Season 5, Episode 4: Debunking Blood Sugar Management Myths with Mel Luther

Evelyne: Yes, I am very excited about our conversation today. And first of all, what is lighting you up this week?

Mel Luther: Oh, well, with autumn kind of just hit, I’m up here in the Rocky Mountains, and if you’ve ever spent an autumn in Colorado, it is absolutely amazing when the aspen trees start turning. So literally it’s lighting up the world around me and I’ve been really enjoying getting out and being out in nature lately because of that.

Evelyne: Oh, I love that. I love that. Send me a photo. That sounds amazing. So let me read Mel’s bio and then we’ll get right into it. Melanie is a dedicated nutrition consultant with experience in one-on-one coaching, group coaching, public speaking as a nutrition educator and hosting wellness retreats. She’s passionate about nutrition, education, coaching and science writing.

She earned her undergraduate degree in nutritional anthropology from the University of Hawaii Manoa, followed by certification as a holistic nutritionist through the Energetic Health Institute. She also holds a master’s degree in human nutrition and functional medicine from the University of Western States. And her diverse background includes working in integrative nutrition and pharmacy centers, cardiac rehabilitation programs, and contributing to the writing and educational platforms at Designs for Health. Amazing.

So Mel, you are currently working in cardiac rehab as a nutritionist and you also have your own nutrition practice focusing on blood sugar management. So I’m curious, how did you get into nutrition and what’s your story?

Mel Luther: Well, I feel like pretty similar to anybody else who ends up getting into the functional medicine field or just any sort of alternative health field, it usually stems from having something happen in your own personal life that then conventional medicine fails to help you with and then you end up finding health and wellbeing through other alternatives.

So for me, when I was a kid, I grew up with really bad asthma and really bad digestive issues, which affected me a lot being a young athlete. And I was just pretty much treated with over-the-counters and some pharmaceuticals, and I grew up on a standard American diet. So then as I grew up, in my late teens, early 20s, I started getting really into yoga, so Kundalini yoga and it introduced me to a whole approach to thinking about how I ate.

Vegetarianism is a big part of Indian culture and part of yoga, so I just started to learn about that and implemented those changes and I saw improvements in my health. And I think that’s really when I started being like, “Oh wow, diet and nutrition are a really big part.” And so I just kept going down that track.

And then to get into the blood sugar aspect, years later, actually while I was in my masters, I started having ovarian issues, which are common in a lot of women within their reproductive years. And medical or Western medicine just really couldn’t give me any answers. They actually ended up checking my fasting blood sugar, which makes a lot of sense, and they were like, “Everything looks fine.” But with my background in functional medicine, I looked at some of these numbers and I was like, “Okay, well maybe they’re considered normal.”

But I knew that it was high normal and was pretty shocked honestly, to see that I had a high normal fasting glucose for being young and healthy and active. So I was like, “Man, if I’m dealing with this, it’s no wonder that a third of Americans have pre-diabetes and so many of them don’t even know it.” So it just led me down this whole path of finding how blood sugar management and insulin resistance are a huge part of all the chronic issues we deal with today.

Evelyne: Yeah, very interesting. And I’m super fascinated by your studies in undergrad in nutritional anthropology. I know one other person who studied that, and I just find it so interesting. You must look at the world through a very different lens. So I’m curious what got you interested in that and what did you learn through that?

Mel Luther: I fell in love with anthropology in my undergrad years. I actually had an amazing professor who used to live in the Amazon and he would just convey this topic in such a fascinating tone. I feel like that’s the power of having a good educator in your life and a good professor or some sort of mentor in the educational realm that shares a passion for a topic and you just fall in love with it. So that is how I want to be within the nutritional education world.

But anyways, with nutritional anthropology, so I fell in love with anthropology as I was falling in love with nutrition. I found that subset of nutritional anthropology and studying different people around the world, how people live differently, how people have different views of health. So you can’t just approach everyone the same way when you want to talk to them about what to eat and how to live and lifestyle factors.

So going to the University of Hawaii, I got to actually study a lot of traditional Hawaiian methods like their traditional herbal system called La’au lapa’au, which I didn’t end up going super into the herbal field. I know you are a little bit into herbalism, but I loved it. It was so fascinating, and I got to learn all sorts of different traditional Hawaiian methods for healing that are so different than Western medicine.

For example, one of the days in my La’au lapa’au class, we actually, a professor took us to the beach and he’s like, “This is one of the traditional Hawaiian healing methods,” where we all dug holes and we got buried in the sand up to our neck for two hours. He’s like, “This is what they would do.” It’s grounding, right? It’s essentially what we were doing at the beach. But I was just like, “Wow, that’s so amazing that they’ve been doing this for thousands of years.”

And then one other thing that really stood out during my studies of nutritional anthropology was we were studying different tribal cultures in different countries in Africa. And I remember learning that there was a certain group of people that they wouldn’t eat food made by anybody they didn’t know, which is really fascinating.

So when you compare that to America, you think about how most of the food people eat comes from people they don’t know whether it’s in the grocery store, anything you buy off the shelf, you have no idea who made that. A lot of times it wasn’t even made by a person, it was made in a factory.

But it’s just such a crazy or not crazy, but a very fascinating perspective because I think it really sheds light on the intimacy of eating. When somebody makes food, they’re imbuing their energy into it, and then you are taking food and you are literally putting it into your body. What an intimate relationship that is.

And I think so often in Western culture, we don’t really think about how amazing that is that you’re taking these outside resources from Earth, putting them into your body, and they’re going to become every cell in your body. So yeah, I thought that was amazing. So those are some things I learned in my nutritional anthropology studies over the years.

Evelyne: I love that. Thank you so much for sharing. I think it’s so cool taking that background now into what you’re doing. So you’re working in cardiac rehab as a nutritionist, so you are seeing patients who have had heart attacks and strokes and who probably more often than not have diabetes. I’d love to hear more about, well, first of all how you got into cardiac rehab, but then also talking about the connection between blood sugar mismanagement and heart disease.

