Well, April was tough (I’ll explain the reasons in another email or blog post), but I’m hoping for sun and flowers in May. So, let’s kick the good times off with more educational material on the plague of our times: insulin resistance!
Two weeks ago, I completed filming for my Insulin Resistance course for a company that plans to launch in Fall 2025. We filmed over three full days and got 10 hours of content. The course pulls together everything I know about insulin resistance and metabolic health (there are over 100 references). We talk about food, of course, and exercise, but also the impacts of sleep and stress on our metabolic health.
We discuss self-compassion, motivation, and mindset in the 10-hour session (which should be edited down to about 6 hours, hopefully). We also address common obstacles using the Theory of Change model and other tools from my psychotherapy practice. This is because insulin resistance is a holistic problem that must be addressed holistically, through mind, body, behaviours, emotions, and biochemistry.
A few weeks ago, I released a podcast interview with Dr. Ali Chappell, PhD, on her Low-Insulin Lifestyle. It garnered much interest, probably because we’re all trying to clear away the food noise and figure out how to eat and nourish ourselves in this metabolically deranged day and age.
I received many questions about the podcast, so I decided to release a sister episode, a (much) shorter version of my insulin resistance course, that provides more details on how to approach healing your metabolic health.
I even created a PowerPoint for the occasion. Think of it as a free, access-anytime webinar to help educate you about insulin resistance.
Talia: [0:01] Hello, everybody. I am Dr. Talia Marcheggiani.
Talia: [0:06] I’m a naturopathic doctor and a registered psychotherapist now. And last podcast, we interviewed Dr. Ali Chappell, who talked about the low-insulin lifestyle that got a lot of attention, a lot of interest. So a.
Talia [0:30] And the podcast was all about the impact of certain foods on our insulin levels with this underlying theme of insulin resistance. And I decided to do a presentation today on insulin resistance, the plague of our times. I recently just recorded a 10-hour course for a project that should be released this fall. I also have a microbiome course with the same company. A 10 hour it was 10 hours of filming on insulin resistance um and it was a it was an amazing course i had a lot of fun producing it we filmed it over three days and i feel like it was just a very holistic course where we talked about diet and we also talked about obviously exercise and sleep and stress and but we even rolled in things like self-compassion and motivation, and overcoming obstacles and long-term management, the stages of change. And it was just this all-encompassing, very holistic course. I’m really excited to let you know when it comes out. And so based on that research that I did, I had hundreds of references. And one of the people that I reference is Dr. Ali Chappell. But based on that, I decided to do a presentation on insulin resistance itself.
Talia: [1:52] Because insulin resistance is the plague of our times. So ultimately, all of the health fluencers and everyone that’s talking about health is in some way or another addressing insulin resistance. And if they’re not, then they’re missing a huge layer of what’s going on with our health. Ever since, you know, doing my course, thinking about insulin resistance in a more holistic, but also in a deeper way. I’ve come to understand, and trying the low-insulin lifestyle and looking at the impact of insulin on my body, I’ve come to really appreciate the level at which insulin resistance plays a role in our health and conditions like adrenal fatigue or, you know, even estrogen dominance, these kind of naturopathic conditions that tend to have different names over time, you know, candida overgrowth, SIBO. I’m not saying those conditions are only insulin resistance,
Talia: [2:56] but my stance is insulin resistance until proven otherwise. And we’ll get into why in a second. So I’m Dr. Tali Markajani, metabolic doctor, and let’s get into it. [3:16] So insulin resistance let’s just do a quick overview because we didn’t really get into this with the dr ali chapel of course i mean she had a lot of great analogies but essentially insulin is a peptide so a series of protein of amino acids that creates a protein it acts like a hormone in the body its main function is glucose control so insulin’s job is to shuttle glucose from the blood into our cells. When we eat, we break down the carbohydrates from our food. This raises our blood sugar. And insulin’s job is to make sure that our blood sugar stays within a normal range. When our blood sugar goes too high, our body doesn’t like that. That’s toxic to the body.
[3:56] But we also need sugar for energy. So insulin’s job is to get that sugar into the cells through the cellular receptors. So it’s like a lock and key. You have insulin, the hormone or peptide that, you know, enters into the lock of the cell receptor. And it makes all of these different things happen within the cell, allowing glucose to get in. Glucose goes into the mitochondria. It does the whole, remember the glycolysis, the Krebs cycle, and then it moves along the electron, well, the NADH and all of the components that are produced, move along the electron transport chain with the power of oxygen, and make ATP, which is the energy currency of the cell. So our body uses glucose for energy.
[4:48] So insulin’s job is to make sure that glucose can get into the cell or it can be used for energy, but it also keeps glucose within a range in our blood. It prevents glucose from going too high in the blood.
[5:00] Now, when we become insulin resistant, one of the mechanisms is that we are spiking our glucose too often, so we need to call on insulin too often. And even though you need insulin to survive, if your pancreas, the hormone that makes insulin, or sorry, the organ that secretes insulin, if it’s not functioning, you don’t make insulin, such as in the case of type 1 diabetes, juvenile diabetes, you waste away and die unless you inject insulin into your body to do the important work of allowing your body to absorb, allowing your cells to get glucose. But when you have healthy functioning pancreas and you’re calling on insulin over and over again to manage repeated blood sugar spikes this can create some resistance in the cell where instead of having in this example you have two receptors on the cell now your cell takes one away and you just have one receptor and it’s harder to stimulate that receptor you need more insulin in order to do that. So then your insulin levels start to climb, and eventually your body has a hard time managing glucose levels.
[6:15] This starts off in muscle cells and fat cells and liver cells, where there’s a whole other cascade that we get into in my course. I don’t know if it’s relevant here, but essentially fat cells become overstuffed, because when your body needs somewhere to put that glucose and if it’s not burning it, it starts to turn it into fat. So it loads fat cells up with glucose that gets turned into fat. Then those fat cells become so overstuffed and insulin resistant that they start leaking fat. This creates inflammation in the body, elevates triglycerides, and it starts to create an inflammation, causes more insulin resistance. And there’s a whole bunch of vicious cycles that can occur with this imbalance in our body. Because one of the things that my friend and I were talking about, my friend who’s a medical doctor, whose clinic I used to rent, she was like, why would this happen? Like, why would our body respond in this way? Why do we, you know, rather than establish homeostasis where everything stays within a healthy balance, why does our body kind of spiral that when you have all these blood sugar spikes, you know, it’s hard for our body to figure out what to do. And I think it exposes this weak point in our physiology, because our bodies were designed and evolved through millennia of periods where starvation was commonplace. And it’s only in the modern era…
[7:38] That we’re exposed to so much caloric density in our diets. And there’s a bunch of other things that have occurred in our diets over the last hundred or so years, and that is the increase in processed food and endocrine disruptors, chemicals in our environment that trigger inflammation and that mess up our insulin receptors. We’re a lot more sedentary. We don’t have the muscle sink anymore that we used to.
[8:06] We’re a lot more stressed and we are consuming a lot more refined starch and sugar. And as a result of sort of the 1970s shift in our diet that told us to consume five to 11 servings of grains a day and to restrict our fat and our animal foods. So ultimately our protein. So our diet became very carbohydrate heavy and deficient in other macronutrients like fat and protein. We became more sedentary. We became more stressed. So these are just a few things. And stress is another cascade. So cortisol’s job is to raise, it has lots of jobs, but cortisol stress hormones job is to raise our blood sugar. So that calls on insulin in the absence even of food to try to bring blood sugar under control. So you create this vicious cycle when you’re extremely stressed out. When you have a lot of inflammation in your body, that triggers a release of cortisol to manage the inflammation, which again triggers insulin to be released. And inflammation independently can cause insulin resistance. And again, you know, and then the more insulin resistant you are, the more inflammation you have because the more your fat cells leak, and then the more insulin resistant you become.
[9:22] Sarcopenia, So being skinny fat or not having enough muscle on your body, you don’t have this great glucose regulator of muscle that helps to manage blood sugar that often works independently of insulin. And then again, you become more insulin resistant, starting off in the muscle, and this creates this cascade where your body is storing more fat and not making muscle. You know and then this blood sugar roller coaster where if you’re repeatedly spiking your blood sugar then your insulin is being called on to bring blood sugar down that triggers hunger and cravings for sugar and so on and so on um so because of all of these different things, we are 88 to 94 percent depending on the study that you look at insulin resistant so in our society, 88% of people, or up to 94%, according to some sources, are insulin resistant. And this does not mean that you have diabetes or pre-diabetes even. You can have completely normal sugar.
[10:34] And so this is often missed. Okay, so this is really important because we don’t test fasting insulin on a regular basis, which when we’re looking at the hormone insulin, that indicates more accurately if we’re insulin resistant than just simple blood sugar.
[10:53] And insulin resistance, it has a lot of different impacts on the body. So one of the big ones is Alzheimer’s disease or otherwise termed type 3 diabetes. So the inflammation and the effect of getting energy into our brain can cause dementia. And so, you know, it used to be thought that Alzheimer’s was caused by plaques and tangles in the brain. And so drugs were geared towards reducing these plaques and tangles, but turns out that they are more likely smoke present at the fire, or even maybe even fire trucks present at the fire. They may actually be there to support the brain, but the brain’s damage is occurring because of insulin resistance. So both insulin in and of itself is toxic to the brain cells, and then ultimately when blood sugar is not controlled, that’s toxic to brain cells.
[11:50] So ultimately, we’re not able, when we’re insulin resistant, we’re not able to access energy, right? So our body is not good at bringing glucose into our cells. And therefore, you know, and eventually we end up with elevated glucose. But even before that, we’re not able to access that glucose. So think about it being a case of you’re storing energy because insulin is a storage and anabolic hormone, you’re storing energy very easily, but you’re not able to tap into that energy to break it down. And so you’re sort of starving in the land of plenty.
[12:27] Mental health issues, there’s a whole field that’s emerging called metabolic psychiatry that looks, and a lot of, in this field, there’s a lot of studies on the impact of ketogenic or extremely low-carb diets on mental health, so things like depression, anxiety, and ADHD, but also schizophrenia, bipolar disorder, so some of the more severe mental health conditions. And a lot of really amazing results have come out in a few studies that have been done. And so some theories about this is that things like depression, anxiety are the result of energy poverty in the brain. So the brain is unable to really access glucose properly. ADHD being one example of glucose hypometabolism. So the brain is not able to really use glucose. and it, you know, becomes dependent on this sort of ups and downs of glucose.
[13:29] And then in order to get energy, so there’s another vicious cycle that possibly can occur that in order to get energy, individuals with this type of glucose hypometabolism seek sugar in their environment. They rely on sugar and so they’re constantly spiking their blood sugar in order to like perk their brains up.
[13:50] Cardiovascular so these cardiometabolic diseases so and when we talk about metabolic health or metabolism we’re referring to insulin resistance metabolism is our body’s ability to use food for energy so glucose fat protein and insulin is a key hormone that allows us to use that that food especially carbohydrates for energy, and to store that energy in our cells. So any disease that’s associated with the cardiovascular system, which is impacted by insulin resistance, or any sort of metabolic issue, so obviously type 2 diabetes, but also cardiovascular disease, stroke, atherosclerosis, heart attack, hypertension, you know, any heart issue. And this is because insulin is inflammatory, And so it creates inflammation in the blood vessels. It also shifts our cholesterol balance. And so what we often think of as a disease related to consuming cholesterol or consuming a high-fat diet, bacon, cheese, is actually, in fact, likely driven by the inflammation and high insulin levels that are a result of insulin resistance. And so this creates an issue with how our body is metabolizing energy and our inflammation levels.
[15:15] Insulin resistance impacts our reproductive health, hormonal health, and sexual health. PCOS, polycystic ovarian syndrome, is an insulin resistance condition that causes infertility and other symptoms, hormonal imbalance, so more testosterone-like symptoms, and lack of ovulation. Erectile dysfunction is related to insulin resistance, which creates more viscous blood and prevents blood flow to the reproductive or sexual organs.
[15:45] Again, because we need energy for everything in our body. So anything that is highly dependent on energy, our liver function, our brain function, our cardiovascular health, our muscular health, all of these organs that require a constant energy turnover are going to be energy impoverished in the presence of insulin resistance because insulin is not functioning properly to allow us to access our energy from food. So instead, we’re just storing the energy for fat as fat, and we’re not breaking it down. Many cancers are also associated with insulin resistance because many cancers feed off of glucose. And then again, insulin is an anabolic hormone, causes the growth of things. Yes, you need anabolic hormones. You need there to be anabolism or the growth of things to store, to build, but you need a balance of both. You need to also be able to break things down so that you can tap into something called autophagy, where you’re clearing out damaged and dead cells. You’re able to clear out, you know, cancerous cells or precancerous cells, and you’re able to engage in repair as opposed to always storing, storing, and building.
[17:06] So we have a lot of different symptoms of insulin resistance because it affects every cell in the body and therefore it affects every hormone in the body or every organ in the body. And because insulin is a hormone, our hormones talk to one another. We have a very reductionistic view in medicine. So we like to just look at like, what does one hormone do? What does insulin do? And then that’s the end of it. And what happens when you replace it or what happens when you take it away?
[17:38] So in the case of type 1 diabetes, that kind of makes sense. The pancreas isn’t producing insulin, so you have to inject insulin into your body. There you go. Cut and dry. So a lot of things in medicine have this reductionistic kind of solution, and we can look at them reductionistically more or less, and more or less we can solve them reductionistically. But insulin resistance is a cascade, it’s a network, it’s a holistic issue.
[18:03] It is involved with these vicious cycles. As our body’s trying to compensate for an imbalance, it creates more imbalances, right? So, you know, we’re stressed, and so there’s insulin resistance that’s caused as a result of that, and then that insulin resistance causes more stress because we can’t access our energy and we can’t mount a proper stress response and that causes it. So it’s like this vicious cycle that then starts to impact our inflammation levels and our cravings and our sleep. And so we have this whole mess that’s impacting all of our organs, our behaviors, our psychology, our emotions, our mental health, as well as our physical health and our behaviors. So when we look at insulin resistance, it’s impacting everything. It impacts our skin. We get things like skin tags, right? So, we get random growths of the skin, turnover of the skin, inflammatory conditions of the skin, like psoriasis, eczema. A condition called acanthosis nigricans is the kind of this darkening or purplish pigmentation of the skin is really common sign of insulin resistance. Rosacea, a key symptom of insulin resistance is this is visceral fat. So fat around the organs, particularly the liver, the pancreas, this is like a harder inflammatory fat. It’s not the type of fat you can pinch.
[19:22] Um, but you will be storing all kinds of fat with insulin resistance, but this key is the visceral fat. And we can measure visceral fat by, you know, roughly by doing a waist to hip ratio, where you, you know, you trace a tape measure around either the thinnest part of the waist or the belly button, whatever makes most sense to measure. And then you measure the widest part of your hips. You divide the waist by the hips. Or is it the other way around? It’s a bigger number on top of a smaller number on top of a bigger number. And then it should be 0.7 or less.
[20:00] Um so right so the idea is that you have a waist that’s smaller than your hips, and if it’s large and so this is for women i believe the number is one is one for men um and and the idea is that you you know the the larger the waist or the bigger the waist circumference the more likely you have visceral fat and the more likely there’s insulin resistance there’s also visceral fat often shows up on the face. So we often have facial fat when we have visceral fat in it. It’s because of some inflammatory mechanisms. In blood work, we see elevated fasting insulin. Very interesting, and this is a huge feature in the Dr. Ali Chappell interview, but also something really frustrating in my work as a naturopathic doctor, that we simply don’t test fasting insulin. So I do as an ND, but it is never tested in routine blood work. People are often gaslit into being told that their blood sugar is fine, so they don’t need to test it, or for whatever reason, they don’t need to test it. It’s a relatively cheap test. I order it as part of a comprehensive panel, but individually, it’s about $30 plus a lab fee.
[21:15] And it tells you, quite frankly, are you insulin resistant? Because if you’re insulin resistant, the first thing that happens is your fasting insulin starts to go up. And your fasting insulin causes its own set of problems. Like I said, it encourages fat storage and it prevents the breakdown of energy. Your body is saying, store, store, store, store, store, don’t spend. So you’re not spending energy and therefore you’re in this kind of energy impoverished state. You’re more inflamed. You’re having a harder time managing your other hormones. So testing fasting insulin is very, very helpful because you’re not always going to see an elevated fasting sugar when you have insulin resistance. Eventually, your fasting sugar, once your insulin is no longer functioning at all and it cannot control your blood sugar, you’ll start to see an increase in blood sugar. And so this represents a later stage on the continuum of insulin resistance, the latest stage being a diagnosis of type 2 diabetes.
[22:21] Which is where your blood sugar is now at a point that it’s a cutoff. I believe it’s 6.5 millimoles per liter. And so you’ve hit this arbitrary cutoff, and now you have type 2 diabetes. But in the meantime, the cascade or the problem of insulin resistance, nothing special changes when you have type 2 diabetes. It’s only a point at which your blood sugar reaches a certain number, but the underlying root of disease may have been manifesting for 15 to 20 years, and that is this insulin resistance where the cells are no longer responding properly to insulin, and you’re seeing an increase in insulin levels. Even earlier than an increase in fasting insulin is an increase in postprandial insulin. So you consume a meal of starch or sugar, it’s about seven you can do a glucose challenge where you consume 75 grams of glucose it’s this disgusting drink they have you drink and then you measure your insulin and your glucose at 30 minutes at an hour at two hours and you will see the very very earliest stages you’ll see this rise in insulin after like a very high rise in insulin after consuming the sugary drink, your blood sugar will be normal but your insulin will start to rise and actually, this is the stage of insulin resistance that I found myself on in another patient who was experiencing a lot of weight gain, seemingly out of nowhere.
[23:51] And, you know, she hadn’t really changed much. She was kind of in like perimenopause. She had a relatively sedentary job, but was eating otherwise healthy and was just noticing a ton of weight gain. So we did her fasting insulin and tested her HOMA-IR,
[24:08] the homeostatic measurement assessment of insulin resistance. So it’s a measure of insulin resistance that looks at your fasting insulin and your fasting glucose, and it gives you a number to tell you the relationship between the two of them. So we did this patient’s fasting insulin, and it was actually quite low, and we calculated her HOMA-IR, because her blood sugar was obviously normal. She did not have diabetes or type 2 diabetes. And we did the HOMA-IR, and that was also normal. She was quite insulin sensitive when we just looked at her fasting levels. But how often are we fasted during the day right and this is part of the problem, because I don’t know about you but when I wake up I eat and then I keep eating until I go to bed and I do a pretty good job of spending 12 hours in a fasted state most nights meaning that, you know if I eat my breakfast at 7 I try to stop eating by 7 p.m at night so that I just give my digestive system and my body a chance to repair and reset and not just be digesting constantly.
[25:18] And it also gives my insulin a chance to settle down. But for the other 12 hours, you know, if I’m getting a large spike of insulin after eating, then I might be in this kind of high insulin state all day long. And when I fast, my insulin looks normal, but that’s not the state that my body normally lives in. So we had the idea of not doing a glucose challenge, but having her just eat a normal, healthy meal and then testing her fasting insulin an hour later. And we did find that her fasting insulin was elevated. Well, it was her postprandial insulin was elevated.
[25:55] So that would be the very, very first stage of insulin resistance. And some people notice that visceral fat is even the first stage. Before you even start to see insulin on blood work in the numbers, you see the symptoms where you’re just noticing this increase in waist circumference, and the driver of that would be insulin. This often happens during the perimenopausal transition because estrogen and progesterone, more estrogen than progesterone, but both of them to some extent, have an impact on our insulin sensitivity. So estrogen makes us more insulin sensitive. And when you go through perimenopause and your estrogen levels start to decrease, you become just de facto more insulin resistant without changing anything. And this is why so many women present with the concern of increased abdominal fat. They’re like, I haven’t done anything. I’m noticing this change in my body composition, and it’s so frustrating, and I don’t know what’s going on. And we do look at estrogen, obviously, whether it’s hormone replacement or other things that we can do. But the big thing to consider is, okay, there may be a time, this might be a time now to refocus on insulin. What was working for you in the past?
[27:16] Given now that your estrogen is lower, is likely not going to cut it anymore. And we need to start shifting lifestyle in the direction of supporting insulin sensitivity.
[27:28] So other signs in the blood are, you know, fasting glucose, obviously, when you’re in the later stages will start to be elevated. And then elevated triglycerides. Triglycerides are part of a cholesterol panel. They are the fat in the blood. So this is when the fat cells become overstuffed, particularly in the liver, we start to see an elevation in fasting triglycerides. And, you know, it’s funny because sometimes patients will come in and they’re like, my doctor says I have, I’m thinking of one patient in particular, she said, my doctor said I have high cholesterol. And so we looked at her blood work and actually have two patients with the exact same thing. Two had elevated, they both had elevated liver enzymes, showing that there’s something going on with their liver. Their liver is not happy. Their liver is experiencing inflammation. The liver is struggling in some way. That’s what elevated liver enzymes tend to tell us. And, you know, their liver’s not working properly. There’s some inflammation in the liver. The liver’s not able to process these triglycerides. And they both had elevated triglycerides. And that was the only thing abnormal in their cholesterol panel.
