Inspired with Nika Lawrie

Unlocking Metabolic Health: From Diabetes Awareness to Brain Health Solutions with John Clithorne, PhD

• Nika Lawrie • Season 2024 • Episode 83

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Discover the alarming reality of metabolic dysfunction in America and how it could be impacting your health more than you think. Join me for an eye-opening conversation with John Clithorne, a PhD in human nutrition, as we unpack the staggering statistics that nearly half of American adults are grappling with prediabetes or diabetes. We dive deep into the distinctions between type 1 and type 2 diabetes, explore the markers that signal prediabetes, and break down the components of metabolic syndrome. This episode emphasizes the critical importance of nutritional awareness and proactive health management, revealing that up to 90% of Americans may be dealing with some form of metabolic dysfunction.

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Nika Lawrie:

Welcome to the Inspired with Nika Laurie podcast. John, welcome to the show. I'm so excited to have you here today. How are you?

John Clithorne, PhD:

I'm great. I'm great and I'm happy to be here. Thanks for having me.

Nika Lawrie:

I'm great, I'm great and I'm happy to be here. Thanks for having me, absolutely. So we are going to talk about a subject that I think is so, so important and, I think, really kind of under-recognized in the sense of the prevalence across the country and how many people are suffering from a metabolic issue, let alone prediabetes or diabetes itself. So we're going to kind of get into that. But before we talk about that today, can you just share a little bit about yourself, who you are, where you came from and really what sparked your interest in diabetes in general?

John Clithorne, PhD:

Sure, yeah. So I have a PhD in human nutrition. I've been studying diet and immune function and nutraceuticals for about 15 years. Really love to understand not just how overall diet can impact health but how the biochemistry of nutrition can be leveraged to really help us live our healthiest best lives. My story of how I got into nutrition was when I was in college. I was living with a bunch of football players and I ate and drank like they did, but yeah, they did and I had to find, use nutrition to find my own health. And you know, for me it was a really empowering journey. And now I work for Atkins and you know, a big part of Atkins is truth and nutrition and I truly believe that a lot of people can benefit from understanding more about how diet can help them be healthier.

Nika Lawrie:

Absolutely. I'm not usually a big proponent of different kind of get behind is Atkins. I think their approach to really looking at nutrition and lowering our simple carbohydrates is so impactful. I know for me same kind of thing I ate like crap, I had fun, I did my things and then I started to feel really sick after a while and I was like what is going on and that same thing sparked my interest in nutrition. So I relate to you in that sense, definitely. So can you share? So you know, as we mentioned, we were going to talk about diabetes today, but can you share really? You know how common is diabetes or even pre-diabetes? I think a lot of people think about diabetes as like the big moment when you're diagnosed with diabetes, but they don't realize that they may actually be pre-diabetic, or how many people could be pre-diabetic. So can you talk about the prevalence of both a little bit?

John Clithorne, PhD:

Yeah, but the most recent data that came out of the CDC showed that about half of American adults have prediabetes or diabetes. I believe it's about 95 million American adults who have prediabetes and another 30 million American adults who have type 2 diabetes, which type 2 diabetes, is really the most common form of diabetes. There's also type 1, but that's about 5% of cases, so we're talking about a lot of people.

Nika Lawrie:

A little bit too.

John Clithorne, PhD:

Yeah, yeah. So type 2 diabetes is generally a condition where you are no longer responding to the insulin that your body is producing and ultimately you go down the pathway where you can't produce enough insulin to cover the glycemic load that's being placed on your body through your diet, and that's kind of managing your blood sugar with your own insulin that you're producing. So frequently people will have to go on to insulin in order to kind of cover that dietary glucose that's coming in, Whereas type 1 diabetes most research shows that it has some sort of autoimmune aspect where people who have type 1 diabetes actually have pancreatic beta cells that have been damaged or destroyed via that autoimmune condition and so their body doesn't produce any insulin, whereas a type two diabetic might have insulin being produced still, but it's just not enough. Type one diabetic typically doesn't produce any insulin and they have to go on insulin in order to manage their blood sugar or not consume carbohydrates in order to keep their blood sugar stable.