Mel Luther: Well, as I became more and more passionate about blood sugar management, pre and type 2 diabetes, based on that personal experience I was telling you about, I started understanding that cardiovascular disease and diabetes or pre-diabetes are so intimately intertwined. One study at least showed that 73% of people who have myocardial infarctions or heart attacks have dysregulated blood sugar levels, and that about half of people who end up having heart attacks have diabetes. So we know that there’s a huge, huge connection there.

But yeah, I think that’s one reason that they hired me and wanted me to be a part of the team at this cardiac rehab center is just because I see that connection and they know that diabetes and blood sugar management are so important and underlie cardiovascular disease and that so many of the people we work with deal with both. Because if you’re diabetic, some statistics show that you have a two to four times higher risk of having a cardiovascular disease of some sort or an event.

And within insulin, we know that high insulin impedes nitric oxide production and damages blood vessels, same with high sugar intake. If you have high fasting glucose, it’s damaging your blood vessels, causing inflammation. And then we also know that if you consume a lot of sugar, it turns into triglycerides and has a negative impact on our cholesterol levels too. So those are just some really obvious ways that both of them are connected and related.

Evelyne: And within the program that you’re doing, I’m curious about what the actual program is like. Are you doing one-on-one sessions with patients? Are you doing group programs?

Mel Luther: This program actually follows the Pritkin protocol, and it’s a 72-session program, so it’s very long. It’s actually twice as long as a traditional cardiac rehab session or program. So people are with us honestly for at least a year, sometimes three years or more and it’s very amazing. So it’s mainly groups. I do work one-on-one sometimes with people, but it’s a really awesome program.

So the foundational three pillars of it are nutrition, exercise, and mindset. So it’s definitely not a fully functional medicine program, but it’s definitely integrated, which I like, and they love my functional medicine approach that I get to bring to the patients. But yeah, I mean those three pillars are pretty amazing to be focusing on for cardiac rehab program.

And they’ve shown that people who stick with this program for the full time and really implement the changes can add five years to their life expectancy. So that can be really amazing for somebody who has a heart attack and they think that maybe their life could be over, but if they can learn how to make these lifestyle changes that we and I help them with.

So basically we have different group sessions all throughout the week. I see dozens of people all week that I’m working with, and we talk a lot about the basics. I mean, Mediterranean diet is a big dietary factor we focus on just because there’s so much research. It’s the most well-studied diet in the world to show that it’s really helpful for cardiovascular health, brain health, blood sugar management.

And what is the Mediterranean diet really? It’s a diet that focuses on plant foods, high in fiber, high in polyphenols, antioxidants, has some healthy fats in it, healthy protein sources. It traditionally doesn’t have ultra-processed foods. So really you could take that framework and apply it to any cultural background, a person maybe wanting to do that. It doesn’t have to be Mediterranean diet-specific style foods, but nonetheless, if you can take that framework and apply it to somebody, it can make a big difference.

And then in addition, we talk about gut health to them. We teach them about fiber, about protein intake, how to read nutrition labels, how to do healthy shopping, how much water they should be consuming every day, all these things that a lot of people just don’t understand and or they’ve just never been taught it. And I think sometimes we live in bubbles in the functional medicine field where we forget that a lot of people don’t know this. But I mean, I’m sure a lot of practitioners who are listening to this have that experience, exactly what their patients are like, “Oh my gosh. A lot of times I just end up working with the basics and building off from there.”

Evelyne: And I think especially for us living in California and Colorado, I think we definitely do live in some bubbles and being in the space that we’re in and our friends are all in the field and that’s who we just interact with on a day-to-day basis.

So I’m curious more too about the health coaching and motivational interviewing aspect of it because you’re working with people who are often older, probably after 60 years old, who because they’re just learning about health then after having a cardiac event, do you find that they are a lot more motivated? And is it people who voluntarily sign up for this program or is it like they had a cardiac event and then in the hospital they were assigned to become a part of this program?

Mel Luther: It’s voluntary. After they have an event of some sort, their doctor can recommend them to this program and insurance will cover it for them. So if they’re dedicated and motivated and really want to see lifestyle changes, that’s generally people that we’ll see in these types of programs and sticking with them for the long term because we have a lot higher of a success and finishing rate in our program than other traditional cardiac rehab programs, which is great. And I think it’s because we really talk to people about the basics and the lifestyle and the nutrition and the mindset.

But we have health coaches, we have nurses, we have personal trainers, and then nutritionists like myself. So we’re coming at them from all different angles. They get to build multiple relationships with different people who are helping them with the different aspects of trying to get well. So I don’t personally do as much with these patients on motivational interviewing and all that, even though I do know it a bit, so I can implement it into my educational aspects and consulting when I’m working with people.

But a lot of it’s about just finding out where they are. Okay, so I’m like, “How much education background do you have? What are you implementing so far?” So I can see where they’re at and how much change they’re already making. And if they’re not making changes, I’m like, “Okay. Well, then how can I maybe talk to them differently or talk to them about what they’re facing that’s getting in the way and try to help them through that?”

Evelyne: That’s great. And in your own practice with your clients, you’re also focusing on blood sugar management in pre-diabetics and type 2 diabetics. What are some of the top changes that you have your clients implement for proper blood sugar management?

Mel Luther: I mean, I think my biggest passion when it comes to helping the people that I work with and in general is trying to get them off ultra-processed foods. I really do think that that’s the downfall to our health. So that’s one of the primary things I work on. It’s like I’m not just trying to take things out of people’s diets that they enjoy, but it’s like I educate them on why we need to minimize this.

It’s not that you can never eat processed foods. We all enjoy them from time to time, and there’s different levels of ultra-processed to processed to less processed foods. But when people start to understand how much sugar is actually in things they’re eating, it’s crazy to see their reactions. They’re like, “Oh, wow, I just had no idea.” So I try to help them take out ultra-processed foods, understanding why, and then implementing more fiber into their diet.

