Managing Type 1 Diabetes With Diet, Meditation, and More

Intro:

Welcome to Dr. Ruscio, DC radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Dr Ruscio, DC:

Hey everyone. Today I spoke with Dr. Hannah Hamlin from our office. We discussed blood sugar regulation to which she brings a very unique and helpful perspective as someone who is a Type 1 diabetic. We also discussed female hormones and how helpful gut care can be toward balancing female hormones, and also how helpful some of the herbal blends can be at balancing female hormones. Additionally, we discussed a healthy perspective on diet and how to find a balanced diet and the right diet for you. And Hannah shares a very fascinating journey of her own wherein she went from each end of the spectrum only to find a point in the middle was actually the best for her in terms of overall wellbeing. Great conversation with Hannah. She is an awesome part of our clinical team, and I hope you enjoy the conversation as much as I did.

Dr Ruscio, DC:

Hey everyone. Welcome back to Dr. Ruscio, DC radio. This is Dr. Ruscio, DC today here with Dr. Hannah Hamlin, one of the awesome, sharp, smart, caring, empathetic doctors from our clinic. And we had heard from Hannah a while back, but it’s been several months so I wanted to have you back on, Hannah, to talk about the good work you’re doing at the clinic. And tell a little bit more also about your story and how you got into functional healthcare. So welcome back to the show.

Dr Hannah Hamlin:

Thanks. I’m happy to be here.

Dr Ruscio, DC:

Tell us a little bit about your background. I think we may have hit a snippet of this last time you came on the show, but people know my story—had a parasite, really messed me up, and that led me to the massive importance of gut health—your story’s a little bit different, but I think equally interesting. So yeah. Give us the overview of your background and how you got to be where you currently are.

Dr Hannah Hamlin:

Okay. Yeah. So my story with functional medicine or medicine in general really started when I was a teenager. At age 13 I was diagnosed with an autoimmune disease called Type 1 diabetes. And what that is, is our immune system makes auto antibodies against our pancreas and so we don’t create a hormone called insulin, which means that our blood sugar can be very difficult to navigate because we’re constantly supplementing an external hormone. And so what that typically looks like for most kids with Type 1 diabetes is taking multiple shots a day and testing blood sugar up to 10 times a day, or now wearing a continuous glucose monitor. So at age 13, I started on this journey of autoimmune disease and really trying to figure out how to navigate lifestyle factors like food and exercise while balancing my blood sugar.

Dr Hannah Hamlin:

And I had some great doctors. I went to a lot of primary care, a lot of specialists, really with questions on just how to feel better in my body. And I found growing up that I was able to balance my blood sugar pretty effectively, or at least for the standard of care, but I still didn’t feel great. I had a lot of fatigue. I had a lot of trouble trying to figure out how to get exercise in and do other things for quality of life. And so I ended up studying nutritional sciences in undergrad at Texas A&M where I started to learn a lot of answers of how I could change my day-to-day lifestyle choices to help me feel better in my body. And really found that there was a lot of nutrition science that gave me answers to feeling better.

Dr Hannah Hamlin:

And that inspired me then to go on to medical school. I actually found functional medicine as a patient prior to medical school, and really felt like I was able to get my health back enough where I felt good and that’s what I wanted to do. So after medical school I then studied functional medicine and now here I am with you. It’s been a journey as far as running this long term and equals-one experiment with blood glucose regulation. And I’ve learned a lot about, overall, what it can feel like to be a patient and have questions of how we can do better and not find answers. And I think that it can be really isolating and difficult sometimes. And finding a physician that can really listen and hear where you are and meet you where you are in your story is usually valuable. So I love that we’re able to do that here at this clinic, and we’ve created space where we can take time for our patients that way.

Dr Ruscio, DC:

And there’s so many ways we can go from here, but one of the things that you had said before we started the recording that I think will be particularly interesting for our audience is as someone who’s been wearing a CGM, how long have you been wearing CGM for? Years, years, and years and years?

Dr Hannah Hamlin:

Yeah. About six to seven years.

Dr Ruscio, DC:

Okay, so you’ve got some really good experimental data, observational data in terms of all these things that impact your blood sugar. And I’ve talked about in the podcast, I was surprised that going in the sauna would impact so much and exercise would impact it. I mean, I guess I wasn’t super shocked after I thought about it more, but when you’re wearing the device, you’re like, “holy cow, did I just have a soda?” Or “did I just get that exercise,” seems so similar in terms of the reading I’m getting on the device. You mentioned these other factors that can significantly impact blood sugar, stress, sleep, you may have said inflammation also. I’d love to hear more, especially from your perspective of having such a long term look back on these things. What should people be considering when they’re trying to improve their blood sugar in terms of yes, carbohydrates have an impact, but you had said something along the lines of there’s more than carbs. And sometimes people are perhaps too fixed on carbs and they’re overlooking some of these other items.

Dr Hannah Hamlin:

Yeah, absolutely. So to take a step back there, when we look at blood glucose levels, there are two things that contribute that. And one is the amount of glucose coming into our body and being broken down and absorbed and put in our bloodstream. And then the other is how our body is able to move that blood glucose out of the bloodstream, into the cells, to be able to use for energy. And so we often spend a lot of time when we’re looking at blood glucose optimization, really thinking about the changes in the sugar that’s coming in, but it’s really that insulin sensitivity piece that can be hugely important for how we’re able to balance the blood sugar in our bloodstream. And so making understandings about how we’re able to move the glucose is huge. That’s an insulin sensitivity piece.

