Prediabetes and Diabetes: Why Is Sugar the Enemy?
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Diabetes is a serious disease and it’s increasing at an alarming rate. One in 10 adults around the world now live with the condition, which is listed among the top 10 causes of global mortality.
More surprisingly, 1 out of 3 adults has prediabetes – a serious health condition where blood sugar levels are higher than they should be, but not high enough to be diagnosed as type 2 diabetes. Yet of this group, a whopping 9 out of 10 don’t even know they are prediabetic.
This represents a golden opportunity to intervene. With the right help, you can actually change the way your body handles sugar without ever having to go on medication.
Watch the video and:
- Discover how the process of diabetes starts long before the actual diagnosis.
- Learn how to take charge of your glucose levels
- Find out what you can do to prevent and, in some cases, even reverse your prediabetes and diabetes
Dr. Lickey has spent the last 21 years taking care of people with diabetes and prediabetes. He has seen firsthand the negative and lasting effects these conditions can have on his patients’ health. But he’s also seen patients who take their diagnosis seriously, make changes in their lifestyle, and see surprising benefits as a result.
Understanding Diabetes and Pre-Diabetes: Insights from Dr. Mark Lickey
Dr. Mark Lickey, from Maxwell Clinic, shares valuable insights on diabetes and pre-diabetes, shedding light on the importance of this topic and offering practical tips for managing these conditions. In this comprehensive discussion, Dr. Lickey covers various aspects, from the prevalence of diabetes to lifestyle modifications, medications, and the impact of factors like nutrition, exercise, stress management, supplements, and sleep.
The Diabetes Pandemic
Dr. Lickey starts by addressing the alarming prevalence of diabetes, labeling it as a global pandemic. He highlights that approximately 10% of the global population suffers from diabetes, with the United States facing a particularly serious issue. Obesity and diabetes are intricately linked, with overweight and obese individuals facing a significantly higher risk. Dr. Lickey stresses the need for lifestyle changes to combat this epidemic, emphasizing the importance of addressing the root causes, including diet and sedentary lifestyles.
Understanding Pre-Diabetes and Type 2 Diabetes
Moving on to the specifics of pre-diabetes and type 2 diabetes, Dr. Lickey provides clear definitions and explains the diagnostic criteria. Pre-diabetes, characterized by elevated blood sugar levels, serves as a warning sign for potential progression to type 2 diabetes. Dr. Lickey delves into the pathophysiology of diabetes, focusing on the role of insulin resistance, beta cell dysfunction, and the interplay between genetics and lifestyle factors.
Lifestyle Interventions for Diabetes Management
Dr. Lickey emphasizes the pivotal role of lifestyle interventions in diabetes management. Nutrition plays a crucial role, with the Mediterranean diet emerging as a highly researched and effective approach. He discusses the glycemic index and net carbs, providing insights into food choices that impact blood sugar levels. Exercise is highlighted as a cornerstone of diabetes management, not only for its immediate effects on glucose metabolism but also for long-term benefits in improving insulin sensitivity and body composition.
Stress Management, Supplements, and Medications
Stress management is deemed essential in diabetes management due to its impact on hormone levels and blood sugar regulation. Dr. Lickey recommends various relaxation techniques, emphasizing their role in controlling stress-induced fluctuations in blood sugar. Supplements such as N-acetyl cysteine, CoQ10, and cinnamon are discussed for their potential benefits in managing insulin resistance and mitigating nerve damage associated with diabetes. Additionally, Dr. Lickey provides insights into different classes of medications, highlighting their mechanisms of action and potential side effects.
Addressing Common Queries
Throughout the discussion, Dr. Lickey addresses common queries related to diabetes management. From the hereditary aspect of diabetes to the efficacy of intermittent fasting and the impact of sugar substitutes on blood sugar levels, he provides clear and insightful responses, empowering individuals to make informed choices about their health.
Conclusion
In conclusion, Dr. Mark Lickey’s discussion on diabetes and pre-diabetes offers valuable insights into understanding and managing these conditions effectively. By emphasizing the importance of lifestyle modifications, proper nutrition, regular exercise, stress management, and, when necessary, medical interventions, Dr. Lickey provides a holistic approach to diabetes care.
For further information and personalized guidance on diabetes management, individuals are encouraged to consult healthcare professionals. Together, through education, awareness, and proactive measures, we can work towards combating the diabetes epidemic and promoting better health for all.
