298: How To Tell If Your Blood Sugar Is A Mess w/ Erin Holt

Brought to you by Quell

This episode is bought to you by Quell — to help support rebuilding healthy skin from the outside-in + inside-out!

Take 10% off your next order! Use promo code QUELL10 at check out — Get started HERE!

– – –

People always ask me what's a priority in terms of dealing with skin issues, and they usually start with diet. However, if you're a longtime listener, you know having healthy skin is NOT just about what you eat. One thing to check in the beginning of any health journey is blood sugar levels, but there are a variety of factors that go into regulating blood sugar. Today's guest dives into how she looks at balancing blood sugars as one of the foundational things when working with her clients, especially when dealing with hormonal imbalances.

Erin Holt is an integrative and functional nutritionist with a feisty attitude and over a decade of clinical experience. She blends evidence-based practices, functional lab testing, energy medicine, boundary setting and humor for a unique and customized approach to women’s health. She dives deep with women to get to the root cause of their health issues and finally get answers to their mystery symptoms. In addition to running multiple online nutrition and functional medicine programs, Erin is the founder of the Funk’tional Nutrition Academy, a 14 month practitioner training and mentorship helping nutrition pros level up with functional medicine methodologies. You can find Erin rabble-rousing on her weekly show, The Funk’tional Nutrition Podcast.

What's one thing that has helped balance your blood sugars and has it helped your skin or other health condition? I'd love to hear about it in the comments!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

  • What blood sugar balance means for skin + overall health
  • Understanding insulin resistance, carbs + blood sugar
  • Crazy impact stress can have on blood sugar balance
  • Best labs for blood sugar (so you know what's going on)
  • Pros + cons of a Continuous Glucose Monitor (CGM)
  • Erin's tips for better blood sugar balance


“What's normal is that you eat food and you just feel less hungry. There really shouldn't be a dramatic change of your energy levels. If there is, that could indicate blood sugar dysregulation.” [06:21]

“One of the things that happens is that our adrenal hormones, cortisol being one of them, come in to bring glucose back up. So there's this real intimate connection and it's why, before I even help somebody balance their hormones, I want to make sure that their blood sugar is balanced so that cortisol is not being called on all of the time to do the job that food should really be doing.” [03:26]


Find Erin online | Instagram | Funk’tional Nutrition Academy

Get Erin's FREE GUIDES: The Digestive Guide | The Metabolism Training Series

The Funk’tional Nutrition Podcast- Episode 87: Eczema, Skin Rashes & What You Need to Know with Jennifer Fugo

Healthy Skin Show ep. 052: Blood Sugar Imbalances And Skin Problems w/ Dr. Ritamarie Loscalzo

Healthy Skin Show ep. 282: Metabolic Dysfunction Disaster Fueling Skin Problems w/ Dr. Robert Lustig

298: How To Tell If Your Blood Sugar is a Mess w/ Erin Holt FULL TRANSCRIPT

Jennifer Fugo (00:07:00)
Erin, thank you so much for being here! I'm really excited to have you on the show!

Erin Holt (00:19.284)
I'm so excited to be here. We talk all the time on Instagram, so it's nice to connect finally.

Jennifer Fugo (00:24.362)
I know, I know. And so one of the reasons that I wanted to talk to you was because you, and especially on your Instagram, you talk a lot about glucose management and blood sugar balance and why it's a big deal. And this is something that I've been repeatedly asked about, especially, you know, psoriasis has a lot of comorbidities, one being metabolic syndrome, although there are other issues with other skin issues. And there's plenty of people who listen to this who might not have skin issues, but they themselves are listening for someone else and this could be beneficial. So I thought you were the perfect person to talk about this. So let's dive into a little bit about the importance. What is glucose management? And then why is it such a big deal?

