Managing Diabetes

[00:00:02] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it. Hello, everybody, and welcome back to another episode of the Nervous Herbalist. My name is Travis Kern, and I'm here with my co host, Travis Cunningham. And we are here to talk to you guys today a little bit about diabetes. Everybody's favorite topic, diabetes. Diabetes is something that a lot of people deal with, and it's becoming increasingly common, specifically type two diabetes, which is the number one thing that we see in the clinic. It's an acquired condition for most people, and I think most people know now that historically, diabetes was something that old people got right. You'd expect to find it in people over 65, certainly over people over 75, but now we see it more and more frequently in younger and younger people. So people under 55, people under 45 starting to show with symptoms of diabetes. And so we wanted to take a little bit of time to talk to you guys about it because it's something that's probably going to come into your clinic, and a lot of people want to know if there's a way that they can treat their diabetes without having to take pharmaceuticals. Right, right. [00:01:25] Speaker B: Yeah. [00:01:25] Speaker A: And I will say right at the top, it kind of depends on where they're at and how bad the problem is and how resistant or compliant they are to making diet and lifestyle changes. I will say, though, also definitively that if food and lifestyle can cause a problem, food and lifestyle can also correct a problem. [00:01:48] Speaker B: Yep. [00:01:48] Speaker A: Right. If the thing is strong enough to hurt you, it's probably also strong enough to help you. [00:01:53] Speaker B: You know, it's the whole basis of our medicine. [00:01:55] Speaker A: Yeah. I mean, really? And there are so many, I think, very well meaning doctors out there, but they don't necessarily believe that that's true. Right. That you can actually correct it. You know, they're like, well, I mean, you can try. And I will say part of their reticence might come from the fact that a lot of people, frankly, are very bad at following or making significant lifestyle changes. So the general assumption goes that, well, you probably, you know, eight drink flow, activity yourself into this problem. And so therefore, it would be very difficult for you to eat, drink, and activity yourself out of this problem. And so just go ahead and take this medicine. [00:02:30] Speaker B: Yeah. [00:02:31] Speaker A: Right. And the medicines can be very effective, but the ultimate question is, what else is happening in your body besides your blood glucose being high? Right. The thing that shows up in the test that the medications will prevent the blood glucose from being high in many people. Not everyone, but many people. But from our point of view, the underlying pattern problem that's leading to your blood glucose being high is unlikely to be addressed by metformin or equivalent. So even though the thing that sends the person to the doctor, the thing that triggers the conversations about blood glucose management, is a measurement of that person's a one c. Right. Their blood glucose, there's more to it than that. That's one of the measures, but there's more to it than that. [00:03:20] Speaker B: Yeah. [00:03:21] Speaker A: So I wanted to start with just like a general overview for everybody, just as a reminder about sort of what diabetes is and kind of how it works, but in short terms. And again, we're talking, too here about type two diabetes, which is primarily an acquired version of diabetes. Type one diabetes is often congenital, and it shows in younger people, it shows up in children, and those folks have a severe resistance to insulin and. Or they don't produce it. Right. And so that's a. That's a different kind of concern than what we're talking about here. So what we're talking about is type two diabetes, an acquired diabetic condition. So diabetes, essentially, in the shortest version, is the idea that your body no longer uses insulin to process glucose in the way that it should. Right, right. And so that's generally referred to as, like, insulin resistance. Right. So your body has some kind of insulin resistance. And depending on how progressed or severe that insulin resistance is, you may be able to use a medication like metformin, or you may have to do insulin injections or have an insulin pump or various other interventions to get your body to actually use insulin in a way that needs to happen. So how do we know that? How do we measure that? Well, the primary thing is a blood test. Blood test is an a one c hemoglobin, a one c test whereby we look at your blood and we figure out how much, on average, how much glucose has been in your bloodstream over a fixed amount of time. And so a one c, if you have a one c, less than 5.7. So 5.7 is the, generally speaking, the western number. You go get your blood tested, they do the hemoglobin test, and the numbers come back. It'll be somewhere between, like, one and ten. Right. Although it can be higher than that. But anyway, less than 5.7, okay, is normal. You're good to go. If you're between 5.7 and 6.4, you're what the biomeds are going to call pre diabetic. Yeah. And if you're above 6.4, you're diabetic. Right. And that number can go up pretty high. I mean, generally speaking, if someone's in the 910 range, that's pretty high, a one c. But it can be twelve, it can be 15, which is dangerous. [00:05:27] Speaker B: What's the highest you've seen for people in the clinic? [00:05:30] Speaker A: In the clinic? Twelve and a half. [00:05:32] Speaker B: Yeah, I think I've seen people right around twelve before. [00:05:35] Speaker A: Yeah. Twelve point 412.5. It was. It was very high. Right. And twelve point 412.5 is a very concerning level of a one c, because what's happening here. Right, well, what we're measuring is that there's excess blood glucose in your system. And why does that matter? Well, it's because glucose molecules are great big old sugar molecules that are floating around in your bloodstream and if they're not being broken down and processed as they ought to be, then they can cause damage. And so they will damage the inside of your blood vessels. They will damage nerves. Right. And particularly sensitive tissues like nerves, are the ones that start to show up first. And so the downstream effects of unmanaged diabetes, the ones that most people are familiar with, are loss of sensation, particularly in the feet, and then damage to other nerve pathways, like eyes, like your retinal nerve. Right. And so you end up in a situation where you lose vision. Right. And lose sensation. Lose sensation. Why does that matter? Well, it's painful and you can't. Like, in the beginning it's painful and then you lose complete sensation. And now it feels like your feet are made of like wood. [00:06:37] Speaker B: Yeah. [00:06:38] Speaker A: And then you nick yourself, cut yourself, and you don't know that that's happened. You get an infection, your foot goes gangrene, and then you chop off your foot. That may sound extreme, but that happens, in fact, so much so that if you look at biomed guidance for diabetics of a certain level, and particularly of a certain age, they will literally have foot care guidelines that'll be in the pamphlets that they hand you to tell you to inspect your feet and don't cut your toenails yourself and things like that. That's quite. It's quite a serious concern. So, of course, the question then becomes like, okay, well, why did this happen and how do you manage it? The truth of the matter is, is that biomedically, we're not entirely sure why it happens, but we do know that there's some relationship to diet, a severe relationship to diet, particularly around carbohydrate. Consumption and fiber. Right. Those two things seem to matter. Activity level, total body mass, as in how much do you weigh? Right. And then overall metabolic functions. But not moving around a lot. Eating a high sugar diet and being overweight don't guarantee that a person will get diabetes. [00:07:48] Speaker B: Right. [00:07:49] Speaker A: And this is the part that we don't really get. But from a chinese medicine point of view, those things almost certainly will engender a lot of the pathogenic influences that are the patterns we see in diabetes. Right, yeah. Phlegm, dampness. Damp. Heat, spleen deficiency, wood overacting, like all the stuff that you would expect to see. That's the kind of stuff that we'll see over and over again. All right, so you have a patient comes in, they're interested in using chinese herbs to help with their diabetes. You got to establish a baseline. Right? What are you talking about? When did they get their last a one c? What was the number? And look, we don't have formulas that will lower a person's a one c. Right. And what I mean by that is no chinese physician wrote a formula to lower blood glucose because that was not a thing that people measured. Right. But that doesn't mean that even the classical Chinese weren't aware of this as a problem. Right, right. I mean, they had it. Schalke wasting and thirsting syndrome. Because one of the common symptoms of untreated diabetes is that people are crazy thirsty and they urinate all the time, and they actually rapidly lose weight. [00:08:59] Speaker B: Yep. [00:09:00] Speaker A: Right. They're hungry. They're thirsty. They can't keep weight on. They waste away. Right. How many of your diabetic patients look like that when they came in to see you wasting away? Hungry, thirsty, being a lot of time. [00:09:11] Speaker B: A lot of them. Yeah. Yeah, a lot of them. [00:09:14] Speaker A: Mine are all overweight. Right. [00:09:17] Speaker B: Yeah. You can see that, too. Right. [00:09:18] Speaker A: So what do you do with that? Right. So now you're looking like. Because if you go to classic texts and you read about Schalke and be like, oh, people will say, like, oh, shout, that's diabetes. And then you read the patterns there and you're like, wait a minute. All like, none of my patients are, like, thin and wasting. Right? Maybe they urinate a lot. Maybe they don't. Maybe they're thirsty, maybe they're not. Right. But all of them are overweight and phlegm dampy. Well, where's that in the discussion? [00:09:43] Speaker B: Right, right. [00:09:45] Speaker A: And I think this is actually one of those places where history has made a really big difference. Right. Because if you manage to contract Shao Ku in, say, 1550 in rural China, it was probably not because you were eating too much taco bell, right? I mean, just a guess. Yeah. It wasn't a question of abundance. Problems at that stage. Right. There are other patterns that are going on. So when most people think of diabetes, now, they think about it in these terms of, like, well, you've just been eating too much cake, right. You should stop eating candy. And for sure, like, eating lots of high sugar foods can somehow impact your blood glucose over time. But there's more to it than that. Right. There's other things that are happening than that. And while when someone has reached an a one c that we consider diabetic, we're definitely going to caution them about the way that they're consuming carbohydrates in particular. The reason is not, from my point of view, because I'm deathly concerned about your carbohydrate numbers. It's because sweet flavor foods, chinese medicine, sweet flavor foods, tend to impact people's