If you’re in the Nashville area and want to become a patient at MaxWell Clinic, we’d love to talk to you! Schedule your free 20-minute discovery call with our New Patient Coordinator to see how you can start your healing journey today.
hello everyone uh dr mark lickey here coming to you from maxwell clinic um
glad you could join us this afternoon and uh we’re gonna try and get through
a bunch of information on diabetes and pre-diabetes which is a big topic um but
we’ll try and get through the high points so you can learn a little bit more
and then we’ll have some time for some q a at the end
so let me get you going with the slides here
all right so um why is sugar the enemy um we’re gonna be
talking about a lot more than sugar today but um that does play into this
so um we’re gonna try and get through
these uh these different parts of this topic so why are diabetes
and pre-diabetes important to talk about um what is the path of physiology which
is a big name for what’s the problem um what can we do about it um try and give
you some helpful tips that uh are just really simple things that you can take
away from this whether or not you’re diabetic too because there’s a lot of things that we
talk about in diabetes and about health promotion that are good for everyone
i’ve said many times to patients i’ve taken care of we should all eat more like a diabetic
so um so let’s start with with just some facts and statistics about diabetes
and this will show why this is an important topic so this is a pandemic about 10 of the
global population has diabetes but uh this is a this is a pandemic we aren’t
talking that much about and in the u.s it’s a serious problem
so we’re going to focus more on the statistics that are uh here in the u.s and not so much
worldwide so first of all weight and diabetes tend to go together
[Music] so overweight and obese individuals have doubled since 1980s so
we are in an epidemic of obesity and there’s also been another term that’s
been coined die obesity because 90 of type 2 diabetics are obese or overweight
in the united states um so it isn’t necessarily true all over the world uh oddly in china only about
50 of diabetics are obese um so
type 2 diabetes uh much higher four times higher in developed countries
uh basically because of lifestyle it’s a higher calorie diet sedentary lifestyle
we have put ourselves into this problem and and unfortunately
as we export things like fast food into other countries their levels of diabetes are
rising and then there’s a direct correlation between bmi which is body mass index is
basically a height to weight ratio and insulin levels and insulin resistance
which we will talk about a little bit more as we talk about what happens in diabetes and
how what goes wrong in the body um so
11.3 percent of the u.s population
diagnosed is about 28.7 million people um you know there’s what
235 200 or sorry 335 or 340 million people in the us
um undiagnosed uh 8.5 million so 23
of adults are undiagnosed uh so there’s a lot of people out there
that don’t even know that they have it and then prediabetes which we’ll define in just a second
96 million people over the age of 18 have pre-diabetes that is 38
of the us population that’s huge well over a third and then if you look at uh
the age group of 65 plus you’re looking at close to 50 percent have pre-diabetes
and pre-diabetes has ramifications it’s not just diabetes it does
so diabetes there’s a lot of reasons why we have concern about diabetes and and the
increasing incidence of it a high leading cause of blindness kidney
failure leg and foot amputations cardiovascular disease cardiovascular disease which is the number one killer
in the u.s period um unfortunately this next one is is sad um
45 of the new diagnoses of type 2 diabetes are in kids
so children under the age of 18. so the rapidly increasing obesity rate
of kids is contributing to this [Music] it’s a risk factor for parkinson’s
disease and alzheimer’s alzheimer’s kind of known as type 3 diabetes
there’s definitely a shorter life expectancy if you have diabetes 50 of diabetic males have low
testosterone that’s kind of a big topic these days and as i said before diabetes the
incidence is just skyrocketing as obesity is
so let’s talk a little bit about what we mean by pre-diabetes type 2
diabetes we aren’t going to really touch much on type 1 diabetes that’s for another talk but
um pre-diabetes uh is defined as a fasting blood sugar
of somewhere between 100 and 126. so if you get your labs done and your
sugars north of a hundred that’s uh to be that’s some concern uh because pre-diabetes as
i said has ramifications um a hemoglobin a1c so i want to explain a little bit about what that is so
uh hemoglobin a1c is essentially a percentage of your red blood cells that
have sugar attached to them that’s the easiest way for me to kind of explain that
so normal is up to about 5.6 percent and so
if your hemoglobin a1c is somewhere between 5.7 and 6.4 percent that is considered
prediabetes um and then also a two hour post perennial or after meal
glucose of 160 to 200. so that’s pre-diabetes type 2 diabetes
is one step further a fasting sugar greater than 126. a
hemoglobin a1c of greater than 6.5 percent and a two-hour postparandeal after real
glucose of greater than 200. um type 1 diabetes is a it’s a bit of a
