#36 – Member Story: How a CGM helped a seasoned registered dietician and her clients become more metabolically flexible | Julie Cottrell & Ben Grynol

Using a CGM helped a seasoned registered dietician understand what was going on inside her body, gain blood sugar control, and be metabolically flexible so she could further advise her clients looking for weight loss and energy management. Levels’ Head of Growth Ben Grynol sat down with Member Julie Cottrell to talk about her perspective on diets as a dietitian, her own journey through different fad diets and what elements are most important when building your own food philosophy.

03:13 – Julie’s background as a registered dietician

Julie shares her background on how she became a registered dietician.

I was born in 1970 in the age of processed foods. I loved processed foods. And I didn’t eat a single fruit or vegetable until I was a teenager. So, I have a very picky… I can empathize even with young children or even adults now that tell me that they don’t like a vegetable or something. I’m like, “Hey, I was there. I had to teach myself how to like a lot of different things.” I didn’t really know what I wanted to do. I got a degree in biology. And the last elective that I took was a nutrition course. And so, I asked my professor, “Could I go into nutrition with this?” And she said, “Oh, absolutely.” And plus, I already had an emphasis, like I did gymnastics, and then cheerleading, and then running. And I was very interested in health and that sort of thing. I ended up going and getting a master’s degree in nutrition. As I got started on that, I realized, hey, if you want to do anything in this world, you need to become a registered dietician. So, I went that route. And so, I became a registered dietician in 1996.

08:53 – Julie’s biggest struggle

Julie said she takes time to understand where her clients are coming from, what motivates them, and what their daily life is like to help them craft a diet that works and is intrinsically motivating.

That’s been my greatest struggle because I don’t want to lead people down the wrong road. And that’s why I do a lot of self-experimentation. I’m always trying to figure things out and change, whether it’s low-carb or it’s a vegetarian type of a plan. And people are confused and they do want to know like, should I do keto? It’s like they want to grasp onto an entire food philosophy. Or, I want to be plant-based. I’m going to be vegetarian. And I deal with all of that when I talk to people, trying to understand what their motivations are, where they’re getting their information, try to explore that with them, when they say “I’m trying to be plant-based.” And I’m like, “Okay, can you tell me more about that? Why are you feeling motivated to do that sort of thing?” I really like to figure out all their motivations and what the context of their life is, what their family situation is, and who all is pulling at them, but also understanding that they don’t have to have one specific food philosophy.

10:06 – Everybody needs protein

No matter what diet you follow, you need a certain amount of protein to build a healthy diet.

I’ve had to come to this realization over time, is that there are some pillars that seem to be true no matter what. Whether you want to be vegetarian, or you want to be keto, or whatever, you need a certain amount of protein. Some people are, “I’m not sure I want to eat any protein or not.” I don’t care which plan you’re on, you need some protein. Also, we’re in a culture where we eat just way too many carbs. I mean, that’s a really clear message I can give to anybody. I don’t care if you’re plant-based or not, just eating a ridiculous amount of carbs, your body can’t handle that many. And just trying to differentiate for people. It gets scientific sometimes. I mean, it’s hard to not. Like just the difference between, are you a carb burner or a fat burner? And pretty much everybody I talk to is carrying a lot of extra body weight. Right there, it’s like, why are you carrying all that extra body weight? Well, because you are a carb burner, you are not accessing that body fat. You’re not metabolically flexible.

11:20 – Eating windows

Limiting the hours of the day where you’re open to eating food helps you regulate your food intake.

Some of the other pillars that I’ve come too that I didn’t know when I first started would be like an eating window. I mean, that wasn’t anything I ever heard about, learned about. And now, a lot of studies and everything are backing up how eating in a tighter eating window is so much more beneficial, no matter where your calories are coming from. And so, that’s something that I can get into with people pretty quickly is understanding when is the first food going into your body, and when is the last food going into your body of the day? And can we condense that eating window regardless of what foods you’re eating?

14:39 – Trying the low carb approach

After following the low-fat diet diligently without good results, Julie shared what motivated her to try a low-carb diet instead.

And that’s when my husband, and he was in residency at the time, and some of his fellow residents, they were all trying out the either Atkins or carbohydrate addicts diet. And so, along with that, they were all doing it and losing weight. And I’m over here on my low-fat pedestal and not feeling a hundred percent great. But I mean, I’ve got that philosophy in my mind. And they’re losing weight and I’m sitting here struggling to figure out what I’m going to eat that’s going to taste good, and look good, and all that. That was my first point of questioning the low-fat scheme. And knowing I wasn’t feeling my best, my cholesterol numbers were high, my triglycerides were high, but I was latched on to that food philosophy. And so then, as an experiment, I tried doing a lower carb approach.

18:58 – Give your body time to reset and regenerate

One of the pillars that Julie believes in is the importance of finding balance.

You got to give your body downtime to process through, and reset, and regenerate. And so, that goes with any diet. It doesn’t matter whether you’re vegetarian, or ketogenic, or what you are. And so, when I was experimenting with ketogenic diet and thinking, I want these higher levels of ketones, and now of course, I’ve got the ketone monitor going, and just like I’ve got the CGM on right now, but I love to monitor these things. And so, I was, what’s it going to take for me to make some ketones? I ended up just as frustrated as a lot of people do. If you think the goal is I should be walking around with ketones of 1, or 1.5, or 2, I mean, you’re going to have to do a two or three-day fast to do that. And is that practical or realistic for most people? Very often, that doesn’t jive with life.