metabolism in a negative way when they are in this state. [00:10:50] Speaker B: Right, right. [00:10:51] Speaker A: And so we have to, like, begin to moderate that. [00:10:53] Speaker B: Yeah. I think there's also, for some people, there's a genetic component to these things. Like, I I have some friends that are in our field who are pre diabetic if you take their blood work. But they're like, they're not eating cake, you know, like, they're very careful with their diet. And their whole family has the tendency for diabetes. Like, everybody in their family is like that. So one of the things I think people get hit with often with diabetes is that it's your fault. Right? Like, it's. [00:11:28] Speaker A: Yeah, you screwed up. [00:11:28] Speaker B: You screwed up, and therefore you have diabetes and you need to stop eating sweets and you need to exercise. There's this kind of narrative that it's. It's you. You're the problem, you know? And people feel a lot of shame about that. And then there's the reflexive response of not wanting to address it. I've definitely seen patients where they've been diagnosed with diabetes, and they just don't want to deal with it. So they kind of live in this headspace of, like, it's, well, it's not that bad right now. I'm older, I'm just going to do what I want, and I'll die when I die. Right. And that's the attitude that they have at first, and then stuff starts to decline, and then it can, and then they're like, well, you should probably come in for some treatment. And then they wind up a place like this, you know? [00:12:22] Speaker A: Yeah. So definitely a genetic predisposition plays into not only, I think, being diagnosed with diabetes, but also just some of the other metabolic dysregulations that tend to lead to diabetes, I think are also very ancestrally oriented. [00:12:39] Speaker B: Right, right. [00:12:39] Speaker A: It's very common to see this stuff in families. Right. It's very common, for example, to find someone who struggled with weight gain, for example, in their adult life to have also struggled with that as children and to come from parents or at least one parent who has also struggled with that. Right, right. So there's. There's an ancestral category, like a sort of jing, quote unquote genetic thing. And I think there's also the enculturation of that. Right. Like, you grow up in a certain household with certain relationships to food. And I think it's really, you know, if people are particularly in the sort of, like, pre diabetic range, by and large, their diet is well maintained and they have activity. Probably that's mostly some sort of constitutional thing. That doesn't mean you don't need to look into it, but it's probably that. I will say, though, I don't know that I've come across people who have a one cs like that are seven and a half or nine and a half or ten and a half that have great diets and move around a lot. [00:13:32] Speaker B: Yeah, I don't know that I do either. But I think the tendency as a diabetic person is to go into, let's say, your MD's office and kind of be scolded by an MD, for sure. Right. Like that. The reason that I'm bringing it up is I think it's important we know that with a patient who comes to see us because they've likely already been told, like, well, or it's been implied this is because of you, you know, and then people will feel anxious and also shameful about their conduct around their diabetes. [00:14:11] Speaker A: Right. [00:14:11] Speaker B: Which is a thing that we see a lot of. So that's the reason I'm bringing it up, is I think it's just important to know what the narrative is like for a lot of people who deal with the disease. [00:14:22] Speaker A: The irony being, too, that not only do they get scolded in that way and told, like, hey, there's all this stuff that you need to change, probably, but then they're not really handed much else beyond the scolding. [00:14:33] Speaker B: Right. [00:14:33] Speaker A: Like, they'll get, like, a referral phone number for a dietician. [00:14:36] Speaker B: Yeah. [00:14:36] Speaker A: Like, so call our dietician and they'll set you straight. And the thing is, if they actually call the dietician, they'll probably get some pretty good advice, right? You know, my mom was actually a diabetic educator for 30 years. And they know their stuff, man, they know their numbers, they know their diets, they know their pieces. And while some of their stuff is a little bit different than ours, you know, relative to saturated fats and other things, you know, by and large, the dietary advice is very good, right. It's even compliant with what we would think of as a chinese medicine diet, right? Maybe a little more salad than we would prefer, but by and large, pretty solid. Trouble is, is that it's not integrated into the, into the diabetic response. So the patient like goes, they get their blood paneled, they get it read by the doctor, doctor says, oh, you're pre diabetic, you're diabetic. So you're going to need to make some diet lifestyle changes. Here's a phone number for the dietician. We'll see you again in six months. Right? [00:15:26] Speaker B: Right. [00:15:27] Speaker A: So of course we know what happens next. Patient Googles this, right? And Doctor Google starts to answer all their questions and what happens? They get crazy confused because y'all stop going to the Internet and googling your shit, right? I know that feels like that's a good thing to do, but it's not. And all of you know, it's not, right? Even as providers ourselves, you go and do it and you're like, well you got brain cancer. Your a one c 7.1 probably got brain cancer. [00:15:54] Speaker B: Yeah. [00:15:55] Speaker A: Right? I mean that's just where that goes because it's not informed and it's not organized. Right. Instead you need to find an actual professional resource who can help you with this. So that could be the dietician phone number that they got. It could be a chinese medicine office who has some kind of specialization in this place. Because I will tell you, as much as I'm critical of a lot of biomedical stuff, particularly around nutrition, because I just think it's so myopic and so limited. [00:16:21] Speaker B: Yeah. [00:16:22] Speaker A: The way, like while we don't have a great understanding of what exactly makes a person be diabetic, we do have a very good understanding of the chemical mechanisms that are at work in diabetic people, which means we do know a lot about how to manipulate those levers relative to diet in a way that keeps people stable. [00:16:42] Speaker B: Yeah. [00:16:42] Speaker A: You know, so the discussion there is talking about, like if you go and look at those guidebooks, what you'll find is that there's a lot of discussion around grams of carbohydrates that people should be consuming. Right. And so if you are, you know, a woman generally is 30 to 45 grams of carbohydrates per meal. And if you're a male bodied, it's 45 to 60. So you have a little bit more to work with. And the real challenge with the patient is getting them to figure out how to understand what 15 grams of carbohydrates is, because that's kind of the serving size. Right. So it's, you know, if you're 30 to 45 or 45 to 60, you can see the math there. Right. So it's like servings of carbohydrates where one serving is 15 grams. And that is the part that I spend some time with my patients in the beginning. So we get talking about, hey, how can chinese medicine help? Okay, well, we can definitely help, but we do need to talk a little bit about diet and lifestyle, and you need, as Travis said, you need to make sure to not come at this from a scolding point of view. [00:17:35] Speaker B: Yeah. [00:17:35] Speaker A: And I also want to make sure that you guys don't come to it from a restriction point of view. [00:17:39] Speaker B: Yeah. [00:17:40] Speaker A: Right. Really important, because the truth is that there's actually really solid meals that you can continue to eat. [00:17:46] Speaker B: Yeah. [00:17:46] Speaker A: That are. Feel very normal. [00:17:48] Speaker B: Yeah. [00:17:48] Speaker A: You know what I mean? Like, you can have an english muffin with a sausage patty and egg on it. Right. [00:17:54] Speaker B: Yep. [00:17:54] Speaker A: For breakfast, has a perfectly compliant diabetic meal. [00:17:58] Speaker B: Yeah. [00:17:58] Speaker A: Perfectly compliant. Okay. No problems at all. In fact, you could even have it with a little fruit. What? You know, and still be able to. Still be able to hit your 45 to 60 grams, you know? So it's a matter of understanding about portion size, and it's a matter of understanding, uh, the frequency and rhythm of eating. A lot of diabetic patients have poor relationships to when they eat. So sometimes they eat breakfast, sometimes they don't. A lot of them will be like, especially ones that have struggled with weight gain. Their appetite will be quite low, and they'll think that's a good thing. Right. They'll be like, oh, yeah, I don't have to eat. I don't usually eat till, like, 230 in the afternoon. Right. And we're always like, nope, no, nope. We gotta reboot that, man. Like, we gotta get your blood sugar managed. So there's a lot of stuff that goes into it. And so you guys already know all the things that we're gonna say. Right. It's the same chinese medicine information as always. So people need to eat breakfast. They need to eat their meals at roughly the same time every day. They need to eat not too much, right. In a single sitting. They need to eat not too late. Right. Their food needs to be cooked and easy to digest. All the same rules that we would give to anyone. And then on top of that, the thing that you can start to help them understand are which foods are actually things that are spiking to blood glucose. What's going to make their blood sugar go up rapidly. And what that usually means is when they eat a lot of carbohydrates with not a lot of fiber. Right. In a single sitting and usually in large quantity. So think of, like, we're going to Sunday brunch, and I'm going to have, like, the french toast and a cup of coffee and a bowl of fruit and a slice of key lime pie. Right. That's going to hit you. [00:19:33] Speaker B: Yeah. [00:19:34] Speaker A: And we've all experienced that meal. You had that meal. And then after, you're like, oh, I got to take a nap. So tired. Got to take a nap. Because that's how your blood glucose is spiking way high. If you don't have insulin resistance, your body's going to dump a whole bunch of insulin into your system. It's going to start to work on the glucose. Your blood sugar is going to drop. Right. And in that process, you're going to feel tired because you now have this, like, crazy spike and then a pretty rapid drop. The goal of dietary advice for a diabetic client is to help them understand how to keep their blood sugar kind of on a classic sine wave, like a slow rise and a slow fall. And a slow rise and a slow fall. We just want it to look like normal, like a normal little sine wave. We don't want these crazy spikes and crazy drops, because that's the thing that's really going to mess with not only their sense of their own health, but it's the thing that's damaging over time to their, their overall system. How easy it is to get a patient to get into that is really. It ranges quite a lot. [00:20:31] Speaker B: Yeah. [00:20:32] Speaker A: We have built a bunch of tools here. I've got food lists of all these different things. Fruits, carbs, toasts, snacks, nuts, meats, all