Dr. Jurgelewicz: Sure. I mean, specifically, if we’re looking at the statistics in Australia, when you’re looking at the self-reported diabetes, this has increased from around 3.3% up to 4.4% from 2001 to 2017 or ’18. And when we think about this more globally, it’s estimated that one in two people living with diabetes are unaware of their condition. So, there could be lots of complications associated with that. And then also, just over 1.3 million people were newly diagnosed with type 2 diabetes between 2000 and 2021 in Australia. And this is an average, when you’re really looking at, from a number perspective, around 60,000 people each year. And as one of the things you initially alluded to when we’re thinking about women, you have a subgroup of those with insulin resistance, with PCOS, or polycystic ovarian syndrome. And that represents, in Australia, about 8% to 13% of women, which is about 1 in 10 women.

And when we think about some of these statistics, we have to think about the expenditure. So, when you look at, from 2019 to 2020, there was an estimated 3.1 billion AUD of expenditure on the Australian healthcare system that attributed to diabetes, representing 2.2% of the whole disease expenditure. And this can represent those with type 2 diabetes, gestational diabetes, so, that’s during pregnancy, and then other causes of insulin resistance, such as the polycystic ovarian syndrome. And as you mentioned, with the significance of pre-diabetes, this affects about 3.1% of those in Australia. And why this is important is those that have pre-diabetes have 10 to 20 times greater risk of developing type 2 diabetes. And if you’ve been told you have type 2 diabetes, it’s important to make those lifestyle and dietary changes, such as exercise, because one in three people that have pre-diabetes will end up developing diabetes. So, that’s about 30%. And what’s even more significant with that is there’s an increase with dyslipidemia, so, those with hyper, high cholesterol levels, or high blood pressure levels, is significantly greater in those with pre-diabetes than diabetes, because these are the people that are typically not getting managed with anything, and the problem is these people that are, you know, on-diagnosed with it have that additional concern of developing, you know, other sort of complications such as, you know, chronic kidney disease, issues with diabetic retinopathy, and even stuff from a vascular perspective.

Andrew: Yeah. I think one of the frustrating things, at least for me, is, when you talk about pre-diabetes, it’s not even acknowledged in Australia. Try and get a fasting insulin done, or… This is something that concerns me. If you asked a GP, an orthodox GP, for a fasting insulin level, you would be knocked down and told that it’s not approved, basically. If you, however, ask for a HOMA-IR, a HOMA insulin resistance test, that involves fasting insulin, but that’s approved. And it’s kind of like this disconnect of, do you know what is involved in that test?

So, I also wanted to catch myself out. I just before, in the first question, said naturopaths and nutritionists, and I should, of course, be including chiropractors and holistic doctors, and all of those brethren of the complementary integrative medicine fields. But yeah, what do you say? What’s the landscape in USA? Because you’re…as opposed to Australia, because you’ve sort of dabbled in both.

Dr. Jurgelewicz: Yeah. So, I mean, obviously, I wanted to provide everyone with some of the statistics in Australia. But in the U.S., it’s similar in the sense that individuals that have prediabetes in that range are not really being told they have prediabetes, because it’s more of a dysfunction at that perspective. And until they really hit that threshold, from a fasting glucose or a hemoglobin A1C, they’re not gonna really get managed with medication for their symptoms and disease management, and why the frustration or challenging with that is, when someone’s in that pre-diabetes range and they don’t know it, that, number one, that’s probably one of the best opportunities to make the changes, because they’re in a more dysfunctional state, as opposed to that chronic disease state. But in addition to the conversation about, I think it’s 10% to 12% of those with pre-diabetes are actually told they have it. So, the other 90%, since they don’t, that’s, like I said, the perfect opportunity, but in addition to, as a result, these individuals are not being told that they can change the trajectory of their dysfunction or disease state with dietary, lifestyle changes, or nutritional therapeutics. And it’s really just, “We’re gonna keep an eye on things,” and not really any sort of game plan.

