Nataliia Sanzo, RD, LDN: 0:00

Hi everyone. Today on Hashimoto's Nutrition Rx, I'm thrilled to have Isaac Palman, a registered dietician and the founder of the Palman Institute. Isaac is a recognized expert in blood sugar regulation, insulin sensitivity and functional nutrition. With years of expertise helping clients optimize their metabolic health, he brings a science-backed, personalized approach to managing chronic conditions and enhancing overall well-being. Isaac's insights into balancing blood sugar, improving thyroid health and addressing underlying imbalances are transformative for so many of us looking to take control of our health. So in this interview, you will learn how blood sugar regulations affect your thyroid health and autoimmune conditions like Hashimoto's. Isaac will explore and share advices on managing blood sugar, reducing inflammation and improving insulin sensitivities, tools that will help you support not just your blood sugar but your thyroid function as well. You will discover how stress, circadian rhythm and even trends like CGM can play a huge role in the balancing of your energy, improving symptoms and taking control of your health. So, without further ado, let's dive into this conversation, isaac welcome.

Isaac Pohlman, RD: 1:32

Yeah, thanks so much for the introduction, Natalia. It's great to be here.

Nataliia Sanzo, RD, LDN: 1:35

Yes, we're so lucky to have you. Thank you for dedicating a whole hour to us, so I'm so excited. We have so many questions. I have so many questions from myself from just being, as a registered dietitian, working in Hashimoto's space, but I also just this frequently asked questions that I get from my clients and I hear on Instagram. I just pile them all up, gonna throw them all at you. Everybody's buckle up Now, Isaac, before we get started. Throw them all at you. Everybody's buckle up Now, Isaac, before we get started. I would love to start by hearing about your journey. What led you to become a registered dietitian and why did you choose to specialize in blood sugar management?

Isaac Pohlman, RD: 2:16

Yeah, I think, natalia. It started for me in high school very early. I was 15 years old and I was at that time an athletic, energized teenager who seemingly was on track to play like college soccer that was. I was at that time an athletic, energized teenager who seemingly was on track to play like college soccer. That was my specialty at that time. And then fast forward eight years later and I'm chronically fatigued. I'm just being diagnosed with type one diabetes and I'm full of symptoms and so quite a big, stark contrast within just a few years time. And I just made it through a bunch of symptoms during my undergrad and I had low testosterone and low thyroid labs, I had chronic acne and food allergies and sensitivities, and so I just made it through all of those different pieces and now I enter grad school at University of Michigan because I was inspired, basically based on that progress that wow, this is super interesting. I learned a lot. I was able to improve on that progress. That wow, this is super interesting. I learned a lot, I was able to improve a lot in a short period of time. I want to pursue this as more of a master's degree and get my registered dietitian license, and so during that time my second year I started noticing some weird symptoms and I started feeling really thirsty, and that was really out of the ordinary. Normally, I wasn't chugging down gallons of water a day, and it just shifted in the spring of 2017. And then I started peeing frequently, like 20 times a day. I'm like, wow, there's something off here. And then I started tracking my calories and I was eating about 3500 calories a day, but losing like 20 pounds within the course of two weeks, right. And then I felt extremely tired after meals, especially with carbs. And as soon as I started connecting those dots, I was like, wow, do I have diabetes here? What's going on? And I tossed it up to stress at that time because I figured there's no way.

Isaac Pohlman, RD: 3:56

Well, a week went on, went by, and I started getting more and more extreme symptoms of that nature, and I thought, yeah, I got to check this out. And so I purchased a glucometer, which is a monitor to check your blood sugar, and the next morning I checked it it was a 275. And so normally, that is supposed to be between 70 and 99. And so by that point, I knew I probably had some form of diabetes. It's just a matter of hey, is this type one or type two? And I had a family history of type one, so that was probably what I was leaning towards and obviously, stereotypically, those are a little bit leaner, tend to be type one. So I got the antibody test a week later back from the doctor that said I indeed had type one.

Isaac Pohlman, RD: 4:36

Now at that point I was feeling very defeated. I've just been through all these symptoms, I just made it my way through that and now I have to deal with this again, and so momentarily, I think, I felt bad for myself, like being in that position, like not catching a break. But that quickly shifted into wow, I have such an opportunity here, because not only do I have a nutrition background, but I have a holistic background in solving problems that I just went through. And then now I have this type one diabetes, and so it gives me credibility, especially from a blood sugar perspective, that I'm in it with you. And so that's what really shifted my perspective to blood sugar.

Isaac Pohlman, RD: 5:09

And I started off with an A1C of 9.7. And through the things that I've learned within that three-month period of time, I got it down to 5.6. And that wasn't doing any fasting, that wasn't doing any keto, low-carb diets or taking an excessive amount of insulin. That was just with root cause, foundational approaches, and I thought, wow, if I could do this with myself, I can definitely help other people. And so now to this day, we have formed the Pullman Institute, where we have a total of seven practitioners, where we work with people around the world that struggle to eat carbs without having a spike or a crash in their blood sugar to eat carbs without having a spike or a crash in their blood sugar Amazing.

Nataliia Sanzo, RD, LDN: 5:51

Thank you so much for sharing your personal story. It makes I don't think it's necessary to have a certain disease and to relate to your patients, but I think it helps. I have Hashimoto's and I only work with people with Hashimoto's. I can relate, truly relate, and I'm my own guinea pig and, just like you said, like you learned so much in three months, dropped your hemoglobin NYC in what half? Almost right From nine and something to five to a healthy range. I think it's such an important part of journey and I'm so glad that you dedicated your learning and everything that you studied in school you dedicated to helping people just like yourself. I think it's a big part.