A big thing I also help them with is trying to get at least 30 different plants in their diet throughout a week, because that’s going to add a lot of different micronutrients, fiber, phytonutrients, antioxidants, all sorts of great things. So it’s about replacing things. It’s not just taking things out. We’re also adding in things and how can we get you to do that and make that a long-term successful change in your life?

And then beverages are a huge one. It’s like, “Well, if you can cut out any sugary beverage from your life and just replace it with water or herbal teas or maybe using some stevia instead to sweeten things.” So just doing that is honestly usually where I start with people, and even that can help them out a lot. And then as we go down the road, we have to get into more nuances about why things are getting in their way. But yeah, that’s generally where we start, and that can be a lot of work by itself for some people.

Evelyne: In terms of timing of meals, I feel like this is somewhat controversial because some people say if you have blood sugar issues and blood sugar drops or spikes that we should eat regularly throughout the day to keep blood sugar balanced. And then there’s also the thought, “Oh, well, we should eat a meal and that should keep us full for four to six hours if it is balanced. And so we should only eat three meals per day.” So I’m curious what you recommend with your clients.

Mel Luther: I’m not as in favor of eating a ton of small meals throughout the day. I mean, for some people it’s just how they like to eat because they just won’t eat large amounts. So if that’s the way somebody really wants to be, then I’m not going to fight them on it. But I do think it’s better to eat a little bit more fuller satiating meals, around three throughout the day that are going to be higher in protein, higher in fiber, higher in healthy fats, and they’re just more satiating.

And so that way, like you were saying, after you finish that meal, you don’t really find yourself, one, craving a lot of other foods for the next few hours, and then that’s going to help stabilize blood sugar levels. So if you were just having three larger meals, but they’re higher in protein, fiber and fats instead of more refined or starchy carbs, then you’re not going to be having these big spikes and drops. The big thing that we’re really trying to work on is stabilizing blood sugar levels.

And then whatever, sometimes people want little snacks throughout the day or whatever it could be. And I say, “Hey, handful of nuts, that’s fine. Or have a piece of fruit, apples with some almond butter on it. Those are okay to have.” I don’t think snacks are, they’ve become a huge part of American culture to have snacks, which is like, traditionally humans didn’t really snack on things. We just ate when we could eat. But yeah, the whole snack culture is kind of funny, honestly.

Evelyne: Snack culture and treat culture.

Mel Luther: Yeah, exactly.

Evelyne: I’d also love to talk about some nutrients that play an important role in blood sugar management. Everyone talks about chromium and magnesium, so I’d love for you to maybe share a little bit about those if you use them, at what doses, but also what else? What other nutrients are you using in your practice with people?

Mel Luther: Yeah, it’s true. I mean, chromium is a big one. We know it’s needed for glucose factor and glucose metabolism. Magnesium, we all hear about it. It’s true, those are great and I will use those in a blood sugar stabilizing supplement, like ones that Designs for Health makes I actually really like.

But my passion is really more in the B-vitamins because I feel like they’re so underrated. People do not talk about them nearly as much because, I don’t know, they’re kind of nuanced and they are found in so many different foods and they’re just called the B complex. So people just don’t always dive into what the details of it are. But if it’s okay, I’ll go through some of the important ones and talk about why I think they’re so important.

Now, there’s another pillar that I know we have talked about and wanted to bring up, but that’s the whole mental health side. So I will tie them into the triad that I really focus on a lot, which is the cardiovascular disease, diabetes, and mental health, because those three are so intertwined too. And so that’s why I focus and love to educate and make sure people are getting enough of these B-vitamins because they support all three of that triangle.

Evelyne: Absolutely.

Mel Luther: So vitamin B1 thiamine is really important. The RDA for thiamine is just 1 milligram a day, but we find that if people take 100 to 300 milligrams a day for a therapeutic dose, it can really help with blood sugar metabolism and even mental health because thiamine is needed to metabolize the carbohydrates that we eat, the fat that we eat, and then the protein and amino acids so that they can be used by the mitochondria for energy.

Thiamine’s also been seen to help with glycation. So a lot of practitioners and people out there, I’m sure are aware of AGEs, advanced glycation end products. Well, thiamine plays a role in DNA glycation, and so we see with diabetics who have low levels of thiamine that they actually might have more glycation. And one study showed that if you give people thiamine for five months, it can actually reduce some of the DNA glycation in their body. So it can be really powerful for that.

Evelyne: Oh.

Mel Luther: Yeah. Thiamine also plays a role in nerve and muscle function. So for diabetic neuropathy, thiamine can be helpful. And then there’s been some studies that show thiamine in conjunction with taking an SSRI has actually shown to increase the efficacy of the SSRIs and make them actually work a little bit quicker. Like two to three weeks, they start seeing benefits as opposed to five or six weeks later.

Evelyne: Interesting. I haven’t heard that before.

Mel Luther: Yeah, it’s really fascinating. So it’s like just taking thiamine by itself, is that really going to solve all your issues? No, but every nutrient in the body works, well, they all work together. We’re just this big musical orchestra inside and all these B-vitamins, they help each other and other vitamins and minerals. So thiamine’s an amazing one, and I think people don’t think about it very often. Riboflavin I don’t go quite as much into because it’s just people aren’t really often that low in it because it’s so ubiquitous in our diet, but it is important.

But I’d like to talk a little bit more about niacin. So niacin is B3. The RDA is 16 milligrams a day, but most often people will take niacin to help with cholesterol metabolism. So it’s almost used as a nutraceutical in a sense, to help with lowering LDL and raising HDL. And we’ll see that with about 50 milligrams or higher you have to take to start getting those benefits.

Now the issue with niacin that a lot of people don’t like is the niacin flush. So once you start hitting that 50 milligrams or higher, people get that uncomfortable feeling. It’s basically all these prostaglandins opening up to your blood and your skin, and so all the blood is rushing to your skin. Now at these lower doses, it’s not harmful, it’s just uncomfortable. At super high doses, maybe it’s something more to think about. But when you’re just taking it enough for some cholesterol metabolism, it’s fine if people are willing to deal with it.

