: 47:00

Yeah, vinegar seems to be like the answer to everything.

Speaker 1: 47:03

Right. So there's been clear scientific studies that if you add vinegar before you eat, right, then it smooths out that curve. Yeah, If you add significant protein to your meal before you eat, it smooths out that curve. So I think you can use this continuous glucose monitor to change the way you eat to smooth that, smooth that curve out.

Speaker 2: 47:25

Yeah, there's a recommendation we use quite often. That makes it really, really simple. But you know I'll bring it up because of even what you say with the oatmeal. But if you're going to start to make, you know, dietary decisions and I'm a huge, I mean read about metabolic efficiency training by Bob Seabahar. I've done my metabolic training through Bob Seabahar and he's a brilliant guy. He's really kind of followed this, this metabolic efficiency testing that we do, as well as these crazy practical at the same time, and he'll talk about, you know, one of the four methods that it will use the hand model of just trying to protein to carb ratio. For every gram of carb, or for, for every one to two grams of carb, you should have at least one gram of protein, so one to one ratio, a two to one ratio, and that should help you stabilize your blood sugar.

Speaker 2: 48:13

And remember, you were talking about the oatmeal and I was like, oh man, sure you got to add more protein. You're like, dude, I did right, I did, and even though you did, you still spiked up. I believe that's why I was wondering how high it went, but it's still spiked up. And then, by adding the MCT, so on paper, you did the right things and you wouldn't have known it, because there's no maybe you've noticed that a 10 I crash and maybe just thought my blood sugar got low. I need another meal, as opposed to by having the CGM. Even though you did the things right on paper, everybody's body's different. And then by test don't guess right you were able to add one thing in the MCT oil and that helped flatten it out for you. So I think that's the huge value in having it. So you, you have a strategy going in and that strategy is a great place to start. But the data that you get helps you make really, really good decisions.

Speaker 1: 49:01

So I think that's one of the key. I think that's one of the key aspects to having the CGM. You have to have a purpose to it. If you're looking to change the way you eat to smooth out your glucose curve, great, that's your purpose. If you're looking at your glucose value why you're training, why you're training I don't think we know what, what those important values are. Yet I don't think we know what the ultimate. I don't know. I looked at it for for eight weeks and I couldn't figure out what my specific glucose level was for optimum performance, yeah Right.

Speaker 1: 49:38

So I was looking at the curve and ups and downs in the curve. I never figured out and I need to be at 120. Yeah, yeah, to be, to be, to be, to be super competitive.

Speaker 2: 49:48

Yeah, but that's why I was curious. I was wondering where you were. But but there are some things that are known. Number one is the heart spikes, right. And the other thing two are the extreme boundaries right. You don't want to go below 70, maybe 60, and you really don't want to be above 180. I'm I can set my zones. I wanted to stay between 70 and 140. So now I want big spikes, but I also know I didn't want to be in boundaries.

Speaker 2: 50:08

I got a great example and I just took a shortcut. I know we shouldn't, but I was my girl's place soccer and one of the first, maybe the second or third day I had it on. They had a big gap between playing. It was at the same place but there was a few hours and you know there was a Chick-fil-A like quick cart there, so we got a Chick-fil-A sandwich and I needed some caffeine, so I got a Coke right, and we know that there's tons of sugar and coke, so it's not it's. I already know that's not a great decision, but it gave me a boost and I got some fuel and I didn't eat fries or anything like that.

Speaker 1: 50:40

We screamed for Coke at mile 18. Oh yeah.

Speaker 2: 50:41

Coke, coke. That's great during exercise, but apparently so.

Speaker 2: 50:46

now, reviewing the graph, man, I spiked up to like 170, very, very quickly, and then right back down With one Coke With one Coke and it was, like you know, even though that was a shortcut, it felt good because I'd been yelling and cheering and coaching and directing. So I needed my excuse. My reason was because the, the carbonation, felt good on my throat and it gave me a little bit of energy. But reality was I wasn't aerobic, I was just out moving around and had a negative effect. So that made me realize that like right, so now when I the psychological benefit for me was now when I see that it makes me cringe because I know the effect it has on my blood sugar, instead of look at it and sort of crave it going ooh, that would be good. So my relationship with high glycemic foods has changed because you know, we, we talk as athletes. Hey, view food as fuel, right, you're fueling your body, getting we know that and we know to eat healthy things. But reality is sort of getting just stuff and you just sort of throw it in, you get on with your day when you see the graph it. For me personally and I don't know if anybody else would feel like that it changed a little bit more with the relationship that I had with food to realize that like hey, what, what I didn't feel from before, has a negative effect which not only affects my metabolic efficiency as as an athlete, but for long-term health. Right, there's lots of studies to show that, like the blood sugar and the high sugar, is detrimental to our long-term health. We talk about that hub all the time we're trained for it's eight decade and beyond, and even though I burned my engine hot right, I can't shove everything in there. It's got a cost. So that was really really valuable for me.