Nika Lawrie:

Yeah, absolutely, and I think I cut you off a little bit so I apologize for that. But going back to the prevalence, I think it's really scary and it'll stop you in your tracks when you start to understand how many people in the US, let alone around the world, but especially here in the US are facing prediabetes. Can you talk about what is prediabetes? What really sets us into that specific group? What are some of the markers that we'd want to look for?

John Clithorne, PhD:

Yeah, I mean the classical marker of prediabetes is looking at hemoglobin A1c HbA1c is kind of how it's abbreviated on blood work usually and anything below a six or between a 5.7 and a 6.4 on that scale is considered to be prediabetes.

John Clithorne, PhD:

But really prediabetes is still kind of late in the disease process. People develop insulin resistance and live with insulin resistance quite a while before they would be classified as having prediabetes. Their blood sugar levels are still relatively normal but they are producing a lot of insulin to try to manage their blood sugar. And kind of the classical presentation of that is what we would call metabolic syndrome high blood pressure, high triglycerides, low HDL, central adiposity kind of carrying that weight around the middle, central adiposity kind of carrying that weight around the middle. And there isn't a lot of great data on how common metabolic syndrome is overall. But there has been some research that's been done looking at all these different indicators of metabolic dysfunction. How common is that in the United States? And actually one paper that came out was showing that about 9 out of 10 Americans have an indication of some sort of metabolic dysfunction, so a large portion of our population.

Nika Lawrie:

Yeah, I mean I think I know. When I was going through functional nutrition training, I think the statistic was about 75% of Americans had metabolic disease or some kind of marker of it. So even thinking, 9 out of 10, that's potentially 90% of Americans have this kind of issue. Can you explain for those who may not know what metabolic disease is or really, what kind of the factors are that maybe play into that?

John Clithorne, PhD:

Yeah, so metabolic syndrome. This thing that we're talking about used to be called the insulin resistance syndrome. They started calling it metabolic syndrome because people understood metabolism as a function of being able to burn energy, produce ATP through the burning of fat and carbohydrates or ketone bodies, and so that effective ability to be able to turn macronutrients into energy as well as store macronutrients away for use later, is really what we talk about when we're talking about overall metabolism. But there's a lot of aspects that go into metabolism, whether or not it's triglycerides that are floating in our bloodstream and how those fats are then stored or managed, as well as cholesterol particles that floating in our bloodstream and how those fats are then stored or managed, as well as cholesterol particles that are in our bloodstream. That's considered part of our metabolism. I like to think of it as the liver is the master regulator of metabolism.

John Clithorne, PhD:

And everything that the liver does, which is so many things producing blood sugar, managing cholesterol, increasing or regulating fatty acid levels. All of that is aspects of metabolism.

Nika Lawrie:

So I think a lot of people will start to think maybe I'm gaining weight or I have a larger kind of midsection, or maybe I don't feel as energetic, and they start to be kind of concerned about their health, but they may not understand that they have pre-diabetes or diabetes itself. What are some of the real kind of key signs and symptoms, even for someone who may be not, you know, fall into the stereotype of looking like someone that would have this disease? What are some of the signs and symptoms that we would want to look for in ourselves, to kind of you know what I'm saying. What are the things we want to watch out for?

John Clithorne, PhD:

Well, certainly those characteristics of high triglycerides. If you go into the doctor and maybe your blood sugar is normal but you have really high triglycerides or you have really low HDL, which is our good cholesterol. If you have low HDL, that's a good indication that you have this kind of early stage of metabolic syndrome. Or there's other factors, like you're just never satisfied, you never feel full. That's indicating there's something going on with your metabolism. Perhaps you get really, really sleepy after meals. You're constantly craving sugar those are other indications. Maybe at like a less of a biochemical level. But just you're not feeling like yourself. You have brain fog, fatigue, that sort of stuff those are other good indications.

John Clithorne, PhD:

When you progress further into that more type 2 diabetes-like realm frequently urinating, being thirsty all the time, vision or tingling in the fingers can be a common symptom. And what's kind of a scary statistic is actually what came out of the Centers for Disease Control was that a lot of cases of prediabetes and even quite a few cases of type 2 diabetes are considered undiagnosed. People don't even know they have it. So they're walking around with these conditions and the high blood sugar associated with that is damaging their vasculature, their eyes, their nerve cells. So it's really something you want to address as soon as possible.

