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- [00:01]
A
Hey sweetie, your mother showed me this Carvana thing for selling the car. I'm gonna give it a try. Wish me luck. Me again. I put in the license plate. It gave me an offer. Unbelievable. Okay, I accepted the offer. They're picking it up Tuesday from the driveway. I haven't even left my chair. It's done. The car is gone. I'm holding a check anyway. Carvana, give it a whirl. Love ya.
- [00:24]
B
So good you'll want to leave a voicemail about it. Sell your car today on Carvana.
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C
Pickup fees may apply.
- [00:31]
D
Your summer start starts now with Memorial Day deals at the Home Depot. It's time to fire up summer cookouts with the next Grill 4 burner gas grill on special. Buy for only $199 and entertain all season with the Hampton bay West Grove 7 piece outdoor dining set for only $499. This Memorial Day get low prices guaranteed at the Home Depot while supplies Last price invalid May 14 through May 27 US only exclusions apply. See homedepot.com Pricematch for details.
- [01:03]
C
My wife, Ken and I experienced a bit of shock in February when she discovered that she's pre diabetic. As much as I criticize Maha and wellness influencers on this podcast, which, to be clear, is focused on their health and science claims, in reality, both Kellen and I live our lives in much the same way as they do. We split cooking duties three nights a week each focusing on whole fresh foods. We batch cook for lunch. Since we both work from home, we both exercise diligently. So discovering that she's pre diabetic was quite a bit of a shock, though as we were to learn, it shouldn't have, given the genetic component. Callan is half Thai and Asian Americans have an elevated risk of diabetes that goes beyond traditional risk factors. I'll get into that in a moment. You're listening to Conspirituality, and I'm Derek Barris and as always, you can find us on Instagram and threads@ConspiritualityPod. And if you have the means to do so, you can Support us@patreon.com conspirituality or via Apple subscriptions. This episode is going to focus on prediabetes first with a very brief overview of what it is, and then I'm going to interview Callan about her experiences living with it. I know a lot of listeners come from the wellness world, just as we do. We actually met in a yoga class 12 years ago, so rather than going into debunking mode, I want to discuss this very relevant issue that likely affects you or someone you know. Given the numbers of people either suffering from type 2 diabetes or from prediabetes, I'm not going to discuss type 1 diabetes, just to be clear. I also want to say that nothing in my explanation or in the interview with Callan is medical advice. I simply want to share how we're navigating this space and how it's affected our household. Let's get into it. Prediabetes is characterized by elevations in blood glucose below the threshold for a formal diagnosis of diabetes. It describes a state in which glucose metabolism is disrupted enough to represent serious metabolic dysfunction and meaningfully elevated health risks. The American Diabetes association uses three blood based criteria for diagnosis. The World Health Organization uses slightly different thresholds, which helps explain why global estimates of prediabetes prevalence can vary across studies. There's also a bit of clinical nuance. Different test options do not always identify the same patients. This inconsistency is why it's important to get a comprehensive screening rather than relying on a single metric. Prediabetes is not benign, however. People with it are at significant risk for progression to diabetes as well as cardiovascular disease and several other serious conditions. Mounting evidence shows that organ level damage can begin during pre diabetes itself. It's been associated with elevated long term risks of cardiovascular disease, heart failure, chronic kidney disease and mortality. A major umbrella review found that pre diabetes is associated with a 6 to 101% increased risk for all cause mortality. It's quite a range of outcomes, but it's there as well as the incidence of cardiovascular outcomes. Coronary heart disease, stroke, heart failure, atrial fibrillation, chronic kidney disease, total cancer and all cause dementia. As I said, it's a growing problem in America. 115 million adults have pre diabetes, which is over 40% of the population. More worryingly, 8 in 10 adults with pre diabetes don't know they have it. These are estimates. To be clear, I've seen different numbers, so I'm going with sort of the aggregate here. Pre diabetes also accumulates with age. Over 31 million people 65 and older, which is 52.1% of that demographic, have prediabetes. But this is not only an American problem. 634 million adults, which is 12% worldwide, have impaired glucose tolerance, which is the primary marker of prediabetes. By 2050, that number is predicted to shoot up to almost 847 million adults. The financial burdens and its downstream consequences are quite large. The total annual cost of diabetes in America is about $413 billion. And that includes 306 billion in direct medical costs and 106 billion in indirect costs. People with diagnosed diabetes now account for one of every four healthcare dollars spent in the US and 61% of diabetes costs are for adults 65 and older. Prediabetes also carries measurable costs. On average, it costs roughly $500 per person a year in medical costs. A 2017 analysis estimated prediabetes accounted for 43.4 billion doll burden. Also want to note that when Ken starts talking, you're going to hear talk about how her continuous glucose monitor is not covered by insurance. And that's its own problem that is pretty widespread. There are certain exceptions that can be made, but it requires a lot of red tape. You have to prove that you