Know Your Physio
Knowing your physiology, the very science that makes you who you are, is the best thing you can do to optimize your health, bolster your performance, look and feel your best, and enjoy a longer and more fulfilling lifespan. My dedication to this field derives from a selfish place born out of necessity before it became the bright, selfless passion I'm known for. It was through my health journey (mainly battling ADD and ten years of Adderall dependency plus related side effects) and love for the scientific method that I found my way. Eventually, with the right knowledge and mentorship, I stumbled upon an enhanced state of awareness between mind, body, and spirit where healthy intentions met actionable steps and lasting, positive lifestyle change. Today I call this "physiological intuition," and to me, it's a right that every human being deserves to thrive with, without having to battle themselves or pursue a degree to discover it. Every day I spend on this planet, I get to connect with world-leading experts on my podcast and learn more of the substance I wish I could have gotten my hands on earlier, for YOU to apply and enjoy total mind and body fitness, personal mastery, and self-actualization! The more you #KnowYourPhysio… Enjoy the show!
Know Your Physio
The 15-Minute Movement Secret That Annihilates Reactive Hypoglycemia
Dive deep into the groundbreaking intersection of diabetes management and athletic performance with Phil Southerland, CEO and Co-Founder of Team Novo Nordisk, the world's first all-diabetes professional cycling team, and President of the Team Type 1 Foundation. In this powerful episode of "Know Your Physio," we explore Phil's incredible journey from a young man diagnosed with type 1 diabetes to a global advocate and elite athlete.
Discover the intricate science behind insulin, glucose, and ketone metabolism, and learn how to optimize these pathways for better diabetes control. Phil shares his personal experiences with exogenous ketones and discusses cutting-edge treatments like SGLT2 inhibitors. We also delve into the latest research on pre-exercise food ingestion and reactive hypoglycemia, providing practical strategies for managing blood sugar during physical activity.
Phil's innovative approach to diabetes and exercise, particularly through cycling, offers life-changing insights for anyone looking to improve their health. We discuss his global mission to educate and empower the 1.2 billion people living with diabetes, and his collaborations with the United Nations and Novo Nordisk.
Hear inspiring stories from Team Novo Nordisk's races and learn how they are redefining what’s possible with diabetes. Whether you're a healthcare professional, a person with diabetes, or a fitness enthusiast, this episode delivers crucial information and motivation.
Links Mentioned in Today’s Episode:
Super Sapiens
Team Type 1
Not Dead Yet: My Race Against Disease
Gary Hall Junior Olympic Swimmer
BioStrap
Book: The Joy Of Movement
Phil on Twitter
Phil on LinkedIn
Phil Southerland:
It's a game, right? Glucose management is a game. And the more you play the game, the better you're going to get. The more you play the game, the better, the more you're going to learn how to react. Let's try to look beyond ourselves as individuals and look, you know, who are our friends that could be struggling right now? Who are the family members that could be struggling right now? And try to, let's, we've got this addiction to activity. Let's try to spread it to more people.
Andrés Preschel: Alright, so Phil, here we are finally. I've been spending the past few weeks, past couple months, planning this amazing episode. And in the meantime, I've had the chance to dive into some of your amazing work, your movie, your book, and I've also had the chance to dive deep on all things blood glucose through your amazing platform with my high performance clients, everything from executives of Fortune 100 companies to some of the best tennis players in the world, a world series of poker finalists, Le Mans race car drivers. And what I love about Super Sapiens is that it's the most reliable platform, in my opinion, to showcase one of the number one proxies for all things health and performance and has helped me help other other folks to get their glucose to work for them and not against them as is often the case with a lot of the you know guys gals and uh aliens that live on this planet so welcome to the show and if we can start somewhere i tend to describe this glucose response to stress from an evolutionary perspective is that we've spent millions of years as a species that when we endured stress, typically it was life-threatening, and our bodies are designed to help us run away from that stressor, whether it was a predator or some extreme weather, some kind of catastrophe. And so glucose gets pumped out and into our bloodstream, and now we have the fuel we need to effectively run away, except nowadays, the responsibility and the danger that we face We face it head on while we're sitting down. So the glucose is kind of lingers there. So it's like that alone, I think is sufficient in incentivizing movement around stress. But I want to get your take on that evolved response. What are some of your thoughts and how do you think you can maybe add some further incentive to get people to move before, during or after stress?
