#1413 Low Dose Naltrexone

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

Liz shares her family's autoimmune journey and how low-dose naltrexone helped. She highlights overlooked links between thyroid, insulin resistance, and autoimmunity.

+ Click for EPISODE TRANSCRIPT

---

DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome back to another episode of The Juicebox Podcast. I

want to jump right into this one, but Liz is back. She's a returning guest, and today we're going to talk about a lot of stuff, but mainly we talk about how she's using low dose Naltrexone. Now, you either heard that and thought, Ooh, interesting. I can't wait, or I don't know what that is. Either way, hang out for a second. It'll all become clear. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan, don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com when you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink, ag one.com/juice box. Don't forget, if you're a US resident who has type one, or is the caregiver of someone with type one, visit T 1d, exchange.org/juice box right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help. Today's podcast is sponsored by us Med, US med.com/juicebox you can get your diabetes supplies from the same place that we do, and I'm talking about Dexcom, libre, Omnipod, tandem, and so much more us. Med.com/juice box, or call 888-721-1514, this episode of the juice box podcast is sponsored by the ever since 365 that's a CGM that lasts a full year, ever since cgm.com/juicebox one year one CGM Liz has been on the podcast in the past. She was in an episode called blackberries to the rescue. Blackberries to the rescue. You should go check it out. It's a very interesting conversation that culminates with a story of her husband and son, both type ones out on a hike. The low snacks got used up on the sun. The husband gets super low, saves his life with berries on the uh, it's a great story. You should go listen to it. But Liz comes back today because A lot's happened in her family over the last couple of how long would you say,

Liz 2:39
um, I'd say just Yeah, the last year, year, yeah. So we have, we have four kids, and my oldest is the one with all the all the medical stuff. So he has type one. He was diagnosed when he was 12 months old, and then a couple months later he was diagnosed with severe food allergies. And when he was about eight or nine, he was diagnosed with what I now know as Hashimotos. At the time, I just thought it was hypothyroidism, yeah, so the reason why I wanted to come on was mainly the thyroid and autoimmune stuff that we had pop up in our family this last year. So I'll start with my daughter. So she was 12 at the time last year, and she normally loves school. She's a great student, and she started just missing so much school and getting really tired. Sometimes it was like her head was hurting, sometimes her stomach, sometimes her joints, just extreme tiredness. So she missed a lot of school, and I took her to a walk in doctor and asked just for auto immune screening, because we have a lot in our family, and it came back that she has Hashimotos that sort of started me on, I guess, a deep dive of researching Hashimotos and thyroid. And I knew, since her TSH was was optimal. I knew that it could be years, and maybe, you know, maybe she won't ever need it. Hopefully, that's the case, but I knew that she wasn't going to be treated by a doctor for her symptoms, or even acknowledge that the symptoms that she was having were related to thyroid. So anyway, so I just started researching at the same time my son, who was 17 at the time in October, his TSH was also optimal, but his endocrinologist wanted to lower his dose because he lost some weight. I reluctantly agreed, because he already was sort of symptomatic even at that optimal dose, but he's kind of always been like that, so they lowered his dose, and when we retested it, the educator said the doctor's happy with the number. There's no need to change the dose. And I asked what it was, and it was had gone from point four originally, and it had gone jumped up to 4.7 Or something at the at the high end of the range, which is not optimal, and he was also feeling more symptomatic. So I had to basically beg her to adjust the dose. And I asked her, if she wasn't willing to go back up in a dose, could we just alternate? She said to me, there's absolutely no medical reason. And I want to stress this to you, there's no medical reason to adjust his meds, because if he's feeling anything, it's not related to his thyroid, because he's in range. And she said, it'll make you feel better. We can alternate the doses and try that. So how

Scott Benner 5:39
did that make you feel that they said there's no reason to have this medication, but that you continue to ask. And then they were like, Okay, fine, you can have it. Then, yeah,

Liz 5:48
you know, I just, I feel like she was like, anything to just make this intense woman get off my back. Isn't

Scott Benner 5:56
it strange, though, because too much thyroid medication is also bad. So if the doctor really believed that it was going to be too much, this is my assertion.

Liz 6:05
Yeah, she should. She she could have just flat or refused, but, you know, I'm

Scott Benner 6:10
saying she wouldn't have given it to you if she thought it was going to cause a problem. So she, I think what that story tells you is she didn't know either, and then she tried to put it on you, right? I believe the kids call this gas lighting. Am I right? Do I understand gas lighting correctly? Yeah, that's what she does, right? She puts it on you. There's no way she doesn't think, Huh, that might be what's going on here, but I don't want to put my name on it. We'll let the mom take the responsibility. I think it's shitty, is all I'm saying. So, yeah,

Liz 6:41
it felt, it felt. It felt pretty shitty, actually. Okay, yeah. So anyway, we, you know, I, I was very even though I wanted to put him back on his original dose. I was like, if I do that, you know, the blood tests will be different. So I was very faithful. I alternated the doses, and then I got a phone call from her with the next check and his TSH had jumped up to seven something. And she said, Okay, at this point, even though I still he's probably not feeling symptomatic at this point, but we will go back to his original dose. And so we went back to his original dose, which was still, you know, likely not enough at that point, because he was also growing and still feeling worse and worse and worse. And at the next the next blood test, he had jumped up to 31 his TSH, this all spanned from October to me, you know, this is his grade 11 year, and ended up missing so much school, and there was other stuff going on as well. It wasn't, I can't say it was all his thyroid, because he also, we found out that he had other allergies that were undiagnosed because he was having reactions as well. So, you know, he was having severe gastric upset. And some of the times he was missing school, it was because he just couldn't drag himself out of bed, probably because of his thyroid. And then other days it was, you know, because of allergy stuff. And while this was all happening as well, I came across an article that said

Scott Benner 8:17
this episode of The Juicebox Podcast is sponsored by the ever since 365 get 365 days of comfortable wear without having to change a sensor. When you think of a continuous glucose monitor, you think of a CGM that lasts 10 or 14 days. But the ever since 365 it lives up to its name, lasting 365 days. That's one year without having to change your CGM with the ever since 365 you can count on comfort and consistency. 365 days a year, because the ever since silicon based adhesive is designed for your skin to be gentle and to allow you to take the transmitter on and off to enjoy your shower, a trip to the pool or an activity where you don't want your CGM on your body, if you're looking for comfort, accuracy, and a one year where you are looking for ever since 365 go to Eversense cgm.com/juicebox to learn more. You've probably heard me talk about us Med and how simple it is to reorder with us med using their email system. But did you know that if you don't see the email and you're set up for this, you have to set it up. They don't just randomly call you, but I'm set up to be called if I don't respond to the email, because I don't trust myself 100% so one time I didn't respond to the email, and the phone rings the house. It's like, ring. You know how it works. And I picked it up. I was like, hello, and it was just the recording was like, US med doesn't actually sound like that, but you know what I'm saying. It said, Hey, you're I don't remember exactly what it says, but it's basically like, Hey, your order's ready. You want us to send it? Push this button if you want us to send it. Or. Or if you'd like to wait, I think it lets you put it off, like a couple of weeks, or push this button for that, that's pretty much it. I push the button to send it and a few days later, box right at my door. That's it. Us. Med.com/juice, box, or call 888-721-1514, get your free benefits checked now and get started with us. Med, Dexcom, Omnipod, tandem freestyle, they've got all your favorites, even that new eyelet pump. Check them out now at usmed.com/juice box, or by calling 888-721-1514, there are links in the show notes of your podcast player and links at Juicebox Podcast com, to us Med and all of the sponsors. If you

Liz 10:43
are allergic to grass and you have asthma, which he is both, there's a chance that you could be reacting to one of the filler ingredients in your thyroid meds, and which is, it's a case, yeah, it's from this tree, you know, like the tree doesn't grow anywhere near us, so it's not like he would be reacting to the pollen, but it's, you know, it's related to the grass stuff, you know. So I knew it was a long shot, but I was like, I know he's allergic to something. Like, there's something happening that I should be able to figure out, and he's suffering, and I can't figure it out, right? So I think this was before we knew his TSH was 31 so at this point, the endos thinking he's seven, probably going down. He's probably, you know, he's probably fine, thought, right? Wise. Anyway, so I wrote her an email saying, think there's a chance. I said, chance. Like, I'm like, I'm not positive, right? But I was like, if there's any, if there's any possibility, I I would love for him to try a different Med, that there's so few meds that he can try in Canada here, like, we don't have that the tears sent up here yet. And so it was like, maybe we could go to a compounding pharmacy, you know, get it without the fillers, just, you know, and I will have the allergist test for it. And I realize it's a long shot, but you know, what the heck there's a chance, right? You know. Keep in mind,

Scott Benner 12:00
you're talking about eight months this has been going on for him. Yeah,

Liz 12:03
yeah, she was, you know, she contained her

Scott Benner 12:07
disdain for you.

Liz 12:10
And so she's like, Okay, I highly doubt it. I highly doubt it. But if, if you want, we can, we can go that route. And by the time I, you know, heard back from her, he did have an appointment at the allergist a week later. So it was like, okay, you know that we'll see what's happening. But I did feel that, you know, I was being, you know, she in her mind, she thought I was crazy, because she already, you know, she kept on saying, whenever I bring up the word optimal for thyroid, she's like, well, we have very different ideas of optimal, and there's no reason to think that anything, any symptoms he has. It's not really, oh. And then at the same time, I had been asking to know if, if he in fact had Hashimotos, because I was like, has, could we get his antibodies tested? Because I'd like to know. I think it's good for him to know if he does in fact have Hashimotos or just right hypothyroidism. And you know, chances are. And to their credit, you know, she's like, we don't need to test antibodies. There's no reason to test antibodies, and we're not going to

Scott Benner 13:07
because what's the reason against testing for them? Well, I think it's

Liz 13:10
a money thing. Like, I did find out she I wanted her phone calls, she she called back, and she's like, I did look again in his chart, because she'd said she'd already looked in his chart and he'd never been tested. And then she said, I looked again, and when he in 2012 when he was diagnosed with leading thyroid meds, his antibodies were tested at that time, and it does show that he has Hashimotos.

Scott Benner 13:33
Yeah, I would have said, why was it necessary then, but not now? Like, I feel like you just make things up when you're talking to me, is what I would probably have said. But okay, good. I

Liz 13:43
feel like what it is is that, you know, the government has mandated that they don't test antibodies because it saves money, and then they have to come up with the reason to defend that. Otherwise, if they told their patients that are asking for it, we really think that would be a great idea to test for them, but we can't, I don't know. Like, I'm trying to reconcile why they why they said all this stuff. By

Scott Benner 14:05
the way, I don't mind that there are financial reasons to do things and not do things. I mind the lying. I mind the making things up, because then you, you cling to those reasons like you don't mean like the doctor said. So down the road, you might use that as a reason to justify something else, when the truth is, it feels like they're just saying whatever shuts you up. Yeah.

Liz 14:30
And I said, you know, I said to her, I was like, I feel like it's his, his medical knowledge, like he has a right to know, you know, if, if he has this or not. Because, what if, no, what if, when?

Scott Benner 14:41
What if it has other impacts on other things too, exactly

Liz 14:43
like, what if he has other if he has kids, and he needs to know, look, I have this autoimmune disease, this autoimmune disease, you're going to be more like, you know, I feel like it's his, his information that he should be privy to In the meanwhile, like I had found all these research medical journals. Yes, that states if you have auto immune thyroid disease, even if you're in range, like before you even start taking meds, you are much more symptom, like you have an increased it's not in your head. Basically, what you're like what they're saying. You know,

Scott Benner 15:16
that's why we always tell people we by the way, I'm a guy that makes a podcast. I barely got out of high school, but nevertheless, it's why I'm always saying to people like, treat the symptoms, not the test result, right? If you have Hashimotos and you feel a certain way, and that's a symptom of Hashimotos, but your TSH, the doctor goes, well, the TSH is okay, I still feel this way. What do you care what the test says? Ridiculous. Yeah,

Liz 15:40
and my, my daughter for a perfect example. So her TSH is optimal and perfect. She doesn't need meds yet. Her, you know, her free t4 is good, her t3 is good. They don't do reflex. They don't do reverse t3 up here. So I have no idea what the conversion is. It's not even an option for the endocrinologist to check off, but yeah, so she was feeling so symptomatic and and my husband also, I mentioned earlier, when we weren't recording that my husband, when he he found out that my daughter has Hashimotos, he also has type one, so he thought, well, maybe I should test myself to see if I have it. And he has Hashimotos as well. So he's in the same boat as my daughter, in that his TSH, right now is good? Yeah. So neither of them, you know, they might not leave meds for years, right? So what I was doing, you know, that whole year, so I was researching a lot on Hashimotos, and what I can do is there anything that they could take my daughter and my husband to help their symptoms while they're in this sort of limbo state where they don't need thyroid meds yet, but they are, it's not in their head. I can see what's happening. You know, my daughter's hair is falling out and, you know, she can barely move some days because her joints are hurting so badly. And I can't remember where I came across it, if it was on one of the Hashimotos groups, or I also belong to a Ehlers Danlos group, because I think some of my kids have that and so it might have. I don't know where I found it, but I came across this drug called low dose Naltrexone. In my mind, it seemed like the perfect answer for both of them, and then me as well, because I have, I was just diagnosed with fibromyalgia last year, so I have a lot of chronic joint pain and everything. So low dose naltrexone, at its normal dose, is used for opioid and alcohol addiction. And so it's a opioid antagonist, I guess. And so it just blocks the blocks the effects of narcotics. They found out that if you take it at a very, very low dose, like, you know, 0.5 milligrams, up to 4.5 instead of the typical 50 milligrams, that what it does is it lowers body inflammation, and it for a very brief time, like maybe an hour. So it it locks the endorphins to your brain, and then your brain realizes, hey, I don't have any endorphins. I better make more. And then it makes, it sort of spits out extra endorphins. And somehow, the mechanism with these extra endorphins is it lowers pain, lowers inflammation, which is not going to cure your autoimmune disease, but it potentially could help you from picking up another autoimmune disease, because it's putting your body in a state of, I don't know, so just, I guess helping with inflammation. You know, it seemed like a very low risk thing to try. There's, there's very few side effects. The main complaint is sometimes people get vivid dreams from it. You start off very slow, and you titrate up the dose, but then if you decide that you it doesn't work for you and you don't want to take it, there's no tape. You don't have to taper down. You can just stop. And there's no side effects from stopping. Yeah, there's no side effects, and there's no addiction to it anyway, it just seemed like the answer.

Scott Benner 18:59
So Okay, who did you start with? Like, because you, you probably should have gotten, like, a candy jar full of it and giving it to everybody. But where did

Liz 19:07
you start? I originally asked my doctor for me, and she said, No, I do have some patients on it, but before I start you on it, I would want to try these other options. And so she, she wanted me to try deloxetine, which forget the other name for it, but it's basically, it's a pretty hardcore pain med, okay? And researching that, I talked to so many people that had been on it, and they were like, run the other direction. I'm sure it does help some people, but it seemed like a scary option to try, because a lot of people, you know, they were, they were saying, you know, I was on it for one month, and then I decided I didn't want to. It wasn't for me. There were too many side effects, and it took me two years to get off of it. And I was opening up the capsules, counting out the beads, trying to

Scott Benner 19:54
wean myself, you know, what's it? Called myself off. And I delox,

Liz 19:57
the team d i. U L,

Scott Benner 20:00
I'll figure it out. Is it Cymbalta? Yes, yeah, it's Cymbalta. Okay.

Liz 20:06
Meanwhile, I had booked through one of our it was our local diabetes Facebook groups. I was sort of venting about all the thyroid nonsense that was happening with my son and and daughter, and at the same time knowing that if things got worse for my daughter, she was going to end up at the same clinic that my son went to, which, you know, they're great for many, many things, but I knew that thyroid wasn't one, yeah, yeah. So what can I do to help her in the meantime? So somebody on the group had commented clinic that I work for, and there's a really wonderful nurse practitioner that is great with thyroid. She's helping me with my thyroid. And so I booked, I booked all three of them in with her, and before I could even bring it up, like I had all these like arguments. Why I thought this was the best option for them. This is like, I'm ready. I was ready to go on fighting. I'm ready. She actually brought it up. She's like, well, there's one thing that we could try to help lower their symptoms. And she, she brought it up. So that's how we got it prescribed

Scott Benner 21:12
for them. So long did it take for you to notice it helping them? My

Liz 21:15
daughter was, I should have kept a journal, but I, I feel like it was like, within the first increase in dose, like, maybe not, maybe nothing, the first week or so, but definitely within the first month, I'd say, couple weeks. So

Scott Benner 21:29
what did you start her on? Like, a starter dose? How long did that go for? When did you ramp it up? Was this on the doctor's orders? It

Liz 21:36
goes through a compounding pharmacy. So because they they have to take the 50 milligram pill, and then, you know, put it in a capsule. And so we started on 0.5 it was like, every two weeks we would go up, up in dose. Okay, so it was like 0.5 to one, and then, you know, so it took a while to go up. I think she started my husband on 1.5 and six weeks, he was up to 4.5 so, so he went up quicker. She just wanted to go slower with my daughter, but yeah, so she was, she was taking anti inflammatories every day. You know, she was taking Advil every day because she was in so much pain with her joints. And she basically just, she stopped eating Advil, and she it helped her with her energy, you know, she was able to get back to school. And I feel like she's, she's not what she was before this all happened, you know, like she doesn't. She sometimes needs a little bit more, I guess, repair time after a big weekend. Or, you know, I was mentioning to you earlier that she does cheer, and before she was on this if she would do a cheer practice, I feel like it would take her the whole weekend to to get better or to get her energy back, you know. So any

Scott Benner 22:48
other impacts? So what? What stick with your daughter for a second? What impacts Did it have for her?

Liz 22:55
I think it helps her well, for sure, her her overall body pain. It's helped a little bit with her energy. And do

Scott Benner 23:03
you think energy because it's improving her energy? Do you think that not being in pain is giving her more energy?

Liz 23:09
It's hard to say. It could be both, yeah, and I feel, you know, like last year, she was giving she was coming down with strep throat all the time, or what she thought was, I think it was definitely strep throat once or twice, and then other times, you know, she would just have a she was always complaining of a sore throat, and I wonder if that was like her thyroid was, was sort of inflamed, and it felt like sore when she was swallowing. I'm not sure, yeah, yeah. Just just energy overall and joint pain for her, yeah, joint pain, yeah, yeah. Sometimes it would be in her hips, and then other times it was her back. And, you know, some of it could have been cheer related, for sure, because she does a lot of lifting. She's, you know, she's one of the the kids that I think has either Stan most. So she's very hyper mobile and flexible. And one of the things with that is that it's easy to hyper extend, and, you know, put strain on your your joints. Is she

Scott Benner 24:04
so cracky? Does she What does her back or neck crack all that stuff? Yeah, yeah, yeah. She feel like, you can't get it, like, to stop Arden. Using my Arden as an example, you could crack gardens back, it'll explode. And you could do it five minutes later, it'll do it again, yeah?

Liz 24:18
And that's how, that's how I am, too. I went down so many rabbit holes last year. I went down the thin All right? Thyroid one, the Ehlers, danlos rabbit hole. And originally I was thinking three of my kids and my husband. Have you looked into the the bitin score? What is this for Arden? Have you? It's the scoring system that they use for to diagnose the hypermobility. Oh, kind of

Scott Benner 24:40
yeah, there's think that's happened to Arden in a doctor's office before, like,

Liz 24:44
you get one point if, if your right elbow hyper extends, and one point for your left and your if your knees hyper extend backwards, if you can touch your hands flat to the floor, bending down, and if you can bend your you. Your thumb and have it touch your forearm, yeah, yeah. And then, so that's, like the, the major criteria. And then there's other things, like hernias and organ prolapse and stretchy skin, all that stuff I was thinking, and it's hereditary, right? So I was thinking, okay, my husband, he can easily pass he gets a positive I've diagnosed him with it.

Scott Benner 25:24
What a fun date. That must have been, honey. Come in the bedroom. He was like, oh, it's happening. And he's and you're like, can you move your thumb towards your form? He's like, this isn't what I thought was gonna happen. But okay, what else that's awesome. You diagnosed him, by the way, byton, B, E, I, G, H, T, O, N, scoring system, if somebody wants to look it

Liz 25:45
up, you know, I just assumed, like the kids, they they can all pass it to right, like my, especially my, my younger one, he's his middle, you know, like the ends of my, like the last joint in my fingers, they all bend backwards. You know, I have, like, the the tips of my fingers basically bend backwards, but also the middle joints on his fingers also bend backwards, so he can make a C, a backwards, C with his fingers, if he bends his fingers, you know,

Scott Benner 26:13
hold on. That just gave me the heebie jeebies. He's

Liz 26:15
so stretchy and so bendy. And then middle son, you know, he was doing, like, party tricks, you know, when he was little, like, his his head and like the back of his head, he can bend his back and it basically touches his back, you know,

Scott Benner 26:29
with the back of his head. Oh, so that wait, yeah, so he can tip his head

Liz 26:33
back and, like, basically touch the back of his head to his back. Oh,

Scott Benner 26:38
my God. Like a pest dispenser, yeah, yeah.