different animal uh autoimmune mediated which basically means your body is attacking itself and it specifically
attacks the cells in the pancreas that secrete insulin
almost universally in children although what we’re finding is that there is there are more and more adults that
we’re finding that actually have autoimmune mediated diabetes but we’re not going to really go into that
with this discussion um all right so let’s talk a little bit about pathophysiology
um and what happens we’re gonna start up in the upper left-hand corner with the pancreas because that’s the main
organ we’re talking about so the pancreas is kind of it kind of sits behind the stomach
and uh kind of goes off to your left um and so what does it do it secretes
insulin from something called beta cells you also have alpha cells in your
pancreas which secrete glucagon those do opposite things insulin decreases
glucose and glucagon increases glucose
so in both pre-diabetes and diabetes what happens is you get a decrease of insulin
insulin secretion from those beta cells you also have increase in beta cell
apoptosis that’s a big name for programmed cell death so we have
apoptosis going on all over our bodies different cells but unfortunately in
this particular disease state you have more of that apoptosis the the
program cell death going on um you you have a decrease in beta cell mass so beta cells again are the cells
that secrete insulin and you have a high level of glucagon so
glucagon as i said before increases your insulin so not what you want going on and then
in the gut um there’s a signal uh with something called incretin which
basically tells the pancreas to secrete insulin
and so if you’ve got an impaired ingredient signaling then your gut isn’t telling
your pancreas to produce insulin so that’s a problem both the liver and the muscle get
insulin resistant which we’ll talk about a little bit more and then
you have an increase in hepatic which is liver glucose output so
you have a kind of an intermediate storage of sugar called glycogen in the liver and
so you actually have increased uh basically a
transition of glycogen into glucose and the the adipocytes
those are fat cells and so you have increased levels of fatty acids which is
bad in all sorts of uh different ways and hyperlipidemia which is high cholesterol
so almost universally diabetics have high cholesterol so which also contributes to the
increase in cardiovascular disease so um this is kind of a from top to bottom
what happens over time with with diabetes this is type 2
specifically so you have an abnormal insulin sensitivity that’s really the
first thing that happens um is your insulin receptors become
insensitive so the insulin receptors are on certain cells especially in places like muscle
and uh they get kind of lazy and then what happens as a result of that you get
hyperinsulinemia otherwise your body compensates for that by trying to secrete more insulin from the pancreas
unfortunately with higher levels of insulin you get
more obesity so uh and it’s central so otherwise right in the center of your
body you’re around your belly so you’ve heard of people who are apple shaped and pear-shaped it’s apple-shaped
people who are more likely to get diabetes so weight gain and physical inactivity
are things that tend to contribute to this and then over time you end up with
higher glucose levels higher free fatty acids there are some genetic factors although
we still don’t know a lot about that but what happens is we start losing beta cells if you’re losing beta cells you’re
losing the cells that produce insulin and then you end up with impaired
glucose tolerance your blood sugar starts to go up and then you end up with diabetes
so um this graph i i like the only thing i don’t like is the uh the yellow
it’s hard to see but um what i want to focus on is is what we’re talking about but more
in a different uh graphical sense so over time what happens is you start
out with normal insulin levels uh normal insulin production and
normal glucose levels to the left to the bottom left and as time goes on you
start having rising insulin resistance so those insulin receptors get kind of
broken down and what happens is in reaction to that your body starts producing more insulin
and then the impaired glucose tolerance in the green uh sorry the glucose level in the green
starts to go up as your insulin resistance goes up so after a time your body can’t continue
to produce insulin to be able to compensate and that’s when your your sugar level starts to go up so glucose
isn’t basically another name for your sugar level so um
this is one way that i’ve i’ve talked to patients in the past about uh
how to how to think of this so pretend like so when you eat you eat
something that has some sugar or something that is broken down into sugar and it starts to get digested and
basically i think of that sugar molecule as a boat and what happens is the the uh boat is
detected by the bloodstream and insulin comes out and it attaches to the boat
and so what’s the boat looking for the boat is looking for a dock okay the dock is the insulin receptor
and so what usually happens in uh if our bodies are working correctly is
the boat goes and it finds a dock an insulin receptor it attaches there
that’s attached to a cell the sugar is sucked into the cell and then the body knows what to do with it
it can use it like initially use it right away to burn