[28:36] And their doctor put them on a statin, which we know’s main job is to reduce LDL, cholesterol, one of the cholesterols, but total cholesterol as well.
[28:46] And, you know, has an impact on triglycerides, but not a large impact. And it’s not the therapy, in my opinion, for elevated triglycerides. It’s certainly not the first line that I would recommend. I would recommend first supporting the liver, figuring out what’s going on there. In one case, it was Tylenol overuse. In another case, it was insulin resistance that was causing fatty liver. So it’s first supporting liver and then addressing insulin resistance if it’s present. And in one patient, it was. But certainly not a statin. It’s not addressing the root or even the issue. And again, this is reductionistic, right? It’s like cholesterol, statin.
[29:27] Ignoring the fact that there’s a lot of different things going on in a cholesterol panel. And statin may be the answer for some particular people who make a lot of LDL cholesterol and they have scary high levels despite having low inflammation. And even then in that case, I would argue that we might not be that concerned about their LDL if they have low inflammation and they’re insulin sensitive. But those people would probably be the people who would benefit most from a statin just to keep them from overproducing the LDL cholesterol that they genetically overproduce. The other thing that we’ll see in blood tests are inflammatory markers elevated, and these can be elevated for various reasons, and they won’t always be elevated in insulin resistance, but we tend to see inflammation, and so that would be a reason to look at why there’s elevated inflammation.
[30:20] And you know other symptoms that we see insulin resistance affects our brain so we have brain fog it affects the health of the blood vessels we get hypertension or high blood pressure we see mental health issues for various reasons we know depression is an inflammatory condition in the brain there’s low levels of inflammation that create this um kind of like low mood an issue with serotonin and dopamine metabolism that presents the symptoms of depression, right? Low mood, sadness, apathy, you know, disinterest in things that previously brought you joy, anxiety, we know has a lot to do with this blood sugar rollercoaster triggering the autonomic nervous system.
[31:08] We get fatigue when we’re insulin resistant because we can’t, again, we can’t access our energy properly. We have difficulty losing weight because we are constantly telling our body to store, store, store, and not use. We get fatty liver and fat on the organs. I am convinced that adrenal fatigue, until proven otherwise, is insulin resistance. And my friend actually came to this conclusion when she went on the low insulin lifestyle. After I introduced her to Dr. Allie Chappell, she was like, she’s like, I no longer get that crash from 2 to 4 p.m. And she’s like, so what I thought was adrenal fatigue that I was managing with like salt and adrenal herbs and stuff like that was in fact insulin resistance. And it’s interesting too, because a lot of the adaptogenic herbs, the adrenal herbs, a lot of them have, I mean, one of the impacts of cortisol is to raise our blood sugar. So a lot of these adaptogenic herbs will raise blood sugar and it gives you kind of this boost, right? And that’s that 2 to 4 p.m. crash. We always tend to gravitate towards sugar or carbohydrate snacks during that time, unless you can take a nap or something. But it’s like this sugar crash that we get. And again, when you’re insulin resistant, you know, you’re having trouble managing your blood sugar. Maybe you had a lunch that had too many carbohydrates, you got a huge insulin spike, and then you get this huge crash from 2 to 4 p.m.
[32:30] Estrogen dominance. Again, you know, this whole sort of, PCOS thing where we’re putting on more body fat and our estrogen level, like, you know, we have heavier periods or more painful periods or, you know, this weight gain. So, even though estrogen increases insulin sensitivity, a lot of these symptoms of excess fat gain or heavy periods or irregular periods that we would tend to call estrogen dominance, this might be, in fact, insulin resistance, PMS, PMDD. Again, that’s not a known fact that those conditions are caused by insulin resistance, but knowing that insulin resistance messes with your hormones, messes with energy production, messes with your neurotransmitters, with your brain function, with your liver, which is responsible for processing hormones like estrogen. It affects your digestive system, which we know digestion is a highly energy-intensive activity. So if you’re not able to access and use your energy, you’re going to have issues with things that require a lot of energy, like digestion, like reproductive health and sexual health, hair growth, skin health, all of these things.
[33:49] So it’s sort of like every symptom in some way we could argue is connected to insulin resistance and so my advice is when patients are presented with a whole bunch of things as we do a fasting insulin test as part of routine blood work in order to assess and also given that 88 to 94 percent of us have some sort of metabolic dysfunction it’s fair to say we should definitely rule this out because the norm would be, or at least the common thread would be insulin resistance, is having some role to play in what someone’s experience is.
[34:29] So the blood sugar rollercoaster, throughout most of my naturopathic practice, I’ve been harping on this idea of blood sugar because our body does not like to have high blood sugar. This is toxic, and it doesn’t like low blood sugar, right? Low blood sugar triggers cortisol, triggers an autonomic fight or flight response, right? The sympathetic nervous system response, and that triggers cortisol, and then your blood sugar goes up, and then you’re craving, and you’re going on this roller coaster. And this is the case with anxiety. I see it time and time again um you know anxiety until again until proven otherwise is a blood sugar roller coaster phenomenon brain fog adrenal fatigue all this is connected to our blood sugar and supporting blood sugar has been really important in my naturopathic practice to support people with mental health concerns and then you know as a psychotherapist um.
[35:33] Psychotherapy is extremely effective it’s an amazing tool and modality and we really we get deep and we sort through the emotional experience and and you know the how we think and our self talk and our boundaries and we do all that stuff and uh you know but then if there’s, if a if a psychotherapy client is like having a croissant for breakfast and then a sandwich for lunch, you know, there’s only so much psychotherapy we can do without really addressing their blood sugar.
[36:09] So, you know, so many of us are on this blood sugar roller coaster day in and day out, right? You wake up and then you’re kind of nauseous and you’re anxious and that’s low blood sugar. It’s your cortisol trying to kick into gear. Then you have, you know, the typical breakfast. I, When I was a kid, I would have cereal and skim milk, like sugar cereal often. And I don’t know how I survived. But yeah, I was like daydreaming. I was like not focused. I couldn’t, you know, figure out what was going on in math. Yeah, and then I remember we had lunch and I probably made myself a sandwich. Sometimes it would have meat in it. There’d always be a sugar treat. It wasn’t a horrible lunch, but yeah, it was back in the 80s or 90s. It was kind of the height of our nutrition disaster.
[36:58] And so, so many of us still do that, right? Cereal for breakfast or toast or croissant or just kind of a carb breakfast, you know, something easy on the stomach. You wake up, you don’t have much of an appetite. You’re anxious. You just want to eat something quickly, a banana, whatever. So, your blood sugar goes up and then your body releases insulin, it comes crashing down, and then over time, you become insulin resistant because insulin stops responding effectively to, or sorry, the cells stop responding effectively to insulin. So, you need more and more insulin to create the same effect on cells. So, you end up with high insulin levels, and this triggers more sugar cravings, and so on and so on.
[37:39] And this impacts our brain. We can’t think clearly. We have brain fog. We feel anxious. we feel stressed out, we feel irritable, and we suffer from inflammation. So the blood sugar roller coaster, horrible. There’s always this New York Times article that I reference, and it’s called, Do You Have Decision Fatigue? And it talks about these parole board members who would make weird decisions just right after lunch, like that 2 to 4 p.m. They were like, I don’t know, Some guy was caught stealing and like, you know, same offense. And then all of a sudden there’d be this different parole decision right after lunch. And then when they gave them a snack, everything kind of settled. So they decided, they figured out that this decision fatigue they were having where they just couldn’t make a decision, they couldn’t think clearly, was caused by low blood sugar. And, you know, blood sugar is important. Our brain needs a steady stream of consistent energy. And so if we’re on a blood sugar roller coaster and our blood sugar is dipping, our brain is starved of nutrients and we can’t think, you know. And if your brain is particularly sensitive to this, you know, so someone with neurodivergence, anxiety, depression, you’re going to experience this all the more profoundly.
[39:03] And it’s going to feel impossible to make a decision. You’re going to feel completely overwhelmed. You’re going to feel like you cannot handle what’s going on. Um you know i had a uh another patient i’m thinking of who you know always struggled with mental health his whole life things would be good good good and then like kind of in the afternoon would get this hit of depression really profound existential depression that left him like feeling like if i don’t medicate this like i can’t function it’s horrible and we determined that yeah like that he it was a blood sugar crash ultimately blood sugar was low he hadn’t eaten for a while lunch wasn’t that substantial and breakfast wasn’t that substantial so he was going on this blood sugar roller coaster and so many of us in north america we backload our food so we eat our biggest.
[39:57] Best meal at dinner and we spend the rest of the day on a blood sugar roller coaster so i preach this all the time i’ve talked about this in courses and i was really jealous when i discovered as many of you’ve heard the glucose goddess so somebody whose entire brand is focused on blood sugar and her whole thing is that she puts on a continuous glucose monitor so this is something that measures creates these graphs here that show your blood sugar going up after you eat and she’s showing you all these different like permutations and combinations of of food and how food impacts blood sugar and so that’s really cool and i was really jealous just like five million followers. I’m like, why didn’t I think of this?
[40:37] Even the name Glucose Goddess, genius. She does a lot of good work. She’s a biochemist. I have referred tons of patients to her work.
[40:45] And so things that she talks about are, you know, apple cider vinegar prevents you from getting this glucose spike, the sour in the vinegar, the acidic acid, it helps to kind of slow this glucose absorption.
[41:00] When you add fat, fiber, and protein, so she calls this putting close on your carbs, it tends to blunt the glucose response. So fiber, how does that work? Well, fiber, it kind of creates this coating and it’s harder to access the glucose. So you don’t get this crazy spike of glucose into your bloodstream.
[41:25] But we’ll talk about what fat does in a second. And, you know, so, but, you know, to regulate blood sugars, if you’re just looking at blood sugar, then this makes sense because you’re, if you’re adding clothes to your carbs, you know, you’re, you’re adding fat and protein to your carbs, you’re not going to get this huge blood sugar spike, which is great.
[41:44] So you’re not going to be on this blood sugar roller coaster. It also slows and delays gastric emptying, so the sugar that you’re eating is sort of metered out over time. So again, you’re maintaining this steady glucose level, and that’s great. And we’ll talk really quickly about the blood sugar impact of food. There’s different ways to measure this. So you have the glycemic index. The glycemic index is like how quickly does a food spike your blood sugar? So glucose straight glucose has the highest glycemic index, like table sugar, pretty high because it’s just a glucose and fructose molecule. Your body, your digestive system splits that and then it absorbs the glucose. Starch as well, like white rice or white bread, these are, starch is a long chain of glucose. And again, when you cook it, it kind of breaks it apart. And when you digest it, it breaks into individual glucose molecules, spikes your blood sugar. When you add fiber to it, you get a slower rise in glucose. So, you know, I don’t know what has, like, I mean, brown rice is going to have a lower glycemic index because of the fiber on it.
[42:57] The glycemic load is probably a better measurement because it takes into account how much sugar is in the food. So, for example, watermelon has a high glycemic index. The sugar raises your blood sugar very quickly, but there’s not a lot of sugar in watermelon when you’re eating a normal serving. Watermelon has a lot of fiber and a lot of water, and it also has some good nutrients, too. So the glycemic load is ultimately what Glucose Goddess is looking at. In her graph, you’re seeing, okay, you’re having chickpeas, and you’re seeing both the index, I guess, because you’re seeing, okay, how quickly does her, and this is her body, how quickly does the glucose rise in her blood, and how long does it stay elevated?
[43:43] And so she shows in this case just chickpeas, which have a lot of starch in them. They also have some fiber and some protein, but not as much protein as people think. So the starch is broken down in the chickpeas, and you get this rise in glucose. And then she says, oh, if you mix, if you blend it, you’re pulverizing the fiber, and so you’re actually accessing the carbohydrates more easily. So you’re increasing the glycemic index. So look at that. Look how much faster my blood sugar rises. And then she says, but if you consume hummus, you add fat to your blended chickpeas. Look at that. You barely get a rise in blood sugar. So, wow, that’s so cool.
[44:26] So, ultimately, adding fat lowers the glycemic index, and it looks like the glycemic load. But, so I always had this suspicion, because one of the things we are not measuring is the insulin index, right? So we’re not measuring insulin at all with a continuous glucose monitor. We’re not looking at all at how insulin looks after eating. And this normally is fine because usually when glucose goes up, insulin goes up, and when glucose is flat, insulin is flat, but not always because there’s a few foods that will spike insulin or that will impact insulin but not impact blood sugar.
[45:13] And what happens when we spike insulin is we actually see, because insulin’s job is to lower blood sugar. So under this glucose goddess post is this is where I first was exposed to Dr. Allie Chappell, where she reminds us that adding fat to starch enhances the insulin response. And this is the reason you see a drop in glucose on your graph. And she’s like, I saw a similar post with bread and butter. And so adding butter to your bread doesn’t make your bread healthier, but it will flatten your glucose response so you’ll have a prettier continuous glucose monitor graph because your insulin is being spiked and that’s flattening the glucose response but it’s insulin that’s causing the issue i mean insulin is what’s causing fat storage insulin is what’s preventing you from accessing your carbohydrates to burn them and accessing fat stores to burn for energy.
[46:08] And so yeah and you know it’s okay so it’s not like i didn’t know this um but i guess i didn’t understand the impact of it and this is an important lesson for me even a holistic practitioner a naturopathic doctor who routinely tests people’s insulin levels who understands the importance of insulin who has seen elevated homa ir in all types of people who is looking at insulin resistance and considering that as a factor and assessing symptoms of it. But I was looking at it as kind of an isolated thing that can occur. I was not looking at it as like a blanket issue that is occurring across all of my patients and should be assessed in essentially everyone who have the symptoms and some signs of it.
[46:53] But yeah, I was aware of insulin and the impact of insulin on food. And I was even aware of the insulin index, which looks at the impact food has on our insulin levels. So how food spikes insulin. And I knew that, yeah, obviously white bread is going to spike your insulin because it spikes your sugar and that spikes insulin. But I also knew that things like skim milk were potent generators of insulin or created an insulin release. And so, I kind of knew, okay, you know, stuff that doesn’t necessarily have a lot of sugar has an impact on insulin levels. And so, what we know is that carbohydrates have a high insulin index, right? So, starchy carbohydrates, starches and sugar.
[47:46] Protein actually has a moderate impact on insulin. So, it will not spike your glucose. So, it’s not going to change your glucose monitor, but it will have an impact, a moderate impact, about 20% release on your insulin.
[48:02] Fat will not have an impact on insulin or blood sugar. So if you consume olive oil, if you just drink a bunch of olive oil, it’s not going to do anything to your insulin and it’s not going to do anything to your blood sugar. But when you add fat to starch, it will accentuate an insulin response.
[48:20] So it is going to impact fat storage. And we knew this from adding fat and sugar was a potent way to store fat. So, you know, so this was something that I knew, but I never really kind of connected this to Glucose Goddess’s work. And so I thank Dr. Allie Chappell, and this is how I found out about her. So Allie Chappell, her, she created, because she works with PCOS, she created this idea of like, okay, foods that spike insulin are starches. Okay. So rice, not just white rice all rice bread flowers you know potatoes sweet potatoes um so kind of like tubers and grains essentially and legumes sugar so table sugar added sugar but also whey protein so unfermented dairy so milk um you know whey protein powder because whey protein stimulates a peptide called IGF-1 or insulin-like growth factor 1. And again, we know that insulin is a storage hormone. So whey protein is used for muscle building because we need insulin. We need IGF-1 to stimulate muscle protein synthesis.
[49:40] But if we’re trying to keep our insulin levels down, maybe we should be weary or maybe we should just be aware of the fact that whey protein can stimulate an insulin release and it won’t have any effect on your continuous glucose monitor. This was a whole debate that Dr. Allie Chappell got into and we’ll talk about
[49:57] it when we talk about protein in a second. It was also part of my conversation with her, And I think it’s a little bit where we differ, but I’ll get into that. Foods that don’t spike insulin are non-starchy, colorful fruits and vegetables. Okay, so leafy greens, colorful stuff.
[50:17] Fruits contain fructose, so they don’t have as much, rather than glucose, which is what starch is made of. So it doesn’t have as much of an impact on our blood sugar levels and our insulin. Our liver converts fructose into glucose eventually, but it doesn’t create this big glucose spike and an insulin spike. You will see a rise on a continuous glucose monitor when you consume fruit, but you’re not seeing as much of a rise in insulin. And fruit also has fiber, so it’s managing the glycemic index. And it doesn’t have that much sugar fruit, so it also has sort of a moderate glycemic load. So a good way to get carbohydrates if you’re trying not to spike your insulin is from fruit and vegetables non-starchy vegetables so animal protein again a moderate impact on insulin about 20% that of starches fermented dairy so she recommends this in limited quantities it’s about a cup of greek yogurt or an ounce of cheese nuts and seeds don’t impact insulin so you know which is you can have tons of almonds whatever and fats have no impact on insulin so it’s ultimately this kind of paleo diet where you’re not including legumes and you’re not including potatoes. And so there’s a lot of research she’s done on this.
[51:36] I’m sorry, my face is covering some of it. But so there’s three studies that she conducted and a randomized control trial. And it was on women with PCOS. So I would love to see this study extended to, I would love to see it extended to mental health because there’s some research on ketogenic diets for mental health. And my story that I’ve shared on my blog is that, you know, before Christmas of 2024, I kind of just was going through a funk and I just said, you know what, screw it. Like I’ve been avoiding gluten for forever. And I just don’t want to anymore. So I just went back to eating bread and it was glorious. I had a great time. I had brie. I had baguettes. Like I had sandwiches. It was amazing.
[52:27] But my body was not happy, and I had horrific brain fog. That was the first thing I noticed, and all this water retention, inflammation, I just felt horrible. So after Christmas, I said, you know what? I need a bit of a reset. My gut is not happy. My brain is not happy. And I did a ketogenic diet, more specifically the carnivore diet. I wanted to try it. I just wanted to simplify things.
[52:49] And I just wanted to give my gut a reset. And there’s actually a benefit. This is very counterintuitive and an aside, but there is a benefit. There’s documented evidence that just restricting fiber can actually help digestion. For me, it was a good reset. I don’t think we should avoid fiber forever. Maybe some people with particular health concerns need to, but for me, it was a good reset. So I did the carnivore diet for about three months and I felt my mental health was fantastic. I felt my brain fog clear in like 24 hours and it felt magical but one of the things with carnivore diet is it’s very hard because you’re you don’t have any carbohydrates in your diet at all you don’t have what we what’s called muscle glycogen which is this stored starch-like molecule in the muscles that allows us to burn energy quickly and also retain some water in the muscles so one of the very common symptoms that people experience on a ketogenic diet, especially a carnivore diet, is like a lot of thirst and issue with water balance and muscle fatigue. So I felt that. I felt like I didn’t have strong endurance.
[53:57] I felt, you know, and then at a certain point, I just felt like food was just very brown and I was not so much craving, but I liked the idea of colorful fruits and vegetables and juicy like apples and stuff so my friend um started doing the low insulin lifestyle because i was i was discovering it around the time that i was doing carnivore i was writing my course.
[54:23] On insulin resistance and um.
[54:27] And, uh, and she was trying to do the carnivore too, but it was breastfeeding. And so it wasn’t working out. She, it was affecting her, her milk supply. So she decided to try this and she was, she was like, you know, I feel great. I don’t have any cravings. You know, by day three, like I’m really, really full and satisfied. And again, it’s because you’re able to tap into your energy because your insulin levels are low. So you’re using your body’s energy stores. Um, And, you know, I was also kind of stagnant on carnivore. And so the big aha moment I had was that I was mixing whey protein into yogurt almost every day to get this kind of hydration.
[55:07] And also the whey protein was kind of sweet. And it was a fast way to, you know, instead of having to like cook meat and chicken and eggs, it was something quick that I could have as a snack when I wanted food. So I was having whey protein almost every day. And so I wasn’t experiencing any weight loss. And I was, you know, it kind of, I wouldn’t exactly crave things, but I don’t know. Something just didn’t feel right. So I switched to this, I started adding back in fruits and vegetables. And it felt really, really good. And it felt very sustainable. And I started reflecting on things I’ve tried in the past, things that were successful for me, ways of eating, paleo, particularly comes to mind as something that felt very wholesome and holistic and satisfied my nutrient needs. And I was like, you know, what works about paleo was probably this. Fruits and vegetables, animal protein and fat, nuts and seeds.
[55:58] And, you know, I looked back at my life and, you know, my particular response to carbohydrates and likely having something called reactive hypoglycemia, where you get a big insulin response. Your insulin is, you get a big insulin response essentially after eating. So, you’re not carbohydrate sensitive. In other words, you’re carbohydrate intolerant, right? The glucose tolerance test, you get this big spike of insulin after you consume carbohydrates.