Dr Hannah Hamlin:

And really it’s fascinating that there are so many things that can change insulin sensitivity in a 24 hour period, in a day-to-day period, that can drastically change the amount of sugar that ends up staying in our bloodstream. So sleep is a huge one. That’s one that you mentioned. And certainly we have big studies that tell us that sleep can usually change insulin sensitivity. What I’ve noticed, personally in my life, is that when I am not sleeping well, say I’m working night shifts in the hospital or I stay up late studying, I really notice that I need almost up to 50% more insulin the following day for the same amount of carbohydrates that I’m eating. And so sleep is one that can just drastically change things.

Dr Ruscio, DC:

Now, there is stress. Now stress is huge. I think back to going through training and thinking about the finals week, and before big exams, I would notice that my blood sugars would increase sequentially as we got closer to the test and I would need more and more insulin per day. And then after the test, it would go back down to my normal baseline. And, it’s pretty interestin, there’s this chronic stress piece and then there’s the acute stress piece too. Even interestingly enough, and not that this is necessarily concern for long term glucose regulation, but some of the acute stressors, even I remember I went ziplining once and my blood sugar spiked 200 points unexpectedly and a lot of that is from our body breaking down the glucose that’s stored in our liver and putting it in our bloodstream. But that’s another thing that could impact it. So acute stress and chronic stress.

Dr Hannah Hamlin:

And then inflammation, certainly. We know that classically, we get insulin resistance when we have acute viral infection, like a cough or a flu or cold. We can also see that with chronic low-grade infections as well. And so that’s something to be in consideration of. But all those are our big things that can impact insulin sensitivity, which really if we’re not paying attention to our sleep and stress, and we’re trying to micromanage the carbohydrates that we’re eating, it’s just not going to get us all the way there for blood glucose optimization. And I think that’s a big piece that I’ve really been able to learn from that and equals-one experiment.

Dr Ruscio, DC:

Sure, sure. Are you finding that the time you go to bed has as much of an impact as the hours that you sleep?

Dr Hannah Hamlin:

Yeah. I have found that certainly consistent sleep hours, so a consistent bedtime/waketime, really does help with normalization. I think it’s really that change in really any big pattern that I’ve noticed changes. Certainly the amount of hours of sleep. I’ve almost gotten to the point where I can calculate if I get less than six hours of sleep or at that six hour mark, I’ll know I need to take more insulin the following day. And I can almost predict it at this point. So that’s been my cutoff, but timing does impact it. Just not as severely as hours of sleep.

Dr Ruscio, DC:

Well, that’s fascinating. Have you found anything that’s helpful at buffering the stress? We talk a lot about things like walking in nature or meditation, what have you, and this is definitely a very specific question, but have you noticed that, “okay, there’s a big stressful event coming, I’ve learned from the past that I’ll need more insulin. This time, [when] the next stressor comes I’m going to try taking a walk outside, a walk in nature, meditating, breath work.” Have you run any experiments like that? And if so, have they been able to move the needle a significant amount?

Dr Hannah Hamlin:

Yeah, absolutely. So a walk in nature, I would say really walking in general or any type of increased movement. So I remember back in my training days before those big exams, I would take my flashcards to the gym and walk on the treadmill and go through things or listen to lectures and move. That certainly does help. I would say, I just could never get to the point where exercise was completely bringing me back to a place where my insulin sensitivity was the same. So it never quite completely overcame it, but it did help significantly.

Dr Ruscio, DC:

Meditation is something that really I’ve noticed a big difference in my life when it comes to blood sugar regulation. I think certainly whether that’s maybe from a place of lowering cortisol, which we know it could do from studies, but also maybe just from a mindfulness place of being able to slow down and instead of making quick decisions about what I’m going to eat or how I’ll take my insulin. I’m a little bit more mindful and it just allows me to slow down and be more methodical and thorough with the things that I’m doing. So it’s hard to tell for sure where that one comes from, but meditation has been huge.

Dr Ruscio, DC:

Would you say, and this is not necessarily trying to paint this do-list perspective, but is meditation more effective than walking at lowering your blood sugar when there’s stress?

Dr Hannah Hamlin:

That’s a hard one. I think acutely, just looking at a continuous glucose monitor graph, walking will typically move the slope of the graph and help it come down, or at least plateau if it’s elevating. And so walking is one that I’ll see within 20 minutes a change on the continuous glucose monitor graph. Meditation is more that day-to-day. I find if I can keep my stress levels low then my, what we call, basal insulin dosing (which is part of your total daily dose) that typically tends to stay lower if my chronic stress is lower.

Dr Ruscio, DC:

Okay. Okay. And man, there’s so many things here to unpack. One thing that I’m wondering about is what unit and what app do you like the best? Because there’s a whole number of apps that can plug into a handful of different units from the Freestyle to the Dexcom. What have you found to be the most representative of where your blood sugar probably should be?

Dr Hannah Hamlin:

Yeah. Yeah. So I’ve tried all of them, I think almost, over the years. And so that’s been fun is experimenting with the new tech that comes out. The Freestyle Libre is what I’m using right now. And that’s purely because of insurance coverage reasons. I use the one that connects to the free, so Libre, app on my phone, which is nice. But I would say by far out of all of them on the market, the Dexcom is my favorite. It is a little bit more accurate, but what makes the Dexcom really helpful, especially I think for people who are also taking insulin, is that Dexcom uses Bluetooth so that it automatically updates the graph on your phone. And the app has a setting where you can customize your own threshold for when it will alarm you. And so it allows me to go through my day-to-day life and if my blood sugar were to become a little elevated or start dropping low, it’ll send me an alarm and that’s helpful for preventing hypoglycemic events and also catching hyperglycemia before they happen. It allows me to take insulin in that window.