Isaac Pohlman, RD: 6:31

Yeah, yep, and that's one of the first things that many people will say to me is hey, I wanted to sign up with you guys because you and a lot of your practitioners have type one or have been through similar experiences. And having that personal connection I think is very important and I think, natalia, you just highlighted that too for yourself as well.

Nataliia Sanzo, RD, LDN: 6:48

And actually not to jump through the questions, but I had to wear a CGM continuous glucose monitoring device on myself. I don't have type one or type two, but I needed to know how to relate to my clients that do use that. So that's just a little side notes, things we do to relate to make sure that we are the best practitioners we can be.

Isaac Pohlman, RD: 7:11

Yep 100%.

Nataliia Sanzo, RD, LDN: 7:12

So now, why should everyone be concerned about blood sugar regulations, Regardless? What if people don't have type 1 or type 2 diabetes? Why should we still be concerned about blood sugar regulation?

Isaac Pohlman, RD: 7:24

Yeah, that's a great question and, truthfully, I think that's the stereotypical message If you have diabetes, you're going to be checking your blood sugar more frequently, and that's definitely true. Like people that don't have diabetes, I don't expect them to be checking their blood sugar or slap on a CGM necessarily. So there is some truth to that that there's more emphasis with diabetes. But, you know, what's also true is that people who do not have diabetes also have blood sugar, right, that's also a thing, and so when we look at blood sugar regulation, what I look at it as is our proverbial gas tank, similar to how our car operates on gas or electric these days. That's their fuel source. We're our fuel source that we run onto that.

Isaac Pohlman, RD: 8:06

For me to conduct this podcast, for you to sit here, we run off of blood sugar. That's our immediate fuel source, and if there's discrepancies with that, where it spikes up or it drops, that's where it starts to create chaos and where we can lean into that a little bit more is what occurs at the cell level. So let's just say that you had a high blood sugar, right, your blood sugar is spiking up, maybe into the 200s. Well, you have a lot of energy within your bloodstream, but that energy is not making it to the cell level where we really need it, right, so there's an energy crisis. Same thing when you have a low blood sugar drops below 70, right, you're maybe feeling a little bit more shaky, dizzy. There's not enough in the bloodstream to draw from and therefore there's not enough at the cell level to take in either, and so it's a very similar reaction. The only difference between a high and a low blood sugar is what occurs at the the blood level, and so with each case, there's a deficiency in energy at the cell level, which we have a great backup system to help with, so we don't pass away and die, and that's called our stress system, and so stress kicks in. It helps to break down our body's resources that we have for energy, which help to resolve the energy crisis that we have at the cell level.

Isaac Pohlman, RD: 9:21

Now, that can be very helpful, especially in the short term, to get us by.

Isaac Pohlman, RD: 9:25

The problem is that many of us rely on that for far too long, and what happens is we increase that stress on our system, and stress, over time, does a few different things. It inactivates hormones, especially thyroid hormone, preventing us from either producing it or being able to use it properly. It suppresses our immune system and, over time, if we're not able to release as much stress hormones which comes as a result of being stressed for some time we don't get the energizing benefits of it. We don't get the anti-inflammatory benefits of it, at least in the short term, and as a result, we can be more at risk for autoimmune conditions. We can be more at risk for fatigue, for blood sugar swings throughout the day, we can be at more risk for weight gain, right, we can get more risk for any kind of thyroid issue, and so I look at it as energy management, and so if anybody wants to feel at their most optimal self balancing blood sugar should be at the top of their priority balancing blood sugar should be at the top of their priority.

Nataliia Sanzo, RD, LDN: 10:24

I agree with you 100% because blood sugar regulation is the foundation to overall health.

Nataliia Sanzo, RD, LDN: 10:30

It doesn't matter what problems we're talking about type 1, type 2, hashimoto's, rheumatoid arthritis, anything you pick, any disease I think blood sugar regulation it's in the base and the foundation of that because, like you said, it helps maintain energy levels, mood stability, brain function.

Nataliia Sanzo, RD, LDN: 10:48

But when it comes to thyroid health, blood sugar issues can exacerbate thyroid function, especially in somebody with Hashimoto's, where the immune system is already attacking the thyroid and insulin resistance and elevated blood sugar can worsen inflammation which negatively impacts the thyroid hormone production and the whole gland. And, of course, blood sugar imbalance. It triggers, like I said, inflammation, which is already an issue in those of us with Hashimoto's. It's unstable blood sugar can make it harder to manage Hashimoto's symptoms like fatigue, weight gain, brain fog and proper blood sugar regulation supports better energy right, we sleep better and it's just overall symptoms do improve. So foundation, we're setting up the foundation right, 100%. Now, to give our listeners a clear understanding of what to look for in their own health, can you talk about some classic signs that our blood sugar needs attention? I know you mentioned frequent urination, thirst, anything else that people should look for, even if they don't have type 1 or type 2 diabetes?

