Type One Diabetes And The Pathway To Peak Performance With Erin Keyes MPH MBA

The combination of AI and personalized or precision medicine feels like we are entering into this new era of medicine. There are exciting possibilities. Everybody needs to kind of put their heads together and say, "Okay, what are we going to do? How are we going to handle this?" At the end of the day, I would love for us to create a system where the decisions that we're making and the policies that we're passing consistently move us towards the society that we want to be. There are so many influences over health decisions and health outcomes that even just focusing on healthcare is insufficient to give us peak performance and health.

All right, Aaron Keys, welcome to the show. It's so great to have you here, my friend. And um, wow, all the way up from Los Angeles. What a long trip to San Francisco. Thank you for having me. It's been a journey to get here and the drive and the exploration. As I was telling Zach, uh, we've done a tour of San Francisco. My daughter is extremely excited to go to the ferris wheel, which she calls "merry-go-round." And we took both our 100-pound dogs and child on the ferris wheel in advance of this. So, you know, podcast isn't a big deal. That was way more stressful.

Wow, 100-pound dogs on a on the ferris wheel. That's quite a sight. I'm kicking myself a little bit for not buying the touristy photo of it because that would be hilarious, but I probably still could. You know what? I have one from Niagara Falls that just never gets used anyway. So, you know, it's sort of the same thing, right? Do it for the memories. Yeah. Yeah. It's, you know, it's funny. You can keep them in here just as well as you keep. It's like, uh, yeah. Anyway, so, so great to have you here and lots and lots of stuff to talk about.

Let's start off with your charity. Let's talk about it. Yeah. Tell the audience what it's all about. We're going to do Breakthrough T1D, which supports type 1 diabetes research, programmatic development, advocacy, and really trying to improve the life of the lives of type 1 diabetics across the nation and the globe. So many people just don't know. They don't understand the huge difference between type 1 diabetes and type 2 diabetes. Pre-diabetes totally. Maybe let's just start there for a moment and go through that if we could. You know it better than anybody.

Yeah. So I have type 1 diabetes. Type 1 diabetes generally is an issue with producing insulin. So an issue with the pancreas and the beta cells and producing insulin, which are a key metabolic resource for the utilization of glucose in the body. Type 2 diabetes and pre-diabetes tends to be more along the lines of insulin resistance. So your body is oversensitized or desensitized, overproducing insulin and doesn't use it as efficiently. What's really interesting is we're seeing other types of diabetes as well. So with a with the food system and the calorie dense nutrient-poor food choices that we have, we're seeing kind of this emergence of other types of diabetes too, or a combination of lack of insulin production and insulin resistance, which has become very complicated to manage. And we talk about my story, we can talk a little bit about insulin sensitivity, too.

Is this like some form of metabolic syndrome in some way, shape or form? Is there an offshoot of that or what's, tell us about that? It's interesting. So, I think you know when people talk about your metabolism, there's so many things that go into a metabolism. One of which is related to insulin and the utilization and usage of insulin in the body. For pre-diabetes, that is a degree arbitrary classification of your hemoglobin A1C and your running blood glucose levels. And so when you get slightly elevated, people call it pre-diabetes. And then when that is increasingly elevated, that's when it moves into a type 2 diabetes category. But at the end of the day, what we want is for your general blood glucose to be on the lower side, you know, less than 100 ongoing as a type 2 or pre-diabetic. So, moving people more towards better insulin sensitivity and improved glucose management.

For type 1 diabetes, it's kind of this complicated endeavor, right? Because we don't produce insulin and so it's all self-injected. And with that comes risks of both high glucose and also low glucose. And there's a perfect balance of how much insulin you have, how much glucose you have circulating in the blood, in the muscles, etc. And so finding that fine-tuned line is a bit of a challenge. And there's so many factors that go into it. That's really I think where we can help individuals explore how to better control their glucose regulation and utilization and give type 1 diabetics better tools to monitor and work with the body to better manage those levels.

Okay. You are an epidemiologist. So yeah, I do want to ask you how many, because I want to make sure my my facts and data it's correct. So long story short, how many diabetics are there in the United States? I actually have no idea, but it's a ton. I think it's some, you know, if we combine type 1, type two, pre-diabetes, etc. It's something like 40%, I think. Yeah, my number was, I thought it was 30%. But I guess when you add in the pre-diabetics, it gets goes much higher, perhaps even higher than that actually, but it's a significant portion of the population. And then even outside that classification, to your point, there are examples of insulin insulin resistance, metabolic insufficiency. There's many degrees of metabolic management that we can improve or we can focus on to improve how the body really regulates itself. But the metabolism is really complicated. So this is just kind of one variable within that.