Andrew: Yeah. It’s almost like, you know, they’ve noted that women who have gestational diabetes have a higher risk of going on to develop diabetes themselves. Same with their children.

Dr. Jurgelewicz: Yeah, absolutely.

Andrew: But it doesn’t seem like, as you say, to have a game plan, to say, “We should be watching you. You should be under constant surveillance from there.” I’d also like to ask there, with these 90% of people that fall through the cracks, what should maybe they be looking for, to alert themselves, to say, “Hmm. Maybe I should be seeking some help here?” Are we talking about, you know, the post-lunch crash, the post-prandial crash, or are there any other symptoms they should be looking for that might tweak their interest or their alert?

Dr. Jurgelewicz: Yeah, I mean, a lot of these individuals are gonna possibly have some of the similar symptoms that someone that has uncontrolled diabetes, I think. If they can start to notice they have frequent urination. They may be waking up in the middle of the night, going to the bathroom. In addition, due to the dysglycemia, or that imbalance in the blood sugar, you’re right, they could have different crashes throughout the day when they’re eating food. And in addition to, they may have some sleep disturbance, because the whole regulation, with blood sugar handling and glucose can impact, and those things can crash and spike throughout the middle of the night, and you have some issues with that as well.

Andrew: So, do you advocate for these sort of people to maybe get one of these patches that can test your blood sugar on a continual level for two weeks or so? Do you use these a lot, to sort of say, “Hey, listen, maybe we should be looking at this,” or do you just go in with a fasting insulin or other tests?

Dr. Jurgelewicz: Yeah. So, I mean, that’s a good point to mention with the insulin, because it’s not just the fasting glucose, it’s the fasting insulin many times that can increase first. But, to your point, at least here in the U.S., I mean, we typically can have a fasting glucose easily tested with their metabolic panel as their annual check of what they get with their primary, often. But the challenge is, it’s not really just looking at that blood sugar [inaudible 00:09:24] that one-time snapshot in the morning, where, that can be normal, but, to your point, they may have a high fasting insulin, which is often not tested, and they often do not get their hemoglobin A1C tested, so we don’t really know what their average handling is. So, that’s something that we can typically test relatively easily, and even if it wasn’t through insurance, can do that pretty inexpensively here. But, and so we can get some of that information. I mean, I do think the continuous blood sugar glucose monitors and things like that, you know, can, unfortunately, are somewhat expensive, but, you know, there are ways to monitor stuff. I think there are a lot more individuals in the last couple years that have become more interested in nutrition, and I also think, through some of the frustrations that they may have experienced in the traditional model, with practitioners, and maybe not really having people listen to them or spend time with them, and really listen, there’s more people that are…

Because, many times, with the insulin resistance, it’s not just really looking at blood sugar and insulin. A lot of them may have, you know, other metabolic dysfunction around dyslipidemia, and other issues. And they’re often aware of that, and I think more and more people, just due to side effects with certain medications and things, are seeking natural alternatives, and they’re coming to either integrative functional medicine practitioners or nutritionists.

Andrew: And so, with regards to dietary factors, obviously this is a huge issue. I’ve run across patients who, at no stage in their whole diet, ever, do they eat fresh food. Every, 100% of their diet is processed fast foods, including drinks, by the way. You know, it’s the sugary drinks. There is nothing healthy about their diet. It seems to be burgeoning. I’ve seen so many… I shouldn’t say “see so many,” but I’ve seen more and more, whereas this didn’t exist when I was nursing. Now I see it more and more, particularly in younger people. Are you seeing this real shift? I thought we’d move away from it. I thought we’d realized the error of our ways.