have potentially severe complications from having pre diabetes and also in order to get it covered. And I don't know if you caught a couple weeks ago on social media, I was talking about how Dexcom, which is one of the two largest CGM manufacturers in the world, they have a partnership with Glucose goddess to sell CGMs, basically for biohackers. Interestingly, what that did to the market is it allowed people to access CGMs without a prescription. Now there are so some other companies, we've talked about, Casey Means's levels, which are doing this already. But here you have one of the major medical device manufacturers who have released a sort of consumer grade monitor that people can get without a prescription. But the thing is, this is all part of the problem of American health care. The fact that someone with prediabetes cannot have their monitor covered. And given the costs that Kellen and I pay for our insurance every year, even though it's partly covered by her employer there, it's just infuriating that there now needs to be more money spent on something that we're trying to use so that it doesn't spill over into type 2 diabetes and become an even larger economic burden. It's the backward nature of this healthcare system. It's, it's again, infuriating. Okay, let's go back to pre diabetes rant over. But not really because this will be my, my chronic problem with how healthcare distributed in the United States and how it's treated. Risk for pre diabetes is shaped by conver convergence of biological, behavioral and social factors. So key markers, they include age and weight, sex, in fact, more men than women have it, family history, sedentary behavior, the social determinants of health, of course, like food insecurity, low household income, and not having private health insurance and diet are all implicated. And of course, this is where it dovetails with conspirituality, because the MAHA movement is almost exclusively focused on the problems with diet. Now, research does suggest a pro inflammatory diet is associated with higher fasting plasma glucose and greater odds of prediabetes and insulin resistance. So, as with a lot of this, there's a grain of truth there, but it's a lot more complicated, especially given the genetics, which is what I'm going to get into now, because one of the most significant shifts in screening guidelines over the past decade has been the recognition that Asian Americans are a high risk population, even at body weights traditionally considered normal or healthy. The core issue is that BMI body mass index, which has long been used as a proxy for metabolic disease, rate, systematically undercounts risk in people of Asian descent. Asian Americans are at an increased risk for diabetes at lower BMI levels relative to the general population. The biological explanation for this centers on body composition and fat distribution. Visceral adipose tissue, or deep belly fat that surrounds the organs promotes the circulation of free fatty acid molecules, which include insulin resistance in surrounding tissues. As it turns out, Asian Americans tend to carry more visceral fat relative to total body weight than people of European descent. That means that at any given bmi, they have a higher metabolic risk. And so one study of Asian adults in Northern California found that diabetes prevalence was 31.9% for Filipinos, 29.1 for South Asians, and 15.6 for Chinese Americans, compared to 12.8% of white adults. And tragically, the CDC still does not present nuanced thresholds in public facing materials, which means the gap between clinical guidelines and public awareness remains pretty substantial. And as you're going to hear Kellen talk about in a moment, she had to turn to one of her closest friends, who happens to be an endocrinologist, to really get the information because her primary care doctor was not able to provide it. We also after this, this wasn't the only reason. We were at Providence here in Portland, and I've had issues with them for years, given all of the lawsuits that have been against them for doing things like trying to double bill Medicare and Medicaid patients, which they made millions of dollars from. There's been a lot of shadiness. So after her diagnosis, we left, and now we're at a much smaller, independently owned clinic in Selwood, which so far has been fantastic. Okay, another ramp. But anytime I talk about health care, I'm going to Go on some sort of rant. Okay, last part, and we'll get to Callan. As of now, the landmark Diabetes Prevention Program, which is a multicenter randomized clinical trial that was funded by the nih, remains the gold standard for treatment of prediabetes. They suggest a structured lifestyle change program in which participants aim to achieve weight loss of 5 to 7% of their body weight, reduce the risk of DIV, and that reduces the risk of developing type 2 diabetes by 58% of adults at high risk for the disease. The lifestyle intervention protocol remains at the heart of the program, and it focuses on two goals that minimum weight loss and weight maintenance and a minimum of 150 minutes of physical activity per week. Okay, that was a lot of information. If you are dealing with this, you probably know a lot of that already. If you're not and you haven't been tested and you're concerned, as you're going to hear Callan talk about in a moment, she sort of. This was sort of a chronic issue that was underlying other issues ever since she first got Covid. So we're talking about over five years that this was probably happening in the background of her life. And what. Once we actually addressed prediabetes, things have gotten much better for her overall health profile. So definitely good. Even if you don't think that you might have it is just to get those sorts of comprehensive screenings. Okay. Callan, how did you first feel when you learned you had pre diabetes?