Liz 26:42
Interesting. He used to do this thing where he would bring his his foot up, like, bend his knee, and then bend his like, basically, his foot would end up, like, on his pelvis, but his knee, with his leg was pointing down straight. Like, it's hard to describe, but it's just

Scott Benner 26:58
super bendy, right? Yeah, Pence pence dispenser, don't do that. Yeah, that's crazy. I'm gonna start calling him that. Hey, Pez, what you start calling your kids. I want to be invited Felix. I want to be invited to dinner if that happens. Because if I feel like I'm the one who's like, like, brought that to fruition, I don't think he's gonna enjoy that. Tell me more about like, whatever, because are, is everyone using low dose naltrex? Like, and are you going poor paying for it because this insurance cover it? Well,

Liz 27:27
okay, so now the three of them were taking it. So, you know, I had my other son who, you know, the one with type one and thyroid, even though he's on on Synthroid. I thought, you know, why not? Like him, of all people, like, he has all this stuff. Like, let's help him out with his inflammation. He sleeps a little bit better, and he I think his mood is a little bit better with it, but it's hard. You know, his thyroid numbers are up and down. So my husband and son, they haven't had such a significant it is helping them. Like, I think it's helped my my husband's mood as well, but I think my daughter has seen the most significant benefits from it. But interesting, I wanted to talk about so on the there's a website. It's called LDN research, trust.org, and it has, you know, all the information about it. But when I went before we we started taking it, I I kept coming across whenever they talk about people with diabetes using it, doctors advise their patients to lower their insulin doses, because it does help with insulin resistance. So I was really careful when we started out. I was watching their numbers, and they both did have to lower their doses, and especially when we would see it when we were bumping up in dose as well. So it wasn't huge. It wasn't like what you talk about on your GLP episodes, but I'd say maybe 10% 15%

Scott Benner 28:50
I think that's a lot, by the way. I think that that's, yeah, that's awesome. Yeah. You know

Liz 28:53
that wasn't what we were going for, but it's, you'll take it's yeah for sure. Take a second and

Scott Benner 28:58
collect yourself. I want to read to people. I'm going to people. I'm going to do everyone's favorite thing, read the Internet. Low dose Naltrexone. Benefits for autoimmune conditions. Immune system modulation balances an overactive immune response, reduces auto immune attacks on healthy tissue, helps regulate T cell activity to decrease inflammation, reduces pro inflammatory cytokines, proteins that trigger inflammation, increases production of anti inflammatory cytokines, temporarily blocks opioid receptors, leading to increased endorphin production, higher endorphin levels improve immune system function and reduce pain under pain relief alleviates chronic pain associated with autoimmune conditions like joint pain and neuropathy, reduces central nervous system inflammation, which is called neuroinflammation, which is linked to widespread pain, slows disease progression, may help the progression of autoimmune diseases like MS or lupus by reducing systematic inflammation. For Ms, improves fatigue, spasticity. And neurological symptoms. For ra reduces joint pain, swelling and stiffness. For Hashimotos, lowers thyroid antibody levels and may alleviate fatigue or brain fog, inflammatory bowel disease, Crohn's and Ulcerative Colitis, colitis, excuse me, promotes intestinal healing and symptom reduction, may reduce systematic inflammation. Fatigue for lupus improves skin and joint inflammation for psoriasis and psoriatic arthritis, Sjogren helps reduce dryness and fatigue. Systematic sclerosis may alleviate symptoms like pain and stiffness, reduces chronic fatigue and brain fog, often associated with autoimmune issues, so it can help increase your quality of life that way, or by improving sleep, protects against neurological inflammation, auto immune conditions like MS or lupus, minimal side effects, provides a safer alternative for people cannot tolerate stronger immune suppressive drugs for insulin resistance. Insulin resistance is closely tied to chronic low grade inflammation, a low dose naltrexone, lowers pro inflammatory cytokines. So we know that's going to help there improves metabolic function. This is all under insulin resistance. Chronic inflammation disrupts the body's ability to use insulin effectively by reducing inflammation, LDN helps restore normal metabolic pathways. LDN can aid individuals with obesity related insulin resistance by reducing inflammation, some studies show it helps regulation in appetite, reduces cravings, which may indirectly improve insulin resistance. It can modulate the gut immune access. It says emerging evidence links gut inflammation to insulin resistance. LDN reduces gut inflammation, which may enhance glucose metabolism and insulin sensitivity, and there's potential benefits for type twos as well.

Liz 31:49
So yeah, Isn't it incredible? I mean, I'm like, Why? Why is not everybody on this drug?

Scott Benner 31:55
A number of months ago, art and Zendo tried to give it to us, but it's cash pay here, you can't get an insurance company to cover it.

Liz 32:03
Okay? So there's a workaround for that, like so right now, our PharmaCare is our government plan is covering ours, which I didn't know it was going to, but I was that was a pleasant surprise. So we there is a deductible on our PharmaCare, but we always reach it. I mean, it's huge, but because of all the diabetes stuff, we always reach it. So the 50 milligram pills themselves, I guess, are very, very cheap. And so what a lot of people do that can't afford the med is they dilute it in, like distilled water, keep it in the fridge, and then draw up from that, that correct dose, you know, so that you could have to mathematically work out how much water you put in and what the dose is. So that's one way that that it can be affordable for people that are not able to otherwise. Wow, I am taking it now as well. So I like, like I said, I'd asked my doctor, and she wanted me to try that Cymbalta first. And I was like, no, and then I ended up booking in with the nurse practitioner as well. And she was like, Oh, I have no problem prescribing it for you. I mean, that's way more sense to try something low risk before trying something with lots of side effects. So it is helping a little bit. I like my overall pain. I feel like it's helping my immune system. I felt like I was always one of those people that was, you know, I would pick up every cold or get sick, and I haven't been sick since I since I took it. But, yeah, I don't know. I think it's amazing. And I think the reason why a lot of people don't know about it, there aren't a lot of studies, because it is such a cheap drug, there's no motivation for people to do studies on it. I

Scott Benner 33:40
was wondering that. Because, yeah, the lady that talked about it for Arden and for Kelly, by the way, she's just a forward thinker. And it did occur to me, like, when your doctor was like, no, why don't you try this one that, you know, the sales people have already told me to tell you

Liz 33:55
about. I know, I know it's gross. It did feel like that a little Yeah, I really recommend it. And if you know, if, if people are interested, and they they want to reach out to me on like, through the the group, I'm, I'm happy to talk to anybody about it. And there is a great Facebook group too, like a LDN Facebook group with lots of knowledgeable people. So I think it's definitely worth trying if you have any autoimmune stuff.

Scott Benner 34:18
I mean, it's been a benefit for your family so far, you think, yeah, just looking

Liz 34:22
at the difference in my daughter, it's, it's made a huge, huge improvement. I mean, she was, she could barely pull it together last year with her school and and so

Scott Benner 34:35
you think it helped your one son who was having gastro problems. Do you think it impacted that at all?

Liz 34:39
You know, it's hard to say. So I jumped around so I was talking about how I thought that he was allergic to the Synthroid filler. And when we went in for testing, what happened with that is that, you know, I brought the actual a Casey, I sourced out Acacia powder, and then they also tested him. They crushed up one of his. Synthroid pills and tested him with that, and he didn't react to that. So I was wrong, and it was right. I'm

Scott Benner 35:09
not Is that a thing we brought up in your first recording where we didn't record your voice, or here I

Liz 35:13
got, I'm not sure. Well, okay, so just real quick. So I was sort of racking my brains like something he's, he's reacting to something. He's, I know he's allergic to something. I had this, you know, nagging feeling in my head, because he was, you know, had all these gastro issues, and I had read that you could be allergic to the filler if you have asthma and a grass allergy. So I went to the end of saying, I think he might be allergic to his Synthroid. And she, you know, basically looked at me like I had two heads. But she was willing to appease me and try to, you know, go through a compounding pharmacy and then I had the allergy testing done. So I had to tell her that she was right in that, but I was also right because it it turned out that he was allergic to something that we didn't know, and he was that's what was causing a lot of the gastro issues. So what did you figure out he was allergic to soy, which is in everything.

Scott Benner 36:04
So does he just breathe air now through a straw with a piece of cotton over it? Or how does he

Liz 36:09
Yeah, poor guy. I mean, he was already so limited in what he can eat, and at the time, he also had been vegetarian his whole life. He was never crazy about, like, the meat alternatives, but anytime that he would have one, it was soy based, you know, so he was, he was just getting, oh my gosh, yeah, even when he wasn't eating tofu or soy, he always hated tofu. But every once in a while, I'm like, Just eat it, you know, like, you need protein, and then he would eat it. And then, you know, probably for the the days after that, he was, you know, having all sorts of issues. And then, yeah, it was just very hard to narrow down, because there's, it's in, yeah, it's in everything. And his allergist does say that he's okay with having soy Letha sin and soybean oil because they're so highly refined that he didn't think that he was going to that. So we kind of eat those foods cautiously and just watch him. But anything with actual soy like soy sauce or soy protein, or, yeah, he can't have that anymore, and it does seem like it's, it's helping him. Like, yeah, last year we had, we ended up having a colonoscopy and a endoscopy, and because we also thought, well, maybe he's, you know, celiac, or maybe he has guessed, you know, gastroparesis or something. So all these

Scott Benner 37:25
different problems the body is just attacking itself in different places and ways. And it comes out in the real world, you know, the way it comes out, and then it sends you down all these rabbit holes. And it's just, it's, it's crazy, almost, that the doctors don't start with that. Like, I always think it's crazy, the doctor doesn't start with what's wrong with you. Well, let's keep in mind you do have an autoimmune disorder, you know, and the one you have is type one diabetes, but that's an indication that your body is looking at itself and going attack. So, like, why would it not happen? Like, just because they, you know, it manifested in your type one doesn't mean it's not happening in other places, smaller places, joints, fingers, you know, your your stretchy bits, your ligaments, like, that kind of stuff. Like, it could be happening everywhere, like, and it makes sense that it is right, like, so it's just so interesting that we skip over that, and it's, you know, because I don't know if we talked about it in this one or the the ill fated recording, but your son waited nine months to go to a gastro for the gastro to tell him, like, ah, it seems hard to me. Well,

Liz 38:34
it was actually, yeah, it was more than nine months, because I was looking back on my emails, and it was I had been asking to be referred for three years knowing that something was wrong. Yeah. I mean, I feel like one of the things that I wanted to talk about was just, and we've, you know, we've covered it, I guess, but just knowing that it's okay to push your doctors when you know that something is wrong with your kids. Because, had I not taken my daughter in and asked, you know, for the screening for the auto immune stuff. Maybe at this point she would have been diagnosed with depression, be on, you know, be put on depression. That's, you know, unnecessarily or and especially with women having this sort of invisible illness where you look okay on paper with your TSH, but you have a raging auto immune disorder attacking your thyroid. And there's legitimate journal articles out there saying that, yes, you it's a thing, you can be symptomatic and feel this happening despite looking normal on paper, right?

Scott Benner 39:34
Hey, did your daughter suffer with any acne? No, no. Not yet. Okay, well, maybe, like, maybe, like, a tiny, tiny little, but not like, persistent or anything, no. But

Liz 39:44
my second son, who's 15 and a half, he's starting, starting to, okay. Do you have any advice for

Scott Benner 39:52
that? Well, no, I just are. You know, in the last couple of years, Arden's been hit pretty hard, and the only thing that seems to like dull it is. The GLP, okay, so as you're talking, I mean, I'd be remiss to say, like, there's a bottle of low dose Naltrexone in my house that's meant for her that we just have never, like, done anything with.

Liz 40:11
Oh, okay, I wonder if that would help.

Scott Benner 40:15
Yeah, I'm interested, because in the end, it's inflammation, is what I'm thinking. Yeah,

Liz 40:20
right, just last night, when I was sort of gathering my notes and stuff, like going over, you know, I think, like months ago, I sent you an email with, like, links of all these articles and stuff. So I was kind of going over them again. And one of the recommendations, I think it was like, from the American Diabetes Association or something, if you have what, I guess is it's called poly glandular auto immune syndrome, like where you have type one diabetes and Hashimotos if you if you have somebody in your family that has that, what they recommend is routine screening of all your first degree relatives for other autoimmune diseases. And when I went in after finding Hazel. You know, my daughter and husband had that I went in wanting to have my other two kids screened. And they're a pediatrician who I really love, and she's always been great. She was making me feel like I was over the top and overly anxious about even asking that. And she, you know, she was like, why would you, why would you want to do that? Like, there's no reason. Maybe they don't want to know. Or, you know, wait,

Scott Benner 41:28
tell me that. Start that story at the beginning. Yeah. So

Liz 41:31
what I was saying is, last night, I was going over my my notes, and then I came across this recommendation that if, if you have somebody in your family, what they recommend is that everybody gets screened and even sent to genetic testing. It kind of hammered home that I wasn't, I wasn't that far off base, you know, wanting to get my other kids screened, you know, for Hashimoto,

Scott Benner 41:51
but the doctor just told you, like, why would you want to do that? Yeah, you know, she didn't

Liz 41:55
say the word crazy, but that was like, she's like, you're, you're, you're overly anxious, and she's, like, and rightly so. You've had a lot, you know, you have a kid with a lot of complex medical needs, but basically, chill out. You don't need to, like, look for it everywhere. You know, it was just, I guess,

Scott Benner 42:12
just say, I'm not looking for it. It just, it's here, it's here. I just

Liz 42:16
want to know, you know, like, so I can, yeah, so I can prepare. And maybe, yeah, I think it's good just to follow your instincts and and, you know, I wasn't wrong in thinking that they should be tested, you know, but maybe here in Manitoba, when they they have to come up with a reason, you know, when they're checking off that if they're going to get audited or something, you know, for sending unnecessary tests, I don't know, but

Scott Benner 42:44
it does feel to you like that some of it is about that, is that they just, yeah, I think so yeah, cost and I don't want to get in trouble, like that kind of thing.

Liz 42:55
Yeah. And then also, you know, she was, she was thinking that it would, it would create anxiety, and especially my older son, you know, the younger one probably wouldn't.

Scott Benner 43:04
I'm stunned that they wouldn't think that actually seeing your kids struggle and be sick would also not bring anxiety, didn't I mean, like, I don't understand, like, something's wrong, let's not try to fix it. That'll make you anxious. You don't think that something wrong is making me anxious. Just

Liz 43:23
like, let you know. Let's just sit back and wait for things to get really bad, you know, before we we fix it. And that kind of leads me to another strange thing that that happened with me this summer, and I guess, potentially still happening. I don't know, so I don't know if you remember, on one of your your Facebook Live things, I wrote in I was like, I think I'm getting diabetes. My son and my husband have it. The nurse practitioner, she ran the summer, or I guess in the spring, she ran my insulin hormone, just like she did a bunch of blood tests, right? And it came back as not flagged as low, but it was low enough that she assumed that I ate low carb. So she said, Okay, so you eat low carb, and I'm just like, No, I eat, like, tons of carbs. And she said, Well, you know, since you it could be, could be anything that's causing it, but since you have access to CGM, like, it might just be interesting for you to put one on and see what's happening. So I put one on anytime I've ever done a blood a finger Coke, I've always been in the fours, like, I've never even seen a five point something when I test my sugar, right? And so I put one on, and my average blood sugar was 6.5 and my time in range was, like, 80% in range, instead of, you know, like I assumed I'd be, you know, 96 or 98% in range or something, you know. And I was often in the range, but always on the high end of the range. And every time I would eat, I would, you know, I would go up to every breakfast, I would spike up to, like, 11 or 12. Yeah, and I would come back down, but I would, I would hit, like a 12.5 or, you know, I had a 14 at one point, which, in my head, I'm, like, I have diabetes. Like, this is like, and my brother, who is 55 or something, last Christmas, he was diagnosed with lotta, and he was misdiagnosed as having type two for three years. But anyway, so in my in my head, I'm like, okay, my brother has lotta, so it's clearly on my side of the family, and I have maybe just caught it in the very, very early stages. So my doctor gave me a standing order to go get like, a random glucose but every time, you know I I would go out, I'd see my blood sugar go I'm like, Okay, I'm 12. Okay, I'm gonna get the lab now. And then I would be sitting in the chair, and I'd see my blood sugar go down. So it was like, Yes, I was hitting those numbers, but I wasn't staying up there. And so I never, I never caught a lab value higher than nine, and had just aged out of the trial net like I had done trial net when my son was diagnosed, but like 16 years ago, and I didn't have any antibodies, but I know that you can develop them at any time, and I know that one of the things that can lead to an autoimmune disorder is being super stressed, which I Feel like I've been super stressed the last 16 years. Yeah, excuse me. Sorry, yeah. So this summer, I was like, Okay, this is like, I've just happened to catch it at the very early stages, and I found myself in this sort of limbo land again, because I couldn't my I couldn't get into an endocrinologist without a diagnosis, and I couldn't get the diagnosis without the lab result of the high blood sugar, even though I was going up to 1112 multiple times a day. But just not staying there, I was coming back down. You know, it's not significant, like having a I was mostly hanging in the high sixes and sevens, and it's still in range, but it's not, I was never seeing fours, and I was never seeing steady lines. I was like, up and down and up and down all the time, you know? And I remember, like, you said, you put a sensor on and you couldn't, no matter what you did, you couldn't get over a certain number.

Scott Benner 47:12
Yeah, I had to

Liz 47:14
eat. I think it's probably 10. Like, like, yeah, like, I'm trying to think the translation of the numbers.

Scott Benner 47:20
Well, I can, I can get you that hold on a second. But I'd eat three slices of pizza and then, like, eat a box of, like, sugar candy over top of it to get my blood sugar to once over 160 Yeah, which would be, what, like an 8.9 Yeah, yeah. And, I mean, so I haven't done it in a couple of years now, but, I mean, I ate three slices of pea. I was forcing the food down. It was way too much food. So like, Here, give me, here's a whole bunch of fat like that. Slow my digestion way down. And then I forget what the candy was, but it was probably something like bottle caps. Like, I was looking for something that was, like, just sugar, and then I just ate a bunch of that over top of it, like Swedish Fish, like that kind of stuff. That's what I had to do, not having diabetes to get my blood sugar over 160

Liz 48:03
Yeah. And sometimes I would be, you know, I was like, I was out for a hike, and I was I hadn't eaten in, you know, a couple hours, and I would be, like, an 8.9 or something. I'm like, this is this is not right, you know, like, I know something is off. But then I would talk to my doctor, and it's like, well, it's normal, you know, people go, people's blood sugar goes up, you know. And my last a 1c was 5.1 she's like, I can't send you to an endocrinologist with a 5.1 so let's wait until you're due for a new a 1c and then, then we'll, we'll go from there. And meanwhile, this I had started low dose naltrexone, so I don't know, like, I don't know if that played any part in it, if, if that is somehow helping my blood sugars a bit as well. It's, it's very strange. So I went, in September, I went for a new a 1c and my a 1c was 5.1 again. So no change. So I'm like, Okay, well, maybe, maybe my blood sugar has always been doing this, and I haven't known, because I haven't worn a sensor before, which is possible. I've just never, never seen a number over four. And then when I was wearing a sensor, I was hardly, like, hardly ever, for, you know, I if I did dip down, it was like, I would have that reactive hypoglycemia, where I'd have a fast acting carb, and then I would tank, and then I would go back up again, though that, but that was the only time I was into the forest, was after I'd had a fast acting sugar. And then I would, I would drop really fast, I don't know. So I still think something is potentially going on. But then so I stopped. You know, I can't wear my son's sensors all the time, so and my numbers were, they were actually kind of gradually getting better. So I was like, I know. I'm not in any danger of going into DKA. I'll just keep an keep a watch on it. And so the other thing is, only endos can order the type one antibody testing, so a normal doctor or any other person in Manitoba can't. Order that, and I was too old for trial net to test it again, so I felt like I was sort of stuck in this point of like I had to get worse before I could get better. And T seal is not available in Canada yet, but it's on my list of things, like, I'm gonna start making some noise. Like, I've already, I've spoken to the health minister at gift function, like a diabetes function. I was like, we need to start the pro because it's on the pipeline of drugs that are coming to Canada, the T seal. But as it stands now, if nothing changes when that drug is available here, if nobody can order antibodies to know if somebody is in the early stages, nope, that drug is not going to be available for people here. So are

Scott Benner 50:40
you genuinely worried that you have diabetes, or will have diabetes, or do you think you're do you think you're now looking too closely at things like, I don't know,

Liz 50:48
I don't know, like I so again in September, I retested my ANC, and my ANC hadn't changed, but I had also upped my LDN dose as well. So I don't know if I have no idea, I don't know what's going on. I've and I know that Lada, if it is Lata, it could take years, you know, for it would

Scott Benner 51:11
also, I mean, listen, I'm not saying you're not, like, not not seeing ghosts, or you are seeing ghost or whatever. But, I mean, your husband has type one, right? So it would be crazy if you ended up having type

Liz 51:22
one, I know, wouldn't it, yeah, but my brother has it, but your

Scott Benner 51:26
brother has Lata and, yeah, and has, he has his, is his lot of still? Like, is it still Lata? Like, is it still slowly happening? Or do you think he's full blown type one?

Liz 51:35
Oh, well, I think no, he's full blown now, but, like, it was over sort of three years when he he's funny in that he didn't tell anyone it was happening. So when he was when he thought he was type two, for three years, he didn't tell me, which, if he would have told me, I would have been like, go get your antibodies tested.