Speaker 2: 52:19

And I've been smarter with my meals and now that my training is down in off season, plus sort of coming off an injury, my protein is much, much higher Meaning. So I've just got a lot more proteins in. Like I purposely eat more protein. I make steak, I eat a lot more eggs and I keep the extra steak or I will make some even like bacon in the morning, but I'll make an omelet with feta cheese and and some sort of protein, whether that's chicken or whether that's some leftover meat. So instead of having like toast and oatmeal and all those things, when my volume is not down, it is now, it is now not. Even my carbs are significantly lower. Now, again, I'm not saying go keto and I'm not saying go carnivore For me, for right now in my in my training, it matches my training because my training isn't very high right now, and then, as my training goes up, we'll test on guests.

Speaker 2: 53:10

I think the glucose monitor is going to help me make good decisions. Do I know what the optimal zone is? I don't know what the optimal. Maybe if I kept it on for a significant amount of time I'll start to see trends. But I do know the boundaries that I don't want to go to and I do know that I don't want sharp curves and I want to make better decisions and for me, having the visual evidence is a game changer. It's worth it for that alone and I think I need that for probably maybe two, three months and then I think maybe, knowing me and my squirrel brain, I'll probably need it every six months to go hey, dummy, stop taking the shortcuts. Right?

Speaker 2: 53:44

I had a coach who, um, um, I thought this is stuck with me for life. He would start every practice and say you either get better today or you get worse. Nobody stays the same, so we don't stay the same. So you would start every practice and be like what are you going to do today? You're not looking to throw the Hail, mary. What are you going to do today to make yourself a notch better?

Speaker 2: 54:03

And that was very powerful, because a lot of times you go through the motions and you just sort of like I check that box, I run drills, I do run drills, I don't need to do run drills. Well, you're either getting better or getting worse. You're either keeping the skill that you got or you're slowly starting to degenerate. So over time I know I'm going to start to slip into um, maybe not um. You know making the greatest decisions and for me, I'm a data geek. If you show me the data, I will abide by it. If you tell me sort of like the like philosophy and what should happen, like, I'll kind of like be like, yeah, I'm buying in a little bit, but but for me that makes a big difference. So the CGM for me was Was that big? And I and then, if I'm not getting paid by anybody, it's not, I had to pay for the darn thing.

Speaker 2: 54:42

But I did a lot of research between what was available in the US and the dexcom g7. The g7 just came out. It's a little bit smaller. The reason I got it, and more than anything else was. The graph was just really easy and simple. You can log some meals in there. What I don't think it has and I wish Super sapiens was in is that Super sapiens seems to be really integrated Into training peaks and to have more of a performance base as opposed to.

Speaker 2: 55:07

This is for diabetics, but it fits my purposes really nicely and there's Coupons. If you go to their website, I think I got it for like half off. So I want to say I paid 180 for a month's supply. It's like 300, some dollars still expensive, so it's expensive, but for me, for where I am, it was an investment in my health. Yeah, what I do it every month for the next 12 months, no, well, I do for the next 90 days to help me make better decisions. Yeah, just so happens to be around the holidays, so maybe too bad. There wasn't an off switch for Thanksgiving, yeah, but but that's it's. It's been really really great, man, it's been really great.

Speaker 1: 55:44

Nothing. As long as you have a purpose and what you're, what you're looking at, I think that's good. Yeah, I think that endurance and endurance athletes tend to jump on. I knew fads, friends and fads and I jumped on me. I was, I was doing it back in the back back a year ago. I jumped on it because I was interested in it and as long as you understand what your purpose is, yeah, I think it's fine. Yeah, but I think we get Caught up in data. Yeah, and I do. I do not think that the CGM monitor is the same as a power meter. I do not think the CGM monitor the same as a heart rate guy. Yeah, I'd see zero, you know zero interested me racing with it. Yeah, right, cuz, cuz the delay.

Speaker 2: 56:33

I do see, and you've raced with it. You've seen the data from the race, right.