The issue is that there’s different forms of niacin, just like with every vitamin. And so the forms of niacin, like nicotinic acid that are the most helpful for cholesterol also cause the most flushing. So people want to end up taking the niacin forms that don’t cause as much flushing like niacinamide or nicotinamide or the inositol form, then they’re honestly just not going to get the same cholesterol metabolism effects. So you got to decide how you feel about it based on the forms.

And then in addition, niacin has also been shown to help with some depression symptoms. So just at 40 milligrams-ish or more is where some of the studies have seen some benefits. That’s probably because niacin plays into NAD+, which has a role in dopamine production. And so that could be the pathway. We’re not totally sure why it seems to help, but that’s one hypothesis.

And then with niacin too, we know that tryptophan can be turned into niacin in the body, which is great. So if your patients are eating a good quality protein diet, they might be getting all their niacin through that. But just like we said earlier, all nutrients work intricately together. So if somebody is actually low in riboflavin, B6 or iron, they can’t really convert tryptophan to niacin. So it’s important to make sure that people have their full B vitamin and all their nutrients met. Iron’s a huge one.

Now, something else to keep in mind with niacin is that if people are taking really high doses, like 1,000 milligrams or up, it’s been shown to actually cause insulin resistance in mouse models, and then we see it in some human studies too. But that’s a crazy high dose. The RDA is 16 milligrams. I mean, do we really need to be taking 1,000 milligrams? Probably not. So I would say that we definitely shouldn’t be taking that high of doses.

Now let’s talk about vitamin B6 a little bit, which is pyridoxine. So that comes mainly in the form of pyridoxine 5-prime-phosphate. So we’ll see that in all the good quality vitamins and B-Supreme and all that. The RDA for that is just 1.3 milligrams, but we also see a therapeutic dose of around 50 milligrams is very beneficial for people.

So about 50 milligrams a day has also been shown to help with depression and some anxiety symptoms, which makes a lot of sense because if you’ve learned about B6 at all, the main thing that you usually hear about is how it’s a precursor to serotonin, dopamine, melatonin, GABA. So we know it plays a super important role in neurotransmitter production. But it also helps with the metabolism of glucose and fatty acids and proteins once again. So there’s that combination, right? We can see it plays a role in mental health and blood sugar management right there.

In addition, vitamin B6, if people are deficient in it, they have a certain neuropathy that’s almost identical to diabetic neuropathy. So when you’re looking at what does a vitamin do in the body, when you can look at what the deficiency symptoms are, it can tell you a lot about what that vitamin helps with. It’s like if you don’t have this but you give your body it, then that’s what it’s going to work on. So I always tell people, if you’re not sure what a vitamin does, look at what the lack of it does and that can tell you.

And then homocysteine, I mean as practitioners, we know homocysteine is a big role player in cardiovascular disease and diabetes. And B6 folate and B12 are the main contributors to helping to keep homocysteine down through methylation, which is a whole topic we can talk a little bit more about.

But the last B vitamin I just want to talk about for a minute is folate, because methyl folate is an incredible methyl donor in the body, and methylation is super important for SAMe and neurotransmitter production in the brain. So it helps with mental health and it’s also been shown to help with SSRIs in some studies too. It’s supportive of them so they can work synergistically together.

So yes, they’re all really amazing, but those are the basics about the B-vitamins. And then with methyl folate, sorry, 400 micrograms is the RDA. But amazingly, they have been shown to give people 10 to 15 milligrams to improve mental health. So that’s a super high dose compared to the RDA, but doesn’t seem to have any negative effects at that higher level and can actually help with people who might have depression and anxiety.

Evelyne: Super interesting. And I’ve seen that prescribed, right, the 15 milligrams of folate as DEPLIN.

Mel Luther: Yeah, exactly.

Evelyne: I think this would be a good time to talk about some nutrient depletions. So I know that you worked at Pharmaca, the integrative pharmacy, and you worked with people who were taking medications, and you also worked on the Designs for Health Drug-Nutrient Depletion and Interaction Checker, which we’ve mentioned a few times, which is an amazing resource available to practitioners. I’ve already received great feedback from the practitioners I work with in San Diego, so I’m very excited that you were part of that project. So what are some of the top medications that you see that deplete some of these nutrients?

Mel Luther: Yeah, I worked at an integrative pharmacy and then on the DNIC for Designs for Health. So it’s pretty amazing.

Metformin, which is the number one drug for blood sugar management for diabetes, we have seen impedes B12 absorption a little bit, which is also an important methyl donor. So that can have big downstream effects on energy level and all sorts of things.

Statins, I mean, we’re all pretty much aware at this point that it depletes CoQ10, so we always have to make sure that that’s being supplemented alongside for long-term health.

Another one is gabapentin, which I know people use for all sorts of off-brand or off-label uses, like pain management and stuff, but it’s shown to deplete some biotin as well as B6. And we just talked about all the important things B6 does. So that could be a big deal if somebody’s not sleeping well, if they’re taking gabapentin, if they’re having low mood, all sorts of things. And then biotin, classically, we know it as hair, skin, and nails, but it does so many other things as well.

And then we can talk about GLP-1s for a second on this. I mean, I think there’s still so much research coming out about GLP-1s, and I know that there’s some talk that maybe they inhibit vitamin D a little bit. I think we’re still trying to figure out exactly how or why that happens. But the big thing with GLP-1s is that because they just lower people’s appetite so much, people just end up eating less in general. And that can put you at risk for every nutrient deficiency if you’re just only eating 1,000 or 1,500 calories a day in some cases, and you’re not eating enough protein and you’re just not eating a lot of nutrient-dense foods.

So I recommend, or I would say that if you have patients who are on GLP-1s, just make sure they’re on a really good multivitamin, maybe taking some really high quality protein powder with leucine, maybe a good whey protein powder to support muscle mass because we do know GLP-1s can lead to loss of muscle mass. And then having good collagen in there too, can also just support all the processes in the body.

Evelyne: And in the cardiac rehab program, I assume that you are working with a lot of patients who are probably on GLP-1 medications, right?