Scott Benner 51:54
I might have moved him along. Yeah. Also, by the way, I want to say, if you do end up listen with your your brother's situation, your husband's situation. Maybe this is the secret sauce to giving kids, like, a bunch of different autoimmune issues. You know what I mean? Like, yeah, maybe you, you, I hate to say but like, maybe you will end up with type one. Then you'll be able to step back and go, Well, it does make more sense that my kids all have allergies and these different issues and the joint pain. Like, it does make more sense now, because they're getting it from both bloodlines, basically,

Liz 52:24
yeah, yeah, yeah. So as it is now, I'm not, I'm just, it's sort of on the back burner, like I'm, I'm gonna watch out for it. And the other thing is that I did, I lost a lot of weight, you know, and I'm, I'm small to begin with, and, like, over the course of this last year. But it also coincided when I started my ADHD meds, which lowers your appetite a bit. But despite that, I was still, I felt like I was still eating, you know, a normal amount. I didn't pay any attention to my weight loss because I knew I'd also recently stopped migraine medic medication that sort of made me gain weight. So I'd stopped that so I wasn't, it didn't raise any red flags for me that I was losing a little bit of weight. But then when I in the summer, when all those, you know, blood sugar, blood sugars, I it sort of dawned on me that, yeah, I had lost a significant amount of weight since the year before. Yeah, and, you know, I was, you know, I felt like I was peeing more and more thirsty, and

Scott Benner 53:21
it sucks that it's all in your head, to be perfectly honest. Like, it just, it's, I mean, you've been looking into people's health for so long, by the way, I've lived through this. I've lived with people going, like, hey, stop looking into our problems. And I'm like, you still have problems. Like, nobody's really gotten to the core of these issues. Like, yeah, do you really just want to, like, go, Okay, I guess this is it, like, this is as good as it gets. And we'll just, I think you need to keep looking. But it's funny. It isn't crazy that you could be on the path to it, and it isn't crazy that you might just be looking too hard. That must be frustrating, I guess is my point. Yeah.

Liz 53:57
I mean, you know when it was happening, I was pretty stressed out about it, but now put a sensor on recently, just to, sort of, just to sort of check in and see what was happening, and my numbers were a lot better, but I was having, I was having more lows, which is straight and again, like, maybe it's the LDN, maybe I was like, maybe there was something that my body was fighting off this summer for a couple months, that was creating, I have no idea, but it's just, I'm going to keep an eye on it. But it was just, I thought it was interesting in that other people in that are living in that experience right now in Manitoba, they are stuck. They would basically have to get to the point where they would go into DKA before they could, you know, like, it's like you have to get you have to get sick before you can get better. And same thing with with Hashimotos in Manitoba, they won't start you unless you get lucky and get a doctor that's willing to treat you earlier. The protocol here is you don't even. Start medication until your TSH reaches 10, and then they put you on meds for the first time. I don't know if, when my son was diagnosed, if that's, if that's what they waited for him to get to I'm not sure. But anyway, yeah, it's, it's, it's weird. But my son, also, he has a diabetes alert dog. Now his dog had been alerting me, and I thought it was just because, you know, she was looking for attention. Or, you know, like, sometimes I would go in at night, if, if I go in to treat a low blood sugar for for him at night, sometimes she will alert me. Instead, I think when he's lying down in bed, she doesn't know, like, where to paw him, and so I just thought she was alerting me about him. But then when I put the sensor on a couple weeks ago and saw that I was dipping down, it was like, well, maybe she really, was truly alerting me, because she's trained to alert anything below, like 4.7 Yeah. So if, if I was, you know, like, even if I was a 4.1 and I was, you know, this last couple weeks, I was, you know, getting down into the high threes. So anyway, I just, I thought that was interesting. And if you

Scott Benner 56:12
end up with type one, you're gonna have the biggest I told you so ever, I mean, it's not gonna, it's not gonna be super satisfying, but, you know, you'll have it. Yeah, I

Liz 56:20
recognize that about myself is like, you know, I do go down these rabbit holes and I hyper focus on medical stuff because I feel like I have to, I have to have all the knowledge for my family, because I know the doctors aren't going to be pulling all the pieces together. And I have great respect for doctors and but I also just know that, like you said, it's not like AI, where it's not an algorithm where, like, if you if you name one more symptom, they're not going to say, Oh, it must be this auto immune disease.

Scott Benner 56:49
You can't put it, you can't put it together. Like, it's too broad, sweeping for, I think, for the generalized human mind to just especially an endo who's doing a bunch of different things, there's no way that thyroids on the top of their list. Like, you know, like, people know, like, we use a doctor that's local here, but she's dug in on this stuff. You know what? I mean? Like, she's spending her days really, like, closely, considering these things, most endos are treating type twos, and you're walking in there going, like, I have a thyroid issue, and they're like, oh, thyroid, let me look at the thing. Then it that it's green on your test. You're okay. I mean, that's really what's happening to you. You know what? I mean, yeah. So, and meanwhile, I was doing a little like looking while you were talking, just now, the observed increase in frequency of Hashimotos can be attributed to combination of different factors. So, yes, it's been increasing over decades. Partly, they think it's improved diagnostic techniques. So you know that they're you know that you have it, that the medical community has become more aware of it. There's also some stuff about iodine intake that could have impacted it, but also environmental toxins like industrial chemicals and pollutants, heavy metals, radiation exposure, hereditary factors, dietary factors, processed food and additives increase consumption of processed food may contribute to inflammation and immune system dysregulation, right? Like there's chronic stress, there's a lot of things that have happened in the last 40 years that impact this inflammation, and I think you're seeing what comes from it now, you know? So, yeah, one

Liz 58:19
thing that I wanted to mention too, which I found super interesting on my deep dive. You know how a lot of doctors are, endos are reluctant to prescribe an addition of t3 medication, and they say, you know, it's, it's so

Scott Benner 58:35
that's not necessary so

Liz 58:36
rare that it would work, right? So I feel, I feel like I discovered, I didn't discover it, but I came across a definitive thing that would, you would be able to tell if, if you would be a candidate for the t3 which it was super interesting to me. I had no idea, you know, I knew that the thyroid is produced in the body, and it, you know, converts and changes and everything. So the genes that are responsible for making your thyroid hormones are called the and I could be saying it wrong, the diabetes genes. And there's, there's three types of them. There's like the Dio one and Dio two, Dio three, and they all have their their mechanisms. But I found out, and again, this might be a link to your your bipolar question that you always ask. So originally, when I came across this, I was like, that's when I wrote that email to you. I was like, I have to tell Scott this. Like, this is the link. This is the missing link. If somebody has a polymorphism or a variant in their diabetes two gene, they are the people that need an addition of a t3 med. Isn't that cool?

Scott Benner 59:47
Wait a minute. Seriously, yeah, say that again.

Liz 59:51
Okay, so if you have a polymorphism, a genetic like a genetic mutation of your. Diabetes gene number two, you are the person that likely needs a combination t4, t3, therapy.

Scott Benner 1:00:09
How do we find that out if we have the polymorphism of the blah, blah, blah,

Liz 1:00:13
blah, it's specifically called the E, H, r9, two, a, l, a, dash, D, i, o2, Gene. And there are other Hold on

Scott Benner 1:00:22
a second. Thr, go ahead, boy, hey, listen, you get out. You ever go outside? You ever see the sun?

Liz 1:00:30
Thr, so my husband was gone like a year? No, I know, according, my husband was gone a year. So this is what I would do at night. I would like read medical journal articles.

Scott Benner 1:00:39
Go slow, T H, R, T H, r9,

Liz 1:00:43
two, a, l, a, yeah. Dash, D, I O, 2o, or zero,

Scott Benner 1:00:54
uh, diode, 2e,

Liz 1:00:55
I o2, yeah, the the Dio two, polymorphism, diabetes. I'm

Scott Benner 1:01:02
asking the internet about the test for it, but you got deep, it's

Liz 1:01:05
probably just a genetic, genetic like you would have to go to a geneticist or get your your raw DNA sequencing done, or, or, but if

Scott Benner 1:01:13
you have so, if you have this, you need the t3 Yeah,

Liz 1:01:17
most likely, I think. And so there's this whole, I mean, there's a whole list of things that the people that have this variant have. So I couldn't find any articles that specifically talk about this variant and type one diabetes, but it talked a lot about people with Hashimotos with this variant and that so it causes insulin resistance. So a lot of people with type two diabetes, this is the genetic factor that would cause them to have type two diabetes, obesity, hypertension, osteoarthritis, dementia, like a lot of neurological things, dementia, thyroid, cancer, mild cognitive impairment, bipolar. There it is bipolar disorder. So the people that have this variant, it could be the cause of their bipolar, I guess. And not to say that if you do have this variant, you're going to have all these things,

Scott Benner 1:02:10
sure, sure. But if you have these things, and you go back and find that variant, it's a AHA situation. Yeah,

Liz 1:02:15
there are gestational diabetes. Yeah, it's, I don't know. I just found it super interesting. Yeah,

Scott Benner 1:02:21
no. And you hadn't had sex for a year, so you were interested by almost everything. I don't know if, did we talk about it in the first part where your husband had to go away for a year for work? Yeah,

Liz 1:02:32
I talked about in the first part, he was on sabbatical, so he was gone a lot, and then I felt like that that year, it was like the year of health stuff, falling apart. So my, you know, my daughter and my son's thyroid being totally mismanaged, and then my husband getting diagnosed with Hashimotos. And then he also, he's going for a celiac scope tomorrow, like his celiac antibodies were at the high end of the range, so not, not technically out of range, but they're high enough, and he has Hashimotos and type one. I'm like, Well, yeah, chances are you're gonna You

Scott Benner 1:03:07
guys better get in that bubble that John Travolta had and start eating oxygen. I think that maybe is the only answer for you. But yeah, in the end, though, you just are a family that's kind of riddled with auto immune issues.

Liz 1:03:17
Yeah. So I came across another like, if you're looking for an argument to give to your if, like, if your doctor is reluctant to try t3 another thing that you can you can say is you can say, okay, test my ferritin before you give me the t3 and then give me the t3 and then test my ferritin after. And if your ferritin goes up, that shows that the t3 is is working, because the reason why your ferritin was low is that you you're not having the proper conversion. And really. So, yeah, I thought that was also interesting. That's awesomely Interesting. Yeah, so the quote was measuring serum ferritin before and after t3 therapy may prove useful in the diagnosis of thy rate hormone resistance.

Scott Benner 1:04:04
Can I have all your notes? Are your notes typed in front of you, or are they written on like, I

Liz 1:04:08
scribbled out like, six pages of notes last night, but I can send you the links to all these things, but and then

Scott Benner 1:04:14
please listen to me, yeah, send me all the links and take photographs of your scribbles and send me the photographs, okay, and I'll have, I'll just let chat GPT turn it into text for me so I can look at it. I would love to. Okay,

Liz 1:04:27
you're gonna love this. So in one of the last endo appointments, this was even before I found out his TSH was at 31 luckily, we meet with the educator first. And I really, I love our educator. She's great. She also has type one, and she's so nice.

Scott Benner 1:04:43
She's been in Canada for so long. Everybody, no matter how much they screw you're like, I love these first they're lovely people.

Liz 1:04:48
Yeah, well, the educator is, you know, she's great. She's great. So I, I completely vented to her, you know? I said, when we were told about his thyroid, we were told it wasn't a big. You. And, you know, I didn't do my research, and since then, I've learned all the stuff that should have been told to us. And I know that, you know, maybe part of it is they're they're not wanting to overwhelm the type one parents, because they know that such a big thing that they, you know, it's like minute to minute, but the thyroid is huge, and I didn't realize I should have put it together, because it's the same doctor, it's the same clinic that we see for his thyroid, that we see for his diabetes. But I in my mind, they were completely separate, and I never connected them. But then I find these research articles, and I actually just posted the links of them. The other day, somebody was asking about them on the Facebook group, like, if they were connected, they are so closely connected that if one is out of range and mismanaged, it directly affects the other. So for instance, if you have high blood sugars rampant, high blood sugars all the time, it's going to affect your thyroid function, and vice versa. If your thyroid is not being medicated properly, it's going to make your blood sugar harder to control, and it's like this, you get stuck in this vicious cycle. I feel like it's important enough that you feel like there should be information sessions, you know, it would also be a way to, you know, for the type one parents to connect with other parents. It's it can be a very isolating, lonely disease when you know your friends and family, they try to understand that you don't, you don't really know, unless you go through it yourself too, right? So I can see how it would be extra work for them. But when you get diagnosed with diabetes, there's, you know, you go through training, and you go, you you get, sometimes a binder sent home with you, you know, like you it's like stuff that you have to know. And I feel like there's stuff with maybe not as much, but stuff that you should know with thyroid that we weren't told, and I had to find out. And I, when I said that to the endocrinologist, I said, I feel like I had to do my own research. And she said, Well, you don't have to do your own research.

Scott Benner 1:06:58
Did you say, Well, I was waiting on you, and it wasn't happening,

Liz 1:07:01
you know, like, for instance. So I don't know. Maybe you know this, maybe you don't. But did you know that if you go for your thyroid test on like, morning fasting, your TSH is going to be significantly higher than if you go, like, two hours after eating, like post pan, friend or I can't say that. You know

Scott Benner 1:07:22
what I mean. Post, oh, Jenny and I went over this pro post, real, prandial, all right. Well, figured out. So I

Liz 1:07:31
have an article that says, like 75% of the patients in this study were reclassified when they tested them with a morning fasting test versus the afternoon test when they had already eaten. Like, that's significant. So that means that people could be getting the wrong they could be getting the wrong dose or not getting a dose change when they they need one. No, for sure, because, you know, they're like, Oh, your your number's fine. You're like, in range. It could look optimal when it's out of range. And so 75% of the people in the study were reclassified as subclinical. Because that's

Scott Benner 1:08:08
a significant number, by the way, it yeah, very significant. So just listen to Scott medicate the symptoms there. I'm taking all the thinking out of it for you, if you have thyroid symptoms, and did medicate the symptoms till the symptoms are gone. Yeah,

Liz 1:08:23
and maybe your doctors are looking at the time that you did your blood like the timestamp on when you did your blood test. But maybe they're not. Probably not. I feel like it's important for people to be aware either do it one way or the other, but stick with that, you know, or just always do your thyroid test with morning fasting. I want

Scott Benner 1:08:42
to tell you, Liz, I'm I'm going to turn this episode around very quickly, and it's the first time. I'm going to send it to art and tell her like, I'm not going to pay for college if you don't listen

Liz 1:08:52
to this. Oh, and the other thing did you know about biotin? Like, before you do your your thyroid tests, depending on, I guess, like different labs would use different assays or whatever, but it's really important to stop your supplements that contain biotin before you do your, like, a couple days before you do your thyroid test, because that can also falsely lower the lab value. Like, it's not going to affect your actual TSH level, but on the lab it will show up as lower than it is. And also eating, like, if you're eating a bunch of foods, like, if your diet is, like, rich in biotin, like eggs and pork and like, you can do an easy Google search of like, biotin rich foods. And so ideally, you would stop eating those a couple days before your test, and stop your supplements that contain biotin, because you don't want to have anything that's going to skew your results, especially if, if you know you're super symptomatic, and you're hoping that your doctor is going to increase your dose. When you go in there, and you've had a bunch of bio 10 and your your number looks a lot lower than it is, they're they're not going to change your dose.

Scott Benner 1:09:58
You are a font of information.

Liz 1:09:59
Yeah, look at you right. Why did I have to do my own research? Scott, I don't know,

Scott Benner 1:10:04
but at least you did it. This is awesome. Seriously, you should put together a little like a bullet. Listen, you don't have the outlet for this, but if you put a bulleted list together of the things that you figured out, I would absolutely like put them out for people to look at.

Liz 1:10:18
Yeah, I'll do that. I'll do that for sure. 1,000,000% Yeah, I don't know. I just, I feel like there is lots of valuable information that should have been presented. No, for sure.

Scott Benner 1:10:32
Listen, I have a I have a dream where eventually we can, like, go into people's I always have this, like, dream of like, can you imagine if you took a very smart entity and let it just watch the Facebook group and come up with ideas about, like, what are the questions people have? What are the answers to those questions? What are complaints people have? What end up being the answers to those questions, like, that kind of stuff. So you could just these communities are awesome, right? But it's still sort of, I ask a question, I get my answer, I go away. I hopefully I'm better off. And now my question, my answer, disappear. They go off into the ether, right? Which is what keeps it's also important, by the way, because it keeps the group functioning, and, like, you know, current so that new people can come in, it is actually really important. But, you know, I just, I look forward to the day when, like, I, you know, I think I said this in the first interview that nobody's gonna hear. But I just, I look forward to the day where we're all just talking to our computer and making sure that it knows everything about us, so that it can say, Well, have you considered this? Because it can actually keep all this stuff straight, you know, like, you're keeping it straight in your head as best you can, and you're doing an awesome job. And still it's, it's still storyteller ish when you're telling it, like, oh, then this happened, I forgot to mention this, oh, biotin. Like, you know what I mean? Like, what I want is, hey, computer, I'm going to get my blood draw two days from now, or, you know, two weeks from now, for my thyroid. What are the things I'm supposed to be doing? Well, stop taking your multivitamin, you know, don't eat eggs this week. Like, blah, blah, blah, because you're having symptoms, and we don't want the doctor to see a false number. We want your medication to get adjusted correctly. Okay, great, right? You know, the

Liz 1:12:16
other thing that I had no idea, and again, this was just like when I was going over my notes last night on an article that I had read, but I missed this, this tab of it, so they're saying so people with type one that have hypothyroidism, so they have a lower absorption of glucose, like their body has, like, a lower ability To absorb glucose, and so there's also, like, lower hepatic glucose uptake, lower post absorptive glycemia. That's

Scott Benner 1:12:49
now you're just making stuff up, but I know I'm

Liz 1:12:50
just making words up, and you need a lower insulin dose in diabetic patients, and then you need to raise your insulin dose after you start replacement therapy? I never knew that. I didn't, you know, I always thought like, why are my husband and son, like so prone to hypoglycemic events? You know, I'm thinking it's because I'm bad at managing diabetes. Well, maybe it's because he has Hashimotos and his body doesn't absorb glucose as much as he should. Or maybe when he has a an increase in his his Synthroid, I need to his ratios a little bit because maybe now he can have a little bit more insulin. I never thought of the correlation between the two diseases, but it makes so much sense that they're so closely related. Yeah,

Scott Benner 1:13:39
and in fairness, even, you know, for me, like, if you've listened to the Pro Tip series, at some point in there, you'll hear either I or Jenny say that a, you know, an ill, managed thyroid issue is going to impact your insulin use. But we don't go into deep, like, you know, like deep conversation about it. But it's absolutely true, you know. And not a thing again, that people think about, I think,

Liz 1:14:01
yeah, it's interesting, yeah? I just, yeah, I thought that was it is. I thought that was very interesting. And especially about the, you know, like, so that's, like, your the hepatic glucose uptake. That's what I assume they're talking about, like, the the glycogen stores,

Scott Benner 1:14:16
right? Yeah, well, I mean, we need to get someone on this. It's not you, by the way, like, You're doing a great job, but like, why isn't somebody digging into this and making this information that's easily digestible, that's shareable, that, you know, everyone shouldn't have to get to the point where they're like, oh my god, I think I'm gonna die. I gotta figure something out for myself. Like, that's, that's, you mentioned it earlier, but it's what, it's exactly what up like, You got to this point, probably because you love all the people that this stuff is happening to, you had a bunch of time on your hands, and you were like, you know, like, I gotta figure out what's happening to these people. But for most people, they're just gonna struggle through their lives. And like you said, struggling can look like a lot of things. Could just be like a what comes off looking like a bad attitude, right? Or brain. Bog, or I'm tired all the time, and how that impacts your life and what you don't do, or, or, how about, like, you know, Gastro issues. Like, oh, I'd like to go to the city and see a play, but I What if I can't find a bathroom? Like, like, you know, I mean, like, all the different things that happen to the point where, you know, their families, though, that'll go generations telling stories to each other, like, Oh, we've just got a weak stomach, you know? Or, you know, like, I heard a one one family say all the time, it's so coarse, but like, they're like, this person, like, came into this family, right? And one day just said, you guys talk about a lot, but when you look at the family, there's a lot of auto immune through them. Like, wouldn't it be cool if they didn't have to talk about a lot? Like, you know what? I mean, like, like, Wouldn't it be cool if your daughter didn't need to go to, like, you know, take two days off to recover from a day of activity. And if there was an answer, if it and, Jesus what? If it was low dose naltrexone, or, you know, what, if it was getting the thyroid balanced out better. Like, like, these, yeah, things that look like, I think these things that people spend their lives thinking, well, this is just my lot in life, like, I wonder if they couldn't be helped,

Liz 1:16:07
yeah, or, you know, it didn't. It didn't turn out that way for my son. But somebody else could be allergic to their their synth, right? Or their level of fillers, you know, because they also are allergic to grass, and they can't have, you know, and they should maybe just try another thyroid Med, exactly.