uh as energy it can store it short term in the liver as a glycogen or it can
store it long term as fat so what happens with diabetes is
basically your doc is broken down so the boat is wandering around trying to find a
dock that is working and it can’t find one and so essentially you have sugar running
around in your bloodstream and it’s not getting into the cell where it can be utilized so the weird thing about
diabetes it’s basically starvation your cells are starving
because you need glucose for your cells to function right and for your brain to function right
so that’s why we get some of the problems that we do with diabetes is because you’re basically having a problem with
starvation of the cells so um that’s a little bit about
how diabetes develops um and so what can be done about this well there’s a lot
that can be done um and [Music] how do we control blood sugar well um
the big the big things are nutrition exercise stress management
supplements and medications these are the the big things that we’re going to go over
and so we’ll start with nutrition which is huge um
so as far as what we’ve learned in the past couple decades there’s been a lot of
research about different kind of diets what works what doesn’t for diabetes
and the one that definitely has had the most research is the mediterranean diet which you’ve probably heard of
so if you look to the right at the food pyramid which is not exactly a typical food pyramid that
a lot of us grew up with but mediterranean diet high in in whole grains uh vegetables fruits legumes nuts
olive oil fish and seafood so
these things are helpful and it is helpful in controlling blood sugar
and then certain certain of those foods uh are great because they decrease inflammation and diabetes actually
causes inflammation so it’s good to be decreasing inflammation because increased
inflammation will actually make diabetes worse over time so um
this was interesting uh that they found that this is out of
stanford that a mediterranean diet was just as effective in controlling blood glucose levels compared to a ketogenic
diet you know probably some of you guys growing well what about the ketogenic diet that’s a super low carbohydrate
diet um definitely harder to follow um than a mediterranean diet so
actually was found that these were equal in controlling blood sugar but yet a
mediterranean diet just because i think a lot of it has to do with combination of foods
and you don’t have to be as restrictive with your carbs but probably a good idea
to keep carbs level carb level you know somewhere between uh
20 and 70 grams um and uh
so let’s talk a little bit about what’s called a glycemic index sorry about the
quality of this slide it’s not great hopefully you can see it well enough to get an idea what we’re talking about
so a glycemic index it ranks foods and and the carbs that are in
foods so carbs are things that basically turn into sugar
according to how much they cause the blood sugar to rise rise after they’re eaten
um so on a scale of zero to a hundred so you know say a piece of fish is going to have a very
low glycemic index because there’s no sugar in fish um as compared to like say
a donut so a donut with a donut made out of a doughnut is made out of white flour sugar
and those two things obviously sugar turns into sugar and white flour doesn’t take much to be converted into sugar
so um this just gives a graphical representation of this so a high
glycemic index is going to shoot your blood sugar up quickly and much higher than something that has
a low glycemic index so i think that’s a helpful uh
a helpful way of looking at different foods and and how they’re going to affect your blood sugar
levels uh nutrition labels are important uh and i think
uh you know as we’re talking about diabetes in particular what we’re looking at is
the carbohydrates so if you look at the total carbohydrates down there is dietary dietary fiber and sugar
um and then we’re going to talk just a second about what’s called net carbs probably a lot
of you are familiar with that so it’s basically just total
carbohydrates minus the fibergrams okay so in this case uh it looks like this is
looking at a peach so you got 17 grams of total carbohydrates
but 3 grams of dietary fiber well fiber cannot be digested cannot be
broken down into sugar it’s basically what a lot of us know as roughage
so that doesn’t count basically and that cannot be converted into sugar so if you take the total carbs minus the fiber
grams so like in this case 17 minus three you’ve got four grand 14 grams of net
carbs so that basically means that 14 grams of the carbs in a peach
can be converted into sugar so i think that’s just another helpful
way of looking at different foods and the amount of
basically potential sugar rise all right well exercise obviously is
important as well exercise is burning excess sugar at the
time you’re exercising this is another thing that i i have
come to really appreciate over time is the exercise changes your body composition and that’s very important
and the reason why that’s important is because muscle makes you less insulin
resistant and fat cells make you more insulin resistant so
if you’re exercising regularly you should be converting some of that fat hopefully over time into muscle
and if you change your body composition from less fat to more muscle