Dr Hannah Hamlin:

So the Dexcom really is my favorite and it is just statistically a little bit more accurate than the Freestyle Libre as well. Recently, there was a new one that I haven’t yet tried, it’s called Eversense. And that one has just been FDA approved and it’s actually for up to six months of wear, which I think is pretty nice for people doing it long term, just to prevent those site changes, less needles, less calibrations, and such.

Dr Ruscio, DC:

And is the Dexcom, is that also on the back of the tricep or on the hip, or is that just on the hip?

Dr Hannah Hamlin:

The Dexcom was originally FDA approved for only within the abdomen. So it could be on your hip or on your stomach. A lot of people with Type 1 diabetes use them in non-conventional places because you don’t want to build up scar tissue. If you’re going to be on a continuous glucose monitor long term, it’s nice to move it. So typically I wear my Dexcom on the back of my arm. But even in the summer you’ll see kids with them on their legs or their upper hip. You’ll see them on the glutes. You’ll see them everywhere. Just because it’s good to rotate in that soft tissue.

Dr Ruscio, DC:

And you’re wearing the Dexcom […] is it two weeks, like many of the others, in terms of its duration?

Dr Hannah Hamlin:

So Dexcom is actually just 10 days. And so that’s more frequent of switching it out. But I think the accuracy and the alarms, for my friends in the Type 1 diabetes community, that is mostly the preferred unit to use because of the accuracy and the alarms. It allows you to sleep throughout the night without having to wake up and test your blood sugar. It just provides so many facets that the Freestyle Libre without the alarms does, if that makes sense.

Dr Ruscio, DC:

Yeah. No, that sounds fantastic, having the alarms and the auto sample, if you will. Because that was one of the things that I didn’t love about having to always…So for our audience, if you’re using something like a Freestyle Libre, irrespective of whatever app is plugged into, you have to touch your phone to the sensor, usually in the back of your tricep, to get a reading. And you do get ongoing data, but it’s nice to not have to be manually like running that sample. And I’d imagine that if you’re a diabetic for whom you could run into some dangerous territory, you want to make that a non requirement and have the alarm be proactive as proactive as possible.

Dr Hannah Hamlin:

Yeah. The Dexcom, before it came out years ago, I just grew up waking up once or twice a night to prick my finger and test my blood sugar every night, because it’s hard to go eight hours without knowing where your blood sugar is, that can become dangerous quickly. And so the Dexcom was the new device that allowed me to sleep through the night for the first time. And I mean, that’s huge, just not having to wake up and do that. So yeah, it’s a game changer.

Dr Ruscio, DC:

Hi, everyone. If you are looking for a functional healthcare provider or doctor reminder that our clinic offers telehealth nationwide. And I’m very excited to share that we currently have a six-patient case series in peer review for publication in a medical journal. We have another gut-thyroid paper in the works for a fairly large medical journal. And third, and finally, we are continuing to collect data on treatment of hydrogen sulfide SIBO with Probiotic Triple Therapy. And I’m excited to say, as the data coming in, they look very encouraging. So if you are in need of efficacious, cost-effective, and practical functional healthcare, please reach out to the clinic. We also do offer free 15 minute discovery calls with our nurse. So if you’ve been thinking about this and you have a few questions you’d like to get answered, then please feel free to reach out. The clinic website is RuscioInstitute.com, RuscioInstitute.com.

Dr Ruscio, DC:

Now from a dietary perspective, what do you do? And what have you found is best? There’s many different approaches and perspectives on what diet is best, well, I mean for a number of reasons, but as it pertains to blood sugar, there’s also debates—you shouldn’t be on high fat, you should be on high fat and low carb, you should be Mediterranean, there’s plant based, there’s glycemic index, glycemic load, food combining…So this is, I mean, a topic we could probably talk about for an hour or longer. But what’s your hot take? You’ve tried a bunch of stuff, this is what you found works best for you? And we should clarify this is you and not everyone’s going to have the same needs that you do, but just curious [about] your own personal experience.

Dr Hannah Hamlin:

Yeah. So I’ve really experimented in a lot of these different categories. And I think partially for me with my training has just been a lot of fun. I really like to nerd out with the nutrition piece. But also, just trying to get to that place where my quality of life is good, where I feel good day-to-day, I’ve got good energy, and I’m able to stabilize my blood sugar. So I’ve done quite a few different experiments or different chapters of life. Before I jump into what I’ve done, just to remind the audience that I think the way that you eat with Type 1 diabetes is trying to manage and match insulin because that’s the deficiency. But type two diabetes or prediabetes is typically insulin resistance. And so that can look different, which diet is maybe optimal for which category. So just to preface it with that.

Dr Hannah Hamlin:

But I started eating a standard American diet as a child. That was what was recommended by our pediatric endocrinologist is not to make any dietary changes, which I thought was interesting. And it was confusing for me at the time. And so that was partially the reason to go to nutrition school. But, with that, I learned quickly in undergrad, I started listening to Robb Wolf’s podcast and learned about the paleo diet and really dove into that and saw a huge benefit in both blood glucose and energy level and just felt better overall. I learned during that time that I had some food sensitivities. Dairy really doesn’t do well with me. And I think learning that was a huge foundation in just really overall immune health for myself.