While we're on diabetes and talking about it, when you think about it, are are there points in time when somebody who is a type 2 diabetic can move to a type 1 diabetic? So, yes. That's a great question. And I actually had someone reach out to me recently because I posted something about having my insulin denied by my insurance coverage, you know, kind of data error and how we manage the approval of prescriptions. But someone mentioned that their mom was reclassified as a from a type two to a type 1 diabetic and is having to resubmit coverage to their insurance very frequently because of the level. You know when you get better control decreasing hemoglobin A1C below the classification of a type 2 diabetes category no longer covering insulin so yes I suppose it can happen.

Type 1 diabetes tends to be an autoimmune disease, so something where you have a disregulated immune system. The immune system attacks the beta cells within the pancreas and reduces their ability to produce insulin effectively or at sufficient quantity. Type 2 diabetes you still have the beta cells in general, but you are less sensitive to insulin and the process is less efficient. Is there a world where your immune system could be activated after having type 2 diabetes and then kill off cells? I'm sure is there also a world where we kind of, you know, effectively lose the ability to produce sufficient insulin that could then be reclassified as type 1 diabetes? Probably. But honestly, not my area of expertise.

I mean, so do you feel like the type 1 diabetes thing is some sort of genetic lottery that you just get the dubious luxury of working with our wounds? Good question. I mean, for autoimmune disease as a whole, there can absolutely be genetic components to that. There's also environmental exposure. So one of the things that I'm very interested in from an epidemiological framework is what I like to call the exposome and what is classically called the exposome. So it is sort of this summation of all of the things to which you are exposed and the allostatic load or overload that you receive from that. So that might be everything from your individual genetics through toxin exposure through stress management through infectious diseases, etc.

And so when you overload or overwhelm the body, it can you know kind of interrupt the natural healing cycle or maintenance process of the cells themselves and cause risk factors to have something like an autoimmune disease. So stated more simply, when we put an undo amount of stress on the body and the cells, they kind of, you know, get overwhelmed and have a misstep and that can lead to immune dysfunction, which causes an autoimmune disease because your immune system didn't follow the instructions that it natively has and that can lead to great consequences. Serious consequences. Yeah. Like life or death consequences, right? Definitely.

When do we see like diabetes start to show up where people have wounds, you know, they start to get neuropathy and you can't and they step on a Lego and they cut, you know, whenever it won't heal. Where does hyperbaric oxygen therapy play into that? How does that all work? Yeah. So, in the diabetes process, there can be an evolution of degradation. And so chronic high or elevated blood sugars can, you know, wreak havoc on the body, on circulation, on a whole bunch of foundational elements to maintaining cellular health, particularly in the extremities. And so with continued issue with circulation or aggravation in the body itself from the sharp glucose in the blood you can, you know, really effectively destroy your tissues and and circulatory systems. So that tends to be with chronic elevated blood sugars and mismanagement.

But, you know, I say that in, you know, kind of my historical teachings, which frankly I feel like has been historically a fairly judgmental discussion around how diabetics manage their care and thinking about from a systemic lens all the ways that we can help support someone to protect themselves better. This is everything from access to insulin through to education through to taking a look at our food system through to creating a walkable environment that someone feels safe to move their body and activate those large muscle groups to improve insulin sensitivity. There's just so many ways our lived environment is stacked against maintaining a healthy metabolism that we're evolving in a way that we have to now compensate for things that we've done over the last decades to evolve. You know, there are consequences to the ways we've evolved our society. And I think diabetes is an example of a group that's really suffered from some of those larger scale developments.

Yeah. I mean, I think also it's pretty clear that with this, you talked about food. We have food scientists that are figuring out how to, you know, get the right amount of sugar, the right amount of fat, the right amount of salt in something to make it hyper palatable, ultra-processed, digests quickly, high glycemic, hits the blood sugar, you know, gives you a dopamine spike, and, oh, I love this. Yeah, right. I want more. How lovable is it? It's so good. Oh, how do you resist that? Seriously, put a little MSG in the mix and like, you know, it's it's like, you know, hey, I'll have the ramen and the ice cream. Thank you. After the podcast, we'll go do that. We'll do that. We'll eat the ice cream first, right? You know, life's short. Dessert first. Why? Why not? I've seen you do that, by the way. So, hey, you know this about me, though. If I love food. I think food is the epicenter of a home, of a culture, of a relationship to self. You know, we're here for a short time. Let's enjoy the very natural delicious parts of life. And if I'm gonna make that choice, I'm gonna try and make it the best choice that I can have. So if I, this, I think, was the example that we've talked about, too. Oh, I'll have a cookie, but I want it to be the best cookie so that I can enjoy a bit of that cookie and be like, "Oof, that was great." Not 12 Oreos, unless it's from Chinatown in San Francisco and I got to try a new flavor. I'm like, "Okay, yes, Oreo." Yeah. Well, wait a minute. What was the flavor in Chinatown? Matcha. Matcha. Yeah, it's good. Wow. Matcha Oreos. Have not heard that. Yeah, that's uh that's interesting. I liked it. Packed full of great seed oils and all sorts of stuff. M palatable. No one knew that Oreos were vegan, right? Ah, that is hilarious to me. Like when you can process something to the degree that they are vegan, like what are we doing? That's so funny, right? I It's just It's just absolutely hilarious. I mean, comedy of errors when you think about the food assistance. Totally. I mean, yeah. Gosh, I mean, I could go on and on about that. You both.