Isaac Pohlman, RD: 12:03

Yeah, 100%, and the way that I look at it, there's two different metrics that you can look at. You can look at the numbers, which is where most of the attention gets right your A1C, your blood sugar. What I often find that isn't tested, though, especially in terms of numbers, is like a fasting insulin, and that is particularly missing, especially if someone has signs of insulin resistance, which we'll get to in a second, but has a normal A1C. That is often not tested, and so that is one category that you can look at getting those numbers checked of blood sugar before or after meals, in addition to A1C and fasting insulin. But the other category that I think isn't talked about enough is what I call biofeedback, which would include all those symptoms that we touched on already in a little bit more, because biofeedback are basically the signals that your body's giving you whether something is working or not, and the more that your blood sugar is dysregulated, the more negative signs of biofeedback that your body will display, and so one of those is feeling tired immediately after eating, especially if that meal has carbs. Right, you're feeling sleepy, you take a nap like a food coma sort of feeling that will typically be the case. We often see that with afternoon sleepiness, so two, three, four o'clock which we're coming up on. For many people that's when they need like a coffee or need like a snack to get that boost again. So we see that quite a bit.

Isaac Pohlman, RD: 13:19

For those that have more insulin resistance, we see weight gain around the center of the body, especially around their abdomen. We see skin tags. We see like a dark line on the back of their neck at times as well. We also see and this is just depends on the person, but we also see some people that will crash after they eat and so that can be called hypoglycemia or reactive hypoglycemia, where their body is just overproducing insulin and initially that can cause your blood sugar to crash and so they might feel dizzy, lightheaded, shaky after eating and it might have to eat like frequently throughout the day, like every one to two hours, for them to feel okay.

Isaac Pohlman, RD: 13:58

We also have folks that have appetite issues either way, where they won't feel hungry at all or they'll feel hungry every one to two hours and have to constantly eat throughout the day. So we see that. We see those that wake up in the middle of the night, like you said, that need to pee frequently one, two, three times during the middle of the night. We have those that don't handle stress very well like anything minor they really react to and it really bothers them Moody, and we also see clients that have higher blood pressure, higher cholesterol as well. So those are a few different ones. Now, as far as conditions we often see, like autoimmune conditions rise, we often see hypothyroidism, hashimoto's tend to rise as well and, of course, the longer that exists, forms of diabetes as well.

Nataliia Sanzo, RD, LDN: 14:43

So you named a lot of signs and symptoms to watch out for. I think this is like you named all of them. It's so generalized and it can apply to any other disease. So we have to, so to be, always listen to our body right To figure out, and I always say test, don't guess. So if you have any, if you're watching or listening to us, if you have any of the symptoms that Isaac just mentioned, make sure you get at least your blood sugar checked, because I think it's one of the most inexpensive tests and the quickest one. To come back Now, all those signs and symptoms are indicative of insulin resistance. Isaac, can you explain a little bit what insulin resistance is and how can we support our bodies to utilize insulin properly?

Isaac Pohlman, RD: 15:33

Yeah, of course. Broken down simply, it's the inability to use the hormone insulin. That's all it is. And insulin is a hormone that helps your body lower blood sugar, and essentially you can think about it as like being the mailman it delivers, just like a mailman delivers mail from the post office to your mailbox. Insulin delivers carbs or energy from your bloodstream to your cells so they can get it and use it and you can feel good, right.

Isaac Pohlman, RD: 15:57

Well, when we have insulin resistance, what ends up happening is your body is really relying on insulin to manage your blood sugar, and there are a million ways to manage blood sugar. Insulin is just one of those hormones that helps us to do that. Now, if we're not able to utilize other resources outside of just insulin, our body has no choice but to release a lot of it to take care of that blood sugar spike that we're getting, because it always wants to keep things in homeostasis, in other words, within balance, and so it will release a lot of insulin to be able to do that. If we don't have resources to help, and when our body is releasing more insulin, it can help to temporarily take care of that blood sugar spike. So our blood sugar stays within normal range. But over time especially as we don't have those other resources and again, we can get into that maybe later on what ends up happening is we rely more and more on insulin to regulate our blood sugar, and over time the cells of our body start to become desensitized to that, meaning that it doesn't work as well. And so imagine like you have a lock in a key and you've put that key in that lock over like 2,000 times, right? That key probably deforms, maybe a little bit, it doesn't look as well, or maybe it doesn't even fit within the lock, and that's similar to insulin resistance. Essentially, that insulin is no longer working because the body has been so bombarded with the sheer amount of insulin within your body, right, and so, as a result, the energy or the carbs within your bloodstream is not delivered from your blood to the cells where we really need it, and therefore blood sugar starts to rise and it's really stubborn to get down, unless you improve the variables that help your body rely less on insulin to manage your blood sugar, right.

Isaac Pohlman, RD: 17:38

And so, as a result of insulin resistance, we see people that have higher blood sugars, particularly in the morning at first, and then after and before meals, we see large amounts of insulin, like a fasting insulin. We'll see that pretty high, typically significantly above 10. We'll see blood sugars significantly above 100, and then A1c above 5.7. And so we have the numbers like we just talked about, and then we have the symptoms. Some people are really aware, some people are really body aware.

Isaac Pohlman, RD: 18:05

I like to say men are a little bit less body aware and so they might not notice symptoms, but they often go into a lot of the symptoms that we just described Mood disturbances, brain fog, fatigue, sleep stress issues, low ability to tolerate carbs, and then something like weight loss resistance or even like fertility issues. We find a lot of that within our practice as well, and so ways to help to take the pressure or the strain off of insulin will help your body become less insulin resistant, and so that could be something as simple as walks. That could be something as simple as finding dense, nutritious meals that contain a lot of good vitamins and minerals that help your body process those carbs better, so you're not releasing so much insulin. As a result we have one of the biggest things is circadian rhythm balance, which we can get into more detail too, when your circadian rhythm or the hormones of your body is misaligned, you're automatically going to be more insulin resistant and more carbon tolerant, so that is a huge one.