Dr Hannah Hamlin:

Then I did more reading, there’s a popular book called “The Diabetes Solution” by Dr. Bernstein. And it really is a very strict ketogenic diet. And I did that for, oh gosh, almost two to three years. And I found that I was able to get just phenomenal blood sugar control. I mean, my blood sugar didn’t look like I had diabetes at all. It was really great, but my body composition didn’t do as well. I gained about maybe 15 pounds. I didn’t have as much muscle mass. And over that time, I was working out and trying to eat calorically the same. I did a lot of macronutrient calculating and really tried to make sure I was getting all my vitamins and minerals. I really, like I had spreadsheets. I went way over the top. I was testing keytones.

Dr Hannah Hamlin:

And it was great because I was doing all the things right and I was getting the good blood glucose result, but man, I did not feel good. And actually after a little while I even started to stop menstruating, I lost my period. And I just realized it, started looking around, I said, maybe there’s another way. And so I started looking and I reflected just on the genetics in my family and I looked at all the women in my family who tend to eat high carb diets and are pretty lean and are able to hold onto a lot of muscle tone. And I thought, well, maybe this isn’t the right diet for me, maybe it’s good for some people with diabetes. So then I got back to that paleo baseline, which was helpful. I did a classic autoimmune paleo elimination diet, which was really helpful to understand things but not sustainable long term.

Dr Hannah Hamlin:

And then one day I really went off and tried the very opposite. I said, this clearly isn’t working. So I read a book called “Mastering Diabetes,” which is really about a whole food plant-based diet, so high carb, low fat. And I did a a whole food plant-based diet for about two years. And I was really strict there. And again, I was able to take less insulin, eat a good variety of foods, my blood sugar control was really good, but then I noticed, I just wasn’t doing well on an extremely low fat diet either. And so now I’m in between where I just eat a whole food diet. And I’m at a place where I eat probably what would look like a very healthy diet for the average person for the average American.

Dr Hannah Hamlin:

I think that the way that I’m eating now is probably best for me as a person and has less to do with diabetes. I think it’s just been learning to manipulate my insulin dosing to match the types of foods that I’m eating. So I eat this paleo diet with more seafood, less saturated fat, and that team seems to be a good fit for me, metabolically from a blood work perspective, my blood glucose is much better that way. And I have flexibility so I can show up as my whole cell self at social events and not feel isolated at Christmas. And I stay healthy that way. So it took me swinging from one side to the other to find a good middle spot. But that was a quick overview of the things that I’ve tried.

Dr Ruscio, DC:

Yeah. That’s great. And where would you guesstimate your carbs are clocking in at per day now? 100 grams, 200, 300?

Dr Hannah Hamlin:

I’d say about 150, 120-150. I tried going under a hundred even, just low carb, not ketogenic and that didn’t work for me either. But that was something that I did for a little bit. But right now I’d say about 150 on average.

Dr Ruscio, DC:

Yeah. You’re not the first person, actually, Amy Gallo, one of the phenomenally smart nutritionist and health coaches on our team had recently commented me that she upped her carbs and her performance increased and she lost some body fat. Which is just helpful to hear. And I say this, partly for me, because [though] I don’t have any diet hangups, there’s still that little bit of a flicker of the hardcore paleo background I came from when I really started getting into nutrition. There was it was a lot of Paul Chek and Robb Wolf, paleo community, which leaned in a very good, healthy whole food direction, but there was also a little bit of a bias toward lower carb. And then, find whatever guru you want, who will be talking about all the bad things that carbs do. And again, for a fair number of people who are eating Twinkies and drinking soda, they need a little bit of that fear messaging to rattle the cage a little bit.

Dr Ruscio, DC:

But if you’re talking about having things like rice and fruit, that’s where it’s helpful for me to hear these things, because it still feels a little bit funky to me when I have a whole bunch of rice as part of my dinner. But, for me, for our audience, this is why we try to be not [totally adherant] to one dietary camp, but rather look at, like you so beautifully outlined Hannah, this range of diets that we have on offer and help an individual navigate to where they may do best.

Dr Ruscio, DC:

And for some people upping the carbs leads to better performance, better wellbeing, better body composition. And you’re thin, Hannah. I mean, unless something’s changed between now and the last time I saw you, you have a very nice body composition. You’re very thin. And so I’m assuming that getting the carbs and the fat and everything else dialed in, that’s where you feel like you hit the ideal body composition. And you weren’t necessarily seeing a correlation between the best insulin flatness, let’s say, or consistency of needs, but you felt better and you had the best body composition with a diet that was really treating you or tailored for you and not tailored for a lab marker.

Dr Hannah Hamlin:

Yeah. Yeah. And what I found along that journey too, is just that when I got to a place where I was eating the right types of foods and the right macronutrient ratio for me, I never really had to regulate my appetite. It’s like my appetite tells me exactly how much to eat to maintain this. And I really don’t even think about calories anymore at all. I’m just at this place where it seems to fit and I can listen to my own body signals for how much to eat. And that’s a really, a really comfortable place to be. So I’m glad I found there, but it wasn’t always that way.

Dr Ruscio, DC:

Sure. Yeah. I’m right there with you. And this is also something, and I’m not trying to beat up on low carb because it can be very helpful for some people, but there was a point in time where I wasn’t sleeping very well and, man, did I I’d buy like one bag of chips per week and it was ridiculously hard not to just have one and then black out and come to and see the whole bag gone and myself covered in crumbs. Because my cravings for carbs were just intense. And I think back, and I can connect the dots now like, “oh, you were too low carb,” and that will interfere with sleep and it will also cause cravings. I’ll say the same thing that I don’t really have much in the way of cravings now. And it’s just amazing how, if you get these things where they should be, you won’t have cravings.