Well, I mean, the interesting thing about you, your origin story, which is kind of where we start the show always. Yeah. You know, it's kind of like going back to where are you from? Yeah. But what's the whole how did you get to this place? You know, where your MPH—so for those that don't know, Master of Public Health, which is not an easy degree to get, depending on the program, I'm sure, not a not an easy field to work in right now even. No, I would have bet it isn't. And then putting an MBA on top of that, which I think is a very interesting combination that that intersects the sort of ability to look at the greater good of health of a population and be a true epidemiologist. You get that chance to see that and then also take a look at it from a business standpoint. That's a rare sort of intersection. So I'd love to hear, hey, how did it all start? Where did you go? What' you do? How did you get there?

Yeah. I'm from Detroit, Michigan, which is a wonderful group of people in my opinion. When you talk about like all quarters of the US and the globe, I love a good Midwesterner. And usually I'll meet someone and then find out they're from Michigan, be like, "Ugh, no wonder I liked you." There's like an authenticity there that I think is really beautiful. So, just wanted to shout that out. Yeah. grew up there, went to Michigan, I studied molecular biology and had always a very kind of fundamental interest in the body. Maybe that was a result of the type 1 diabetes, but I think in many ways it's also a result of how my brain works of, you know, to make that higher level decision, I think we have to have a deep understanding of the inputs that create the decision, let alone the outcomes. And so I always had this kind of like, uh, let's take that one level deeper type of approach to problem solving like even as a kid.

So I was diagnosed with diabetes when I was in elementary school. That was terrifying for my parents. My dad's best friend died from diabetes, type 1 diabetes. And that, you know, there is a combination there, right? Like we can victim shame about it or we can talk about how the system really does fail type 1 diabetics repeatedly. There's a great comedian who talks about how diabetes is one of the very rare states where a doctor's like, "You know what? Here's this medication. It might kill you. It might save your life, but like you go decide based on vibes alone how you use this medication. Good luck. I'll talk to you in 3 to 6 months." Whoa. So doing that as a small child, I think also triggered some curiosity for me about two things. One, what are the systems that we can set up to really help protect the decisions that people make in their own best interest that double click on on the risk factors so that we can protect against those and then help them to optimize the decisions they're making. But two, the importance of personalization and that we are I think we're moving into a new era and I'm very excited to talk about that with you actually because with this combination of AI and personalized or precision medicine like it feels like we are entering into this new era of medicine for the first time really. You know, people have wanted to do this but we didn't have the skills to do it.

All right, my origin story. So I went to Michigan, studied molecular biology, worked at a cardiophysiology lab there for a while and that I think really supported my understanding of cellular function and kind of giving me this framework of scientific thought, scientific methodology, but also sort of this hope and this vision that we can improve the state of humanity that the hard work that people do, this intelligent, um, in many ways selfless work can alter how a population exists in this world, how we're able to enjoy our lives.

I didn't love working in a basement with no human contact. So, I wound up going back to school. I was deciding between a PhD, the Masters of Public Health. I'd also studied Spanish in school and had kind of this aspiration of improving access to care across populations globally and locally. So, I went to Emory from Masters of Public Health. I really enjoyed that. Some of the best years of my life. I think from a personal perspective, it really shifted how I've approached everything I've done subsequently. And so really giving a deeper understanding of human behavior, everything from education through to implementation and where we get caught, where we get in our own way.

So did that, worked globally for a bit. graduated, worked at Centers for Disease Control and Prevention. Worked on global migration and quarantine. A lot of it was in the infectious disease realm, which was really cool. Worked on things like bioterrorism and the downregulation of human body function, which was really the first time I kind of understood this world of cellular medicine. Of course, that's in a destructive landscape, but you know, if we can downregulate function, we can sure as hell upregulate it, right? And so, that's ultimately kind of this conclusion that brought me to peptides.