Nika Lawrie:

Absolutely so. If we don't address it, what are some of the health problems that would come from having diabetes?

John Clithorne, PhD:

Well, I think most people are familiar with diabetic retinopathy, which is the slow loss of vision that occurs in type 2 diabetes. But also nerve pain is really really common, which is really unfortunate because you start to have a lot of pain when you're trying to move around, and then wounds that don't heal very well is very common and those are more of the direct kind of relationship with type 2 diabetes. But what really is prevalent in people with type 2 diabetes is really high risk of cardiovascular disease, stroke, heart attacks, that kind of stuff, which that's lethal and that's really unfortunate when that happens.

Nika Lawrie:

Yeah, I know. You know I worked for the Alzheimer's Association for a long time, and so I had the privilege to learn from a lot of the top dementia researchers around the world. We did different educational conferences, and I know a lot of what they were starting to look at was a potential correlation or link between blood sugar or insulin levels and brain health too and really brain function. Do you have any thoughts on this or input that you could share? I know it's a broad subject and things that we're still really looking at and researching, but have you seen any kind of links that you've found interesting or noteworthy?

John Clithorne, PhD:

Yeah, I mean years ago. I heard Alzheimer's disease described as type 3 diabetes.

Nika Lawrie:

Yeah.

John Clithorne, PhD:

I'm sure you've heard that before as well. Right, and it just shows you know brain metabolism. Our brain is one of our most energy intensive tissues. At rest, the brain consumes about 20% of our total oxygen, despite being less than about 5% of our overall weight.

John Clithorne, PhD:

So, metabolism is so important for the brain. When we have these disruptions to metabolism, that can really impact brain function, as well as the fact that the vasculature that feeds the brain if that gets damaged because of high blood sugar levels, then the brain can't get all the nutrition and the oxygen and the nutrients that it needs to function at its best. And so there is a lot of interest in how nutrition can help brain health, especially help manage or even treat Alzheimer's disease, how we can restore the function of the brain energetic system to get it to metabolize things like ketones a little bit better.

John Clithorne, PhD:

It's not metabolizing glucose very well. Maybe we can get at some of these alternative fuels. I think there's this misperception that the brain only can use glucose as its fuel source and so if it becomes insulin resistant and it's not responding to glucose very well, you're kind of out of luck. But that's really not true. There's quite a bit of research that's come out that shows the brain is very adaptable and can use ketone bodies for energy at quite a high rate. In fact, some studies have suggested almost 70% of the brain's energy can be derived from ketones under certain conditions. So shifting the metabolism away, giving the brain some alternative fuel sources, can actually help improve cognition in some of those people who have earlier stage dementia or Alzheimer's disease.

Nika Lawrie:

Absolutely For those who may not know, can you kind of explain the difference between glucose and ketones as energy sources?

John Clithorne, PhD:

Yeah, so you know, when it comes to producing energy, we always need to produce ATP. That's our basic energy system, but there's a lot of different things that can be used to create ATP, and two of the primary ones the third probably being fatty acids can be broken down and turned into energy. Ketones are a molecule that are produced kind of as a byproduct of fat metabolism and they can be used by energy by a lot of tissues, whereas glucose is more of that food that you're eating, and especially carbohydrates are broken down into glucose in our digestive system, absorbed and flows through our bloodstream, and so glucose is in, like the high carbohydrate diet, the primary fuel source for most people's brains and bodies. But as they shift their diet macronutrient profile, you'll start to see the body start to produce ketones, other tissues that burn fatty acids, and then those ketones can be used by other parts of the body, like the brain, that can't use fatty acid.

Nika Lawrie:

So how do we, if we want to start making that shift I want us to get into a little bit of this preventative or effective management of diabetes or prediabetes how can we start to make that shift in less of a scientific discussion and more of like an everyday discussion? How do we make that shift to kind of lower our simple carbohydrates, lower our glucose and really start to look at how do we increase our ability to burn ketones?