Mel Luther: Yeah, some of them are. I mean, I would say a lot more of them are on metformin or ACE inhibitors for blood pressure. So I see that a lot more. We’re constantly checking their blood pressure, but some of them are on GLP-1s. But yeah, I am always recommending and helping them find good multivitamins and protein powders and things like that to help support their health because a lot of them, they don’t know.

Evelyne: You actually get to do that as part of the program based on your scope of practice?

Mel Luther: Well, yeah. So I get to see what medications they’re on and things like that, and some of them will come to me and ask me because they’re like, “Hey, I don’t feel better.” And then I’ll look and I’ll be like, oh, their doctor prescribed them ferrous sulfate, for example, which is the form of iron that’s still prescribed by medical doctors, and we just know that it’s not great. So I’ll be like, “Okay.”

So I’ll make a note and tell their physician and their nurse, be like, “Hey, maybe we should …” I’ll send them a recommendation for just an iron bis glycinate. And it’s like, this is going to be so much better on your digestive tract. You’re not going to be constipated anymore, and it’s going to help with your levels.

So yeah, I always have to inform their physicians and their nurses that I’m recommending them to potentially take these supplements. But because of the program and the mindset and the understanding, the integration side of the program, that they’re usually pretty open to it.

Evelyne: And what about other support for those patients? So I’m assuming you’re doing some herbal support as well, maybe some other nutrients, you’re working on inflammation along with the diet change. So can you talk a little bit more about all of those nutrients?

Mel Luther: Yeah, I mean, one of my favorite nutrients to work with patients on getting more of is fiber, which you can just get from your diet. But if they’re just not willing, they can’t find fiber sources that they’re willing to put in their diet, I’m like, “Okay, well, let’s talk about maybe some dietary supplementation of fiber, whether it’s a blend.” Designs for Health offers ones like that. The GPX, I think it’s called. I’m forgetting the name of that one. Sorry, PGX. PGX has been shown if you take it before meals to help with blood sugar management, and it just gets more fiber in the diet to help support our gut bacteria and all that. So fiber is a big one I like to help my patients get more of.

Sometimes I’ll talk about berberine and things like that, but to be honest, if they’re on metformin and they’re on these blood sugar lowering drugs, you can’t really just be throwing in a ton of different herbs and things that are also going to just keep lowering blood sugar levels. They’d have to work with somebody if they want to come off of that drug. That’s got to be a first goal of theirs. It’s like, “I don’t want to be on metformin the rest of my life, so how can I come off of this?”

And in my private practice, that’s what I deal with because that’s who’s coming to see a private nutritionist is somebody who wants that life or that long-term goal of getting off of drugs. But sometimes in these programs, it’s not a primary goal, but I’ll educate them on it and I’ll be like, “Look, you can, if you want to come off these drugs over time, you probably can. I mean, I’m not going to make any promises, but if you work with all of the different support systems and you want to, we could help you in that direction.”

But yeah, good multivitamin, good quality minerals, like a good mineral supplement I’ll often recommend. And then sometimes Arterosil and things like that that are going to help support the nitric oxide levels and support the flexibility of the blood vessels might be something that they’re interested in taking. It really just depends if people are even interested in taking a number of supplements or if they’re like, “I’m just not going to do it.” So you got to meet patients where they’re at with that.

Evelyne: And then I want to go back to in your private practice, so you said you do use berberine. What are some of the other nutrients that you use or herbs that you use for blood sugar support?

Mel Luther: So in my private practice when I’m working with blood sugar management, I do recommend people potentially taking berberine. I think that it’s been shown in a lot of studies to be very helpful. As far as non-pharmaceutical interventions, berberine is potentially the most powerful as far as herbs and nutraceuticals, I guess you could call it.

So yes, if they’re trying to come off of metformin or if they’re in the earlier phases and they’re not on a drug yet, I recommend like, “Hey, start taking metformin throughout the day before meals because it can really help with reducing your blood sugar spikes if you’re going to have a carbohydrate-rich meal.”

Chromium, magnesium, I mean, that’s why I just think everybody should go on a multivitamin, honestly, because then they’re going to get their nice array of B-vitamins, they’re going to get magnesium, they’re going to get chromium, they’re going to get all these little micronutrients that are needed to support blood vessels and glucose metabolism. So that’s a big one.

I mean, I’m not as much of an herbalist. Sometimes I wish I knew about herbs more, but I know ginseng, American ginseng can be very helpful. So those are kind of main ones. And then like I said, the fiber is going to be something I focus on a lot and just trying to help them get more fiber in their diet to support slower release of sugar.

Evelyne: Absolutely. I want to go back to the blood sugar and mental health aspect. I loved how you explained all the connections with the B-vitamins. Let’s also talk about the connection between stress and sleep or lack of sleep and blood sugar.

Mel Luther: So blood sugar and mental health, well, we know that it’s like a two-way street. So people who have depression and anxiety are actually shown to have higher risk of having diabetes or pre-diabetes. And people who have diabetes are at higher risk of having mental health issues. So it’s not like really that one’s causing the other, and we don’t really know what’s causing what. We just know that there’s a positive correlation between the two.

But some studies have shown that depression is two times higher in diabetics than in people who have healthy blood sugar levels. So that’s pretty dang high. And why is that? Well, we can think about different things. If you’re depressed, for example, or anxious a lot, you’re more likely to be eating unhealthy foods because you’re just seeking the high you can get from eating carbohydrate-rich, sugar-rich, fatty foods. And if you’re not feeling good about life and yourself, you’re not going to spend the extra time to make a home-cooked, make amazing satiating salad and things like that. You’re just going to reach for more easy, exciting foods.

We know that there’s inflammation in both of these conditions, and that’s something to think about. Nutrient deficiencies, we just talked about all these B-vitamins and nutrients that support mental health and blood sugar. So if you’re low in those, whichever one’s manifesting first, the other one has a high chance of following it.