I went and worked for Deloitte. Deloitte has an incredible federal government program, particularly federal health in my opinion, but I'm biased. worked across a number of agencies, worked on global health security, worked on a whole number of commercial and federal projects, which was a great exposure for me of some of the ways that our regulation influences the processes of our health care system and our stakeholders within it, but also what the constraints are at an individual level of who's making decisions to take care of the patient in front of them. And so it gave me this really kind of intersectional understanding of all of the ways that our healthcare decision-making is influenced from a federal down to an individual discussion point.

After that, I was very curious about the entrepreneurial nature. I got an MBA while I was at Deloitte. And there seemed like this really good opportunity for me to look at innovation. And I think a lot of innovation is doing something that we're doing in another field in a novel place or in a new context. And so to your point about the kind of rare combination of an MPH and MBA, I hope that that becomes more popular because how do we create sustainable programs that have the best investment for ROI? Whether that ROI is in context of human lives, money, resourcing, etc. How do we actually make our health care system more efficient and more performance-oriented?

So going back to why the MPH and the MBA is a unique combination that I hope is more common in the future having cloud roof team members. Having both of those perspectives I think allows us to think about frameworks where healthcare can be more performance-based and more effective in delivering ultimate care. So we can understand how ROI whether that's measured in daily adjusted life years, the benefits of life, the human lives or dollars or resources, how we effectively allocate the ingredients of high performing health care system to manage a program.

After consulting and understanding this opportunity and entrepreneurship and in innovation, I jumped into startups. I worked in traditional healthcare. It was before COVID and so telehealth wasn't really a thing, but I had huge aspiration for that going back to access to care so I wound up working for an extremely large urgent care system joint venture project with a number of academic health care centers in the delivery of effective ambulatory care on demand care in that we launched a virtual care arm that really exploded during COVID with the need, the need for virtual care for a number of really good reasons and that itself kind of propelled what I work on forward. It created an opportunity with the reimbursement market and the interest of consumers to deliver a technology forward solution for their healthcare that kind of restored some of the beauty of like an at-home visit.

You know, when someone doesn't feel good, making them come into a hospital system is really hard. And often times, the best healing we have can be at home. And so creating systems that can alleviate some of the tension across the health care system, allow for improved staffing, improved comfort of patients, reduced infectivity. There's a lot of benefits of that. Once we had the the framework of technology and there were a number of startups that I worked with or for that were interested in utilization of digital delivery but also data sets actually like fundamentally looking at healthcare data in an individual lens and an aggregate format to best predict outcomes. kind of like open the doors for utilization of emerging technologies, emerging molecules, etc. So that's when I really got into peptides.

Insulin is a peptide. So I'm like the longest running peptide user for a lot of people. So insulin was the first commercial peptide. There are a number of other peptides. I think you've talked about it in the show, but it's like a a brief refresher. All a peptide is is a short chain of amino acids. It's somewhat arbitrary in the the length of them. It's like, you know, KPV has three amino acids and other peptides, you know, they cut off at 40 or whatever before moving into a biologic. So, it's, you know, basically it's an endogenous molecule that we can use exogenously.

And for the uninitiated, since a lot of people who are listening go, what does that mean? Yeah. Our body produces these molecules, right? and we synthesize them for consumption in the body to improve certain processes rather than Yeah. Yeah. So peptides are signaling molecules that help direct kind of this orchestra of function within the body. I have huge interest in this because I think it's really sort of the cellular medicine framework is the first time I've seen an actionable framework for prevention. So even when we were talking about prevention, primary prevention, secondary prevention, like preventing diabetes, we're preventing a disease versus how do we actually optimize for overarching prevention and better health for the time that we have. It might extend our lives, but it's definitely going to make the the years we have better. And that concept of an actionable framework for general prevention and optimization, this feels like kind of the first time we can have a true structure to support that was really cool to me. It's a turning point.

We look at the traditional sick care model of healthcare and I think those days, man, I don't know, you know, all I know is I would not want to be the CEO of any health insurance company. That'd be a tough one to put my head on the pillow every night taking big bonuses while rationing care for people who really need it. Yeah. I think at the end of the day, it's a interesting time and one where there are exciting possibilities. Everybody needs to kind of put their heads together and say, "Okay, what are we going to do? How are we going to handle this?" I'm hoping that someone in Washington DC calls me and then we design a personalized program to support the evolution of endogenous molecules.