21:56 – Low carb plan

There is more than one way to eat healthy, even though Julie feels like a lower carb plan is better for most people, there’s no reason for anyone to feel like they need to be limited in what they eat either way.

So, I’ve been preaching, personally, a lower carb plan, not necessarily a ketogenic plan, but a lower carb plan for a long, long time. Even back then, that was back, like I said, around 1998, ’99. And I had cardiologists that would refer… One cardiologist would refer patients and they needed to do Dean Ornish. They wanted me to instruct patients on Dean Ornish. I don’t know if you’re familiar with that plan. It’s vegetarian, very plant-based, not too much protein, versus I had some that were saying Atkins, and they just wrote that in the medical chart, Atkins. And so, I mean, it was like I was torn both ways right then. And so, it’s been ever since then that I have realized that there was more than one approach. But I have consistently felt like a lower carb plan was better. And the way I define that is about 100 grams of carbs per day or less.

28:13 – The connection between habits and diet

Building habits that support your ideal diet makes it much more achievable.

The other thing I realized too is habits. I haven’t talked about this, but this is one of my other emphasis that I think is very interesting. I’ve done a lot of studying about habits, and just understanding that… I mean, because when it comes to alcohol, we can be in a habit of drinking it, but we could also be in a habit of not drinking it. But studying people up and trying to understand what their habits are, what defines their life, that’s been very helpful to me as far as counseling and then trying to figure out what habits would help them more in the future.

34:02 – The benefits of fasting

Fasting is a great way to detox, cleanse your body, and help your body rebalance.

I have definitely made changes. One of the things is just to shrink the eating window. I do really like that. That’s one of the things I end up talking to patients about too, just the benefits of fasting. Although, you can’t push too hard on that was for some people. And like you said, with menopause, it could be that a woman’s body, as it’s changing, may or may not be able to tolerate a super long period of fasting. So, we can’t elevate fasting to the point that we think do or die. It’s do what you can, listen to your body.

43:35 – The importance of reading labels

The challenge with determining which foods are healthy is complicated by misleading labels and marketing that misdirects the consumer.

Teaching people to read labels and understand what really is in their food. And like I was saying, the sucralose is one that, when we look at artificial sweeteners and stuff, they may be using that Skinny Girl dressing. And then, I have to tell them, “Well, it is lower calorie.” If I could write Skinny Girl a message and say, “Hey, could you just change to stevia?” I could promote your product. But the sucralose sneaking into the coffee creamers and all these things that people think they’re doing themselves a service. And then, when I say, “It’s probably driving your insulin level up, and we need to make some changes as far as that goes, too.” So, just reading labels and trying to understand those things. But there’s just so many misconceptions about which foods are healthy or not. That’s the battle is just trying to help people see what really is healthy, what’s really making them feel better, not crash.

Julie Cottrell: (00:06) Most people don’t want to be just straight up told, “Here’s a piece of paper. This is what you’re going to have for breakfast, lunch, and dinner.” People aren’t really looking for that anymore. They’re looking more for strategies, and they really do seem to latch onto when I tell them, two solid meals a day and a snack in between. That’s my pillar there too is let’s eat twice really good. Many people have found that strategy to be what they were looking for.

Ben Grynol: (00:39)

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health. And this is your front row seat to everything we do. This is a whole new level.

Ben Grynol: (00:51)

If you followed nutrition for a while, you’ll have seen that it continues to evolve. There are lots of fads. There are lots of trends. And there’s new science that continues to come out. It shows people different ways in which food affects their health. Well, this is very much the case for one of our members, Julie Cottrell. Julie’s been a registered dietician and focused on nutrition with her clients for more than 25 years. And over the course of this time, she has seen everything oscillate as far as what to eat and what to avoid. And sometimes those things come full circle. And so, when Julie started using a CGM, she had data that gave her a feedback loop so she could have insight into the way that her body was metabolizing certain foods, the way that different lifestyle choices made an impact on things like her glucose variability and her average glucose levels. And so, CGM has been one factor of many and her journey of health and wellness. Here’s the conversation with Julie.

Ben Grynol: (02:09)

It would be awesome to kick it off and, yeah, dig into a little bit more about your background. You’ve got such an interesting background as a registered dietician for 25 years now, for-

Julie Cottrell: (02:22)

I know. I was doing the math and I couldn’t believe it. I thought, I really have been a dietician that long, and I’ve seen a lot.

Ben Grynol: (02:31)

Yeah. Well, over the past 25 years, food trends and the philosophies have changed and evolved so much, partially because of, we’ll call it, trends and partially because of science. But now, we get things like CGM and other technology that allows us to have a different lens on the data side of things, so there’s a bit more quant coming into some of the qualitative things about the way people physically felt by eating certain foods. So, would be cool to go into your background, how you got into being a dietician, just walk through to present day.

Julie Cottrell: (03:06)

Oh, sure. Yeah, I sure didn’t plan this to become a dietician. And in fact, I started off life… I mean, I was born in 1970 in the age of processed foods. And I loved processed foods. And I didn’t eat a single fruit or vegetable until I was a teenager. So, I have a very picky… I can empathize even with young children or even adults now that tell me that they don’t like a vegetable or something. I’m like, “Hey, I was there. I had to teach myself how to like a lot of different things.” I didn’t really know what I wanted to do. I got a degree in biology. And the last elective that I took was a nutrition course. And so, I asked my professor, “Could I go into nutrition with this?” And she said, “Oh, absolutely.” And plus, I already had an emphasis, like I did gymnastics, and then cheerleading, and then running. And I was very interested in health and that sort of thing.