Speaker 1: 56:37

And I do seem to be interested in wearing it. We're wearing it during a race and a week leading up to a race and looking at my glucose control before and looking at it after, thinking, shoot, you really fell it For four hours, right yeah so that's a you know good question for you that I.

Speaker 2: 56:56

So when you wore you got the data after cone. It did that upload. So if you look at that, does that have any? So we go in on the bike and say, hey, I want 70 grams of Carb, right that's. And then when I get on the run, maybe I want 40 grams of carbs. So we know from performance and from feel. Can you see that with a CGM? Can you see any like, can you see fluctuation During it, to make a better decision? To say, hey, maybe that was too many grams. I, I, I went too high. Or hey, you know what? That was a little bit too. I crashed down. Did you see a difference with you have?

Speaker 1: 57:29

to look at it. Yeah right, so you hate me and I'm saying what did you see from? Well, it only records eight hours of data, and I was out there a lot longer in eight hours. I mean, I was out there for like eight days. Yeah, I'm surface of the sun. I got the, I got. I got my swim diet. So swim dad and my bike, that was. I felt good during that.

Speaker 2: 57:49

They're in those times and your numbers were stable.

Speaker 1: 57:51

I know we're stable, and but I mean I would have won. I would have loved to see my run data because I felt apart. Yeah, so I. But that's, that's one of the problems with the CGM if you're not carrying your phone, it's not, it's not downloading in real-time basis and because the data is so big it can only store eight hours.

Speaker 1: 58:13

Yeah, right, so if you leave your hotel and you've left your phone, you sit at the start for an hour. You got about seven hours of racing, yeah, and as long as you get back to your phone, you can download that seven hours, but you've lost that last bit of data, yeah, right. So If I was a sub eight hour guy I could probably get Well, yeah, one full race, but not so. Yeah, I think we would know we missed that.

Speaker 2: 58:39

Yeah, but you saw some cool stuff with the you can. You saw some cool stuff with different gels. Your body reacted differently with different gels.

Speaker 1: 58:45

Now that was the biggest interest coming back from from Kona, because I I was convinced Some gels were different and I was how I was trying to see if you can was it was what they said and you can't was exactly what they said. Yeah. So for me, I know there's a 15 minute delay, but for me, you know you, you can in a Steady-state, upper, you know, upper steady state run Lasted about 70 to 80 minutes and I saw a drop Right and the in the you can can gel I was using it lasted about 30 minutes and there was a drop. Yeah, well, the other gels there was like a 15 minute and there was a bigger spike. Yeah. So for me, in my, my body, I saw the you, you cannot pay for, you can they all sponsor anything. But I saw you can Gave me a more steady-state glucose control. The graph that I had on on my super sapien, you know, you know monitors, exactly the same as they showed you.

Speaker 1: 59:43

Yes you know, for two scoops of you can, half hour before your exercise, that there was probably 90 minute relatively steady-state.

Speaker 2: 59:51

Yeah, you know be interesting, especially the one that gave you a little bit more spike. Is that a better gel for an Olympic as opposed to the you can, then you can grace for iron man. Maybe that other gels great for a half iron man. The intensity is different, exactly right.

Speaker 1: 1:00:03

So the, the sugar needs are different and the effect of a Caffeinated gel, yeah, was different than really non-caffeinated gel. Huh, because caffeine, the caffeine effect is it spikes your, stimulates your glucose. Yeah, the caffeine effect. If you have a, if you have a larger glucose spike, you're gonna have a faster drop, yeah, so if you're using caffeinated gels when you raise or train, you probably got to use more often. Yeah, right, cuz you're gonna get much bigger spikes and valleys.

Speaker 2: 1:00:37

Yeah, and you're willing. You got to be careful with how many gram, what, how many milligrams of caffeine you're using. I mean caffeine. Caffeine is a performance enhancer up to a certain point, and then it becomes right. You counter no, that's, it's man, it's. It's pretty neat, I don't know that yeah. It's really really neat to use it and see how it's how it's worked and some other interesting research.

Speaker 1: 1:00:56

It kind of goes back to our last, last podcast. Is women with chronic fatigue syndrome? That that, that that that we know is from Poor or lack of adequate calories, right. Will this help them be better? Yeah, right. So there's some newer. We know the little literature is just is just very sparse with women data, right. So there's, there's some interest in some researchers. You know, looking at these runners, these female, female runners that I have a crush on, are it is there. Is there chronic fatigue syndrome from just Lack of nutrition? That should show up in this continuous glucose monitor.

Speaker 2: 1:01:43

Yeah right.