Isaac Pohlman, RD: 19:07

And then, across the board, if you have blood sugar issues, you automatically have stress issues, and stress. We can define it in a lot of different ways, but essentially it's your body overproducing stress hormones in response to your environment, and you could be really stressed. You'd have a lot of things going on, or you might be thinking you don't have a stressful life at all, yet your body's still overreacting to your environment. And so what? I look at that as how can we improve your stress response so we're no longer secreting so much stress hormone in response to your environment? And when we can do that, we're less reliant on insulin to manage our blood sugar and more reliant on other levers to be able to do that.

Nataliia Sanzo, RD, LDN: 19:45

Thank you so much for breaking down exactly what insulin resistance is, what signs and symptoms to watch out for, and, especially if you're male, you need to be a little bit more mindful of what your body's trying to tell you. So, since you started talking about food and how to minimize the insulin resistance right and increase insulin sensitivities, how do you feel about the classic approaches to blood sugar regulations that often recommend completely cutting out carbs Like why might that approach miss the mark and potentially worsen the thyroid health?

Isaac Pohlman, RD: 20:23

Yeah, yeah, I think this is a huge problem. That has grown, I think a little bit, especially with the rise of the CGM movement, which I think is great. People can biohack all they want and if that's up their alley, great. I think it's put so much pressure on to get perfect numbers. Or if we're using the CGM, a straight line across the whole day and if we look at anybody that's even metabolically healthy, that does not have any blood sugar issues, even they will not have a straight line, and that's not a bad thing, it's a very normal thing. And the reason why that's the case is if we look at other measurements within the body let's just say blood pressure and heart rate. If I were to start doing jumping jacks and pushups right now while I'm talking to you guys, I would be out of breath. And when we look at that a little bit deeper, we know that my heart rate is rising. We also know that my blood pressure is rising and there's a good reason why that's happening. It's to facilitate blood flow to my muscles that are working, that are working out, and back to my brain, so I don't pass out when I'm doing this workout. But if we looked at that in the vacuum and said, hey Isaac, wow, when I'm doing this workout. But if we looked at that in the vacuum and said, hey Isaac, wow, your heart rate is really going crazy or your blood pressures is hitting like cardiovascular risk numbers, if we looked at that in a vacuum, we might see that, wow, this is pretty serious not realizing it that during exercise it's actually beneficial. That comes up.

Isaac Pohlman, RD: 21:43

Now how could we look at that from a blood sugar perspective? What could possibly be the benefit of a blood sugar rise? And I want to make sure I preface this I'm not talking about like a blood sugar spike where we're going into 200s, 300s, 400s. I'm not talking about that. But I'm talking about a small rise and a fall down. And the reason why that's important is because it allows your liver to soak up the extra glucose, similar to a sponge with water.

Isaac Pohlman, RD: 22:08

Right, it soaks it up, and that liver plays a huge role in your blood sugar regulation as well as your overall health, for a few different reasons. When we have stored carbohydrates in our liver, which is called glycogen, it lowers stress on the body because we don't need to go to that stress response that we talked about before. We can literally utilize the energy that we have in our liver to be able to take care of energy crisis, which is great. So it takes stress off the body. Number two it helps to prevent low blood sugar from happening, which also helps with regulating stress.

Isaac Pohlman, RD: 22:40

Number three, and probably one of the most important things in the entire body, is it helps to activate thyroid hormone, and that's one of the most important reactions that we see body-wide, because thyroid hormone, the active form, impacts every single cell in the body, the health of every single cell. So, if you think about every single cell, that's mental health, that's feeling calm, feeling less stressed, less moody, right. That's physical health digestion, energy, sleep. That's lab values A1C, blood sugar, blood pressure, thyroid antibodies right. So it helps to regulate all of those. But if we're just siloed, thinking and saying, hey, I have high blood sugar, I have blood sugar issues, carbs raise my blood sugar. Therefore, I should just get rid of carbs, we're missing such a huge piece that oftentimes ends up backfiring on people, especially the women that we work with, where they end up maybe helping their blood sugar temporarily, but they end up making 10 other things worse because they're just focused on one metric.

Nataliia Sanzo, RD, LDN: 23:38

I agree this narrow thinking either you doing a CGM or just checking your blood sugar through the fingerprint. It's micromanaging and for someone without type one diabetes or uncontrolled type two diabetes, those CGMs are, I think, useless. They can actually lead to a lot of disordered eating. People develop disordered eating and I could see it when I was wearing it for two weeks, just so I could relate to my clients. Yes, I had the spikes and I hate this word spike. It's just an increase in your blood sugar. That it's normal. Your blood sugar increases after exercise, during stress. It's all normal reactions to keep, like you said.

Nataliia Sanzo, RD, LDN: 24:17

I love the examples that you brought up. To keep you alive, if you need to run away from a lion, like back in the days, it gives you that adrenaline rush and all that stuff. And the most important thing you mentioned that is related to my community Hashimoto's. It activates the T3, the active thyroid that goes in your cells and liver is one of the most major organs for that activation. So that's why a low-carb diet is not recommended for someone with Hashimoto's. It's because of this T3 upregulation and all that stuff, because the last T3, so you have all this T4 hormone. It either converts into T3, or it downregulates to reverse T3, which is a break for your system, for your metabolism, and it exacerbates all the symptoms. So why do real quick? Why do we? People with Hashimoto's tend to develop type 2 and type 1 diabetes. What's the deal?