Well, I think I think you had a conversation there before, so it might might be might be possible that, you know, at this point in time, we can we can move things forward. Certainly some great things have happened right getting dyes out of foods and and stuff. So going back to the exposome I think reducing exposure of things that create distress in the body at a high level is a wonderful pursuit and I think there's a lot of ways we can villainize how we prioritize reducing the distress of an exposome but at the end of the day I've settled on this framework of is it moving us closer to the society that we want to be or is it moving us away from the society that we want to be and if it's moving us closer I'll support you in it and let's advocate for the priorities that we have that we think can move us there either at better velocity or in a more ROI based performance-based setting. But at the end of the day, I would love for us to create a system where the decisions that we're making and the policies that we're passing consistently move us towards the society that we want to be.

I think there's some confusion though around what do we want to be as a society because unfortunately health care isn't just healthcare like we're talking about with built environment it is also our economic structures it's our development built environment design of cities it is my husband's an urban planner and he does more public health than I do at this point. There are so many influences over health decisions and health outcomes that even just focusing on health care is insufficient to give us peak performance and health.

That's a really interesting point because you could be doing all these things. I mean there's so many it's so many factors go into it. You know, you talk about urban planning or city planning or whatever the planning is. It's like regional planning, you know, the differences between someone trying to consume healthcare in rural Arkansas versus Los Angeles County. It's a really different math. And that's why I love telehealth. Yeah. Yeah. It was interesting, you know, early in my career doing work in all over the country, but also down in Watts. Yeah. and and seeing like wow, you know, like it's really tough for a lot of people to when you say Arkansas, you know, it kind of makes me think of like you could be really close to something and not be able to get it and you could be really far away from something and not be able to get it. Totally. And it's yeah I think that's a really really interesting point of what are the characteristics that prevent someone in Watts in Los Angeles from accessing care in the systems that we have created for someone that you know has to drive in the Mississippi Delta that has to drive a really long time for emergency care.

There are so many things that are preventable or salvageable, but when you don't have access to that care, you know, it sort of doesn't matter if it is able to be solved if you have no one to solve it. And the dir of support and healthcare right now, I think, is creating generational issues for families. Let's talk more about that. What are the effects of this for a family standpoint? I want to go back to, you know, when you first had that diagnosis, did it comprehend to you? I mean, obviously back then, um, you're not that old, so back then. Yeah. Well, you're not. So, the reality is it's not like I I mean, I I I just don't really know enough about what does it mean to have to have an insulin pump. I remember Well, I didn't have a pump at the start. It was straight up injections. Just injections. Mhm. Okay. So I mean that for an elementary school kid I mean I guess I don't know what the gauge of the needle is is 27 or something like that or 31. 31 small pretty teeny honestly you don't really feel the injections and it's the same for peptides as a whole. It's the idea of it is way worse than the experience of it in injection. The risk tends to be in proper dosing for insulin in particular because you know I don't even know if I knew my multiplication tables yet. Like I don't know if I knew how to add at that point. Um you were really young but I had to or maybe I was just not that bright and yeah that the the brightness just sort of was a sudden onset thing. You know what I mean? Right. Who knew? Oh that's a story for another. one day she just all of a sudden was super smart. Oh, you know, confidence is a big piece of that. But, you know, the error of two units when you weigh 70 lb is a is a big difference.

And at diagnosis, you have something called a honeymoon period where you still have some activation of cells. And so, the management of it is is scary. The bigger part of it was going through puberty. Oh, yeah. And so when you think about this concept of the human body and all of the complexities that it has, throw in a variable like going through puberty or menopause for women or andropause, going through a a period of high stress. All of these things have impact on cellular function, organ system function, the body as a whole. I was talking last night, I'm going to butcher this quote, but Phil Jackson said something about how, you know, the strength of a team is the individual members and the strength of an individual member is the team. And that applied so strongly to me on the human body where we talk about biological age and how each organ system can set our biological age. If you have a highly degraded reproductive system, that's at your biological age. But for those to have peak performance, your body can then improve its performance. But if those aren't matched, if you're not treating this from a whole body perspective and an individual system perspective, you're going to have issues. So it's like a massive control room. Yeah. Pretty pretty wild.

There's so many points along the way in that and I think that it's really really interesting. I mean for a kid was that traumatic in some way, shape or form? Totally. Yeah. You know, I think it was sort of the first time I ever understood how to abandon myself. What does that mean? There are sort of a, you know, there's probably more than two options, but for me there was always kind of two options on how one handles stress. You move through it regardless of costs. And that tends to be like I think of myself as like, we talked about this like the Tier 1 operator framework of like no we're getting to that destination. I don't care how many things we have to drop. I don't care how many bruises I have. I'm getting there. How many tourniquets have you we're going to arrive. The wheels are going to be falling off but we're going to get there. Or maybe the wheels aren't going to be falling off. That would be the ideal scenario. But we're going to get there. Or, you know, there's this concept of like, oh, I can, you know, sit with this and understand what my next step is and be a little bit softer and gentler and arriving at that next step.