Erin Holt (01:04.732)
Um, it's a huge deal because it's kind of like ground zero for all other health situations, whether that's immune health or hormonal health or thyroid physiology…  blood sugar physiology, like really, really matters here. And it really, we, our body needs to, it's always gravitating towards and craving homeostasis and balance. and blood sugar management is one of the ways that it does so. So essentially, like just kind of, you know, real basic, we eat food and then that food puts glucose into the blood. So that's blood sugar, blood glucose. And then that's gonna tell the pancreas to release a hormone called insulin. Insulin is what helps to take the blood sugar out of the blood and then put it into cells. And that's where it needs to go in order to get into the mitochondria, go through the Krebs cycle, produce ATP, which is energy. So we all kind of know that we eat food in order to get energy, but that's like the, the, you know, what's happening behind the scenes. And so blood sugar management or blood sugar regulation is just making sure that that whole system is functioning appropriately. It's balanced. So we're not having super high highs or super low lows.

Jennifer Fugo (02:24:316)
How does cortisol… in the skin world, we're very attune to the cortisol issue dues to hydrocortisone- the man made version of cortisol…

Erin Holt (02:44.956)
Oh my gosh, it's so intimately connected. Cortisol is a glucocorticoid. So, glucose is right there in the name. And one of the things that cortisol does, it's not just a stress hormone, but it also helps to raise blood sugar. So, if we don't have enough glucose in our blood, that tells the brain, like, oh, something's off. Our brain needs a pretty steady source of glucose in order to do all of its jobs and keep us alive. Unless we're existing on ketones, we need a pretty steady source of glucose. So if the brain recognizes that it's not there, it's going to sound the alarms. And one of the things that happens is that our adrenal hormones, cortisol being one of them, come in to bring glucose back up. So there's this real intimate connection and it's why, before I even helped to help somebody balance their hormones, I wanna make sure that their blood sugar is balanced so that cortisol is not being called on all of the time to do the job that food should really be doing. So if we're under eating or skipping meals or we're doing fasting in some cases, especially if we're pairing that with high intensity interval training, really intense exercise, a lot of cardio, that's gonna put us more often than not in a low blood sugar or hypoglycemic state. And so we're consistently calling upon cortisol or epinephrine, norepinephrine, in order to raise our glucose. And the way it does that is just by taking it out of its storage form. It's in its storage form in the liver as glycogen and putting it into the blood so the brain can, the rest of our body can access it.

Erin Holt (04:28.408)
So fascinating. But that's really why mismanaged blood sugar or dysregulated blood sugar is a stressor to the body. Number one. And it's also really, really inflammatory. That's why I say it's kind of ground zero and it can affect everything, every system in our body from top to tail. We know that chronic low grade unchecked inflammation is no bueno, whether we're, you know, talking about the skin or the immune system, hormones, anything. And this is a wildly huge contributor to inflammation in the body is mismanaged or unregulated blood sugar, whether that's high or low.

Jennifer Fugo (05:06.642)
So what you're saying, and it sounds like, this was one of the reasons I wanna have this conversation with you, is that it's not just about what you eat. There are a variety of factors that go into regulating blood sugar. And as you were saying, I almost like to think of, people always ask me what's a priority in terms of dealing with skin issues. And it sounds like if you're gonna deal with especially hormonal imbalances, would blood sugar be at the bottom of the priority pyramid as one of the foundational things?

Erin Holt (05:41.52)
Oh my gosh, it makes so much sense. I'm in lockstep with what you're saying and absolutely without question, it is like one of the top five things that, honestly, the reason that I got so into blood sugar is because literally every single client that I worked with in the beginning would come in and they would have some type of symptom of dysregulated blood sugar, whether that was irritability or chronic headaches, mood issues, anxiety, feeling really fatigued after eating, or feeling like, gosh, after I eat, I finally get my energy back. By the way, neither of those are normal. What's normal is that you eat food and you just feel less hungry. There really shouldn't be a dramatic change of your energy levels if it is, or if there is that could indicate blood sugar dysregulation. So I just kept seeing this consistently, and this is where I had to start with every single client before we go on to the next steps, before we even do any type of like functional lab testing or higher level interventions, we have to start here. So we know like movement is a big deal. A lower inflammatory diet is a big deal. Hydration is a big deal. Blood sugar management, I would say, goes in with like these foundation principles. Like do not pass go, do not collect $200. Absolutely start here.