Isaac Pohlman, RD: 25:17

here yeah, yeah, this is such a big one and it can be either way Like Hashimoto's can increase the risk for insulin resistance in type 2 diabetes or even type 1, for example, and vice versa, and I can walk through both of them and just give you a small example of why that can be the case. If we look at something like Hashimoto's, what we know especially when it's not controlled or regulated, we know we tend to have a little bit lower metabolism. We're in metabolism the way that I define it is the ability to convert the food that you eat into energy. That's it. And if we're not able to do that as well, the carbs that we eat are in the bloodstream. They stay there a little bit longer. And when they stay there a little bit longer, well, we're more reliant on insulin to regulate that because, remember, the body doesn't like big discrepancies in blood sugar and wants to keep it balanced. And so over time, as that happens, more and more we become more reliant on insulin. And then that's no bueno, because if we're more reliant on insulin, we're going to become more insulin resistant over time. If that's not addressed through lifestyle and nutrition. The more blood sugar swings that we do have, the more of again going back to what we talked about before the more of that energy crisis that we have. We have a lot of energy in the bloodstream, not enough at the cell level, and so our stress response gets activated. Right Now, we become more insulin resistant, those blood sugar swings become bigger, and if we look at something like type two diabetes and insulin resistance, one of the biggest drivers of that is stress, and so that is particularly one of the main reasons why someone with Hashimoto's could develop something like insulin resistance or type 2, because the thyroid hormone is such a big driver of helping your body process food and carbohydrates and in the thyroid space.

Isaac Pohlman, RD: 27:02

A good person to look into, if viewers are interested, is a guy by the name of Broda Barnes. He was a physician way back in like the 1950s or 60s I want to say mid 1900s but he was revolutionary in the way that he helped people with thyroid conditions, whether that be something like Hashimoto's or like hypothyroidism in general. So he showed that when people had prediabetes or type two was fixed when they improved their thyroid health, and then vice versa, if we have type 2 diabetes and we have more of the blood sugar swings. It's kind of the same thing.

Isaac Pohlman, RD: 27:35

Where, at the cell level, we have the energy crisis, stress increases, and when stress increases especially from an autoimmune perspective one, we get the suppression of the immune system, so the immune system isn't working as well. Cortisol, initially, can be something that can be quite anti-inflammatory. That's why people use it as a steroid, for example, for autoimmune conditions, like it has some benefits, but over time, if our body isn't able to produce as much cortisol which happens when you really exhaust your adrenal glands now, we don't get the anti-inflammatory benefit, and so we have the combination of a suppressed immune system and then high inflammation, which are big triggers for autoimmune conditions like a Hashimoto's or a type 1 diabetes, and so both of these are intrinsically connected. If you have one, you're more than likely to have some semblance of the other.

Nataliia Sanzo, RD, LDN: 28:26

Absolutely 100%. And I think you mentioned this inflammation right, and we're talking about chronic inflammation and chronic stress and since Hashimoto's is an autoimmune condition, meaning that the immune system attacks the thyroid, this chronic inflammation can affect other organs and systems, including those insulin-producing cells in the pancreas right, and it disrupts the glucose metabolism, increasing the risk of insulin resistance and type 2 diabetes, and I see it all the time. I would say probably 50% of my patients have type 2 diabetes.

Isaac Pohlman, RD: 29:01

Yep, I believe it.

Nataliia Sanzo, RD, LDN: 29:03

Very, very common. That's why blood sugar regulation is like we talked about earlier, is the foundation of all medical nutrition therapy approaches that we, as a registered dietitian, are licensed to implement. So I'm so glad we're having this conversation touched on non-food contributors to blood sugar dysregulation. Would you say it's stress, right, sleep and lack of exercise. Can you elaborate on those things?

Isaac Pohlman, RD: 29:40

Yeah, there's big ones. I would actually, in terms of hierarchy, I'd probably put stress first, and when I say stress, what I like to lean on a little bit more is your stress response. It's not necessarily always just external circumstances, because you can have some crazy external circumstances and maybe have four kids at home and be working and have lots of extracurriculars. But if you have a resilient enough routine that's building up that resilience for you where you can tolerate that, you might not have any issues with your blood sugar, your health because you have this buffer at play. Not have any issues with your blood sugar, your health because you have this buffer at play. Now, do most people have that? Probably not, and so that's where stress starts to become more of a difficulty is when we can't tolerate it as well, we start to get more issues, especially when it comes to blood sugar, thyroid health and symptoms as a result. And so what I look at, especially with clients and this is something that really resonates with them is sometimes I just say you don't have a blood sugar problem, you have a stress problem. And how I compare that is if you think about if you guys drive, or viewers drive, you have on your car dashboard, you have an engine light that turns on, maybe when your oil quality is low or your gas is low. Right, it's a signal that something is off, and that's how I look at blood sugar. It's a signal that something is off, but it's not the problem in itself. There's something underneath it, and stress is one of those pieces, and so what I look at for clients is how can we build a routine in a way of eating that really helps you build up that resilience to stress, so that when you do encounter it, when you do have stressful days, when you do have a bad day at work or a bad day at home, that it's no longer driving the reason why you have blood sugar or thyroid issues. So that's number one. Number two, I would say, is actually circadian rhythm, and circadian rhythm, if you guys aren't familiar, is really the group of hormones that your body releases in response to light or darkness outside, which is crazy to me to think about. Like lighting has the ability to influence the hormonal profile of your body, like it's amazing.