Scott Benner 1:16:23
And also, like, Listen, if you don't make yourself crazy or kill yourself, you might still figure out what's wrong with your son. Because it doesn't sound to me like you're gonna stop, yeah,

Liz 1:16:32
and I feel like, you know, he's been, he's been collecting, he's been collecting allergies his whole life. And I don't think I feel like I just can't sit back and relax. And you talk about that whiteboard you have in your office, I feel like I have a whiteboard in my brain, and I'm always making notes of things that are happening with him and what else could potentially like. I can't remember what it Yeah,

Scott Benner 1:16:55
seriously, take time for yourself. But I think it's I think it's great. It shows an immense amount of concern and thought and love, and I'm sure he'll appreciate it one day if he doesn't. Now I but I want to, we're a little long here, so I'm going to end by telling you that I really appreciate all the effort you put into all this. Thank you. No, no, I'm no one else is interested. I'm, I'm supremely interested in this,

Liz 1:17:18
and I knew you would be interested in the bipolar connection, because I was like, Oh, I have to tell Scott about that. No,

Scott Benner 1:17:24
all of that I'm interested in. And again, this was said in the previous recording that nobody's going to hear. But I shared with you that I take a fair amount of crap from people with type one who don't have other issues, who are like, you know, this guy talks about thyroid too much. And I'm like, I mean, and you brought up back when I said that, you said, what was the number? How many in 10 people with type one also have thyroid issues? Yeah,

Liz 1:17:49
17 to 30% of people with type one have autoimmune thyroid,

Scott Benner 1:17:53
right? So that's worth talking about in a group of people who have type one

Liz 1:17:58
for the diogene polymorphism. Morphism that also is quite common in like the general population. So it said that it occurs in 12 to 36% of the population. So that's huge as well. So it's not a wild question to ask your your Endo, you know, like, if your insurance is going to cover genetic testing, or, if you want to, you know, pay for the sequencing yourself. Like, I feel like it's worth it to know, you know, if, if you're one of those people that you know this is, this is like a real reason that I need. I need an additional three

Scott Benner 1:18:35
and one day, and probably not in our lifetime. But who knows them? AI's going quickly, but like, you're just basically talking about biohacking. You're talking about getting, getting your personal settings correct, you know, with chemicals and etc. I don't know, we all grew up with like, a, like, a, I don't know, an uncle who was a dick or something like that. Like, imagine if he wasn't, like, you know what I mean, like, imagine if your uncle wasn't a dick. What if his ferritin was low because his blah, blah, blah didn't uptake t3 but like, you know what I mean? Like, that's unfair for him to live his life that way. And I don't know, like, I know that's difficult. It's harder. It's, you know, it's easier said than done to figure these things out, but at least if people know to look for them, and doctors don't stand in their way when they're looking for them, insurance doesn't stand in their way. Like, maybe you get to go live the life you're supposed to live instead of the water. And, you know, like,

Liz 1:19:22
especially with people with with bipolar, like this one article was saying it, it speculates that bipolar disorder is a form of cerebral hypothyroidism. This one article was they were had great success with giving people with bipolar, it was like, actually a high dose of levothyroxine, and that was helping these people, like putting these people in remission from their bipolar. Because one theory is that people with bipolar, it's because they can't convert the the free t4 to t3, yeah. So. And we have, we have a friend that is, is going through that like, you know, he has, he thinks he has bipolar and, and it breaks my heart, you know, like looking at all this information, you know, and there's so much stigma with mental illness and, but maybe bipolar is not a mental maybe it shouldn't be classified as a mental illness. It should be classified as a, you know, like you, like an autoimmune disease. And there's, if there's just something like not converting in someone or, you know, they're it's an inflammation thing, you know? And it's,

Scott Benner 1:20:31
I, I'm with you. I, I'm telling you right now. I don't know much, you know what I mean, like, and you could look at my, my educational background, and say, I don't know why we're listening to this guy, but I've just had 1000s of conversations with people, and I don't know it was a few years ago, I was like, Why does everyone with type one? When I asked them about other autoimmune diseases, why does so many of them get to an uncle with bipolar? That just can't be a coincidence,

Liz 1:20:55
right? Yeah, so what I what I think is the link is, I don't think it's the type one bipolar link. I think it's the people that have maybe undiagnosed Hashimotos and maybe this variant, yeah, you know, it's like, it's the hush, it's the it's the thyroid connection, rather than the type one, like, type one is connected to thyroid, and thyroid is connected to bipolar, maybe. So I think everybody, yeah, everybody should get their auto like, their antibodies tested. Yep,

Scott Benner 1:21:22
I appreciate this very much. It's a high likelihood that you'll be back on the podcast one day, but let me thank you, as if I'm never going to talk to you again. I really do appreciate

Liz 1:21:31
this. Thanks. Thank you so much. Scott.

Scott Benner 1:21:33
No, sir, will you please send me all the links and your notes and everything. Would you do

Liz 1:21:37
that? Yeah, yeah, I apologize in advance for my scribbles. No, I'm telling you, you have

Scott Benner 1:21:41
no idea. You drop an AI and you say, transcribe this, and it just writes it out. It's awesome. I don't know what you people aren't doing out there, but it just works so well for some things. It, by the way, it doesn't work well for other things. But when you find what it works well for, pretty awesome. Let me let you go. Hold on one second.

Liz 1:21:58
Okay. Thanks so much, Scott.

Scott Benner 1:22:06
Arden has been getting her diabetes supplies from us med for three years. You can as well us med.com/juice, box or call 888-721-1514, my thanks to us, med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at Juicebox podcast.com to us, med and all of the sponsors. Today's episode of The Juicebox Podcast is sponsored by the Eversense 365 you can experience the Eversense 365 CGM system for as low as $199 for a full year visit ever since cgm.com/juice box for more details and eligibility, if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698 in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording, wrongwayrecording.com. You.

Please support the sponsors

---

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#1412 Life Coach: Anonymous Female

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

A woman in her 50s (anonymous T1D mom) seeks advice from Scott on leaving a psychologically abusive relationship.

+ Click for EPISODE TRANSCRIPT

---

DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.

I'm hoping that this episode becomes a series. I have a couple recorded already, but this is my first one. I asked people to reach out if they wanted a life coach. And to be perfectly honest with you, I was being sort of light hearted about it, but then I got a real request. Today's episode is with a woman in her 50s who wishes to remain anonymous. She knows about me because she has a child with type one diabetes, but this episode is not about that at all. This is about being in a psychologically abusive relationship that she liked to get out of, and she was looking for advice. The reasons that she came to me are revealed within if you're looking for a pretend life coach who has a podcast, reach out to me through my website. It doesn't have to be about a serious matter. It could be about anything. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink. Ag one.com/juice, box. You

this episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour next.com/juice box. Make better sleep your New Year's resolution with cozy Earth best selling bedding, because quality sleep is essential for managing your health. Learn more at cozy earth.com and don't forget to use the offer code juice box at checkout to save 40% off of your entire order. Today's guest is going to remain anonymous, so we're not going to use any kind of names, and we're going to be pretty vague about other things that could be identifying. But why don't you tell me a little bit about yourself as much as you're comfortable, and then we'll get into your

Anonymous Female Speaker 2:14
story. Okay, I am a longtime podcast listener, Juicebox Podcast. I'm the mother of a type one, and that's how I found the podcast. And when Scott proposed this new series where he was going to coach us, I thought this would be a great opportunity for me to get some wisdom from someone I respect, and to bring some attention to the kind of situation I'm in, which is, to be more specific, I am In a long term relationship that has become emotionally and psychologically abusive, and I I need to get out of this situation and heal.

Scott Benner 3:12
Okay, let's see what we can figure out. So we're going to keep you just so people know your your voice is going to be changed, like when you listen back to this, you won't recognize it too. So if anybody is listening right now and they think, Oh, I know who this is, you don't you just know what your voice sounds like when it's changed to sound like something else. Let's figure out a little bit about yourself so you're married, yeah, okay, for a long time, like more than a decade, more than two decades,

Anonymous Female Speaker 3:41
more than two decades we've been together more than three decades, like 35 years.

Scott Benner 3:47
Wow. Okay, and you have one child with diabetes? Do you have other children? You don't have to tell me how many, but do you have other children as well? No, no one child. Okay, give me a little like, like flavor. I guess, of these 30 years, you're having problems now, did they start immediately, or are they more recent? How would you describe your relationship up until now?

Anonymous Female Speaker 4:11
I would say that the situation has escalated in the last three to four years, and we can get into what's happened since that has led to this. But as I'm going through the process of reflecting back and wondering to myself, why didn't I see these things, I can recall what should have been red flags, but at the time, I was young and naive.

Scott Benner 4:44
What do you think some of them are like? Looking back, I would

Anonymous Female Speaker 4:48
categorize them as little points of exerting control. Particular incident that comes to mind when we first started dating, we were. Were at the supermarket, grocery shopping. We we didn't live together. At that time. I was an independent person. We met in college. I was independent. He was independent. We happened to go grocery shopping together. So I was gonna buy my own groceries, and he would buy his own groceries. That was the way I'd always done it, the way I assumed. But for some reason, he insisted on buying my groceries, I guess too, at the time it, it seemed like an act of kindness, but I remember he started taking the groceries out of my basket and putting it into his and I took them back. And I kind of laughed about it, like it was a light moment. And I just remember him taking them back. Then I take them back. I thought it was kind of funny, but then he said, God, you're annoying. And for some reason, that particular moment has stuck with me all these years. And I know that there were issues from the beginning, but I was just too I love to see. How did

Scott Benner 6:18
that strike you then like the god, you're annoying. Did you think it was playful, like, I'm trying to help you and you won't let me help you? Or did you see it as more like attacking of yourself at that point? And if so, then I guess, start there. Like, how did you see it in the moment? Do you recall it

Unknown Speaker 6:40
was more the latter. The tone of voice, the facial expression, which stick in my mind, were not playful.

Scott Benner 6:50
Did you see him treat other people that way? No,

Anonymous Female Speaker 6:52
you know, as we got closer to the present, that's one of the things I came to understand, is that behind closed doors was a different person than when we're out and about or when

Scott Benner 7:07
other people are around. How was he in front of his family?

Anonymous Female Speaker 7:13
Oh, caring, yeah, caring, protective, everything you would hope for and boyfriend, eventually, husband, definitely and

Scott Benner 7:25
towards his parents and his siblings, if he had any same No, oh, how

Anonymous Female Speaker 7:31
does he treat them? Yeah, I would say that there are times when he sort of lashes out at them or criticizes some of them, not all of them. Oh, ones whose life choices he disapproves of.

Scott Benner 7:49
Okay, so he's judgmental about the people he disagrees with in his family. Very gotcha, and that has been very consistent the entire time,

Anonymous Female Speaker 7:59
yes, from when we were dating till now. Yeah,

Scott Benner 8:03
and had that bothered you when you were younger? Or did you not kind of rub up against it back then,

Anonymous Female Speaker 8:10
I took his word for it, because I didn't know them. I hadn't met them or been around them much. I mean, when I finally met them, it was just sort of limited in big family gatherings. So it's not like I had time to have intimate conversations and really get to know them and and at the time we we lived kind of far away, so family gathering gatherings were few and far between, so I really didn't get to know them on my own. I depended on what he was telling me, and I trusted his judgment at that time. Okay,

Scott Benner 8:51
did you find yourself like, getting on his team, like, if he was harsh on people? Did you find yourself being like, yeah, they do suck. Or, how did you handle that if you didn't like get on board?

Anonymous Female Speaker 9:03
I'm embarrassed to say that. Yes, I went along with what he was saying, Not ever when we were around those people, but when we were in our apartment or wherever. And he made some kind of comment, I feel like, oh, gosh, that's that's not right, that's not good.

Scott Benner 9:27
So it starts off like that. That's kind of the entry. And how long are you together before you get married? A while, a while, like five years, more, less, more, more than five years. Okay? And what's the impetus behind that? I guess, like, did you want to get married? And he didn't. Vice versa. Did nobody ever bring it up, I

Anonymous Female Speaker 9:49
wanted to get married. He never said, No, I don't want to get married. But it was, I don't even remember the exact excuses, but. I was just like being strung along. I mean, I made very clear that I wanted to get married, but I don't know I stayed. I thought I was in love with a great person. I assume that the hiccups and ups and downs were natural part of any relationship. And the thing to do when you love someone is you love all of them, The Rose and the thorns and All

Scott Benner 10:32
right, so you had a a pretty, not childish, but young idea of everything, because you, you guys meet in college, right? Did you date in high school? Like, did you have a lot of dating practice before you met this person? Far too often we accept the blood glucose meter that someone hands to us. The doctor reaches into a drawer and goes, Here, take this one. That is, that is that the one you want, is it accurate? You have no way of knowing. But if you want accuracy and you want to be confident in the blood glucose readings that you're getting from your meter. You want the contour next gen. It's incredibly easy to get the same meter that Arden uses just go to contour next.com/juicebox that's all you have to do. The contour next gen is easy to use and highly accurate. It features a smart light that provides a simple understanding of your blood glucose levels, and, of course, Second Chance sampling technology that can help you to save money with fewer wasted strips. Contour next.com/juicebox if you'd like to sleep on the same sheets that I do. Head to cozy earth.com. Right now, and look at those bamboo sheet sets. You can feel the difference with cozy Earth, their best selling bamboo sheet set is made from 100% premium viscose from bamboo. It's breathable, uniquely soft, and only gets softer with every watch. And if you're worried about quality and care, cozy Earth bedding products, have a 100 night sleep trial and a 10 year warranty so you can't go wrong. Or maybe you want new cityscape hoodies and sweat pants set. I just got mine. They are super soft and comfortable one way or the other. You want to be more comfortable. You want to chill out in some quality stuff, like I do cozy earth.com use the offer code Juicebox to check out to save 40% off of your entire order.

Anonymous Female Speaker 12:24
No, no. And I would say to parents out there who are thinking that that's a protective mechanism to not let your kids date when they're under your roof, it's not wise give them an opportunity to learn about themselves in a relationship, so that they can recognize when someone else is valuing them for who they are and not just what they bring to the table

Scott Benner 12:54
when he stretches out the courtship process while you've said, like, I'd like to get married, and you're getting older, and I mean If you met in college, and you mean you were, were you in your 20s, so when you got married, or were you into your 30s and to my 30s? Okay, so he strung this out for a long time. And is there a moment during that where you think, Oh, God, I did the wrong thing, but like, now I'm like, pot committed this is it like? What am I going to do?

Anonymous Female Speaker 13:22
I did feel stuck. I felt like I didn't know how to start over. And at that time, we were living somewhere where I had no family, so I didn't know where to go. It comes back to having no experience on my own, and even though I had a pretty important job and I felt confident at work, maybe importance the wrong word, but I had a job with a lot of responsibility, and I felt confident, and I knew my bosses believed in me and I was being promoted somehow at home, my mindset was just frozen and different, like

Scott Benner 14:10
you were a teenager. Still, yes, yeah. Do you think in that period of time he was aware of the the control aspects that he had like, do you think he was not marrying you on purpose to keep you in flux? Do you think did he move you away from family, or did that just happen?

Anonymous Female Speaker 14:29
He didn't say, you know, we're going to move now. It's never that explicit. It's it's more subtle, and that's one of the things that's one of the reasons I'm doing this interview, is it's not so easily recognizable as more over types of control, where it's like, you're gonna do this or else, it's more subtle, like, oh yeah. Want to pursue my career over here, and you can come along, you know that kind of thing,

Scott Benner 15:07
yeah. Can I ask, like, I'm gonna play devil's advocate here for a minute, like, do you think that if you were in a different part of your life or a different person, that you would have resisted it because you've had a long time to think about this, right? Like, you've been thinking about this forever? Am I right? Like, the last five Yeah, for a long time. Yeah, right. So like you've been going over this in your mind and trying to figure out where you went wrong, and yeah, it has there been a point in time where you've ever thought to yourself, like, I have to take responsibility here, like I could have done something and I didn't. Or do you see, I'm not saying that you should have I'm asking you, like, what your assessment of it is, Do

Anonymous Female Speaker 15:44
I have any blame or culpability? Of course, you know I, I was an adult, but I was a very inexperienced adult in matters of the heart, and I didn't feel like I could speak to anybody about this or learn about what I was going through. Nowadays, there's so much information out there, and that is, that's how I got to this point. Is social media, somehow those algorithms are so smart. Started putting little things in my feed about these kinds of relationships, and I watch one, and then all of a sudden, 50% my feed is like this. So I start watching more, learning more, and like this haze or cloud, just like lifts, because I finally have the vocabulary and the understanding to step out of the situation emotion, step out emotionally and look at it objectively, and see What has been happening when you're in deep, emotionally deep, I don't know, like, it's like the other part of your brain, the thinking part, the logic part, gets impaired. Yeah.

Scott Benner 17:09
Have you heard people say my algorithm figured out I was gay before I knew? Yeah, yeah, that kind of stuff, right? Yeah, yeah. So your algorithm figured out that you weren't happy or that you were being controlled by a partner or something like that, and started feeding you more stuff. You started seeing people speak openly the way you're speaking about it now, and you you're like, oh god, that's me. Like, I recognize myself in these people's stories. Absolutely, yeah. Were you ever afraid that that wasn't you, but it offered an explanation, so you would just go with it. How do you fact check that to make sure you're you know, I'm saying, Does that make sense?

Anonymous Female Speaker 17:53
It just makes sense. This the information I was seeing on social media. Part of it, yes, part of it was individuals like me speaking about their personal experiences, but the greater majority of it was PhD psychologists who have clients in this kind of situation, who have a lot of experience, who've written books about it, who've researched it. They have YouTube channels and books and practices where they specialize. This is the niche. And when those people are talking about certain things and defining certain things, describing experiences, and it's all clicking in my head, like, wow, yeah, this person could I have no idea who this is. They have no idea who I am, but they could be describing my life right now,

Scott Benner 18:45
right? Do you think your husband? Does he know this stuff about himself? Like, no, consciously, he's not aware of it. Like, if you turn to him today and said, Hey, I'm leaving. Here's the reasons why he'd be blindsided by that. Yes, and so have you brought this up to him in the past, and he's ignored it, or have you never said anything?

Anonymous Female Speaker 19:07
We have had discussions, arguments, whatever you want to call it, about other things, like more specific thing, whereas, like this, I call, like a higher level meta kind of thing. And it's clear to me, and by the way, our our t1 also has similar experiences,

Scott Benner 19:31
experiences that they've brought to you, or experiences that you've witnessed, and you've said, Oh, that happens to me with their father too.

Anonymous Female Speaker 19:38
Both, both, so we've all been in the house when something happens between them, and I'm hearing it with my own ears, or the kid is out with my husband, and the kid calls me like this, and this is happening, and I don't know. How to Deal with it. And this is really frustrating. He never listens. They used to say that all the time. He never listens. And that is also my experience from in your previous question, Have I talked about this before with him? I've tried having adult, mature, calm discussions. I don't think there's a lot of capacity to receive criticism and to self reflect. Why do you think? Why do I think? Yeah,

Scott Benner 20:30
I mean, you've, you've had to have diagnosed them and and dissected him over the years, like, Why do you think he can't?

Anonymous Female Speaker 20:37
I actually think he might be on the spectrum, and how they say that, I think that's part of the reason I have kind of stuck around, because I would make excuses for just the general behavior, the general lack of I think it's a lack of empathy and understanding, ability to self reflect. I'm obviously, I'm nowhere, anywhere, trained in anything like that.

Scott Benner 21:08
Well, we have that in common, because I am completely untrained in this. I want to make this is probably a good time to point this out. I have no certificate, I have no training, I have no education. I had this idea the other day, somebody was talking to me and said, you know, you could be a life coach. And I laughed about it, because, I mean, and no offense to life coaches, but it doesn't seem like a real thing to me. I know it is, like, don't get me wrong, like, I understand that there are people who need help, like, you know, formulating direction, and I understand that, like, I'm not, I'm not teasing anybody. It just seems like one of those things, like, I'm a little older, you know what I mean? It feels a little, a little hocus pocus E, but I thought they'd be fun conversations if people wanted to come on and, you know, people who were connected with diabetes and talk about other ideas. And I could whip out some of my, you know, 1970s ideas that I think are sometimes valuable. And you reached out. A number of people actually reached out. It's awesome, but, yeah, I just want to point out I have no training. I should not be doing this. This is not, uh, this is not legally binding. Can I take a right turn for just one second before we get back to it? Yeah, what has happened between you and I through this, this medium, that this actually seemed like a good idea to you. Well, I

Anonymous Female Speaker 22:23
think that a coach, whatever training they have, they have, but it comes down to being a good listener, a thoughtful person who has seen a lot of life and who can communicate to the person they're coaching ideas in a very digestible manner. And the Juicebox Podcast is, is that to perfection?

Scott Benner 22:52
Thank you. I'm gonna say I'm a life coach. I'm gonna have a T shirt made. Never mind you've talked me into it. You're sweet. I really appreciate you saying that I wanted to understand like so that happened to you or for you from me, through diabetes conversations,

Anonymous Female Speaker 23:10
absolutely, you know, a diagnosis. I didn't know where to turn for information at the very start, we were in the ICU, but I knew that I loved listening to podcasts, that I was the longtime podcast listener, and I knew there was a podcast about every subject on Earth. So I just opened my app and there's like, there's got to be a diabetes podcast. Found the Juicebox Podcast, and I probably tried listening to one or two before, but upon listening, it's it's just immediately apparent that you have a gift for talking with people and using their stories to educate this is gonna come off like crazy when I say this, but please, I'm a person of faith, and it's the same technique that Jesus used with parables. Certain things are just more digestible and more memorable when you hear them through the art of storytelling, whether your storytelling in a format like This American Life podcast where you storytelling in a Q A interview format, by knowing how to bring out what questions to ask to bring out the person's story. And I knew that I could listen to the Juicebox Podcast over and over and not get tired of it and learn learn so much from it that was immediately apparent because I listened to other podcasts when they're very pedantic, just like instructional, it's so boring and nothing sticks.