Speaker 1: 1:01:44

So there's some interesting stuff there, and it's also interesting to me that the, the Biking board, or the what's the board that does a bike racing, you see I, you see I has banned it. Yeah, they have, they have banned it and they're like the dirtiest sport in the world.

Speaker 1: 1:02:06

And now they've bought, they've banned glucose monitor goes monitor so and and the argument which is just I thought was ridiculous, was they didn't want people looking at their monitors while they were racing, because it was unsafe. Oh yeah, how many PsyCyclists are, you see, are looking at their monitor, at their?

Speaker 2: 1:02:24

at their power me the whole time. Look, you said I mean it's not a power me. That's what you're looking real-time. Dad, is your heart rate right? Yeah, that's what you're looking at.

Speaker 1: 1:02:30

Yeah, so so they say it's just one more thing distractor rise more because because it's just was one female over a writer who won some big race recently, she got, she got dequeued, yeah cuz she was wearing a glucose monitor.

Speaker 2: 1:02:41

They'd be a better argument there. It was like, hey, we're just trying to get athletes to stop sticking stuff in their arms. I like between an IV, between, like the hematocrit. You know no epo, no cgms, no, nothing in arms. You may not be penetrated by by a metal object right.

Speaker 1: 1:02:57

So so the minute. And then this woman wrote a response to this, being dequeued. That was, look, I'm interested in, in chronic fatigue, since in drum and female athletes, yeah, what one of the comments you made was I mean, I should not go in hypo glycemic because that's gonna lead to crashes, yeah, so so. But you know, but UCI has has banned the use of cgm, which I think is a statement which is ridiculous.

Speaker 2: 1:03:25

Yeah, that's silly. So I would I mean, I know about you, I if, if, if you're interested, I think it's well worth doing it. I mean, get, get, get a monoran and just gather Data and watch the graph and I think, if you keep it really simple, try to minimize the spikes. I think one of the best ways to do that is take your sugar levels down and increase your protein right, fat naturally usually come up and you puritization of nutrition, which is, you know, your, your nutrition needs to match the training. So there's sort of not one of those like one size fits all approaches. How's your body respond? How do you keep the the spikes from like going way up and then crashing way down? How do you keep it pretty level?

Speaker 2: 1:04:08

You know the standard is there of like 70 to 160 and and I would say I would shop for an even narrower Profile, but those extremes are there and those are people with diabetes, right? So I mean there's, there's life-threatening things that can happen from blood sugar control. So you're, you're looking to to flatten that and just test, don't guess and maybe you'd have the same thing that I did, which is I helped my relationship with what, what I was eating, and Not to say I do it perfect all the time. I know it and I'll still do it like I'll eat.

Speaker 2: 1:04:39

It was Halloween, I would eat some candy and be like, oh, can't wait to see this bike. But instead of eating like endless amounts of bite size which seemed like they were just small, you know, I'd be a little bit more mindful of what that was. So it? So it helped me and I think it's got its place. I think there's a lot to be figured out of exactly what it does, but you've you've picked up on some amazing things. I mean I, between the MC MCT oil, between the different gels and yeah, I thought that was pretty cool.

Speaker 1: 1:05:07

Yeah, and you know and now I'll say this enough, I've been a physician for a long time, but this is what's wrong with medicine, meaning that Old-style medicine is all about treating a problem after it happens. Yeah, so An old style doc is gonna say, okay, you have type two diabetes, we're now gonna put a monitor on you. You're gonna pay for the monitor, you're gonna pay for all this medication. We're gonna try to change your life, right. In my mind, the medicine 2.0, or improved medicine, would be we're all about prevention, right? So every single person, you get a colonoscopy, you get a dermatology check and you get to wear a CGM monitor three months and we're gonna follow your sugar and if there's a tendency for you to get into that pre-diabetic range, we're gonna try to make some life choices. Right. So why not use a CGM monitor to prevent the millions of people that go to type two diabetes before they ever you know, ever get there? So, yes, we're using performance. What we before, during, after is helping performance. But in my mind, medicine 2.0 should be about prevention, and prevention can be.

Speaker 1: 1:06:30

Rob Green, you wear a monitor for three months out of the year and you see, you know, your blood sugars tend to, you know, to the 130. If they're the crap you put in your mouth ain't great right. So I would hope, I would think the insurance companies would think that was important, right, because they're paying millions of dollars for the monitors, for the medication. But that's the way medicine has been and the lobbyists from the you know, the pharmacology companies, it's just, it's wrong. But if we went toward prevention, where, if you know, eight weeks out of the year you wore a CGM and you said, yeah, I'm on track, or, oh God, my blood sugar's running high, I'm pre-diabetic you may prevent a lifetime of misery.