Isaac Pohlman, RD: 31:32

And when we look at something of like circadian rhythm hormones, there's a few that come to mind, one of which is cortisol, and so much of the talk around cortisol. It's a bad thing. Well, it is anti-inflammatory, at least at the beginning. And two, it helps to wake us up, help us to give us that energy, it helps us to be alert, especially in the morning, and so it's good that we actually have enough of that. Now, if we don't have enough, we tend to feel really crummy in the morning, like we just slept a full night's sleep, and we feel like we need to sleep again. So if someone has low cortisol, that can be problematic. Same thing for the end of the evening.

Isaac Pohlman, RD: 32:09

We need to produce something called melatonin, and many people might be familiar with that, with the sleep aid that it can bring, and many people do try to take it as a supplement. I don't think that's probably the best strategy, but we produce it if our circadian rhythm is within balance. The problem is if we're not able to produce that enough and when that happens as a result of, often the lighting environment that we're in, maybe not going outside enough, maybe not going outside in the morning throughout the day, and or being exposed to too much artificial light at the wrong times, especially at the end of the night. Maybe we're on screens like this, maybe we're on our phone watching Netflix, whatever the case may be but your body is getting now a signal that it's hey, it's 11 AM in the morning, it's 1 PM in the afternoon, right, even though it's actually 11 PM. So we're getting signals of daytime even though it's nighttime.

Isaac Pohlman, RD: 33:00

And that's where things get a little bit confusing, because, as a result of that, our body's not able to produce as much melatonin, and that melatonin helps us to be ready for sleep, helps us to be more drowsy, and so if we're not producing that, we automatically produce more cortisol and again going back to that stress response.

Isaac Pohlman, RD: 33:18

That's not good, and one of the interesting things that I found with people that have circadian rhythm problems is they often have, of course, sleep challenges, but they're often more insulin resistant, they're more weight loss resistant, they have appetite issues, energy issues and thyroid issues, oftentimes that conglomerate, and I'll find, when maybe they haven't eaten in seven, eight, nine plus hours yet, their blood sugar in the morning is rising significantly beyond 100.

Isaac Pohlman, RD: 33:46

And that is a key sign that your circadian rhythm is dysregulated, that your liver is kicking out more glucose in your bloodstream without even having to eat. And so I would say those are the top two when it comes to non-nutrition. Now, the third one would be movement, and when we look at movement especially, there's two kinds and the first one I would look at especially for someone that has like thyroid issues and maybe they're really feeling fatigued and depleted, like a light exercise would probably be most beneficial frequently throughout the day, because it's less intense, it's less depleting and it's less stressful. And it doesn't mean intense exercise is bad, but just for that person I think it can be helpful because it helps to use up extra glucose within the bloodstream. Therefore you're not spiking so much after a meal and so that can be utilized throughout the day. It's something as simple as a five, 10, 15, 20 minute walk.

Nataliia Sanzo, RD, LDN: 34:39

And is that right after a meal, or can we wait?

Isaac Pohlman, RD: 34:43

Good question. Just depends on the person. If you're someone that is spiking significantly after a meal beyond 140, then I would say immediately after the meal, like within 15 minutes. I think that could be good. But if your choice is to either do it at some other time or not do it, I would say absolutely, just do it, like the timing matters significantly less than just fitting it in Great question. But yeah, if it's someone is spiking, I would say close to after meal is as best that you can and ideally if it can be outside, because you kill two birds with one stone. You get the circadian rhythm benefit and then you get the walking benefit as well and, of course, all the stress benefits that walking provides. So we have that. And then we have, like more intensive movement and that's probably for more advanced people that have a little bit less symptoms. Maybe that's been helped and improved and their energy is back. Well, maybe they can dive into some of that where maybe they're looking at sports and maybe sprints or weightlifting, where they're really building some extra muscle. And if we think from a blood sugar perspective, when you have extra muscle you have more real estate to store that glucose instead of it sitting in the bloodstream. So it's huge, and I'll wrap it up with this too, because I think it's really fascinating part of this hypothyroid conversation.

Isaac Pohlman, RD: 35:55

There is a theory called the personal fat threshold and it was a theory produced by a guy by the name of Roy Taylor. He's a researcher in the UK, really brilliant guy, really weight loss or insulin resistant and maybe have some thyroid issues as well. We often look at diabetes as being like this thing that's just to people that are overweight and obese. But the interesting thing throughout my career that I found, especially when I was starting out, I was like wow, I'm working with a lot of overweight and obese people, but they don't have any signs of blood sugar issues. Their insulin looks normal, their blood sugar looks normal, a1c looks fine, yet they have a lot of this weight and this personal fat threshold really helped to explain that.

Isaac Pohlman, RD: 36:40

Because if someone has a high personal fat threshold, they can store a lot of fats underneath their skin and, while as unsightly as many people believe that is, it's less metabolically impactful because it's not impacting their blood sugar. So you can have a lot of weight but not have blood sugar issues. Yet if someone has a low personal fat threshold, meaning they have a low ability to store fat underneath their skin, they can more easily have blood sugar issues than someone that is overweight or obese, and the reason has all to do with not the sheer amount of fat, but where it's stored. If the fat is stored within the pancreas and the liver, the pancreas and the liver don't work as well. Your pancreas doesn't kick out the insulin that we need to regulate our blood sugar, and then the liver kicks out more glucose into your bloodstream, resulting in that rise in blood sugar, and so we get many people that are lean and they can't explain it.

Isaac Pohlman, RD: 37:32

I'm healthy, I live healthy. I'm lean, I'm a normal weight. Yeah, I have blood sugar issues. Well, it has a lot to do with that.