Scott Benner 24:53
Yeah, I agree with that part. I can't I mean, I don't understand when people put content out like that. It's just like. Uh, check boxes. Go forward. No personality. I mean, listen, you said a lot of words there. What I just heard, basically, was Jesus like, so I'm gonna go with that. Um, I'm gonna change my life. Coach, first of all that you're, you're lovely. I appreciate that and, and I am kidding for anybody who would imagine that I'm not, I think you're right. I think that I don't know why it occurs to me this way, right? I have no idea. I don't I don't know how I became who I am, or why I respond the way I do, or think the things I think or say the things I say. But to listen to you thoughtfully break it apart. It's so funny, because earlier you said my social media fed me, you know, psychologist talking about my situation, and I thought, Oh, they're describing me. And when you described what makes good storytelling, I thought, oh, that person is describing me, but I never would describe myself that way. It's interesting, isn't it? Like, if you asked me, like, you've, you've listened for a while, so, you know, like, if you ask me what the podcast is, I'm the least articulate about what it is, because I don't, I'm just doing the thing that occurs to me to do. But then when you described it, I was like, Oh, I do that, but not on purpose. Maybe that's why it works. I don't know. Anyway, that's that is really nice of you. I didn't I didn't expect all that, but I'm definitely going to take it and say thank you. I asked you if you thought he was cognizant of who he was, because you do not want to be in a situation where you spring this on him, because it's going to turn into anger, because you're going to be this person with very reasonable, measured, time, honored, you know, experiences, and you're going to say, I don't want to do this anymore. I'm going to stop doing this now, and what you're going to get back is anger. Then the way you're being treated unfairly is just going to shift, like you're going to trade the controlling part for the anger part. I don't want that for you, but I don't know if there's a way to avoid that or not. And it sounds like you've tried to explain a number of times what your problems are, and he doesn't seem receptive. Doesn't matter, by the way, if he's on the spectrum or not, like, whatever it is, he's he's unreceptive to your Hey, listen, this is happening. Explanations. I don't want this to happen. We can't do this. You can't treat the kid this way, you know, etc. You're in a bad spot, like, for sure. Can I ask you, do you have love left?

Anonymous Female Speaker 27:38
Love, not the way you're probably thinking of it. When you ask that question, I try to, and this is one of my problems, is I try to find the good in people. I even, even in this situation, for example, he, he's always been a good provider. We don't live in any or fiance or anything, but I always have had a roof over my head. Food on the table. Kids always been taken care of, so have no complaints.

Scott Benner 28:12
Are you going to be okay trading one sadness for a different one? I think you can expect that by giving away your problem, you're going to be happy, but I think that what I see most people do is they give away their problem and they trade it for a different problem. And I'm not saying you should stay because the next thing is not going to be fun either, but I do think it's worth being aware that in the interim, at least, this is not going to be fun like and it might be a number of years of not fun, you know, lawyers and arguments and splitting the kid and one person having control the diabetes on the kid one time, and the other one the next time. And, you know, the first time you see a blood sugar that's crazy, and you think, Oh, I can't call or text because the lawyer says I'm not allowed to, or whatever it's going to end up being. It's tough because this isn't fixable. You don't think this is fixable, right?

Anonymous Female Speaker 29:09
No, right. No, I don't, but I do want to make you aware of two other important things. So one is the kid is a legal adult, now off at college. Okay, so thank you Juicebox. Thank you loop community. Kid is doing great at college. Awesome. What led to at the beginning of this conversation, I had mentioned that things had escalated in the last few years, so the situation which has also kept me here is that few years ago, I was diagnosed with cancer.

Scott Benner 29:50
Oh, my God, I didn't know

Anonymous Female Speaker 29:52
okay, and the treatment kept me alive. Thank God. But. The side effects were somewhat debilitating. I am officially disabled, and for me, what that looks like is constant fatigue. I need I need helpers to help me with the activities of daily living. So showering, changing my clothes, I can feed myself, but like preparing meals, things like that, are a little harder. And I'm not only dependent financially, I'm very dependent, and that has kept me here, and

Scott Benner 30:34
he's helping you with those things, or he's paying for services

Anonymous Female Speaker 30:38
he's paying, and I am grateful for that. He's made clear that this is all too much, which I absolutely acknowledge being having your spouse severely ill, and then going from an active person who used to take care of the household, the groceries, the laundry, driving the kid around, if someone who went from that to being bedridden for quite some time. I can walk now, but not far I don't drive. So I need people to help me. He's made very clear that that's not his role, actually helping me with day to day things I'm not not for him. So

Scott Benner 31:32
you're not having a lot of contact. Then none. Sorry. When did you stop having sex? How long ago? I

Anonymous Female Speaker 31:40
can't remember a decade. Probably

Scott Benner 31:45
Gotcha. So you're not even like good roommates, like you're not even he's not even like, Hey, let me get that dish for your roommates so you sleep in the same room. Still, no, no, functionally. Did that happen when you got sick and you came back? Or had it happened before that, even before before that. Do you think he cheats? I don't know if you call it cheating in this situation, but do you think he's got like a relationship outside of your marriage,

Anonymous Female Speaker 32:10
not that I'm aware of, and you know, I would say it's not likely i He, to me, is like a rule follower who wants very much to be perceived as the good guy. No people can always surprise you. So if that's what's happening, that's what's happening. I don't have any evidence, and I don't I don't think it's in nature, but I would never say never to anybody if

Scott Benner 32:42
that happened, would you care? I'm so interested if you'd be hurt by it, or if you if it would just seem like it's Tuesday and the newspaper game. I

Anonymous Female Speaker 32:53
don't miss intimacy with Him, actually. Let's not call it intimacy. Let's just call it sex. Don't miss it. It was okay. I'm trying to be kind here. Would

Scott Benner 33:06
you be hurt by it, though, like but would it feel like a betrayal or No, no,

Anonymous Female Speaker 33:11
you know what feels like the greater betrayal is, is to get sick and then feel abandoned.

Scott Benner 33:19
So you guys had split your lives up pretty much before this, but then your illness comes, and it turns things more stark, like things are getting said out loud now that we were just agreeing were happening prior to that. Yes, things

Anonymous Female Speaker 33:34
are definitely getting said out loud there. Let's see, do I describe this without details. Certain things are such the details are so particular, they would be identifying. I like my bedroom a certain way. It's, it's, it's very within normal people. Nothing crazy. It's just a bedroom. The accusation was that this thing that I'm doing to my room is harming the property. Okay, you just have to trust me when I say it's like, totally normal. Okay, everybody does it. I am actually friends with the people who used to live here, so I call them up like, I haven't talked in a while, like, this crazy question for you, I'm in the bedroom that they were in. Did you guys ever do this in in the room? Like, do this to the room, and they're like, Yeah, of course, everybody does that. And I said, Well, did it ever hurt anything in the house to do like, what if they thought it was crazy? Because it is totally crazy. So that night, there was just this big I'll call it an argument. But. It was really one sided, because at that point I stopped being reactive. I realized that when I tried to reason, it just escalated. So I learned that not reacting would at least de escalate, but the things that were being said to me were like, You need to leave. You're damaging the house. I make the rules in this house. This is him saying that kind of stuff. You're

Scott Benner 35:31
making reasonable requests about stuff, and you're being told that it's not your decision. You can't do it, and moreover, it's not okay, because you're ruining the resale value of the home. Yeah, which doesn't appear to be true, as far as you can tell.

Anonymous Female Speaker 35:47
No, yeah. And then other other things are okay. So I mentioned that I'm kind of limited in mobility, so I really don't go anywhere. I can't unless somebody takes me and he doesn't take me anywhere. So I rely on my helpers, my paid helpers, and friends. So I'm pretty isolated, and I know that's not healthy, so I I actively accept when people text me and they're like, Hey, can we come over to see you, please? I'm not talking about having a party and play like one friend. Come over we chat for half an hour, something like that. There have been complaints that this has become like a hotel, like people, complaints about people coming in and out of that house and Google and there's no privacy, and like the day after Thanksgiving, two of my friends dropped off food, like home cooked food, which is nice, because mostly I eat processed food, because I Order from, I ordered whatever frozen food from grocery store gets delivered, and because that's what I can handle, right? I can't I can't cook anymore. So my friends, two friends, separately, they stop by and drop off the food. So they didn't stay if they've got stuff going on with their family. It's the holidays. One was here. I went back and looked at the ring camera. One was here for three minutes because she had brought a bunch of stuff, and she helped me unpack, put in the fridge. The other one was here for, I think it was like 30 seconds. She came in, gave me a hug, handed me a little bag of food, said, Happy Thanksgiving had left. I

Scott Benner 37:40
got a role, yeah. How did he characterize those visits? Where are

Anonymous Female Speaker 37:44
all these people coming over? I can't get any peace and quiet that

Scott Benner 37:51
kind of stuff. Does your friend group know that he's like this, like, Is it obvious at this point, or is he doing a good job of hiding it? He was

Anonymous Female Speaker 38:00
doing a good job of hiding, and so was I, and I recently, so I recently told all my very close, trusted friends, because I did see on one of my social media educational videos that after the first step of acknowledging that you are in this kind of situation, the Next step is to stop hiding and let people know. So I started telling my dear, dear friends and everybody shocked, because I kept up such the pre temps that, yeah, they were, I gotcha, and that's why I want people to hear this, because as a society, we speak a lot about sexual abuse. Did he, whatever? Send the news a lot. There's a physical abuse you can prove, let's say you've got bruises or whatever, emotional, psychological abuse you can't see it, and when the abuser acts so differently in public, you really believe. You come to believe no one would ever believe you if you told them the things that were said and done behind closed doors. So you keep silent to that, and that's what I did. What's

Scott Benner 39:19
your plan moving forward?

Anonymous Female Speaker 39:23
Well, the kids gone. Kid is aware, actually, as I said, they experienced a different kind of, different

Scott Benner 39:33
form of it, yes, yeah. And

Anonymous Female Speaker 39:35
they're like, I'm so happy for your mom that you have finally opened your eyes. I have always wanted you to be treated better, and I think you need to go live your life without all of this, because coming back to my health diagnosis, the stress could literally kill me. I. Good. You probably heard of that, but the Body Keeps the Score. Yeah, yeah. I'll never be able to prove it, but I think the stress of all those years probably, I think there's a good chance it led to my initial diagnosis, and then people had been telling me, but I finally accepted and understood that if I stay in this situation, this toxic situation, my recovery is going to be an uphill battle, because I'm not only battling the physical health situation, the mental stress, it

Scott Benner 40:34
doesn't stop. I was going to say like, you know, I said earlier, you're going to trade one sad thing for another sad thing. But then you you kind of opened up a little more and and told me more of the story. And I don't think I feel that way at this point, like you are alone, but with a force in your home that's making you uncomfortable constantly in a number of different ways. Obviously, it would be much better to be alone without that force. Your child being older, right? Like, and not being like, you're not gonna be passing the child back and forth. There's no like, kind of custody issues there. That's not gonna be a an impactor for you. Are you able to like, what is your goal? Is your goal for him to leave the place you live? Or is it for you to leave that place? Have you thought of how you want that to go. Because

Anonymous Female Speaker 41:22
of my limited mobility, it would be easier if he were to move on, but that doesn't seem to be what

Scott Benner 41:33
will happen. You think he'll defend he'll want the place for himself

Anonymous Female Speaker 41:39
or control of it? Yeah, well,

Scott Benner 41:42
I don't think it's gonna, I mean, I don't think it'll end up working out that way. I think you might be forced, you might be forced to sell it, to split proceeds, if that's a situation, if you own some of it, or all of it, do you have a place to go? Have you worked all this like, how far are you? I'm trying to remember if this is something you brought up to me before we began recording or not, but your plan is to leave, right? So, like, Yeah, is this a short term plan? Like, do you think this is going to happen within three months? It

Anonymous Female Speaker 42:11
depends. It's not easy for me to go apartment hunting.

Scott Benner 42:16
Yeah, no, I hear that. However,

Anonymous Female Speaker 42:20
gosh, I just love my friends. They're like, we'll do it for you. We will, on the weekends, go look at things, and then we'll narrow it down and then dance like two things, two places. And then you can look at those two and

Scott Benner 42:36
figure which one you like, choice. Yeah. Do you have any physical concerns? Do you think he'll like when you tell him? Do you think he'll become violent or extra angry, or anything like that?

Anonymous Female Speaker 42:45
I don't think so. There's never been physical violence or a threat of physical violence. Now, that's too specific. I'll tell you after, but something happened. And I have another friend who's a social worker, I told her, and she's like, that gets very close to and maybe even crosses over to a form of physical abuse you could I don't even know how it works, like you file some sort of complaint with whatever court handles such things, and is

Scott Benner 43:26
that a thing you want to do? Or do you just, what's your pie in the sky? Vibe here, like, what is it you're hoping happens? You're gonna let him know? Hey, listen, I think we both know, you know, we're not really married, so I, you know, it's time to split up. I'd love it if you'd leave if you don't want to, you know, if that's not something you're open to, you know, we're gonna have to make some, some plans to get me a place to live. Obviously, I'm gonna need you to keep covering my medical like, that kind of stuff. Like, I mean, you're like, look, I've got a lawyer. Like, you should get a lawyer. Like, how do you imagine that opening conversation to be

Anonymous Female Speaker 44:05
that sounds about right? I, I have had a free consultation on, you know, a friend of a friend of a friend is handles these kinds of things, and she offered to do phone consultation to help me understand the laws where I am, because my number, I have two major concerns. One is health insurance, because, yeah, the UN the United States system is so screwed up. You

Scott Benner 44:41
definitely can't lose what you have, that's for certain.

Anonymous Female Speaker 44:45
And the second would be housing, because I don't know, it's very expensive, yeah, so

Scott Benner 44:55
do you have that? I mean, does the household have that kind of money? Like you said you had a. A job before, but have you worked since you've been sick? No,

Anonymous Female Speaker 45:04
but I'm on disability. Okay, like, I qualify for disability, but it's not anywhere near enough to cover rent where I live and my helpers, yeah.

Scott Benner 45:19
Is that covered by insurance or the people that help, or is that a is that a cash prospect? You pay people out of pocket for that? That's

Anonymous Female Speaker 45:27
totally out of pocket? My limited understanding is that long term care insurance could have paid for it. But I think very few Americans have that. They have that,

Scott Benner 45:38
do you have any fear that you're going to be an out of sight, out of mind for him, like he's paying for people to help you, because he doesn't want to be involved. But if he's not there, then, like, is that a concern?

Anonymous Female Speaker 45:49
Do you mean if we were to be formally divorced, yeah,

Scott Benner 45:54
Mike, I mean, obviously that would get taken care of in some sort of a an agreement, but like, prior to the agreement like that, that gray area my parents were divorced, there's a gray area in between where there's nobody's being compelled to do anything. And you know that can sometimes take time. So my thought is, is that right now, he's probably happily paying for people to help you because he doesn't want to be involved with you to begin with. But if you are off in an apartment, and there's no court order in in place that says that, you know he needs to keep paying for your care. I'm gonna guess that's gonna be difficult money to shake out of him. You see what I'm saying? Yeah, cuz you're gonna be out of sight, out of mind. Then, like, if you're in the house and you need something, if he doesn't pay for somebody to get it for you, he's gonna end up having to do it, so he's probably happy to spend the money to avoid the contact, but the contact gets avoided when you leave. That's my concern for you, is that in the middle time, like, how are you gonna get the services you need so that you can actually make the separation leave and get the process underway? So there's an actual court order in place that that handles this like that in between time. I'm concerned for for you.

Anonymous Female Speaker 47:08
Yes, thank you for bringing that up. That's something that I hadn't thought of yet.

Scott Benner 47:13
Make sure you understand what that's going to be, because you could very well end up, I mean, you guys are so separated to begin with, that you might be one of those people who gets divorced while you're in the same house, and that you never leave during the divorce process. That happens and then eventually someone moves out. I can't see that. It's not going to end up being him. You know what I mean? Like, it seems unreasonable for someone to try to compel you to leave it does

Anonymous Female Speaker 47:43
seem unreasonable. I'll tell you why after I

Scott Benner 47:49
bet you a lot of your life seems unreasonable. Jesus. I mean, do you see what I'm saying? Like, if you've got a mediator, or if you get lawyers talking right away, like I don't know that if I was you, that I would leave right away. I

Anonymous Female Speaker 48:06
don't plan on it. Yeah, for two reasons. One, one is this just hard for me, right? And I have thought that okay. Once, once I leave, I have no way back.

Scott Benner 48:21
You lose a lot of power by leaving the house. I think, yeah, yes.

Anonymous Female Speaker 48:24
I mean, as a resident here, I just think there have got to be laws. We've been here for 1617, years. Yeah,

Scott Benner 48:36
it's your house too. I wouldn't go anywhere. That was my point. That's what I was getting to I wouldn't just move out. I'd stay unless you were you felt like you were in danger, and if you feel like you're in danger, then I'd get him removed. But I wouldn't secede that house if I was you. Okay, you know what I'm saying? Because, like, you said, like, once you're out, you're out. I mean, that's your house as much as it is his. You have a medical reason that leaving is difficult. And I can't see a world where a court or a judge or a mediator says, Hey, one of his got to go, and it's you. It just doesn't. It doesn't make sense. And I'm going to guess that once you put the proceedings into motion. He's not going to be comfortable there. You might be surprised that he might. He might happily move to another place at some point.

Anonymous Female Speaker 49:30
It's possible. I wish he would. He actually, he knows people where he could stay there easily. You

Scott Benner 49:41
know what I mean? It's going to become uncomfortable. Also, like, right now, you get to keep pretending that you're like, you're more that your relationship is morphing like even though you're not sleeping in the same room, or he doesn't seem interested in helping you with your health concerns. But he's still getting to pretend that, you know, for. The outside. People don't know for the most part, oh

Anonymous Female Speaker 50:03
Exactly yeah. How is it gonna look if he says, Oh yeah, my wife has cancer. I'm divorcing her. The optics of that,

Scott Benner 50:14
I do think at some point the optics will get the better of him, and probably deservingly. So by the way, I don't want to sound bitter, but like, I mean, I'm not hearing his side of the story. But like, you know, if your side of the story is anywhere near accurate, then I would think he'd get embarrassed and leave honestly. So you've had a consultation, a phone consultation, your child's over 18, away at school, you're looking at, were you trying to get through the holidays? Were you trying to get through like, a thing with your health? Like, are you ready to go? Is it just a matter of, like, getting the nerve where you at?

Anonymous Female Speaker 50:49
I'm trying to gather the information that the attorney recommended that I have before taking a more formal step, okay,

Scott Benner 51:04
bank records, writing down, writing down, your your experiences, things like that.

Anonymous Female Speaker 51:10
I suspect that there are things I don't know of. I suspect there may be hidden assets.

Scott Benner 51:18
Oh, got money in the walls, maybe awesome.

Anonymous Female Speaker 51:25
I saw some mail that was clearly financial. That was nothing I had ever heard about before, interesting,

Scott Benner 51:40
so you're looking into that as well?

Anonymous Female Speaker 51:42
Well, yes, or at least my attorney, or when that person becomes my attorney, you haven't hired them yet formally said that their firm has ways to find anything that's hidden, if that is the case, is the case, and to have some screenshots of said mail to help. Jeez.

Scott Benner 52:14
It's ugly. It sucks, doesn't it like I mean, are you so far past it sucks that it doesn't bother you anymore, like you just said, I'm saying like, there doesn't sound like a lot of again, you're not longing for a thing to be the way it was, like that that's out of your mind. You don't have that expectation. You're old enough that I don't imagine you're thinking about like, you know, I get away from this person and restart another relationship or something like that. Like you're just trying to just get yourself some distance to see if your health will respond to to a better environment. Is that correct?

Anonymous Female Speaker 52:53
Yes, that is my number one priority. Who's the hottie? Now I don't even know my date was Brad Pitt. Well, he turned out to be kind of mature. A hot guy could walk through the door and it wouldn't matter to me.

Scott Benner 53:09
Yeah, that's not your situation. That's somebody. Do you think this is going to be a crazy question, perhaps, but do you think that if it wasn't for the cancer, you ever would have decided to leave

Anonymous Female Speaker 53:18
no and that is, you know, coming back to my faith. You know, I had heard people say things like, when, when bad things happen. Oh, this is a blessing. And I thought they were dulu, or whatever the kids say now, but I understand, I fully understand now I would have kept justifying and justifying and trying to understand and trying to be empathetic and sympathetic and be the one to bend and flex to keep things going. And I realize now none of that effort amounted to anything, because this is not someone who is open to change. And I, I joined a support group. I mean, it was originally for health, the kind of health issues I have, and I I got to know these people pretty well. And one day, I was just like, I know I've been telling you I'm struggling with this physical health thing, and that is true, but I need to, need to give you a little more color on why it's been so hard

Scott Benner 54:32
for me. Yeah. Talk about the rest of it. Yeah.