[56:27] I don’t think that I’ve ever really been glucose tolerant and I don’t know if that’s my Mediterranean genetics I don’t know what’s going on with that but then you know putting the pieces together so I think a lot of people really resonated with this idea because when I sent an email out and shared the Dr. Ali Chappell interview a lot of people were like responding and I mean I think that a lot of people were seeing this as like the next new diet right because the the tagline is in two months women lost with PCOS lost 19 pounds and they didn’t restrict what they were eating they ate all that they wanted from a number of foods fruits non-starchy vegetables and fruits animal proteins also some plant-based proteins tofu edamame hemp nuts and seeds and fats and so they ate everything they wanted they didn’t restrict at all. They were told not to exercise just to standardize, but exercise would actually probably have enhanced their results.
[57:31] And yeah, they had great weight loss. Weight loss that is not typical in a lot of studies. You know, you can expect maybe 11 pounds in four months on a calorie-restricted diet. You can expect maybe something like 11 pounds in six months on a ketogenic diet or intermittent fasting, things like that. So 19 pounds in two months, unrestricted, is pretty incredible. Eating all the fruit you want, because people are always kind of wary about fruit, and we like fruit and nuts and seeds, and these are kind of foods that are appealing.
[58:08] So yeah, it was this great tagline. A lot of people were writing to me, how should I do this? What should I do? I think for me, the biggest thing, it’s not so much weight loss. It’s the digestion feels great. Brain feels good. Energy feels good. I’m not constantly hungry like I always have been. I was like pounding back protein to prevent myself from eating constantly. It’s like always with kind of this food noise in the background. I don’t have that on this. And I feel very satisfied. And you get all of the nutrients that you need. It’s not that grains and legumes are bad for you.
[58:43] It’s just that they contain starch and you can have all of the you can easily get the nutrients that you need from fruits vegetables animal animal proteins and animal foods and so it’s this kind of comprehensive feels very holistic diet you know um.
[58:58] So there’s lots of different studies that were done. Her classic kind of PhD study, she just did the diet for a test drive. Another study, they looked at how much fat people were burning after they consumed a high-fat, high-calorie shake. So before they were on the low-insulin lifestyle, the insulin in their body prevented them from tapping into fat. So they were just essentially burning sugar and then hungry, burning sugar and then hungry, and storing fat. But after the two months of the low insulin lifestyle, they were able to burn fat. And so this is also supporting consistent energy levels, you know, in the brain and in the body and reduced hunger and cravings. Because you’re able to tap into your energy stores. You’re able to tap into fat. You’re able to be what we call metabolically flexible, where you burn sugar. When you’re done burning the sugar, you burn fat.
[59:52] And so you’re no longer, you’re off now the blood sugar rollercoaster where you just burn sugar. Than cray sugar burn sugar cray sugar burn sugar cray sugar um another study looked at time to conception because it’s pcos so the goal for many people was fertility and it was about 85 days was the average time to conception and another study looked at standard treatment so it was like a mediterranean diet exercise metformin calorie restriction all in one group and the other group did the low insulin lifestyle and the Mediterranean diet people gained a third of a pound in two months and the low insulin lifestyle people, they lost their 17 to 19 pounds. They had people do diet diaries a couple times. So again, no restriction. My thing that I always think about with the diet diary is if I was a participant and you asked me to fill out a diet diary, I probably would, it would influence how I eat that day for sure. I wouldn’t eat like the pound of bacon or binge on a bunch of nuts and seeds if I knew I had to record it. So I think you can maybe assume.
[1:01:00] And I haven’t, you know, Dr. Ali kind of agreed with this, but I don’t know if, you know, she fully did. You can maybe assume that it was sort of their best day. And that would be, you know, like an average really lower calorie day. But the diet diaries showed that they were consuming about 1400 calories again they’re not counting they’re not tracking they’re just eating what they want from the amount of foods that they’re allowed again you could eat like all bananas technically you could eat all bacon like, but they were they were sort of and this is also the thing when we’re eating whole foods because ultimately fruits vegetables and animal protein these are our whole foods that we find in nature You, you know, get some lettuce that’s growing from the ground, you pull an apple off a tree, you kill a chicken or eat its eggs, right? These are like whole foods, they come from the foods in nature, whereas like, you know, rice, yeah, it’s still a whole food, it’s not that processed, but it still requires this kind of refining and processing to get it to something that you can eat.
[1:02:10] And so when it turns out that when we’re eating these whole foods it it has a very satiating effect in part because of its impact on our insulin levels and our ability to kind of be metabolically flexible but we also are like kind of able to to tap into our body and what it needs, And there’s been studies on this in babies, actually. And they found that, like, yeah, your body can kind of ask for the nutrients it wants. So it’s like, do you want an apple? So that’s kind of more of a sugary thing. Or do you want something savory, which would be like chicken? And they actually ended up eating quite a bit more protein than the typical, you know, woman that I see in my practice.
[1:02:57] They’re eating about 95, 90, 94 grams of protein a day without trying to track and emphasize protein. And I think the reason for this is because, yeah, you’re either eating kind of like a sweet food, or if you want a savory food, you’re going to go for protein. It just, because you just have these whole foods to draw from, you’re probably going to do about at least a quarter of your foods are going to be these animal proteins. And so then you end up eating about 25% of your calories from protein, about 30% came from carbs, about 90 grams of carbs. So that is a low carb diet that they were naturally eating. Again it’s very very hard to get a lot of carbs when you’re just eating fruit and vegetables because there’s only so many apples you can eat there’s only so many grams of carbs in broccoli or something like that whereas yeah if you eat a cup of rice you’re getting a huge dose of starch and they were actually eating quite high fat so about 45 percent of their calories were coming from fat so it’s a higher fat diet a moderate protein diet and a low carb diet and that’s just naturally what people gravitated to when they were given those foods to eat. So really cool. I think I probably eat more than 1,400 a day. Definitely, actually. But this was ultimately what resulted in their weight loss. But they were also able to tap into the fat because their insulin levels were low. And they had a 50% reduction in their insulin levels after two months.
Speaker0: [1:04:25] So, really impactful research-based lifestyle, you know, and I would love to see, I think there’s going to be more in the works of this lifestyle, but I would love to see some research on it for mental health. I know that the PCOS patients, they filled up quality of life questionnaires, and they did have a positive impact on their mental health. Um but you know i don’t know if they were doing they weren’t doing like um you know gad sevens and stuff like that measuring their anxiety their depression like phq9s like measuring their mental health specifically they were measuring like quality like you know their tendency to binge eat went down their irritability and impulsivity went down so kind of their food behaviors and how that relates to mental health all improved but there wasn’t i don’t as far as or any specific like mental health symptoms. Although subjectively, if you talk to them, I’m sure that they would probably have good things to say about how they felt mentally and emotionally. Yeah. So, the thing, the protein question, so there was a lot of controversy. I don’t want to, like, draw more attention to it, but Dr. Allie Chappell was involved in this debate around whey protein.
Speaker0: [1:05:41] And the main argument was, so in my podcast, she was talking about how whey protein is a waste product, and whey stimulates IGF-1, so it stimulates insulin, and that’s not good for us. And so on the low insulin lifestyle, they’re told no whey protein, they’re told limited amounts of fermented dairy or so that they don’t overly impact their insulin levels. And, you know, and then we get all these great results. So, okay. So yeah, whey protein highly stimulates insulin. And so she recommends against it. And then she also says, you know, I think we emphasize protein too much. And I will tend to, so this is what we see, right? So I have been harping, just like the blood sugar thing, I’ve been harping protein, protein, protein, you need to eat more protein. Look at someone’s dietary, you’re not eating enough protein. You’re, you know, a perimenopausal woman with insulin resistance, you need to eat more protein. I will actually, when working with diet with people, I will tell them to eat protein first. And I see memes all over the place now.
Speaker0: [1:06:48] Where it’s like, you know, eating protein is a full-time job. It’s so hard to eat protein. And then you have protein cereal and protein bread and protein pancakes. And it’s usually whey protein that they add to that to get the protein.
Speaker0: [1:07:01] So Dr. Allie is like, whey is a waste product and it’s, you know, impacting your insulin levels. So avoid it.
Speaker0: [1:07:10] And then she had a debate with somebody who said, okay, you’re looking at the mechanism. You don’t like that whey has an impact on insulin, but what’s the impact on metabolic health when people consume whey protein? And so there are studies that show either no effect or maybe it’s beneficial. And the reason it would probably be beneficial, me without having looked in depth at the studies, I would assume that adding whey protein would be beneficial because whey protein stimulates muscle synthesis, right just like insulin does but the protein in way and the impact on insulin is a potent stimulator of protein muscle synthesis okay so when you have more muscle that’s going to positively impact your metabolic health especially if you’re strength training, further adding more protein in people who are largely protein deficient because most people are not getting enough protein i mean now maybe they are because protein has become a marketing thing. People are tending not to get enough protein because the guidelines were always to get 0.8 grams per kilogram of body weight, which we now know is like the minimum to prevent muscle wasting. And it’s not enough to be well muscled. And so we have this epidemic of low muscle and insulin resistance.
Speaker0: [1:08:34] So yeah, when you start adding protein to people who are protein deficient, doesn’t really even matter where the protein comes from, that’s going to have a positive effect on them, even if it’s stimulating their insulin, because they’re probably stimulating their insulin anyways, if they’re eating like a high starch diet, and then maybe they’re not eating as much starch, because they’re full now, they’re eating protein, so a whole bunch of things. The thing with nutritional science is it is not reductionistic by definition. It’s very, very hard to just change something and get an effect. Like when you have a drug trial, you know nobody starting off a drug trial has taken or ever seen this drug before and then you take half of the participants and you give them the drug and the other half you give a blind placebo right so if there’s an effect you know it’s probably because of the drug especially if it happens to the group that got the drug and not the group that didn’t but when you give even if you’re doing a randomized control trial when you give one group whey protein and the other group let’s say i don’t know just like, I don’t know, a placebo powder, like if they’re deficient in protein, that’s going to have an effect and it’s going to change a whole bunch of stuff. And then adding more protein, which is something that our body requires, it’s not a drug that’s like a novel thing added to your body. It’s like, you know, you’re getting something that has a physiological effect on a lot of different body systems, impacts your behaviors in the way that you eat, and impacts the macronutrient.
Speaker0: [1:10:00] Makeup of your food because you’re getting protein, right? So, you’re getting extra protein. So, a whole bunch of things happen when you add whey protein. So, I don’t know if it’s fair to say, like, I appreciate knowing that whey protein stimulates insulin because I would rather consume hemp protein or pea protein or a type of protein powder that doesn’t impact my insulin levels because I don’t want to spike my insulin. You know, but after a hard workout, if I really want to like, get jacked, I might do whey protein with like, you know, glucose, to be honest, and get a huge insulin spike, but put that insulin to work building muscle. So there’s a time and a place for it. But what we do know is that so Dr. Ali Chavez kind of like, you know, you don’t need that much protein. But there is quite a bit of research around the importance of protein. So, you know, 30 to 50 grams of protein per meal. And again, you don’t need 50 grams at a meal, but 30 is great. Stimulates muscle protein synthesis, and that supports our metabolic health. It regulates our blood sugar, partly yes, because it does impact our insulin. But if you’re having just animal protein, it’s not having a huge impact on insulin levels.
Speaker0: [1:11:15] And, you know, the more muscle we have on our body, the more longevity we have, you know, the less our risk of dying from anything. Muscle is a glucose sink, so it soaks up glucose at rest, but really goes into overdrive at soaking up glucose when you’ve just worked out. And in fact, you don’t need insulin to bring your glucose down when your muscles are working. So this is the advice where you take a walk after dinner, you start working your muscles and you don’t eat even insulin to get the glucose into the muscles and store it as muscle glycogen. Further, we store about 400 grams of carbohydrate as muscle glycogen. It’s a huge like reservoir of glucose that doesn’t have to go into fat cells, doesn’t have to overstuff them. So the more muscle you have, the better glucose sink you have. And then you have this quick burning energy.
Speaker0: [1:12:08] So the more muscle you have the better and you need protein to you need two things to stimulate it when you’re at an adult you need um protein so lysine specifically branching amino acid and you need resistance training so you need to like have a stimulus on your muscle to to create muscle um and we know there’s lots and lots of studies on protein forward diets so diets that deliver about 0.8 to one gram per pound, not kilogram of ideal body weight per day. So it’s almost double the previous recommendations of 0.8 grams per kilogram. So we’re saying 0.8 to one gram per pound. I just aim for one gram per pound of body weight. And so if you distribute that over the course of a day, a course of across three meals, then maybe, yeah, if my ideal weight is 150 pounds, and I’m trying to stimulate muscle and decrease body fat, then yeah, I’m probably aiming for about 50 grams per meal.
Speaker0: [1:13:11] You know, there’s studies shown by Dr. Cabot-Leon that are like not new studies from the early 2000s, where when, you know, people had like a bigger protein breakfast, a decent protein lunch, a decent protein dinner, versus a group that had like a really crappy low-protein breakfast, and their biggest meal was dinner, they lost more body fat, lost less lean mass when they were engaging calorie restriction. And there, you know, there’s another study that shows, you know, low-protein diet, low-protein plus exercise, high-protein diet, high-protein plus exercise. And the best group, of course, was high-protein and exercise, but the second best was high-protein.
Speaker0: [1:13:54] In terms of body fat lost and lean mass preserved. So a lot of benefits to having protein. Does that mean go eat like protein cereal? Honestly, like my answer to the memes where it’s like, I’m working overtime trying to get enough protein. My answer to that is like, just eat meat. Just eat meat. We’re so scared of meat. If you eat meat, chicken, fish, eggs, you’ll get enough protein if you eat like a decent serving you know a five ounce serving at every meal or if you’re tofu and edamame those are great too and you can also do hemp protein powder or collagen powder um it’s collagen is not a complete protein but who cares when you’re mixing it up with other you don’t need to worry about complete protein when you’re getting complete protein across your day in my opinion um so yeah when you’re doing a low insulin lifestyle because really all you have is like animal foods and fruit and vegetable you’re naturally probably going to eat more protein because what are you going to put in your burrito bowl um you can’t put rice in there can’t put tortilla so you’re going to probably put a lot of ground beef uh maybe you’re going to put um a bunch of different salad ingredients avocado and yeah so the savory the salty is going to come from the ground beef and so then you’re getting enough protein.
Speaker0: [1:15:13] And you know people always ask about people are scared of animal protein and i think it’s because of this, again, all the brainwashing and gaslighting that we’ve had from the 1970s on about having a high-carb diet and not eating animal. And the fact is, our diet is largely plant-based in North America. And it’s, that’s not, turns out, plant-based isn’t the right heuristic for a healthy diet. A plant-based diet that’s like made of whole foods, sure, that could be good for you. Um but it’s probably going to be heavier on starch and if it’s not then you have a very limited amount of protein foods to draw from so yeah it is possible to do a low insulin lifestyle on a vegetarian or vegan diet it’s just your your protein sources are going to be very very limited and then maybe yeah you should definitely be doing hemp protein powders and things like that if you want to try it um but fun fact is somebody who i was really like watching.
Speaker0: [1:16:10] What’s her name it’s a health influencer that is like a fruititarian so all she consumes is or like raw raw fully raw christina so she has these beautiful like platters of fruit she gets to eat all this food because all she so she is doing a low insulin lifestyle vegans vegan version lots of nuts and seeds and fruits and vegetables so uh she’s just not eating any animal product and she’s surviving but I think she started adding protein powder in recently um so yeah so very interesting um.
Speaker0: [1:16:44] You know, kind of debate that happened. But I think that, you know, we definitely want to eat enough protein. And I, you know, in my course, I suggest, you know, starting with protein first, because the thing with that is, you know, it’s less about restriction, which can be really helpful, especially if you, so if you struggle with insulin resistance, chances are you’ve done a diet before, you know, because if you have difficulty losing weight, you’ve probably tried something to try and lose weight, whether it was fasting, whether it was Weight Watchers, whether it was something. So you’ve done restriction before, you’ve counted calories, you’ve tracked your macros, you’ve done something like that. So telling you to eat less of something, I mean, yeah, that’s helpful, especially if it’s like don’t eat any starch, particularly if you have really strong insulin resistance.
Speaker0: [1:17:36] But, you know, I like to suggest protein forward first, because it feels less restrictive, you’re focused on eating something, you can always eat it at the end of the day if you you know weren’t focused like you can always have like a protein smoothie or something at the end of the day or a steak if you’re like i didn’t i didn’t you know follow it today or had a busy day versus like having to reverse, overeating or eating something that you weren’t allowed to so it has this, positive frame. And it will displace other macronutrients in other foods. You feel more satiate, your blood sugar is more stable, your brain has, you know, more continuous glucose control. It increases tyrosine, which increases dopamine, which supports motivation, reduces cravings, supports executive functioning. There’s all these positive benefits to adding protein. and so it’s not the only thing it’s not just protein and nothing else it’s just my first step often when patients come in and we need to start working on lifestyle foundations, lifestyle foundations are it’s hard to get someone to do big changes right away.
Speaker0: [1:18:47] Um in my course too we talk about like what happens when you have to eat out what happens when you go to someone’s house what happens how do you say no to people who offer you their pecan pie you know so there’s a lot but if your if your goal their first goal is just to increase protein it’s like you can hand you can navigate all of that stuff you know you just focus on protein and just see what changes and that’s like a good way to start thinking about food and tracking food and not thinking about restriction and then you’re not hungry so you don’t have that same association of like i’m gonna do a thing to be healthy and it’s gonna result in me being, frigging hungry, which was my association my entire life. So on the low insulin list, I don’t find that I’m hungry, actually, I’m very satiated. But, you know, it can be something to wrap your head around to be like, I can’t have starch. So what’s starch in? And what can I eat? And what’s the list? And what’s the grocery? So what am I going to, how am I going to have tortillas? How am I going to do this? So Dr. Ali Chavali uses a lot of almond flour. But yeah, so I think protein has a very important place in supporting metabolic health.
Speaker0: [1:19:49] Now putting it all together um you know so i think when a patient comes in the first thing is we do an assessment we may do some testing and we come up with an individualized plan right so, yeah you can take this and run with it you can just google the foods but again it’s like no starch no sugar no unfermented dairy and then you can have you know all the fruits and vegetables all the animal protein. I will say that a patient that I saw recently, you know, she was like, she’s like, I’m going through perimenopause. I have brain fog. I have no energy. I’ve got all of these symptoms. I’m gaining weight and I can’t lose it. I just, I feel like garbage. My mental health is terrible. And I just, I want to, you know, rehaul my health. And so we talked with the low insulin lifestyle because she had other signs of insulin resistance.
Speaker0: [1:20:46] We didn’t measure insulin, but we definitely have a plan to do that. Cost is a factor in terms of blood testing. And we want to just test everything together. So she already had a lot of signs of insulin resistance. She had high triglycerides, low HDL or good cholesterol, some inflammatory markers, and actually was starting to get elevated hemoglobin A1C or blood sugar was starting to go up. So it was kind of in the at-risk range. So, okay, we, you know, we don’t have a baseline insulin test, but let’s go ahead with, you know, treating insulin resistance. So, I recommended low insulin lifestyle. She was already doing lots of strength training, had a good exercise routine. And she came back and she’s like, I feel amazing. Within three days, everything transformed. My symptoms are all better. What are you eating? And she’s like, well, I’m eating quinoa every day and I’m eating lentils every day.
Speaker0: [1:21:38] So, and I’m eating chickpeas. so you don’t have to be perfect in other words is that um you know so there’s an individualized approach i didn’t have the heart to tell her that those foods were not didn’t belong on the plan but if it’s working why be more restrictive right if you can have there’s lots of benefits to having lentils lentils have iron they have fiber they have there’s another protein source quinoa it creates variety you’re allowed you feel better because you can eat these different foods you can replace rice with it.
Speaker0: [1:22:08] You know, I like this lentil flatbread that I make. So if you don’t need to be that restrictive, if you don’t need to do zero starch, then great. So we’re looking kind of at an individualized plan. Like, what are you already eating? How can we tweak things? Maybe we start with more protein. Maybe we start removing some starches. Maybe it’s just sugar that we deal with. Maybe we say, you know what, don’t worry about fruit. Eat all the fruit you want. In fact, when you eat fruit, it’s helping address a sugar craving and then you’re craving candy less and you’re having less binges. We’re looking at the individual and we’re bringing all the features together. So yes, you can just try a diet on your own. That’s great. But I am always concerned that it just becomes another diet that we try. And then we meet the same internal or external obstacles and we feel bad about ourselves and that triggers that shame and that triggers that that feeling of defeat and you cheat on it and you don’t have someone to help you reframe that that it’s not a cheat it’s just like okay like whatever you know so you know how do we approach this individually is is always so important um i think my face is covering it but essentially the low insulin lifestyle is no starch and sugar you know increasing protein fat and fiber and strength training two to three times a week so adding in strength training supporting muscle building.