Dr. Jurgelewicz: Yeah. I think, I mean, for the most part, you’re right. I mean, when I obtain a seven-day food diary, because you can ask someone what their diet’s like, and if it’s just something verbally, we may think it’s better than it is, but when you really see them write it down and it’s, it’s not just the food itself. It’s really, like, what’s their activity level like throughout the day? What time are they going to bed and waking up? And so, what’s their water intake for the day? But, to your point, many individuals are eating products, and not real food. And simply by making those changes alone, and getting rid of beverages that count towards calories, and replacing it with water, you know, we have to understand, sometimes these people, they’re not gonna make this dramatic shift in 24 hours or in a week. It’s more about, you know, trying to move some of the things… Because eventually, it’s not gonna be diet. It’s gonna be more of a lifestyle, and we have to kind of coach them and guide them, really, a new way of eating, and some people just don’t really know how to, you know, prepare their food. But, to your point, it really comes down to cutting down the processed foods, because they’re the ones that are, they’re not nutrient-dense, typically. They’re high in calories, and they have lots of sodium, and things that are just gonna work against them from a metabolic perspective, a just contribute to further weight gain, and metabolic dysregulation.

Andrew: Let’s talk further about what type of diet you recommend. There’s so many diets on the offer, on the platter, for us to offer.

Dr. Jurgelewicz: Yeah.

Andrew: Where do you start with these people?

Dr. Jurgelewicz: Well, I would say, if we just think about just some of those dietary factors, sure, there’s lots of different, like, food plans, or diet-type templates we could essentially recommend. But, I mean, I will say there is some pretty strong research, even though we see a lot of trends with intermittent fasting and everything, and time-restricted eating, typically, eating breakfast during, or getting a good amount of protein with breakfast, tends to improve the metabolic rate, and it tends to, you know, you get the satiety from that added protein. And then when we think about some of the things that people are consuming, from a beverage perspective, many times, things that are promoted as being diet-related or weight loss have a lot of artificial sweeteners that can contribute to insulin resistance, because, although they may be non-caloric, they still have to pass through the gastrointestinal tract, and exert that effect on the microbiome, which can, you know, play a role with certain peptides and things, and negatively influence that. And then we also have things such as, like, food sensitivities that people may have, that contribute to inflammation.

So, it’s the dietary patterns, you know, and medications that they could be taking, and the exercise habits that can contribute to that, but then when you think about what really we would recommend from a dietary perspective, and it’s, there’s not, like, a perfect diet that I’ve found that is a one-size-fits-all, and it’s more, it really needs to be somewhat… We can give a template. It should be more personalized, but essentially, what we have to also look at is what types of foods do people enjoy eating that are healthy, and then tailor it that way a little bit, and some types of things may work better than others, and some examples of that could be, when you really look at some of the interventions that have been shown to either prevent type 2 diabetes, or have evidence for, you know, correcting that, I mean, obviously, you see, like, a Mediterranean diet, right, that’s gonna be anti-inflammatory, rich in extra virgin olive oil, your essential fatty acids, etc. But then there’s also things around the intermittent fasting, that I alluded to before, where there’s that time-restricted window, where, simply, if people are only eating over a 8-hour window, they’re most likely, in a lot of instances, only gonna be able to consume a certain amount of calories, and that also gives the body a break from, you know, putting out, you know, the insulin and the glucose throughout the day.

And then you have other things, such as, like, a low-fat diet, that has some research, low-carb diet, high-protein diet, and then you have some of these really low total expenditure diets, where they’re really low-calorie. And so, I think…and you have ketogenic-type diets. So, I think it’s a matter of really trying to figure out… Like, protein is always, has to be a moderate macronutrient that is in there, because that’s gonna be really essential for, you need the proteins, those essential amino acids, just for practically everything that you do, from maintaining your muscle mass, lean tissue, etc. But you can’t eat a lot of all of the macronutrients. So, you can’t just stuff your face with all the protein, all the carbs, and all the fats. Where you’re gonna have to get more manipulative is, you know, really looking at, like, the carbohydrates and fats, and if you’re gonna balance them, you know, make sure there’s portion control, or manipulating one to either extreme, to some sense. But, essentially, doing that around a whole food-based diet.

