Dr. Patrick: When you see someone who's healthy, active, you know, looks lean, how common is it to see that they may be metabolically unhealthy in terms of at least, you know, their glucose regulation?

Dr. Snyder: Yeah, well, on the glucose side, it's quite frequent actually. So we have some studies going on with something called continuous glucose monitoring. But backing up a little bit, it's pretty clear that actually, 9 out of 10 people who have pre-diabetes, so not yet diabetes, actually have no idea. What that means is their glucose is starting to go out of control. They're not officially classified as diabetic yet, but they will be. And it turns out that 9% of the U.S. population is diabetic, but 33% are pre-diabetic. And most of those pre-diabetic will go on to become diabetic and yet, they have no idea they're pre-diabetic. And so we think actually capturing that information is pretty darn important so that they can start getting their glucose under control long in advance of getting full-blown type 2 diabetes.

Dr. Patrick: Now, this is something that I would imagine a routine, you know, checkup that people do, I mean, maybe they don't do this once a year or twice a year where you're getting something like, I guess. Would that even be reflected on HbA1c, which is your, sort of, long-term glucose measurements? And also you know, if there are so many people that have what are pre-diabetes...and maybe you can sort of...I don't know if you can tell us what those levels are, and if it's a pretty hard...I mean, is there a scale that's, kind of, sliding, or is it like, this is, like, for sure if you're within this range you're pre-diabetic? And also I, kind of, want to get into you know, what you've been doing with your work at Innovation Lab in terms of, like, measuring using continuous glucose monitors, which you know, a lot of people are now using these days to actually inform people about their glucose regulation.

Dr. Patrick: Continuous glucose monitors are still considered a medical device... for that reason, they are prescribed under the care of a physician. However, increasingly, they're fairly commoditized with companies like NutriSense, January.AI and Levels, making them available to virtually anyone through a physician network and selling them usually for around a couple hundred dollars per month with the most well-known CGM brands being the Dexcoms and the Freestyle Libre.

Dr. Snyder: Well, as far as range, yeah, there is. So normally people want to have their glucose at 90 or below. And when it gets over 120, then you're typically classified as type 2 diabetic. And so in between is typically called pre-diabetes. They are arbitrary numbers because it's a scale people...you know, you can be anywhere in that range. So the goal is to keep your glucose numbers down. But it's actually even more complicated than that because people will spike to foods and different foods can spike you very much out of control. So for example, if I eat pulled pork, believe it or not, that'll send my glucose over 350, it goes totally out of control.

So you do want to know what foods do that to you. It turns out that it's different for different people. So different foods by different people. And these continuous glucose monitors, which is one of the things we are using in our study is a great way to measure those. So we can actually dive deeper on that if you want. Turns out everybody spikes to different foods differently. Some people spike to bread, other people to bananas, other people to pasta, and it's just different with different people. It's thought that at least part of that's due to what's called your microbiome, the microbes in your gut that digest your food differently. And so we're all different.

And so that's why it's really important to get these personal measurements and that's a big theme of ours. Try to collect big data because everybody's different and those data will be different for different people. And so understanding people's baseline and then how they're shifting from that baseline is absolutely critical for understanding your health.

Dr. Patrick: What do you think about people that are...I mean, obviously, using continuous glucose monitors for people that are diabetic, type 1 or type 2, or for pre-diabetic. What do you think about for just the general population? I mean, there's a lot of companies now popping up that are doing, you know, just that -- allowing, you know, just normal people, like I, myself, where you and I have discussed previously in another conversation, and I've gathered a lot of data but I, sort of, want to know what your thoughts are on...?

Dr. Snyder: Well, I think everybody should wear one. Now, I'm biased, I'm a guy who likes to collect a lot of data around these things. But what's really clear, it comes back to what I was saying before, for pre-diabetics, they have no idea most of the time. They have no idea they're spiking away. And so putting these monitors on, first of all, they discover that, but even normal people, it turns out, will be spiking as well. And it has to do with the way we currently measure glucose dysregulation. We look at final glucose levels, like, we started talking about, or this hemoglobin A1C, these final levels. But there's actually different ways to have different glucose dysregulation. My own belief is diabetes is probably 50 different diseases when you lump it all together into one or two, basically, whether you have type 1 or type 2. And the reality is there's many subtypes. I'm a very unusual type 2 diabetic, actually. So these monitors are great for discovering people who have glucose dysregulation, but it doesn't show up by normal means.

They're also phenomenal because as I say people spiked to different foods. So you get to see what foods you will spike to and then you can actually personalize your habits. If you spike to bread, for example, well, maybe you want to avoid bread and eat other things. And so one of the companies I was involved in founding that's exactly what they do. They have a food recommender that says if you, you know...this is what you normally spike to, don't eat that when you go to the restaurant, eat something else that won't cause this. And I think getting taught those habits early before you're diabetic is absolutely huge. Because I think the key is to get things under control before you have disease. And that's a big theme of ours, try to catch disease early before symptoms so you can manage it and keep people healthy, basically.

Dr. Snyder: We saw one case of...I was talking to a journalist who said he was trying to eat really healthy. He had salmon on a salad every day. And he said, you know, he couldn't think of anything healthier than that. And then his sugar spiked through the roof. And it turns out it was he had some balsamic salt on it that had sugar in it. And the same thing in hindsight he said, "Oh, of course." But he didn't realize that at the time. We all have these habits that probably has some not-so-healthy things snuck in there even when we think we're being perfectly healthy to avoid.

So anyway food avoidance, you know, or eating better foods for you is one easy thing to do. Another thing to do is exercise. I know it sounds obvious, but it's very obvious when you're wearing a glucose monitor. In fact, I can teach people as part of this app, January AI, where you actually eat something...nearly everybody spikes to rice, by the way. White rice is kind of nasty, it spikes people.

Dr. Patrick: Oh totally, I avoid it like the plague.

Dr. Snyder: So does corn flakes and milk, yeah, also pretty nasty, actually. Yeah, so that's good. Anyway, so as one training exercise, you'll eat white rice and then go eat white rice and then do a brisk walk 15 minutes later, you'd be amazed at how much it suppresses your glucose spikes. So you can actually learn these habits just either on your own by wearing a monitor or some of these apps that are out there now and programs are meant to help teach you, help you modify your behavior. So again, you can be healthier. And then the goal is to get in healthy habits so that you will be living a healthy life basically.