Nataliia Sanzo, RD, LDN: 37:39

Yep, that was me. That's why, when I was wearing CGM, I noticed that my fasting blood sugar in the morning was high and, of course, so it took me about two months to do all this nutrition and non-nutrition approaches to implement into my life to decrease my hemoglobin A1c and my fasting glucose. I don't have a family history of diabetes, but I was developing insulin resistance and I live by the book, I practice what I preach and I was still in trouble. So it's so important to dial in. And since we're talking about a lot of people don't know that they have insulin resistance. What role does the root cause testing play in the fighting or finding hidden imbalances?

Isaac Pohlman, RD: 38:28

Yeah, with insulin resistance, it's interesting. I was actually planning to go a different direction with this, but since you said insulin resistance, I actually go in this direction. There is something called iron overload or iron recycling issues, which plays a huge role in insulin resistance, and we have had so many clients that have had anemia, for example, where they've had low iron and as a result of taking like iron supplements or iron infusions, their blood sugar has skyrocketed, where, instead of normal blood sugar now they have prediabetes or even type 2. We've seen that before, and so iron recycling issues are a huge player that drive insulin resistance, because the extra iron I'm not saying it's bad, because it's absolutely essential nutrient and, within the right balance, we absolutely need it. The problem is when it becomes more in excess of what we need, then it starts to become what's called a pro-oxidant, which means it promotes more inflammation, and the more inflammation that we have in our body, the more that our blood sugar rises.

Isaac Pohlman, RD: 39:30

And, going back into your point that you just mentioned, natalia, when that liver is stored within our liver, or when that iron is stored within our liver, our liver tends to kick out more glucose into our bloodstream, raising blood sugar in the morning, even if we're, of course, a normal weight, and so minerals like that can be super impactful. And we run a series of tests. One is called HTMA. Htma is hair tissue mineral analysis. If viewers aren't familiar with that, that can be very impactful, especially for those with Hashimoto's Howard issues. And then we run something called a blood sugar and monty panel lab, which can look at pieces like iron, for example, that can promote more insulin resistance and blood sugar issues, iron just being one of those pieces more insulin resistance and blood sugar issues, iron just being one of those pieces.

Nataliia Sanzo, RD, LDN: 40:18

It's amazing. Yes, I think it's so important to look to first work with somebody who understands the condition and the complexity of it and can look at things that most people or doctors just non-functional, just conventional medicine doctors don't even look at it. I never even heard of this condition or just this iron overload and recycling in my school in five years of medical school. So it's incredible of how many aspects we need to look at and I would say I would add a GI map stool test to the testing, because research has shown that an imbalance in the gut microbiome, known, of course, as dysbiosis, can negatively affect insulin sensitivity and contribute to insulin resistance.

Nataliia Sanzo, RD, LDN: 41:01

And I think the GI map test well. It identifies harmful bacteria, yeast right, it's other pathogens in the gut that can lead to systematic inflammation and this inflammation can impair, like we said, the body's ability to respond to insulin, leading to elevated blood sugar levels. The GI map can also identify an overgrowth of certain bacteria or fungi, such as like candida and pseudomonas, which is very, very common in people with Hashimoto's, and those two bacteria are linked to insulin resistance and poor glucose metabolism. So I think it's important, depending on if you already have done all the testings the basic panel, I think to look into the stool test. It would be a great insight. I always say this is one of the best investments in your health and you're literally looking inside your gut, inside your health.

Isaac Pohlman, RD: 41:57

If you want to dial in on insulin sensitivity, yeah, I will comment on that with something like SIBO, for example, or candida. Oftentimes, if you look at the research, it's connected to iron issues in part and because if we have iron overload which can, iron can be stored within our guts and so if we have iron there, it's a food for a lot of these pathogenic bacteria that feed off of that and they stick around longer that we have that iron in place. Versus if we can improve the mineral balance, we can improve things in part like SIBO and candida, because they start in part because you have iron issues most likely.

Nataliia Sanzo, RD, LDN: 42:36

So you mentioned iron, right, that's a big one. Are there any other minerals that are important or essential for blood sugar balance?

Isaac Pohlman, RD: 42:45

Yeah, great question. There are a few. Now, if we're looking at blood sugar balance, what I would probably say is one of the more important, and especially for your audience too, is potassium, and potassium is key for a few different reasons. One of the tests that we run that I just mentioned is the HTMA, which is a hair tissue mineralysis test, and with the HTMA, we get a small sample of your hair and we send it off to a lab and since hair follicle is at the cell level where all the action is taking place, it's one of the more important tests that we can run. And after we get that sample back, that hair follicle sample is basically a reflection of the mineral content that your cells have access to, and one of the ratios on that test is something called a thyroid ratio, and a thyroid ratio is the ratio between the mineral calcium and then the mineral potassium, and what we find when clients have a normal ratio, which is around like four-ish, a normal ratio of this, their thyroid works better, but they also have better blood sugar as well, and this can be high for a few different reasons, and when it's high, we tend to have problems with have better blood sugar as well, and this can be high for a few different reasons, and when it's high we tend to have problems with thyroid and blood sugar Number one.

Isaac Pohlman, RD: 43:58

What ends up happening is we can have high calcium, where the calcium on our hair test is really high, which can happen because we're really living on vitamin D supplements when we really shouldn't be taking those. We're taking calcium supplements when we really shouldn't be taking those. We're taking calcium supplements when we really shouldn't be taking those. We have had a lot of stress and trauma in our lives. We see that quite a bit. And then we're having lots of blood sugar swings. We're really reliant on insulin to keep that blood sugar within range. We see that quite a bit.