Jennifer Fugo (07:03.342)
So if, or maybe the question I should be asking is, as I'm listening to you talk about all this, are carbs the problem, right? So is that the thing that we have to worry about? Like when you have someone come in and you're looking, you're like, okay, you have these signs and symptoms, the alarm bells are going off, there was a blood sugar issue. Is it the immediate assumption that carbs are the issue or is it possible that there's a more complex picture going on here. Cause I worry that we get into this thing like we can only have this many carbs and we need to like weigh our carbs and we need to like manage and count. And we start, I don't know, to me that starts to make me feel a little like crazy. And like I'm not probably not gonna do it. So I'm just wondering like how big of a deal does counting the carbs and obsessing over the carbs play into all of this?

Erin Holt (07:58.996)
I'll just say that I come from a history of eating disorders. So I had eating disorders for 13 plus years, and so many of the women that I work with have some type of disordered eating. So I think that everyone can like breathe a collective sigh of relief to hear like, hey, maybe we don't have to count carbs or like bring our calculator to lunch or like have a scale in our kitchen to weigh everything if that's not a vibe for us. So it's like the answer to your question is like, yes, and… Carbohydrates definitely impact our blood sugar, especially those refined carbohydrates IF they're not paired with protein, fat, and fiber. So it's really like the highly processed, highly refined carbohydrates that tend to be more problematic because what happens is they spike our blood sugar. So we eat them, our blood glucose goes up. Insulin's like, oh my gosh, there's a lot of blood sugar here. So insulin can really mount a pretty significant response to take all that glucose, pull it into the blood. Now, if this is happening consistently, day after day, week after week, month after month, year after year, we can end up with a situation known as insulin resistance, where our cells actually stop responding to insulin. And so despite the fact that we're pumping up plenty of insulin, our blood glucose stays high. So a long-term high carbohydrate diet can potentially lead to high blood sugar levels and insulin resistance. That's no bueno because that's really like the, that's like the first step before we get into metabolic disease and metabolic dysfunction. So that's not good. But what can happen in the interim, short-term, and, I tend to see this pretty commonly with our female clients, is that insulin can actually overshoot and it can pull out too much glucose from the blood. And so we end up with reactive hypoglycemia. And we definitely see this with a lot of higher carbohydrate foods.

So if you eat a piece of bread, for example, or eat a couple of pieces of bread, just bread, like naked carbs, and we can see more of that hypoglycemic response. That's why you might like eat a bagel and then like two hours later, you're like hungry and crabby and craving more food. It's like that reactive hypoglycemia. So carbs definitely play a role here. I'm not gonna lie to you and say no. What we really wanna be doing is eating more of a balanced meal. So we pair that carbohydrate with some fat and fiber like avocado and with some proteins like a fried egg on top. And that helps to blunt that like really significant glucose spike and then we won't get that subsequent crash. And so carbs are a big part, how we eat, when we eat, all of this factors into our blood sugar regulation.

We can go into the specifics of that if you'd like, but what's not talked about as much, is the role that our stress response has in our overall metabolic health. I was just talking to a client who was doing all the right things. She's like lifting, she's walking, she's reducing her carbs, she is eating a whole foods diet, she's doing the high intensity interval trainings, doing all the quote unquote right things and she could not bring her glucose or her insulin levels down. So they were consistently too high. And she told me, “I noticed”, cause she wears a continuous glucose monitor so she can always see her data. And she's like, “I noticed when I go on vacation, it doesn't matter what I'm eating, doesn't matter what I'm drinking. My blood sugar comes back into normal, healthy levels. And she's like, it's definitely a stress thing. Right?” And I'm like, maybe, you know, maybe. So what we worked on was really just getting her to do some meditation, to do some mindfulness practices, to take the focus off of the food, and put it more on stress management. And we were able to see her blood glucose levels drop into normal range and stay there. And her fasting insulin levels drop into normal healthy range and stay there. And so I just, we're always like, yeah, yeah, yeah, that stress thing, it's a big deal. But I mean, it's a really big deal. We can see the effects of it on lab. So that's a big one that we need to think about.