you are going to change your insulin resistance so that is basically the main reason why
you can change so much by doing regular exercise as far as your blood sugars
lowers risk of heart disease and nerve damage and then they found in in
patients who were high risk for diabetes for one reason or another combination of
resistance training and aerobic exercise decreased the risk of developing
diabetes over time so exercise very important here
um stress management okay you’re like asking what does stress have to do with
it well actually quite a lot because stress and anxiety release
hormones such as cortisol and adrenaline and those have a direct effect they
actually signal for higher blood glucose levels so
actually managing your stress well will help your blood sugar so you know things like relaxation
techniques meditation mindfulness yoga uh being in nature your spirituality all
of those are helpful in managing your blood sugar something that people might not think
about but definitely important supplements play into this um and
you know we tend to use more supplements around here than uh than medications but
uh you know there’s there’s a lot of different supplements that can help and they help with insulin resistance they
help with reducing the effect of nerve damage over time which
is a big problem with diabetes you’ve probably heard of diabetic neuropathy
so you know n-acetyl cysteine coq10 the antioxidants help
uh probably because uh diabetes actually causes a lot of um a lot of oxidation alpha lipoic
acid probably a lot of you have heard about cinnamon cinnamon is helpful here
omega-3s which are pretty much helpful in almost everything uh resveratrol green tea all these
things are helpful there’s actually a longer list in this i just wanted to
pick out a few so that is where
we like to start around here as long as people’s sugar levels aren’t crazy high
medications there’s a lot of different types of medications to control diabetes i’m not going to go over all of them i’m
just going to mention a couple different types the glp ones they’re kind of the newest
large category of medication for diabetes um they’ve been used for diabetes as
well as weight loss and have been fda approved for both um
so they they have a an interesting mode of action uh they increase insulin
secretion but only after eating which is a good thing um they decrease glucagon secretion
which we talked about earlier glucagon actually increases your blood sugar
and they delay stomach emptying and that’s a good thing because at least early on in diabetes the stomach tends
to empty too fast and that makes people start getting hungry too fast
in that particular type of medication there’s a small risk of a rare type of thyroid cancer called medullary
medullary carcinoma of the thyroid so there is there is some risk there
and then a lot of people with that particular type of medication get problems with nausea
so um and sometimes that goes away and sometimes it doesn’t i’ve seen i’ve seen
definitely a percentage of the population uh who have used those types of medications and and the nausea is
just persistent uh metformin um this has been out for a
long time it’s considered the uh starting point in traditional medicine um definitely not where we at
maxwell clinic would would start but it’s there’s a lot of experience with this as it’s an older drug
um has also been used off label um so pre-diabetes um it’s been used uh pcos
polycystic ovarian syndrome um it can lower the risk of cancer dementia and stroke in patients with
diabetes and there’s kind of for you biohackers it may slow aging and
increase lifespan not without its own risks
lactic acidosis is a risk b12 deficiency is a risk
but you know not a horrible drug but uh you know can be used
so there’s a lot of other different kind of medications unfortunately the older ones were
lots of problems what’s called the sulfonylureas because basically they were just pounding at the
at the pancreas to produce more insulin and uh hypoglycemia low blood sugar was a big
problem with those medications so they’re not used nearer as much these days metformin and the glp ones have a
very low rate of hypoglycemia so um
so i appreciate you joining me for this uh it’s a lot to cover um i could have
talked for easily double the time but i think we hit the high points
and want to go to some questions if you have them
um all right so leslie was asking about how much cinnamon to take
every day um i mean that probably about a teaspoon a day
um you know cinnamon in larger amounts that’s that’s the nice thing about using things that are natural
um they they aren’t gonna hurt you you know you’re gonna have to take an awful lot of cinnamon before it’s gonna hurt you
but probably either a teaspoon a day or a teaspoon a couple times a day is about what you’d want to take and um
you know what i found with cinnamon is it’s much better to be using cinnamon before the cat’s out of the bag
otherwise if you are pre-diabetic i find that it’s it’s much more helpful than if
you’ve got diabetes and your sugar levels really out of control because a lot of the supplements are going to
have a hard time controlling you know when you’re hemoglobin when anyone sees 10
so that’s why we like to find people’s blood sugar problems before
they ever develop diabetes you know when they’re in that early pre-diabetic state with the hemoglobin a1c kind of creeping