And then we see that with certain food additives, those can impact our wellbeing and our mental health. So I think that there’s still a lot of research to come out on that, but I think that that’ll come out a lot more in the years to come if more research and money is put into understanding those.

And there’s a whole thing about you can only eat so much food in a day. So if you’re reaching for unhealthy food, then you’re not eating healthy food. It’s like you’re choosing one or the other. You can’t consume both of them at equal amounts. I mean, it’s like whatever meal you’re choosing is what you’re choosing. So when people end up eating unhealthy foods, they’re not eating healthy foods. And that can lead to nutrient deficiencies too, and unhealthy microbiomes, which we know play a role as well.

In addition, I mean the whole world of mental health is pretty big. It’s not just depression and anxiety, right? It’s ADHD, it’s even dementia could be thrown into that category too. And we know that, well, I guess there’s conversation that dementia is considered type 3, and it’s starting to be understood that insulin resistance in the brain is one of the factors in dementia. So that’s also blood sugar regulation, and that also plays into pre and type 2 diabetes because if your neurons can’t get the glucose they need for the energy production, then they starve and that affects your mental health.

And then methylation. So with the B-vitamins, any sort of methyl donors, especially when so many people have the genetic variants that they can’t methylate appropriately, methylation plays an important role in neurotransmitter production, and it plays an important role in melatonin. You were talking about sleep, so if people aren’t sleeping well because maybe they’re nutrient-deficient, could be all sorts of things that cause people not to sleep well, light pollution. I mean, there’s just a whole list of things and it can be hard to try to figure out what it is that’s causing our patients to not sleep well.

But there’s been some research, and I think it’s talked about in the community quite a bit, that when people don’t sleep well the next day they’re a little bit more insulin resistant. So you might wake up with higher blood sugar levels and just throughout the day, you’re more likely to reach for unhealthy foods and your cognitive function is just a little bit off the day after you haven’t slept well. So it’s just a downward spiral as far as sleep and mental health and then blood sugar management and all of that as they play together.

Evelyne: I know when I have had a bad night of sleep that the next day I just want more carbs, and it’s like I cannot feel satiated enough.

Mel Luther: Yeah, exactly.

Evelyne: It’s like nothing satisfies you.

Mel Luther: Yeah, you’re like, “I don’t know why. It just seems like a good idea to have a donut this morning.” You’re like, “My God, I would never do that, but jeez, I feel that way today.”

Evelyne: Not as big of a fan of donuts, but a croissant maybe. Yes.

Mel Luther: Yeah, we all have our things.

Evelyne: I have two more topics I want to cover with you. CGMs, continuous blood glucose monitors, do you use them in your private practice or even in the cardiac rehab program, is that part of it? And what has been your personal experience with using a continuous blood glucose monitor?

Mel Luther: Yeah, I mean, I think it’s pretty amazing that CGMs are coming out to be more and more accessible. They’re still pretty expensive for the average person who just wants to go out that doesn’t have a referral from their doctor saying they have high blood sugar levels.

I’ve actually used a CGM, which was amazing. I got such incredible feedback into understanding how different foods affected me. So I recommend if anybody can, if you can get any of your patients get a CGM, then it’s only going to be valuable for their health. When I work with patients or clients, some of them are already going to have CGMs. It’s something they’ve already thought about or with their doctor or they’ve gone out and spent the money on it themselves.

And I always educate them on, hey, if you can, you should definitely get it because people talk about things that are “healthy,” but is it healthy for you? Is it based on how it affects blood sugar levels? For example, let’s talk about oatmeal. Oatmeal is commonly considered a heart-healthy breakfast. And I’m not saying it’s bad for you, but it causes huge blood sugar spikes in people. I mean, it’s insane. So people think that they’re having a healthy breakfast by having oatmeal, and then if they had a CGM on, they’d be like, “Oh, wow, I think that’s not such a great idea.”

Maybe it is better to have eggs and veggies for breakfast that are going to be more blood sugar stabilizing. And especially when research hasn’t really seemed to back up very strongly that eggs are bad for heart health and that affect cholesterol in the way that they were always talked about. I mean, I know eggs are a controversial topic, but when you’re looking at blood sugar management, it’s like, well, they don’t spike your blood sugar and they have a lot of nutrients and some protein. So maybe that is more heart-healthy than oatmeal at the end of the day.

And then in addition, within the cardiac rehab program, some people have continuous glucose monitors or they’ll have the Libre, which is, it’s not necessarily always giving your readings, but you can check it anytime you want. I believe that’s how it works. So yeah, it’ll be fascinating, and those people will have a much better understanding about how foods affect them. They’ll be like, “Yeah, I know oatmeal is not great for me. I have crazy spikes from it.” As opposed to somebody who’s not wearing any sort of CGM, they don’t understand that from a personal experience. I think that they’re a great tool. If anybody can get ahold of one, then yeah, I think that they’re amazing.

Evelyne: And with your clients who you’ve used them with, are you also tracking how their blood sugar and maybe are they more insulin resistant at certain times or does their blood sugar change throughout the cycle? I just interviewed Dr. Stacy Sims, and she talks about the sex differences between men and women in training performance, nutrition, et cetera. And so I’m curious if you’re also working on that with people.

Mel Luther: Yeah, I mean, I will say that I’ve learned from Stacy Sims, so I can’t say anything that she hasn’t already talked about. And we went through the same master’s program and she was a part of that a little bit, which was amazing.

But yes, I do see that with my female clients, and I see that in my personal life too, when I’m measuring it and when I’m working with them. We see that women often, not always, but it’s very likely that we become more insulin resistant and have higher fasting glucose levels leading into our period. So during the luteal phase and then during the menstrual cycle itself. And then during the follicular phase and leading into ovulation, usually it’s more stable and you’re more sensitive to insulin.

So it does fluctuate throughout the month, and that’s why if people aren’t having continuous glucose monitors, but they’re just going to get that one pinpoint check maybe once a year or every few months just to have some sort of idea about what’s going on, they should consider the time of their cycle that they’re going, because if it’s higher, but it was right before their menstruation, it would make more sense as opposed to in the middle of their cycle when they should be more insulin sensitive, when it might’ve been lower if they had it checked.