Phil Southerland: you know, when people are gonna go out on a really hard run, like if I go out on an easy bike ride, you know, my glucose is gonna stay relatively stable, but if I go hard right off the bat, my glucose is gonna shoot up. Same with, you know, anyone really, because the body knows where the amount of glucose it needs in the system, and it does a really good job of getting it there. Some people respond differently to stress than others. So, like Bobby Julek, you know, on our team, when he gets in the car with his wife, He can have a stable glucose of 80 when he straps the seatbelt in. Within 12 minutes, his glucose is above 200, because she drives like a bat out of hell. That's his, you know, like, I'm gonna die, like, I better hold on and protect myself. But other people don't have that response to stress. So, again, that response is individualized, you know, and you can see, or he's someone who, like, you know, I think for an athlete, he's gotta take that shot, you know. shot at the very end of a game, are they going to have a big glucose response? Which, if you haven't utilized that glucose, then insulin is going to produce and you're going to crash. What's the counterintuitive? So, how to manage all this, whether it's breathing or other techniques that you as an individual have to help optimize, I think are really important. Now, when it comes to using activity, I think Me personally, one of the highest stress points I put on my body is Mexican food. And I love Mexican food. I've got like data point after data point after data point that says this is bad for me. Like this will be, you know, I'm at 159 flat right now. It's just that's too high for me. Like I really like I'd rather eat 10 grams of gummies and, you know, 30 minutes because I gave a little too much insulin then hover around 160. But I know that, let's say my normal Mexican meal, if I add it at lunchtime, I need about four injections, 22 units of insulin for that meal. If I go on a two-hour bike ride in the morning, I only need five units of insulin to get back to normal. So if you know you have a very stressful scenario coming up in your daytime, or you're gonna have a stressful situation, like a big meeting at 12 o'clock, or whatever it might be, let's get your metabolism firing, because you might have that stress response and glucose might go up, but if your muscles are there and they're hungry, then they're gonna absorb it back in quickly for fuel, rather than your body responding with insulin and then causing a rapid crash, which creates a, call it, it's a reactive hypoglycemia. And I don't care who you are, if you have a reactive hypoglycemia, that's a moment of weakness that you're gonna have in your day. And your body as a non-diabetic will correct for it with glucagon, which will release the liver glycogen, but you're still going to have 15, 20 minutes of cognitive weakness or physical weakness with that reactive hypo. Now, maybe you didn't get exercise in the morning and you have that stressful meeting and you're sitting at the computer and glucose is going up. Take a break. Just go walk for 10 to 15 minutes. And again, let your muscles taking that glucose for fuel, because if you don't, your body's going to produce insulin, and that fuel in your bloodstream is going to get converted to fat. It's the cortisol that causes the brown fat in the stomach area. Well, if you don't use the fuel that's in your bloodstream, it's going to get converted to fat eventually. Find little ways to just ensure you prioritize some form of activity throughout the day.
Andrés Preschel: Absolutely. Once you start to track your glucose, and especially with a platform like yours that is just so insightful, you all of a sudden gain agency in the underlying game of biological chess that's happening. You can be very strategic about what you're going to do, when, and how to win every single time. And interestingly, you know, you mentioned how the exercise isn't only good in the morning before a stressful day, but in general, it's good. And if I can just add my two cents here, it's like all of these sort of use stressors, these hormetic stressors like exercise or fasting, cold exposure, even even sauna. You want to dose those appropriately so that you can build that stress response and that reflects in things like your HRV. So if I can give a quick analogy here, it's like imagine you take a yogi in a deep meditative state, eyes closed, lotus pose, hands at the heart, and all of a sudden a lion appears. And this yogi has to quickly snap out of it, get up, run away, and deal with that stress. And then all of a sudden, these zookeepers come, they put the lion in a cage, and the yogi is asked to return to the meditative state. So a yogi that has really good autonomic nervous system control can very effectively deal with stress, And then once the stress is gone, they can return to baseline effectively. Of yogi or an individual with poor autonomic nervous system control, stress happens, they don't know how to deal with it, they just kind of sit there, they're like, what's happening? And then even once the stress is gone, they're still kind of hanging on to it. And I think we can extrapolate this to HRV and to glucose and show how they're interlinked in the sense that if you don't have the awareness and therefore the management of your blood glucose, it can work against you. and if you don't have the awareness management of things like your autonomic nervous control it'll work against you and it'll continue to keep you in this state of danger and and um if you can optimize the two then all of a sudden you're in a great position you're optimizing for all things health performance longevity and on top of that You are practicing stress response through things like exercise, cold exposure, fasting, and heat exposure, sauna, steam room, etc. You're practicing stress response in an environment where you have control over that stressor, where you can dose it appropriately. Like if you're taking a cold shower, you can immediately step out. You know, and that helps you for the unplanned stress, business meeting, dealing with loved ones in a difficult time, being in a race environment, you know, so it's like if you can do these things when the stress is planned, you can effectively track your metrics, make sense of them, then all of a sudden when things are unplanned and up in the air and all full surprises, your body's prepared to engage and to work for you, not against you.