Speaker0: [1:23:34] That’s very important, right, is building that muscle. There’s a whole section on muscle and exercise in my insulin resistance course. Diet, yes, is really important, but it only has one, it’s only one core, like one part of the course. And then a huge part of my course is on stress management and like regular movement, lifestyle, like, you know, stuff that supports your mental health. Again, it’s like, yeah, insulin resistance is good for your mental, healthy insulin levels supports your mental health but supporting your mental health like with these self-care practices like for me it’s getting out in nature practicing hobbies socializing reducing your stress getting to sleep on time sleep support um all of that is also good for your stress levels which is good for your insulin levels so you can like reverse these vicious cycles you lower your inflammation, maybe there’s certain supplements that can help right if you’re not sleeping supplements for sleep, if you have sugar cravings, there are supplements that can support that. Supplements for muscle health.
Speaker0: [1:24:37] Again, I say this in my course too. I mean, interestingly, I’m a huge advocate for lifestyle. I think it’s lifestyle really that is going to have the biggest impact on our health. And a lot of it requires a little bit of an entire reframe, right? Especially if we’re living in a chronic disease state, like insulin resistance, and especially if it’s been longstanding, then yeah there’s a lot of connections and associations and identity patterns even that need to change and that’s scary and that’s huge and because we’re social creatures and we’re we’re not just biological creatures we’re social and we don’t like eat in isolation and we are a product of you know the people around us and how they and how healthy they are and how they behave that just going on of, you know, changing your lifestyle, not that easy. It’s an entire identity shift oftentimes. It’s huge habit change, you know. So supplements often are a way to get people’s nutrient levels up where they feel better, where their body works better. And that can be positive motivation for and physical energy, you know.
Speaker0: [1:25:51] Positive mental and emotional and physical energy and motivation to make some changes, you know, whether it’s going for walks, because now you’re not so exhausted, because you slept better, or you just, your adrenals are functioning better, your brain is functioning better. So now you can make decisions like going for a walk after dinner, and now you can eat more protein, that makes you feel better. And then you think, well, okay, nothing, you know, I still would like to, I still have visceral fat, I’m still experiencing X, Y, and Z symptoms, So maybe I’ll consider now reducing my starch or taking out starches, right? So there’s so many approaches and ways in, you know?
Speaker0: [1:26:29] And I think in a huge part of my course was around self-compassion and shame and addressing obstacles, you know, so individually, what is helpful to you? Where do you start on the journey? Like, what’s important for you? What is your blood work say? What is, you know, waist circumference, all these different things? Like, what’s your starting point? What do you already do that’s working for you? What are you doing that might not be working for you? And a lot of it, you don’t know, right? Like, a lot of it is we don’t know. And there’s so much confusion in the nutritional space and you know protein no protein starch no starch bananas no bananas can I eat fruit can I not what about nuts what about seeds what’s this portion oh it’s just about your macros actually it doesn’t matter just calories in calories out.
Speaker0: [1:27:13] There’s so much and so all of that could be true for a specific person right maybe for one person it is calories that’s the thing now you know you’ve done you know all of these different things and that’s where you’re stuck. It really actually may be we need to just track calories, you know? It’s probably not the majority of people, but I, you know, it could be that person. But maybe that person’s not interested in tracking calories, that that’s highly triggering, unpleasant.
Speaker0: [1:27:40] Like if you’re like me, you don’t want anything to do with that anymore. So what else could we try? You know, do you do better by just saying, okay, like, again, I’m talking about myself, no starch, no sugar, you know, no way. Okay, perfect. Just tell me what I can’t eat and I won’t eat it and that’s fine. Um, so, you know, what works for the person? Um, or is it like, you know, your nutrition is dialed in, but you don’t move and that’s what we need to work on.
Speaker0: [1:28:07] Or is it a case of, you know, again, nutrient deficiencies are big. Um, I see them a lot in my practice and they will be an obstacle to feeling better, you know, um, zinc deficiencies or B6 deficiencies or, you know. So, yeah, so there’s an entirely holistic approach, essentially, in which we’re addressing things.
Speaker0: [1:28:35] And yeah, so that’s it, everyone. So if you have questions, reach out, connect at tallyandeed.com. If you’re following on YouTube, like and subscribe, please. I have lots of ideas. I have lots of plans. And I think, you know, subscribers, questions, engagement would really help me with the execution. I’m happy that I released this. I’ve been thinking about this for a while. April has been quite the month. It’s been terrible, quite frankly. But the foundation of low-insulin lifestyle and movement have actually been very helpful for me, keeping me afloat.
Speaker0: [1:29:16] So I think that’s, you know, I can say that when put into practice, it works. It’s possible to, at your lowest point, follow this lifestyle, and it helps, you know. And again, these are all things that I like to work with people on. You know, if you’re at your lowest point, like what’s the minimum that you can do? Like how do we get you out of it? How do we help you out of rock bottom? You know? And then, and this is a huge thing in psychotherapy is like people often come in with a rock bottom kind of chronic problem that distracts them from the deeper work that they want to actually do. Like, you know, examining childhood patterns and, you know, our schemas, things that we, you know, we have like our kind of chronic surface problem so that we don’t go into the deeper traumas that, you know, influence us and keep us stuck. So a lot of cool stuff. I know the economy is scary, but if you have benefits in Ontario, in Quebec.
Speaker0: [1:30:23] And I believe Nova Scotia for psychotherapy. Yeah, reach out. I am offering naturopathic medicine and psychotherapy in Ontario and other provinces that my psychotherapy license is good in. And yeah, I would love to work with you. If you have benefits, use them because this is how we get out of tough times is with support and help. And, yeah, I know that, yeah, it’s scary to spend money, but if you have it covered, I would suggest going for it. I’d love to help. Yeah. Like I said, I’m going to look into offering membership and a course, like a very holistic course. I released one back in 2020, I think, called Good Mood Foundations. And so I’m looking at making Good Mood Foundations 2.0. And this Good Mood Foundations is going to have sections on nervous system regulation, self-compassion, attentiveness and observation when it comes to our body, as well as nutrition, lifestyle. We’re going to talk about the microbiome. We’re going to talk about hormones and menopause. Like, it’s going to be truly holistic.
Speaker0: [1:31:42] And, you know, it’s my way of allowing you to access this information and walking you kind of through my brain for a very low price if you don’t have coverage. Or just if you need support. You need, like, more information. You like to digest more information. you know it’s hard to get it all from just one-to-one sessions because we have limited time together so you get that individual support where we’re like really getting into the nitty gritty but maybe you want kind of the overview that you can consume on your own and maybe you want a community so you know give me suggestions i run my courses right now from thrive cart um i would love to get like a community membership thing going so we’ll talk more about that soon, and I’m going to be writing a lot more. So yeah, make sure that you’re in my email list because that’s where I’m going to reach out to you about new things that are coming up and writings and things like that. So thank you for listening. Let me know your questions and comments, you know, leave a comment below or reach out at connect at taliand.com. If you live in Ontario, I’d love to work with you. Take care, everybody.
I wanted to share a recent story about my experience with the Carnivore Diet and Low Insulin Lifestyle. Maybe it’s because I just finished watching Netflix’s Apple Cider Vinegar, but sharing my health experience feels strange: very health-influencer-esque. There is some mention of weight and weight loss and some mention of body image and my relationship with food, but that’s not really what the story is about: it’s about insulin. I know I’ve shared things of this nature before, and sometimes, weaving stories can add some humanity to what might otherwise be a cold and clinical onslaught of health information.
So, if you find the idea of reading about me intriguing or even entertaining, read on. As usual, remember that this is my experience and can’t be extrapolated to everyone. Let’s talk in a clinical setting if you read something that resonates with your experience and want to learn how it might fit your health history and goals.
Last summer, something shifted in my health. Maybe it’s the same thing that happens to most women around this age (late 30s), i.e., the catch-all explanation-replacement for “it’s just stress”-perimenopause. Maybe there was a shift in how I was taking care of myself, although it felt like I was staying on top of everything. I walked a lot, went outside, and ate fruits, vegetables, and protein. But something still felt off.
And the thing that felt “off” was what so many patients often complain about. I felt… well, I had gained some weight, and not just physical weight. I felt mentally and spiritually heavy. The weight seemed to pile on out of nowhere. I shun the scale and rarely weigh myself, but one day, I did. The jump in number was so big in such a short time that my judgey scale asked if I was the same person who had weighed in 3 months before. Wow. Nice…
The heaviness wasn’t without its causes. That Spring, I finished my Masters of Counselling Psychology–a long, almost three-year slog. Shortly after, my 15-year-old dog, Coco, stopped eating for four days. He was diagnosed with protein-losing enteropathy and put on a daily dose of liquid prednisone, a steroid. Coco has been with me from the start of all this, when I first filled out applications to attend naturopathic college. He slept beside me during late nights of studying. He came with me to my exams. The sleepless nights, the decision-making, weighing the responsibility of senior pet ownership–when to intervene medically, when to decide to end his suffering, of course, the sheer financial cost– was a lot to grapple with and went on for months. It’s still going on, to be frank.
That summer, my Nonna passed away a few weeks before her 97th birthday.
I wondered if it was grief, or stress, or even steroids getting on my skin, but I felt puffy. I was tired. I felt sluggish and less stress resilient. I was still active but doing more sedentary activities: reading and learning guitar.
Weight and digestive issues have been a struggle my entire life. The “healing journey” has led me on some valid paths: exploring food sensitivities and gluten-free living, nutritional support through supplements and nutrient-dense foods, meditation and mindfulness, adrenal support and herbal medicine, and prioritizing rest and mental health.
But, regarding nutrition, I felt I was doing everything I could. I didn’t want to go down the road of caloric restriction. I didn’t want to deprive my body or fight its process. Sometimes, weight is protection. Sometimes, we need a warm, heavy blanket. Sometimes, we need to slow down.
So, I did. Of course, I was tempted by thoughts of how to solve the weight gain by dieting, as so many of us have been programmed to do. I even recorded a podcast about retraining myself to value and preserve my muscle mass rather than trying to become smaller. I accepted this new shape and focused on the tasks: my work, hanging out in nature, surfing, and healing my gut.
My gut health was terrible, although I was managing it based on all the research I had sifted through on my way to creating a gut health course. I added in more fibre and fermented foods. This worked for a time but didn’t solve the problem entirely. For most of last year, my irritable bowel syndrome was wrecking havoc. I was highly distended, often in pain.
I had brain fog and physical sluggishness. I felt stuck in a parasympathetic state. So, I sat on the couch, enjoying slow mornings, reveling in the absence of deadlines. I read books. I went for long walks. That summer, I swam in lakes and went to the Atlantic ocean.
While trying to be patient with my body, I constantly felt that I wasn’t tapping into the energy from my food. I would eat a full day’s worth of food and some stews, legumes, rice, smoothie, and salads and still feel hungry. I was constantly thinking about food. I tried to honour this by just eating more whole foods. I believe the body asks for what i needs, if we’re willing to listen. So I tried my best to listen.
Around Christmas, I was at a cafe with my boyfriend. He was eating a sandwich. Ever since naturopthic college, I have diligently avoided gluten. But I was already feeling sluggish and bloated. I was already tired. And here was a delicious, bready baguette. A delightful sandwich with soft carbs, mayo, cheese, and meat, just inviting me to sink my teeth into it. What good was avoiding gluten doing me at this moment? I avoided gluten to feel energized, healthy and light. I already wasn’t feeling that way, so eff it, how could things get worse?
I took a bite. It was divine. I let myself eat gluten for the next month. Glorious, glorious bread! I felt like my life was straight out of the pages of Eat Pray Love as I gorged on all the pasta and pastries I wanted. I chilled at Christmas parties, eating brie, bread, cakes and pies. I had all the dessert. There were no limits anymore. And, in a way, that food freedom did heal my soul. It was like a vacation from all rules and guidelines. We need this from time to time.
But, if I was barely staying afloat before then, adding in the gluten and sugar made me slip below the surface. I was insanely bloated. My weight soared. I felt sore, stiff, and clumsy. I had significant brain fog. My ankles and face were comically puffy. While I didn’t regret a second of it, after my foray into the world of gluten, I decided it was time for a reset.
After much consideration, a light switch clicked on, and I decided it was time to try the Carnivore Diet.
The premise of the Carnivore Diet is that it’s the ultimate elimination diet. It’s ketogenic, or zero carb, and contains no FODMAPS (fibre), grains, or other allergenic foods. It gives the gut a chance to reset.
While we often hear about how good fibre is for us, the truth is that some research shows that eliminating fibre can heal constipation. Emptying the gut and consuming a low-reside diet, in other words, all the components of the diet are digested and absorbed early on in the digestive tract, can give the colon a break. Further, burning ketones can heal the gut as the primary ketone, betahydroxybutryrate, is food for gut cells (we often hear about butyrate in the context of eating fibre).
Advocates of Carnivore talk about appetite control, abundant energy, healthy digestion, clear skin and effortless ease in maintaining a healthy body weight. I wanted this. I also wanted to feel more connected to my body and its energy processes. I wanted agency over my food cravings. I felt my appetite was out of control and my body needed something it wasn’t getting or couldn’t access.
Within the first 24 hours of Carnivore, my brain fog lifted. After the first week, I dropped 12 lbs . It felt like emerging from the fog into sunshine, and tossing off a heavy cloak.
I felt fully nourished for the first time in a long time. I ate a lot of fat, meat, eggs and even dairy. I felt energized. My appetite calmed down. I woke up in the morning, and instead of rushing something down my throat, I made myself a coffee and felt hunger slowly creep in.
I would prepare a big breakfast of meat and eggs that would hold me until the mid-afternoon. The food noise died down. My brain felt supercharged- I could think again. Even after long hours of talking to patients or working at the computer, I felt my brain could keep going and going and going. I no longer got that white noise static electricity that I associated with oxidative stress caused by overworking my neurons.
My mental health was better than it had ever been. I felt calm, persistent brain energy and agency over my thoughts. I felt emotionally stable and resilient. Nothing seemed to phase me. I felt strong.
I felt great. My original intention was to do the diet for a couple of weeks, but after the first week, I thought, I can do this forever! This is my diet, it’s my way of eating, something about it felt right. It was also the dead of winter. What would I be surviving on if I were in the wild right now? No fruits and vegetables were around; the ground was covered in snow. I would be hunting and killing animals and surviving on their meat. This way of eating felt aligned with the season, and I believe it was what my body needed at the time.
My brain and body thrived on the ketones. I had no cravings. Even on my birthday, I just wanted a nice ribeye steak. I couldn’t care less about cake, potatoes, or any other exciting comfort foods we look forward to on birthdays.
It was hard to sustain the diet on vacation. When I went to Ecuador in late February, I decided to let go of Carnivore and eat what was available. Because of the sun, surf, walking and relaxed vibe, I felt good in Ecuador, but my body felt far from magical. I dealt with chronic gut issues, miserable period cramps and a three-day migraine throughout my time there. On the plane ride back, I was ready to restart Carnivore and found it relatively easy to jump right back in the following day.
I hesitated to talk about my experience on Carnivore even three months into the experience. I felt great. My body felt like an efficient engine, burning fuel cleanly. However, the food was all…well, brown. And salty. And I often felt dehydrated. Also, after the initial drop in weight, I had stalled.
Grocery shopping was a strange experience. It felt surreal to be surrounded by all this… food. Stuff that wasn’t a part of my day at all. It wasn’t the snacks or chips or candy or even the carbs that tempted me. It was the rainbow of fruits and vegetables that greeted me every time I wheeled my cart into the store.
The fruits were shiny and colourful, advertising their sweet, hydrating juices and vitamins. Glycogen, or stored carbs in our muscles and liver, hold water in our bodies. On a low-carb diet, we often burn through our glycogen stores. If there was one thing I craved on Carnivore, it was the sweet hydration of juice.
One day, I was browsing Instagram and saw a comment on a popular account about glucose regulation. The account features a biochemist/influencer who shows a series of continuous glucose monitor graphs and discusses the glucose response to food. Her methods feature tips like “add fat to your carbs to lower your glucose spike.” This post highlighted how adding fat to starches (like hummus, which adds fats like olive oil and tahini to starchy chickpeas) can reduce the height of a glucose spike, helping to regulate blood sugar.
This is something I often coach my patients on, as blood sugar regulation is the key to mood stability, mental health, cognitive energy, and adrenal function, among so many other things. Interesting how I was kind of wrong about that.
The comment that caught my eye was written by a PhD who pointed out that while adding fat and carbs together can lower a glucose spike, it does not change the height and area under the curve of the insulin spike. Adding fat to starches might make the insulin response to food larger, even if it’s curbing and controlling the rise in glucose. It hit me then. We’ve been focusing on the wrong thing. I assumed glucose and insulin were like two twins on a tandem bike. One rises, and the other one joins in. Seesaw, yin and yang. But I started connecting the dots from the cases of patients I’ve seen, my experience, and third-year biochemistry. Yeesh, it’s all about insulin.
I remembered something else, too: the Insulin Index.
88-90% of humans are insulin resistant. We can’t access our fat stores or the energy from our food because we have chronically high insulin levels and unresponsive cells. Insulin’s main job (or maybe its most famous job) is to help drive glucose into shelves. You consume starch, glucose explodes onto the scene, and insulin puts it all away for you. It stores the sugar as glycogen and fat, and your body burns those later for energy.
Naturally, whatever causes a rise in blood glucose will also cause a rise in blood insulin. But sometimes, glucose isn’t rising on a continuous glucose monitor because insulin has already lept onto the scene to bring sugar down. Further, some foods, like whey protein and milk, don’t spike glucose much but will have a (significant) impact on insulin levels.
The commenter, Dr. Ali Chappell, PhD, described herself as an insulin researcher. Her research involves examining the effects of a low-insulin spiking diet on PCOS (an insulin-resistant hormonal condition that affects about 10% of women). The Low Insulin lifestyle was tested on various women who reliably lost 19 lbs in two months without counting, eating as much fruit, non-starchy vegetables, nuts and seeds and animal protein as they wanted. When I discovered Dr. Ali Chappell, I had just been hired to do a course on Insulin Resistance, which involved researching the manifestations and solutions to keeping ourselves metabolically healthy.
While a low-carb or Ketogenic diet like the carnivore diet can certainly heal metabolic dysfunction, it didn’t feel right to recommend this lifestyle to patients. It wasn’t for the faint of heart, for starters, and something in my soul was starting to miss fruit and vegetables. As part of my course research, I began to dive deeper into the low-insulin lifestyle.
Some bells started to ring for me. At the same time, my good friend was struggling on Carnivore because, while she felt great, she was breastfeeding, and the diet was affecting her milk supply. I shared with her what I learned about the Low Insulin Lifestyle. She started on the diet and, within a few days, told me her cravings and hunger were diminished. She was dropping her weight-loss-resistant belly fat like a stone.
After she had been on it for a week, I followed. I was ready to add more colour to my life. I removed the whey protein and dairy I had been eating, thinking it was fine and not realizing it was impacting my insulin. I added more fruits, vegetables, nuts, and seeds. I had dark chocolate again!
The variety was lovely. My gut was ready for fibre again, particularly the soft, gooey, juicy fibres from fruit. It felt good to fill my stomach with bulk. And it felt terrific to eat so many colours and textures of food.
Weight loss that had stalled for months after that initial drop on Carnivore kicked up again. My appetite chilled out, and I felt nourished again. I realized this eating pattern had been something I stumbled on from time to time: my trip to Brazil in 2020, my first forays with Paleo, even following the guidance of a microbiome test I did in 2021. However, none of these experiences involved intentionally targeting insulin. I would often eat starches like sweet potatoes or rice. I sometimes cut out fruit, with its fructose, which has a minimal impact on insulin.
This finally clicked things into place for me. It helped create a framework to encase my intuition around food and what humans should eat.
I was consuming whole, natural foods our ancestors would have consumed. Unprocessed plants and animals. Lots of healthy fats. Lots of sugar from fruit. Phytochemicals from colourful plants. Protein and nourishing fat from meat, eggs and some yogurt or cheese. I ate berries and burgers. Salads, broccoli and asparagus. I had sausages with organic tomato sauce. So many bacon and eggs breakfasts. I had nuts and seeds and pumpkin seed butter. I had dark chocolate and bananas. Pistachios. Shawarma meat and salad (hold the rice). It was easy to make decisions and figure out what to eat.
Looking back, I think glucose intolerance has plagued my whole life. It has affected my body and my relationship with food. It led to years of binge eating that only stopped if I ate more consistently. Protein helped immensely.
When things started to feel off, I consulted with a family doctor. I ordered some bloodwork through her and did some myself. My fasting insulin levels and insulin sensitivity (HOMA-IR) value were normal. However, when we eat foods spike insulin, it can cause a post-prandial (i.e., post-meal) rise in insulin that can stay elevated all day, as we go from one meal to the next. It can spike hunger and cravings, causing us to eat and continue to boost insulin. While hyperinsulinemia can lead to insulin resistance, I don’t think my body was there quite yet. I was raising my insulin levels, blocking my body’s access to energy stores and driving the hunger, inflammation and heaviness I was feeling.