Another one is our overall gut health, the bacteria in our microbiome play a very significant role in metabolic health. So our bacteria produce short chain fatty acids. These are just like bacterial poop, right? They eat things and then they like poop out these little critters back, uh, short chain fatty acids and short chain fatty acids do a lot for our actual gut health. They help to keep the gut lining healthy and strong to prevent leaky gut. They help to keep inflammation in the gut nice and low. They're fuel for our colon cells, but they also have systemic effects and they impact our blood glucose signaling, our insulin signaling, our overall metabolic health.

GLP-1 is like being super talked about right now. You might know that from Wigovia or Ozempic drugs, like it's a GLP-1 agonist, right? And so what's not being talked about is how much these short chain fatty acids can impact GLP-1. Also impacted like G-coupled proteins, peptide YY, that's the hormone that tells our brain like we're full, stop eating. And so we can't overlook what's happening at the level of the gut and the microbiome when we're thinking about insulin and blood sugar as well.

Jennifer Fugo (13:55.39)
And we talk a lot about gut, the gut-skin axis and the interactions between the two. So I love that you called it bacterial. It's basically bacterial poop. That's what it is. It's waste products. Yeah, it kind of is.

Erin Holt (14:07.016)
Kind of. Yeah, exactly. Waste products, but it's like one man's trash is another man's treasure, because we can really use those waste products.

Jennifer Fugo (14:13.674)
Yes, exactly. So I wanted to ask, because I think that people would be curious, are there any types of labs that you find to be, and I will ask you about the continuous glucose monitor, because we never really talked about that on the show before, but just quickly, are there any like the rough and dirty kind of labs that might be helpful that somebody at home might have had their labs recently run, and they could just like take a peek at them and be like OH. Maybe there's an issue.

Erin Holt (14:46.992)
Yes. Yeah, three really basic ones that you can ask your GP, your primary care provider for hemoglobin A1C. So this is really looking at blood sugar over the course of like three to four months. So you get a longer picture read. Fasting glucose. So this would require you to actually go to the lab to go to the blood draw fasted, meaning you haven't eaten any food whatsoever.

And that's going to give you more of a snapshot of what's happening at the time of the lab draw and then fasting insulin and fasting insulin is just, it's not routinely checked. So it's something that you actually do have to ask for more likely than not your doctor's not just going to run this for you, but it's so key because you can see these numbers start to creep up before you have a impaired fasting glucose or impaired hemoglobin A1C.

Hemoglobin A1C is the lab marker that folks are looking at for diagnostic criteria for diabetes. So that one is routinely checked, but fasting insulin really isn't, and that should be one, I think, that we're doing at every single lab draw that we have.

Jennifer Fugo (15:58.998)
And that's good to know. And like you said, the more people know to ask for these things, they can better advocate for themselves when they do speak to their doctors, or if, you know, in a lot of places, you can order your own labs. And so maybe if you are ordering your own labs every six months or something like that, you can add that one in as well, because it is usually something you have to check another box for. But it's good to know what these are. And so… We have the lab data, but then we also have the continuous glucose monitors or the CGMs, which you can get yourself. There's pros and cons to these. I don't think my personal experience with it was the greatest, but I didn't get too far into it. So why don't you talk about what a continuous glucose monitor is and some of the good things that you could get from it and some of the not so great concerns that you and I both have with them.

Erin Holt (16:53.596)
So yeah, so a CGM, continuous glucose monitor, is just a patch that you wear. There's a little needle involved. And so it's monitoring your blood glucose levels throughout the entire day. So you get really incredible data. And depending on which one you choose, it's kind of plotted out in a pretty beautiful way. There's different, these used to be only available by prescription. So for diabetics, they could get a written one prescription for these and now they're available to the public. So there's different companies and we won't mention any companies because this isn't an ad or a promotion or anything like that. Um, but they are so much more popular, at least in my circles, like I'll have a lot of clients who are coming to me already wearing a CGM. So the data that it shows is really incredible because you get to see in real time how your body's reacting. You can see how your exercise impacts your blood glucose, you can see how food, different food choices, different food combinations impacts your blood glucose. You can see how stress impacts your blood glucose. But the way that I think about this is we don't want to get super lost in the weeds of the data. I think these really shine, these really excel if we can pattern assess. And Jen, I mean, I know you and I both run labs in our practices. So I think it's safe to say that we both really love information. We both really love having the data, but I think that being able to discern what to do with that data is sometimes more important than the data itself. And so I think this is where people can get lost in the weeds with the CGMs because it becomes a situation where like, oh, what does this mean? What does this mean? This just happened. What does this mean? This just happened. What does this mean? Especially for folks who tend to be a little bit more hyper-vigilant with their food choices or with how their body is responding to food, I think it can kind of perpetuate some unhelpful behaviors and even some disordered approaches to eating. So I really think CGMs are a phenomenal tool. It just kind of depends on who is like wielding the tool, so to speak, but those would be some things to be mindful of.