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B
My first reaction was really emotional. I had this kind of weird blend of disbelief and guilt. I felt like I had somehow failed at being healthy, even though nothing in my regular life was reckless. I've been active my whole life. I cook most of my meals at home. I barely drink. I don't really have a sweet tooth. And I was really invested in the idea of being a healthy person. I immediately did the thing that you're not supposed to do, which is Google everything and speculate.
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C
Where do you think the guilt came from?
- [14:36]
B
I felt like I had failed a test that I didn't know I had been taking. The diagnosis had felt like a judgment on the way that I was living my life. And previously, I'd been pretty proud of the way that I was living.
- [14:49]
C
Proud of your relationship with food?
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B
Proud of my relationship with food. Proud of my relationship with movement and exercise.
- [14:56]
C
How did the diagnosis change your understanding of your relationship to food?
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B
Before the diagnosis, my mental model was pretty simple. I cooked most of the time. I don't eat much junk food. I move my body so I thought it was fine. When I told a friend that I was pre diabetic, she joked with me and said, have you been secretly pounding Sour Patch Kids and cheap wine? And I thought, no, honestly. And if I had gotten here through some sort of nighttime binges, at least I would have enjoyed it. Big shift for me was realizing that healthy isn't generic. It's very personal. I started learning how common type 2 diabetes was and pre diabetes are in Asian populations in particular, and how strongly family history raises your risk.
- [15:43]
C
What aspects of your diet have changed then?
- [15:46]
B
One of my closest friends from high school is now an endocrinologist who specializes in diabetes. When I texted her, her first response was, hey, glucose goes up and down all day. Maybe you just ate, don't worry about it. And then when I told her it was my HbA1c value and it was quite high at 6.2, her response was, holy shit, you're one of those Asians. Which was a really startling way to break the news. But she called me immediately. She said, don't change your diet yet. Get a cgm, get a continuous glucose monitor and wear it for two weeks and live your normal life. We need real data. So I did. After that, I found out the surprise villain of my story turned out to be rice. Rice noodles, plain rice, any rice. My glucose would spike well out of range. I don't even particularly like rice. It was just like this default carb. I found out that liquid dairy, like the milk in a cappuccino in the morning, sent my numbers up. So I stopped. I stopped drinking any kind of milk. And meals in general where I didn't start with a big portion of vegetables, spiked more dramatically.
- [17:00]
C
Did you change anything about how you exercise?
- [17:03]
B
Movement has always been a part of my identity, so I didn't start from scratch. But the meaning of it changed a lot for me. Before, lifting weights and doing yoga were about mood and feeling good in my body. And after the diagnosis, strength training started to feel like part of my treatment plan. I became more intentional about timing. I walk after big meals, I walk every evening, and I lift on days where I know I might be eating something more challenging.
- [17:34]
C
For me, what were the disparities between learning about the condition from your doctor compared to your friend?