John Clithorne, PhD:

Yeah, I mean let's go back to the basics here, right, like we don't need to think about how can we really manipulate our metabolism.

John Clithorne, PhD:

Let's start at the basics, and the basics are consuming more fiber, cutting back on those refined carbohydrates, those white flours, those white bread, white rice, that kind of stuff, adding protein and fat to your meals to make sure that you moderate the glycemic impact of the meal. I think that's so, so important, and what that means is, after you eat food, your blood sugar will rise pretty much no matter what, but how much it rises is really what we're talking about when we talk about the glycemic impact. So just cutting back on your sugar and your refined carbs and that's the first step for moderating that blood sugar response. The second step is then making sure you have fiber, protein and fat in your food, because all of those things slowed away that the glucose is absorbed into your bloodstream food, because all of those things slowed away that the glucose is absorbed into your bloodstream, and just doing those little things can really help manage your blood sugar, which then ultimately helps your metabolism reset, work better, shifted towards being more efficient at burning fat and producing ketones.

Nika Lawrie:

Do you have any tips for? I know because, I mean, I share the same kind of information with my clients. It's really, let's look at eating whole, real foods, right, Like remove as much processed food and those simple carbs as possible. But what I see people run into a lot, especially when they're first making those changes, is the cravings, the struggle to let go of the sugar, the struggle to let go of maybe kind of the trans fat products, those kind of things. Do you have any guidance or suggestions on managing those cravings and kind of moving through those early stages making that transition?

John Clithorne, PhD:

Yeah, I think everyone goes through those struggles, and so having convenient options is really important, Planning out your day, making sure that you have snacks on hand that are going to maybe satisfy your sweet tooth but won't spike your blood sugar as much. Have some fruit especially low glycemic fruits like berries on hand can be a great tool when you need something sweet but you don't want to spike your blood sugar, and you can also look at some packaged foods. There are products out there that have low glycemic index claims on them, and those have been tested to show that they don't spike your blood sugar. So I think that's really important is just being prepared for when those cravings strike and having a plan for how to deal with them.

Nika Lawrie:

I think sometimes also, people get confused about carbohydrates in general, like thinking about simple carbohydrates versus complex. Should we give up all carbohydrates? Should we eat more complex? Thinking about veggies and fruits? You mentioned the berries. Should we continue to eat that? Is that going to impact our glucose levels in our body and, if so, how?

John Clithorne, PhD:

Yeah, so you know, complex carbohydrates is a huge category of molecules, so I think even the simple, complex kind of oversimplifies the issue. So rather I would say eat your fruits and vegetables right, like that's the very first thing. White rice is technically a complex carbohydrate, but it'll wreak havoc on your blood sugar. So, starting with those basics of looking for fiber-rich carbohydrates that's probably the best choice when it comes to carbohydrates and then looking for colorful vegetables and fruits can vary on how much they're going to spike your blood sugar or the impact they have on your blood sugar. So you can go online and research low glycemic fruits. Berries, melons those sorts of things are actually going to have a lot less of an impact on your blood sugar than something like, say, a pineapple or a banana.

Nika Lawrie:

When we think about the impact on our health, we also need to also consider the impact of kind of the economic significance. So how do we? We start to think about I'm not asking the question very well, but we're thinking about you know how what the prevalence is of this disease across the country? Right, we've talked about it's. Potentially nine out of 10 people may have some type of metabolic syndrome. We're talking about millions and millions of people who are either pre-diabetic or diabetic, and then there's a lot of health layers that come with it. So it's not just the need for insulin, but it's also the need for other care, potentially cardiovascular, potentially dementia, other types of care like that. When we're thinking about the impact of diabetes and prediabetes, how do we look at the bigger picture of how this is impacting the medical system, how it's impacting our ability to access healthcare and financially as well, what kind of impact is this going to have on, say, medicaid or Medicare? Now, it's kind of a broad question, but what are some of the bigger picture things we need to think about?

John Clithorne, PhD:

Yeah, I mean I was just reading a statistic that said one in four healthcare dollars that the federal government spends is on diabetes care, and that kind of blew my mind to think about all of the you know diseases that are covered by our federal healthcare, medicare, medicaid programs, and to think one in four, a quarter, of those dollars, are going towards diabetes care.

