How this physician assistant improves metabolic health in underserved patients

Kyla Ehrenreich educates a broad range of patients on metabolic health. Here, she shares the lessons she’s learned.

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Who: Kyla Ehrenreich, 39
Where: Sebastopol, CA
Most Useful Takeaway: Whether you know a lot about metabolic health or very little, everyone benefits from having support to help them make impactful changes.

1. How did you get into working in the metabolic health space?

Immediately after graduating, I went into family medicine working with underserved populations at a Federally Qualified Health Center. In primary care, clinicians are expected to see patients very quickly. And the people I was working with and continue to work with are generally metabolically ill. They come from underserved backgrounds and don’t have access to a lot of education when it comes to nutrition and lifestyle.

I have to address their health problems in an eight-minute visit. After doing that for 12 years, I had to figure out a way to spend more time with patients, and that’s when I went into private coaching. I looked at it as an alternative way of taking care of people in a much more holistic and meaningful way.

I was always aware of preventative health, but metabolic health was not on my radar until two years ago when I really started diving into the topic on a cellular level.

2. What kind of conversations surrounding metabolic health are you having with patients now that you weren’t two years ago?

Many of my coaching clients already come in with a lot of knowledge. They’ve already read Ben Bickman’s book Why We Get Sick. So these clients will come in and say something like ‘I want to do this low-carb, high-fat diet. How do we make this happen so it works for me and what do we track?’ And that’s where we use continuous glucose monitoring as a tool.

When it comes to my patients at the health center in primary care, I have to take a step back. For example, I had a female patient in her early 20’s and she had all of these vague complaints–exhaustion, acid reflux, weight gain from the pandemic, menstrual irregularities–that a 20-something shouldn’t have had. And so, we did some bloodwork to see what was going on. And her insulin was sky-high. Her blood sugar was in the prediabetes range. Her triglycerides were high and even some of her hormone levels were off. I sent her a couple of links to interviews that talked about metabolic health on a basic level. I prescribed a glucometer so that she could track her own levels. (A CGM was cost-prohibitive.)

We met on a weekly basis over video. And she made basic changes in her diet by going low carb and high fat. Six months later, her waist circumference was way lower and her body weight had gone down. Her biomarkers had improved. She was feeling so much better.

In the past, it would’ve been easier for me to jump to some pharmaceuticals. But by better understanding metabolic health and nutrition, we were able to make those diet changes that helped her go in the right direction. 

3. What type of behavioral changes do you encourage patients like her to make?

The first question I always ask patients has to do with the sugary beverages they consume, such as sugary coffee with lots of milk, soda, energy drinks, and alcohol. That’s usually low-hanging fruit that we can tackle pretty easily. From there, I ask about how much processed foods they’re eating. We consider these anything in a bag or box with a barcode.

As time goes on, we’ll talk a little bit about the timing of eating. Beyond that, the conversation goes to movement and exercise, sleep, and stress, which are other obvious implications of metabolic health. 

4. How do you help clients make those changes stick?

Number one: cabinet clear out. Go into your cabinets and get rid of those things so you won’t be tempted by them. That also speaks to planning for situations where you’ll feel tempted. If you’re going to end up at a party where there will be soda available, bring your own drink. Put bubble water with fresh squeezed lemon or limes in a thermos. Or treat yourself to a new water bottle that you like drinking out of. Incentivize yourself to make the best decision for you.

It’s also important to be confident with your choice. We tend to be our own worst enemy when it comes to feeling embarrassed about that stuff. We assume people are judging, but a lot of times they’re not–and they may learn from us.

Then, there’s support. Some of the folks I’m working with have incredible knowledge when it comes to metabolic health and cellular health, but they’re coming to me for a reason. Even with tons of knowledge, people still struggle. Whether you know a ton about metabolic health or very little, the role of a coach, clinician, friend, or family member is going to be about helping that person support behavior change, stay accountable, and avoid the unfortunate toxins of our society when it comes to food, sedentary lifestyles, overworking, and not sleeping enough. 

5. You wear a CGM. What did you learn about your diet or exercise habits that surprised you?

I realized I needed to pair my carbs with fat and protein, which definitely reduced my spikes. By far my favorite meal of the day is breakfast. It’s usually after I exercise, so I’m pretty darn hungry. My really level breakfast is plain, full-fat Greek yogurt with walnuts or pecans and ground flaxseed, chia seeds, and cacao nibs, alongside coffee with homemade almond milk and Laird Superfood Creamer.

I’ve also switched my tune a little bit on my exercise regimen. I was a triathlete but moved to do more HIIT and strength work because of the positive implications muscle strengthening has on metabolic health and longevity.

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