Dr Ruscio, DC:

And sometimes this means acquiescing to bringing some carbs into the diet. For some people, conversely, carbs can be like quicksand. And you probably heard this in the clinic, right? People say, “if I have a little bit, all of a sudden I find myself eating a ton.” So great, you want to listen to that and help the person cue in on what they should eat and what, again, I always reference Melissa Hartwig who says, “what are the foods with no breaks?” And for me, I know what some of those are. But I guess also your point, sorry if I’m rambling a little bit here, once I got my macros where they should be, I really didn’t notice I had as many “food with no brakes” in the pantry, so to speak, where I could have some chips but not the whole bag. I could have some of the raw cheddar cheese that I adore, but not the whole block. And it’s great when you find that balance point and you feel like you’re not always reaching for whatever your guilty pleasure is.

Dr Hannah Hamlin:

Yeah. I’m right there with you. I think that that’s been easy, I think for me too. It’s gotten a lot easier is really just being able to not have those cravings has been huge. I also did that when I was keto for a long time, is I would just totally crave things. And then when you start, it’s like your body almost instinctually knows it needs it and it won’t let you stop. It’s really interesting. But I would say I’m that way too. I think except maybe for the exception of some processed foods. I think the more processed it is, it’s harder for my body at least to intuitively have the brakes. I think that’s just from the design and the engineering behind some processed foods. But I think when it comes to whole foods, there’s really nothing that I fall through like I used to there.

Dr Ruscio, DC:

Yeah. And it is amazing that the whole foods, man, I can have three potatoes and I just ran this experiment recently. I would have three potatoes with dinner. I just, I ended up cooking what I was thinking for the next couple days and I was hungry and I said, well I just ended up eating the whole thing of potatoes. Let me see if that impacts my weight. And I think I actually lost a pound the next day after having three large potatoes with dinner, which felt like a ton of food and it was very satiating, but it being whole food didn’t seem to have the same deleterious effects as if I were to eat out and let’s say, have a dessert or something. Even though the dessert was maybe a third of the volume that the potatoes are. Now, there’s also to be fair, it’s probably a glass or two of wine factored in with eating out and having the dessert. So it’s not a complete, side-by-side comparison, but to your point of processed food, if I notice if anything moves the scale, definitely it’s way more with processed foods.

Dr Hannah Hamlin:

Yeah. And what’s interesting is that reflects very literally to blood sugar, is that processed carbohydrates absolutely move the continuous glucose graph to a much higher slope than non-processed carbohydrates do. And so I wonder there too, if there’s that metabolic signaling that that’s a component to that.

Dr Ruscio, DC:

One other thing regarding metabolism that I found to be helpful is fasting. And I don’t always do this, but I typically will do an OMAD on Sunday, so one meal per day on Sundays. So that extended fast seems to work well for me, it doesn’t push me too far to where I feel like I’m burnt out, I’m tired, or what have you. What role has fasting played with with your blood sugar or just with your diet in general?

Dr Hannah Hamlin:

Yeah. I love fasting. The intermittent fast from maybe 14-16 hours are something that I go to multiple times a week. I’ve played around with fasting to different extents. I’ve done a couple 24 hour fasts and I’ve done the, I guess the opposite of the spectrum, where I tried to eat breakfast and more snacks as well. But I find that fasting is just, well I think with Type 1 diabetes, it’s complex, I’m running my metabolism in manual. And so if I’m fasting, I just don’t have to think about it during those hours. And I think that’s one of the huge pieces for me is just less variables.

Dr Hannah Hamlin:

But when it comes to fasting, what I’ve found just throughout my life with that is when I do a maybe 16 hour fast, that first meal that breaks the fast has been typically pretty challenging for me to guess my insulin needs correctly. And it’s something I’ve really played around with. And it took me a long time to tailor and get to a place where I could not have a blood glucose spike after that first meal. But just recently the American Diabetes Association had a big conference and they presented a study that showed that breakfast can actually help prevent lunch post-meal hyperglycemia, meaning high blood sugar after lunch. Which is really fascinating. So I think fasting is great. I’m still going to use it as a huge tool. It’s just, there is something to the way that we absorb carbohydrates or maybe metabolize them at that first meal that is a little bit different, I think, than other meals. And so that’s interesting and may be interesting for anybody out there playing around with this, that has blood sugar imbalances.

Dr Ruscio, DC:

You had also mentioned or made note of your experimentation with elemental dieting. And this is something that I could see someone with diabetes potentially being wary of because by definition, the carbs in the formula are meant to be processed. The fiber’s been processed out good for being non-irritating to the gut, but “bad” in the sense that these carbs will absorb quickly. Now you can get around that with sipping on these things. And it’s almost like a little IV drip. You just sip throughout the day so you get a little infusion of carbohydrate and this shouldn’t lead to spikes, but this is to some extent theory. I mean, there’s a pretty good body of clinical observation that supports this, but from your perspective with elemental dieting, what has that done for you and how has that felt?

Dr Hannah Hamlin:

Yeah, so Michael, I haven’t even had really the chance to talk to you about this, but I did a three day elemental diet maybe a couple months ago. And I decided to go with our Elemental Heal—the regular one, not the low-carb—and I just wanted to experiment and just really as a trial to see how it would go and what would happen. And so what I did was I did notice that if I were to make a whole shake and drink it at once, as opposed to sipping with it, I did see a blood glucose spike. But what was fascinating though, I mean when I was sipping it sequentially like recommended, that that worked really well from a blood glucose perspective.