up 5.75.8 and i’ve had patients in the past that have been able to stay there for a very
long time and i’ve never seen them convert into into true diabetes even though about five to ten percent per
year pre-diabetics convert to diabetes um
let’s see there was uh joseph wanted to know he said his diabetes passed down like from
generation to generation uh both his grandmother and mother had diabetes
um is it passed down yes it’s passed down uh is it all genetics no
the genetics aren’t fully worked out yet and it’s it’s on multiple genes
and a lot of what we think is going on with diabetes and being passed on from
generation to generation is more of a lifestyle issue so if you’ve got
multiple family members with diabetes the best thing you can do is eating well
exercising controlling your stress managing your stress um you know the things that we talked about
here because the genes we don’t know yes there’s a pretty high incidence if you
have a lot of family members with diabetes that you you have an increased risk of it but you can definitely
mitigate that risk you can decrease that risk with with the lifestyle modifications
um [Music] intermittent fasting somebody asked stacy asked about intermittent fasting
yeah um intermittent fasting i would say is also one of these things that is
better to be done in pre-diabetes and early diabetes
when somebody’s got more advanced diabetes especially if they’re on certain types of medications you really
need to have consistent calorie intake but in early diabetes and pre-diabetes
intermittent fasting has definitely been shown to be helpful and it’s definitely been shown to be
helpful with weight and since weight is one of the big problems with diabetes
uh intermittent fasting would definitely be something that would be uh beneficial
um okay let’s see michael wanted to
touch on how sleep affects diet pre-diabetes so sleep kind of goes along with
the kind of what we talked about with stress lack of sleep
creates more stress on your body and you are going to be more likely to
be producing more cortisol and epinephrine and adrenaline when
you are uh when you’re not sleeping as much or you’re not sleeping well
and so that’s going to raise your blood sugar and that’s been shown over and over again
and it tends to poor sleep actually tends towards obesity as well and since
the obesity and diabetes are directly correlated they all play together so yeah
definitely sleep affects diabetes and pre-diabetes
um let’s see here look at some other things
[Music] so net carbs in relation to glycemic
index uh this is stephanie that wanted to touch on that so
yeah those two things are related so if you have something that’s high
glycemic index in all likelihood the net carbs of that particular food are going to be
high so they’re really well correlated so you know something that’s going to be
you know a glycemic index of 80 or 90 is likely going to have a lot of net carbs
because the net carbs are the carbs that turn into glucose basically in your system once it starts getting digested
um and michelle was wondering about do we treat
diabetes at maxwell clinic most definitely um i’ve been dealing with diabetes
treating diabetes for my entire career and all of us here at maxwell clinic treat
diabetes and it’s fun to treat because
it’s very rewarding you know one of our big things here at maxwell is lifestyle
and uh you know there’s so much as we talked about that can be done with lifestyle
modification that can really help diabetes um so and and you know the sooner you
get to those lifestyle modifications uh you know in in the disease process
the more benefit you can get but there are there’s definitely benefit that can happen no matter where you are
at in in diabetes and i’ve seen people who have really buckled down with their
lifestyle and have made huge differences in their blood sugar
i had one guy who he came to me and he had developed diabetes his team global a1c it was like 10 and a half
and he buckled down and in like three or four months he had knocked down his a1c
to 5.5 which was in the normal range so it can be done so um it’s it’s great
it’s fun for me to see that um very rewarding it’s very rewarding for for the patients as well
um so some rusty you want to know about how the
body processes stevia and other sugar substitutes compared to sugar does your glucose level react same
the the answer is no but i’m going to put an asterisk by that
i think that a lot of people think that if if we’re using things that are sugar
substitutes that it won’t affect our blood sugar and that’s not necessarily true the problem with sugar substitutes is
your body gets very confused and the reason it gets confused is that you’re
eating something that tastes sweet but it doesn’t have the calories that go along with it
and the body gets confused and it actually does raise your blood sugar some
in in response to that so no it doesn’t affect it like sugar does it still raise
your blood sugar yes it does so um what time is it that’s that’s about all
the time we have for questions but uh thank you for joining me and uh
appreciate the time and uh if any of you guys are interested in
becoming patients at maxwell clinic we would be happy to see you and i hope you all have a great day
thank you
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