Julie Cottrell: (04:08)

I ended up going and getting a master’s degree in nutrition. As I got started on that, I realized, hey, if you want to do anything in this world, you need to become a registered dietician. So, I went that route. And so, I became a registered dietician in 1996. And then, I’ve had different jobs along the way since then, depending on… I’m a mom too. So, I didn’t always have the opportunity to be working in the hospital setting or whatever. I’ve done outpatient stuff and just scrambled around, because nutrition kept changing, and my thoughts about nutrition kept changing.

Julie Cottrell: (04:51)

I had to, I don’t know, I mean, I parted ways with the traditional nutrition advice. I reached a point where working in a hospital wasn’t really going to work for me, because I didn’t necessarily agree with all of the guidelines that, as a registered dietician, I’m obligated to. That’s a whole different system. I’ve watched as all these different health coaches have come on the scene. And my husband, my husband’s a physician, he’s family practice trained, and he actually is an ER doctor now. But we’ve had conversations about that. And he says, as a dietician, you are really designed to work in an institutionalized place, a hospital, a nursing home, something that requires your expertise and your credential. And so then, when I go wanting to work and promote health, and wellness, and stuff like that I’m just competing against a health coach, somebody else who just happens to have an interest in nutrition and who, many times, could have more experience than me.

Julie Cottrell: (06:04)

So, I had to switch gears and make some changes from a career standpoint as things changed. My ideas changed, and wanting to still help people, I have that inner drive to help people. You can’t study it this long… I would read nutrition book after a nutrition book, even if I wasn’t trying to get continuing education for it. That’s just what I do. And it amazes me sometimes when I talk to patients who now will say, “Just tell me what to do. I don’t want to read about it. I don’t want to think about it. I just want you to tell me what to do.” And I’m just like, “Seriously? How could you not care or want to read about it?” But that’s truly how some people are. It just doesn’t interest them. They just want to get through their day and try to be as healthy as they can without knowing every detail.

Ben Grynol: (06:58)

Yeah. It’s interesting because I’d imagine that when… It sounds like you had that inner conflict of when working in the hospital where the prescriptions, we’ll call it that, it’s very prescriptive of here’s what you have to have. We won’t even go down that rabbit hole, because it’s a very, very deep one. But the same thing goes when these food trends change, right? Like, this is the latest diet and that. And that people feel almost conflicted themselves where everything becomes noise. The more that everyone’s had the ability to amplify their own agenda and their own messages, then it becomes even more challenging. So, they say like, “Just tell me what to do.”

Ben Grynol: (07:43)

The challenge, and this is where CGM’s data comes in is, you know firsthand, what works for one person does not necessarily work for another person for many reasons, whether it’s lifestyle choices, whether it is genetic makeup, whether it is stage of life, something that you’ve talked about in the article, the member spotlight article that we did with you. How have you worked through that with clients, where you have to give them guidance, but knowing that it’s really hard to be prescriptive and you still want people to generally understand the difference between let’s be hyperbolic… Like a Twinkie and a Brussels sprout, very different outcome. So, if somebody says like, “I don’t really care to know, just tell me which one to eat,” it’s like you should still understand the foundation of why you are eating X and Y together versus avoid Z completely, just don’t do that. So, how have you worked through that, knowing that it’s almost Sisyphean and like you’re trying to work with so many people, but at the same time help them in their best interest and do something that’s intrinsically motivating?

Julie Cottrell: (08:53)

Right. That’s been my greatest struggle, because I don’t want to lead people down the wrong road. And that’s why I do a lot of self-experimentation. I’m always trying to figure things out and change, whether it’s low-carb or it’s a vegetarian type of a plan. And people are confused and they do want to know like, should I do keto? It’s like they want to grasp onto an entire food philosophy. Or, I want to be plant-based. I’m going to be vegetarian.

Julie Cottrell: (09:26)

And I deal with all of that when I talk to people, trying to understand what their motivations are, where they’re getting their information, try to explore that with them, when they say “I’m trying to be plant based.” And I’m like, “Okay, can you tell me more about that? Why are you feeling motivated to do that sort of thing?” I really like to figure out all their motivations and what the context of their life is, what their family situation is, and who all is pulling at them, but also understanding that they don’t have to have one specific food philosophy.

Julie Cottrell: (10:06)

It’s more like, and I’ve had to come to this realization over time, is that there are some pillars that seem to be true no matter what. Whether you want to be vegetarian, or you want to be keto, or whatever, you need a certain amount of protein. Some people are, “I’m not sure I want to eat any protein or not.” I don’t care which plan you’re on, you need some protein. Also, we’re in a culture where we eat just way too many carbs. I mean, that’s a really clear message I can give to anybody. I don’t care if you’re plant-based or not, just eating a ridiculous amount of carbs, your body can’t handle that many. And just trying to differentiate with P for people.

Julie Cottrell: (10:51)

It gets scientific sometimes. I mean, it’s hard to not. Like just the difference between, are you a carb burner or a fat burner? And pretty much everybody I talk to is carrying a lot of extra body weight. Right there, it’s like, why are you carrying all that extra body weight? Well, because you are a carb burner, you are not accessing that body fat. You’re not metabolically flexible.

Julie Cottrell: (11:20)

Some of the other pillars that I’ve come too that I didn’t know when I first started would be like an eating window. I mean, that wasn’t anything I ever heard about, learned about. And now, a lot of studies and everything are backing up how eating in a tighter eating window is so much more beneficial, no matter where your calories are coming from. And so, that’s something that I can get into with people pretty quickly is understanding when is the first food going into your body, and when is the last food going into your body of the day? And can we condense that eating window regardless of what foods you’re eating?