John Clithorne, PhD:

It's a very expensive condition to manage. There was other data showing that people with diabetes generally spend about twice as much on health care as healthy individuals will, and so to me, when you look at the overall economic impact, we're not talking in the low billions, we're talking maybe half a trillion dollars between diabetes and its related comorbidities. So this is a huge economic issue. What it really comes down to is you can pay now for healthier food or you can pay later for more health care, and I would say that generally, when you're paying later for more health care, your quality of life isn't going to be as good either. So you know it's. I know that food prices have gone up and it's kind of a shock to people, but remind yourself that you're investing in your health so that you don't have to pay later.

Nika Lawrie:

How do we find sometimes people struggle with that? They can see the future, they know it's bad, they know it's going to impact them, but they still want the sugary drink today. What are? Do you have any suggestions on tools to kind of keep that you know? Invest now so you don't pay later, kind of front and center? Do you have any suggestions to kind of help motivate people to make that change now?

John Clithorne, PhD:

You know, I think, always defining your why. Why do you want to be healthier? And then reminding yourself of that over and over again. Is it because you want to see your kids grow up? Is it because you want to go on that vacation? You know, what is it that really motivates you? Finding that why is so important. And the second thing is find a social group to do whatever diet changes or lifestyle changes you want to make with. Over and over, research has shown that when you do things as a partnership, as a group of people, those barriers are a lot smaller than when you're trying to do these things alone. What do you do when you're coaching people?

Nika Lawrie:

Work together, we partner together to go through the process. Yeah, yeah, yeah, absolutely so, john. Before I have some quick fire questions, but before I get to that, I want to ask is there anything that you would like to add that maybe we haven't touched on, or a key fact that I think people really need to understand or grasp the importance of this conversation?

John Clithorne, PhD:

Yeah. So I would start by saying that for a long time, type 2 diabetes has kind of been considered this progressive, diet-related chronic disease that has just progressed and there's nothing that can be done about it. But research has shown that with these dietary changes you can actually not just stop the progression of diabetes but even reverse your diabetes so that you would no longer be considered a person with diabetes. And what that research is really based off of is studies that have has now included lower carbohydrate diets in their standards of care, saying there's the most evidence for lower carbohydrate diets for improving glycemia, blood sugar levels, as well as reducing the amount of medication needed for people with diabetes. I think we have this perception that low carb diets have to be really, really strict. You know all I eat is bacon, eggs and and steak type of diets, but that's not true. It can be lots of non-starchy vegetables and low-glycemic fruits and berries, as well as even smaller portions of carbohydrates spread throughout your day, and that really, I think, makes it much more accessible to people.

Nika Lawrie:

Mm-hmm. So when we think about kind of an ideal meal for somebody to eat, maybe for lunch, what would the portion size potentially be for looking at our carbs versus proteins versus fats? To kind of put that in a simple form.

John Clithorne, PhD:

I like to think about half of your plates should be vegetables, about a quarter should be some sort of protein with maybe a little bit of added fat, and then that other quarter, depending on your kind of health status, should be some sort of carbohydrate, fiber-rich carbohydrate, whether it's a little bit of true whole grains, and I don't mean like whole wheat cookies, I mean like quinoa or brown rice or wild rice, or even just some low glycemic fruits and berries on the side.

Nika Lawrie:

What are your thoughts? Also, I get asked a lot about sugar alternatives. So people are trying to give up sugar, or you know, they hear, you know all the bad things about honey or agave, all those kind of sugar things that have been popular for the last few years, but a lot of times you'll see them turn to equal, or the aspartame kind of things, or even stevia. Do you have any thoughts about these different types of sugars and are they better alternatives or are they things that should be avoided?

John Clithorne, PhD:

Yeah, we do quite a bit of research on this here at Atkins. We do a lot of product testing to make sure that. So we do use some of those sweetener alternatives and our research shows that they do not have impacts on blood sugar. They don't have impacts on insulin. But what we found is that when it's a overall diet shift, when you combine those products with a shift reducing the amount of true sugars you're eating and carbohydrates you're eating, actually cravings for sugars, fast foods, sweets go down. We've actually published that research. So I would say, in isolation those things might not be as effective as making that entire lifestyle change. You really have to commit, you have to be ready to do that, and then you can use some of those sugar alternatives when the cravings strike and you're like I'm either going to go to the vending machine and get a candy bar or I'm going to have a product made with a sugar alternative.