Insulin sensitivity and glucose tolerance tend to shift as our hormones change through our late 30s and 40s. As estrogen and progesterone levels change, insulin levels increase, and we become more insulin resistant. This explained that shift I felt. The old patterns of diet and exercise I was engaging in weren’t working either. I needed to be more intentional with the way I was eating and exercising.
I started adding in more resistance training, scheduling in weights and high intensity interval training two to three times a week in addition to my yoga, swimming, and walks. The carbs from fruit helped fuel my muscles. I felt myself shift out of that parasympathetic shutdown state. I watched my nervous system enjoy more flexibility.
In a few weeks, I will start filming my course on insulin resistance. Then, it will go to editing. I’ll let you know when it’s time for it to be released. The course has been a gift. It allowed me the space and time to dive deep into the research and start putting various bits and pieces together. Metabolic dysfunction is the great health crisis of our age. I’m becoming more and more convinced that it drives so many of the common concerns we see in natural medicine practices: SIBO and candida overgrowth, adrenal fatigue, estrogen dominance, and chronic inflammation. There is a whole budding field of mental health called “metabolic psychiatry” that examines the role that insulin resistance has on mood and brain health.
Until proven otherwise, if a patient is dealing with high insulin, we must address this as a potential root cause that ties together all their concerns.
The medical establishment often overlooks insulin resistance, as the primary focus is on diabetes, which represents a later stage on the disease continuum. Decades of dietary advice have also set us up for metabolic inflexibility and an overabundance of dietary glucose that overworks insulin and blocks our ability to use energy for brain and body health.
The good news is that I believe the solution is simple. Eat a diet that leaves insulin alone: animal protein, nuts and seeds, fruits, non-starchy vegetables and healthy fats. Leave aside the starches (grains, legumes, root vegetables) and sugar. Add in some higher intensity training and work your muscles. With this approach, we have the start of a full-blown health revolution on our hands.
Stay tuned for more podcasts and courses on this topic in the coming months!
I am excited to introduce a new podcast episode (I know it’s been a while). I’ve been deep in the weeds of research about insulin resistance for a course I’m working on (for a health education platform that I’m very excited to tell you more about in the coming months).
I came across Dr. Ali Chappell, PhD, when researching my course. She helped hit home for me this idea that we’ve been focusing too much on blood sugar when the real focus for better metabolic health, body composition (i.e., weight management), energy and mood needs to be on INSULIN.
For years, I’ve been telling patients to “put clothes on their carbs” by adding fat and protein to higher-carb meals to regulate blood sugar. I’ve also recommended whey protein for protein powders. I didn’t realize this was the wrong approach for supporting metabolic health when someone is dealing with insulin resistance (as many of us are).
While these foods and practices DO regulate blood sugar, they don’t minimize the root of blood sugar and insulin resistance issues, which is insulin spikes.
You might have heard of the “glycemic index,” which tells us how much a food spikes blood sugar. Well, there is also something called the “insulin index.” Dr. Ali Chappell, PhD, decided to look more deeply into this concept when developing a lifestyle to treat her PCOS, an insulin resistance hormone condition, and the number one cause of infertility in women.
She found genuinely remarkable results in herself and decided to turn to science to test her theory.
In this podcast, we discuss her research done on women with insulin resistance and PCOS. These women got incredible results, losing an average of 19 lbs and reducing their fasting insulin levels by 50% in 2 months—eating all the nuts, fruit, vegetables, fat, and animal proteins they wanted. In this study, the women counted no calories, carbs, protein, or macros. They just avoided foods that spike insulin. It’s very simple.
This research has been repeated three times, and a randomized control trial is set to be published soon. In this trial, the lifestyle was tested against conventional medical advice for PCOS and insulin resistance (eat less, exercise more, and take medication).
We talk about the science of insulin resistance and how food impacts insulin, why we need to start focusing on insulin as a medical community, and how to take back your life, manage your appetite, and stop cravings—all the good things—so you can live with lower inflammation, better mood, and better energy.
We might have discussed this lifestyle plan if you’ve seen me in the past few weeks.
This podcast is a must-listen if you’re struggling with
Abdominal weight gain and difficulty losing weight
low energy
hunger and cravings
considering Ozempic or other GLP-1 medications
PCOS and other insulin-resistance conditions
Have seen high insulin, high blood sugar, or high cholesterol on your bloodwork
have hypertension, insomnia, energy crashes throughout the day, irritability
inflammatory conditions (anything that ends in “itis”)
a family history of Alzheimer’s and dementia
a family history of cardiovascular disease
…and so on and so on- everyone can benefit as 90% of us are insulin resistant, and I’m becoming more and more convinced that conditions like “adrenal fatigue” or menopausal weight gain are due to elevated insulin levels affecting our bodies’ ability to get energy and burn fat.
I’m so excited that Dr. Ali agreed to speak with me and that she was so generous with her time and information.
Speaker1: [0:02] So welcome, Dr. Ali Chappell. Thank you for meeting with me.
Speaker0: [0:06] Thank you for having me.
Speaker1: [0:07] Yeah, and how I found you, just for the audience to know, is I was on a very popular Instagram account about glucose regulation. We may not mention the name, and that shows a lot of continuous glucose monitoring. And one of the things that it highlighted was if you combine, like if you eat if you combine chickpeas with fat, you get less of a glucose spike. And I was drawn, my attention was drawn to your comment. And you had a very thorough, very interesting comment about how, I know, partly why that glucose spike is reduced is because when you combine starches and fats together, you get this big insulin spike, which is lowering your glucose. And it, you know, as a naturopathic doctor, you know, I think, you know, we pay a lot of attention to insulin resistance, we pay a lot of attention to blood sugar, glucose, metabolic health, but there’s something about how the medical community and even natural health doctors tend to frame everything about glucose, you know, and this is a very popular Instagram account. Everyone loves it. It’s like all about how to lower your glucose. And we forget that it’s actually insulin that we’re trying to regulate. And so then I started following you, you know, read your book, read your research. And so I’m really excited to have you on.
Speaker0: [1:25] It’s my favorite topic.
Speaker1: [1:26] Yeah.
Speaker0: [1:27] I, Sometimes I get a little frustrated when I scroll through Instagram because it is this very glucose-centric, but that’s not just Instagram, that’s the medical community as well. So I think we’re turning a page and I think we’re moving in the right direction from a medical perspective, but we’re not there yet completely.
Speaker1: [1:47] Yeah, like we’re hearing the word insulin mentioned more, but it’s still all about glucose. And so maybe we can start by you explaining a little bit about, you know, blood sugar, insulin resistance and insulin, you know, and I mean, I told you in the email and in our communication that my audience knows, they have a bit of a background about insulin resistance, but it’s always helpful to hear it again. And also for newcomers that are just joining, it would be helpful for them to hear a bit of an explanation.
Speaker0: [2:14] Yeah. Well, maybe I’ll start with how did I even get into this, right?
Speaker0: [2:19] And where did Um, you know, I have PCOS. I started having symptoms at 14, just a lot of weight gain and acne. And at 21, uh, and I had one period a year. Um, and at 21, I was studying to be a dietitian, never heard of PCOS. I went to the on-campus clinic and a women’s health nurse practitioner diagnosed me and basically said, well, you need to lose weight, which every dietitian loves to hear.
Speaker0: [2:46] And that, you know, I need to watch my weight. And, you know, here’s a brochure and a pat on the back and here’s some of my pentacle pills. And that was, that was it. And I was like, how does my diet and my ovaries have anything to do with each other? Like I literally am about to graduate with a bachelor’s in nutrition. I’ve never heard of PCOS. So that really where I started researching this and was like, it has all to do with insulin resistance. And at that point, the only thing I knew about insulin was, you give it to diabetics to lower their blood sugar. That was all I knew. So it was understanding really how insulin is the driving factor of PCOS. So then I thought, okay, well, what raises your insulin levels? And that really led me down this journey of, well, okay, so there are certain foods that raise insulin, even if they don’t raise blood glucose. And what does that mean? And what are those foods? And that is really what started this journey. So, you know, I incorporated this kind of what low insulin diet, although I just don’t like the word diet. It’s kind of a four-letter letter word, especially because I struggled with binge eating for so long because of PCOS and because I couldn’t lose weight. So I called it a low insulin lifestyle.
Speaker0: [3:52] And that really started the journey. It worked, you know, it was amazing results for myself, you know, with acne and, you know, helping me lose weight. And so that’s when my PhD advisor was like, well, why don’t you just do a study
Speaker0: [4:05] and see if it works for other people? And so, you know, I was very lucky. I got grant from the Laura W. Bush Institute for Women’s Health Research, you know, a prestigious research scholar grant for $25,000, which allowed me to kind of start the study. And that really, the results were, you know, better than I could have expected. I was working with a reproductive endocrinologist, and she was sending only all of her patients. And so that really led down this journey. So now we’ve been, we’ve done three studies now, a randomized control trial. And So here’s what that is kind of what’s launched this whole low insulin lifestyle and all the data to support it. But, you know, I think when you start with understanding that over the past several decades, more than that, probably.
Speaker0: [4:52] Medical establishment focuses on glucose, and they don’t really care about how you lower glucose. They just want glucose within a normal range. And so that has led to the development of many, many drugs, pharmaceutical drugs, that stimulate the pancreas to make more insulin, right, in an effort to lower blood glucose. And once that patient’s glucose is in the normal range, they get a glurine check, and they’re off on their way, and they’re healthy.
Speaker0: [5:19] But the problem with that is that so many people, their pancreas is just overworking so hard to keep that blood glucose in the normal range that there’s a class of medications I’m sure you’re familiar with called sulfonylureas, and they stimulate the pancreas to make insulin. And yes, the glucose levels normalize, but the long-term side effects of these medications are pancreatic cancer and worsened insulin resistance. Because when you’re raising insulin levels in the blood, you’re going to have worse health outcomes. And so we’re now beginning to realize that it wasn’t ever the glucose that was the problem. It’s always been the insulin.
Speaker0: [5:58] And so I try to explain it as, imagine you hire somebody to fix your foundation of your home. And they come in and all they do is patch the cracks in the wall, right? And they fix the cracks. So you don’t see the foundation, you know, the cracks anymore. And you’re like, they’re like, all right, it’s fixed. And you’re like, did you really fix it or did you just fix the symptom? Because that’s the problem. Glucose imbalance is a symptom of an insulin problem. And so I think now, finally, we’re starting to really turn the page and say, well, you know, if I’m not measuring insulin, then how do you really have the full picture of what’s going on in the background to make that blood sugar go well? Does that make sense?
Speaker1: [6:42] Yeah. Yes, definitely. Yeah, it’s infuriating, as you said. I mean, people will have all the symptoms, which I’m sure we’ll talk about, of high insulin, insulin resistance, but their blood sugar will be normal, even ideal. Their HbA1c will be ideal. And then it’s like, okay. So often what I have to do when people bring in blood work if we’re not ordering it ourselves is like kind of look peripherally at the signs and symptoms like, oh, you have high triglycerides, you have low HDL. Oh, you’ve noticed weight gain, you’re not sleeping. So it’s looking at kind of all around it when we could just directly measure insulin. It’s not very expensive.
Speaker0: [7:18] It’s not, but you know, there’s some problems with that. So historically it was using what are called immunoassays, which are We’re not always very consistent, but now we’re using mass spectometry, which is very consistent, very accurate. So a lot of the providers and the things, why the reason that measuring insulin isn’t in standard practice guidelines is because they say that the results are not necessarily always accurate, and so they don’t want to test that. That’s not true anymore, right? We have devices that can measure hormones in urine using your phone. And you’re telling it, we can measure insulin accurately in the blood.
Speaker0: [7:58] The second problem is that we haven’t developed standard normal ranges. Okay, so if you go and get your insulin tested today, whether it’s through Quest or wherever, all of them are going to have a different range of normal and they’re all wildly inaccurate. So they’ll say that anything between 3 and 30 micro units per milliliter are normal. Like anything over eight is considered to be too high. And some even say even above six is too high, but eight is as a more well accepted, you know, they’ve been, they’ve done some studies looking at this and over eight really is where you, it sets you up for, you know, problems. So for somebody, I’ve had plenty of people say, well, I have all these symptoms, but I’m not insulin resistant. And I’ll say, well, did you get your insulin tested? And they said, yeah, it was 22. I’m like, well, that’s three times higher than it needs to be, you know, but we don’t have the standard normal ranges. So until we have mass awareness that testing insulin is important, normal ranges so that people actually know what is and is not considered a problem, then I think we just, and also just the general education of the healthcare community that measuring insulin is the other part of the conversation and even a bigger and more important part than just glucose um because otherwise people are just walking into a house and you know assessing the foundation by whether or not there’s cracks in the walls and that’s just not how you do it.
Speaker1: [9:27] Yeah and i think too um knowing how to treat it right because a lot of people and and also for the canadians eight uh is about 42 or 50 in the standard units so people looking at their blood ever being like that.
Speaker1: [9:45] But still, you know, the ranges in the SI units go up to 300. And I have seen people over that range, but not commonly. But often people will have a HOMA IR value that is abnormal. So it’s a little bit more nuanced and helpful, which is a calculation with fasting glucose, fasting insulin. But another part is just knowing how to treat it because people are told like, well, you’re already eating well, very general term, and moving. So let’s just watch and wait until you have type 2 diabetes, and then we’ll give you drugs for it, basically.
Speaker0: [10:22] That’s absolutely what’s happening. And that’s where really the issue is. And what I’m trying to do is that the standard nutrition recommendations don’t really work for insulin resistance, because they’re not focused on minimizing insulin spikes. So I’d always like to use this like an orange with thumbtacks. I don’t know if you saw that post on my profile.
Speaker1: [10:49] Yeah, that was good.
Speaker0: [10:50] Yeah, I thought I.
Speaker1: [10:50] Was stealing your idea from my course I’m doing. It’s a great vision.
Speaker0: [10:54] The more education gets out there, the better. So, you know, I kind of show this orange with these thumbtacks. And I say, well, this is a cell. And these thumbtacks are your insulin receptors. And when you eat foods that spike insulin, and I’m gonna say insulin, not glucose, although sometimes they’re together and sometimes they’re not, but we’ll talk about that later, is that when you eat foods that cause these insulin spikes.
Speaker0: [11:16] Those receptors become overwhelmed with all the insulin in circulation, and they start basically saying, whoa, whoa, whoa, I’m overwhelmed. I’m going to start removing these receptors from my surface. And when that happens, there are fewer receptors where insulin can bind and pull glucose in because the only way they get glucose out of the blood is to have insulin bind to a receptor and it pulls the glucose into the cell. Well, if you have less receptors, then you have less ability to get glucose from the blood.
Speaker0: [11:45] Well, pancreas then says, hey, wait, there’s too much sugar in the blood. We can’t have all this sugar in the blood. So it sends out more insulin. And that kind of starts this vicious cycle. So now you’ve got the pancreas compensating for these reduced number of receptors, which then makes more receptors disappear. And here you are eating every two hours foods that are causing more insulin spikes. And it really causes this huge vicious cycle because more insulin in the blood means more of the food you’re eating is going to be stored as fat as compared to used. And it also means your metabolism is going to slow because your brain says, whoa, my cells are starving. We don’t get enough glucose. I don’t know where my next meal is coming. I’m going to slow everything down so that we don’t have to start burning muscle for energy. And that’s when you go take naps. And that’s when you have chronic fatigue. So all of it really starts with what you’re eating and whether it’s spiking your insulin, because that is the stimulus that gets the snowball rolling.
Speaker0: [12:50] And then, you know, at that point, the problem that most people find is that they will have all these symptoms. And like you said, their glucose will be normal because your pancreas is still able to secrete enough insulin. It just… It just can’t get the job done. It can keep the blood glucose level stable for long enough, but eventually it starts to get out of hand. I think of like the I Love Lucy episode. I’m dating myself. But, you know, when they’re in the chocolate factory and they’re like, oh, this is okay. Like, we’re good. And then the machine like starts going and they’re like, whoa, whoa, whoa, I can’t keep up to date. But that’s basically like your blood sugar, essentially, where it starts to
Speaker0: [13:32] get too out of control and they no longer can get it managed. The pancreas can’t manage it. So I hope that I like to give these visuals so that we understand like what’s happening below the surface.
Speaker1: [13:42] Yeah, I often use the like beach ball. It’s like, OK, your beach ball, you’re pushing it down. But the more buoyant it is, the harder you have to push. So the amount of insulin is telling us how hard are basically is your pancreas working to keep your blood sugar where it is. So your HbA1c is, let’s say, 5 percent or your fasting glucose is 5. These are the Canadian units, which is normal, which is ideal. But there’s two people with the same blood sugar. One may have really high insulin pressing down on that fasting glucose and someone else may have low insulin. So their cells are a lot more sensitive. And so it’s like only when you can no longer suppress it, then you start to see rises in blood sugar. And then you start to, you know, have your doctor call you in to say, hey, you’ve pre-diabetes, you know.
Speaker0: [14:29] Yes. I think that’s the other thing. I wish that the diabetes community would come up with different terms for the different types of type 2 diabetes, right? Because if you’re just measuring a glucose, well, you don’t know if that person’s making so much insulin, it’s just not working very well. Or if their pancreas is, I call it a lazy pancreas, if you saw in my book, right? Or they have a lazy pancreas. So, you know, I think there’s quite a bit of people now talking about these very thin people who say, I’ve always struggled to gain weight. I’ve never been able, I’ve never had to struggle with my weight, but now I’m pre-diabetic. What’s going on? Well, and that also is kind of, and I talked about how you can’t look at other people and say, well, look, they, you know, Asian people eat all this rice and they’re very skinny. And how can they get away with it? It must be good for you. Oh, they have a definite, a very different metabolism. They can’t make enough insulin, right? They’re not going to gain weight no matter what they do. So, you know, it’s just, it’s like we need a type A, a type 2A and a type 2B.
Speaker1: [15:29] Yeah, that’s true. Yeah, it should be called different things ultimately because it’s, yeah. I mean, one of the things I was seeing in practice, not so often, but my type 2 diabetic patients were being prescribed insulin, which is wild, right? Because you’re getting more of the thing that’s driving the disease process is very short-term, short-sighted thinking based on a paradigm that’s not, the whole paradigm is shifted off of what’s actually true, which is weird. Because it’s not that hard to just shift it to more accurate, which is what you’re doing.
Speaker0: [16:04] And even if you have, let’s say you have a lazy pancreas, right? You can’t make enough insulin to keep up with the food that you’re eating. Giving them a medication like a sulfonylurea to just force that poor little overworked, you know, pancreas to make even more insulin is like kicking a dog while it’s down. Like it can’t keep up. And now you’re going to force it to make more. And all that’s doing is going to lead to beta cell failure. And then they are going to have to take insulin because their pancreas is going to be so worn out, it can’t function anymore. And that does happen to the other group too, right? I mean, eventually their pancreas is like, I’m retiring. I’m done. I’ve been overworked for so many years. I’m just not, I’m just, I’m just done. And then they then become. So I wish that we could get to a point where diabetes management is insulin management and not glucose management. But there’s just a lot of education that would have to be done, I think.
Speaker1: [16:58] Yeah. And I think, you know, you were coming at it from your own experience, which is having PCOS, which for anyone listening, if you don’t know, polycystic ovarian syndrome, which is a condition of insulin resistance. But it’s often not framed that way or treated that way. I mean, one of the therapies is metformin, which is a diabetes drug. But, you know, people are also prescribed, like, testosterone blockers and anti-androgens and birth control to regulate the period, which, you know.
Speaker1: [17:31] But, yeah, and I think, yeah, a lot of conditions that are not being flagged as being insulin-resistant conditions, you know, and again, this is kind of more of that same problem. And how insulin resistance can affect you know aside from sort of diabetes it has all of these other symptoms in the body potentially Alzheimer’s weight gain and these changes in in menopause and perimenopause that can increase insulin levels that can contribute to all these symptoms that people notice like I’m having difficulty sleeping you know I’m irritable my I’m noticing all this weight gain and I haven’t changed my diet or I haven’t changed my exercise and all these really frustrating symptoms that people are just left to deal with on their own. And they’re told to exercise and diet more, which is difficult because as you mentioned, you’re fatigued, you have all these cravings, your blood sugar’s cycling, your insulin is spiking and it’s making you starving and tired. And so, yeah, we’re sort of missing a huge opportunity to treat people.
Speaker0: [18:38] You know, if, first of all, insulin resistance affects 89% of U.S. Adults, but just as many, you know, abroad as well, as well as children, you know, insulin resistance really starts in the womb.