Speaker 2: 1:07:15

Yeah, totally. I mean that's that ounce of prevention, pound of cure. I mean it's so valuable and I mean that's why the insurance isn't covering it. I mean that's why I have to pay for it, because it, because I don't have a problem, so they're not doing anything proactive.

Speaker 2: 1:07:27

But that costs prevent people from doing it, Dude it's way less expensive than managing it afterwards. Like you said, and I think it's. You know it's changing because docs have the same philosophy that you got, because ultimately you're trying to help people and the consumer's getting smarter. I think that's huge. I mean, as a consumer, the average everyday person is understanding and the market is growing because people want to be proactive in their health. They're doing proactive imaging, they're doing proactive tests and, thankfully, modern medicines trying to move in that direction. Yeah, with colonoscopies, I mean, colon cancer has come down significantly because they're getting it as polyps in colonoscopies. So, you know, and things like this, hopefully, yeah, hopefully, things are changing, but the consumer's smarter and there's options. Like I said, that's a. I mean it's a big cost. One 80 a month is not nothing light, but to me it's an investment in my health. So I'd rather do that than I would buy something that's shiny, right, I'd rather have something that makes a difference. So, yeah, hopefully modern medicine continues to do that.

Speaker 2: 1:08:30

But you as a consumer, can educate yourself and you can do things like this to set yourself up for, you know, a long, high quality of life. As you said, it's not, it's life span, right. So it's how well and how high quality of life you can have. Like, nobody wins this game, right, we all end in six feet under, but at the end of the day, you can put up a hell of a fight and you can live a high quality of life over a long period of time. And it's the things that you do and blood sugar and the evidence that is clear on that blood sugar has a lot to do with your long term health One of the most important things Truly.

Speaker 1: 1:09:06

Lessons from the Knuckleheads.

Speaker 2: 1:09:09

All right. So this week, lesson from Knuckleheads. We're heading into winter holiday time. A lot of you are reflecting on your season and it's a great time to learn from how the season went and what your goals are for next season. But lessons from Knuckleheads don't smash the winter right.

Speaker 2: 1:09:29

So I think a lot of people go into winter time and maybe they're motivated to attack their weaknesses and all the different things they can do to be better next year. In reality, it's like just don't, don't smash. I mean it's a time to rest, recover. It's a time to diversify your movements, it's a time to add some strength in. You know, maybe work on some mobility and if you're going to attack anything, absolutely I mean you want to be consistent through the winter and I would say focus on skills, right Skills, whether that's technique in the water, drills on the run, biking and different. Maybe that's even like equipment and fit and do a bike, fit and get kind of acclimated to it. So absolutely, you know, winter is an important time to train.

Speaker 2: 1:10:12

But like there are just so many people that just attack, I have athletes that think that like I've got to go in and I've got to be great at, you know, biking, I've got to be great at running. Now's the time for me to get better. And you're like that's, I get it. I get why it sounds good on paper, but reality is like it's not going to lead to. Where do you want back off? Allow your body to heal, a lot of your mind to heal. Be consistent, keep your fitness, make it enjoyable. Work on skills, get better, get more efficient, but don't train the house down. It's not a linear line of progression. More people underperform year after year after year because their winter is just too intense. So I think the lessons from Knuckleheads would be just like stop smashing the winter. You know what, do you think?

Speaker 1: 1:11:01

I think that's exactly right. There is no linear progression, like you said, and you can be a March hero or you can be a race season. A lot of people get hurt in the winter from doing stuff they shouldn't. I think consistency is the most important thing. You can't stop training. I think letting a little bit of fitness go from your pre I mean from your race fitness is a good thing. I think bike fit, bike handling is key. Run drills are key. Find something new and disgusting, like rolling, you know give that a try.

Speaker 1: 1:11:37

Do some swim technique stuff. Find a master's group. Spend time with your family.

Speaker 2: 1:11:43

Yeah, we'll have, I think maybe one more near podcast we'll get into maybe what an offseason looks like. And I don't know about you, but I'm casting stones from Glass House. I mean, I've done that in the wintertime Like I thought I needed to attack something and even though you may see some incremental growth and you don't want to get my FTP up this winter, it just doesn't work out in the long run. It just really sort of doesn't. It's not to say that you don't have some little mini blocks and maybe have a boost in an FTP for three, four weeks in the wintertime and then come back down. And then there's some management and you know we do that differently with different athletes, kind of depending where they are, and have some mini goals. But the main theme of it is like heal regenerate, stay super consistent, don't over train, don't intermittent train, work on skills, get more efficient, right and fatigue back off.