Julie Cottrell: (12:01)

And then, processed foods. I mean, we know that there’s an awful lot of stuff that’s in the processed foods. That’s not doing us any favors. And so, as I explore their diet with them and find out, how much cooking are you doing at home versus how much are you just grabbing and going from restaurants? Because, food quality and just bringing more things into your body that aren’t necessarily health promoting. And it wouldn’t matter which type of diet you’re on, whether you’re doing a vegetarian diet or a keto diet, I mean food quality matters. And I do try to bring that to light with people as much as I can during our conversations.

Ben Grynol: (12:50)

I know that you’ve tried so many different things, but you had this period where you experimented or went deeper into a ketogenic diet, and then backed off because of certain learnings, where it sounds like you went from not eating carbs altogether, and then starting to maybe pair them with fat, fiber, protein, introduce them back in. Because, the natural state is like, great, I’m going to just only eat protein and high fat foods. And so, people over-index on going… I think that happens almost with any new, we’ll call it, new way of eating, whether it is prescriptive diet that people are trying to follow or maybe changing their food philosophy.

Ben Grynol: (13:34)

But it’s like, you go so deep, let’s make an assumption right now and make up an example, because they’re fun, is somebody wants to go plant-based and they want to get more fiber, and they just all of a sudden start eating tons and tons of beans. And it’s like, well, those are also higher in carbohydrates. You got to pair those. So, it’s like anytime you go too deep in one direction, then it can steer you off course of what you’re trying to achieve. What were some of the things that when you started changing the way that you ate and bringing it into stage of life, how did you figure it out? Was it data, was it the way that you physically felt? What was it that sort of made you evolve this idea of the way that you could eat to feel better?

Julie Cottrell: (14:19)

It’s funny, because I’m… Okay, so I come out of being registered dietician, come out of my internship, I start my first job. And I thought I knew everything then. I mean, I just came out of school. And it’s all low-fat and just anything we can do to eat low-fat. And that’s when my husband, and he was in residency at the time, and some of his fellow residents, they were all trying out the either Atkins or carbohydrate addicts diet. And so, along with that, they were all doing it and losing weight. And I’m over here on my low-fat pedestal and not feeling a hundred percent great. But I mean, I’ve got that philosophy in my mind. And they’re losing weight and I’m sitting here struggling to figure out what I’m going to eat that’s going to taste good, and look good, and all that. That was my first point of questioning the low-fat scheme.

Julie Cottrell: (15:22)

And knowing I wasn’t feeling my best, my cholesterol numbers were high, my triglycerides were high, but I was latched on to that food philosophy. And so then, as an experiment, I tried doing a lower carb approach. I mean, this is around 2000, 1999 maybe, 1998. And I felt better and I lost weight. I’m 5’4″. I’ve never really been more than like 128. I mean, I usually fluctuate 115, 120. But at that time I was about 128. And I went down immediately to 123. And I saw that it was not that hard to do. And I was like, why have I been on that pedestal of, you’ve got to be low-fat to make everything work and feel good?

Julie Cottrell: (16:11)

And I mean, what most people are trying to do is lose weight. They want to feel good, but they want that scale to go down too. I realized then that I didn’t know everything. And I have been curious ever since. I started reading books that would seem peripheral, like that’s not what the American Dietetic Association is telling. And I understand, they are a big ship that’s not going to change course very quickly. But they’ve been evolving. I will give them credit. Because, there was a time when, if I wanted to do my continuing education hours, I only got to pick from X, Y, Z. And now, I just read Dr. Gundry’s new book, Unlocking the Keto Code, and it’s already listed as something I can get continuing education for. So, their minds have expanded, and mine have too.

Julie Cottrell: (17:10)

And so, just for me personally, just understanding that there isn’t one right way, but we’re looking for metabolic health. We’re looking for metabolic flexibility. I mean, you can’t listen to any of these podcasts now and not hear somebody talking about that. So, that’s the goal.

Julie Cottrell: (17:26)

And so, I think, to answer your question about the ketogenic diet, I think there’s some great aspects to that. And for somebody who is stuck in glucose burning, and they don’t know how to use that body fat, and they can’t go from meal to meal without… They need a snack, they need that hit. They need to learn how to burn fat. And so, it could be that a ketogenic diet or a very, very, low-carb diet that shuns everything else that could potentially be healthy, do that for a while, because you’ve got to change the way your mitochondria make energy. And so, I can see it as a means to an end for just the general person who just isn’t able to burn fat very well.

Julie Cottrell: (18:12)

Does that have to be their way of life forever? No. They could learn to expand back out. And that’s really where I am in my own understanding of it is trying to understand how much carbohydrate can I get away with without having an allegiance to a ketogenic diet? Because, I don’t really think it’s about just making a whopping number of ketones. I think it’s for the fact that your body can make ketones. And that’s where the benefit of that shorter eating window comes in, the longer fasting window, that your body has the downtime, can start generating those ketones.