kinds of things that are broken down in 15 grams carbohydrate chunks, so that people can start to understand, like, okay, one slice of normal bread is about 15 grams of carbs, right? Like half an english muffin is about 15 grams of carbs. Like this kind of stuff to get people to understand about how much 15 grams of carbs is. And I tell people upfront, I say, look, we're going to spend about a month really focused on these minute details, things that are going to feel a little bit tedious. Right. You're really going to count out your grapes or like measure how many almonds you're going to eat. And I tell them in the beginning, yes. And the reason is because we need to recalibrate your native sense of what a serving size is. [00:21:23] Speaker B: Right. [00:21:23] Speaker A: Right. And it can be a little challenging for people. But if you set it up front. Right. Like communicate up front, this is what we're doing and this is why. Right. That it takes about a month, some people, six weeks. But at about that point, they've started to internalize what a 15 grams carb serving is. And so they don't have to think about it in those terms anymore. They just know, like this breakfast that I eat totally fine. Right. This lunch that I eat three days a week, totally fine. Because after about a month or six weeks, you're repeating things that you're eating. Right. I mean, most people eat the same thing for breakfast every day. [00:21:54] Speaker B: Right. [00:21:55] Speaker A: A lot of people eat mostly the same thing for lunch every day. [00:21:57] Speaker B: Right. [00:21:57] Speaker A: So there's ways to kind of build it in. Right. The other thing I tell people is they need to give themselves a little, cut themselves a little slack. [00:22:04] Speaker B: Yeah. [00:22:05] Speaker A: Because they're not going to be great at it in the beginning. [00:22:07] Speaker B: Yeah. [00:22:07] Speaker A: Right. And then there's also going to be like their mom's birthday. [00:22:10] Speaker B: Yeah. [00:22:11] Speaker A: Their friends from college are going to come in town and they're going to go out to wings and beer. Right. It's okay. [00:22:17] Speaker B: Yeah, it's okay. [00:22:18] Speaker A: Like you need to live your life as a human being. Where we really care a lot about this is in the mundane time. [00:22:25] Speaker B: Right, right. [00:22:26] Speaker A: The Tuesday dinner where nothing's happening. What's happening on that day? What's happening on all the days that are like that Tuesday, that's the place that we really care about making sure that these things get, get matched. [00:22:39] Speaker B: Right, right. [00:22:40] Speaker A: Have you, what's been your success question? I guess with talking to people about. [00:22:45] Speaker B: Diet, lifestyle stuff, it's tough, man. It's a, it's a tough thing. I mean, at this point, I just refer them to cu, to do because I, I hate talking to people about food. But it's one of those things where if you, for this type of patient, a patient with diabetes, if it's unmanaged. It messes everything else up. Like, you, you're trying to treat their hip pain, it messes up with, like, you can't treat their hip pain, you're trying to treat their neuropathy, good luck treating their neuropathy. If their blood sugars are all over the place, you know. [00:23:19] Speaker A: Yep. [00:23:20] Speaker B: Trying to treat their headaches, good luck, whatever it is, if that part of it isn't there, you're fighting uphill the whole time, and the best you're going to do is get temporary results. Something that occurred to me when you were explaining your approach with this is that the main thing you're encouraging is a kind of rhythm and stability. Would you say that's true? What do you think the relationship is? So I have a couple of questions that come to mind, but what do you think the relationship is to rhythm and stability and why that's helpful for people with diabetes. And then part two is, do you think that diabetes is a disease that's paired, that maybe arises out of some kind of instability? [00:24:12] Speaker A: Yeah. So I think the kind of diabetes that I see the most of is at its core an exhaustion problem. And I mean that in a broad sense, yeah. I mean, sure, people are physically tired often, but I mean that their normal operating systems, their normal health maintenance systems have been exhausted. [00:24:35] Speaker B: Yeah. [00:24:36] Speaker A: And in my mind, the metaphor is a little bit like, you got a car and it has like, a nitrous, like a nitro booster, you know, and, like, you press the button and the fire shoots out the back and you take it off. I mean, the thing is, though, like, if you always press the nitro booster, like, you just drove your car around with the nitro booster depressed, I don't think your engine would last very long. Right. Because, like, it's not meant, like, it's momentary. Like, oh, you hit the button and we take off. Right. I think one of the problems is that through demands of being a modern person, through overwork, through instability of rhythm, and I'll get back to that in a second. Through diet, through lifestyle, through all kinds of stuff, people have been like, their body has to constantly press the nitro booster to get through the day to make sure everything happens. And so the system gets exhausted. And so the reason that I think rhythm is really important is because, firstly, a lot of modern people don't have good rhythms. And what happens when you don't have rhythm is it means your body doesn't have the time to rest and recover in the same way. [00:25:40] Speaker B: Yeah. [00:25:40] Speaker A: And if it doesn't have the time to rest and recover. In the same way, it has to reach for those sort of prenatal qi sources. Right. It's gotta pull that prenatal jing and convert that into usable qi so that you can get through the day. [00:25:53] Speaker B: Yeah. [00:25:54] Speaker A: And that's your body pressing the nitrous booster. Right. They go, we need more than we've got. Press the button. Right. You do that over and over and over and over again, and people get exhausted, and that exhaustion leads to these problems. It's not the only kind of problem. [00:26:07] Speaker B: Right. [00:26:07] Speaker A: For sure. Cognitive problems, dementia, Alzheimer's disease, Parkinson's, like a lot of the disease, we don't understand very well biomedically. Almost all of those are connected to some kind of deep level exhaustion. [00:26:20] Speaker B: Right. [00:26:21] Speaker A: You know, and so the rhythm part, I think, matters because, firstly, it encourages people to get back to a restorative state because consistent rhythm encourages the body to have its own kind of excitement and contraction. And excitement and contraction. Right. Which is how everything around us works. The sun comes up, it goes down. Summer gets hot, and the winter gets cold. There's plants grow, and then they die. Everything around us, everything about this particular version of the universe that we all live in, is predicated on expansion and contraction. And if everything is constantly expanding and you're constantly reaching into the pool to keep it expanding and pressing the nitrous booster over and over and over again, you get exhausted, and then the systems all start to collapse. [00:27:05] Speaker B: Yep. [00:27:06] Speaker A: So I think that's firstly why rhythm is really important. I do think that diabetes is a disease of arrhythmia. Yeah. Except that it's not the rhythm itself so much as, like, you wouldn't just correct your diabetes by suddenly having rhythm, but the diabetic, like the a one c, the thing that the biomeds are calling diabetes, that is a symptom of this fundamental dysregulation. [00:27:33] Speaker B: Yeah. [00:27:33] Speaker A: And the reason that that dysregulation matters is because it's exhausting and your body can't run optimally anymore. [00:27:38] Speaker B: Right. [00:27:39] Speaker A: So I think that's sort of, like, how all that plays in. And so part of the thing about the rhythm is, like, I mean, we would encourage any of our patients to have rhythm. Right. They've got an insomnia patient, and they got no rhythm. They don't eat at the right times. They're always working too late. Like, it's. We would encourage the same thing there. Right. [00:27:55] Speaker B: Well, and a lot of these patients, I don't know about you, but they have the sleep. The sleep is a big issue. [00:28:01] Speaker A: Yep. [00:28:01] Speaker B: Yeah. [00:28:02] Speaker A: Yep. In fact, I would say that if you had a patient who was very sedentary and had a very sort of, like, processed carb diet and had a very high stress job, but who actually managed to sleep well, you would delay how long it would take to see the diabetic. Why? Because they're restoring. There's a place there. And this is exactly why. This used to be a problem of older people, because by the nature of being older, you have exhausted more of your systems. So of course it starts to show up. But now, because of the world that we live in, you can exhaust yourself by 25. Right. I mean, we see exhaustion in teenagers. [00:28:43] Speaker B: Right. [00:28:44] Speaker A: A patient two years ago who was like, a female bodied patient, she was 15, she was a competitive runner. [00:28:52] Speaker B: Yeah. [00:28:53] Speaker A: Slated to be an Olympic team. Right. Vegan. Her whole family was vegan. Nothing wrong with being a vegan. But it wasn't a good fit for this kid from my point of view. She's doing two a day practices. She's sweating constantly, she's pushing herself constantly. And she was always. Her tendons hurt, her bones hurt. She had stopped menstruating. She was tiny. Right. And all of this, for me, is like, you are exhausting yourself. And you are 15. Yep. You're 15. Like, 15 is not the time to show this level of exhaustion. I mean, literally, her elbows and knees were creaky and tight like a 70 year old. [00:29:36] Speaker B: Yeah. [00:29:37] Speaker A: You know, and this is just because this is the world that she was living in. And there. There's some diet, lifestyle stuff for sure. But even if that hadn't been the case, even if she had been pumping herself full of high quality animal proteins and drinking lots of water and getting lots of sleep, the conduct is still out of balance. Right, right. And I think the thing is that we live in a time now to where people imagine that you can achieve everything no matter what. [00:30:06] Speaker B: Yeah. [00:30:06] Speaker A: And I think that's the other problem, is people don't want to recognize the fact that there are, in fact, limitations, you know? So if you want to be an Olympic runner, you might need to eat meat. [00:30:16] Speaker B: Right. [00:30:17] Speaker A: You should really need to give that some consideration. And also, even if you do, being an Olympic runner might shorten your lifespan. [00:30:25] Speaker B: Yeah. [00:30:25] Speaker A: Right. Hey, that's not a problem. It's just a reality. Right. Like, it's a choice that you get to make about how you want to live your life. You know what I mean? Because certain demands on your system will change the outputs. [00:30:39] Speaker B: Right. [00:30:40] Speaker A: And again, it's not a moral thing. It's not a good or a bad thing. It's just understanding that not everything. Like, you can't just have everything for free. That's not how it goes. There are inputs and outputs. [00:30:49] Speaker B: Yeah. I think one of the places where people get stuck here is we get, because we're westerners by nature, right. By birth, we get raised in western culture and we have the greek ideal of, like, the physical body. Right. And so you can see a lot of modern dietary and exercise culture worshipping the type of body that one would have as a. As an olympic athlete. [00:31:19] Speaker A: Sure. [00:31:20] Speaker B: And that being equated to health. [00:31:22] Speaker A: Right. [00:31:22] Speaker B: Whereas if you look at the east asian medical view of what a healthy person looks like, it's entirely different. [00:31:29] Speaker A: Yeah. [00:31:30] Speaker B: Right. [00:31:30] Speaker A: Yeah, yeah. No one. No one looks like a greek God in the east asian model of health, for sure. [00:31:38] Speaker B: Yeah. [00:31:38] Speaker A: Right. Because again, like, it's about choices and decisions. I think that's the thing that it always comes back to. For me, it's the same with diabetic patients or any other patient. It's how do we help a patient understand that they are empowered to shape their life in whatever way they want. [00:31:52] Speaker B: Right. [00:31:53] Speaker A: But that how you choose that you can to have all the things probably. [00:31:58] Speaker B: Right. [00:31:58] Speaker A: You know what I mean? Like, probably not. Because if you want to be like, swole, like Hercules. Right. It comes with some challenges. If you also too want to be as flexible as a dancer. [00:32:10] Speaker B: Right, right. [00:32:11] Speaker A: Those things are incongruous. Right. You might be able to find like a kind of compromise position between the two of them. [00:32:16] Speaker B: Right. [00:32:17] Speaker A: But it's unlikely that you will be Mister Universe and also be able to pirouette like a ballet dancer. [00:32:24] Speaker B: Yeah. You might be able to be a gymnast. That's. That's kind of our. [00:32:27] Speaker A: Yeah, the middle. And that's an interesting note that, like, gymnasts, while super ripped, are not the size of Mister Universe. [00:32:32] Speaker B: Right. [00:32:33] Speaker A: They would fail at being Mister universe. [00:32:35] Speaker B: Yep. [00:32:35] Speaker A: Are they strong? Are they fit? Are they flexible? Yes. [00:32:38] Speaker B: Yes. Yeah. [00:32:38] Speaker A: Are they Mister universe? [00:32:39] Speaker B: No. Yeah. That's different type of body development. [00:32:42] Speaker A: Exactly. And then that's just the question of choice. [00:32:44] Speaker B: Right. [00:32:45] Speaker A: What does it take to achieve the thing you're trying to achieve? You know what I mean? I think when it comes to dealing with diabetic patients, I always still try to couch all of this discussion, though, in a positive choice structure, which is to say, like, I'm not going to tell you all the things that you shouldn't eat or that you can't eat, but I want to help you understand how you can eat the things you want to eat in a way that works for you because you can still have cake and candy and popsicles. But if you are watching your carbs, you might ask yourself, like, well, like, seven milk duds is going to hit my snack quotient for carbs. So, like, I could eat seven milk duds, but also, like, how satisfying is it to eat seven milk duds? [00:33:33] Speaker B: Right. [00:33:34] Speaker A: Is there something else I could eat that would be more satisfying and would still be within the numbers? [00:33:40] Speaker B: Right. [00:33:40] Speaker A: And so what you can end up with people doing is making their own kind of risk calculation. Right? Their own satisfaction calculation, instead of me telling you, hey, you probably shouldn't eat milk duds, because the truth is they go to movies and they're gonna. They're gonna eat milk duds. That's what's gonna happen. So we need to create a circumstance and a structure where people can understand what they're doing and opt in. [00:34:01] Speaker B: Right, right. [00:34:01] Speaker A: Because that's really the thing. The sort of, like, passive, I'm not paying attention. I'm just sort of eating because it's habits and whatever. That's the thing that we want to avoid. We want to empower people to make choices. [00:34:13] Speaker B: What about the tendency to make dietary lists, like, what to eat, what not to eat. Yeah. How do you feel about that? What to eat, what not to eat. How do you educate people about this in a way? [00:34:29] Speaker A: So I start with lists in the first month. [00:34:31] Speaker B: Okay. [00:34:31] Speaker A: I do. I have lists, and my lists are organized by 15 grams serving sizes. [00:34:37] Speaker B: Okay. [00:34:38] Speaker A: And I start that way, as I said, because I want people to start to understand, like, what 15 grams is. [00:34:43] Speaker B: Right, right. [00:34:44] Speaker A: I don't really have anything on my list. And my lists, for example, even include stuff like ice cream. [00:34:50] Speaker B: Yeah. [00:34:50] Speaker A: Right. Now, the quantity of ice cream that you can eat and still be compliant with a diabetic lifestyle guide is quite small. [00:34:58] Speaker B: Yeah. [00:34:59] Speaker A: Much like the seven milk duds. It's kind of like, well, should I even right now, three tablespoons of ice cream. Is that really going to be satisfying to anyone? [00:35:07] Speaker B: Right. [00:35:08] Speaker A: You know, and I actually intentionally include that stuff because I want people to understand that it's still possible and that you could do it if you want it, but you just have to decide, does this work for you? And so I actually start with lists, but my goal is not for people to always have lists. But I think it's important for people to know where they're at. So when a person comes in the very first time we're talking about this, I actually am going to before I even talk about foods and stuff, I just kind of give them a breakdown of what diabetic treatment looks like in chinese medicine terms. And that is to say, it's long, right? So you're looking at three to six months, right. Preferably six months of regular treatment. Those six months of regular treatment in the beginning are going to involve weekly or even twice a week acupuncture. You're going to be taking herbs, probably that whole six month period. Right. And the first, you know, two months of that time is where we're really going to hone in on the diet lifestyle piece, right? We're going to get you set up with a movement coach. We're going to get you set up like, we're going to help you find something that you like to do. Here's the other thing I want to say. If you're a person who likes the gym, it's very hard for you to understand why people don't like the gym. And you say to yourself, well, I mean, if they just go, you know, they'll always feel better if they go. No, stop projecting your love of the gym on people who don't. Right. If you don't like the gym, you've never liked the gym. You hate the gym. You go to the gym because people make you feel like you should go to the gym. And yeah, sometimes you do feel better when you go, but that's not enough to make you like it. Right? It still sucks and you hate it. Okay. That means that if you tell this person, like, hey, let's get you a gym membership, let's get you on the treadmill, that is never going to work. [00:36:56] Speaker B: Yeah, it's not necessary either. [00:36:58] Speaker A: Well, they need to move. [00:36:59] Speaker B: It's not right, but they need to find something they like. [00:37:02] Speaker A: Yeah, like, you got to help these people find something they like. [00:37:05] Speaker B: Right. [00:37:06] Speaker A: And that can be, I mean, it can literally be a treadmill, but it can be walks in the park in a conventional way. It can be swimming. It can be all that kind of stuff. It can also be martial arts. It can also be yoga. It can also be dancing. It can also be sword training. I mean, like, it's literally, like, it doesn't matter what it is. [00:37:22] Speaker B: You just got to get it moving. [00:37:23] Speaker A: Just gotta get it moving. Right. Even if it's just a mundane walk around the neighborhood, it's fine. [00:37:27] Speaker B: Yeah. [00:37:28] Speaker A: The thing that you got to remind people of those, like what I say that only to be, just remind yourself that these people know, like, when you talk to a diabetic person, do most diabetic people know where there are holes in their diet and lifestyle? Yes. Yes, of course they do. [00:37:41] Speaker B: Right, right. [00:37:42] Speaker A: Of course they do. They've internalized all this stuff, so don't sit there telling someone, like, well, we've got to really get you on that treadmill. Like, no, like that. That's not the way. So anyway, I lay out the whole, okay, this is the plan, six month plan. And then that first visit, I send them home with a food journal. [00:37:58] Speaker B: Yeah. [00:37:59] Speaker A: Because I just need to know what's going on, right. And I let them know, like, hey, this is a food journal. This is a non judgment space. I don't care, like, what you're eating or not eating. I just need to get a sense of our baseline. Right? What. Where do I need to put my attention? You know, and you and I, you know, rooted branches, food journals. I have other information, and I want to know how hungry you are. I want to know if this was a normal day. I want to know, like, when you exercise, it's a little bit more robust than just like, do we. [00:38:22] Speaker B: Do we have those food journals up on the website for people to download? [00:38:25] Speaker A: I don't think we do, but we. [00:38:26] Speaker B: Can put, we should put them up so people can see it, put them. [00:38:30] Speaker A: In show notes and stuff for this, links to it. That way people can find it. But, yeah, I mean, it's nothing special. I just made it in excel or whatever, but it has some extra information in it that I like, and so I send them home with that, and then they come back the next week, and then while they're on the table with the needles, I really spend some time with that food journal. Right. And I try to understand quantities and I try to understand rhythm. Um, and a lot of times I'll. I'll start with that one week, but I'll have them do a second. [00:38:53] Speaker B: Yeah. [00:38:54] Speaker A: Because one week is, it's not usually representative enough, so you get a second week. And what I'm analyzing, firstly is what they're eating, how much of it they're eating. And then I also do a quick scan on how much fiber they're eating. [00:39:05] Speaker B: Right. [00:39:06] Speaker A: Because fiber, um, you know, everybody knows that fiber is helpful for, like, constipation and stool and stuff, but fiber is also a factor that helps to mitigate carbohydrate loads. Right. Sort of how quickly your blood sugar spikes and how. How your body manages it. And we have a pretty good sense of this biomedically, but we don't. We're not experts on it exactly, just yet. [00:39:26] Speaker B: Right. [00:39:26] Speaker A: Nonetheless, almost everyone doesn't eat enough fiber. [00:39:29] Speaker B: Yeah. [00:39:30] Speaker A: Even people who have good diets, they're like, oh, I eat lots of vegetables. They have plenty of fiber. Probably not, actually, if we were to take a look at your diet, unless you're eating, like, huge amounts of whole grains and brown rice and stuff like that, beans, lentils, and I mean, a lot, you're almost nowhere near your fiber number. Right. Because the goal is, like, 