If you know that you have a tendency to be like, get hyper fixated on individual data points, it might not be the best tool for you. However, if you have the ability to kind of step back and look at the overall patterns of like, Oh gosh, I realized that when I eat oatmeal for breakfast, it really spikes my blood sugar. But when I eat eggs, it doesn't like, if you can kind of like pull some like nuggets out of that, I think that's really good. I wore one for three months and I feel like that was just the perfect amount of time to glean a lot of information about myself and then kind of move on. I don't personally think it's something that we have to wear every single day for the rest of our lives. I think it can be a short term intervention to just grab some data.

Jennifer Fugo (19:49.326)
I'll have to try it again. I'll have to try it again. I did. No, and I know that. See, and this is what happens, like many of us, you try different things, and if you have an experience, it turns you off to the idea. And I've recommended it to clients because I do think, like for example, if you, you know, your hemoglobin A1C is a three to four month view into things, right? And even the fasted glucose, the day of the lab, well, what if you feel really stressed out going to get a blood draw, right? So you don't entire, those data points are helpful, but they're not 100% like the truth, right? And so I feel like there is a time and a place for a CGM where it can get into the weeds, like you were saying, and provide us more in the data in real time.

Erin Holt (19:52.332)
You had a wonky experience. I don't think that that's the norm.

Jennifer Fugo (20:41.758)
And so that's where I find it interesting. And I have in the past, especially with some psoriasis clients, as long as there's no issues with their skin and those areas where they would apply it, I have recommended it before because there is just a huge, I mean, the comorbidity with liver issues and diabetes and psoriasis is just huge. And so it's a lot of times, especially two of you, you're just not sure is this food a problem and you need some guidelines. As long as it doesn't become this food is bad. That's where I start to get nervous is they're like, this food is bad and we start labeling foods bad. Well, maybe that food just doesn't work for you. Or as we will discuss in a moment, maybe there's a way to pair the food or to do something as you've already mentioned that could be more productive than this like good versus bad conversation that we, a lot of people get stuck in the middle of. So what are some of those non-negotiable things?

Erin Holt (21:36.452)
Yeah, I will just say too, it's not just like the individual food, but it's like the context of the food too, like how are you consuming the food? What are you pairing the food with? Were you really stressed out when you ate the food? So we have to have the ability to like bring context online, which is easier said than done. I noticed that when I was eating energy balls made with dates, it would like spike my blood sugar in kind of an interesting way. And I'm like, Oh, okay. That's good information. It doesn't mean I'm never going to eat a date again, but maybe they're not an everyday food for me and for my physiology. So it's kind of like that. We want to just, you know, make a well rounded decision. I guess I also think it's fair to say that I don't think CGMs are a starting point. So if you're, if you know, you really got to like, I got to clean up my diet. Like I'm, you know, I'm eating kind of the standard American diet. I'm eating a lot of processed foods. I don't think the CGM is the starting point. I think it's like, you kind of drill in some of the, the, the tactics that we're going to talk about in a second, probably you kind of like drill some of that and you're eating like a primarily whole foods diet.

You are eating in a balanced way. You're eating in a way to support blood sugar. And if things are still kind of wonky and you're like, gosh, I'd really like to like kind of fine tune this a little bit more. I think that's where CGMs can really shine.

Jennifer Fugo (22:58.382)
So with that being said, what are some tools or strategies that listeners could take away from this conversation immediately, aside from the like cleanup, the really refined starchy carbs, like maybe try to make some swaps, so maybe we can talk a little bit about that.