Isaac Pohlman, RD: 44:25

So we could have a high calcium and or we could have a low potassium, and that could be simply because we're not eating enough we require. The adequate intake for potassium is around 4,800 milligrams, which is quite a bit. So it could be as simple as that, but more often than not we find it could be a combination of that, plus stressors that are wasting through those nutrients a lot quicker, where we're not able to hold on to minerals, and so many people think about minerals as hey, it's a supplement that I got to take. 75% of the work that we find is can you help your body hold on to that mineral more? And that comes through the way that you design your nutrition, the way that you strategically eat throughout the day, to be able to do that.

Isaac Pohlman, RD: 45:08

Because when that ratio is out of balance, what ends up happening is there's a calcium kind of shell that's formed around the cells of your body, at the cell level, and thyroid hormone can't get in as proficiently and glucose can't get in as proficiently. And so if that's not happening, well, no matter how much medication in terms of thyroid that we're taking, it doesn't matter. It's not going to get access to the cell where we really need it to get the benefit. Same thing with glucose Even if we're doing everything right, it's not going to allow that glucose access to the cell, which raises blood sugar. So this can be really impactful. To look at minerals like calcium and potassium even things like magnesium, of course to copper, iron all those minerals are helpful, but for your audience, I think that could be an interesting one to look at.

Nataliia Sanzo, RD, LDN: 45:52

Absolutely. And the fact that people are taking handfuls of these supplements, minerals, vitamins, and thinking that's what they're going to absorb. I always say it's not what you take or eat, it's what you absorb. And with candida and seba and all those chronic gut infections, increased intestinal permeability, we don't absorb all the not just pills that we take, but even the minerals and vitamins from food. So that's point number one I wanted to make. And second that's a second question Can someone like take their hair and just send it to you guys, or do you have to have somebody in person?

Isaac Pohlman, RD: 46:26

Good question. So how we send it out is like test kits, so we will. It's like a little bit old school, so we'll send. It's like a little bit old school, so we'll send it via physical mail. My assistant would rather, and we send it to their address. They ship it out to a lab in Texas that does the analysis for those.

Nataliia Sanzo, RD, LDN: 46:41

That's amazing, I want to do that? I've never heard of it.

Isaac Pohlman, RD: 46:45

Yeah, yeah, it's really interesting. I think it could be, even if you just looked into it for your own patients. The thyroid ratio that we talked about can be really impactful and if you learn to interpret it. It takes some time to be able to interpret it well, but I think it can be very impactful, especially for those that have more thyroid blood sugar symptoms, things like that.

Nataliia Sanzo, RD, LDN: 47:04

I love it. I love learning about resources like this and new tests that can help you fine tune things, Because sometimes you just you feel like you're doing everything right, especially when it comes to blood sugar management, and it's just not budging your hemoglobin A1C not budging. So you have a lot of good resources and I want to for our audience, I want to. You mentioned that you have a free training, actually two free trainings, right One that will help you transform your blood sugar from big swings to balance, and the 21 day blood sugar reset. Can you tell our audience a little bit about it?

Isaac Pohlman, RD: 47:42

Yeah for sure.

Isaac Pohlman, RD: 47:42

The first one that you mentioned transforming your blood sugar from big swings to balanced.

Isaac Pohlman, RD: 47:46

That is a culmination of the work that we've done with clients.

Isaac Pohlman, RD: 47:49

It shows a lot of client stories, people that we work with various blood sugar issues whether that be people with type 1, type 2, insulin resistance and we really look at the root cause of what is contributing to their blood sugar imbalances so they can eat carbs and feel good at the same time, and so you'll see a lot of wins.

Isaac Pohlman, RD: 48:06

You'll see our process for how we've helped others be able to do that, and so if you're looking for improvements in blood sugar, that can be a great place to start to see how other clients of ours have been able to do that. And then, if you're looking for a quick win, like within the next 30 days or so, the 21 day course that you mentioned can be an absolutely great place to start because it gives you some of the foundational habits that are really key to improving your blood sugar nutrition and otherwise to really start seeing an improvement in your blood sugar within 30 days or less. And this was a campaign that we sent out, like last year, and we had so many people do so well with it that we just made it free course within our program.

Nataliia Sanzo, RD, LDN: 48:46

I love it. I may even sign up for this because I love a little challenge and I'll send my clients over there because we love as human beings, we love structure, we like to follow certain things and especially these two trainings being completely free. You have no excuse not to sign up. You have nothing to lose. So, isaac, I'm going to leave all of your information, your website, of course, your Instagram handle everything under this podcast episode or YouTube video, whatever people are tuning in from, so they will be able to find those free trainings, learn a little bit more about you, about your practice and other practitioners that are working for you, and maybe reach out and do the testings, the hair testings and all that stuff. So I know you have to go. We really appreciate your time and thank you so much for sharing actionable tips today. It was your wealth of knowledge and I cannot wait to have you on another podcast. Maybe we can dial in into one topic, maybe circadian rhythm or something. Yeah.

Isaac Pohlman, RD: 49:52

There's so many rabbit holes that we could go down. I think an hour can sometimes be a little bit too short for some of the topics that we discussed, so happy to jump on again and again. Thanks so much for having me on.

Nataliia Sanzo, RD, LDN: 50:03

Absolutely. Again, thank you so much for your time and I'm looking forward to having you next time.

Isaac Pohlman, RD: 50:07

Yeah, thanks, natalia.

Nataliia Sanzo, RD, LDN: 50:09

Bye everyone time. Yeah, thanks, intiah. Bye everyone. Okay the live.