Dr Hannah Hamlin:

But what I really noticed that was almost challenging to keep up with during that time period was my insulin sensitivity shifted so quickly that I needed less and less insulin to the point where I stopped taking short-acting insulin. I was only taking my long-acting insulin and I had to decrease that sequentially throughout the three days. I think on the last day I maybe took 30-40% of what I typically would take in a day. And what’s so interesting to me is that we standardized the carbohydrates and the calories that I were eating were not hugely different that if I were eating whole foods. So there was really something to that anti-inflammatory benefit, I think that impacted my insulin sensitivity. But it was pretty fascinating. And I definitely felt great when I was on it and I felt great after too. But it was quite interesting with the low glucose piece and just the rapid change in insulin needs.

Dr Ruscio, DC:

That’s very interesting. And yeah, I mean, we’re just speculating here, but I would think that a reduction in inflammation would be the main reason that accounts for needing less insulin while on this meal replacement that has a decent allotment of carbs. Again, you’re using it in a sipping fashion, so you’re not getting the huge carb bolus but, nevertheless, wow, that’s amazing to see that your needs for insulin dropped so precipitously. That’s really cool.

Dr Hannah Hamlin:

Yeah. It was really interesting. And it’s hard to know exactly what went into that, but there’s something there that was really good from an overall, I think, inflammation perspective.

Dr Ruscio, DC:

Yeah. That would be my guess. And that’s just another good reminder of why it’s important to eat in such a way where you feel the best, right? Because you are also feeling well at the time and usually, this not an absolute rule, but usually if what helps that person feel best does not also lead to biomarkers looking better than we don’t have the biomarkers quite figured out just yet. Again, there’s some violations to that. You can say an alcoholic could try to go off alcohol and then have alcohol again and feel better once he gets back on alcohol.

Dr Ruscio, DC:

But especially as it pertains to items in the gut, there’s a lot that we haven’t fully sorted out so we can use these biomarkers in the lab test to partially guide care. But it’s really important, I think, to put how the person feels first. And in this case, it was nice to see that you felt better and the biomarkers improved, but for those who might be grappling with, “I do one thing and I feel better doing the one thing, but my glucose is a little bit higher,” follow your body. And that’s also what you did with your diet Hannah, right? You were saying that the low fat plant-based diet was “better” for your insulin, as was the keto diet, but you didn’t feel best there. So you really chose to put your personal wellbeing over the biomarkers. Is that fair?

Dr Hannah Hamlin:

Yeah. Yeah. I think in the world of biohacking and all the different data trackers we have, whether it be even just traditional blood work or things like the Oura ring, we get so much data. And what I’ve learned from getting just a preponderance of blood glucose data for the last seven years is that what really matters is that there’s so many variables and we can try to balance variables and look at different graphs and try to take everything into consideration, but I think our bodies are able to look at all those variables better than we are. It’s really hard to isolate a certain biomarker and say this is better overall for us. It’s really that big picture piece. And I think there’s such beauty in just listening to what our bodies are telling us, whether or not we’re feeling better, and I think that’s huge.

Dr Ruscio, DC:

Yeah. Well said. Shifting gears for a second, I know that at the clinic you are seeing lots of patients with gastrointestinal distress and you’re also seeing female patients. And so as a female yourself, I’m curious your perspective on the tie in between gut health and female hormone symptoms. And what tools you’re particularly interested to share with the audience that you’re using in the clinic to help this cohort of patients that are female and have both—whether it be gas or bloating or constipation—and some of the classical female hormone imbalance symptoms—whether it be hot flashing in a menopausal woman or PMs and a younger woman who’s still cycling. Thoughts, observations, and anything that you’d want to share with our audience there?

Dr Hannah Hamlin:

Yeah, it’s been really interesting with women who have irritable bowel symptoms—so the gas, the bloating, or diarrhea, constipation—it’s almost predictable that they will also have some type of PMS symptom. Now that’s not always the case, but it’s a really, really high correlation. And if it’s a woman who is perimenopausal or postmenopausal we’ll also see some type of hot flash or symptom associated with that change. It’s shocking to me how common that was. And we think about that.

Dr Hannah Hamlin:

I think we see often that women grow up often with painful periods or symptoms before their period—whether it be bowel changes or cramping, bloating, or even things like sadness, increased sensitivity, and tearfulness—we’ll think that that’s normal. I think that at least in the society I grew up in Texas, that I thought a lot of the girls that I friends with also had those symptoms around menstruation and they felt like they were just a normal part of being a woman.

Dr Hannah Hamlin:

And what really I think not everyone knows is that often those symptoms are a sign that there’s something a little bit off. So it’s a red flag your body’s raising to say, “hey, pay attention, there might be something going on.” So with that, what I see is that with irritable bowel syndrome or different GI symptoms, they come hand in hand. So typically at our clinic, we always really work with gut health and gut optimization first. And now, not always, I think that’s an overstatement, but often that’s a strong place to start with the intention of then circling back and treating the hormone maybe imbalance or hormone symptoms a little bit later on in the course of treatment. And it’s very frequently that just treating the gut will help women normalize those period symptoms or menopausal symptoms.

Dr Hannah Hamlin:

There are some times where we’ll get to a place where those symptoms maybe are still present after really working through the gut health piece and gut optimization, and in that case we were using a lot of herbs. And I find that that’s been hugely effective, actually to the point, I think, for over the last year since we’ve been working together, Michael, I haven’t really had to go past using any herbal adaptogenic help for women in hormones. Typically we get there and that clears symptoms to where they’re content and we don’t need to keep walking down further treatment protocols, which is truly amazing. I think that it’s really exciting. And menstruation symptoms or menopause symptoms are a huge weight on quality of life and so I love that we’re able to treat that upstream.