Julie Cottrell: (18:50)

And so, that’s like when I’m coming back to my pillars, that’s why that’s one of those pillars that doesn’t seem to change for me is you got to give your body downtime to process through, and reset, and regenerate. And so, that goes with any diet. It doesn’t matter whether you’re vegetarian, or ketogenic, or what you are. And so, when I was experimenting with ketogenic diet and thinking, I want these higher levels of ketones, and now of course, I’ve got the ketone monitor going, and just like I’ve got the CGM on right now, but I love to monitor these things. And so, I was, what’s it going to take for me to make some ketones? I ended up just as frustrated as a lot of people do. If you think the goal is I should be walking around with ketones of 1, or 1.5, or 2, I mean, you’re going to have to do a two or three-day fast to do that. And is that practical or realistic for most people? Very often, that doesn’t jive with life.

Julie Cottrell: (19:55)

So, it makes me question, okay, well ketones might be good, but maybe not to that level. Maybe we want just these lower levels of ketones. It’s like having a high level of ketones is maybe no more beneficial than having a high blood sugar. They’re both energy sources that are in the blood. Yeah, I don’t think that, oops, that the ketones are as important as just being one of those background things that we’re looking for. And so, I don’t have to have an allegiance to a ketogenic diet, but I do have an allegiance to a lower carb diet. And it doesn’t have to be 50 grams a day or less.

Julie Cottrell: (20:41)

But coming back to what I was saying initially with my husband and the carbohydrate addict diet and all that, I learned… This was my first job actually with being a dietician. And standing in front of a group of patients that… I was doing a diabetes support group meeting. And I had used the calculations that I was supposed to go by, which is 50% to 65% of calories from carbs. And so, I’m telling these patients, based on a 1500 calorie or 1800 calorie plan, whatever, you should be able to eat 50% to 65% of calories as carbs. When I did the math, I mean, that’s 200 grams, maybe 250 grams of carbs per day.

Julie Cottrell: (21:28)

I mean, the hands shot up in the air. They’re like, “If we eat that many carbs, I mean, our blood sugar will go through the roof.” And I’m like, But the guideline says this.” And I’m doing this head scratch like, hmm. It’s not working out then. I mean, and how much protein could you eat or how much fat could you eat? So, I realized then that the carbs are what has to come down, however much that might be.

Julie Cottrell: (21:56)

So, I’ve been preaching, personally, a lower carb plan, not necessarily a ketogenic plan, but a lower carb plan for a long, long time. Even back then, that was back, like I said, around 1998, ’99. And I had cardiologists that would refer… One cardiologist would refer patients and they needed to do Dean Ornish. They wanted me to instruct patients on Dean Ornish. I don’t know if you’re familiar with that plan. It’s vegetarian, very plant-based, not too much protein, versus I had some that were saying Atkins, and they just wrote that in the medical chart, Atkins. And so, I mean, it was like I was torn both ways right then. And so, it’s been ever since then that I have realized that there was more than one approach. But I have consistently felt like a lower carb plan was better. And the way I define that is about 100 grams of carbs per day or less.

Julie Cottrell: (22:57)

I remember when Mark Sisson came out with his thing. I share that like with patients. It’s on my patient education materials, is his carbohydrate curve, if you’re familiar with it. That, I mean, you go over 100 grams, and it just becomes a lot more difficult to… Unless you’re very active. And I do have a son who’s a runner, and he can get away with those carbs. But he’s constantly using them up. Most people I talk to are not very active. And so, I just feel like, let’s get you under, that’s another pillar for me, is let’s get you under 100 grams of carbs any way we can. Let’s do some carbs swaps. Maybe, instead of your pasta, you’re going to eat the spaghetti squash, something like that. Let’s get some strategies in place that are going to help you lower the carbs without you necessarily feeling like you have to adhere to a ketogenic plan.

Ben Grynol: (23:54)

When you started using a CGM, were there anecdotes or takeaways where you could link the way that you physically felt prior to seeing data back to it, to be like, “Oh yeah, that feeling,” because you all of a sudden have the data? So, the classic example is, which so many people can relate to, is the head nod at 2:30 in the afternoon where your head’s about to hit the keyboard, if somebody works at a desk and they’re sitting there. And it’s like they can’t figure out why. And so, it means like, I need more coffee, I didn’t get enough sleep. It’s like you’re trying to connect the dots, but it’s the wrong thing altogether. And it’s like, oh no, the Jimmy John’s sandwich that you ate 30 minutes ago is making you go hypoglycemic.

Ben Grynol: (24:40)

And so, as soon as you see the data, it’s a lot easier to go, “Wait, for the past 20 years, that thing that I was always feeling…” Because it doesn’t have to be at the desk, it can be anytime you start to go hypoglycemic, you can feel it. It’s so visceral, once you know the data. You don’t need the CGM to see, you can just feel all the sensations about it. And so, were there any points for you where you were able to link back the way that you felt as you evolved your eating philosophy, and then maybe some of the things that you passed along to clients of like, this is what happens with this, because you were able to connect those dots a little bit better?

Julie Cottrell: (25:19)

Yeah. I was already doing a low-carb diet when I started. And so, I don’t have the same a-ha moments as somebody would who is eating… They’re eating oatmeal that they think is healthy, which could be, or a bowl of cereal. I mean, I talked to plenty of people that they’re… Or the cereal bar or something like that. I wasn’t doing any of those things. So, that part of it, I couldn’t really assess.

Julie Cottrell: (25:50)

That’s probably why, when I did my other interview with you guys that I said, actually, relative to alcohol is one of my things is because we like to drink a little wine or something like that in the evening. And that would be the time that I would start to experience what I felt like was a low blood sugar. This is in the context of a low-carb diet, which as I’ve understood more about alcohol now, I understand that your tolerance goes down. You need to hydrate more. There’s all kinds of things that you can do to make it better. But you also just have to understand that you truly don’t tolerate it as well. And so, wearing the CGM showed me that indeed I was experiencing a low blood sugar.