Anonymous Female Speaker 54:35
So I talked about the rest of it. And what did you know? Like half the group had similar experiences. And apparently I haven't fact checked this, but I it did come up on my feed, just like a meme. And actually, you've talked about it a little bit, something similar with regard to Team One dike. System. Anyway, something came up on VIP that said the divorce rate for marriages where there's a chronic illness is 75%

Scott Benner 55:12
it goes up to like two. It goes from like one in two to two in three. The last time I had heard about it, yeah,

Anonymous Female Speaker 55:21
significant, yeah, this is where one of the partners is the one who's chronically ill. And it says something like, if, like, if it's a heterosexual couple, that's the male is the one who is sick. That's like 3% of the divorce. Anyway, if it's a female, it's a much higher number.

Scott Benner 55:44
You saying boys bail quicker than girls, by a significant margin.

Anonymous Female Speaker 55:49
I'm saying this is a meme that came up for, I don't know. It's not, not a meme, but a post that came up in my social media feed. I have not had the time to fact check it. Well, some I read

Scott Benner 56:03
the comments. Doesn't sound unreasonable. Is that what you're

Anonymous Female Speaker 56:06
saying? I've read the comments, and just anecdotally, so many people commented that, yeah, exactly, totally believe it. That was my life. That was my situation. So, I mean, I'm not here to bad mouth men. There are amazing men. I just not with one of them.

Scott Benner 56:25
Just didn't get one. It's funny too, right? Like you, you coupled up so early in college, and you were, it sounds like you were head over heels. So, like, you overlooked a lot of different things. You didn't even know what you were overlooking, probably at the time. I don't think any of us do. But then, you know, like, some people get lucky, right? Because I don't think anyone's perfect. Like, there's a world where a different you and a different him get together and, you know, you Zig when you should have zagged, or something changes a little bit, or something does happen or doesn't happen, and you grow in it, and it's a different situation. But this is just how this one went. So, I mean, for whatever reason, eventually pushed you to do something, you're gonna have a net positive for making this decision. I don't want to tell you that. I think it's going to be 100% better. Like, it could be crazy. You could wake up three years from now and be like, Oh God, I wish I was still married like I have no idea you know what I mean, but I don't know what to tell you is going to happen. I just know that if you believe right now that you're being treated that poorly, if you're being isolated already, if this is the life you're leading, but there's stress is in your house, and you're worried that this stress is compounding your health issues, then I think the only reasonable thing to do is the thing you're doing. It makes sense to Yeah, it makes sense

Anonymous Female Speaker 57:46
to me. That makes sense. Yeah. I'm really thankful for this opportunity to talk things out with you. Oh,

Scott Benner 57:55
my God, did this help by any chance? Yeah? Yeah. I have no idea what I'm doing. I'm just like, this might be a good idea for the podcast. Do you have, like, the the feeling like you want to ask a question of me before we go, or do you just feel like the conversation was valuable?

Anonymous Female Speaker 58:11
I think the conversation was definitely valuable, and especially since, like, that point you made about the in between period being prepared for that, because, unfortunately, I do not live close to any family. I have a lot of what we call, call it family by choice. I guess people friends became friends over the long period, and I trust them very much. One has even offered like a spare bedroom. But I think I need to mentally prepare for staying here while things get worked out, because that would just overall be better for me and my health needs, and I have to put those first. Yeah, no,

Scott Benner 59:07
for sure. I mean, you obviously you couldn't share too much, because the details would let people know who you are. But I mean, you've had a significant health issue. It's ongoing, and to give yourself the best chance possible, I agree with you. I don't see how you could live around all the stress. So, yeah, I mean, listen, you're in a bad situation, you know, like, this is not like. This isn't like. If you just made one different decision, this would all be like, you know, rainbows and sunshine. This is a this is a mess, like your illness, your relationship. You know, the years that you guys have put into pretending this wasn't happening until it was like, You know what I mean, like, it's not going to be easily untangled. I don't know if you'll ever untangle it, but you could certainly put yourself in a better spot. I think yes,

Anonymous Female Speaker 59:53
and then I wanted to figure out how to heal and move on. So I don't know if it. If you want to how much time we have left, or if you want to go there, but I met him so young, like I didn't really give myself time in between leaving home for college and getting into a serious relationship to just be on my own, not attached to anyone or anything, and just learn who I am. And, hey, you want to do that? My kids said you can do that now. You know, once you're out of here, um, I in my 50s, I just don't even know where to start. And I think that thought is another reason people in situations similar to mine stay Yeah, like the thought of and forget about, like, even if you don't want to do dating, set that aside. I I've been a stay at home mom. I don't know if I can work, and even if I can, like, how do people go about getting jobs now? Like, so much has changed, so you

Scott Benner 1:01:08
feel like the world changed while you were doing this and and it's hard to imagine starting over again, even

Anonymous Female Speaker 1:01:16
just that I'm from the day of paper resumes. And now it's like, everything is online. You have to have certain keywords or whatever in your resume or their the algorithms, those algorithms don't pick you. Yeah. And then I take your point, blame my absence for the workforce, like, like, AI is taking over everything. Who's gonna hire me? Like, that's going through my mind

Scott Benner 1:01:48
a lot or and even if that person exists, like, how do you find them? Yeah, and how do they find you? Yeah, I hear you. That's the bummer. And I'm aware my son just found a job this year, and so I watched him go through that process that you must have to keyword your resume so that the algorithm likes it enough to show it to somebody. Yeah, it's interesting, and that's not a thing you know about anymore, not currently. You could learn.

Anonymous Female Speaker 1:02:16
I'm willing to learn. But where does a person? Where does this person go to learn these things? Like, I'm from the day and age where you take a class or whatever? I guess so much is on social media. Now. I mean, hey, I learned about narcissistic abuse over social media, so maybe there's a way for me to learn how to reinvent myself over social media.

Scott Benner 1:02:40
You learned how to take care of your kid. It's diabetes. With social media, you learned about your life situation. I'm sure you could figure this out as well. And you have a good, astonishingly, a good attitude about I mean, unless you're unless you have, like, a ton of seething rage inside of you that you just didn't tell me about you seem like you're in a at least mentally in a reasonable place to do this. I

Anonymous Female Speaker 1:03:07
spent a lot of time being angry over the years.

Scott Benner 1:03:12
Are you just done with it now?

Anonymous Female Speaker 1:03:14
Yes. I mean, I came to understand that it didn't help me at all. Yeah. You know, I'm just redirecting, like I don't want to waste any more energy or just head space on someone who doesn't deserve my time?

Scott Benner 1:03:32
Yeah, no, I hear you. I think that's an incredibly healthy decision to make. Really, you should give yourself a lot of credit because you are like you said, you're in your 50s. You've been at this for a long time. It would be easy just to, like, dip your head in the sand and go, like, I just got to make it. Like, 10 more years, you know, we'll all get real old, none of this will matter anymore. And blah, blah, blah, no, I think, take advantage of the time you have left, no matter what that time is, or the you know, how much you can get around or not, get around like you're still living your life every day. You might as well live it, at least in the way that you see fit, and in a way where people are not, you know, asserting their on you and making you feel a certain way or feeling burdened by you. Because, I mean, maybe the most insulting thing of the conversation, I mean, of your explanation of your life. I feel like the most insulting thing is just being told, like, well, you're sick now and you need help, and I don't want to be involved in that. That's, yeah, I think that's terrible actually, but I don't think it's uncommon, but I do think it's terrible.

Anonymous Female Speaker 1:04:36
Yeah, I completely agree that that's the thing that psychologically kept me confused for the longest time, because I kept trying to figure out ways to make him care, and then it just I got educated, and I let go of that expectation, and. The freedom came with that. So coming back to what I the reason I put myself out here in this podcast now I know you have such a huge audience for anyone who's listening, who is in a similar situation and feels so stuck, I just want you to hear this and realize you are not stuck, man or woman, you are not stuck, and you can educate yourself, look up narcissistic abuse and use that education to empower yourself. It's one step at a time. We did not get here overnight, and extricating ourselves from the situation won't be quick either. Yeah, that's for sure. Or painless, it'll be quite painful. But think of it if, if I who am dealing with cancer and the side effects, the rare side effects of the treatment. Can make this shift in mindset and start taking baby steps, one step at a time, to get out. You can too. Don't stay I think

Scott Benner 1:06:14
it's a reasonable way to sum it up, right? It's not going to be easy and it's not going to be fun, and it's a decision. You don't have to let life keep happening to you. You could at least make a decision and try to move it into a different direction. I don't say that any of us could sit here and know for sure what's going to happen to you through this process, but you know what's happening to you now, and it's not something you're interested in, so change something and see what happens. Maybe it'll get better. I think it will, like you said, for time, feel like it got worse, but you're gonna have to go through the you know, like you said, it took a long time to get here. It's gonna take a long time to get out of it again. So it's all very good advice from you. It sounds like you've really had a lot of time to think about this, and it feels to me like you're, you're well thought out and probably ready to make the next step. It sounds to me like you're gonna, you're gonna be okay.

Anonymous Female Speaker 1:07:08
I do a lot of praying for that, and I do believe I'm going to be okay. I've got great friends, and I'm taking my power back. It's awesome. Whatever the young kids see

Scott Benner 1:07:23
you're still young. I know somebody who would tell you you're still young. They tell me all the time, and I tell them, No, I don't think we are I think we're old. But they keep saying we're young. So I choose to listen. You have plenty of, you know, plenty of good years to do something great with it, you just got to go figure it out. Do you think I the one thing I didn't ask you about your condition is, is there a prognosis where you're you're doing better than you're gonna than you are now? Or do they expect this to be your baseline?

Anonymous Female Speaker 1:07:55
It could very well be my baseline. If this had happened to me, a few years ago, I would probably not be here, but some new drugs have been developed in the recent years, who have been released or approved or whatever, and they've made a significant difference

Scott Benner 1:08:17
okay

Anonymous Female Speaker 1:08:18
to keep people like me alive, and maybe the next step is in the next 10 years, whatever 15 years is to then improve quality of life. So I'm hopeful, and I have to just stay positive and be hopeful. But if I'm where I am, my objective is to find a way to to be happy, to be of service to other people, to give back. Because I have, I mean, the amount of doctors and nurses and pas and MPs who have just helped me so much over the years. I want to find a way to give back, and that keeps me going too. Yeah,

Scott Benner 1:09:06
well, that's a great purpose that you won't need to keyword a resume to do. That's for sure. Maybe you'll be one of those people on social media that helps other people get out of their stuff by sharing their thing. Have you thought of that? You come full circle maybe one day. Who knows? Like you said, the world's different now, like it's it's incredibly digital. People are able to find ideas and voices that they never would have met in the past. You know, you do a good job of telling your story, and you go out there and tell people like, look, this is my situation. And you know, it's not any Imagine, imagine a couple years from now, like this isn't my situation any longer. You know about getting through problematic relationships, you know about getting through incredibly difficult health issues. There's a lot of people out there that could use that at uh. I don't even want to say advice. I would just more say an example. I think part of what the podcast is for people with diabetes is just like I had a daughter diagnosed very young. We had to figure everything out on our own. And now we're just, I'm just re sharing the things that I figured out. That's all like, I'm just talking about the things that I figured out. And, you know, that stops other people from having to struggle the way we struggled. I'm really just doing what you said you wanted to do. You could do it too. A lot of people do it. You know, a lot of people out there that need help. You never know. Well, you'll figure it out. That's for sure. Let me thank you for doing this. I really do appreciate this is obviously very difficult thing to talk about, like, just like this. I can't thank you enough for adding your voice to the podcast and for being the first person to reach out when I said, like, I think what I said was, like, Would you like to be coached by a completely, I forget how I put it, but untrained life coach, and you were like, yeah. So thank you. I really appreciate it.

Anonymous Female Speaker 1:10:58
Oh, you're welcome. I really hope this series becomes a huge success. I'll be shocked if it's not, because you're just a great person to talk to. Scott, it's very easy to talk to you. Thank you, lovely.

Scott Benner 1:11:11
You're very nice. I'm sure the people in my life are probably like, no, he's not. But you know, like for everybody else, awesome. Thank you. Hold on one second for me,

today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next.com/juice box. I'd like to thank cozy Earth for sponsoring this episode of The Juicebox Podcast and remind you that using my offer code juice box at checkout will save you 40% off of your entire order at cozy earth.com that's the sheets, the towels, the clothing, anything available on the website. If you'd like to be on the life coach series, give me an email. Guess I usually say give me a call. You can't call me, but you can email me through Juicebox podcast.com Make life coach your subject line and let me know what you want to talk about. Hey, kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy, the private Facebook group for the Juicebox Podcast. I know you're thinking, Oh, Facebook. Scott, please. But no. Beautiful group, wonderful people, a fantastic community Juicebox Podcast. Type one diabetes on Facebook. Of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in, but make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe, will really help the show. If you go a little further in Apple podcast and set it up so that it downloads all new episodes, I'll be your best friend, and if you leave a five star review, ooh, I'll probably send you a Christmas card. Would you like a Christmas card? My last thanks to rob at wrong way. Recording. Rob is the editor for the Juicebox Podcast, and he changed this person's voice so magically, I swear, if you heard this person's real voice, you'd just be stunned. Did such a wonderful job of protecting her anonymity. I want to thank him so much. Check him out at wrong wayrecording.com, you.

Please support the sponsors

---

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#1411 GLP Essentials with Dr. Hamdy

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

Dr. Hamdy, Medical Director of the Obesity Clinic Program and Inpatient Diabetes Program, discusses GLP medications and the important steps to take when using them.

+ Click for EPISODE TRANSCRIPT

---

DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.

I'm very excited to share this episode with you. I'm talking today with Dr Hamdy. He is a senior staff physician at Joslin Diabetes Center, the Director of International Medical Affairs, the Medical Director of the obesity clinic program and inpatient Diabetes Program, and an associate professor at Harvard Medical School. And he's here today to share his very important message for those of us using GLP meds, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin when you place your first order for AG, one, with my link, you'll get five free travel packs and a Free year supply of vitamin D drink. AG, one.com/juice, box. Don't forget, if you're a US resident who has type one or is the caregiver of someone with type one, visit T 1d exchange.org/juice box right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help.

The episode you're about to listen to is sponsored by Omnipod and the Omnipod five. Learn more at omnipod.com/juicebox use my links to support the show. We're also sponsored today by touched by type one, and they have something great coming up on March 8. Touched by type one is hosting their very first steps to a cure walk. And you can register right now to participate. Touched by type one.org Go to the Programs tab, click on Steps to a cure and sign up today. You can sponsor walk or volunteer. Check it out.

Osama Hamdy, MD, PhD 2:06
I'm Osama Hamd,. I'm the Medical Director of the obesity clinical program at Joslin Diabetes Center and associate professor of medicine at Harvard Medical

Scott Benner 2:16
School. How did we meet each other? Who put us in touch? Do you remember one of

Speaker 1 2:21
our nurse practitioner, Daniel rock,

Scott Benner 2:25
what did she tell you? I'm interested. What made you be willing to do this? Yeah,

Speaker 1 2:30
he told me it is a very popular broadcast, very efficient broadcast. He follow a lot, and he thought that it would be a good idea that we comment on muscle mass and some of the work that we frequently do in that space on obesity. I had been in obesity field for 40 years now, wow, and I created the obesity clinical program at Joslin Diabetes Center as one of the biggest programs. We had been doing several weight management. You know, we did research that cost us almost $16 million to come with the the best weight management, multi disciplinary weight management program for our patients. It's called, why weight, weight achievement, intensive treatment. And then we have another program called diabetes remission outcome program, drop program, which aimed for diabetes remission in early inpatient, was early diabetes.

Scott Benner 3:27
Can I go to the beginning and ask you about how we got to that? Yeah, yeah, we can. You can ask whatever you would like. You know, you've been in it for 40 years. Let me ask you what got you into it, and what was it like back then, versus what is it now, and how did it change throughout the time? Oh,

Speaker 1 3:44
there is major, major change. You know, the whole concept that link obesity to diabetes was not clear in the old days. You know why people with obesity develop diabetes? Who will develop diabetes? Why Some develop diabetes and others are not until we discover the whole idea of insulin resistance, that once you are obese, and especially if you have more fat in the abdominal area and visceral area, you'll become insulin resistant. And this could be the reason why people, when they gain weight, the start to develop diabetes. So my early research back almost 25 years ago, we found that 7% weight loss improves insulin sensitivity by 57% Wow. So I remember I was whispering to my colleagues at that time, telling them that means diabetes is not a chronic disease. Actually, in reality, we can reverse diabetes. But that concept was not there at that time. Concept that this is a chronic disease, whatever you will do, there is nothing that can reverse it. But people who repeated those studies found 7080, even 90% after. Bariatric surgery significant improvement in insulin sensitivity, which means that if you catch it early enough, especially within the first five to seven years, you can actually reverse diabetes. So

Scott Benner 5:12
for type two, how does the bariatric help? Does it help with the weight loss, or does it help with the with something else, too many?

Speaker 1 5:19
The best to answer is that patients with after bioethic surgery, they stop their diabetes medication in frequently. Why they are in the hospital even before weight loss?

Scott Benner 5:32
Why do you think that is the what's the cause and effect? It is a

Speaker 1 5:36
reduction, significant reduction, in the anti hepatic fat, so when they are in the hospital. After surgery, they are not on oral feeding that much. It is all IV fluids or IV glucose. There is significant deficiency in nutrients in the beginning. So the easiest for the body to do is to take the fat inside the liver and use it as as a source of energy. And immediately, with the reduction in the intra hepatic fat, you will, you will start to see improvement. And then later on, when they start to lose weight, that's when you get the maximum improvement.

Scott Benner 6:17
Wow, that's insane. So, so you saw that you saw, give these people bariatric surgery, they what can reverse type two or stop pre diabetes, either or,

Speaker 1 6:29
you know, it depends in at what stage you are doing. If you are in the pre diabetes phase, definitely okay, you will prevent the type two diabetes. But if you're already on type two diabetes, when it is shorter duration, less than five years, definitely remission can occur for how long that remission will maintain. It is not studied significantly right now.

Scott Benner 6:53
So is the biggest hurdle, then, is losing the weight, not

Speaker 1 6:58
losing the weight in precisely it is when you lose weight, when you say lose weight, you lose muscles, you lose fat, but when you are when we are talking here, we are talking about the critical fat in the body. This is the intra abdominal fat and intra hepatic fat, visceral fat, intramuscular and sufficient fat, all this ectopic fat is dangerous. Okay, this is a problem.

Scott Benner 7:25
I hear people talk about all the time how extra fat impacts hormones and causes hormonal issues. Is that, is that something that you're aware of, today's episode of The Juicebox Podcast is sponsored by Omnipod. Before I tell you about Omnipod, the device. I'd like to tell you about Omnipod, the company. I approached Omnipod in 2015 and asked them to buy an ad on a podcast that I hadn't even begun to make yet because the podcast didn't have any listeners. All I could promise them was that I was going to try to help people living with type one diabetes, and that was enough for Omnipod. They bought their first ad, and I used that money to support myself while I was growing the Juicebox Podcast. You might even say that Omnipod is the firm foundation of the Juicebox Podcast, and it's actually the firm foundation of how my daughter manages her type one diabetes every day, omnipod.com/juicebox whether you want the Omnipod five or the Omnipod dash, using my link, let's Omnipod know what a good decision they made in 2015 and continue to make to this day. Omnipod is easy to use, easy to fill, easy to wear, and I know that because my daughter has been wearing one every day since she was four years old, and she will be 20 this year, there is not enough time in an ad for me to tell you everything that I know about Omnipod, but please take a look omnipod.com/juicebox I think Omnipod could be a good friend to you, just like it has been to my daughter and my family. That's

Speaker 1 9:05
absolutely right, and I wrote about it before. You know adipose tissue is not an inner tissue. This is an endocrine gland. It secrets hormones like, for example, Leptin hormone, the satiety hormone, the major satellite hormone is coming from adipose tissue, from fat tissue. There is another hormone called the bone actin, which actually increase insulin sensitivity. Unfortunately, when people are obese, adiponing is low, and that's why they are insulin resistant. Interestingly, when you lose weight, adiponing start to go up. And to make it even more complicated, visceral fat is different than subcutaneous fat. Okay, those are two different organs in their genetic expression, in their hormonal secretion, in their even relationship to each other. And so the distribution of fat is. More important when it comes to the endocrine function of the devastation.

Scott Benner 10:03
How does it impact satiation? Yeah, there is a hormone

Speaker 1 10:07
comes from subcutaneous fat. Subcutaneous fat, okay, there's external fat, not the internal fat. It's called leptin. So Leptin is a hormone, one of the major hormone that induced satiety. Just to consider leptin as a defense lawyer for your fat. You know, anytime you start to lose fat, leptin goes up Shut your appetite. Try to preserve fat as much as you can. And interestingly, leptin has a circadian pattern, so it is mostly secreted between 8pm till 8am that's why we will are eating during the day, and they don't eat during during those hours, right? Exactly, right. So let me give an example. If we will get leptin abnormality or Lipton deficiency, they start to eat significant amount of food in the evening. We call them night eating syndrome. So night eating syndrome affect around 2% of the US population. And the eating average studies showed, in average is three big meals after their supper, three big meals. Each meal is 1250 calories. So you can imagine if that hormone is just deficient. Yeah, wow. Some people are, they are born, but this very rare born nose lipicsy And they are very obese from their

Scott Benner 11:34
younger childhood. For people who would say, just do a setup, go for a walk, like, can you tell them why that doesn't work all the time for people who are or in this situation,

Speaker 1 11:46
you know, your your body, need different types of exercise, and each exercise had its own benefit. It is, you know, walking is aerobic exercise. This is very valuable for your heart, for your cardiac effect. But other types of exercise has measured, measure different, different angle. For example, you you need, you need to stretch your body. And stretching your body, which people can do it just for 10 minutes in the morning, increase blood flow to to the body, reduce energy injury, improve movement across the joints. There is a lot of benefit from stretching, but the most important component of exercise is actually strength exercise. Okay, and you cannot do exercise without doing muscle strength exercise. And the reason, the reason is that as you age, you lose muscle mass over time. So normal people without diabetes lose around 5% of their muscle mass every 10 years from age 30 up, people lose diabetes lose around seven to 8% of their muscle mass every 10 years from age 40 up,

Scott Benner 13:02
do we know why people with diabetes lose more than people without?