Speaker0: [18:52] So before a mom even gets pregnant, they’ve done studies where they can take
Speaker0: [18:56] insulin in a mom before she even conceives. And it will predict whether her female child would have early puberty because when they have too much insulin over the course of pregnancy, and pregnancy is a natural state of insulin resistance because insulin resistance helps you store fat and it helps you grow. And so insulin resistance is super important in pregnancy. But if you already had too high before you even got pregnant, then you’re even higher. And that leads to the baby to have genetic changes that leads them to over-secrete insulin. And your breast milk, because milk has insulin in it, it’s what helps cause insulin resistance in a newborn baby because insulin resistance is important in newborn babies because what are they doing? They’re growing and they’re storing fat. So that breast milk is helping do that because their pancreas isn’t advanced or mature enough to make enough insulin, so they’re getting their insulin from the breast milk, which happens from cow’s milk too. We can talk about that later.
Speaker0: [19:58] So, you know, they’ve even looked at moms who have high insulin levels. Their breast milk has higher insulin levels, which means that baby’s getting more insulin from the mom. And that leads them to this spiral. So when we look at all these intervention programs for young kids who are overweight and obese, the intervention is like almost too late by that point. The intervention needs to start in the reproductive age women to get them as healthy as possible before they even have a baby.
Speaker0: [20:24] But you know I say all that to say you know.
Speaker0: [20:28] There could be nothing more important than insulin management because, like you said, especially menopause is the same thing. It’s this very, I wouldn’t say natural phase of insulin resistance, but it is. I mean, when estrogen drops, insulin rises, and they start having all these symptoms, including cardiovascular disease. That’s why heart disease risk increases after menopause.
Speaker0: [20:49] And it’s definitely something that we’re missing, for sure.
Speaker1: [20:53] Mm-hmm. Yeah, I also in my course talk a lot about these sort of vicious cycles of inflammation driving insulin resistance and vice versa. And then you mentioned like muscle breakdown in order to get glucose levels normalized, which, you know, reduces some of our insulin sensitizing capacity because we have less muscle. And so there’s all these, you know, stress and how that affects our blood sugar and how that affects our insulin. And so we’re kind of caught in these like snowballs and, you know, which also resists kind of very basic treatment recommendations like, oh, just eat less, exercise more. Eat less, exercise more. Yeah, exactly.
Speaker0: [21:33] So, you know, that kind of goes back to this journey and what I just realized and what I understood about what foods really spike insulin. And so I think, you know, I can get wrapped up in how bad insulin is and what it causes and all these things. And people are sometimes like, OK, I get it. But like, what do I do? So, you know, the thing about insulin is that first, what we’ve been teaching for nutrition perspective, you know, all through my dietetic education and everything was more whole grains, more beans, less meat, more low-fat dairy. I think that’s been pretty much the advice that we’ve been given. And the problem with that is that, you know, when you look at whole grains and beans and sweet potatoes, they’re all starches, right? And starch is the only carbohydrate source that is pure glucose. Now, of course, those foods give you protein and fiber and vitamins and minerals, right? But they also give you lots of starch. I mean, a third of a cup of quinoa is 36 grams of starch. That’s a lot of starch. Well, the problem with that is because starch is essentially just made up of pure glucose. Pure glucose chains, that’s what starch is. So when you eat that and you break all those glucose molecules up, all that is doing is causing a huge insulin spike. So when people say, well, we should be able to have some starch, it’s not that this is a never thing.
Speaker0: [23:00] It’s like telling somebody with a peanut allergy that they should be eating peanuts because they’re healthy for them. When you’re insulin resistant, it means you’re glucose intolerant. That is essentially the medical term to our glucose intolerant. That’s why we give them glucose tolerance tests. And if you fail that, which most people do, it means you’re glucose intolerant. So the last thing you want to be doing is eating sources of pure glucose, right? That’s not going to really help you towards your goal. So when you think about carbohydrates, it’s not about limiting your total carbohydrates or having to count them. It’s simply getting them for foods that are lower in glucose, which are non-starchy vegetables and whole raw fruit versus starches. And the other thing is that, yes, those foods give you fiber and protein and vitamins and minerals, but you can get all of those same vitamins, minerals, protein, fiber in more insulin friendly options. So that’s one component that’s kind of against conventional nutrition recommendations that’s part of a low-insulin lifestyle is limit the starches as much as you can. Eat as many carbs as you want just from fruits and veggies. The second is around dairy.
Speaker0: [24:13] So remember, breast milk, the purpose of breast milk is to provide insulin and insulin growth factor. Insulin growth factor is this very, very potent growth hormone.
Speaker0: [24:24] In infancy, it’s so important. It’s what helps babies double their length and triple their weight in the first year. It’s the most rapid time of growth. I mean, just look at the clothing sizes. Anybody who has a head of baby sees that these babies are growing. But adults, or really even after infancy, were not growing really. that much. The next time that IGF-1 or insulin growth factor levels increases, again, is during puberty when we’re growing. You don’t want, you know, insulin growth factor, IGF, you don’t want IGF levels to be high throughout the lifespan because IGF-1 is the strongest predictor of cancer risk because cancer at its most basic is an overgrowth of cells, right? And so that’s just a growth hormone that’s telling your cells to grow. So milk provides both insulin and insulin growth factor. And cow’s milk provides even more than human milk because look at how much a cow has to grow. So from a milk perspective, milk is very, very insulin spiking because you’re essentially just drinking insulin. Okay. Now, the second component of dairy that’s very insulin spiking are the proteins in milk. So the proteins in milk are whey and casein. They have a very unique amino acid profile. They’re the most concentrated sources of branch chain amino acids, which are essential. You need them to build muscle.
Speaker0: [25:46] You don’t need to overdo them because overdoing branch chain amino acids causes excessive insulin secretion. And there’s tons of research looking at branch chain amino acids and type 2 diabetes. So, you know, that really begs this question of, well, we have whey protein in everything. I mean, when one walks down the-
Speaker1: [26:04] So popular you know protein cereal it
Speaker0: [26:07] Is in everything and the reason it’s in everything is because it’s a waste product from the dairy industry to make one pound of cheese it makes nine pounds of whey waste and they didn’t know what to do with it all so in the 70s and 80s somebody was like oh let’s powder this and dry it and we’ll aggressively market it to the fitness industry and you know it’ll be a high protein we’ll market it as protein and put it in everything because it’s a waste product and it’s they couldn’t they’re not allowed from the environmental protection agency if that still exists um they’re not allowed to pour it down the rivers because it killed all the fish because it causes algae bloom so they literally didn’t have anything to do with it um and so they started marketing it to people and it’s now a multi-billion dollar industry so now you look at, anything and everything. And it has whey protein in it, not because it’s healthy, but because it’s very abundant, if you can imagine.
Speaker1: [27:06] I’m so guilty of recommending it. And there’s also this conflicting, I think you made a good point about how it’s not like people get confused and they get wrapped up in emotional. And so for anyone listening, it’s not about like foods being, it’s not about like quinoa being bad. It’s about what your underlying health concerns and health goals are and whether it’s appropriate like glucose you’re not glucose tolerant just like someone who can’t consume peanuts they’re not peanut allergy but it’s some right and so when we hear of like branch chain amino acids and whey protein stimulating protein muscle synthesis it’s like okay that is appropriate for that context maybe but if we look at the context of someone who’s insulin resistant you don’t need to be spiking your insulin and this could be working gains too and this is what I was on a keto diet which we’ll probably talk about and I was like why am I not really getting that great results while I was mixing my whey protein into some yogurt high fat yogurt natural yogurt and I was like when I read your stuff I was like oh okay that’s why I’m starving after I have this
Speaker0: [28:18] Well, and let’s go back to, because I do get a lot of criticism when I make posts about whey protein from the bodybuilding community, because let’s talk about why is it effective for stimulating muscle growth?
Speaker0: [28:30] Because it spikes insulin and it spikes insulin growth factor. And those are growth hormones. I mean, they’re not that different than anabolic steroids. An anabolic steroid means growth hormone. And insulin and IGF-1, especially IGF-1, is a growth hormone. So if you’re eating things, I mean, there are some bodybuilders who are just injecting IGF-1. Like that’s now part of the doping, the doping, like where the Olympic Association is now measuring blood levels of IGF-1 to determine whether people are doping. That’s how strong of a growth hormone it is.
Speaker0: [29:06] For somebody who’s like taking a walk around the block and then coming home
Speaker0: [29:09] for a whey protein shake is not only counterproductive, but possibly worsening. And so that’s the thing is you’re going to the grocery store and you’re buying these protein pancakes thinking, well, there must be better than regular pancakes. And actually they’re worse because it’s the same processed flour, but now you have processed flour with whey protein in it. And that manufacturer of those protein pancakes paid nothing for that whey protein because it was just a waste product. And they’re charging you more for it because you think it’s healthier because it says high protein. I mean, it’s just, and even then, even if you’re not buying the protein pancakes, it’s in everything. I love Birch Bender’s pancake mix, the keto pancake mix. Well, they recently reformulated their recipe to add whey protein in it, but it’s not high protein. It’s not a high protein food. They added whey protein as an additive for who knows what. So it’s just, it’s literally in everything. And it’s like, why would, you know, to think about it, even in one cup of milk, right, if you just get a cup of milk.
Speaker0: [30:12] 20% of the protein in a cup of milk comes from what? Only 20%, which is probably biologically being like, well, we want these babies to grow, but like, let’s keep it kind of regulated, right? Let’s not make the whole thing just this huge insulin spike. But yet now we’re concentrating it and adding multiple scoops to a propotein shake and having way more branched chain amino acids and insulin spike than nature ever intended. And it’s scary. So, you know, that’s kind of the whole thing about dairy. But I’m not dairy free. Because, and I’ll, sorry, you had a question.
Speaker1: [30:52] No, no, no, go ahead. No, I think, well, yeah, go ahead.
Speaker0: [30:55] Yeah. I’m not dairy free. You would think, well, obviously she doesn’t eat dairy. No, because fermented dairy, when you think about Greek yogurt and cheese, to make Greek yogurt and cheese, you have to remove all the way. Okay. That’s why they’re, that’s why Greek yogurt is very thick compared to other types of yogurt. Skier is very thick compared to other, like regular Yoplait yogurt or whatever at the store. It’s kind of runny. That’s because it still has a lot of whey in it. Same thing with cottage cheese. It has a lot of whey in it because whey is liquid. But Greek yogurt and cheese, the way to make those is to completely remove the whey. So you’re just left with casein. Now, casein still raises insulin and insulin growth factor, but when you ferment those, the bacteria changes those branched-chain amino acids to branched-chain ketoacids. It changes the actual structure of those branched-chain amino acids, which lowers that insulin response. So when you look at these studies that look at dairy and health, they all will say, well, yogurt’s still good for you and people see a benefit because you have the probiotics from the fermentation, but you also have fundamentally changed the insulin component, the insulin spiking component of that casein. So you have a much more insulin friendly product. So I still, so it’s Greek yogurt and I recommend full fat because if you take out the fat, what are you concentrating? The protein.
Speaker1: [32:23] And the sugar.
Speaker0: [32:24] Protein is, yeah. So you want the fat in there because you don’t want so many dairy proteins. You know, dairy proteins, their biological purpose is to stimulate insulin. So I still recommend that if they’re going to, you know, for a low insulin lifestyle, we recommend getting rid of all dairy except full fat Greek yogurt and aged cheese.
Speaker1: [32:44] Yeah, which is great because it still gives you, like you said, there’s a lot of studies where it’s like, you know, yogurt can reduce belly fat, so it can be confusing for people when they hear. But I was going to say when you were talking about whey protein and the insulinemic effects, if you are monitoring your glucose with a continuous glucose monitor, adding whey protein would probably lower your glucose. Yeah.
Speaker0: [33:11] Yeah. And so that’s another thing. It’s so funny. I get, I get these people that are like, you don’t know what you’re talking about. I wear a continuous glucose monitor and it doesn’t spike my glucose. I’m like, I didn’t say it spiked glucose. Whey has no glucose in it. It’s not going to affect your glucose. It’s going to drive insulin. But you know, one of the things that protein also does naturally is it also, this might be too sciencey and we don’t even have to get into But.
Speaker0: [33:37] You know, you have glucagon also, right? So you have insulin and glucagon. And when glucagon rises, it releases glucose from the liver. And so they’ll say, oh, well, it increases glucagon, which makes people more full for longer. And that’s all true. But the reason it stimulates glucagon is because if it doesn’t, a person’s going to be hypoglycemic. It has to have that glucagon release the glucose into the bloodstream so that it doesn’t overcompensate and drive the blood sugar down too low. Does that make sense? So you have a net neutral of glucose because you’re releasing more glucose into the bloodstream from the liver, but you’re also blocking, you know, pushing glucose down lower because you’re trying to drive it into those cells. That’s why it’s great for muscle building but you don’t whey protein after a workout yes you need insulin to drive muscle growth and get those amino acids into the cells to build um but that’s like whey protein is like starting a fire and throwing gasoline on it like you can start a fire without gasoline yeah it may be faster with gasoline but you’re going to cause potentially a lot more.
Speaker0: [34:44] Problems than you intended by doing that. So yeah, definitely if people want to have a protein powder, I recommend foods with a much more balanced amino acid profile like egg white protein is great. My husband loves J-Rob. We’re not affiliated. That just seems to be a really good one. J-Rob egg white protein is good. Bone broth protein powder is also a good one or if they’re plant-based um, hep C protein is, uh, is a good one as well.
Speaker1: [35:14] Okay. Yeah. Thank you. That’s good. What about pea proteins? People ask me this all the time. So often they’ll remove the starch, although peas would naturally have starch, but do you know about the branch amino acid?
Speaker0: [35:26] Well, they are not going to have many. They are, they do have some, so they are like a complete protein, although that’s not even necessary. Like you don’t have to have every single protein source have to be a complete protein every time. As long as you’re eating a variety of protein foods, you’re going to get all you need. So when people say, well, bone broth protein is not a complete protein, you’re going to be fine. But with pea protein and brown rice protein, yes, they do remove the starch. So from an insulin spiking perspective, it’s better. It’s okay. It’s just that they’re very processed, right? They go through a very extensive processing to remove all that starch so that you can get that concentrated protein. Whereas hemp seed protein is just hemp seeds, Right now, it does top taste like the inside of a lawnmower, so you better like that earthy taste.
Speaker1: [36:19] It’s pretty rough, but you can doctor it up and make it taste pretty good.
Speaker0: [36:23] Or you can just sprinkle hemp seeds into your smoothie and they don’t have a taste at all. But the same thing with like now they’re coming out with these new protein powders like almond protein powder and pumpkin seed protein powder. They’re just processed to remove all the extra fat which you should be getting anyways because fat is good for us but it concentrates the protein because everybody is so obsessed with getting more protein getting more protein but i’d like to challenge that a lot of that came from the marketing of the whey protein powder industry um that’s interesting to make people think they needed 200 grams of protein a day yeah.
Speaker1: [37:02] I mean well and also and i’m definitely guilty of pushing the protein thing. But when people have high insulin, like generally just high fasting insulin, I mean, you’re already kind of set up to technically build muscle.
Speaker0: [37:17] Yeah.
Speaker1: [37:18] That’s a big complaint.
Speaker0: [37:19] Yeah.
Speaker1: [37:20] People are like, I easily put on muscle. I just can’t lose weight. It’s like, well, okay, then you don’t need whey maybe.
Speaker0: [37:27] No, you definitely don’t need whey. I hope that I don’t ever sound like I don’t think protein is important. Protein is absolutely important. I do not track protein at all. I did track one day just to see like, what do I get? I’m curious, you know, and I had about 95 grams of protein and that’s like from peanut butter. I love shelled, I love shelled edamame and like, you know, for lunch, I eat a pound of frozen vegetables that I put in a pan and I cook it in some avocado oil and I throw shelled edamame, like a half cup of shelled edamame and I sprinkle some grated Parmesan cheese and some toasted a pecan and it’s like this big and I will eat the whole bowl. And it’s like 30 plus grams of protein just for that. You don’t really need to track it as long as you’re being mindful that every meal you’re having fruits and veggies, you’re having something protein and you’re having some fat, you’re going to be fine. I think this idea of these excessive protein goals came from the fact that the only way you can meet that goal is by using protein powder, which then plays into the industry, you know?
Speaker1: [38:33] Yeah, I mean, we’ll get into this, but I think I was going through one of the studies where it showed sort of the macronutrient results because they had people do diet diaries. You had people do diet diaries a couple times during the two months. And yeah, they were eating about 90 grams a day, which is a lot of people struggle to get that much. And I wonder if maybe there’s something about kind of removing the food noise by having like, OK, here’s the foods that you’re eating. And, you know, a huge chunk of that is protein foods. Um maybe there’s something about how starch kind of changes our appetite or or our satiety so we’re not really interested in protein but yeah it’s interesting that we’re kind of falling into it you know
Speaker0: [39:13] They i mean these were patients who were you know very overweight they their average fasting insulin was 31 now remember it needs to be eight so their average fasting is eight or less Their average
Speaker0: [39:26] fasting insulin was 31 and their A1C was 5.2 or 5.3, like totally normal. If they went to the doctor, the doctor would be like, you’re healthy as a horse. I don’t know why you’re having all these symptoms, you know, come back when you’re in bed. Right. That’s basically what they’d be told. And behind the scenes, their insulin is three or four times higher than it needs to be. And we basically said, okay, well, you’re going to follow this plan. You’re going to eat as much as you want, whenever you want. at these foods that don’t spike insulin. Non-starchy vegetables, whole fruits, you know, lean proteins. We didn’t even stress the lean on the protein, but we were like, just trim visible fat. By no means do you need to eat egg whites. Like eat the eggs. Make sure you’re getting lots of healthy fats. I even was encouraging them. I was like, I want you to eat a whole medium avocado every day. Like I want you to make that a goal.
Speaker0: [40:19] And that was it, right? And then we told them, you’re gonna, first eight weeks, we want you to not eat anything on this list of insulin spiking foods. Also, you can have either Greek yogurt or cheese, but only one serving a day. And you could have red wine. If you want to, because it’s a sustainability, am I saying red wine is a health food? No, but… It is part of like just having something that’s sustainable that you can have as a treat and they could have an ounce of dark chocolate. And, you know, what’s really important is we didn’t allow them to exercise. And not the exercise is, of course, important. And we recommend exercise for a clinical research study. You have to make sure that the results they’re seeing are from the diet changes and not that exercise. So they couldn’t exercise. And that was it. You know, and two months later, they lost 19 pounds. They had a 50 percent reduction in insulin. They had a 50-plus percent reduction in HOMA-IR. They had a 35% drop in triglycerides. I mean, two months. Their testosterone levels went down by 25% because they had PCOS. I mean, it was crazy. The results and those results have been extended to all of the studies that we’ve done. And what was great was that they did these diaries. And so for whoever’s listening who hasn’t read the studies, their average calorie intake was just around 1,400 or 1,500 a day. I mean, again, not counting calories, eating whatever they wanted, their carb intake.
Speaker1: [41:42] As many nuts as you want.
Speaker0: [41:43] As many nuts, as much fruit, whatever they want.
Speaker1: [41:46] Red meat.
Speaker0: [41:46] Red meat.
Speaker1: [41:47] Yeah.
Speaker0: [41:49] And one girl told me, she’s like, I ate an entire pack of bacon. I know I wasn’t supposed to do that, but I kind of like just binged on a pack of bacon.
Speaker0: [41:58] I’m not saying bacon’s healthy. You should not eat bacon. It was uncured bacon, thankfully. But because their body is able to burn that fat, it wasn’t just circulating in the blood causing triglycerides, right? And so their fat intake was very high, right? I think they had 70-plus grams of fat, which coming from avocados, the actual breakdown was it was largely monounsaturated. It was coming from nuts and avocados and oils and whatnot. So, you know, that’s the thing. It’s when people get their appetite hormones more regular or regulated, they just don’t feel as hungry. I mean, that is one of the most common in the very first place. Testimonials that people tell me is when I make an, when I take an insulin first approach, not glucose, not calories, not protein. When I take an insulin first approach and insulin levels lower, your appetite hormones regulate. And they’re like, I’m just not hungry. Like I can’t believe that I have no cravings for anything. Like I’m just content and satisfied. It’s like, because your body can access your stored body fat now. And it doesn’t need to force you to eat all the time because prior it was like okay you have a lot of fat in here but like I can’t use it so I need you to keep eating because that’s the only thing I can use for energy, and now it can tap into that fat stores and so it’s like oh I’m good I don’t you can eat if you want but like I’m good yeah that’s essentially what your brain is saying.
Speaker1: [43:22] Yeah I remember reading that thing in the 1400 I was like wow because you’re eating ad libina which means just whatever you want like you can eat as much of all those allowed foods I mean there’s restrictions for the dairy in terms of portions but nothing else has portion restrictions and so people are kind of naturally settling into 1400 calories which i wonder if i mean on a diet diary day i probably wouldn’t eat my pound of bacon so it might oh no not be she didn’t report
Speaker0: [43:49] That that was not on the diet.