Phil Southerland: No, I fully agree. Again, the beautiful thing about sport and training is that we suffer when we do it. We're a little maniacal, a little twisted in the brain. I've been an endurance athlete for many, many years, and people say, why? I say, well, it's suffering that has a beginning point, and it's got a known end point. Once you have the bookends, Then you can analyze how to try to make what's in between the bookends better. But it finishes. And once it finishes, it doesn't matter how much mental stress went into, do I really need to go out train today? I don't want to. But no matter how much you did not want to do it beforehand, The moment you're out there, you feel better. And when you get done, you feel exponentially better. And it's just, exercise is not the only health pillar in life. And like continuous glucose monitoring, it's not, you don't just put one of these on and then everything in your life gets better, right? It's the little pieces. And so I'm the big believer that there's activity, there's nutrition, there's sleep, mental health. Yeah, well, those are from my perspective, and they're the four pillars of health in society. But there's one that I think really stands at the center, and that's exercise. Because when you're active, you typically eat better because you want to feel better in your exercise. When you're active and you eat better, you typically sleep better because you've got more glucose stability overnight, which is a new thing that we've been cracking lately. And when you're active and you're eating better and you're sleeping better, then mental health is going to be through the roof. And mental health is important. It's been underlooked for a long time. And as a CEO, entrepreneur of a startup company, my mental health has been put to the test this year. And I'll say, if I did not have some exercise goals in my life, I might have broken this year. I was able, to your point, to go say, I'm going to go suffer for a period of time. I worked out so much at the stress of my life when I was on my bike or out running at odd hours of the day because that was the only time I had. Exercise and activity got me through one of the darkest periods I've had as an individual in my life. I'm at the other side of it now, and I feel great, and everything's going to work out just the way I want it to. A little twist or turn here or there, but without exercise, who knows where we'd be right now as a company. I don't know where I would be as a person right now. I just would strongly encourage you. I know your listeners, the people who are following you are the ones who are out there and active on a regular basis, and that's great. I want to applaud all of you. Let's try to look beyond ourselves as individuals and look, who are our friends that could be struggling right now? Who are the family members that could be struggling right now? We've got this addiction to activity. Let's try to spread it to more people. Like we said at the beginning of this show, I feel good when I help somebody, We can all help some person get active. And as that person's life changes over the next nine months, you get to say, I was the tipping point. I pushed that small speck of snow and look at the snowball turning now. You will feel a sense of pride and reward for that person's success. And who knows the positive implications you could have on their life. from a health perspective, but more importantly, from a mental health perspective. I think it's one of the best drugs possible when it comes to staying strong in the head.