Speaker 1 13:06
Oh, yeah, there are that is a very complex metabolic issue. But the bottom line is that from age 40 to age 70, you lose around 24% of your muscle mass. I see by ages 70 up, you lose 15% of your muscle mass during your lifetime. If you live till 40, from 40 till 80, you lose 40% of your muscle mass.

Scott Benner 13:32
Is that something that I can I can't stop it completely, but I can get in the way of it, right, try to to slow it down. Is that the idea?

Speaker 1 13:39
Yeah, yeah, no, you do all the effort to prevent it, right? Because loss of muscle mass is, in my personal opinion, is a crime. You know, if you lose your muscle, or anything that makes you lose muscle, you will be in terrible scenario. This is how frailty occurs. This is how we will get poor quality of life. You can even stand from your chair. It is a problem, but there are three major problems. Just to be clear, there are three major problems when you lose muscle mass. Number one, you will not regain muscle mass. You can't get it back, bye, bye, muscle mass. It is very difficult, because you build the muscle mass over years by three hormones, growth hormone, insulin, sex hormones, okay, when you get older, all those hormones are noose down, so you don't have them, so you cannot build muscle mass that much in your older age, or I will say, from even middle age, there's a first problem. Second problem is, once you lose muscle mass, your energy expenditure start to go significantly down, to a degree that if you return back to eat whatever you used to eat, you gain weight, and that weight is not my. Muscle and fat. It is mostly fat. So every time that you lose weight, you lose muscle, and then you gain fat. If you return the back and then recycling, go care. And this leads to what's called sarcopenic obesity. Sarcopenic Obesity means you lose muscle and then you have more fat, okay, but if you age normally, you lose muscle all the time, until you reach a sarcopenia. In this scenario, I say, Okay, the third drawback, just to complete the drawbacks of losing muscle mass, that quality of life start to go significantly down and by percentage loss in the muscle mass. So if you lose 10% your performance of the muscles start to go down. 20% you start to have reduction in your immunity, and you get infections and and problems. 30% you can get pneumonia with zords. 40% of muscle mass loss means mortality will be significantly higher. So

Scott Benner 16:00
how do we balance in I guess, starting with obese or type two community, people are getting GLP medications. They're having some of them significant benefits as far as weight loss goes, but so I don't imagine you would trade their weight loss. But how do you mitigate the muscle loss in the same situation, like, what else should they be doing that we're probably not telling them about Yeah,

Speaker 1 16:21
this is a very, very important issue, because we have to differentiate, Scott from the beginning, between quality weight loss and quantity weight loss. Okay, the weight loss was in keratin mimetic drugs. This is a group of GLP one and GIP and GIP and all this group is volume weight loss, quantity weight loss, not quality weight loss. Quality weight loss is entirely different. Quality weight loss means you lose adipose tissue. You maintain muscle mass, you maintain muscle performance. And quality of life is much better. But if you lose the adipose tissue and lose muscle mass in the same time and have poor performance, weakness in the muscles and so on, you will you will be in in trouble. And that's exactly what happens with those medication. You know, people are happy with the volume of weight loss, but it is not a quality weight loss. So is it

Scott Benner 17:23
possible? Do you think to use the GLP and be exercising and supplementing at the same time to keep a balance? Yeah,

Speaker 1 17:30
we need a lot of research in that area. But theoretically, that's absolutely right. If you take enough amount of quality protein, if you do a Strengths exercise. Very good quality of strength exercise, especially in the muscle, in the bearing muscle the body, bearing muscles around the size and back and and all this area, I think maybe you will mitigate some of the problem with loss and muscle mass. Yeah,

Scott Benner 17:59
so you don't know this, but I am 57 pounds lighter than I was two years ago, and from a GLP medication. Now I try to balance that with a significant amount of animal protein, and I do a protein drink every day to make sure my protein is high enough during that what I try to do is light to medium weight training in the beginning, arms, legs, poor, but it was harder in the beginning, because I was so I was so out of shape. Now, the irony here, I guess, is that as far as the amount of calories I take in, obviously I take in less now, because the GLP, it does, obviously, you know, kind of shut down your hunger. But at the same time, I'm not eating that much less, and so I noticed a difference immediately. I don't have diabetes, I didn't have diabetes, but I would have described to you that throughout my entire life, my body never responded to food in a way that made sense. My digestion didn't work well, and I had to, as an adult for years, get iron infusions, because my ferritin would drop through the floor, like every six months. But since the GLP, I don't need the iron infusions anymore. I now defecate like a normal person would, like, I eat, I don't get sick right away. And like, it has changed so many things for me, and I don't know how to put it all into words, like it feels like it's having impacts that weren't intended by the label, and I'm done now, like I don't really need to lose any more weight. I have some mid section fat that I'm still working through, but everything else I've been able to to get rid of. But I'm 53 I have very dark hair, so it might be hard for you to see that right now. I got to the point in my life where I thought everything I've tried supplementing, exercising, eating, right, all the things that people talk about, none of it was happening like, it just it wasn't doing anything for me. And I thought, I'm gonna die if I don't do something like I genuinely thought I'd have a heart attack in the next 10 years. So I thought, well, let me get rid of this weight the best I can. I'll try to mitigate. The the muscle loss, as best I can, and now that the weights gone, I'm upping my activity and being more strenuous and looking towards more building. Because the exact same thing that you're talking about, like, I I just watched my mother, you know, at the end of her life, in her early 80s, like, not be able to get up and sit down and get out of a chair and, like, I don't want that to be how I go out, so I'm trying, you know, but I don't know if I'm doing the right thing. Because, to your point, they came up with the meds, and they were like, here, and people got so excited that everybody started taking them, and nobody really knows what they're doing. So I'm, you know, lucky enough to have a nutritionist that I talked to on the podcast who warned me early on about the protein and the muscle building. Nobody told me about that, you know, so I don't know, like we're in a weird spot right now, I'm wondering what you feel about all that.

Speaker 1 20:50
What you did is, right? You know, you try to lose weight, because, you know, initially, you are talking about the complications of obesity. You know, Obesity is a disease. You know it is not symptom or a sign. Obesity is a disease. And you have obesity, you have many metabolic and you have many mechanical problem and you are at very high risk for cardiovascular disease and diabetes and many other problems. That's why people are basically awful in that scenario. But reality is that many obese people are malnourished. In reality, you know, study among the US population found the US population in general, obese or non obese, 40% of them have micronutrient deficiency. So when you are talking about iron or any other test elements or any of minerals, 40% have macronutrient deficiency. What do

Scott Benner 21:44
you think that is because I don't eat I'm gonna try to hold this up to the camera. I don't eat much differently now than I did then. I was eating protein, I was eating healthy, I was taking supplements. But look, can you

Speaker 1 21:56
see that? Oh yeah, yeah, I can see it different. It's a significant

Scott Benner 21:59
difference in who I am now, and so that person in that picture doesn't eat much differently than I do. I can tell you that if I inject on a Wednesday and eat normally, everything's fine, but if, even if I get to the end of the half life on the medication, I can see myself starting to gain weight having not changed one thing about what I'm doing in day six and seven. Do you think that there's an inflammation component to this for some people? Because we're also seeing people use it for PCOS. We're seeing people use it for a number of different things that it's not on label for, that all seems inflammation related, but I don't know anything. I only know what's happening to me. I don't really know what's happening.

Speaker 1 22:42
You know, the medication does two jobs, okay? And this is a reason for weight loss. The first is chat appetite. It works on appetite center in the brain, chat appetite. And you know, most of the obviously, problem is related to larger abortion, frequent eating, stress eating, night eating, binge eating, all kind of stuff. So when you shut up, per se, you lose weight the second that is slow gastric evacuation. So basically, what you eat is slowly digested over time, because it takes longer duration in the Git to to move,

Scott Benner 23:22
and that's how I'm getting my iron from it now, because it's staying in there long enough for it to be extracted. Is that right,

Speaker 1 23:28
you know, but, yeah, when, when the food is slowly processed, definitely more digestion, more absorption, more rather than it, if there's, you know, a quick evacuation for, for, for that. But you know, once you lose weight, your body adjusts itself in many aspects. But the most important is that once you start to lose weight, the critical and the bad fat is a thirsty fat to go down, okay, the intra abdominal fat, the intra muscular fat, the intra hepatic fat, the intramyocardial all those ectopic fat start to go down. Once that visceral fat and intramuscular fat goes down, inflammation in your body will go way, way down. Okay, because that fat in your ectopic area is a source of the inflammation in your in your body. This was called sub clinical Corona inflammation. Why this happens? You know, when the fat cell gets larger. Let me explain it in a much better way. When the fat cell gets larger and larger and larger, it can, you know, can be a very big volume, the fat cell rupture. Actually, it is, I will not say rupture. It will be what's called fat cell necrosis. You know, the cell membrane of the fat cell get necrotized and so on. This death of the fat cell attract cells in your blood called the macrophages. Macrophages is like janitors. They come and to clean the debris of the fat cell. But. When they come in, there is it inside adipose tissue. We call them adipose tissue resident macrophage. They live in the adipose tissue. And this macrophages start to produce significant amount of what's called cytokines, inflammatory Cyto This is the reason why people get cardiovascular disease, heart attack, stroke, insulin resistance on type two diabetes is basically inflammation originated from macrophages raised in the adipose tissue in the ectopic area in your body. That's

Scott Benner 25:32
crazy. I never would have understood the pathway to that. That's really something. Yeah.

Speaker 1 25:36
So people who studied all this area, myself and many others found that the core problem of all this cardio metabolic issue is poor nutrition, because when you eat poor nutrition, you start to accumulate more visceral fat. Visceral fat attract the macrophages. Macrophages secrete inflammatory cytokines. You get inflammation, and then the three branch, dyslipidemia, hypertension, Corona, kidney disease, cardiovascular disease, until we will end up in ICU, heart attack or stroke.

Scott Benner 26:11
Is it possible that the increase in autoimmune issues like hypothyroidism, Hashimotos, type one diabetes? Could this all just be nutrient fat over generations?

Speaker 1 26:24
No, no, no. This entirely different scenario, type one diabetes and autoimmune disease, Hashimotos and autoimmune disease, those are entirely different. We are talking about the process of people who are gaining weight, and especially if they are gaining weight in this wrong area and the wrong area, the divorce tissue, in the visceral area, it can be just one to two kilograms of fat, but is extremely dangerous fat, okay, so you can, you can be lean and happy and so on, but you, if you have that visceral fat, you are at that major risk, like, For example, go, go to people living in South Asia and in India, the average body mass index, 2223 but if you do acidity scan for them, you'll find significant amount of edible station, okay, in visceral area, in the visceral area, that's why they get Diabetes at younger age you get cardiovascular disease at younger age, by age 4050, the may have heart attack. Yes, it doesn't matter how your body mass index looks like it is where that fat is located.

Scott Benner 27:33
So for people in India as an example, is that genetic, or is it food related? Is it more cultural?

Speaker 1 27:40
You know, the accumulation of fat and fat distribution in your body is based on ethnic background and some genetic components, like, for example, in the US, African American women accumulate more visceral fat than white women. In the in the in the same time, white men accumulate more visceral fat than African American. Men in Latin America, men and women accumulate more visceral fat. In South Asia, men and women accumulate more visceral fat. Middle Eastern is the same. Just to give you a very simple example of how this can be a problem. If you look to the women Indians and the Bema Indians, Native American they have the highest tendency to accommodate visceral fat. Do you know among the Bema Indians, the prevalence of diabetes 60% 60% because they accumulate significant amount of disorder of fat. You

Scott Benner 28:36
said something, I make sure I didn't misunderstand it if, if I take that same person, like you said, black women in America. Does that mean that black women on other continents don't have the same issue? Is there something to do with them being here or no? Not necessarily.

Speaker 1 28:51
Distribution of fat is entirely different across the globe. Like for example, if you are in the Mediterranean area, South Italy, South France, Greece, North Africa, we will accumulate fat in their periphery, in the lower area of the body, in the side. This is what is called pear shaped right obesity. This is entirely different than Apple shaped obesity, where the fat is accumulated around central

Scott Benner 29:17
area. Is one better than the other. Of course, yes, pear actually,

Speaker 1 29:20
if you have a pear shaped that fat will be protective. Ah, not even, not even harm. It is protective for your body. I want

Scott Benner 29:30
to get my belly into my ass. Is that what you're telling me?

Speaker 1 29:35
But not by transplantation, yeah, let me. Let me tell you something which is so funny. Yeah, when we did our study of the 7% weight loss and we found that insulin sensitivity improved that much, ballistic surgeons said, Oh, that's easy. Let us go and suck 7% of the body fat. Did that work. I will tell you they actually sucked the. 10% of body fat, 10% and I don't know how they suck the 10% i My brother is a plastic surgeon, and I asked him, how you how we can suck 10% of the body? He said, Oh, we have new techniques and and procedures and so on. But do you know the results? 00, benefit, because the what they removed is a wrong fat. They remove the subcutaneous fat, not the visceral fat.

Scott Benner 30:23
I see, oh, that's so disappointing, because I was going to start saving my mommy. When you talk about, I've heard people talk about before their doctors tell them that they sometimes have fat between and under their organs. Is that visceral fat?

Speaker 1 30:37
Visceral fat is inside the intra proteinal cavity, around the organs, around your intestine, all the entire organ and, of course, in the in the liver and around the stomach and all this, all that fat in the visceral lady, when you open the protein, the muscles and protein, you'll find that visceral fat.

Scott Benner 30:59
So the fat I'm left working on now is more about vanity and not about health or no, what

Speaker 1 31:06
you need? You need to reduce a visceral fat. That's that's the aim. You know, if you need health benefit, there's aim. But if you need to maximize the health benefit, you increase muscle mass, okay,

Scott Benner 31:18
the the way to get rid of this fat now is to build more muscle and

Speaker 1 31:22
build more muscles, okay, okay. And by the way, building muscles is the most important thing they can do in your life, especially in elderly population. Okay, so let us go back to the GLP one medication. Yeah, okay. And, but this is around the numbers about, you know what we have been talking about. If you lose weight by just cutting caloric intake, 25% of the weight loss is muscle. So if you lose 10 pounds, 2.5 pounds will be muscles, right? If you do exercise during weight loss, around 15% of the total loss will be muscles. Okay. So if you do nutrition, hypocaloric diet and exercise, the percentage of in muscle mass from the total loss is only 15% okay. When you inject the GLP one hormones. 40% of the total loss is muscle. Why

Scott Benner 32:23
is it different with the GOP than without it? You know,

Speaker 1 32:26
for, yeah, for many, many reasons. You know, a version of food loss of appetite, protein in general, is nussiating. People don't eat that much protein, macro nutrients becomes, you know, lower there is a lot once you suppress appetite and you are not eating, basically imagine someone in the hospital, sick not eating. They lose significant amount of muscle mass during that period. So 40% this is equivalent to around 20 years of loss in one year, 20 years of age, related loss and muscle mass. So this is not a small amount of loss and muscle mass. Like for example, if you look to the studies that had been done on semaglutide, the step one study, they take group of the population, and they did Dexcom to study body composition, and they found that people lost 17 kilogram in average, 17.57 kilograms are lean mass. Okay, seven kilograms are lean mass. This is around 4140 41% okay, of the that that loss, in a year, you are losing all point 5% of the muscle mass. So if you are aging normally, I told you, you lose around 5% ever, every 10 years, right? So in one year you are, you lost nearly around 20, 20% but lean mass is you have also the defined in mass. Lean mass is soft tissue, organs and muscles. Fat, free mass is different. Fat free mass is bone and muscles and all other tissues. But lean mass and muscles is nearly 50% of the lean mass. So the absolute loss in muscle mass, if you calculate it from that whole equation is around 10% 10% of your muscle mass is lost.

Scott Benner 34:25
But you still said you want people to lose the weight, so, like, Dan, so we have to, you got to keep eating, right? Like, I mean, listen, I've been using it for almost two years, and there are days that you have to just walk into the kitchen and say to yourself, I'm going to eat. I'm going to eat something good for me, because I it can happen. I'm not going to lie to you yesterday, I think at five o'clock yesterday, I thought to myself, Oh, I don't think I've eaten yet today, and I did not know it. I wasn't hungry, like my brain wasn't hungry. My stomach wasn't hungry. I was not hungry that. Doesn't happen to me often, but a number of things happened yesterday. People in my house got sick. Things got tossed around. I find it to be incredibly valuable to tell people like you have to eat like chicken, beef. You know, these things like nutrients, get your nutrition, take your supplements, do everything you can do to keep that going while being active, lifting weights, weight training. That's how I've tried to talk about it so far.

Speaker 1 35:22
You know what? We need to educate our patients who are getting on this medication, yeah, that you need to eat high quality protein and do enough strength exercise to mitigate the loss in muscle mass. So usually we will our average we will eat or the recommendation are 0.8 gram per kilogram of body weight. We recommend at our institute 1.2 to 1.5 gram per kilogram of adjusted body weight. But in general, after barretic surgery, the usual patients eat 1.5 gram per kilogram of your ideal body weight of protein, and it has to be high quality protein, right? High quality protein is not plant protein. High quality protein is mostly animal protein. So we have to differentiate, because the Amino the essential amino acids are very important. This is a building block of your hormones in your body. Insulin is insulin growth hormone, other protein based hormones are all a need for that essential amino acid.

Scott Benner 36:20
So now that we understand this about weight loss type two, like, let's sort of pivot a little bit, because a lot of type ones are starting to use glps for insulin resistance. I know it's off label still, but it's happening, and I'm seeing it more and more, to be perfectly honest. So do you have thoughts about how type one should be managing this?

Speaker 1 36:41
Yeah, it is not of label for obesity. Indication, no, no, of course

Scott Benner 36:46
not. But there are type ones now that are getting it for insulin resistance. So what they're doing is they're going to their doctor, and they're the doctor saying, Look, if you didn't have type one diabetes, you'd have type two diabetes, because I see insulin resistance here, and they're getting it covered. You

Speaker 1 36:59
know, I am among the people who created that term in the old days, double diabetes. Double diabetes, really. So double Diabetes means you are type one by auto immune mechanism. You are taking insulin, and so is a growth hormone. And every time you optimize your insulin, you're basically putting in your body more growth hormone blast. They are exposed to the same environment like anyone else, the environment of this activity and high carbohydrate eating and so on. They gain weight. Then they start to be insulin resistant, and then their need for insulin becomes higher, and the insulin is a growth hormone, makes them gain even more weight. So reality, we did that. We published a very nice article about obesity type two, and we were shocked, 53% of type one. Sorry, obesity type 150. 3% of people whose type one diabetes are actually overweight or obese now. Wow. This is totally different from 2030, years ago. Yeah. Let

Scott Benner 37:58
me tell you this, Dr him, because you don't know my daughter. The reason I come by this podcast, my daughter was diagnosed with type one when she was two years old. Yeah, and today she's 20 years old, almost 21 yes. She also seems as near as we can tell to have PCOS. Yes. It shows its head through acne, through painful, longer periods and insulin resistance. Like at some points in the last two years, my daughter's insulin to carb ratio was one to four, and her insulin sensitivity was as low as, gosh, I think 42 one to 42 and so her doctor put her on a GLP and her insulin sensitivity is now more like one unit covers 8085, her carb ratio is up to, like, almost to 10. It's like eight, between eight and 10. She did lose some weight. She did not have a weight issue, but it did, like, just through hunger. It knocked 20 pounds off of her. And she's tall, she's five seven, but she was probably 571 40 when she started, and she's more like 571 30. Now she got to 120 it was too much like she had lost too much weight. So we were stuck because she was doing Manjaro, just 2.5 and it was working great on her insulin resistance, working great for her PCOS, but it was making her not hungry. So what we ended up doing was we now take clean vials and milk the pen into a vial, and then give her less than the 2.5 and we have found the balance where it controls her blood sugars, helps her with her PCOS, but leaves her hungry still, and that has been like the sweet spot we found for so she gained back 10 pounds. She's at a very healthy weight now, and she probably uses, I'd have to guess, 20 to 25% less insulin than she was using before. And she just looks

Speaker 1 39:53
at that's usually the case. You know, we're an hour why wait program around 30 40% and. Range are type one, and we have significant experience in managing obesity in type one. You know, actually, we published several papers about it, and we have to differentiate between two issue, good. This is a benefit of JP one, or the benefit of weight loss.