Speaker1: [43:50] I think that’s probably maybe like i’d be on my best behavior so that might be a little i don’t know if you agree it might be like lower than what they were eating um but they were the weight loss And I know it’s not all about weight loss, but I think it’s so difficult to lose weight when you’re insulin resistant. And a lot of like ketogenic diets and kind of zone diets, I’ve been looking at a lot of research for a course that I’m producing on insulin resistance. And 19 pounds in two months is like amazing. With no exercise. With no exercise. And no counting, no tracking, no restriction. They’re not restricting. I mean, they’re taking out certain foods. So maybe there’s an element of, you know, psychological restrictions like that. But you’re not hungry is the point, you know.
Speaker0: [44:37] And did you read our second study was really, you know, not to get too sciencey, but I think it really helps explain this concept is that, you know, we had patients get under this machine and it basically just measures oxygen and how much you breathe in and out. And it tells you whether you’re burning fat or carbs. I know science is cool. So it tells you whether you’re burning fat or carbs. Well, you know, these patients were coming in after not eating for 12 hours and they were coming in and they were burning almost no fat. Like even after fasting for all night long, their body still had so much insulin in their system that they couldn’t burn their fat. And then after that, we gave them this very high shake, high fat shake. It was just basically an insure that I added 70 grams of fat to butter melted.
Speaker1: [45:22] And also, they’re probably suffering 12 hours of no eating and they weren’t burning fat.
Speaker0: [45:28] Well, it was just that they hadn’t eaten since 7 p.m. the night before. They came in the morning. They, you know, we took them there at rest to see how much were they burning, how much fat were they actually burning after not eating for 12 hours, which most people should be only burning fat, right? You’re not, you haven’t eaten in a while. Like, you should be getting your energy from fast stores. None. They drink this high fat shake. Basically shows they stored all that fat from the shake and just burned the little bit of sugar that was in the Ensure. And that was it. All right. After eight weeks, they come in to do it again, burning almost all fat because now their insulin has dropped after the eight weeks of following this approach. They’re burning almost all fat. They drink the high fat shake, burn almost, you know, their fat burning from that after five hours was significantly higher than before. And it just shows while you go tell a patient with insulin resistance that the only way that they’re going to reverse insulin resistance is to lose weight and eat less and exercise more and come back, you know, and they’re like, I can’t even burn fat when I’m eating nothing. And it’s true. Like I lived to that. That’s why I was a binge eater. Like I would eat nothing because I was like, nothing else works. I’ll just stop eating. And then you eventually get to a point where you eat everything and then you just have this terrible cycle. But, and it’s, it’s so validating. I mean, that study was just so validating to the people who are like, I am doing everything and nothing is working.
Speaker0: [46:56] Um and then you know like just for the randomized control trial i’ll just say it was a it was an independent study right because with research like you have to have an independent group that can replicate your findings because that’s just that’s just important like i can’t run all the studies and be like this is so great somebody else has to do the same thing and see what they find um and they did they did a randomized control so half the patients just did general nutrition they They followed the NIH nutrition guidelines, which was more whole grains and beans and more low-fat dairy, and eat less and exercise more, and they got put on metformin.
Speaker1: [47:32] So they also had exercise and they had metformin.
Speaker0: [47:35] And exercise. And the other group just followed our plan with no exercise. And this was during COVID. So, I mean, this study started January of 2020. So you’ve got a lot of cortisol going along. You’ve got all these things happening. People stuck at home. And the group that followed our plan lost an average of 17 pounds. During COVID.
Speaker1: [47:58] When everyone gained the COVID-19.
Speaker0: [47:59] When everybody gained the weight. So they had, on average, it was between 12 and 17 pounds. And the group on the metformin and eat less and exercise more was, they gained a third of a pound. And their insulin levels went up. So it was just, yeah. So it really just is continuing to validate this. We’re missing the wrong biomarker, right? Insulin is really the only thing that matters and we’re just ignoring it. And it’s frustrating.
Speaker1: [48:26] I think, too, in that study, if I remember correctly, the control group, so like the high grains group, was also in a calorie deficit. Like they were told to eat 500 calories less. So they were supposed to be losing a pound per week kind of thing. And then they were exercising.
Speaker0: [48:43] Like everybody else. Yeah. They tried it because they were just standard nutrition advice, that control group. So the group that did the study was a group of reproductive endocrinologists. And they basically said, we just treated them like every other patient we treat. We have a brochure it talks about, you know, it’s just based on like the NIH nutrition information, eat less and exercise more. And if their fasting insulin was too high, which was pretty much everyone, we gave them metformin. And that was like just the standard of care. Like that’s what every other patient, except for most patients go to fertility clinics. We’re not getting their insulin tested because most fertility specialists don’t even understand that that’s the reason why these patients aren’t getting pregnant. And so, yeah, they just submitted the paper for publication. And so hopefully we’ll have that data published soon. But it was really great to have a completely independent group replicated. That study independently.
Speaker1: [49:39] Yeah, so how many studies are there in total? There’s three, I believe.
Speaker0: [49:44] So the three actual prospective clinical studies, one of those was a case series because out of the 24 patients in the original study, about 10 of them, not everybody was trying to get pregnant, first of all. Some of these patients were just trying to lose weight or improve their symptoms. But 10 of the patients, even though they, you know, were infertile, they had issues with pregnant, were getting pregnant. They were seeing a fertility specialist, which should say a lot. They got pregnant very quickly. And we had some, we had probably four or five patients who had to drop out of the study because they got pregnant in the two-month study. And they actually, so the fertility specialist wrote that up as a case series to said, you know, they talked about each patient. It was like, this patient has been infertile for this time. They’d done these different things and essentially showed that the average time to conception in these patients was 86 days after starting this lifestyle change. 86 days.
Speaker1: [50:42] That’s the average. So it had sooner. Yeah.
Speaker0: [50:45] And it blows my mind. You know, I have a friend, a couple of friends who have PCOS. And they, one of them had five miscarriages in like an 18-month period. And her doctor would refuse to test her insulin. And he said, your A1C is normal. You don’t need to test your insulin. Like, refused.
Speaker0: [51:06] And, I mean, it just blows my mind. It just blows my mind.
Speaker1: [51:09] Yeah, I think in your, there’s a lecture that you have on YouTube where you talk about how high insulin can increase the risk of miscarriage and pregnancy complications. So it’s not even just about getting pregnant. It’s also what the high insulin does to the health. Yeah.
Speaker0: [51:24] And that’s not even just PCOS. I mean, you know, that’s there was this really awesome study out of Columbia University, this group that their fertility division and their maternal fetal medicine department that was that does a lot of research on miscarriage. And this was published in Fertility and Sterility, which is, you know, the biggest fertility journal. And what they did is they said, okay, we’ve been testing glucose and A1C standard when somebody comes in with recurrent miscarriage, which means they’ve had at least two miscarriages within account, two repetitive miscarriages. And so they were like, but we’re testing their glucose and their A1C and it’s normal and it’s not necessarily associated with a higher risk of miscarriage. So what they did is they took some of these, they had patients who miscarried, and they took some of these early placenta cells, okay, and they put them in a petri dish, and they exposed them to either high levels of glucose or high levels of insulin.
Speaker0: [52:26] And what they found was that high glucose levels did absolutely nothing to those early placental cells. Nothing. High levels of insulin was as toxic to the developing placenta as chemotherapy drugs. And yet somebody comes in with recurrent miscarriage, and we don’t even test insulin. We only test glucose. And so that group alone, I mean, they’re a huge fertility center in back Columbia. And they were like, we’re missing the boat. In our clinic, we’re going to start testing insulin in every person. So it’s just, there are people that are out there talking about it,
Speaker0: [52:59] but it just hasn’t made it fully there.
Speaker1: [53:04] Yeah, it’s like it needs to kind of just, like, it’s like a Venn diagram. We’re not quite focusing in properly on what we should be. Yeah, and so back to the results. I mean, amazing. Like, people are getting pregnant. They’re losing consistently. Like, it’s not, I mean, I have a friend who’s started your program. Um, she’s on like day five and she’s like giving me a daily update. She’s like, I was so hungry. Now she’s like, I’m not hungry anymore. I feel amazing. I’ve lost just like half a pound, like almost a pound a day. It’s wild. She’s just like dropping. It’s just coming off. Your body’s like
Speaker0: [53:40] Can actually access that stored fat and do what it’s supposed to do, which is. Burn it for energy.
Speaker1: [53:47] And this is her like trying carnivore and keto just before and it wasn’t really working. And she was like, she’s trying to breastfeed. It wasn’t, you know, so this is like she’s like mind blown. And so she was telling me to ask you certain things. But, you know, I was when I was kind of selling her the protocol, I was like, no, she’s legit. She’s like, she’s repeated these results. It’s not just, you know, a one time study where people lost a bunch of weight. Like this is it’s a consistent result. where people are losing 17 to 19 pounds in two months by following this plan, you know, so you don’t have like a super loser in your group or something like that that’s doing the results.
Speaker1: [54:24] So it’s pretty miraculous. Like it really is amazing. Yeah.
Speaker0: [54:29] Well, so, you know, I don’t know if I don’t share it too much on my page yet, but I am working with the FDA. So I don’t know if you’re aware of that. So I’ve been working with the FDA for the last year. I’ve met with them five times. I have my next meeting with them in a week and a half because I’m trying to get my this app. So I’m launching an app. So it will officially be launched on May 19th. It is in the app stores right now. Do not. We’re still working on the back end, but we have to make it to get it in the app store and then we’re working on it. So I haven’t told anybody it’s there. It’s it’s there. It’s not really functioning yet. So we are officially launching it on May 19th. But one of the things that we’re trying to or that I’m trying to do is get FDA cleared as a what is called a software as a medical device. People have heard of software as a service, whatever. So now the FDA regulates this type of medical device, which is a software. So apps are considered software as a medical device. So, you know, there’s a few that are approved for diabetes, some that are approved for depression. So this would be the very first approved for insulin resistance or PCOS.
Speaker0: [55:34] But, you know, I have to do this big study. right? You have to do a big, study, uh, to support that clearance. Um, and I have an entire independent group, a different independent group. So, um, I’m very, very proud to say that my, the PI or the person who’s basically the ringleader of this study is, um, Dr. Timothy Garvey. He’s the director of obesity research at, um, University of Alabama, Birmingham, which is a huge research center. Um, he’s an, you know, internationally known endocrinologist. So he is taking the study and like, I have a dermatologist dermatologist, a clinical dermatologist at University of Texas. I have an obstetric neurologist who’s doing all of like the mood evaluation changes after using this. She’s at Baylor. I have another dietitian, PhD dietitian who’s out in California. So, I mean, it’s truly independent, right? Like I can’t have anything to do with it. And so, and they’re basically where they’re having patients use our app. So, they’ll use the app for eight weeks, follow the guidance. It has recipes and meal plans and all the things. And after eight weeks, we test their blood before and after and submit it to the FDA for approval. So we’re hoping to have that next year, which would really just be, you know.
Speaker0: [56:50] Amazing for patients and amazing to like really have this become like the standard treatment for insulin resistance is an insulin first approach.
Speaker1: [57:02] Yeah like to just have your doctor be able to give you that advice it’ll actually work so it’s motivating you feel a lot better you’re not as hungry um you’re even your taste buds change because you’re like you’re you’re interacting with whole foods that aren’t spiking your insulin so your like cravings and your appetite are all regulated and oriented towards what the food that you’re getting as opposed to like random you know you’re not ending up at the bottom of a bag of potato chips because you’re like blood
Speaker0: [57:30] Sugars drain i need more glucose and i can’t get it and i need to eat this.
Speaker1: [57:34] Yeah and
Speaker0: [57:36] So that’s why you know i don’t necessarily i don’t necessarily condemn the use of the glp1 drugs because GLP-1 is an important appetite hormone. And tons of data, research has shown that when people have high insulin levels, they have lower GLP-1 because insulin is a master hormone. It affects everything, including your appetite hormone. So when insulin is off, your appetite is really unregulated. And the GLP-1 drugs are kind of just like bypassing that whole system just to like flood the body with GLP-1 so that you don’t feel as hungry, which is fine. But the thing is is that if you were just to focus on this you would increase naturally levels the glp1 because insulin is suppressing that you know so um that’s where i’m like you can you could do that that drug but you have to realize like you’re not fixing the problem and the problem’s going to come back the appetite problem the weight problem is going to come back until you fix the underlying hormonal problem cause of why you are hungry all the time in the first place you know Yeah.
Speaker1: [58:40] Yeah, because, I mean, the problem, I think, it’s a common criticism with those drugs is that it can be a really important tool. I mean, some people have a lot of weight to lose, you know, it’s causing a lot of problems. But if you’re just having less Doritos, like it’s just about appetite suppression, and you’re not shifting your dietary patterns, and you’re not kind of using it as an opportunity to learn and to change things, then you’re either stuck on them forever, getting nutrient deficient and losing muscle mass, or you’re just going to gain the weight back. So you have to kind of change things. So it’s why not try the diet first, the exercise first, and then use them as a tool if you have like 300 pounds to lose or something.
Speaker1: [59:22] You know, if you have a lot of weight to lose, maybe they could be helpful. But yeah. That’s what Dr.
Speaker0: [59:26] Gardy wants to do, right? He’s like, after we do this study, you know, if you would be interested in sponsoring another study to look at patients on GLP-1 drugs who also follow this plan, right? Because taking a GLP-1 drug actually stimulates insulin secretion. And so if you’re eating foods causing even more insulin secretion and you’re in a calorie deficit because you’re not eating as much, you’re just eating less of insulin spiking foods, you’re actually losing muscle because it goes back to the body not being able to burn fat. And so it needs to make up that calorie deficit somewhere and it’s going to pull from your muscle. So that’s really why you’re seeing a lot of muscle mass on these drugs. And so when you, he was like, if we could pair something like this with the GLP-1 drugs, then while you’re getting your own appetite hormones more regulated, you have this. And then when you come off of it, you don’t see such a huge shift in making, you know, wanting to go back to eating all the time because now you’ve fixed the underlying cause. That is how those GLP-1 drugs should be used. But they’re not being used because they’re not giving the right information. They’re not giving the right education. And they’re sending them home telling them to eat more whole grains and beans and low-fat dairy and then they’re just in this cycle of bad. And so if we could come out with that data, I think it would be, you know, life-changing, I think.
Speaker1: [1:00:46] That’d be really interesting. Yeah, it’d be interesting to see, like, what people actually, I’m wondering if there’s data on, like, what do people end up eating when they’re on a GLP-1? Like, what are their macronutrient spreads? Because people tend to lose appetite for, like, high-fiber foods, protein foods. Like, you don’t want satiating foods. You want just kind of easy to absorb, easy to digest. You’re nauseous. So you’re probably going to go for more starchy foods i would assume but
Speaker0: [1:01:12] Well except for now everything it’s like well you need to be a you need to be making eating more protein so you don’t lose so much muscle mass it’s like the reason they’re thought the reason they’re losing muscle mass is not because they’re not drinking whey protein shakes like in fact that might worsen it so it’s it’s that message and so now you’ve got all these food companies that are going about to come out with tons of protein rich snacks because they’re trying to attack they’re trying to attach themselves to the people who are taking these drugs who are trying to eat more protein and those snacks are just the same processed crap with now processed way back i saw that that there’s like very like.
Speaker1: [1:01:57] Big food is trying to design foods that kind of override the natural appetite suppression so that you still stay addicted so it’s like a whole hot mess
Speaker0: [1:02:07] I don’t know if it’s that or they’re just trying to appeal to this new customer who’s like well i’m not really hungry but i have to get my protein in so i’m gonna eat this protein snickers and it’s gonna be better for me so it’s just, and it’s sad and it’s scary and you know that’s that’s where we’re going because everything you scroll on instagram one time and all it talks about is if you don’t get 50 grams of protein for breakfast and you can just kiss your biceps goodbye. And it’s like, hmm.
Speaker1: [1:02:37] Yeah. But maybe, yeah.
Speaker0: [1:02:39] I’m not saying protein is important. I’m saying you don’t need 50 grams.
Speaker1: [1:02:44] Yeah. Like if you’re, yeah, regulating your insulin levels, are you just, are you going to be better at using and maintaining your muscle mass and burning fat instead of burning your muscle, you know, the protein from your muscle to make glucose?
Speaker0: [1:02:58] Yes.
Speaker1: [1:03:00] Like those people, those sugar burners in your, in the study that you referenced were probably just breaking down their muscle mass.
Speaker0: [1:03:06] Yeah they’re breaking down like shake yes the amino acids that they because you know when you eat protein it your body breaks it down into the amino acids and then it uses those whatever it needs right whatever amino acid it needs to build whatever that is whether it’s hair because there’s like you know whatever amino acids they need at the time for those things so that’s like an amino acid pool which is why every single food you eat doesn’t have to be a complete protein because it’s just getting broken down into these bricks right and they’re just pulling the bricks as they need them. But that’s what’s happening is that those sugar burners were essentially just burning yesterday’s excess protein that he didn’t need, which because a lot of times we’re eating more protein than we actually need. Not everybody. Some people are not. But now I feel like people are.
Speaker0: [1:03:51] Putting a scoop of whey protein into their Greek yogurt, which is like a lot of protein in one sitting. And it’s just breaking that down into those bricks that they can then use for energy if they can’t get enough body fat. So that’s basically what they were doing because you can break amino acids down into like essentially glucose and just burn that. So metabolism is very complex, right? It can definitely overwhelm people.
Speaker0: [1:04:16] But I think at the end of the day, if it if it seems excessive it probably is um and if it seems too good to be true it probably is like going back to the instagram account on glucose regulation you know if you are adding there’s this idea of food combining of if you add if you’re going to eat carbs you need to make sure you add fat or proteins to it and it will make sure that your glucose doesn’t rise too fast and sure, there are all kinds of beautiful CGM reports that will support this message that as long as you add butter to your bread, then it will be okay because your glucose doesn’t rise. But what that’s doing is when you have a lot of fat and a lot of glucose in the bloodstream at one time, it actually, the fat, I remember my biochemistry teacher in college said, When you have too much fatty acids and too much glucose in the bloodstream at one time, what that does is it’s like throwing gum in a lock. Those fatty acids block the insulin from working. So then the pancreas does what?
Speaker0: [1:05:28] Sends out even more, right? So you have this huge insulin spike happening in the background, which is driving that blood glucose down. So what you see on your CGM is adding butter to my bread stopped that glucose spike. That’s so great. But what you don’t know in the background is the insulin bomb that happened to keep that glucose level normal. And that’s what the problem is. So, yeah.
Speaker0: [1:05:52] It’s unfortunate because I think now 5 million people think that as long as they add peanut butter to their ice cream or their, you know, whatever, that it’s like better. Again, I’m going to do that. It’s more nuanced than that.
Speaker1: [1:06:07] Yeah, like I, this is why yours have blew my mind because I, I was sort of recommend, I mean, there is a separate benefit to regulating blood sugar, obviously, but it, it, the story is more holistic. Think it makes more sense in the context of insulin because insulin is damaging. So it’s like not about regulating blood sugar at the expense of insulin spikes. It’s, but you know, so I would recommend to people, okay, you’re addicted to donuts and you’re going to get a donut nut to put some peanut butter on it to regulate it. And there’s a bit of like maybe delayed gastric emptying or delayed release of glucose. But when I saw your comment, I was like, yeah, I knew this from biochemistry, but for some reason didn’t put it together.
Speaker1: [1:06:49] And it may speak to, to give myself some compassion and credit, it may speak to just how we’re so not focused on insulin, even in holistic space.
Speaker0: [1:06:58] Like you said, there is an aspect of managing glucose. That’s true. But if you are managing the insulin, then it’s working well. It’s working, it’s doing what it needs to do. And you don’t really need to focus on the glucose. So I have a lot of people say, well, if I have commented to that post or sent me direct messages, they’re like, well, so does that mean that I should just, well, what if I want to eat gummy bears? Like, is it worse to add almonds to my gummy bears or just eat the gummy bears by themselves? And I said, well, this is the actually, what you need to realize is that, you know, if you want it, if you want to eat Oreos, do it infrequently and enjoy them. And if you want to dip them in peanut butter, do it because it’s delicious but don’t lie to yourself that the peanut butter has somehow made the oreos better for you because it didn’t and it actually was probably worse but it’s it’s more about enjoying the foods you want to eat and enjoying them and not feeling like you have to add something to it to make it better because then you’re then you’re mentally thinking well oh i can just i’ll eat you know whatever i’ll eat the bread because i’ll just put the butter on it and it will cancel it out that is just human nature and that is what people do because their cgm tells them that that’s better and that’s just not the case and so it’s it’s not necessarily that that eating it by itself is good by any means but i don’t think anybody needed to tell you that eating gummy bears wasn’t good for you right i’m trying to tell you that yeah adding almonds doesn’t make them better yeah.