28 to 32 grams a day. Most people, even people with healthy diets, are hitting, like, half of that. [00:39:51] Speaker B: Yeah. [00:39:51] Speaker A: 14 to 16. So I take a look at that, too, to just see, like, okay, what's going on with fiber? I will tell you, most of the time, people eat almost no fiber. [00:39:59] Speaker B: Yeah. [00:40:00] Speaker A: Right. And that's just a function of being a modern person. There's just not a lot of fiber in places anymore. And particularly if they were told to be mindful of carbs, they, like, cut out bread and pasta and stuff like that. And so that means they're not getting whole grains in those places. Not that they were getting whole grains before, but you know what I mean? So anyway, I take all that information, and that helps me understand how to now talk to them about the food. Right. Because I want to make sure I understand, like, who am I dealing with here? Like, is this a fast food person? This is a person who's cooking at home. This is a person who has skills to cook, time to cook, space in their life. Where are the process? Yeah. Because it's no use to me to sit down and tell someone all these great recipes and all these great things they should cook if they don't cook. [00:40:41] Speaker B: Right. [00:40:42] Speaker A: Like, we got to start further back. [00:40:43] Speaker B: Yeah. [00:40:44] Speaker A: You know, if they eat mostly out and grab me fast food and they've got, you know, three kids and a spouse, and they're working, you know, 40, 50 hours, we got to figure out a way. We can't just give them a list of recipes and expect that that's going to land. [00:40:54] Speaker B: Right. [00:40:55] Speaker A: You know, so a lot of my work in the beginning is around lists. Right. Just to get people from my own lists, taking their diet material and then giving them lists back. Right. And I actually think it's pretty helpful. [00:41:08] Speaker B: Yeah. [00:41:09] Speaker A: In the long run, though, I don't really want someone necessarily having to reference the list. I want them to internalize this stuff, because my goal is to build healthy living, not so much like, uh, this is, this is like your diet. [00:41:24] Speaker B: Right. [00:41:24] Speaker A: You know, like, you're on a diet, you're on the diabetes diet. It's like, no. How can we actually just get you to like live life and enjoy yourself and eat foods that you enjoy, but just like with a level of consciousness around food that maybe you didn't have before. [00:41:36] Speaker B: Right. [00:41:37] Speaker A: You know, so that that's, I think that's ultimately where I land on the list. [00:41:41] Speaker B: So one of the things that I always wondering about when people talk about, practitioners talk about treating a kind of thing in the clinic. [00:41:50] Speaker A: Yeah. [00:41:50] Speaker B: Is what percentage of the treatment is really the food, what percentage of the treatment, like if somebody is, you have a diabetic patient coming in and they're like, I have peripheral neuropathy. You know. [00:42:04] Speaker A: Yeah. [00:42:05] Speaker B: What percentage of the treatment where they actually get better? If my question making sense, how much of that is diet? How much of that for you? And this is for you because it's your practice. Right. How much of it is diet? How much of it is acupuncture? How much of it is herbal medicine? What's like the breakdown for you? Like what the maybe lifestyle versus the other things? I don't know. [00:42:31] Speaker A: I mean, I would say that it really depends on how bad it is. [00:42:35] Speaker B: Yeah. Right. [00:42:36] Speaker A: Because in fact, the worse it is, the more immediately impactful herbs and acupuncture are. [00:42:43] Speaker B: Right. [00:42:43] Speaker A: Right. Because like it's way out in left field and we have to like kind of just bomb the hell out of it. [00:42:48] Speaker B: Yeah. [00:42:48] Speaker A: To pull it back from, from being way out there. However, as we've talked about many times, there is no amount of herbs in acupuncture that are going to overcome a lifestyle thing. [00:43:00] Speaker B: Right. [00:43:00] Speaker A: That's just impossible. [00:43:01] Speaker B: Yeah. [00:43:01] Speaker A: So we might be able to, with herbs and acupuncture, regular, dedicated, hard hitting herbs and acupuncture take an a one c from ten and a half to 7.5. [00:43:10] Speaker B: Right, right. [00:43:12] Speaker A: But we're never going to get below 7.5. It doesn't matter how much urban lifestyle we throw. Urban acupuncture we throw at that. If the client, the patient doesn't make change with lifestyle. [00:43:21] Speaker B: Right. [00:43:21] Speaker A: It's never going to happen. [00:43:22] Speaker B: Yep. [00:43:23] Speaker A: Right. And hovering at seven and a half is not great. [00:43:26] Speaker B: Right. [00:43:27] Speaker A: You will absolutely end up, you don't have it already with neuropathy, could end up with retinopathy as well, even at seven and a half. So it's too high and you wouldn't make progress without the lifestyle stuff. So most of my patients are not that bad, I would say. In fact, a lot of the patients I've had are just quote unquote, just diabetic. Right. They're sort of 6567 something like that. For those folks. I actually start with acupuncture and food in those first couple of weeks, of course, while I'm trying to figure out what's going on and get a better sense of their constitution, and it's in those acupuncture, abdominal exam, tongue exam, all the stuff we usually do, I'm going to try and get a better sense of some key diagnostic pieces that are going to shape the herbs. Because the thing is, if you go to the textbook and you ask Bensky, what's the formula for diabetes? You're going to get all these formulas that deal a lot with heat patterns, right? Like lung, stomach heat patterns, stuff like that. Because again, in the classical presentation, in the Schalke presentation, that's what you had, right? People really thirsty, really hungry, they're eating, but they're wasting away. Their urine is concentrated, it's frequent, and they're like shriveling. Literally, it means wasting and thirsting. Most of my diabetic patients do not look like that. And while hate, hate, while heat is certainly, hopefully, hopefully hate is not in there. I don't know the cause of all diabetes hate. World peace, you guys, for lots of reasons. While heat is certainly a factor in almost everyone's presentation to some degree, it's not usually the thing that stands out to me, right? So while I'm doing all the assessments in those first two weeks, what I'm really looking for, I'm asking myself, like, okay, firstly, how deficient or not is this person? [00:45:13] Speaker B: Right, right. [00:45:15] Speaker A: How stagnant are they and what kind of stagnation? Like, are we phlegm damp stag? Are we blood stag? Are we cheesestag? Right? And then how hot are they or not? Right. And where does that heat live? Right. Is that heat in, like the chest and upper jowl? Is it living in the middle and lower jow? Like, where is it right now? As, of course, we know, everyone's a mixed pattern. [00:45:38] Speaker B: Sure. [00:45:39] Speaker A: Everyone's. [00:45:40] Speaker B: Especially in the beginning. [00:45:41] Speaker A: Especially in the beginning, because it's all over the place, right? So when you're doing that assessment, for me, the biggest piece has a lot to do with deficiency as a core question, because, again, we've established that this is a problem of overwork and taxation, but that doesn't necessarily mean the person appears in other aspects of their life to necessarily be overworked and taxed and taxed out. How robust are they? Do they appear energized? Are they doing things but they have this blood sugar problem? Or are they completely wrecked. They can't move, they can't function. They have all these other secondary deficiency problems. That's really important to me because it's going to shape which tack I'm going to go toward. Right. Because if someone's more deficient, then we've got to look at like Liu Wei Dihuang ones, we've got to look at Shenzhen ones. We've got to look at formulas that deal with base level deficiencies. [00:46:29] Speaker B: Like lower Jao deficiency. [00:46:31] Speaker A: Exactly. [00:46:32] Speaker B: In that sanjiao model. [00:46:33] Speaker A: Yeah. Deep, deep deficiencies. Right. In those positions. But if someone is just sort of normal, they don't seem to be wildly deficient, then probably you're going to notice a lot more of the stagnation pieces. [00:46:46] Speaker B: Right, right. [00:46:47] Speaker A: Some sort of accumulation piece which pathologically would lead us toward like a quote unquote excess problem. But, you know, apparently they appear, they're not like red faced and angry. Like, they're not like. [00:46:58] Speaker B: Right. [00:46:59] Speaker A: Classically excess. But when you look at them, they're probably heavy bodied. Right. In my patients, they're probably heavy bodied. They probably have a tendency toward weight gain, toward loose stool. They might even have, you know, frequent stool and constipation, like alternating. But the constipation is never hard. Like, the stools aren't hard. They're still soft, but it just, they've got no chi to get there. That could be a deficiency aspect because again, mixed patterns, everybody's a mixed pattern. So you're just trying to like balance these different pieces. Right? [00:47:28] Speaker B: Yeah. [00:47:28] Speaker A: Mostly what I see in the people that I deal with is a lot of flint dampness. [00:47:31] Speaker B: Yeah. [00:47:32] Speaker A: And that flim dampness has some heat component because, of course, the dampness generates heat. [00:47:36] Speaker B: Yeah. [00:47:36] Speaker A: So how you're approaching that mostly has to do with how hot they look versus how damp they are. Right. And so for me, like, people who are in like a flim dampness place are going to need formulas that are going to scour out and clear out phlegm damp. There's a lot of ways you can go with that. Right. But the place that I usually start with is a formula. It's like not a, not a super well known formula, but it's called sang fu dao tan one. And like, it's sangju bancha fu ling chen p dan nanjing. Like stuff that is. [00:48:09] Speaker B: Yeah. [00:48:09] Speaker A: Moving chi drying dampness. Right. And it's a scouring formula. This is probably not the formula they're going to take for six months, but this is the formula that we're going to start with. To try and break up this flimmy presentation. These people are thirsty. They have sticky mouths. They often will have, like, lipomas and stuff under the skin. Like, you'll find, like, kind of fatty nodules and stuff. You know, as often the case, particularly in forearms and forelegs, abdomens are like, the flesh on the surface is kind of watery and soft, but the abdominal muscles underneath are tense. There's, like, a tension there, and so. And they tend to be overweight. Right. [00:48:52] Speaker B: Is usually the case. [00:48:54] Speaker A: I don't know that I've ever seen someone with that presentation who also wasn't overweight. [00:48:57] Speaker B: Yeah. [00:48:58] Speaker A: So we get in there and sort of scale us, scour that stuff out. If they're very hot, you can still take that same approach, but you're gonna have to have some heat clears in there. So Huang Chen Huanglian sugao could be, like, depending on how hot they