And so for me, you know, type 1 diabetes had an association of of severe discomfort. You know, whether my blood sugar is high or low, there's discomfort there. Injections themselves aren't particularly fun. My skin is was really sensitive is to some degree still sensitive which we have to talk about my face for and managing once I got in the pump the glue for it or bleeding back out through the canula. It's like a lot of difficulties to manage and so I have a high association with pain and I think that influences how I feel my body and experience my body. That's one thing that I will advocate for being very important in a healthcare conversation is a patient's connection to self and body experience. So if I'm having a conversation in a clinical setting with someone and they're telling me how they feel in their body, well, I believe them because they're the only ones that know what it's like to experience living in their body. And that's different for everyone. So I think it was the first time that I sort of made this active decision of no, I'm going to pursue progress over understanding exactly how I'm feeling right now. And I started to abandon my respect for my own body and my ability to comfortably ask for help on things that I thought made me different.

Wow. Yeah, that is intense. Well, it's taken me 30-something years to figure that out. But yeah, but I mean that is intense. I mean I I I'll have to go back and listen to that like, you know, being one of the kids is not the bright one, you know. I'm going to It's going to take me a long time. I'm going to have to go back and like listen to that five times, you know, and like then I'll finally get it. Yeah, that's wild. That is a wild um but you know, I always like to What is it? Sandwich method. The good thing, the hard thing, the good thing. We'll do a half sandwich here. The good thing is over time, I think it has given me somewhat of an ability to be a bit more authentic in my interactions. So, I will likely in my lifetime always have something. And that gives me this ability to bond and hear and experience the difficulties other people are going through. And like you said, there's like really nothing that's too small to feel concerned for, you know, like giving people the space and the container to experience the life that they're living. I have a more fine-tuned version of that.

And secondarily, as I've gotten better about prioritizing what really does make a difference for me, like we've talked about on the phone with how do you major in the majors and not major in the minors, it's really important that I learn to have sensitivity to the experiences that I have with type 1 diabetes because you could throw all the peptides and supplements at me, but if my diabetes is not well managed, those are going to be a tiny influence on my overarching health journey. Yeah. And I have to prioritize that and that's taken fold in, you know, how do I not abandon myself and reduce stress in my life or give myself the ability to cook my own food which I love so much and so how does it inform these big decisions that my I make in my life so that I have the container to best take care of myself. So I think it's sort of opened me up to the understanding of the systems and individual behaviors and removing some of that judgment that a lot of people experience in a healthcare setting and advocating for patients or friends or family members or whomever in the healthcare space too.

Let's talk about like insulin availability price. I mean, it's at times it's gotten really expensive and it's also not I mean, there's some some thought that access to can be difficult. So, what's your outlook there? What is my outlook? You know, it's funny because what I'm realizing in this conversation is how little I have interrogated type 1 diabetes because I think it is really difficult to actually take an honest look at your own mortality. Yeah, there have been big decisions in my life that I have said yes to or said no to with the framework of diabetes in my mind, but it's little things where I do I do remember, this is me in a nutshell, just a little fun side story. My husband and I decided to get married on a Friday over pizza. And then got married on Monday morning at the courthouse in Atlanta, Sultan County. And as part of the grand romantic conversation, which to a type 1 diabetic is so romantic, a lot of it was about health insurance coverage.

Now, that is a rose. Yeah. And so the first time I refilled my diabetes paraphernalia with his insurance, I like called him and I was like very emotional. I was like, it's $150. And he's like, "Oh, no." I'm like, "Oh, no. I was paying like $2,700 a month." Wow. For, you know, all of it. And that is my privilege that I still could do that. You know, I still could go out and find all of these tools that I needed to best manage my health. It is really hard for people that don't have the capital resources to still make that purchase. Did I have sacrifices for it? Of course, you know, but being able to make that decision was a huge difference for me. And so there are many other people who they'll be on injections. They will struggle to purchase glucose strips. They will, you know, there's a whole arsenal of materials that you need to best manage a disease state and having to make decisions of do I have my heart disease medication or my insulin this month? How are we still blaming individuals for their management of health when those are the decisions that they're having to make?

So, I think there's definitely a classist segregation of who has access to good quality care, but also the materials to support that high-quality protocol and those who don't. And I think that's actually a really relevant piece of the conversation around peptides as a whole, which tend to be cash-based practices and high cost. And so those who have access to these tools right now are of higher socioeconomic status. Of course, the vision is to create accessible pathways and you know the current administration is also working on that in context of GLP1s. I hope that extends to other peptides. But in the meantime, you know, it really is a decision of like do you have the money to pay for your protocol and do you not? So my outlook is is pretty sad when it comes to that realization.