Andrew: Portion control is obviously a big one, particularly for those people, you know, those more obese people, who are, you know, their stomach is distended. They can fit, some of them, super-obese, can fit a loaf of bread into that stomach. It extends down to their left iliac crest. So, when you’re talking to patients with, let’s say, weight issues that they’d like to control, and then we’ll move on to the thinner people later, but with the larger people, what sort of strategies do you employ about, to help them reach a state of satiety? Is it fats? Good fats, like, for instance, shotting olive oil? So, you know, 60 mills of olive oil or something like that? What other, what strategies are available to you? What work?

Dr. Jurgelewicz: Well, I mean, I think, number…there are a couple things that I think can be helpful. Obviously, you wanna make sure that they’re increasing their water intake enough, because most people just are not drinking enough water, and with that being said, sometimes they’re confusing hunger with thirst, and sometimes if they really make sure they’re getting, like, half their body weight in ounces, they may drink a glass of water or so, and then realize they’re not hungry, or they’ll eat less. I think, also, what can really help, from a huge perspective, even after they eat, is going for, like, a 10 to 30-minute walk, because that can help with the insulin sensitivity, and it will help with the weight loss. And so, and that will help with, you know, kind of curbing that appetite a little bit later. But I think we really have to make sure, you know, if we’re not guiding them from an exercise standpoint, really trying to partner or work with someone that’s either a personal trainer, or find something they’re compliant with, because, ultimately, you know, I may like lifting weights, but that person may not. And we really have to find some sort of form of exercise that they enjoy.

So, they may like walking, or they may have access to… It doesn’t have to be going to a gym. They can do simple bandit stuff at home, but it’s about really moving. And I think there’s been so much research lately with combining the two, that it’s all where…it just, it speeds up the process of everything, and, you know, we just know that muscle is basically an organ, and it has to be stimulated for our function. And so, those are some of the things, but as far as fat, I mean, for sure, that’s gonna help with satiety. But I think it’s important, from a fat perspective, you’re probably gonna be safer eating, like, you know, a half an avocado with a meal, or a handful of nuts, or, you know, using a tablespoon of extra virgin olive oil with a salad, as opposed to, sometimes where things get out of control a little bit is people are using a lot of vegetable oils, that get marketed as being healthy, on, like, their salad.

So, they may have a salad with chicken. And if they’re having, like, several tablespoons of that, those calories can get away. So, when you think about, like, you know, 15 or 16 grams of fat per tablespoon, it’s gonna be much harder for them to kind of exercise that kind of caloric excess off. So, we definitely wanna make sure that they’re getting those healthy fats, but it’s not too uncommon that sometimes people try to eat healthy, and they’re maybe not preparing something, and then they go have a salad out somewhere. And they don’t realize, like, when they start adding to dressings and other stuff, they’re trying to do the good thing with having the salad, and then, just the calories from the other stuff just adds up too much.

Andrew: When we’re talking about walking after a meal, versus that concept of sympathetic versus parasympathetic nervous simulation, how brisk should that walk be? Is it just a leisurely, relaxing walk, where you’re just chilling, or is it, like, “Hey, let’s

Dr. Jurgelewicz: Yeah. I don’t think it’s… And it’s not, like, the second you’re done eating, right? I mean, you’re gonna you wanna have that mindfulness when you’re having the meal, and you wanna, you know, digest that meal. But I would say anywhere from, like, you know, after that digestive process started, you completed your meal, maybe, like, 15 minutes later or so, you can definitely, you know, just, I would be doing more casual… I mean, no one’s gonna do some sort of, like, high-intensity interval training or intense cardio session on a full stomach like that. I’m talking about, in that case, more of just, like, if someone’s going to walk their dog, for example. And it’s just to kind of move that way.

Andrew: Yeah. And so, to nutrients. Favourite nutrients. Can I ask you, you know, we’ve got, for instance, myo-inositol available to us now in Australia. It’s been available for a while now. But I see dosage issues with a lot of products. Can we talk about a few of your favourite nutrients, and perhaps look at the relevant dosage for people with, you know, insulin resistance, diabetes, and especially polycystic ovarian syndrome? I see myo-inositol employed quite frequently here.