are, you're gonna need to clear out some of that sort of lurking heat. And a lot of the formulas that you'll see for that kind of presentation will use, like, blood clear. Blood heat clears, like shangdi and shudi and stuff. But you got to be careful with that because, of course, that can be really heavy and sticky on people. [00:49:30] Speaker B: Yeah. [00:49:31] Speaker A: So if you have someone who's like, phlegm damp and damp heat, but also a little spleen, stomach deficient, you're not going to be able to dump a bunch of shun D. Can't do it. Right. And this is why I think it's important to remember that basically everyone's a mixed pattern. [00:49:46] Speaker B: Yeah. [00:49:46] Speaker A: So, you know, you're like, oh, this person's so, so much damp heat. And you go look up a formula online or in a textbook or whatever, and it's some formula that's packed full of, like, shunned y and shooty, and you're like, oh, yeah, definitely will clear out the heat. But they also have, like, four or five bowel movements a day that are, like, loose and unformed. Don't give them that formula. Don't give them that formula. [00:50:06] Speaker B: And staging. Right. Like, people remember that it's staging with a lot of patients. You don't. There's things you tend to do with most people first. Even if they have, they end up on a Liu dihuang Wan or a eventually. That's often not the first place we go. [00:50:23] Speaker A: No, no. In fact, like, from my phlegm damp patients, I gotta scour first. [00:50:27] Speaker B: Yeah. [00:50:28] Speaker A: Right. So I'm going to hit this pretty hard with, like, all the herbs you'd expect some juancha fulang, et cetera. Right. Effective here. [00:50:38] Speaker B: Yeah. [00:50:39] Speaker A: Patient probably take that formula for three weeks, a month. Right. Assuming is well tolerated. And then you're going to need to start pulling back some of the hardcore dryers because you'll start damaging their yin and their qi a little bit because those people are a little bit deficient, probably spleen, stomach's a little weak. And so you're probably going to want to start to pivot your formula in the direction of, like, a Leo gensatom. And then depending on their relative level of heat and cold, you might actually end up incorporating some metal gel warmers. Right. So then now you're kind of pulling in some legion one kind of ginger based, like, middle gel warmer. If they're still very hot, it's going to obviously be a different approach. You're not going to jump into a fuzzi lizhong one if they're like crazy damp heat. [00:51:26] Speaker B: Right. [00:51:26] Speaker A: You know what I mean? You got to clear out that stuff first. [00:51:28] Speaker B: Yeah. [00:51:29] Speaker A: And so you could actually be looking at one of your faves that the Sha shintongs, which are classic in this place. Right. Because they're just such a nice mix of those pieces together. And so they're super effective for people who have damp heat presentations but are also a little flim damp. Right. And they need, but they also still need middle gel nourishment. [00:51:47] Speaker B: Absolutely. [00:51:47] Speaker A: That's why the shi shintang, I mean, Shei Shintango. I mean, outside of Xiao cha Hu Tang Tang formula, perhaps like the most useful formula for a lot of the kind of problems we see here in Portland. [00:51:57] Speaker B: Yeah. [00:51:57] Speaker A: You know, the other thing I want to mention about these, you know, formula categories. So basically, like, okay, slim dampness and damp heat, those are, you know, kind of tied together. You're going to see blood stasis in people. [00:52:09] Speaker B: Yeah, for sure. [00:52:10] Speaker A: And the blood stasis is going to be caused by any of those other factors. So, like, if they're wicked damp, a dampness that's going to cause the blood to stagnate, if they're very deficient, the lack of chi movement is going to cause the blood to stagnate. If there's a lot of heat in the system, the heat will cause a stagnation, like something's causing the stagnation. And so, of course, if you're treating the right thing at the front end, you're going to help to loosen that up. [00:52:32] Speaker B: Yeah. [00:52:33] Speaker A: But sometimes it might, you might need a little. A little extra. [00:52:36] Speaker B: Yeah. [00:52:36] Speaker A: And it doesn't, you don't need to, like, dump a bunch of bugs, necessarily, or like Tao Ren hon kind of stuff, but it can just be more like in the dachshund kind of relative. Or if you're building formulas that are xiao Yao based and picking churchyard. [00:52:51] Speaker B: Right. Sure. [00:52:52] Speaker A: You're doing like, kind of, like, subtle. [00:52:53] Speaker B: Yeah. A little gentle movement kind of thing. [00:52:57] Speaker A: And I mean, you know, if it turns out that this person's, like, covered in spider veins and their tongue is dusky and, like, they've got all these cardiovascular problems. Okay. Maybe you need to be a little bit more direct about it. That's not usually what I see. I usually see it as a compounding problem. [00:53:11] Speaker B: Right. [00:53:12] Speaker A: And so what'll happen is we'll start to see, like, hair thinning and loss, weakening of nails and nail beds, like ridges on the nails, thickening of the skin at the heel, stuff that is absolutely blood stagnation, but it is secondary to the primary cause, like, it's happening. It's because the other stuff is, like, blocking everything. [00:53:33] Speaker B: Yeah. [00:53:34] Speaker A: So if a person's having some really serious blood stagnation, you obviously need to deal with that branch. You can't just deal with the root. But probably you can just work in some relatively, like, mid grade movers, even some of the stuff in the, like, ya jiao Tong, Jishway tong. [00:53:49] Speaker B: Yeah, sure, sure. [00:53:51] Speaker A: And the other thing is a lot of people, particularly heavy bodied patients that are phlegm damp, have chest stuff that goes along with this. So feeling heaviness in the chest, shortness of breath, lethargy, stuff like that. And also there some of your classic upper jowl phlegm players, like the gualos of the world. [00:54:09] Speaker B: Yep. [00:54:10] Speaker A: Can be helpful to open up shab eyes if they're not too hot. Terrible taste. But as we continue to come around. [00:54:16] Speaker B: But could be helpful, also very useful approach. [00:54:19] Speaker A: Yeah. So, you know, classically, let's take a classic phlegm damp person with a little bit heat. Right. I would probably build out this sang Fu dao Tan wan. As I mentioned, the San Ju players. To start, I might include a little bit Huang Chen and a little bit Danshan and a little bit gualo in addition to that formula as a way to just kind of get things going. Patient take that three to four weeks, assuming well tolerated. [00:54:42] Speaker B: Yeah. [00:54:43] Speaker A: And then if the heat is clearing rapidly enough, great. Otherwise we might need to increase that Huang chin dose. Or if the damp heat really seems to be bowel oriented, we might need some Huang Lian. [00:54:54] Speaker B: Yeah. [00:54:55] Speaker A: To get in there. And then if that's the case? Probably what's going to happen is I'm going to start to shift that formula to a Sheshen town formula. [00:55:01] Speaker B: Yeah. [00:55:02] Speaker A: Right. Because I've scoured the phlegm that I wanted and I don't want to damage their yin. So I'm going to start shifting that to Shajian formula. Shaijin formula becomes kind of an ongoing formula for probably another month to six weeks while sort of harmonize and deal with this hot, cold mix. Right. And then once most of the heat is gone, now I'm going to make the final shift in the last portion, hopefully, if things are going well, to, like a leogent. [00:55:28] Speaker B: Yeah. [00:55:28] Speaker A: So it's still managing some of the excess phlegm that's without doubt still in the system, but now we're actually going to start tonifying again. [00:55:34] Speaker B: Yeah. Yeah. Makes sense. [00:55:36] Speaker A: I don't think it makes a lot of sense to put tonifiers like renshin in particular into a formula from the beginning. [00:55:42] Speaker B: Oh, yeah. Especially if there's phlegm. Right. [00:55:43] Speaker A: Yeah, they're phlegmy. It's too sweet. It's too much like, you gotta. You gotta get that stuff out. Right. And so if you jump to the root too quickly, you're gonna miss this transition. And I lay out, and I mean, that's just sort of one of the major patterns that I see. Of course there would be different progressions for others, but I lay it out because it's important to recognize that if you can get someone to commit to a six month timeline, that almost certainly you are going to be shifting your approach during that timeline. [00:56:11] Speaker B: Oh, yeah. [00:56:11] Speaker A: And you should be. [00:56:13] Speaker B: Yeah. [00:56:13] Speaker A: Right. However, don't do it too soon. [00:56:16] Speaker B: Yeah. [00:56:17] Speaker A: Right. Does the worst thing in the world. They come back after one week and they're like, oh, man, I'm feeling so good. You're like, well, I guess we need to switch to the next formula. Probably not, right? Probably not. This is a long problem. It took a long time to get there, so it's going to take a little while to get out. [00:56:30] Speaker B: Yeah, yeah. And just a note about the blood stasis component. [00:56:35] Speaker A: Yeah. [00:56:35] Speaker B: There's a lot of, there's a tendency when you get into working with diabetic patients to want to move the blood. [00:56:43] Speaker A: Yeah. [00:56:43] Speaker B: If you do, if you pick blood moving formulas early on in some of those cases, you can get a lot of movement initially and a lot of success initially. But like Travis Kay was saying a second ago, it's usually not the root of the problem, so they'll get a lot better maybe quickly, but then your progress will slow, and then you run the risk of not knowing where to go next. So that's one of the reasons why sometimes moving the blood, as your main principle isn't the best to do at first. Yeah. Or you do it at first and then you stop intentionally and you work on something else. So it's just something I've experienced. You can get attached. I think, as practitioners, we can get attached to something that's worked and then not move on when we should and then eventually do more damage because we're attached to that first clinical success with a patient. [00:57:50] Speaker A: Yeah, that's true of anything, right? [00:57:51] Speaker B: Yeah. [00:57:52] Speaker A: That we're treating. It's way too easy to get attached to the piece that you're working on, I think relative to the blood stasis in particular. I mean, unless you have some exacerbating factor, some really terrible neuropathy that you think will be rapidly assisted by blood moving, I think it's better to integrate a much more relaxed blood moving approach into another formula and then ramp up to it. [00:58:15] Speaker B: I think so, too. [00:58:16] Speaker A: Like, you could even. You could even almost not conclude because probably six months still isn't quite enough. But that's going to be your first test balloon amount of time. But by the time you get toward the end of your treatment plan, you could actually probably be in a much more blood moving state, particularly if you've had a little bit of time to tonify. Right, right. Because remember, it takes something to move