That's actually been the more vulnerable part, you know, in talking about my journey with diabetes is since becoming a mom and you know having a life to care for that's not my own and the importance of my survival. That's been a really humbling, very emotional experience for me because it's terrifying, you know, and like to some degree as a type 1 diabetic, every day you confront your mortality. And so if I have a pump malfunction and I get too much insulin or I make a mistake or I sit on my phone and it doses me incorrectly and I die, I just die. And you know, hopefully there's someone there to prevent that. But that's been really scary for me because it does feel like just beyond my control and that's panic-inducing. My daughter's still young, too. And so, you know, I think her understanding my disease process has been scary for her. And yeah, there's a lot of emotions that go into confronting your mortality when you have that desperate love as well.

So I have great empathy for parents of type 1 diabetic children. I have huge empathy for parents who have type 1 diabetes or any disease for all of this, you know, pediatric cancer, any risk factor, you know, housing insufficiency, like all of these things. I have huge empathy because doing your best in the context that you exist is just like a that's a really big part of being human. Yeah. And stuff that we often just don't think about. Yeah. How could you? Hey, you know, it's like nobody really wants to, right? Hey, we just want to like go on with our lives the way that, you know, it's all supposed to go until it doesn't. Yeah. Yeah, I mean it's it's pretty crazy.

Let's talk about wellness washing. Yeah, I think this is something you know obviously one of my fixations here is from the origin story, right, of how do we best understand the priority pathway to improve an individual's health but a population health. And so with that, that's why I have such a fixation on creating a universal database or data set for emerging molecules that we can get them to market faster and more safely, more efficiently, effectively, and improve health outcomes that way. If we don't have measurement, it's very difficult to navigate an environment of wellness with mixed messaging. And you know, the person on the left says yes, the person on the right says no. Tomorrow, you know, we like protein. No, we like fiber. Like, you know, it's just do high-intensity exercise. No, actually just walk and, you know, maybe strength train twice a week. Like there's just so much mixed messaging. And perhaps all of those messages are true, but they depend on the individual. Or perhaps none of those messages are true. But without data and without an understanding of the biology, the chemistry, and the physics of the body for that individual function in that moment, we really can't make good decisions about this.

And so what what does bother me is kind of this wellness washing, which I just made up right now, but it's probably a term. No, no, no. We're we're giving attribution to Aaron Keys wellness washing established right here, right now. I mean, it's kind of like greenwashing with environmental friendliness where, you know, it's someone will take out some negative ingredient and then that becomes a health food. And we could talk about this in context actually of a lot of the things with the dyes. Like we said, is it moving us closer to the society we want to be? Yeah. Is it having the same degree of impact as not consuming Doritos at all? No, but you know that's the reality of being human is like to some degree you don't like you got to go out and live your life like we all die in the end. What is the joy that you're getting in it and how do we help people foster the best decisions for them? So it's really confusing trying to make that decision and allow for freedom and liberty but also guidance and protection of a population. Like these things are at odds and where you sit and where you prioritize is going to be different depending on your state of life, your context, your mood that day. Yeah, there's a lot to think about. It's like a It is a very hard job.

We talked a little bit about peptides and where that's all headed and sort of the accessibility of peptides today and where do you see that eventually going? I mean, because the the goal is that you hope that everybody has access to that then we can create a healthier, more stable population. And it's so much, let's face it, it's so much better for the the country. Mhm. In every way, shape, or form that everybody is healthy as they possibly can be. I think we have some systems that are Yeah. It's very broken. Very. But so where do you see as someone who's been so close to the whole peptide world, where do you see it going? I mean, like what what's just Yeah. Right. I mean, rockets taking off right now. And I think what's really interesting is there's so many more peptides in the pipeline that we don't even have awareness of. And so there will be complexity in how we get these molecules to market in a safe and effective way.

But you know in my in my phone book there's a number of people who have access to through biotech through inheritance through development in their labs novel molecules that you know by the sound of it could really be paradigm shifting and now we just have to figure out how to safely get that to people. this isn't necessarily dissimilar from a lot of other ways we've brought new things to market you know so I work with different groups right I work with vendors and suppliers bringing their work to market I work with clinicians in delivering this care setting up their compliance or business strategies doing protocol development based on data identifying proper sourcing keeping them safe and you know kind of everyone in between building tools to support these processes.

And so what I find, you know, kind of most intriguing about this future explosion that we're going to see both with the utilization of existing molecules that there's some, you know, kind of anecdotal data right now in human form and a good amount of animal data for some of the molecules and others not so much. is how to protect the practitioner. Because what I find really courageous and uplifting about working with this group of clinicians and and care deliverers is that they have the courage and the creativity and the focus to really best deliver next generation care to the audiences that need it. And that there's a risk in that. We mitigate risk at all costs, but there's still a risk to it. I don't want to put them in a position where they lose their license or they are pulled from delivering care at all because those are the individuals that are changing lives on a daily basis and the cost of removing them from care is way bigger than the cost of losing a molecule.

Yeah. You know, it's it's crazy. I when I think about like the potential trajectory of your career knowing you, you I'm surprised at like all healthcare eventually gets lines up in some sort of roll up, right? You know, it's like it's like you're the ideal candidate for some private equity to come along and say, okay, tell us tell us where we should be focused on and how do you make sure that those investments then actuate. Because it seems like this is we are in the right like the beginnings of something that is you know I like that concept though because this is something else that I think is sort of an issue within the market is that we have a ton of point solutions that people have to DIY together. So if you want support with musculoskeletal you go here. If you want support with general optimization you go here. You want metabolic support you go there. And so there's a lack of integration around solving for your own best health.

And so I think to your point about, you know, kind of collaborating at a higher level to instill programs that include peptides or supplements or other hormones, whatever molecule it may be, to help augment the delivery of care. So if someone's working on electric stimulation for musculoskeletal care, how do we leverage peptides into that to create an environment that best fosters outcomes inclusive of their care? So I think you know I would like to be in a space where we can sit at a higher level and understand okay if we add this vertical into here what are the multiplication effects of that what are the revenue effects of that what are the costs of care at a you know higher level so we can augment and bolster the delivery of really high quality interventions and prepare the body to best receive those interventions to really kind of yield success and revenue for all. So I think that is the pathway for how peptides will develop is they will go from being a standalone pursuit into being integrated into other types of care as a foundational element that bolster the outcomes of other interventions as well.

There's a ton of talk about how AI can be utilized in a healthcare environment and what the regulatory impacts about that are. The insurance actually and liability model for AI within healthcare is something really to consider here. And a lot of fear I would say about job replacement in a healthcare environment. And I think, you know, I've always been pretty bullish about AI will add value. It is how we allocate our time, effort, utilization that improves the outcome of it. But if you if you're trying to stay away from AI, it's still going to come. We have to figure out how to best use it in this in this case. And that's where things like computational biology and drug development, I think, could be revolutionized through use of AI.

And like we were talking about before, you know, kind of like my big dream, I just realized all of this time later, I think my big dream would be to work on a project that allows for almost this kind of third category of medication. So we have things that are FDA regulated as drugs, things that are not FDA regulated like supplements and other you know categories within that. And I really believe there needs to be this third category which is endogenous molecules or as we age and we go through our exposome and we have all these assaults to the body, how do we replace and optimize levels of things our body already has access to so that we can clarify the language our body already speaks. And that to me has to be a third category that we invest in approval of those uses, aggregate that data and then foster the development of technology such as a continuous glucose monitor, but instead of monitoring glucose, we're monitoring, you know, testosterone or we're monitoring ATP or whatever it is. and so that we can improve our dosing strategy and our protocol development to really be personalized to that that area.

My brother who's an MD PhD candidate brought this up to me. He was basically like, "Yeah, it was a really cool thing that they made insulin for you." Well, not for me, but you know, it's really cool that they made insulin. But the lives of type 1 diabetics really fundamentally shifted when we got access to glucose meters because before it was kind of a shot in the dark and it feels like we're a little bit in that state with peptides right now where we don't totally know exactly what we're doing with them. Doesn't seem like there's huge risk. Like many people will say you can't really overdose on it. Whether or not that's true, you could overuse them, but we could have more specifics to actually yield the positive health outcomes specific to that person and the ecosystem of factors in the body. So that's where I think AI will be extremely critical for the development of the drugs and the utilization of drugs, endogenous molecules.

All right. Well, listen, my friend, it's been great to have you in. It's been great to be here. Yeah. So many so many things to talk about. It's like I think we could just go on and on and on, but you know what I found is that you try to cut these these three-hour conversations, try to cut them down to something that's reasonable that somebody will actually listen to. It's a big is the big challenge. Because you know it there there are so many things that we could just continue talking about for hours and hours which I always love talking to you about. So I'm sure we'll do this over time. Yeah, I would imagine that would be the case. Yep, just remember the little people as you ascend to greatness or beyond great the greatness that you are today. So one can dream. Yeah. Well, hey, listen. It's it's been a phenomenal for the whole time. So thank you. Back at you. Hey, thanks everyone for watching the show. Please remember to like, comment, and subscribe. It really helps us out here at the channel. And share the video with someone who might be interested in supporting the charity that our guest mentioned in the episode. Thanks again. We'll see you soon.