Dr. Jurgelewicz: Did you wanna talk about myo-inositol first, or some of the other stuff?

Andrew: No. Myo-inositol, please. Yeah. And relevant dosages.

Dr. Jurgelewicz: Yeah. So, I mean, you know, what I would say in general about myo-inositol is, inositol in general, is gonna occur in nine different isomers. And you typically, the most common in the supplement industry, is the myo-inositol. And when you think about what is the average food-derived intake of myo-inositol, it’s about 900 milligrams a day that we would get from the diet. And what’s, as you mentioned, you know, what’s exciting about it is that the myo-inositol has been shown to mitigate some of the symptoms and some of the underlying dysregulations of people with insulin resistance, including those with PCOS. And it’s believed to work by reducing insulin resistance, as well as mitigating metabolic syndrome. So, when you think about, like, whether you take a supplement form of it or you get it from the food that you’re eating, it’s gonna compete with glucose for gut absorption and intercellular uptake. And so, it’s estimated that our endogenous synthesis of the myo-inositol from the glucose is about 2 to 4 grams per day, but the problem is, it’s impaired by high glucose levels. And it’s a component, it’s a second messenger, essentially, to thyroid hormone, insulin. So it’s a component and precursor to intercellular signaling of insulin action.

And so, what happens is, in these individuals that have metabolic issues or insulin resistances, there’s this increased nutritional demand for the inositol. And this may be caused by having too much carbohydrate intake. There could be excess urinary loss of inositol. There can also be genetics, and obviously, that metabolic dysfunction they have, that can exacerbate that issue. But why I think inositol is good, and we’ll talk about some other therapeutics as well, but it’s naturally-occurring in our physiology. But it’s often deficient in those with insulin resistance. So, if we supplement with myo-inositol, it can satisfy this metabolic demand, to really address this critical metabolic dysregulation, which is characteristic of insulin resistance, as well as metabolic syndrome, PCOS. But it’s also gonna up-regulate the production of these myo-inositol mediators, and address some of that impaired glucose transport. And so, when you’re talking about what the dosing is, well, from what I’ve seen, most of the dosing’s gonna be between 2 to 4 grams per day. Typically, like, in a twice-daily dose.

Andrew: When we’re talking about things like magnesium, for instance, we’ve gotta also consider the ligand that it’s joined to, as pertaining to how it acts, how fast it acts, where it gets, you know. For instance, magnesium orotate, much more useful for the heart. Magnesium citrate, you know, the Germans love the citrate. They say it’s best, the better form of magnesium for everybody. You’ve got the bisglycinates, or the glycinates, that I find very fast magnesiums. How do you choose what sort, what type of magnesium to use in insulin-resistant individuals? Do you look at something like, you know, aspartate, that might go on to the inner lining of the cell, or do you just look at a fast magnesium that’s gonna get in there and do the job?

Dr. Jurgelewicz: Yeah. I mean, I think you can definitely get into the nuances and bias things a little bit, but, to your point, when you’re looking at, like, magnesium, in general, and you’re trying to increase intercellular levels for that specific application, and getting more in the red blood cell, I mean, from my perspective, I wouldn’t see any issue doing, like, a mag bisglycinate or your magnesium glycerophosphate, or even the mag orotate, because they’re all good bio-available forms of magnesium. I mean, obviously, in the natural nutrition space, we tend to stay away from, like, the magnesium oxides, just because, although there’s some research on them for certain things, they’re not that well-absorbed, and the other forms, I mean, you mentioned that the orotate, with cardiovascular health, I mean, we have to also think that these individuals tend to have, you know, with metabolic syndrome and insulin resistance, they don’t just typically have the insulin resistance, a lot of times, they have the dyslipidemia as well, so I think, you know, any of those, like, three forms can be good together, or even separate, and it’s really just about getting that, like, around 300 to 500 milligrams a day, and some individuals may satisfy, you know, really getting that level up for them.