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B
This is where my frustration with the medical system really kicked in. I had seen a previous primary care doctor for about four years, and ever since my first bout of COVID I'd been telling her, I don't feel like myself. I'm really exhausted, I'm gaining weight. In ways that I never have before. We checked my thyroid multiple times. Everything was normal. We looked at hormones because I thought for sure I was perimenopausal and I was not. I pushed for a CT scan and a coronary calcium score, also fine. So on paper I was healthy, but I felt really, really awful. She knew I had a family history of type 2 diabetes on my mom's side. And yet in four years, no one ordered an HBA1C. And then I changed insurance and got a new doctor. I did labs and that's how we discovered my 6.2 value. When she messaged me, it was a two line note in the port, basically saying, you're in the pre diabetic range. Consider a Mediterranean diet, which is technically true, but not remotely enough. No explanation of what the range meant, no sense of urgency. I could have become diabetic. When my endo friend saw that message, she was really upset. Not at this doctor, but at the system that gives them 10 minutes and a messaging app, and they call that care. And this friend spent literal hours on the phone with me, texting with me, talking to me, talking me down from my panic, unpacking my guilt, helping me interpret the CGM data and brainstorming realistic changes. She kept stressing, this is not a moral failure, it's a genetics plus environment. We're just getting ahead of it right now.
- [19:33]
C
Did all this change your feelings at all about the healthcare industry?
- [19:37]
B
It did. In the end. I felt really lucky to have all of the resources that I have. I have the money to buy a CGM over the counter without insurance because insurance doesn't cover it unless you're actually diabetic. If you're pre diabetic and trying to ward off diabetes, you don't get coverage. Which I find bizarre because I am the kind of person that if you give me tools and data and support, I will make the necessary changes to be a healthier person. It made me see how easily even someone who lives like me could become diabetic. And I found that really frightening.
- [20:17]
C
What have your experiences wearing a CGM been like?
- [20:21]
B
The CGM was a revelation for me. Before, the concept of blood sugar was this abstract lab value. With the sensor, I could see what my body did with breakfast, what my body did with coffee, with stress, with sleep, with less sleep. It turned me into a kind of citizen scientist. I'd try rice without veggies, huge spike, the same rice after a plate of vegetables and protein, smaller spike, regular milk and a cappuccino spike black coffee, not so much or at all. A short walk after dinner dramatically better curve psychologically. It shifted me from my body is betraying me and I don't know what's going on to my body is giving me data and that reduced a lot of the shame and the panic for me.
- [21:13]
C
Now that we're a few months past diagnosis, how do you feel?
- [21:17]
B
I feel two things at once, really angry and really grateful. I'm angry that I spent years saying something is wrong and nobody thought to check the obvious test given my family history. I'm angry that my actual diagnosis came via a two line text message. I'm angry that when I asked for a nutritionist referral, it took three months for the office to call me back. By then I'd gotten much more practical help from the CGM's free telehealth nutritionist than from the formal healthcare system, which again, I have the resources to pay for. And I'm lucky in that regard. At the same time, I feel incredibly grateful. I'm lucky that one of my oldest friends is a diabetes specialist who took hours out of her multiple days to guide me. I'm lucky that I have the money for sensors and kitchen gear. I immediately went out and bought an air fryer. And I'm lucky that I had the time and energy to cook and experiment. I work from home and that is essential for me to be able to cook all of the things that I have to now so I can eat in a healthy way. Physically, I feel great. I lost over ten pounds in the first couple of weeks without trying to diet at all. It just happened as I lined up what I eat with what my body handles really well. I feel like I have my energy back and I feel like I recognize myself again.
- [22:47]
C
If you didn't have the tools at your disposal, specifically your friend, do you think you would have been susceptible to wellness jargon around their concepts of biohacks and diabetes?
- [23:01]
B
For sure. If I didn't have all of these very valuable tools that I just listed at my fingertips, I would have been frantically googling and I saw all sorts of information that was non information that I was able to cross reference via my doctor friend who was a text away or a phone call away to have her tell me that's that's bupkis. That's not something you need to be paying attention to. That doesn't really apply here. Also, even if it wasn't necessarily incorrect information, having both this friend, this endo friend and a nutritionist helped guide me through the subtleties of this condition there are no absolutes. I'm finding that what is healthy for me is healthy for me in particular.