Julie Cottrell: (26:38)

That could potentially be one of the reasons why alcohol, paired with a meal, could have a health benefit in moderation. Because, I think sometimes people think, oh, well then my blood sugar went down, and it’s almost like they think those calories disappeared, and the calories don’t disappear. Your body’s just shoving that energy away for later while it metabolizes the alcohol. But I think it comes back to understanding that moderation is important, staying super hydrated is important, not drinking too late at night, that sort of a thing.

Julie Cottrell: (27:15)

I think, when I saw my blood sugar go down, then if you’re going to adhere to a lower carb plan, then you’re going to reach for cheese or some nuts or something like that that’s low-carb that’s still staying with your plan. But the truth is, if you have a low blood sugar, those foods don’t bring it back up very quickly. So, if you do exceed what moderation would be, you have a second glass or a third glass of wine, whatever it is, and you start to experience that low blood sugar, you probably need to pull out the crackers or something. Maybe it’s gluten-free, I don’t know, but that’s going to help bring that blood sugar back up. Because, just some chiefs by itself, isn’t going to. I think what I learned is just repeating back that moderation is important.

Julie Cottrell: (28:13)

The other thing I realized too is habits. I haven’t talked about this, but this is one of my other emphasis that I think is very interesting. I’ve done a lot of studying about habits, and just understanding that… I mean, because when it comes to alcohol, we can be in a habit of drinking it, but we could also be in a habit of not drinking it. But studying people up and trying to understand what their habits are, what defines their life, that’s been very helpful to me as far as counseling and then trying to figure out what habits would help them more in the future.

Julie Cottrell: (28:47)

And so, I’ve established some habits around the alcohol, which is maybe you need an alcohol window of time. There’s something to that saying of don’t drink before 5:00. Or people say, “It’s 5:00 somewhere.” Well, don’t be drinking all day long. I mean, you shouldn’t be anyway. But tying it to the meal, knowing that your blood sugar is probably going to be a little bit lower. So, if you enjoy that glass of wine with your meal, that’s the beginning and the end of it. Don’t carry on after dinner. The bottle of wine’s already open. Well, you better pump it and keep it for tomorrow, because you don’t need to keep on drinking. I don’t know. I mean, that’s just an example. I don’t mean to talk all about alcohol because I’m…

Julie Cottrell: (29:33)

But a lot of people ask me about it. I mean, that’s one of the things that comes to light when I’m counseling them is… I’ll ask them just what beverages they consume. And I’m thinking more about coffee, and tea, and sugary drinks and all that. Let’s clean that up real quick. But along with it is, how much alcohol are you consuming too? And are you using that daily? And trying to give the best advice I can based on that too is, how can that fit into your life if that’s what you want, and you can do it responsibly, but not necessarily… And then, you could use a CGM to see what it’s doing for you. But I’ve been able to tell people I’ve worn a continuous glucose monitor, and I’ve been able to see that it does bring my blood sugar down. So, it’s not something that you want to do unless you do have food planned just to help keep it from going too low.

Ben Grynol: (30:33)

Yeah. Alcohol is a very interesting one, because we stay neutral in the sense where we don’t want to be prescriptive and say, do this or don’t do that. But what is important to note are there are certain things where we’ll say, “Alcohol is not a glucose mitigation strategy.” Like when some people think, “Oh great, I can go have this thing, because I’m going to have the wine with it.” And to your point of habits, that’s not the habit that we encourage people to build, again, staying neutral.

Ben Grynol: (31:04)

What we do is highlight data points or any research that is available, where if we talk about alcohol, and say, “Cool, what are some of the other implications of having…” Let’s just say it’s that one glass of wine at night. Well, we know that data will show us, it gives you poor quality sleep, especially the later you consume it, and again consuming it with or without food. But alcohol consumed, let’s just say it was 7:00 PM and somebody’s going to bed at 9:00, they will have lower quality sleep. Lower quality sleep leads to higher average glucose or higher glucose variability, more insulin resistance in a day. And that starts to compound over time.

Ben Grynol: (31:43)

So, when something becomes a habit and somebody’s having one or two glasses of wine every night with or without a meal, and the later they have that, or beer, whatever they are drinking, then you start to go, well, the thing I’m trying to get control of, my glucose, it’s being offset by this other thing that has now become a habit. So, just understanding all the implications of, what does this one input do and how does it affect the other output of what the goal is?

Ben Grynol: (32:15)

And if somebody’s goal is, whether or not this is the right approach or mindset, somebody might say, “I want to lose weight,” and they are insulin resistant. You have to get your insulin under control. And there’s so many lifestyle habits where it can’t be just change diet, but maintain these other, we’ll call it, these other lifestyle choices the way that they were in the past. Everything is so tightly linked in so many different ways that it’s a matter of understanding these things. Like eating poorly, but saying, “It’s okay. I’m eating a ton of processed foods, and it’s okay because I exercise ton.” It’s like, well, no, it’s not really okay. That’s not the way to approach it. There’s too many factors that need to change.

Ben Grynol: (33:05)

So, I would imagine that when you’re working with clients it’s ongoing, especially when people say, “I don’t really want to understand.” It’s like, well, you need to understand how all these things are linked, because it’s not just there’s not some… We always say glucose is not a panacea. There’s the strategy. Just do that. Just exercise, just eat well. It’s do everything, sleep well, understand how your lifestyle choices have to change, if you have the goal of, let’s say, weight loss or whatever someone’s goal is. It’d be interesting to go into how you’ve evolved and adapted your lifestyle choices or even just your diet given stage of life, and some of the things that you’ve talked about as you’ve been going through menopause, and to understand like how women’s health changes over time, and how the way that you approach things evolves.