something. [00:58:38] Speaker B: Yes. [00:58:39] Speaker A: You don't get that for free. Right. So when you put blood movers into the system, they bring their own chi in there and they're going to move things around, but it's going to cost your body some amount of resources to move stuff around. You know what I mean? And so that's why you need to be conscientious about how we move, because it can be depleting in different ways. That doesn't mean it's not called for. It just means you need to be aware of that. So if someone has this kind of underlying deficiency that you were tonifying with, say, your Liu Wei debu or liogensaton, that's great. Maybe you've got a little bit resource now that you can bring to bear these blood moving parts, and that could literally be the last little knocked piece. Right. You finally get in there with enough resources, and you blast out the end of this blood stagnation, and all of a sudden, chi and blood are flowing through the collaterals and the channels like they're supposed to. And now you're really catching traction, really catching fire. Right. Moving forward. That's not unheard of, but I think you get there more at the end. Thank you. [00:59:37] Speaker B: So for the. For the initial approach, with this formula, you're doing like four, you said like four weeks or six weeks, something like that. With this initial approach. [00:59:47] Speaker A: Yeah. [00:59:47] Speaker B: What do you expect in terms of biomedical changes? Like how much do the blood sugars regulate? If so, how much do you think is reasonable? Like how much load do you expect the herbs, like a good herbal formula, to pull? [01:00:05] Speaker A: So this is a good question because we didn't actually talk about how we're measuring this ongoingly. Right. Because a one c is not going to be measured. I mean, a frequent. A one c would be like every quarter. [01:00:14] Speaker B: Right. [01:00:15] Speaker A: Right. [01:00:15] Speaker B: Yeah. We can't do that every day. [01:00:17] Speaker A: No. And so how is the patient measuring their blood glucose ongoing? Well, the ideal way is if they have a continuous glucose monitor, a CGM. Right. Which is a special little tool. It's a little reader that gets stuck on the back of their arm and it goes to an app on their phone, and it's reading blood glucose in the interstitial fluid in the body. Right. And that's a very useful tool, not for accuracy of the amount of blood glucose in your blood itself at this exact moment, but because it tracks trends over time. Right. Which is actually much more useful for this work than finger sticking, which is where people prick their finger and then they put it in the meter and it tells them how much blood glucose is in their blood. Right. Now, that's a very accurate tool, but it shows you no amount of trends and it doesn't track it frequently enough for us to see those trends over time. So a CGM is a really useful tool. If your patients can get them, many insurances will cover them. For people who are pre diabetic or diabetic, I strongly recommend it. There's all kinds of online resources for practitioners to learn how to read them and to educate patients about them. Theoretically, their own doctors would do it, but they almost never do. So you have to do it yourself. But anyway, what's useful about that is it gives us some way to read what's going on. Right. In those first four weeks, I don't really care all that much about what the CGM says, and the reason is because realistically, we're not going to adjust their blood glucose situation in a month. It's not going to happen. Caveat to that is I do care how often their blood sugar is wildly spiking? Yes, because that's going to tell me what's happening with the dietary stuff we're trying to encourage. Right. So every month I'm going to look at, like, you know, they're coming in weekly in the beginning, but eventually, once we get to the month spread, there's a report from the CGMs that will show you a whole month breakdown and it'll show me all the days where their blood sugar was, like, over 180. [01:02:14] Speaker B: Right. [01:02:15] Speaker A: And so between 70 and 180, by the way, everyone is usually the. The standard range. Everyone's blood sugar spikes. That's normal. If any regular person without diabetes eats cake and ice cream, your blood sugar is going to go way high and then it's going to drop, because that's what's supposed to happen. But for people who have diabetes, we're trying to keep their blood sugar regularly between 70 and 180. We don't want it to go way above because, again, it causes all these problems we talked about before. But if their blood sugar is regularly above 180 or it's regularly spiking above 180, I want to know why. [01:02:46] Speaker B: Right. [01:02:46] Speaker A: I want to say, like, hey, what I see, this happens every Sunday afternoon. What's going on on Sundays? What's happening here? Like, it's good information to have, but from an herbal point of view, I don't expect really a whole lot. Okay. [01:02:58] Speaker B: That's good to know. [01:02:59] Speaker A: Yeah. What I care a lot about in that first month is the stuff that you would be relying on if you were trying to treat phlegm, dampness and damp heat. What's going on with bowels, what's going on with energy, what's going on with sense of fatigue, foggy head, what's going on with phlegm in the throat? What's happening with congestion? Right. All the stuff that we would normally read, that's what I care about. Because, honestly, from this, in this case, we're talking about the phlegm scouring case, this is us peeling off the top layer. Phlegm dampness, in and of itself, is not the reason this person has diabetes. Right. [01:03:31] Speaker B: Right. [01:03:32] Speaker A: Dampness is an accumulative response to what is at its core a fundamental weakness in the system, which is causing this issue. So even once we peel back all the flint dampness, us all, what we're going to see is that the body systems start to work better. [01:03:46] Speaker B: Yeah. [01:03:47] Speaker A: Because there's less impediment, but it's not going to do a whole lot for their blood sugar. What will matter a lot in that first month is the dietary lifestyle stuff. That's what will matter. Right. So I'm still looking at the CGM, but I'm not using it to assess how my herbs are doing. Yeah, I am using the CGM to see how diet and lifestyle are going. Right. [01:04:05] Speaker B: That's a good distinction. [01:04:07] Speaker A: Once we start to shift over into, like in this, again, in this case, we switch over into a shishing tongue type formula. We start managing the heat aspect once we peel back the phlegm part. Now I'm starting to see, because hopefully, if everything's going well, the patient is really internalized. Their dietary stuff and their diet, their spikes as caused by their diet, has leveled out. Right. So very rarely happening. And if it does happen, they know exactly why. Right. So if that's the case, now I know that fluctuations in their, their blood glucose are less likely to be due to diet and lifestyle because we've taken the last six weeks and we've really educated them and they've been practicing it. So now I'm in. I am interested to see, especially as we start to clear some heat out and as we start to warm the metal initiation time thing, we're actually starting to get at the last of the excess problems and finally starting to nourish the deficiency problem. So now I'm hoping that my baseline, let's call it, let's assume that my patient's average blood glucose is humming somewhere about 180. It's too high, right? Maybe it's regularly 190, something above the line, but it's regularly like that. Whereas before it was spiking 240, it was spiking 270. It was doing all these crazy jumps. If you looked at the chart, it would look like this. Wild peaks and valleys, but now it's pretty consistent, but it's just too high. Now is when we start saying, okay, this should start coming down, and I'm going to use that to help inform a little bit of the success of my formula. [01:05:36] Speaker B: Gotcha. Makes sense. [01:05:37] Speaker A: I'm still going to pivot that formula, though, regardless of what's happening on the blood glucose meter. If I do, if I've cleaned out enough of the heat, right. If I think from my other, you know, pulse, tongue, abdomen symptomology, if I think the heat is sufficiently gone for us to start to tonify, I'm going to make that change even if we haven't dropped sufficiently. [01:05:57] Speaker B: Yeah. [01:05:58] Speaker A: You know what I mean? And then from there, I should really start to be able to see some consistent improvements. If the patient is now truly rebuilding and tonifying because now, metabolism should be warming. It should be regular. We should start to see the body's ability to recover. [01:06:13] Speaker B: Right. So it sounds like the blood sugar, the read of the blood sugars is important, but it's not important. It doesn't affect your bienzone, like, your pattern differentiation at all? [01:06:28] Speaker A: Not really. [01:06:28] Speaker B: Yeah. You're not, like, adding, uh, Huanglian for higher blood sugars or. [01:06:36] Speaker A: No. [01:06:36] Speaker B: Uh, what is it, guager and, um. [01:06:39] Speaker A: Right. [01:06:39] Speaker B: Licorice. You know, like, doing that to regulate blood sugars. [01:06:43] Speaker A: No. [01:06:43] Speaker B: That kind of stuff. [01:06:44] Speaker A: I'm not. I will say I have seen more direct relationship when we deal in bitter herbs. Yeah, I think that's an interesting little aside, you know? [01:06:54] Speaker B: Yep. [01:06:56] Speaker A: But it doesn't make me say, like, oh, the CGM is still a little high. We got to run these bitter herbs longer. Right. Because if, like, I'm never in a million years gonna let a western tool like a CGM override what I see in the patient, in the clinic, in the room, it's never gonna happen. Right? Like, so if you're like, wicked loose stools that are urgent and you're cold and you've got abdominal cramping because, like, you've just been getting way too much cold herb, right? And I'm looking at the CGM and it's still not dropping. Like, I'll just keep going, like, yeah, no way. No way. Right? Because that's just not how I think about it. You know what I mean? And I don't know that that would be effective anyway. So I wouldn't let something like that overly inform how I'm going to deal with the patient. But I will say that, generally speaking, by the time I'm ready to shift to tonifying, and I think enough of the heat has cleared that the blood glucose is coming down. [01:07:57] Speaker B: Yeah. [01:07:58] Speaker A: Right? I mean, it's not low enough yet, but it's coming down. [01:08:02] Speaker B: I've also had patients, like you get into habits where you think, like, oh, this formula really helped this other patient regulate their blood sugar. So then you can make the mistake easily of thinking that, like, that formula is a good formula for blood sugar regulation. Right. The shaishin tongs are a great example. Gansao. Shaishin tong can be very good at helping. [01:08:25] Speaker A: Great. [01:08:26] Speaker B: You know, to regulate. You can see blood sugar regulation happen on that formula. But I've also seen that formula make blood sugars go up when it's been inappropriately to cooling or when the patient actually needed to be tonified, like, totally tonified with like, a li zhong wanna or shenzhen or