So I do think it’s an important thing to keep in mind, and so much research is just done on men because women are so much more complicated and our hormonal cycles are complicated and it affects biology and all these things. So I just hope that research continues to come out looking at women in our complexity and how amazing it is and how we should embrace it and not look at it as a negative thing, being like, “Well, therefore there’s a reason I crave carbohydrates a little bit more during certain times of the month.” And that’s okay. We live in a world where, I guess I’ll just say men are often saying, “Don’t do this, it’s bad for you.” But there are sex differences to keep in mind, and it’s not always applicable for both sexes to follow the same exact health guidelines.

Evelyne: You just made me think of another question because you mentioned people who are testing maybe fasting blood glucose once a year. When you are either ordering lab work or requesting lab work from a client, I’m curious, aside from fasting blood glucose, I’m sure you’re looking at insulin, hemoglobin A1C. Are you looking at C-peptide? Are there any other ones that you really like to look at in your clients?

Mel Luther: I mean, yeah, it’s great, the more information we have about people, the better. So if hemoglobin A1C is high, I mean, that just says a lot about the two to three month average of how much sugar they’re intaking. So it’s definitely a great piece of data. However, sometimes people have low or normal hemoglobin A1C’s, even though their blood sugar isn’t actually all that stable. There’s different theories about, well, people’s red blood cells have shorter lives, then they’re not going to glycate as much. And so it shows a higher hemoglobin A1C in people who have longer-living red blood cells. So that can skew information a little bit, which is pretty fascinating.

And then in the functional medicine field, we are pretty aware that measuring insulin is super important because people can have totally normal blood glucose levels, but super high insulin, and that’s keeping their blood glucose in a normal range because the pancreas is just working so hard to maintain that level. So yes, I mean, I think getting an insulin reading is super important.

I remember one of my first patients, before we’d even looked at tests, they were like, “Yeah, my friend was …” They had put a continuous glucose monitor on him or something. I can’t remember what the little experiment they did was, but he’s like, “My blood sugar was just so stable, it was insane. I could eat whatever sugary thing I wanted and my blood sugar never spiked.”

And I was like, “Huh, well, that doesn’t seem right.” And I was like, “Oh man, it’s probably because your insulin is really high that it’s just constantly pulling sugar out of the blood and keeping it very stable as opposed to if people don’t have quite as much insulin. They’re going to see a little bit more range in their blood sugar, but then it’ll come back down and stay more stable.” But it’s like that intricate relationship between insulin and glucose is a really important one to understand when we want to truly understand our patients.

Evelyne: Yeah. Let’s talk about PCOS, just to wrap it up. I’m sure you see PCOS quite a bit in your practice, and you told me that you wrote your capstone paper for your masters on inositol in PCOS, so I’d love to hear a little more about that.

Mel Luther: Yeah, totally. Capstones for masters, that was a fun experience.

Evelyne: Oh my goodness, I still have nightmares about that.

Mel Luther: Well, it was fun. It’s fun to look back and be like, “Wow, look at this paper I wrote. I was amazing.”

Evelyne: Right.

Mel Luther: But that was actually around the time where I was having ovarian issues and I thought maybe I was PCOS. So I became really interested in the topic, and that led me into wanting to do my capstone about it. But basically, PCOS for people who work with PCOS patients, it’s basically characterized by anovulation, amenorrhea, hyperandrogenism and cysts. So a woman has to have three of those four to be considered PCOS. So even though it’s called polycystic ovarian syndrome, you don’t actually always have to have cysts to be considered to have PCOS.

But the thing about PCOS is that you can consider it like a symptom that this woman is dealing with metabolic syndrome in some way, shape or form, because insulin resistance is a huge underlying factor in PCOS. It’s not there 100% of the time, but it is very common. And there’s also actually a huge connection between lowered mental health and PCOS. And that makes sense. If we’re seeing metabolic syndrome and insulin resistance and glucose dysregulation and all this, it’s going to affect mental health. And then obviously the ovaries can sometimes get affected by that, and it can come out as PCOS and even fertility issues.

Now, inositol is a natural compound that our bodies make endogenously, but we find that when women have PCOS, they have much lower levels of endogenous inositol. So supplementing with it, there’s a bunch of different stereoisomer forms, but myo-inositol and D-chiro-inositol have stood out to be the most impactful. So if you’re going to supplement with it, those are pretty much the only two forms you’ll even really find on the market, but that’s because they’re the two that have been studied and shown to help.

So basically inositol, inositol, specifically myo-inositol has been shown to help keep the ovaries sensitive to insulin. So when that falls and we don’t have any more inositol in the body, they can become insulin resistant. But if you supplement with it, it can actually help to reignite that insulin sensitivity in the ovarian’s theca cells. Myo-inositol also supports follicle stimulating hormone, FSH, which has a huge impact on ovulation and pregnancy and all that.

So they’ve seen, and there’s a lot of studies out there on this topic, trust me I’ve read through them, that giving women inositol supplementation can actually help improve fertility. So it improves live births, which is amazing because that’s one of the biggest issues women have with PCOS. They’re like, “I want to have children, but I can’t.” So that can be a really great therapeutic supplement to consider. And yeah, it actually was one of the things that really helped me when I was having an ovarian issue. I supplemented with inositol for six months and it really helped improve that.

Now I want to touch on something else that I’m very passionate about because I spent so much time trying to figure out this connection. And then over the years of coming across different studies, it finally started to come together, but this is the relationship of coffee consumption and ovarian health. So I would hear a little bit over the years, I remember one of my girlfriends coming up and telling me, “I just can’t drink coffee anymore because it stops my periods.” And I was like, “What? That’s wild. Are you serious?” She’s like, “Yeah.”

Evelyne: I haven’t heard that before.