Andrew: Anything else that we should be considering? For instance, just the other day, speaking with a patient, and it seems like cortisol, that they had a high-pressure job, and cortisol was driving everything. So I said, “Look, we can put you on to some things that might look at your blood sugars now, if you like, or your dyslipidemia, your insulin resistance-type symptoms now. But unless we address the stress, we’re never going to make any moves.” How do you unravel that web of where you should be attacking the cause?

Dr. Jurgelewicz: Yeah. I mean, in that case, if you can’t, I mean, you can try to have them do other things, like yoga or meditation or exercise, things that are gonna, you know, help with that. But if they have certain stressors that they can’t really address that underlying, you know, cause of it, I mean, they can obviously do certain, you know, adaptogens that may help at least manage things while they have that. You know, in those cases, I think it’s more of them doing, like, different lifestyle-type things in conjunction with maybe some of the adaptogens. The reason… You know, lipoic acid can also be beneficial, but I think what’s good about, like, the inositol and the magnesium, and some of these micronutrients is, because there are other botanicals out there, like berberine and stuff, that you see people use for helping with insulin resistance and blood sugar control.

But a lot of times, when people are in that pre-diabetes range or dysfunction, we typically wanna give them the cofactors that are gonna help them metabolically first, before we kind of have, you know, some of those other botanicals. And, you know, even if someone has diabetes, and when you think about, like, metformin, that they often get put on, it was interesting because they had a study showing metformin combined…you know, by itself, at, like, 3 grams a day. And then they combined it…they cut the dose in half of the metformin, so now the person’s able to reduce their metformin dose in half, and what they added was 2 grams a myo-inositol to it, with lipoic acid. And the metformin group had a reduction in their body mass index by 15%, where the metformin with the myo-inositol and the ALA went down 28%. And it also lowered their total testosterone. So, like, the testosterone came down, like, 33% with the metformin, but it came down 75% when they added the metformin to the myo-inositol. So, it’s not only great for those individuals that have the dysfunction, but it has a synergistic benefit with their medication, and it’s not gonna interact with their medication. And so, especially for those people with PCOS. So, I…

Andrew: Yeah.

Dr. Jurgelewicz: …I really like that. But the thing is, when people have these metabolic issues, they have increased nutrient demands, often, and metabolic demands, and inflammation that they typically require some nutritional therapeutics. Now, obviously, we can’t just out-supplement the poor diet, but they often have lower levels of, they have lower levels of, I would say, sulfur. So, things like glycine could be helpful, that you could get from collagen. And vitamin C can be helpful because they often have low plasma levels of C, just because of those metabolic demands. So, besides giving them, like, a broad-spectrum multivitamin that’s gonna cover some of those cofactors, like their zinc, and maybe a little bit of the vitamin C, you know, adding the things like the inositol and the magnesium. And then, if they’re at a point where they’re in that higher end of the pre-diabetes range, then, at that point, they could consider something on top of what we talked about, like a berberine, because, interestingly enough, berberine is almost like an analog to metformin when you think about its benefits on blood glucose, but what it has that, or what has been shown with berberine, that you don’t typically see with the medication, is you see a reduction in waist circumference, as well as the benefits on reducing the LDL cholesterol and the triglycerides that you don’t typically see with metformin, and there’s also some research on it being safer for the liver than metformin.

So, for some of these individuals that may not tolerate it… And it’s interesting, because there’s all these mechanisms with berberine on, like, the AMPK, you know, activity, but we also have to think about how berberine can modulate the gut microbiota as an antimicrobial agent. So, some of these people typically may have dysbiosis in their gut from, like, the foods that they’ve been eating, and because of that dysbiosis, they can have some populations with, like, their Firmicutes to Bacteroidetes ratios, where they may have a higher caloric extraction from food, the bacteria, than the others, and they can… So, you take a lean person and an obese person, who may be eating somewhat of the same diet, but having a different result from a weight loss perspective. So, you can see a benefit with berberine. So, I do feel like, when I have people that have the dyslipidemia, along with these high insulin, I should say, the dysglycemia, it can really help jump-start them from a weight loss perspective.