Dr Ruscio, DC:

And I’m jealous of women because there’s not quite the cocktail for men. There are some things that can help with testosterone, but in my experience, they pale in comparison to what the herbals for female hormone optimization have to offer.

Dr Hannah Hamlin:

Yeah. I’ve started thinking that too. It’s not quite as simple maybe, or I don’t know if simple is the right word, but it’s not quite as straightforward from a results perspective.

Dr Ruscio, DC:

Yeah. We need to go to the rainforest, Hannah, and just find the new plant or berry or leaf that’s going to help men. And then we’ll hopefully give men something on par to this. I mean there are things that are proclaimed like Tribulus or boron, but yeah, I just haven’t seen them move the needle as much. So just to reiterate for women, it’s really powerful how much of the female hormone imbalance symptoms will rectify with the diet, lifestyle, and gut health foundations model that we use. And then for some gentle support with things like dong quai, black cohosh, Vitex, and it can truly, again, be amazing.

Dr Ruscio, DC:

And I learned this—I’ve told this story on the podcast before so sorry it’s a little bit redundant—but with a woman I dated now, gosh, probably eight years ago and she was so hot and cold. She was a wonderful person, but there was just these moments when it was like, where did she go and who is this person I’m talking to now? And the female herbal supports, that was really the first case study where I saw, holy smokes, these herbs can really move the needle. And it was so drastic to the point where her family even thanked me. They were like, “man, she is so much kinder and more even keeled now.” So yeah, it can be quite powerful. Anything else, I guess, while we’re on the female health, female hormone piece that you think is interesting and worth exploring?

Dr Hannah Hamlin:

I think it’s interesting to hear you say that. I think it’s amazing. Hormones are a scary thing. They can really impact the way that we feel without a doubt. And it almost feels out of control at times. I’ve had a lot of people come in saying that, where they feel like they just certain times they can’t control things about their body. And it’s interesting. I’ve personally felt like that when my blood sugar is really elevated. If I have a high blood sugar because I made a mistake on insulin dosing or something that, I’ll feel like that sometimes is that it’s just difficult to show up as yourself when your body is so far out of homeostasis. And I think that’s interesting that that’s your experience. But to speak to that, I think within the category of irritable bowel syndrome, or just symptoms of abdominal pain, bloating, gas, constipation, diarrhea, what I see is a lot of women who have dealt with these types of GI symptoms long term, for years in their life, they have really tuned in to the way that certain foods affect their symptoms. And by complete normal correlation they start to become fearful of certain foods or certain types of categories of foods, because they know that it’ll affect their body, it’ll hurt their body.

Dr Hannah Hamlin:

And I’ve certainly been there in my life, but getting this fearful relationship with food is something that I see very often in women who have had GI symptoms long term. And that can be just really challenging to navigate. I mean, we have to eat to live it’s important that we eat foods that are good for us, but also I think anytime we’re eating from a place of fear or concern, it can add so much extra stress that sometimes the small changes or the nuances in diet just really aren’t worth the physical benefit when we look at how much stress that can lay on. And so I think relationship with food is really one that I’ve learned to navigate with women this past year, as we talk through these things, because it’s been something that comes up again and again. And so if someone’s out there and they’re hearing this and they feel that way, know that it’s very common and it’s something that can be worked through. But it is just such a big part of healing is also rectifying that relationship with food.

Dr Ruscio, DC:

Yeah. So beautifully said. And I, of course, agree because we’ve talked about this in the podcast so many a time. But yeah, I mean, it doesn’t go away. The more people that we work with, it’s a common theme. And understandably so. I mean, I was there at one point where I wouldn’t eat before exams because it was a coin toss, maybe I’ll get brain fog during a test, maybe I won’t. Thankfully I never got too much emotion tied up in with it, but I can absolutely understand where that comes from. Especially when some of these things are framed with “if you ever eat this, it’s going to cause a long term inflammation.”

Dr Ruscio, DC:

And well, with autoimmunity, actually, let’s talk about gluten, right? Gluten, autoimmunity, Type 1 diabetes, and autoimmune condition. What’s your perspective? What’s your experience? And what would you offer people maybe in this same vein? Because it sounds you have a very balanced perspective on diet, but I would also see you being someone who could be very amenable to some of the messaging around inflammatory food. So tell us about how you’ve navigated that.

Dr Hannah Hamlin:

Yeah. So It’s interesting, with Type 1 diabetes specifically, there’s a high correlation of people who have celiac disease. And I don’t want to start with that because I think it’s important that if you have any type of GI symptom and you have Type 1 diabetes that you check out celiac disease before you move forward with lots of gluten experimentation. But in my perspective I did, when I noticed back in undergrad, I really, I wasn’t feeling well. I got Epstein barr virus and really just struggled with energy. And that’s when I had dove into the paleo lifestyle and really took out gluten exclusively for many years. And looking back now, it was probably six years where I was just almost ate like someone who would have celiac disease because I noticed I felt so much better without it. But I really I’ve been so healthy over the last couple years. I’m feeling so much better that I’ve started, maybe within the last three years, to branch out a little bit more. And I would say probably right now I eat gluten light.