Mel Luther: Yeah, it’s not running rampant, but it’s definitely an issue. And so some women listening to this might connect. So she said she’d have decaf and she wouldn’t have these issues. So then I started hearing that a little bit over the years from different women. And then I noticed that when I would drink coffee, my ovarian pain would flare up. And I started to realize like, “Oh, when I’m drinking a lot of coffee is when I’m having this pain.”

And then I came across a study that showed that caffeine reduces inositol levels in the ovarian theca cells.

Evelyne: Whoa.

Mel Luther: So it’s like, “Oh, wow, that’s amazing.” So that’s the connection is that if you cut out coffee and you increase the inositol levels, then you can help re-heal the ovarian theca cells. So I thought that was fascinating. I haven’t seen a direct study on that, but I’d be curious to keep diving down that rabbit hole. And if any women are dealing with that or anybody in your practice is, then something to keep in mind.

Evelyne: Very interesting. I have never heard that before. Interesting.

Mel Luther: And some people say it could be because a lot of coffee is sprayed with pesticides and things like that too, so there could be multiple pathways going on, but the whole inositol connection was interesting to learn about.

Evelyne: Are you using inositol in your clients who don’t have PCOS as well just for the blood sugar and insulin part?

Mel Luther: Sometimes I do. Yeah, it’s true sometimes I do. It’s not normally a first line of defense or therapy, but it does help with insulin sensitivity all over the body at least a little bit, and it’s quite safe. It’s actually shown to help with sleep at night too. So I say, “Hey, if you’re having a hard time sleeping and you’re also dealing with dysregulated blood glucose, take a little bit of inositol before bed.” I think around 2,000 milligrams of myo-inositol is usually about a therapeutic dose to keep in mind. So yeah, sometimes I do have patients take it.

Evelyne: Awesome. Well, to wrap up, we have a couple questions that we ask every guest, just rapid fire questions. First one is, what are your top three supplements that you personally take?

Mel Luther: I have been really into desiccated beef liver. I love L-theanine for sleep for focus, for study, for Work. I just think L-theanine is amazing. And then astaxanthin is actually one I’ve been taking regularly for many months now, and I swear it has helped my vision staring at computers all day.

Evelyne: Astaxanthin is amazing.

Mel Luther: Yeah, it really makes a difference. I’m like, “I got to keep taking this stuff.”

Evelyne: Yeah, I love that. And what are your top health practices for your own health and wellbeing?

Mel Luther: My top three, of course, there’s so many, but I would say the standout ones are I really try to get outside multiple times throughout the day, especially being a writer and not doing all these things indoors, get outside in the morning, midday, before bed in the evening, try to get that natural sunlight, fresh air, sunlight on my skin. So getting outside is a huge one.

Prioritizing protein has become a huge focus. Just making sure I’m having protein at breakfast, lunch, and dinner. It really helps with my energy levels and my ability to focus.

And in addition, I think we’ve talked about nutrition so much today, so I’ll talk about other things, but lifting weights, actually, lifting weights and just exercising. I have this strong belief that what you do a little bit of every day matters more than what you do a lot of every once in a while. So I just try to make a little bit of time every day to lift heavy weights, do pull-ups, even if it’s just five pull-ups a day or just working out for one or two minutes. It can be amazing how much that can just help our muscles and our cardiovascular and all sorts of things. So those are my three top priorities.

Evelyne: I love that. I love that. And yeah, even didn’t that recent study come out about just doing a couple squats throughout the day can make a big difference. If we can’t get 10,000 steps, that’s okay, but we can get up and do some squats throughout the day.

Mel Luther: Yeah, I think Dr. Rhonda Patrick is who I heard that one through, and she was sharing a study that showed that doing squats can be even more beneficial to help manage blood glucose levels than going on a walk even.

Evelyne: Oh, yeah.

Mel Luther: I mean, don’t quote me exactly, but I think that was what it was saying. But yeah, doing standing squats is amazing. If you can’t get outside, if it’s a cold winter day, get those squats in.

Evelyne: Yeah, love it. And then final question for you, what is something that you’ve changed your mind about through your years in practice?

Mel Luther: So what comes to mind for this is vegetarianism. I’m not anti-vegetarianism, or veganism at all. I think that they can be really powerful, especially for people have different belief systems and that can guide the way people eat. But I think that they’re much better for short-term healing and benefits for the short term because I was vegetarian for five years when I was younger, it really helped transform my health. But then over time, I did start to have a lot of nutrient deficiencies. I wasn’t consuming iron and I had to make up for that years later.

So I just think that I’ve come around to understanding that animal foods and meat can have such an important play in the diet. You don’t have to eat them all the time, but they have so many good nutrients, vitamins, minerals, protein, that if we just completely cut them out, usually it does a lot more harm than people realize in the long term, if you’re not doing everything you can to make sure you’re supplementing for those losses.

And iron is a huge one. I mean, so many people are iron deficient, especially women because they lose iron every month and have no idea. So I think that I’ve just come around to understanding the importance of animal-based foods and how powerful they can be for our health.

Evelyne: Do you work with vegetarians though in your practice or vegans?

Mel Luther: Not as often.

Evelyne: Okay.

Mel Luther: Vegetarians sometimes, vegans once in a while I have, but I don’t know, I think it can be hard if you have a very strong belief on a way of eating like that. I’ll try to help people, but because I just think animal foods can have such an important role, if somebody’s really not willing, then I just don’t always think we’re a great match for each other. So I don’t want to force anything on anybody. But yes, you totally can get your protein needs and all that from a vegan or vegetarian diet, I just don’t think it’s usually the most sustainable long-term for people.

Evelyne: Well, Mel, thank you so much for this chat today. I learned a lot from you. And where can practitioners read more about you?

Mel Luther: I have a website, www.nutritionwithmel.com. I also have an Instagram, @nutrition.with.mel. And yeah, I think those are probably the two places to find me.

Evelyne: Awesome. Well, thank you so much again. This was great. Thank you for tuning into Conversations for Health. Check out the show notes for any resources from our conversation today. Please share this podcast with your colleagues, follow, rate or leave a review wherever you listen. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting-edge research and practical tips.