something like that, and you give them a shaishin tong, their blood sugars actually get more dysregulated. [01:08:55] Speaker A: Yeah. [01:08:56] Speaker B: Right. [01:08:56] Speaker A: Yeah, yeah. I mean, I think the real problem here is not so much that it couldn't be a useful tool. I just don't know that people have done enough testing to really use it in that way. You know what I mean? [01:09:09] Speaker B: I think it's just, it's. It's too, like the mechanism of blood sugar regulation is too complex to pin it on one thing. It's like, oh, yeah. Like, well, we use bitter herbs because there's berberine, and we know that berberine can help to regulate blood sugars. But for some people, berberine causes loose stools, and then it disrupts, like, the digestive mechanism, which can cause different problems. So it's just more. It's more complicated than we would like it to be from a chemical perspective. [01:09:43] Speaker A: Yeah. [01:09:44] Speaker B: And so the best tool that we have for figuring out herbal formulas is our pattern differentiation. [01:09:51] Speaker A: Yeah. Because if you try to just treat this as a chemical problem, then you're just a biomed doctor. [01:09:56] Speaker B: Right, right. [01:09:57] Speaker A: Like, here, just. Just take this medicine. It'll help regulate the problem, but it won't because it's too complicated. [01:10:02] Speaker B: That's a lot. There's a lot of people in our field who will use herbal medicine. They'll use, oh, yeah. Like, we have pattern differentiation. Here's the formula. But, like, Shanja works really well for cardiovascular issues. So I'm gonna put it into my bansha Shaishin tongue, because this patient has a cardiovascular, you see, it's more like, example in school with bai hwa shi shi sao. Oh, that patient had stomach cancer, so put bai hwa shi shi sao in the formula. Even though that there's no differentiation, that would imply that that's necessary. You know? [01:10:40] Speaker A: I know it's so interesting to live in that space because, I don't know, I think this is really connected to the whole just kind of general idea that you would take a thing just because it's good for you or, like, just because someone, like, said it's good for you. [01:10:54] Speaker B: Yeah. [01:10:55] Speaker A: You know, I mean, I had a patient on Monday ask me if I had a list of herbs that could help prevent dementia. [01:11:01] Speaker B: Yeah. [01:11:02] Speaker A: You know, like, what might. What's some good herbs that are helpful to fight against dementia? And I was like, no, I don't have any herbs. I do that, and they were like, really? I read all kinds of stuff online. I'm like, well, yeah, sure. I mean, everyone will tell you like, especially as you get older, all of your targeted ads are absolutely going to tell you about all the things you can spend your money on to prevent dementia, right? Because, by the way, the computers are listening to you and they know how old you are and they know what the fears of people in your age demographic are. And they're more than happy to have you spend money on some, whatever bullshit, you know, capsules. Because some research scientist in Switzerland with a study of seven people in 1947 showed that whatever ex herb is useful for something. Don't believe the hype, man. [01:11:45] Speaker B: Right, right. [01:11:45] Speaker A: Don't believe the hype. People don't know what causes dementia. So biomedically, if you don't know what causes dementia, there's absolutely nothing that you can include to help prevent against it, right. Because you don't know what causes it. And so people are like, oh, just take it. I mean, it's not gonna hurt you, right? You just take this good stuff. I mean, yeah, maybe it's not gonna hurt you. Also, maybe it could give you kidney stones, and it's a bunch of, it's a bunch of money out of your pocket. [01:12:08] Speaker B: Right? [01:12:08] Speaker A: That's what's hurting you. [01:12:09] Speaker B: Yeah. [01:12:09] Speaker A: You're spending all that money and it's. [01:12:11] Speaker B: Not, they're not gonna, the ads are not gonna tell you to chew gum. Right? Like, the reason I bring this up is because one of my acupuncture teachers, who's Japanese, told me recently that they've been doing research in Japan around dementia. And one of the strongest correlations that they've found is that people who have dementia don't chew their food, and most of them have dentures. So I think that because when the dentures get installed, the person doesn't feel the food the same way in their mouth, so they just stop chewing as much. The effect of chewing has some kind of stimulation effect on the brain. [01:12:53] Speaker A: Yeah. [01:12:53] Speaker B: So it keeps, it can actually keep dementia at bay if you chew your food well. So, like, if somebody, if I have a patient who's coming in who's worried that their memory is getting a little bit soft, I have them chew gum. [01:13:06] Speaker A: Because that, yeah, it's, I mean, that's a simple thing, but also, like, you know, people who don't chew their food, like, why. There's so many reasons why people might not chew their food, right? Like, you're watching tv while you're eating, you don't pay attention to what you're doing. Yeah, that's true. Like, soft and processed carbohydrates. Like, there's so many reasons why someone might not chew their food. And so, like, even if that, like, as you mentioned, it's a correlation, right? Like, we don't know why. Just a bunch of these people, they seem not to chew, and people who don't chew seem to have dementia problems. Like, that's super interesting. But again, like, that's the kind of shit, though, that turns into a Google, like, a Google thing. [01:13:42] Speaker B: Oh, yeah. [01:13:44] Speaker A: Oh, my God. [01:13:45] Speaker B: Are you chewing right? [01:13:46] Speaker A: You gotta, you know this guy. You need 10,000 steps a day and 5000 chews. [01:13:51] Speaker B: Yeah. [01:13:51] Speaker A: Are you getting your 5000 chews, by the way? We can sell you this Fitbit that'll somehow measure your chews. It's actually a tooth implant. It costs $40,000. It'll tell you how many times you chewed. I just. I just think that people take their shit too seriously. [01:14:05] Speaker B: Yeah. [01:14:06] Speaker A: Like, this is the most beautiful chinese medicine notion in the world, right. Which is that you need to pay attention, but not too much. [01:14:11] Speaker B: Yeah. Right. [01:14:12] Speaker A: Everything about your life is deadly serious, and absolutely not. [01:14:15] Speaker B: Yeah. [01:14:15] Speaker A: Right? Like, that is the reality of it. And it's hard because we live our whole lives, like, being told that we need to care about all of these small little things, right? Because that's the world that we live in. And, you know, it's hard to pay your mortgage and to, like, buy your food at the grocery store if you don't have attention to detail and you're not present in your life. But I really think that if we paid a little bit less attention, and this is ironic because how many people don't know anything about their bodies at all? Like, I'm not telling you to pay less attention. Like, in fact, you should pay some attention. [01:14:46] Speaker B: Right? [01:14:47] Speaker A: But this is the. This is the balance, right? How do you find the space between being plugged into your world and your experience but not taking it so seriously that you're constantly asking a machine on your wrist to confirm that you had a good day. [01:15:02] Speaker B: Right, right. Yeah. [01:15:03] Speaker A: I mean, really, like, the number of patients we've had in the last couple of years, when I ask them how they're doing, like, they look terrible, they've got, like, circles under their eyes, and they're, like, clearly fatigued. Right. And, like, so how's sleep going? Like, oh, I've been getting 85% on the Fitbit. What does that mean? [01:15:18] Speaker B: Right? [01:15:19] Speaker A: What does that mean, 85%? What is it measuring? Oh, some electrostatic whatever the hell at your skin surface. Like, people should be in tune with their own experience, enough to decide whether they're having a good day or not. They don't need a machine to tell them. Right. And if you're so busy that you need a machine to tell you, that is something to work on. [01:15:36] Speaker B: Right, right. [01:15:37] Speaker A: That's the thing to work on. And that's what I think is actually relevant to this conversation with diabetics, because one of the things that often happens, again, if it's a timing dysregulation problem, if it's an exhaustion problem, is because life and circumstance have put people in positions where they've had to sacrifice their health and their rhythm and their restoration for a variety of needs, some of which they can control and many of which they can't. And so they're in a position where, like, they've got families, they got bills, they got stuff. They don't know how to do this. And our job is to help provide a compassionate and soft place for them to try and understand how to do it and also to help give them permission to cut themselves from slack. [01:16:20] Speaker B: Yeah. [01:16:20] Speaker A: I mean, really? Because, like, you don't need to count how many things you chew. Here's an idea. Eat some whole grains. You have to chew those. You can't just swallow them. You will choke. Right. So you build up a situation where we say, hey, it's time to eat some more whole grains, particularly at breakfast and lunch. Let's chew. When we're eating lunch, let's make sure to be focused on what we're doing and focus on our food. Share conversation with friends. Eat slowly. Right. And now you're killing two birds with 1 st. Yeah. You're meditative, you're reflective, you're chewing your food. All the things that we want to happen. So I just. I think it's an important point to continue to remind patients, like, look, man, some days are going to be better than others, but we're here in your corner, and you can do this. [01:17:04] Speaker B: Yeah. [01:17:04] Speaker A: You absolutely can do it. [01:17:05] Speaker B: Yeah. I think giving people tools as well is an important thing to do, because a lot of the times with this, like a disease diagnosis like this, it can be very scary. [01:17:17] Speaker A: Yeah, super scary. [01:17:18] Speaker B: Giving somebody a tool to be able to interact with things that they can actually manage, that they can actually do, is really powerful. [01:17:27] Speaker A: Yeah. All right, well, let's call it there. I think people got some formulas to work with. They got some information to think about. So, as always, you can reach us. If you guys have suggestions for episodes or questions about this one, you can shoot us an email at info. That's infooodenbranch. That's rootandbranchpapadeltaxray.com and check out our other shows. If this is the first one. We've got stuff on different disease topics, different herbal families, specific formulas, setting up your practice back in the beginning. We're always interested to hear new topics from y'all, though. So if you have something you want us to talk about, go ahead and let us know and we'll pop into the show notes, some of the links to some of the things we talked about today day. So you've got those there. And until next time, my name is Travis Kern. [01:18:14] Speaker B: And I'm Travis Cunningham. [01:18:16] Speaker A: All right, y'all, catch you next time. [01:18:17] Speaker B: See ya.