Andrés Preschel: That's wonderfully said, Phil. And I will add, I will second this by saying that if you do exercise with the people that you care about, it's a win-win across the board. And it works synergistically in the sense that you have a much higher endorphin response, which keeps you coming back, makes it addicting to exercise. And because you have folks there that are literally there to have your back, you go harder than ever before. There's a really great book by Kelly McGonigal, she has a PhD in psychology from Stanford, she's a professor there, and she has one of the most amazing, I think it's the most downloaded TED talk of all time, it's called Making Stress Your Friend, and she wrote this book called The Joy of Movement, where she describes how group exercise, group activity is so good for so many reasons, and again, going back to the evolutionary perspective, we're designed to suffer together. One of these endorphins is oxytocin and so it's actually when you're in a stress state you create this human connection and that has a Cardio protective effect so we can combine two we can combine exercise with social we get the best of both worlds We improve our stress response. We improve our glucose response. We improve our HRV. We get fitter than ever before We're safer than ever before because now people have our back and we keep showing up We keep coming back and then let's face it that has a domino effect If you can inspire someone you're not only helping them you're helping their inner circles those inner circles inner circles and I think that's the greatest gift that we can give anybody else is a domino effect of joy happiness in a long healthy life yeah man I really appreciate you sharing that with us and and sharing well being vulnerable enough to tell us that this has been a difficult time but that you have shown up for yourself to be the leader you need to be for this community and for this movement Let me ask something, if you could put a message up on a billboard, what would it say and where would you put it? It can be a word, it can be a phrase, it can be a sentence, but imagine someone just driving on by, they see this and hopefully it makes a difference in their life.
Phil Southerland: Dream big and get moving to accomplish it no matter what you know and dream big, you know has so many different Possibilities, you know, it could be I want to see my grandkids grow up one day. That's a that's a massive dream I want to be a good role model for my children. That's a massive dream. I want to You know, win Wimbledon. That's a massive dream. No matter what these dreams are, without movement, none of them are going to come true. So dream big and get moving towards the dream. We can all be the best of ourselves, right? Everyone has that power as an individual to be the best version of you. And I think realizing that you want to achieve something and then taking the action needed towards that goal, towards that dream, it's going to be really personally rewarding. It doesn't have to be big. It doesn't have to be massive. It doesn't have to be newsworthy. that's got to mean something to you. If it means something to your heart, and you work for it, and you try your best to make it come true, then life's about the journey, not the destination, right? And let's just make it the most exciting and meaningful journey that we have time for.
Andrés Preschel: Amazing, man. And I have one more fun anecdote here for us that, by the way, when I say anecdote, even though that's at the bottom of the totem pole of research, I think it's a way to showcase and bring to life what a lot of the real research supports, the systematic reviews that we speak on behalf of. But this is a really fun little anecdote, and it's that I had a chance to introduce, the first time I ever came across your platform was I had a client who was a very high performing, very successful CEO here in the US, who was also an elite cyclist. And he had a buddy that somehow managed to get the Super Samy's device on his Garvin computer while he was out cycling. And it was like a cheat code, man. Like I think for a lot of cyclists, once you get a cycling computer and you can see, let's say your cadence and your heart rate, like that's a cheat code in its own right. But once you add the glucose layer, now you're really, you know, pushing it. And so it was a mission to the least to get him set up here in the US since you guys were strictly in Europe. But once he had access to that man, oh my God, the PRs just came flying in. And now it's like almost, I'm super excited for you guys to come to the US, but it's unfortunate for this gentleman because all his buddies are going to start catching up to him now.
Phil Southerland: Yeah, it's been a blessing and a curse for my own personal journey, because now all my friends are getting faster, right? One of my Canadian buddies I mentioned, we're on a five-hour ride, and he's like, ah, this is before he could get it on his Garmin in front of him. He's like, I'm not feeling good. I'm just going to sit on for a while. what's your glucose? And then he pulls his app out, this phone, I'm 145 and I'm flat. I was like, man, you're not bonking, you're just mentally weak. And I said, come on, you got gas in the tank, let's go. And just the knowledge that he had the glucose was all he needed to go to the front and start rotating for the next hour of the ride. But on the flip side, I've seen him when his glucose is in the 90s with an error trending down He goes from a very stable position to a, you see, you see, probably you would know more than anyone about the breath changes with changes in glucose, right? And all of a sudden, breathing becomes uneasy. The body moves in a little different fashion. It, for me, is super exciting. I wish I could do, you know. I'm not a better, like I don't do any sports betting whatsoever, but if I did, understanding how glucose response, I can see when riders are about to bonk when I watch the Tour de France. I can see when someone's about to crack because their breathing changes. And it's not changing because of the output, it's changing because the glucose, I mean, they're all tied together, right? There's not just one absolute. But I mean, talk to me about that, because you've talked about HRV and glucose response and vice versa. What is your perception on Just kind of the importance of one with the other, how do they correlate from your own perspective?