Nika Lawrie:

And thoughts on Stevia. A lot of the times we have questions on stevia specifically because there's debate on how it impacts the microbiome. Is that anything that you've seen in your research or your work?

John Clithorne, PhD:

Yeah, so I actually used to do microbiome research and I will tell you one thing that is very clear coming out of microbiome research, we know that things can impact it.

John Clithorne, PhD:

We don't understand how those impacts actually influence our health, and so a lot of times the cart gets put before the horse, saying, hey, this changed your microbiome, therefore is it bad or good? So you know, just thinking about it in that sense, don't get freaked out because it changes the microbiome. Rather, think what else is happening in my diet that also influences my microbiome Environmental toxins, dietary fiber, other prebiotic substances all of those things work together to ultimately determine what your microbiome looks like. And so that's, I think, the really core piece. And there are studies where people have been given, you know, products that contain stevia and also have tracked microbiome over time, and sometimes you'll see there's there's an initial change, but often it reverts back to its normal microbiome, because microbiome has to get along with your immune system and if your immune system is not changing, ultimately small changes in the microbiome revert back because they have to agree with the immune system.

Nika Lawrie:

That makes sense, definitely. Thank you, yeah. So before I get to the quick fire questions, I just want to commend you on the work you're doing. I think it's so powerful, so needed, and you know we just need more and more research on this, we need more information out there and we need the public to really be empowered and motivated to prioritize their health and kind of take those steps to protect themselves. So thank you for the work you're doing and for the support you're providing people.

John Clithorne, PhD:

Absolutely, and thank you for helping spread the word.

Nika Lawrie:

Yeah, definitely, it's kind of my calling in that sense. I just want to help people feel healthy and have the good life that they deserve, definitely. So, john, are you ready for the quickfire? Questions?

John Clithorne, PhD:

Let's do it.

Nika Lawrie:

Awesome, okay, so my first question for you is what is your favorite or most impactful book, podcast or documentary, and why?

John Clithorne, PhD:

My favorite book is probably the Art and Science of Low Carb Living, or Art and Science of Low Carb Performance, by Jeff Bullock and Steve Finney. It's about how endurance athletes can leverage low carbohydrate diets for ultimate performance and I'm an endurance athlete myself, and these guys just they wrote the Bible on it.

Nika Lawrie:

That's awesome, that's. I'll definitely have to check that one out. I haven't read that one, but I've seen some others in that kind of realm and I've always really liked those, those books. So my next question for you what is your best toxin-free or eco-friendly living tip?

John Clithorne, PhD:

Get outside and spend more time outside.

Nika Lawrie:

Yes, I totally agree. My second to last question for you is what does living consciously mean to you?

John Clithorne, PhD:

To me, living consciously means that you think about how your daily routine will impact your life in the long run.

Nika Lawrie:

Absolutely. That's a big reason why I kind of went into this area was really to get people to think every day about even just the small little decisions we're making, the small little habits that we go through every single day, our routines, how they impact us, how they impact our family, how they impact the broader picture of the planet and kind of earth as a whole, and so I think it's so important to just take those little extra moments to be conscious of our thoughts and our decisions.

John Clithorne, PhD:

Couldn't agree more, absolutely.

Nika Lawrie:

Last question for you, john where can listeners connect with you? How can they find you online and, hopefully, work with you in different manners?

John Clithorne, PhD:

Yeah, well, I'm on LinkedIn and I also. We have a great Facebook page for Atkins, as well as a healthcare professional specific Facebook page for Atkins. It's called Atkins-HCPcom Always spreading new research on that page, and it has a Twitter as well.

Nika Lawrie:

Perfect. Thank you so much. Well, John, this has been phenomenal. I'm so grateful for your expertise, for the information you've shared today, and just thank you for coming on the show.

John Clithorne, PhD:

Thanks again for having me.

Nika Lawrie:

Absolutely.

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