Dr Hannah Hamlin:

Now, I’m at a place where I don’t see symptoms correlated to certain meals that I may eat out at a restaurant that have gluten, but it’s something that I don’t incorporate in my day-to-day life. And that’s really from a symptomatic perspective, less from measuring different autoimmune or antibody markers. But I have found that there are lots of people within the autoimmune category that feel better without it. And so they typically just avoid it most of the time, not having to be hugely strict. Like if I get a salad with croutons on it, I’m not going to not eat it. It’ll just run to the side, but I was for a long time. And I do think that was maybe a part of my healing journey was taking out some of the things that were causing inflammation. And then as I went through and really worked on healing my own gut and getting to a place where my stress was a lot lower and working on overall inflammation, I feel like I can handle those things a little bit more now where I have the resiliency that I think truly I always wanted—to have to have that flexibility, but also know what works for me most of the time.

Dr Ruscio, DC:

And so you don’t feel like it interferes with your quality of life. Because you hit on something there that I think is really important. Firstly, we should frame and just make sure that we’re acknowledging that if someone notices a high degree of symptoms associated with gluten consumption, absolutely avoid it. But it’s for those whom are avoiding it morally on fear or faith that I think we’re, or at least I’m, trying to reach. And that doesn’t mean, to your point, it’s a staple where you have wheat pancakes every morning, let’s say. But if you’re out at a dinner or at a social function, you just have that freedom to not have to worry to the unth degree about it. Perhaps, I’m not sure what level of avoidance you have, but how does it tie in with those occasional circumstances and your quality of life? And how are you sorting that?

Dr Hannah Hamlin:

Yeah. So what I typically do is I just, for gluten specifically, I just don’t buy it at the grocery store. So I don’t have it in my house. I’m a big meal prepper, still, with my current clinic schedule. And so I meal prep on the weekends. I just don’t meal prep with gluten. I don’t plan to eat it, but if it comes in and if someone brings lunch to the office or I’m out at a restaurant that doesn’t have a gluten-free option, I’m absolutely okay with having gluten in my meal then. And so I find that I’m not overwhelming myself with gluten that way that’s comfortable for me, but I’m just not stressing about it either. And I don’t find that when I do that amount of gluten that I have symptoms.

Dr Ruscio, DC:

Right. Great. Okay, seems like a very livable and reasonable approach.

Dr Ruscio, DC:

Hi, everyone. If case you are in need of help, or would like to learn more, I wanted to quickly point out what resources are available to you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is always the clinic and myself or any one of our doctors would be more than happy to help you. And as a quick aside there, we just had accepted for peer review a six-part case series where in we demonstrated the gut-thyroid connection and how crucially important it is to make sure you are not overlooking someone’s gut health as it pertains to thyroid health and thyroid symptoms more broadly. Through the clinic we also offer health coaching and, independent of the clinic, if you’re reading the book or need some general advice, we offer health coaching also. There’s our store where you can find our Elemental Diet line, our probiotic line, and other health and gut-supportive supplements. And finally, there is our clinician’s newsletter, the FFHR, AKA the Future of Functional Health Review database with research reviews, case studies, and other helpful resources for healthcare providers. Everything for any of these resources can be found at the overview page DrRuscio.com/resources. That’s DrRuscio.com/resources.

Dr Ruscio, DC:

What else is there anything else that you would like to mention?

Dr Hannah Hamlin:

Gosh, we’ve covered a lot today. I think this has been a lot of fun topics here. I think that maybe just to wrap back around to getting to a place where not only are you eating the perfect diet for your condition or taking the perfect supplements or really even following recommendations very strictly, coming back to that piece of listening to your body being so important and listening to your stress level about it too. I think when I look back on my journey with health, I’ve made a lot of big discoveries in my life. I also learned things the hard way. And I think the times where I leaned so hard into a treatment plan or a specific diet where it put an additional layer of stress on top of my life were the times where I wasn’t getting the traction. I wanted to see an improvement. And I think sometimes we forget that. I think it’s natural.

Dr Hannah Hamlin:

We want so much to heal. We want to feel good. We want to get rid of our symptoms. And so we’re willing to, I hear this all the time in the clinic, you may too, “I’ll do whatever it takes.” We get to that point. And I was there for a long time. But I think it really is more about listening to your body and your stress level and figuring out what works for your life. And I found for me that what works for my life isn’t the same every year. It can come and go in chapters. But when I tried to adhere to the textbook recommendations for Type 1 diabetes in different camps, in schools of thought, it really didn’t get me all the way to where I needed to be. It took coming back around full circle, listening to my body, and really looking at where I was that week or that month. And that’s how I got to this place of healing. And so, I think that’s a good place to maybe wrap up on is just remembering that part is so important and easy to overlook.

Dr Ruscio, DC:

That’s a really nice tie around. And it also parallels very nicely with what we do at the clinic is very much so that discovery process of there are different diets on offer. There are different lifestyle recommendations on offer. There are different therapies on offer. And we want to really help navigate the person to the plan that’s going to work the best for them. And thankfully, we oftentimes are exploring the middle ground as part of that process, right? It’s not, “well, you got to be just keto or just Pritikin,” but rather taking someone through this discovery process of what works well for them. So yeah, this all ties in very nicely. Hannah, you are a rockstar. I’m so happy that you’re on our clinical team. You’re doing such a fantastic job and I hope everyone has enjoyed this conversation. And, Hannah, thank you again. And I will see you around the clinic.

Dr Hannah Hamlin:

Okay. Sounds great. Thanks so much for having me.

Outro:

Thank you for listening to Dr. Ruscio, DC Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates. That’s DRRUSCIO.com.

 

• Ruscio Institute for Functional Health
• Dr. Ruscio’s, DC Resources