Erin Holt (23:18.152)
So, balance is kind of key here, and I know it's like a kind of a boring, not sexy, not glamorous thing to say, but like your body really loves it. So it's like, we cannot biohack our ways to health if we're not doing like the bare bones foundation work. And so a big one, especially for female physiology is not skipping meals. And I know it's kind of like socially accepted. I'm like, ah, too busy to eat, especially like moms and caretakers were just like flying around from one place of the neck like, you know, chickens with their heads cut off, and it's so imperative that we are not skipping meals because that's gonna pitch us into a hypoglycemic state it's gonna call on that inflammatory stress response and that's just going to kind of move us in the wrong direction of where we're trying to head. So eating regularly throughout the day is key. I love people eating a breakfast within an hour of waking up. And if you don't have an appetite for a full meal right out of the gate, no problem. But even getting like a hard boiled egg or something into your pie hole within 30 to 60 minutes of waking up is really helps to kind of anchor blood sugar. Because if you start off your day with wonky blood sugar, it can be pretty hard to recalibrate. And so if you are somebody who really gets like kind of bonk, gets that mid morning or mid afternoon crash, you get headaches, you get irritable, this is especially true for you. Make sure you're eating within an hour of waking up. Try not to do too many fasted workouts. So what I tend to see people like wake up, they drink the coffee on an empty belly. They get the kiddos off to school. They rush to like do a workout. And then it could be like four hours before they're even eating a meal. And this is just a recipe for blood sugar disaster. So kind of reorganizing your morning just to make sure you get in some appropriate fuel in. When you think about snacking or meals, you are trying to do more balanced. Make sure that you're getting protein in every single snack or meal. Make sure you're getting plenty of fiber. Make sure you're getting fat. Um, I've heard the rule before, no naked carbs. I really like that one. So you're not just, I just keep using a piece of bread for an example, cause it's such an easy example. I don't know how many people just like eating a slice of bread for snack, but it gets the point across, right? So you don't want to just eat like a plain, highly refined carbohydrate of the snack. You want to make sure that you've got those other factors in place. Um, and then again, understanding the stress role, just understanding that it's going to be challenging to regulate your blood sugar if you're just kind of perpetually stressed out all of the time. In terms of exercise, walking after meals can be really, really helpful to reduce post-prandial or post-meal blood sugar spikes.

So just doing like, you know, we're moving in, I live in New Hampshire and the sun is finally out. So we're moving into the season where walking after meals is like just kind of like a really nice thing. Weight training, anything that's gonna put muscle mass on your body is really, really supportive of overall glucose metabolism. So I would recommend doing some of those strategies.

Jennifer Fugo (26:39.054)
Awesome. And you have a bunch of other, you have a lot of, well, you have your podcast, first of all, which I was on and we'll link to my episode in the show notes, but you've got so many episodes, just like me, I feel like, well, you're far behind. How many episodes are you at at this point? Okay, I'm closing in on 300. So we're close, we're close, we're close. So you have to.

Erin Holt (26:56.517)
Over 250, I think. How about you?

Jennifer Fugo (27:06.086)
I know. So we you've got a ton of resources on and I know like you talk a lot about stress reduction and you just offer so many tools on your podcast and it's such an educational resource for people. So I highly recommend that if you guys love this show, definitely check out Erin's show. It's the functional nutritionist, correct? And it's available on all podcast platforms or functional nutritional podcast. And we'll link to that in the show notes to it's easy to find.

Erin Holt (27:41.2)
I say the best place is where I spend the most time for better or for worse is on Instagram. So I'm the functional nutritionist there. And then the podcast, um, functional nutrition podcast. Those are the two best places to find me, catch up with me and grab some information.

Jennifer Fugo (27:58.402)
Perfect. Well, we'll put all of your links in the show notes for everyone. And I so deeply appreciate your time and us finally making this work with our crazy schedules. And I hope that I can have you come back sometime.

Erin Holt (28:12.936)
Thank you so much, Jen, this is awesome.

"What's normal is that you eat food and you just feel less hungry. There really shouldn't be a dramatic change of your energy levels. If there is, that could indicate blood sugar dysregulation."