Andrés Preschel: Well, in a way, and I'm not totally speculating here, but if you notice that someone is calm, they're focused on their sport, they're nasal breathing, they have a relaxed breath, they're in it, and all of a sudden they start hyperventilating, I think that's almost a built-in mechanism of stress that helps pump out the little glucose that they have left in the tank. You know what I mean? Because when you start hyperventilating, you create a stress response that pumps out more from the liver and through gluconeogenesis to break down your muscle fiber, your, you know, to take anything other than glucose and convert into glucose. That's gluconeogenesis. So it's like you need cortisol to promote that process. You, you, you literally need it to promote that process. And so it's like they are compensating for lack of Glucose as a valuable substrate in this case and Yeah, I mean it's unbelievable how being in a stress state Can exacerbate that response how it can lead to all kinds of poor decision-making. So it's like once you have this sort of backbone this evidence-based backbone you can then develop the necessary interoception or that kind of visceral that deep bodily awareness and then when you notice certain signs and symptoms during sport or even living everyday life you can give your body what it needs to perform and to feel good So I think that's another thing that I want to emphasize here that we've kind of brushed on throughout this conversation, but it's like this is so valuable, not just when you're using the platform and the device, but it's also really valuable in helping you harness interoception, a deep bodily awareness. And when you get those two to link up, all of a sudden you're like, it's like being fitted to a bike. It's like, I always tell my friends that have, it's like a regular bike. I'm like, you don't know what it's like to be fitted to your bike. You're like one machine. Everything that you do on that bike translates like a hundred percent. you're like one machine. So it's like if you can use the glucose and the metrics as a backbone, then you have total control over your physiology and the things that you feel all of a sudden can incentivize the decisions that you make to get you feeling even better performing even higher. But yeah, I mean, I'd have to look at the individual sport and the the the player and tell you and maybe give you some more specific feedback but I do think that hyperventilation is almost like a way to compensate for a lack of substrate or or you could even see certain breathing patterns when you are a hyperglycemic when you've had too much you know uh there's a number of different reasons and situations that I can maybe provide some specific insight on but generally speaking yeah
Phil Southerland: I'm curious now that you've got to be doing a lot more nose breathing on the call than I normally would on a call. But I'm curious, because people talk about yoga before bed and how that leads to a good night's sleep. And we've been starting to see now, or at least in the past year, year and a half, I've been really hyper-focused on sleep. We see that a lot of people don't fuel appropriately they have more variability in the night, leads to poor quality night's sleep. You know, a lot of athletes like the Norwegians, Blumenthal, Gustav Iden. Oh, you help use Super Sapiens for fueling while you're on the bike or out in training. Actually, the biggest thing for them was eliminating nighttime hypoglycemia. I'm curious as to, like, could this nighttime breathing exercise just before bed really help you to get to a point of stability? If you go to bed and you have a nice stable glucose, 90 to 100, that's a broad stroke term. Everyone's got their own individual happy place. But if you go to bed 90 to 100 and you can be stable through the night, you're going to get a great night's sleep versus 80 going up or 110 going down, it's guaranteed you're going to have a disrupted night of sleep. My CSO Howard is in-house today, so I'm going to go see him and talk to him about potential sleep study regards to breathing techniques. It's one thing to say better glucose overnight yields better sleep, but how can we help people get the better glucose overnight?