Speaker 2: 1:12:32

And fatigue back off Get tired.

Speaker 1: 1:12:34

Now's not the time to dig yourself a deep hole.

Speaker 2: 1:12:36

Yeah, and people are afraid to let go of that fitness right, because they get done with their last race and maybe they take a week off. But they're like, oh, I don't want to lose it all. I just I've worked so hard Next year I got to be 10% better in this, so I can't let it go. And, man, one of the best things you can do is recover for like four weeks. Man, take a month and just have minimal structure, do the things that you gravitate to, that you want to never, never, make anything. Feel like it's hard and you'd be shocked. You'd be shocked if you come out and you enter into March and April and you know you might, you're, you're, you're, you're, you're.

Speaker 2: 1:13:08

Your mind may play a little bit of tricks on you. You thought you maybe should have done more and then all of a sudden you see this growth beyond where you were Now. It took me a few years of of, you know, doing it wrong to learn to do it right, because you read the science of it all. But there's still that brain that's sort of like, well, I got to, I got to get better. And when you take a step back and you allow your body to heal and you diversify, that you see gains, that what otherwise weren't available to you by overdoing it. So I'd say this winter right, stop thinking about what more you can do and start thinking about what the less you can do. Be super consistent. Take the volume down, take the intensity down. You do a road challenge, mountain bike ski, cross country ski. You know, make it fun and connect with groups, man, and get out and have fun, but don't smash winter All right.

Speaker 1: 1:14:02

So really good discussion on Kenyans glucose monitoring psych to see kind of the data that Rob comes through with us and we'll get a follow up from him in a couple of months, see what he thinks. I think the keys that I see are one you have to understand the accuracy of the device. You have to understand the delay of what the reading is telling you. I think you have to go into it with purpose. What are you trying to see from the data? What changes are you trying to make? Is that a diabetic treatment? Is that change of lifestyle or is that performance? But just have a purpose. I think you have to look at trends, your glucose trends, not not not just just time values, but true trends. And then I think the final thing is you have to make changes. You have to make changes in aspects of your life that allow you to have the best glucose level sleep, stress, meals, timing of meals and the composition of those meals. That's my takeaway.

Speaker 2: 1:15:11

Yeah, totally. I think it's really worthwhile having it on. I would encourage you, if you're thinking about it, do it and, like Dr Haring said, have a purpose with it. And if you want to keep it really simple, you want to minimize the spikes, right, you want to be in a pretty narrow range. Your bullet sugar has to go up and it has to come back down, but you want to see it slowly. You don't want to see these really sharp spikes. You can Google enough graphs to sort of see what that looks like, and it's helped me make good decisions. It really has. I'm glad I've done it. I'm going to do it probably for another month or two.

Speaker 2: 1:15:42

And, yeah, keep it simple. Try to minimize the spikes. Try to get your protein levels up. Try to keep your sugars down. You can't be perfect all the time. Try to be reasonable with it. Right, extremes are not the goal here, but data is, and that can help guide you and it can couple what you think is going on with what is actually going on. And so that part is important to me. And don't forget to be in tune with what you feel. Right, pay attention to what you feel, pay attention.

Speaker 2: 1:16:10

Dr Haring talks about the delay in it, but you're really looking to see what it does for you for the two hours after the meal anyway as well. Like you know, what happens three hours later has an effect of might have been what you did with the meal from before. So, if you keep it simple, try to increase your protein ratio. Try to keep it a one to one to two to one when we look at grams for each meal and there's lots of different ways to do that Find what works well for you, stick with it and then, if you have a monitor, then maybe you can make some refinements to it. I think it's really really helpful. What I do it all the time, probably not Honestly, maybe if it was cost effective, maybe I would, but I really think it was worthwhile. So that's great. So, yeah, see what you think.

Speaker 2: 1:16:54

Again, I use Dexcom G7. You can do some research, see what's good for you, but I find it to be really really simple, easy to put on the arm. That unit's a little bit smaller and I found it's great, awesome, thanks. So nice blood sugar man, lots of good stuff. And that ends it for this week. You got anything else? Nope. Time for a milkshake. Time for a milkshake and after the milkshake, when you get to a fork in the road, go uphill.