Scott Benner 40:15
Yes, okay, yes, I know, and I, I struggle with the same thing. Yeah, the

Speaker 1 40:19
benefit of weight loss is huge. You know, you said that she went from 140 to 130 you mentioned at one point she lost she lost the 20 pounds. If she lost that much, she is now more insulin sensitive, she will use less insulin. For sure, the answer is more efficient, because every time that you become more insulin sensitive, your body responded to insulin is much better way. Yeah, so even less insulin can improve. But the most important is that she should continue to do strengths exercise, especially younger. Younger people benefit a lot from exercise because they they can build the muscles more than what you can do now. You know, from age of 40 up, it's very difficult to build the muscle, but in her age, it is easy to build the muscle. Yeah. So my advice for her is to eat more protein, enough protein, and by the way, protein per se, will improve hair diabetes as well. You know, we know that for years, and it doesn't raise a blood sugar up like carbohydrates, right? I have to

Scott Benner 41:22
tell you, like talking about it technically like this. It makes sense. Everything makes sense. It's the the actual living with it and losing your appetite and then having to eat and like, it seems like a vicious circle, like it's not, it's clearly not a perfect fix. But I've done two interviews this past six, eight months that I found astonishing. One was just with the mother of a then 13 year old girl who had had diabetes, type one for four years. She was using almost 70 units of insulin a day. She has antibodies. She has she's type one, right? But her mom had PCOS, and had used the GLP to lose weight and changed her life. The girl was gaining weight, so the doctor put her on the GLP for weight. But today, I'm still in contact with her. Today, her daughter's not wearing an insulin pump anymore and injects like one unit of basal insulin a day. I'm not saying it cured her. I'm certainly not saying that, but she's having an amazing impact on it. And I also had on a gentleman in his 50s who was type one for like, six or seven years, admittedly, Lata, right? It was a slower onset. He got put on zepbound for weight, which I know is Manjaro. He lost so much weight, they took him off his insulin, and he hasn't been on insulin for a while now, but he's got antibodies, and he is type one. And I expect one day that Lot of will complete its path and he'll end up on insulin. But for the moment, it's astonishing.

Speaker 1 42:48
It's quoted all. What you mentioned is not a surprise for me, Wow, because you remove the type two component, yeah, when they lose weight, the type two component, an insulin resistance component, is gone. They remain was type one. So the need for insulin becomes less and less and less. So to be down to one unit per hour on insulin pump or or sorry, or less, or whatever, not surprising, your body become insulin sensitive after you lose weight. Whether you are type one or type two, if you are type two, you get remission. If you are type one, you remain on answer, but in a very small dose.

Scott Benner 43:24
So then this double diagnosis isn't just a way to trick your insurance company. It's important to know if you have both of those impacts,

Speaker 1 43:30
we don't have COVID for double diabetes, right? You know, you cannot tell insurance that that person has double diabetes. The insurance understand from ICD 10 that either type one or

Scott Benner 43:41
type two. Your opinion, should there be a double diagnosis code, double diabetes? Yes, we should

Speaker 1 43:45
diagnose double diabetes in in people. But my advocate for that term to be used scientifically, rather than just be used that way. I want to thank you

Scott Benner 43:54
for a second, because I didn't really know where our conversation was going to go today. You've indicated me because I took a fair amount of crap online for putting those two episodes up where type ones used the GLP and then came off their insulin. I got a lot of pushback from that. I mean, I understand why, like, type ones don't want you running around telling people, like, don't take your insulin, which is not what I was, you know, definitely not what I'm saying either. I think it does point out how much over the years, old ideas get folded into new ideas, and then along the way, like something gets lost in translation along the way. Do you know? Do you know what I mean by that? Because you said something earlier that made me feel the same way, and it was around the double diabetes, because I had heard people say that in the past, and then other people come along and they poo poo. It like you're either you're type one or your type two. It's then that becomes the argument. You know,

Speaker 1 44:43
let me Scott, let me make it more complicated. We are looking in the future in precision medicine of diabetes, and there will be no type one and type two. There are five different phenotype clusters. Okay, each cluster is treated in entirely different. Way. So type one will be under a cluster called auto immune, severe auto immune diabetes, or said sa ID, severe auto immune diabetes. This will include type one and ladder the antibodies are positive in them. There is another group that exactly similar in the phenotype, but without antibodies. It's called severe insulin deficiency, diabetes, and this is around 18% of people with diabetes, so they are not making insulin. They are lean people, but if you test antibodies, it's negative, and then you have mild obesity, diabetes. This is a common type that we think that, or most people think that this is type two diabetes. That's actually 22% only of all people with diabetes and the diabetes in mild obesity, diabetes is related to obesity. Take the obesity out of the door, diabetes will go out of the window. And this group significantly benefit from weight loss, whether multidisciplinary weight loss or by pharmacologic or by bariatric surgeon I see, and then you have another phenotype cluster called severe insulin resistant diabetes, or cert this group had the severest insulin resistance their body, all the body is resisting insulin, liver, muscles, a divorce tissue. This group, weight loss can be very beneficial. If you see one of those people, they need 100 units of insulin, even 200 units of insulin, sometimes. And then you have mild age related diabetes. This is the biggest one. When you get older, you get diabetes. This is around 39% of people whose diabetes, wow. Basically, understanding the phenotype clusters in the future can tell us who will benefit from what we call it now, type two diabetes is not all of them, but mild obesity diabetes, which is around 15% 22% and the severe insulin resistance around 15% so 27% 20 37% of people with diabetes will benefit significantly from weight loss.

Scott Benner 47:00
What's the roadblock in making this more well understood in for clinicians,

Speaker 1 47:06
you know, this is a classification that you expect to come in few years from now. Okay, there is a cooking for this classification now, and many countries did phenotype clustering, and it looks like the five phenotype clusters are reproducible in a good way. This will help precision medicine in the future. You know, similar to cancer breast, for example, not all cancer is the same. You know you have genetic based cancer. You have hormonal based you have what you know you can manage it in the very precise way. So

Scott Benner 47:42
we're in the not, maybe the infancy, but we're still in the beginning of understanding diabetes then and the way it gets treated more more over at

Speaker 1 47:50
any point in your history of diabetes, you are beginning to understand diabetes.

Scott Benner 47:55
Damn perfect. That's what I wanted to know. Awesome. And for all the people who give me crap online, ha. Dr hand, he just said that I was right. That's awesome. I'd finally write about something. This is great. Listen. I'll tell you something that maybe you'll find interesting, because you're a researcher. I have so many conversations with so many different people who have diabetes, so I record this podcast sometimes more than once a day, but at least once a day, I've had 1000s and 1000s of conversations with people. Have type one. Who are the parents of type ones with people, have type two. With people, have lot of like, all this stuff. After a while, I step back and I say to myself, like, it's not really the way that we're talking about it. Like, until somebody, until you just said what you said, I have to be honest. Like, I never, I'd never heard it, you know, put technically to me, but that all makes perfect sense to me. After having these conversations all these people, they're not all having the same experience, but we call it the same thing. And you know, it's confusing, and then the human component gets twisted into it, because often type ones don't want to be thought of as diabetic or type two, because type two is so closely related to a thing you did wrong instead of, you know what I mean, like, instead of like it happened to me. And I think that argument is where so much of the the resistance to seeing the differences comes into play. But you really think this will be lay the land in a few years the way, the way you spoke about it, yeah, yeah,

Speaker 1 49:23
absolutely, you know, change. The definition of diabetes has changed over time. Many, many times, sure, oh, at the beginning it was just one diabetes. Then they call it after that fatty diabetes and lean diabetes, and then juvenile diabetes and other tons of diabetes. And then insulin dependent diabetes and insulin non dependent diabetes, and then type one diabetes and type two diabetes. But the future will remove all type one and type two and become the five phenotype clusters. And then once we identify the cluster, and by the way, each cluster develop different complications. Okay. Okay, okay. So I told you there are three mild form, three severe form, and and one mile and two mild form. So for example, severe auto immune diabetes, develop micro vascular complications, diabetes, retinopathy, nephropathy, neuropathy, all those kind of complications, severe answer, resistant diabetes, although they are also severely insulin resistant, they only develop diabetes retinopathy and diabetes neuropathy, okay, mild obesity, diabetes, don't develop that much complications. They can develop maybe cardiovascular complication, if they have this liberty or hypertension, severe insulin resistant diabetes, develop hepatic steatosis and mesh and develop Corona kidney disease at younger age, mild age related diabetes, basically don't develop complication except cardiovascular if they have this liberdemia and hyper and hypertension. So if we know the clusters very well, I can tell you what is a prognosis will look like in each one very soon. I had been using the phenotype cluster for two years or three years now in my practice, and I hope in the future, we can educate primary care physician to identify those clusters and treat them in a proper way. Good luck. That's

Scott Benner 51:15
incredible. I'm so happy you came on. Do you see a world where who are type one who don't have weight issues are going to get in my mind, and this is probably a very simple way of thinking about it, the glps have to start coming in vials, so that doctors can help you with dosing, so that it can help you with the things you need without impacting the things you don't because the like, if you don't need the hunger to go away, But you're seeing a ton of help in other spots, just the PCOS help, right? Which is awesome for people. There are people who have PCOS who don't have weight to lose. So, like, what do they do? Like, how do you imagine that endos are going to mix glps into type one care, I guess is my question.

Speaker 1 51:59
PCOS, by the way, related to type two more than type one. Okay, you know, it's kind of care when anyone but it is mostly related because it's part of insulin resistance, and the best treatment is actually not only weight loss, but also some medication that improve insulin sensitivity, like Metformin. And you know, nearly Most cases of BCS are treated with metformin because it improve insulin sensitivity. There are several other hormone medication that also improve insulin sensitivity, but But mind that BCS, they secrete more testosterone hormone, and actually testosterone make their muscles much better. You know, this is a building a block for building hormone for muscles.

Scott Benner 52:42
If I told you my daughter has a bit of a deeper voice, that wouldn't surprise you, then, like, if she has PCOS,

Speaker 1 52:50
you have to measure the three testosterone level. That's the most important point, and then find the reasons. Maybe the testosterone is not just coming from the others. Maybe some other reasons for higher tests.

Scott Benner 53:03
Okay, okay, this is just the thing that happens. Like I said, I talk to a lot of people, and this comes up a lot with women with who have diabetes, or people who have it in their family, and they're talking about their kids or their, you know, sisters and brothers and things like that. Siblings like, I see the same stuff coming up in conversation. This probably is apropos of nothing in our conversation, but the frequency in which someone with type one diabetes tells me they also have a bipolar person in their family is pretty significant. And I don't know if that has anything to do with anything or if it's just

Speaker 1 53:38
random. Yeah, a lot, you know, if we go to the the whole issue of the causes for obesity and hormonal and neurotransmitter changes and so on, you know, we can spend, you know, 345, hours really, because, you know, I wrote many chapters about obesity in mid e medicine, Even textbook, Sister textbook of medicine, and we are explaining a lot of a lot of stuff, but there is a lot that need to be be done. But let me explain you one, one simple thing. Do you know how many hormone and neurotransmitter controlling your body weight in your brain? I have no idea. 34 hormone and neurotransmitter. 34 and it is a very delicate balance. It's like a web all interlaced with each other. So neurotransmitter that related to mood swings and reward system, there is very small, tiny area in the brain called the ventral tegmental area. You know very, tiny area. They know that very tiny area is called the reward center. Reward center is rewarding you for any behavior that you do, so if you are not addicted to anything to make that area happy. The best addiction and the easiest addiction is addiction to food. Okay, a lot of people start to work on blocking the hormonal aspect in the brain, like endocannabinoid receptors. People kill themselves during the study, really, they get severe depression, and they ended up with committing suicide. You know, the brain is very delicate in relation to all those mental issues and all the psychological issues and body weight in the same part. And that, for that reason, many of the major anti psychotic medications, the major one circle and the bricks and the cost significant to again, significant to again, even we will develop diabetes because, because they work on the appetite center, open your appetite to the maximum, okay, antigenic and the significant amount of food, and again, significant weight. So there is interaction all the time between six hormones. For example, you know, melanocortin pathway, which is responsible for skin. Do you know, if you block that bus way, or you stimulate that bus way, you can change the body weight significantly up and down. You know, there is a lot this is a web interaction in that web has to be very delicate, so we are lucky to have a hormone that's relatively safe and working on the appetite without damaging a lot, but still, psychological issue can occur in that scenario as well. How

Scott Benner 56:37
far do you think we are from glps Being a thing of the past, and what you're discussing being the way that you manipulate your body to do what it should be doing. It

Speaker 1 56:46
has to be on the periphery. It has to be with medication that makes you lose weight and preserve the muscles, okay? And there is actually medication in research now that does a job. It's called the myostatin inhibitor, or active in inhibitor. It actually makes the body fat goes down by 20, 30% and the muscle must go up by four or 5%

Scott Benner 57:08
How come that one didn't take off? It

Speaker 1 57:11
is about, it is about what is called the BMA group map, and it is infusion every month. And you know, one of the big companies now got that medication to combine it with GDP one, wow. What's it called? Again? Pima group app. Pima group app, thank you. And it is a monoclonal antibody. Sorry

Scott Benner 57:29
about that. I'll try it better. I'll just say I'm of the opinion Life is short. My body was not doing what I needed it to do to have a long life. And then I have to tell you, like, I really started doing this, like, these are not things I would have normally done till I saw the end of my mom's life, and I thought, I can't let that be how the end of my life goes. Like I'd have to try something. And this is what was available. My point is, if something better comes along, I would certainly be open minded about it. Can I ask you if you could give me some advice? I've been making this podcast for 11 years now. Can you tell me about a couple of things that are coming along that I should be paying attention to and having more conversations about? Besides what we've talked about now,

Speaker 1 58:14
it is definitely we need to understand exactly how the mechanism for weight loss, because this is not even touch it in our conversation, how we can do a multi disciplinary approach for weight management. And we have been doing it for, as I told you, for very, very long time since 2005 and do you know what b will up till now? Are maintaining weight loss? We publish data on five years, 10 years, and we resented that. And the American Diabetes Association for 15 years, and they are still maintaining 8% weight loss. So actually, multi disciplinary, which is proper nutrition, balanced exercise program and Cognitive Behavior modification and medication adjustment, by the way, for people whose diabetes during weight loss, there must be an algorithm for medication adjustment and then good education. When we do that, it is very expensive, but it works very, very well. And people can maintain weight loss for very long duration, but people just take it very, very simple, I will cut my caloric intake, and I will lose weight. This is a commercial way that commercial weight loss, that can end up with people recycling and recycling and recycle. And when you take GLP one, you are in catch catch 22 if you stop the medication, you will gain all the weight back, right? If you continue the medication, you continue to lose muscle mass. So you have to understand very, very well. And this is advice now that intake of protein is very important with those medication strength exercise is very important, and especially high muscles, quadriceps, same string, gluteal muscles, those are the muscles that get weaker and weaker. So I usually ask my brain. Chance take more protein, more animal protein, in a very efficient way. Or you can even take some shake that has protein, especially the I had a shake liberal diabetes, yeah, and do 2030 minutes of strength exercise every single day. And if you don't do it, don't take the medication you need to do 2030 minutes of strength exercise, especially with your soy muscles. Elliptical, against the resistance. Stationary bike against the resistance, squatting, stretch band under your feet. Rowing machine. Squat is quiet, yes, would a rowing machine help? Rowing

Scott Benner 1:00:35
for rubber? Oh, that's for more rubber and lower

Speaker 1 1:00:37
that's absolutely fine, okay. If it is against the resistance it will be. I'm not all looking for a speed. I'm looking for, yes, muscle action.

Scott Benner 1:00:46
You can't see this because I have a green screen, but I'm putting my hand on a bike. My office is making this podcast a bicycle to keep my legs strong. And if I'm being honest with you, a pet chameleon that's over there that you can't see Perfect, that's all to watch you need keep me relaxed. Yeah. Oh, this is, this is fantastic. I really appreciate this. Let me ask you, like, a question that I think people are wondering, we hear so much that it's the food. Like, are foods bad food? Like, you'll hear people say, like, oh, I went to Italy and I ate pasta and it didn't make me sick, but I eat pot. Like, is our food inherently causing this? Or is it just speeding it up? Like, what is it about Americans in general that that puts us in this situation?

Speaker 1 1:01:29
There are two problems in the in the US, you know, and we did tons of research and nutrition. Let me just to make it very clear, high carbohydrate intake, this one big problem, process the food is another big problem. Okay, if we eliminate as much as we can both, you know, process the food, any food you have in a refrigerator, processed or even minimally processed, you have to avoid whole food is a way to go if you need healthy eating. And then carbohies, and you have three major carbo problem, sugar, whatever, added sugar in dessert, in juice, in whatever, any sugar, wheat flour products, bread, basta, beets, bread, so bagels, P and peas, right? Starchy food like potato, rice and corn okay. If you cut those significantly down, you'll find significant with weight loss and soft drinks that has high sugar as well. So usually, when I tell people in my practice do that, say, Okay, what we eat. Vegetables is okay. Fruits are okay, legumes are okay. Bees, beans, whatever. And then dairy products are very, very beneficial all kind of dairies, eggs, chicken, fish, lean meat, Turkey, dark chocolate, even I have no problem, right? Tea, coffee, cinnamon, you know, there is a lot that people can eat, but not just a low nutrition. Sugar, for example, is just empty calories. There is no nutrient. Nutrient effect, right? It doesn't have any macronutrients or any any value. Would you

Scott Benner 1:03:10
think that I should take as low a dose of GLP as possible as long as I'm not gaining weight? Like, does the dose matter? Like, should I not stay on a higher dose if I'm not trying to lose weight? I'm not just talking about me. I'm talking about me. I'm talking about people in general. Like, should they titrate down to where it's working? But not as much as,

Speaker 1 1:03:27
yeah, you got it. You have to be, if you would like, maintenance, and you don't need to regain weight back be on the main the minimal dose that suppress your appetite, and more the state, is suppress appetite. You don't have to have what, you know, 100% suppression, because, you know there is tolerance to this medication. You need more doses and more. By the way, we don't know the ceiling of those medication you know, like, for example, semaglutide, oral revulsus. You know it is in the market, four, seven and 40 milligram, but the company is testing now, 2590 or 100 or 75 milligram. So they are testing, we don't know what is a ceiling for those medications.

Scott Benner 1:04:08
Rebels is an example. They're seeing what's happening with the injected and they're thinking they can maybe get that pill to a point where it's in pill form and helping people.

Speaker 1 1:04:18
It will not work with I don't think that will seem like, look like I guess. But there are other medication coming in the future in oral format, synthetic, non peptide, small molecule, that will cause significant weight loss and improvement in diabetes as well. And this will Bush away all the injectable, yeah, that's good. I don't think that injectable will be the future. They will be only for people with very, very high BMI, but oral will will come in the future. And the prism, how

Scott Benner 1:04:47
long do you think for that next year? No kidding, that's awesome. I actually told my daughter the same thing, as odd as it might sound to some people, my daughter has a fairly significant needle phobia. It's pretty traumatic. Or to have to do this every week like she does Okay, putting on her insulin pump and her CGM and everything, but she's been banned with needles since she was little, and she struggles through it because she sees how much it's helping her. And I kept telling her, I'm like, Look, I think very soon this oral medication, I think it's gonna do the same thing, and you can get off of this. So it's it's comforting to hear you say that too. Thank you. Is there anything I haven't asked you about that I should have? I actually think I could talk to you all day, but I assume you have a life to get back to. It's wonderful that we've met. I'd love to invite you back on if you ever have anything else you want to talk about. This was fantastic, but anything we didn't talk about,

Speaker 1 1:05:34
we need another podcast to talk about nutrition. Yeah, because we didn't, we didn't spend enough, enough time talking about nutrition. Those nutrition, you know, people start to understand the nutrition and the history of nutrition, and how this stuff changed over time, and why we're eating what we're eating right now. But you know, this is very important. Maybe, you know, it's a very, very big topic to discuss.

Scott Benner 1:06:00
I'd be happy to also, let me tell you that. I guess you'll be happy to hear that just this morning with the nutritionist, who's also a CDE and a 35 year type one that I do some podcast episodes with. We were just talking this morning about how the next series we're going to do is about nutrition. We're going to do a whole series about it. I'd love to do an interview with you and fold it into the series, that'd be awesome. Absolutely thank you so much. All right, I'm gonna say thank you for now, because this was absolutely terrific. Ask you to hold on for one second, and then I'll set something up with you for something else. Hold on one second. Thank you

Unknown Speaker 1:06:33
again. Okay, thank you. You

Scott Benner 1:06:44
if you'd like to wear the same insulin pump that Arden does, all you have to do is go to omnipod.com/juicebox, that's it. Head over now, and get started today, and you'll be wearing the same tubeless insulin pump that Arden has been wearing since she was four years old, touched by type one is hosting their very first steps to a cure walk. And you can register right now to participate. Touched by type one.org Go to the Programs tab, click on Steps to a cure and sign up today. You can sponsor walk or volunteer. Check it out.

Are you starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group, just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 I want to thank you so much for listening and remind you please subscribe and follow to the podcast wherever you're listening right now, if it's YouTube, Apple podcast, Spotify, or any other audio app, go hit follow or subscribe, whichever your app allows for, and set up those downloads so you never miss an episode, especially an apple podcast, go into your settings and choose, download all new episodes. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

Please support the sponsors

---

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate