Dr. Bret Scher, Dr. Dulaney: How One CGM Changed This Cardiologist’s Life

Is a plant-based diet the best for supporting metabolic health? Cardiologist Dr. Jaimela Dulaney spent years practicing plant-based nutrition before her own experience with insulin resistance, blood sugar swings, and endurance running led her to rethink what personalized nutrition can look like.

In this episode, Dr. Bret Scher speaks with Dr. Dulaney about what changed her perspective, both personally and professionally.

They cover:

• How CGMs helped reveal unexpected blood sugar patterns
• Why insulin resistance can show up even in active, normal-weight individuals
• How Dr. Dulaney thinks about LDL cholesterol in the context of metabolic health
• Why low-carb and ketogenic diets may help some people improve energy, recovery, and blood sugar stability
• Why there may not be one “best diet” for every patient

This conversation highlights the importance of listening to patients, tracking meaningful lab trends, and staying open to new evidence when personal experience and clinical outcomes begin to tell a different story.

::: spoiler Summary

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I. Introduction and Background

A. Dr. Jaimela Dulaney's Professional Credentials

• Medical school: West Virginia University
• Cardiology fellowship: University of Pittsburgh
• As ultra-endurance athlete and cardiologist

B. Original Practice Philosophy

• Membership-based medical practice
• Strictly plant-based nutrition focus
• Emphasis on exercise and lifestyle interventions
• Value on physical exam over algorithm-based "menu doctoring"
• Individualized care approach

II. Personal Journey: The Catalyst for Change

A. Family History and Motivation

• Strong family history of diabetes and cardiovascular disease
• Grandparents died from complications related to these conditions
• Personal desire to avoid similar diagnoses

B. Athletic Pursuits and Dietary Approach

• Marathon and ultra-endurance running career
• Following standard plant-based, low-fat dietary advice
• Belief this was the optimal approach for both health and performance

C. Emerging Problems and Symptoms

• Frequent energy "bonks" during training and racing
• Debilitating fatigue after meals
• Post-meal symptomatic crashes
• Inability to effectively access fat stores despite high activity levels

D. Observing Patient Patterns

• Patients at healthy weight showing insulin resistance signs
• Rising Hemoglobin A1C levels
• Complaints of fatigue and abdominal weight gain
• Recognition that high-carbohydrate intake was preventing metabolic flexibility

E. Identifying Knowledge Gaps

• Discovery of dangerously low DHA levels in patients avoiding fish
• Recognition that insulin as a storage hormone was causing issues
• Realization that her previous dietary assumptions might be flawed

III. The Turning Point: Influences and New Information

A. Key Influential Works

• Dr. Tim Noakes: "The Lore of Nutrition"
• Nina Teicholz: "The Big Fat Surprise"
• Critical re-evaluation of plant-based dogma

B. Initial Experimentation

• Began low-carb fueling for ultra-running
• Immediate results: no "bonks," improved energy
• Surprising reduction in post-run muscle soreness

IV. The Continuous Glucose Monitor (CGM) Revelation

A. Concrete Data Acquisition

• Used CGM to obtain precise metabolic feedback
• Revealed significant glucose spikes from perceived "healthy" meals
• Example: poke bowls with white rice causing major spikes

B. Understanding Symptom Patterns

• Identified correlation between glucose peaks and symptomatic crashes
• Recognized that symptoms occurred during the drop after glucose spikes
• Data challenged previous beliefs about which foods were truly healthy

C. Personal Dietary Transformation

• Transitioned from plant-based to low-carb/ketogenic approach
• Re-introduced eggs, fish, and eventually meat
• Maintained non-starchy vegetables (greens, broccoli, cauliflower)
• Eliminated energy crashes and improved overall metabolic function

V. Clinical Practice Transition

A. Managing Change in Practice

• Total transparency with patients about her evolution
• Hosted "town halls" to explain reasoning
• Presented own data and clinical observations
• Framed change as adding "another tool in the toolbox"

B. Patient Reception

• Majority of patients appreciated willingness to evolve
• Patients valued transparency and evidence-based approach
• Many patients benefited from new dietary strategies

C. Shift in Treatment Philosophy

• From plant-based advocacy to individualized metabolic optimization
• New approach: personalized rather than one-size-fits-all
• Willingness to adapt based on individual patient responses

VI. New Clinical Approach and Insights

A. Metabolic Health Prioritization

• Shift from LDL cholesterol focus to comprehensive metabolic health
• Key markers now prioritized:
  • Fasting insulin levels
  • Triglyceride-to-HDL ratio
  • Hemoglobin A1C
  • Inflammation markers

B. Insulin Resistance as Primary Driver

• Recognition that insulin resistance is primary cardiovascular driver
• Traditional cardiology often ignores this factor
• Metabolic dysfunction occurs long before clinical diabetes diagnosis

C. Individualized Care Philosophy

• Medicine fails by treating patients as "average" rather than individuals
• Importance of listening to patients beyond "normal" lab ranges
• Need for early intervention using proper metabolic markers

VII. Specific Clinical Recommendations

A. Addressing LDL Concerns

• For cardiologists worried about LDL rising on low-carb diets
• Metabolic health improvements prioritized over LDL numbers
• Willingness to monitor rather than blindly treat with medication
• Focus on particle size and other cardiovascular risk markers

B. Performance and Ketones

• Experimentation with exogenous ketones for ultra-running
• Performance benefits observed
• ketone level requirements depend on patient goals:
  • Performance athletes vs. general metabolic health
• Different approaches for different objectives

VIII. Broader Professional Philosophy

A. Evidence-Based Evolution

• Importance of keeping an open mind
• Willingness to follow actual data vs. theoretical frameworks
• Learning from personal and patient experiences

B. Avoiding Dietary Dogma

• No "one size fits all" diet
• Risk of dietary "religions" over patient-centered care
• Need for flexibility and individualization

C. Patient-Centered Care

• Transparency about evolving understanding
• Sharing personal data and experiences
• Building trust through honesty about practice evolution

IX. Conclusion and Key Takeaways

A. Core Message

• Metabolic health is foundational to overall cardiovascular health
• Individual responses vary widely
• Data-driven approach superior to theoretical adherence

B. Professional Evolution

• Demonstrates importance of scientific openness
• Shows value of personal experimentation
• Models evidence-based practice for other clinicians

C. Resources and Further Information

• Website: doctordulaney.com
• Podcast: Jami Dulaney Wellness Podcast
• Instagram: @Jaimeladulaney :::