Andrés Preschel: Yeah, there's a number of different ways that you can accomplish that. And I'm happy to have further conversations and see if maybe that's insightful for you guys. But I think, so you know how you mentioned your four pillars, my four pillars to health, you know, sleep, nutrition, movement in mind, I kind of tackle them in that order. For me, sleep is like the foundation of everything else, just simply because Well, for a number of reasons, but I would say generally because it helps regulate the nervous system. And if you have better sleep, better recovery, repair, better able to restore, then all of a sudden you're automatically making better decisions about your nutrition. You have better cravings, more regular cravings. choosing the right foods, you have higher insulin sensitivity. And then if you're sleeping right, recovering well, and you're eating right, fitness comes easy. And if you're sleeping right, you know, you're eating right, you're moving right, then your mind's suddenly in a good place. That's how I approach it. I mean, we're totally different. Our secret sauce tastes similar, but it's not the same. Yeah. So I would say that, yeah, I mean, I'm really big on regulating the nervous system before bed, and there's very accessible ways to do so. One of the most accessible is through the breath. also having an earlier meal because again you have less of that glycemic variability the body can you really just focus on sleep because Digestion is such a taxing process. I mean by taxing I don't mean to Add a negative, you know, I don't mean that from like a negative lens But what I mean is like it just requires so much energy and focus for your body to digest food and so if you're eating late It might make you sleepy because you have you know this increase in tryptophan and serotonin melatonin But it's not going to give you deep restorative sleep because your body's going to be preoccupied in a sense by the digestion Another really helpful thing by the way that pairs nicely with that and is kind of thinking in the same perspective is, believe it or not, taking a very powerful exogenous ketone supplement like Ketone Aid, which almost guarantees a deep state of ketosis. So for a lot of these athletes that I work with, they're high performers, or if you're traveling and all of a sudden you see this big shift in your nutrition or you have to eat late, taking a very, very potent exogenous ketone supplement will do a few things. Number one is, all right, puts you in ketosis and stabilizes your blood glucose. But in addition to that, if you ever measure something like your RQ, your respiratory quotient, you'll notice that when you're in ketosis, it shifts, and that actually allows you to afford less breaths per minute, and therefore, you're in a deeper parasympathetic state. So I can do a whole podcast on just that, honestly. But in a way it's like it does two things. It helps stabilize your blood glucose and it helps regulate your nervous system. I think there's also some research that points to ketones being almost like an adaptogen as well. I think I spoke to Ben Greenfield about that recently, so maybe in a future episode we'll dive into that. But yeah, the breath is huge. Yoga before bed is also big because you do a lot of breathing and movement based breathing. And in Savasana, you know, the corpse pose at the end of a yoga session, there is a lot of GABAergic activity. So it's a very calming neurotransmitter that your body produces. Um, and in a way it's almost like compensating for the effort. So it's like a really nice endorphin, uh, kind of like response, a GABAergic response, uh, that tends to be really good for sleep. And so when you pair these together, when you pair breathing and regulating nervous system, uh, being in a ketogenic state, whether it's by eating earlier or adding in ketones or finding some other means of established ketosis and, uh, doing something like yoga, like, yeah, you're going to get much, much nicer sleep. And, you know, I have a whole, yeah.
Phil Southerland: It's really interesting on the ketones. I've experimented this past year with exogenous ketones during exercise. I think the response is phenomenal and the feeling as well, but I've not played with them before sleep. So I'm going to try this.
Andrés Preschel: Oh my gosh. I'll tell you something. Do you monitor your nighttime biometrics? I mean, not. Yeah. Okay. Well, you don't, you don't have to cause you're going to feel the difference in my, you should feel a difference. But if you track with like a whoop or an aura or a bio strap, you'll notice when you take these ketones, your HRV, your heart rate variability explodes. It just absolutely explodes. It's insane. Like I think this is one of my favorite supplements, uh, for so many reasons. It's like a, really effective for endurance sport it's really effective for mental you know cognitive performance so like for example before a long podcast or if i have back-to-back meetings and i just want steady steady flow and focus and to conserve my glucose i'll take the ketones But I accidentally took it before bed one time and my biometrics, my HIV went up to like a 150 average overnight. And typically I'm like a 110, 120, which is already high. It exploded. And so I use it now for more efficient sleep sessions if I don't have enough time to get the hours that I need. So if I only have time for like six hours one day or even four and a half hours, which is extremely rare. I take the ketones, it puts me in a deep parasympathetic state, and my sleep is all of a sudden more efficient. And I've actually, this has been such a tremendous discovery that now I'm in a conversation with Jeroen Molinger, who is a PhD out of Duke. He runs the Cardiorespiratory Lab, and he's obsessed with ketone aid. And he's actually now publishing some research studies on ketones and ketone aid. And I'm going to be collaborating with him to experiment with this in with UFC athletes, um, uh, and all things recovery. So I'll have a lot more valuable insight and research for you maybe in our next conversation in a few months, but it is a very, very exciting and it pairs nicely with everything that you guys do. So it's definitely something to explore and to make further conversation about.
Phil Southerland: Yeah, Andres, thank you so much. Knowing you, I had high expectations coming in, but it wildly surpassed them. So I hope you do this again and uncover the next round of gems for the listeners and the readers out there in the future, now and in the future.
Andrés Preschel: Thank you. I'm honored. Thank you so much, man. Cheers.