Julie Cottrell: (34:01)

Yeah. Yeah. I have definitely made changes. One of the things is just to shrink the eating window. I do really like that. That’s one of the things I end up talking to patients about too, just the benefits of fasting. Although, you can’t push too hard on that was for some people. And like you said, with menopause, it could be that a woman’s body, as it’s changing, may or may not be able to tolerate a super long period of fasting. So, we can’t elevate fasting to the point that we think do or die. It’s do what you can, listen to your body.

Julie Cottrell: (34:40)

Coming back to the sleep, that’s really one of the starting points I do. I never would’ve talk to a patient about sleep years ago. And now, I might spend 10 minutes talking to them about their sleep. I try to give them structure to their day. And so, we do talk about how many meals and things that they’re eating a day. And are they stopping within two to three hours of bedtime? That’s something that’s extremely important to me too. I have my Oura ring. I’m a gadget girl over here. So, I study my sleep. And I was studying that alongside of using the CGM as well, and trying to pair all these things up. I do know how important sleep is and teaching people that that is your reset button. That’s when your body does its repair work. You need to do everything you can to get the best quality of sleep you can and as long as you can. And so, that’s something that we really work on. And then, extending the fast from that point as much as you can.

Julie Cottrell: (35:47)

And I’ve been able to watch my own blood sugar through that morning time and see how it’s responding. Yeah, I think just understanding that you can go for a period of time and not necessarily need to eat anything, if you can teach yourself to be more fat adapted. But that’s a process. A lot of times people want the easy answer. They want it to happen right now. And it does take time to become fat adapted. If you’ve been very dependent on carbs and being a sugar burner, then you’ve got to give yourself time to make some adaptations so that your body can go for longer.

Ben Grynol: (36:28)

The adaptation part is interesting, because it ties into the mindset around goals. Often, will hear people that will say, “Hey, my goal is I want to lose weight.” And sometimes that’s not actually the outcome that will make them content, if you want to call it that. Because weight is an interesting thing where… Let’s make an assumption that somebody isn’t overweight to the point where they want to lose a little bit of weight, but it’s not like 50 pounds. It’s that they want to physically feel better and they want their waistline to change. Sometimes, by changing eating habits and sometimes by getting things like their metabolic health under control, they’re not actually losing weight, but they’ll lose like four inches around their waist. And they go, “I don’t understand. I didn’t lose any weight,” but they feel really good.

Ben Grynol: (37:27)

They’ve started exercising. They’ve started building some muscle. Their waistline has changed. The way that their toned is their body tone and where their weight distribution is completely changes. And they say, Wait, I’m the same. I’m the exact same weight as I was before. I physically look different. I physically feel different.” And so, it’s evolving the mindset around the goal is to physically feel better and to physically be more healthy. And so, the weight can be, it can be a challenging anchor, because it depends on the goal. There is a time and a place for weight loss, absolutely. Absolutely that’s without a question.

Ben Grynol: (38:07)

But when somebody is at a point in their life where they say, “I just want to lose a little off my waist,” it’s like, well, you need different distribution and that’s going to come with not having the venti Frappuccino. The weight around your waist is because you’re having… I don’t even know what the… I think they’re 60 or 70 grams of sugar in some of those Frappuccinos. I mean, it’s absurd. And so, you one of those a day maybe. That’s probably a thing. Some people are having that a day plus other things. That is what’s sitting in the waistline. “I don’t understand. I eat kale salads and all these other things.” Well, the byproduct of that habit is where you physically don’t feel good. And so, it’s changing the lens through which people understand what certain inputs do to them.

Ben Grynol: (38:55)

And they think it’s minor, because they’ll say, “I don’t consume sugar.” And then, you do the audit and you’re like, “What do you think that slurpy, that coffee flavored slurpy is that you have every morning? And how does it make you physically feel?” Oh, the crashing feeling at 10:00 AM, yeah, that’s that thing. Right?

Julie Cottrell: (39:17)

Mm-hmm.

Ben Grynol: (39:17)

So, it’s really hard, but it’s understanding people’s goals and then helping them to shift their lens of, what do you really want to achieve? Because, then once you get there, that’s where people start to go. Now, I do want to understand. Educate me so that I can change my habits.

Julie Cottrell: (39:33)

Right. Right. Yeah. And I do, I find that more people than not have tried diets throughout. And they don’t really want a diet, they want to feel better. I’ve had so many people tell me, “I want to feel better. I want to get off these medications. All these medications have side effects.” So, they are looking for some answers, some people are anyway. They’re looking for some answers that would get them so that they’re not tied to all these medications and just not feeling good, and trying to drink that energy drink just because they don’t have energy.

Julie Cottrell: (40:10)

I’ve been really pleased, actually, with the way that most people don’t want to be just straight up told, “Here’s a piece of paper, this is what you’re going to have for breakfast, lunch, and dinner.” People aren’t really looking for that anymore. They’re more looking more for strategies. And they really do seem to latch on to when I tell them two solid meals a day and a snack in between. That’s my pillar there too is let’s eat twice really good and another snack if you need it. And many people have really found that strategy to be what they were looking for. And coming back to you asked about the CGM, and I’ve been able to verify that lots of the meals that I have recommended to patients then that your blood sugar might go up 10 or 15 points max. I mean versus you throw a potato in there, it’s going up. I mean, it’s hard for it not to. Just the idea that if you really do want to have good blood sugar control, I do know how to achieve that.