Andrew: An awesome point. That’s so important. There seems to be this, it’s almost like a backwards flip with Berberine, going, “Oh, you know, we shouldn’t be using it too long.” Hang on. In these people who are dyslipidemic, they’ve got an issue that you need to be addressing with the microbiota. So, it’s a really good point you make there, Mike. Mike, there are so many points I’d love to cover. I wish this podcast could go on for three hours. Can I ask you, though, maybe as a last question, and I’ll try and stop myself, but you mentioned something there about, you know, the metformin, and the combination with myo-inositol and lipoic acid. When you’re talking about utilizing these therapies, berberine, for instance, it could be an issue. What nutritional therapies do we have to be cautious of during pregnancy? Because some of these women, they’re infertile, their fertility is addressed, but then they go on to become pregnant, then they’ve got the risk of gestational diabetes. How can we help these ladies?

Dr. Jurgelewicz: Yeah. So, when you look at a lot of the natural medicines databases that have the uses, and the dosing, and the safety, that the challenge is, when you look at pregnancy, when you’re dealing with the micronutrients that are based upon the daily value or the recommended daily allowance, once you get outside of that range, there is basically insufficient research, and we’re supposed to avoid using at that time. And then the same thing happens with botanicals or your neurotransmitter precursors, etc. So, what’s typically safe with pregnancy is, like, obviously, like, your multivitamin, your fish oil, your vitamin D, your amino acids, protein, some probiotics. But where inositol is great, you know, specifically the myo-inositol, is they studied this in pregnant women, for gestational diabetes, up to 4 grams per day. So, normally, with other nutrients, if you said, “I’m gonna go above the daily value for that nutrient per day, there’s gonna be typically an issue.

But because this is such a, gestational diabetes is such an issue with pregnancy, and obviously, you don’t wanna cause any harm with side effects of having non-serious adverse reactions with botanicals and things, there’s been quite a bit of studies, like, back to, from starting from 2017 through now, that have shown the safety with these doses. So, comfortably as, like, a manufacturer, what we could say, and even a clinician, that we would be comfortable with that because the studies are there. And knowing that this is an endogenous compound, that’s in our physiology, it’s not like you’re putting something into the body that’s foreign, that we have to worry about, like, “Oh, what’s that gonna do?” And there’s the safety with it. And the whole point is, if we…you know, I would even say, you know, a lot of times in some of the research, it shows that there’s the benefit of supplementation in those that are at risk in their first trimester. So, I would almost be thinking about, if someone is already a little bit overweight, or they have some dyslipidemia, or they’ve had some dysglycemia issues, but they don’t really have…they’re kind of trending upwards, that they may have a risk, or there may be a family history, there’s no harm in starting these individuals in their first trimester along with their prenatal with this, because, again, we don’t wanna be reactive when they get to the third trimester and they have this issue. Giving to this as a preventative standpoint can help reduce that, which is definitely gonna reduce the risks of any sort of complications later in the pregnancy.

Andrew: Absolutely. Dr. Mike Jurgelewicz, thank you so much for sharing your knowledge with us today. I wish we could go longer. There are so many issues that we can dive into here, so many things that you’ve got me thinking about. And thank you so much for taking us through the safety aspects as well. I mean, it’s obviously, you’re a dedicated clinician who knows their stuff from the patient’s perspective, about trying to work with them to change their lifestyle there, and eventually their outcome. But I thank you also for your really diligent research and development, to say, “Yes, this is safe. No, we can’t do that. We should be looking at this.” Well done to you. And thank you so much for joining us on “Wellness by Designs.”

Dr. Jurgelewicz: No problem. Thank you for having me.

Andrew: And thank you, everyone, for joining us today. Remember, you can see all of the other podcasts and the show notes on the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”