Julie Cottrell: (41:22)

And then, figuring out how to be metabolically flexible then is the next case in point is trying to figure that out, how many carbs can you tolerate, and trying to experiment. And that’s probably where the CGM comes in, because each person is going to be different and how they’re going to process those carbs. And what their food likes are and everything about themselves is going to change. So, I think that could be a beneficial eye opener to people understanding that.

Ben Grynol: (41:57)

Yeah, the data gives that extra layer of insight where, assume somebody says they’ve been trying everything, they’ve been following the prescriptive advice, but they don’t realize that, because sugar is hidden in so many things now where… We’ll make it up. It’s a spinach salad and they eat some lemon poppy seed dressing, but they’re not looking at that label and saying like, “What-

Julie Cottrell: (42:22)

And the sucralose, not understanding what that’s doing.

Ben Grynol: (42:26)

Yeah. It’ll be 14 grams of sugar in like two tablespoons, just something absurd. And that’s very normal to see those kinds of things on labels, but people don’t check. And so, they’ll say, “I want to achieve this goal,” but they’re having a challenge. As soon as you have the data, you can start to dissect things and go, wait a minute, this thing that I thought I was doing for like 10 years straight is definitely not helping me in any way, shape, or form. And so, then you can adapt and you can make the right choices, where you go, “Oh, I do…” Assume it was somebody’s habit. They like to have the spinach salad for lunch that they make. And it’s homemade except for that dressing. And they go, “Wait a minute, it’s just olive oil, lemon juice. I can make that thing.” And they just make their own dressing. And they’re like, “That’s easy.” And then it changes things completely in the way that they feel and helping to get to their goal of over time that will compound all those micro things of changing the way that they approach their lifestyle choices.

Julie Cottrell: (43:31)

Absolutely. Absolutely. Yeah. Teaching people to read labels and understand what really is in their food. And like I was saying, the sucralose is one that, when we look at artificial sweeteners and stuff, they may be using that Skinny Girl dressing. And then, I have to tell them, “Well, it is lower calorie.” If I could write Skinny Girl a message and say, “Hey, could you just change to stevia?” I could promote your product. But the sucralose sneaking into the coffee creamers and all these things that people think they’re doing themselves a service. And then, when I say, “It’s probably driving your insulin level up, and we need to make some changes as far as that goes, too.” So, just reading labels and trying to understand those things. But there’s just so many misconceptions about which foods are healthy or not. That’s the battle is just trying to help people see what really is healthy, what’s really making them feel better, not crash, like you’re talking about.

Ben Grynol: (44:35)

Yeah. It’s almost marketing gone wrong. You see it all the time on whether it’s cereal boxes or crackers. I saw, I think it was last week, I saw a beer that said vegan friendly. And I did a check in my head and I’m like, yeah, why is that beer… It’s not-

Julie Cottrell: (44:50)

What does that mean?

Ben Grynol: (44:56)

Yeah. But it’s like everyone just can slap a label on things that say gluten-free. Of course, T-bone steak is gluten-free, of course it… But people put these labels. And then, we’ve got this heuristic because of marketing gone wrong, where people will read that, and they’ll say, “Oh, this must be the healthy option, because it says this thing. Companies only put that thing if it is a healthy option.” You see it on Cliff Bars. You see it on just everything. You see it everywhere.

Ben Grynol: (45:28)

And that’s what’s really challenging is that we’ve got… You touched on the idea of autophagy where we’ve been marketed to. We evolved for so many tens of thousands of years where that was our natural state. And now, we’ve been marketed to the hours of 8:00 AM, loosely, like 8:00 AM, 12:00 PM, and 5:00 PM, when it hits that hour, you eat.

Julie Cottrell: (45:55)

Yes.

Ben Grynol: (45:56)

And it doesn’t even matter what you eat, but those are the times when you put food in your mouth. And you’re like, what? Having a late night snack too, that’s good for you. 9:00 PM, 8:00 PM, that’s good for you. People get sold that, well, that’s what you do. And it’s like, that’s not what you do. Your body needs to enter a state of repair, and adaptability, and resilience so that your mitochondria and all the things that are the byproducts of your body going into the state of repair can get into that. But you can’t get there by just constantly feeding yourself, and feeding yourself, and feeding yourself. So, there’s ongoing education and helping the world understand it is exactly what we need more of.

Julie Cottrell: (46:42)

Absolutely. Yeah. Like I said, I mean, I spend so much time talking to people about their sleep and finding out, well, what time do you go to bed? There are people who are night owls. I mean, I totally get that. But sometimes I think, if you said, “I need to get in bed by a certain time,” and you said, “I’m not going to eat within two to three hours of going to bed,” I think going to bed would look a little more something like something you wanted to do versus eating the bag of chips or something up until you go to bed. I think, people are eating snacks and things like that as a way to get that energy up until they go to bed. And then, it’s interfering with sleep. So, yeah.

Julie Cottrell: (47:26)

I have loved using my Oura ring plus the CGM to just see how I can optimize my own sleep. And then, again, try to come back to patients and say, “I’ve tried this myself. I can understand. Really truly, if you can stop eating within two to three hours of bedtime, that’s going to be a benefit.” I like to practice what I preach. And then, I like to experiment on myself so that I do know first hand, I can speak to this. This is how you correct it. I know what habits are driving some of these other behaviors, but let’s see what we can do to change those habits.