Speaker1: [1:08:27] It’s like just let them serve their purpose which is
Speaker0: [1:08:30] Just serve their purpose enjoy them enjoy them and try make them as infrequently as possible because life is meant to be lived, enjoy the things occasionally, but, adding protein and fat. And like you said, with the delayed gastric emptying, my challenge to that is ideally what you want is you want insulin to be released after a meal, help bring your blood and then you want it to come down, right? And you want it to be low so that between meals, you’re pulling fat from your body fat. And then it goes up again after a meal and then it comes down. And then after dinner and while you’re sleeping, it’s low. I mean, that’s really the idea, ideal. You want it to go up and then back down, up and then back down quickly.
Speaker0: [1:09:09] When you are adding protein to gummy bears now you’re adding like you know some cheese to gummy bears or something what that’s doing it is delayed delaying that gastric emptying but it’s not, it’s not getting rid of the glucose you’re still going to absorb all the glucose from those gummy bears but now you’re just doing it over time well what does that mean that means glucose levels are higher in the system for longer and insulin levels are higher in the system for longer right versus just having it go up and then come back down i’m not saying you should just eat the gummy bears you shouldn’t eat gummy bears but if you do just do it because you like it and try to do it as least less frequently as possible but if otherwise if you’re just eating fruits and vegetables and nuts and seeds and proteins and all of that then you would eat your insulin would come up moderately do what it needs to do and then come back down versus you know eating a biscuit with eggs on it. Like, okay, it’s not going to have a huge glucose spike, but now you’re just going to have glucose higher for longer as it slowly enters the bloodstream. Does that make sense? Yeah, it does. And then really at the end of the day, there is no way that you’re going to slice it, cut it or whatever. Starch is going to lead to higher glucose and there’s nothing you’re going to add to it that is going to make it better. So if you have to have it, enjoy it. Don’t lie to yourself that doing something has made it better for you. Just move on and try to do better at the next meal. That’s my advice.
Speaker1: [1:10:31] Drink water. Yeah. And also, if you’re healing insulin resistance in the background, you’re able to kind of come down again, right? You’re dealing with this cause.
Speaker1: [1:10:40] So maybe you’ve better tolerance for those random spikes and you eat your Oreos and you get done.
Speaker0: [1:10:46] And your liver is better able to clear that insulin from the blood. So like one of the studies that that influencer likes to use a lot is a study that shows, well, if you add protein and fat to starch and sugar, it leads to lower glucose levels. Well, yes, but in the exact same study, it talks about how insulin levels rose 52%, in the same period, right? And part of that was because it increased insulin secretion, and part of that was in decreased insulin clearance. Because when you add the fat and the protein to your fat and the starch, the body’s like, well, I can’t get rid of this glucose or this insulin. I have to have this insulin here because something has to get rid of this glucose. So that’s why it increases insulin secretion and prevents the liver from actually getting rid of excess insulin from the blood. So you just have more insulin, right? More insulin means less less blood sugar. So, you know, if you read the article, it says that very, very blatantly. Like, I think it was on like the sixth line. It was like, it increases insulin secretion and decreases insulin clearance. And it’s like, you’re.
Speaker1: [1:11:50] Yeah, but you’re an insulin researcher. So you’re like, you see it right away, but everyone else is like, that’s great. Higher insulin is what we want, right? That’s, that’s what we do with our job.
Speaker0: [1:11:59] Exactly. I commented on her post like a year ago, or this person’s post like over a year ago. And I said something to that effect. I was like, you can’t manage a glucose and just ignore the insulin. And I think she has some moderators. And one of her moderators said, she’s not an insulin expert. She’s a glucose expert. And I was like.
Speaker1: [1:12:17] Like, okay.
Speaker0: [1:12:18] Okay, I have to walk away.
Speaker1: [1:12:20] I know everyone knows exactly what we’re talking about. I mean, there’s no reason to not say the name, but it’s funny too, because the approach isn’t, like, clinically, when I’m working with people, it’s not an easier approach necessarily. Like, you know, I actually had one patient I’m just thinking of who, you know, we got blood work back, she’s insulin resistant, I started educating her on what that means. And she’s like, you’re not going to make me follow the, you know, this influencer stuff, are you? Where it’s like, you know, fiber before your meal, which is maybe not a horrible advice. And like adding, it’s like, you’re not going to make me follow that, are you? But when I’m recommending the low insulin lifestyle, which I have been doing, actually, a lot of people are like happy to receive it. Like it’s, there’s something very validating about understanding the symptoms. And the diet is very manageable for people, like kind of psychologically. You can eat what you want. It’s logical. It makes sense. It’s not like like low FODMAP diets. There’s certain fruits and vegetables that people don’t categorize that you’re allowed and you’re not allowed. At this one, it’s you’re allowed all the fruit you want, all the non-starchy vegetables, all the animal protein, your six ounces of Greek yogurt or an ounce of cheese, all the fat you want and avoid sugar. And then you have like it’s a very little it’s a small blur that I send people.
Speaker0: [1:13:36] Yeah, it’s a small little thing. And there’s always, you know, you have allulus and monk fruit and all these other things. So you can still have those. I cook with almond flour all the time. I mean, I make almost, I have tons of stuff with almond flour. I mean, I make Cheez-Its. Like I just mix almond flour and egg and some cheddar cheese and I roll it out and I air fry them. And it’s like, you know, so I, there are so many, and that’s part of, you know, what will be on the app is just hundreds of recipes, like things like this to really help. And I’m, I’m not doing a plug, but I’m just saying I am coming out. A guidebook, because I feel like the original book is very silency, but in a layman’s perspective. And if we need to stop, we can. I mean, I’m good. But… Is this guidebook that’s like, if, okay, you know, this is a lot of science. I like to know, and it’s important to know, but I want to know, like, how do I really incorporate this? And some people want something tangible. So in the next month or so, I’m launching a guidebook, which is like, it really still goes into the details of the studies and the data and the science, but with more pictures, less words, more, you know, recipes, meal plans, how to eat at restaurants, what to do in the holidays, how to build a grocery list, how to read a nutrition label. Like, I mean, just kind of like this more reference guide that’s more tangible for people who don’t want to use an app. You know, they can have a book, be very colorful. They can set it in their kitchen and like reference whenever they want. So that’s, I think will help be helpful too.
Speaker1: [1:14:59] It’s so good. Yeah. It’s your Instagram account is great too. You have lots of good recipes. Like, but I think, I think one thing we might’ve missed is why is fruit allowed? Because I think people might be wondering that. I don’t know. Okay.
Speaker0: [1:15:11] So fruit is part glucose and part fructose. Now, fructose gets a very bad reputation for good reason. Too much fructose overwhelms the liver, leads to fatty liver, which is like high fructose corn syrup. So fructose in large amounts, really bad. Actually, just a history lesson. One of the reasons why they came out with high fructose corn syrup, aside from it just being very cheap and very sweet, was because it had less glucose. They thought it would be better for diabetics. Because it wouldn’t lead to the same glucose response. Does that make sense?
Speaker1: [1:15:43] Yeah. They didn’t realize that. We’ll throw this in. It’ll be great.
Speaker0: [1:15:47] What could go wrong? It’ll be so healthy. And then they were like, oh, this was a problem. They don’t care. They still add it to everything. But we know that excess fructose is a problem. Now, whole fruit.
Speaker0: [1:15:58] Well, sorry. The good thing about fructose in its naturally occurring form amounts is that it requires zero insulin release for metabolism. So fructose does not elicit any insulin relief. So that’s, again, why they thought, oh, high fructose corn syrup would be great, but no. So the amount of fructose in a whole raw fruit is not going to overwhelm your liver, right? You have that fiber. It is going to slow that digestion. So you’re getting a slow trickle of the fructose instead of just, you know, a soda. So because it’s part fructose and because fructose does not elicit any insulin response, fructose as a whole has a lower insulin response. Now, fruit still has glucose and you still might see something on your CGM or something, but it’s still going to be far less than, you know, having a whole apple as compared to a third of a cup of quinoa is very different, right? And so the amount of glucose in a whole apple is maybe 10 grand. It’s like 6 grams of fructose, about 10 grams of glucose, whereas 36 grams in a third of a cup of quinoa. So it’s really just thinking about that perspective is that fruit doesn’t have that huge insulin response because it’s part fructose.
Speaker0: [1:17:22] And I always like to tell people, too, agave nectar.
Speaker0: [1:17:27] Is worse than high fructose corn syrup. Agave nectar is 90% fructose. High fructose corn syrup is only 55% fructose. So you’re drinking straight fructose when you’re having agave nectar. So I just try to tell people just because it’s natural sugar doesn’t necessarily mean that it’s better.
Speaker1: [1:17:47] Yeah, that’s a good point. Yeah. And I think one thing that you stress is that there’s no limits on fruit. So people are eating as much food as they want, which when I hear that, I’m like, Dr. Allie, I don’t think you know me. Like maybe you’ve done research, but maybe you haven’t met people like me. Like I could eat a lot of fruit if you’re just going to let me go. But it looks like people were eating about 90 grams of carbs, which is fairly low carb. And your desire, yeah, kind of.
Speaker0: [1:18:14] Your desire goes down. You’re like, I eat fruit every day, but I probably eat like, I don’t know like two pieces of fruit maybe like sometimes one sometimes two sometimes more but again it’s one of those things where you’re just full you’re eating a lot of fiber you’re eating a lot of fat and protein and you just like fruit is great but you’re just not as hungry and you’re definitely not as hungry for carbs so it’s just one of those where you still eat them but it’s not one of those like I want to eat you know this whole bowl of fruit you just have your your taste buds and your appetite changes.
Speaker1: [1:18:48] Yeah, this is so good. What have you seen beyond two months? I don’t know if you’ve tracked people or worked with people or just in personal experience. How long does it typically take for people to get their insulin into the normal range? It looked like people’s HbA1c was all normalized after two months.
Speaker0: [1:19:06] It was normal to begin with. Yeah.
Speaker1: [1:19:10] Sorry, their HOMA-IR. HOMA-IR was what I wanted to say.
Speaker0: [1:19:12] Yeah, yeah. So we haven’t done any studies beyond eight weeks. Okay. Right. Just from financially, right? The longer the study it is, the more money. And even the new study, it’s called the Lilac study, the Lilly App clinical study. The Lilac study is also eight weeks. Because from research, it’s hard to like do these. Now, after the eight weeks, we will give the participants the ability to say, would you be interested in continuing to follow this? and, you know, continuing to even just report patient-reported outcomes, like how their acne has changed. There’s some of these very validated, like, PCOS quality of life surveys that we’ll administer once a month just to continue to keep that data, have them self-report their weight once a month. You know, so I’m excited about doing more research. You know, part of the revenue from our company as a whole will go to continuing to provide more funding for research because I want to do all kinds of, you know, research. But.
Speaker0: [1:20:13] Beyond what after you know eight weeks like I have quite a few Instagram influencers like one girl I think she’s lost she went from like 190 and now she’s 135 she’s pregnant right now so but she’s she’s been following me for over a year a year and a half um and then a personal friend or a family friend of mine she was four foot 11 and 190 and she’s now 135 and she’s that’s been two and a half years and she’s been like just steady at 135 and she she had a stroke like 10 years ago and her doctor now took her off all of her meds because her her blood levels of everything are normal so it is sustainable because it teaches you to think about food in a different way you’re not thinking about of calories and i need to eat more i need to exercise to burn off something it’s it’s thinking of it you know in a different way and i i’ve plenty of people that are like i’ve lost so much weight i’ve gotten around i got rid of all of my fat clothes because i have no concern that i’m ever going to keep it off like i i have no no issue um or others will say i’ll go on vacation and like i’ll do whatever i want but it’s okay because i come home and i get right back on it and the water weight that i’ve gained is off in a week you know and i’m back right back to my normal so it’s like you can still enjoy your life um and have those moments where you can just.
Speaker0: [1:21:35] Eat what you want as long as you know what your default is. You’re going to come home and you’re going to get back on your default and you’re going to give your pancreas a break from the damage you just did. I don’t want to say damage. From the enjoyment that you’ve had and then you’re going to go back and you’re going to give your pancreas a break. So I have what’s called a bounce back blueprint that I put in the it’s like, you’re going to wake up you’re going to drink a bunch of water or you’re going to go for a long walk. Like how to get back into all right I’m going to get back into mine.
Speaker1: [1:22:04] That’s good. Yeah, it’s good from kind of like, like a binge eating perspective, right? It’s like, okay, like, no all or nothing thinking, just get back on it. And, and, you know, you’re not, I think you’ve talked about the keto diet. And this is because you’re eating carbs, and you’re just getting your carbs from fruit and vegetables. You’re not like, going on vacation, getting out of ketosis, then having a switch back in going through that whole metabolic process,
Speaker0: [1:22:29] Like you’re just a few weeks.
Speaker1: [1:22:30] Yeah, you’re just okay, I’ll just I’m just probably going to eat a lot of bananas the first day until everything regulates and then and then my appetite will settle and I’m not having to like metabolically switch in that way that, you know, can cause side effects for people or this idea of like, you’re either in it or out of it.
Speaker0: [1:22:50] Because ketosis is I mean keto basically lowers insulin that’s what it’s that’s what it’s doing it’s just doing it in a very aggressive way and when your insulin lowers that that low and you don’t have any glucose that you’re eating your body has no choice but to switch over and burn only fat which is what is releasing those ketones and what your body is using but, That that leads to that keto flu, because until your insulin level is lower enough to where you can burn that body fat, your brain is like, I don’t have anything here. Like, I don’t have enough glucose. I don’t have enough fat to eat to use because your insulin is too high. You really have to wait until you get to that switch where you can lower insulin and you can start burning all that body fat. But here is this more of a middle ground because your insulin levels are lowering, but you still have some glucose that you’re eating from the fruits and the vegetables. So it’s more of like what’s called metabolically flexible you’re you’re you’re able to burn glucose when you need to and then your insulin levels fall and then you can burn some body fat and then you eat again and you can burn some glucose and then you can burn some body fat you’re just your body is and that’s a term like that’s an actual term metabolic flexibility that you are flexible and that you can burn whatever it is that you need um most people can’t do that right most people can’t burn body fat can’t burn fat for energy um and then keto it’s just a very aggressive way of lowering insulin and wanting to just never have a glucose well you don’t really have to do that right like you can there is a middle ground yeah.
Speaker1: [1:24:17] Which is yeah which is so refreshing to see and like you know it’s well received like people love it like oh i can have as much fruit okay because we’re told often that fruit is bad and everything is confusing you know
Speaker0: [1:24:30] Because it’s glucose right they think oh if carbs are bad carbs are bad like think of it more of like how it’s affecting your metabolism, right? And how you’re, and people think of metabolism as just like how many calories you burn every day. No, no. Metabolism means how you use the food that you eat for energy or store it as fat. And if you’re eating foods that are constantly forcing insulin release, then you’re storing it as fat. You know, that’s just what’s happening. So, and eating big breakfast to boost your metabolism, that’s, eat when you want if you’re not a breakfast person don’t eat breakfast right like this is getting rid of every single food rule there is one rule if it spikes your insulin you should avoid it as much as you can if it doesn’t spike your insulin eat it whenever you want you know that is there is one rule you know and that really it makes people feel refreshed like the amount of, brain space that I don’t spend on food because I just and you know for 10 plus years the amount I mean the amount of time I spent worried about food and calories and carbs and working out and protein and everything else like it’s just like free up your brain for other things in life that bring you joy you know that’s really the most important thing.
Speaker1: [1:25:52] Yeah I can relate to that so much you know and even the being a sugar burner like being metabolically inflexible when I first learned about it I was like yeah that’s me every two hours I need to eat and it feels like you’re not you know especially if you’re if you are a calorie like I was a calorie tracker for a while and I’d be like how am I burnt like if this has 500 calories why am I hungry you know based on this whole calories in calories out all the biochemistry that you learn like I should be full for i don’t know longer than two hours i’m not burning 500 calories sitting here and studying um and so when i learned about that i was like oh yeah i’m not accessing the fat from my food or my body i’m just running on sugar it’s like a bat like a car with a race car engine or something i’m like burning all the gas out and having to refuel constantly and it’s mad
Speaker0: [1:26:40] And this is nine out of ten i think it’s like four out of ten kids they did a study you could test the insulin levels of a five-year-old right now. And it will tell you whether they’re going to be overweight, have type early diabetes, a five-year-old. And they did finger pricks at school for like thousands of kids. And they measured them. They followed them over the course of like, I think, 10 years or so. And they said the number one strongest predictor of early, you know, adolescent obesity was elevated fasting insulin at age five. And it’s so sad. It is. There’s so much to be done. And I will say, people are going to be like, well, why are people not talking about this? Why are doctors not talking about this? Why are you measuring it? I can tell you in one very simple way. Because the only time that clinical guidelines actually change is when somebody foots the bill. And it’s usually Big Pharma. So when Big Pharma came out with cholesterol-lowering drugs, they had the teams that worked with the clinical societies. They worked with the insurance companies. They worked on developing the standard ranges because they had a solution to a problem that they needed to make sure that everybody understood the problem so they would buy the solution.
Speaker1: [1:28:02] Mm-hmm.
Speaker0: [1:28:03] And unfortunately, there is no drug in development for lowering insulin levels. And so because of that, there is nobody footing the bill for increasing access to this information, to making sure that we have standard ranges, to make sure the insurance companies are reimbursing for this. I mean, it is, it takes deep pockets to do that. And the only people who have pockets deep enough are big pharma. And there’s no drug on the horizon to lower insulin. And that is the reason. Because they have huge field forces to go out and educate every single doctor about you need to measure this and why. And look at our data. And this is so important. And look at the outcomes for people who lower than, there’s nobody doing that.
Speaker1: [1:28:40] Yeah. It was a whole task force around fat, cholesterol. It was like decades of people all getting together and deciding on these guidelines. And, you know, and that I’m just thinking about the kid with high insulin who, you know, let’s say the parents are like, OK, we’re going to put some effort in and we’re going to look at your diet and we’re going to follow the guidelines. We’re going to put, you know, pay attention to labels and we’re going to probably be eating our six.
Speaker0: [1:29:05] We’re going to eat whole grain.
Speaker1: [1:29:09] Yeah. Which, you know, so it’s like we take our effort, our best intentions and then we’re we’re not applying the right interventions. And people give up you
Speaker0: [1:29:19] Know yes and then they’re like but whole grains are good for you i’m not saying that they don’t have nutrition that doesn’t mean they’re good for somebody with glucose intolerance which is essentially almost everyone so you know yeah they think that they have the best intentions they go to the store they buy the whole grain goldfish instead of the regular goldfish and they buy the protein special K because it has more protein and low calories and they mix it with the low fat skin milk. And literally every single one of those choices could not put more insulin into the system. I mean, it is literally flooding it. And it’s like, Oh, there’s another dietitian influencer on, on Instagram. And she basically was like, if your kid is struggling and you should, if they want to have KFC and they want to eat the biscuits, you just need to make sure that you give them the chicken leg with the biscuit because the chicken leg gives you the protein and the fat. And so that’ll offset the biscuit. I mean, this is a dietitian. She has hundreds of thousands of followers and it’s just maddening. It’s maddening and so and i feel like nobody can win for losing because they’re just they’re like i’m following all this advice and my kid’s getting worse or you know and it’s just yeah.
Speaker1: [1:30:38] I really feel like it doesn’t work or i’m broken work or yeah
Speaker0: [1:30:41] I made a i made a post recently that we go to conferences we go to the big conflict the big fertility conference and whatnot and i i have i’ve had many doctors tell me fertility specialists tell me i don’t send my pso my pcos patients to dieticians anymore because they come back worse than they started because that they get told eat more whole grains and beans and low-fat dairy and they come back and they’re heavier than they started yeah i.
Speaker1: [1:31:03] Have a patient i’m thinking with prediabetes who’s already on like maxo and the metformin dose and her dietician is like okay when your blood sugar drops because you’re on metformin and you’re not diabetic so your blood sugar is going too low and it’s but you know metformin is lower in blood sugar it is lung insulin a little bit but not enough and uh it’s like just have a candy. Take candies with you and have candies to bring your blood sugar up. I put a diabetic patient.
Speaker0: [1:31:28] It’s just granola bar. Like, oh my God.
Speaker1: [1:31:31] Terrible. So it’s just, and even she was like, this isn’t working. I feel like trash. Like, I’m not going to go anymore.
Speaker0: [1:31:38] Dietitians do not understand insulin resistance. It’s not taught in school. I mean, I graduated in from my bachelor’s in 2009. So that was a long time ago. And I was really hopeful that they’d at least caught up with the data. But I have another follower who’s currently getting her bachelor’s in nutrition. She’s like, The only thing I’ve learned about insulin is that you give it to diabetics to lower their blood sugar and that’s it. Like they do not learn about this. So if everything looks like a hammer, if all you have is a hammer and everything looks like a nail, everyone’s getting the same advice. Yeah.
Speaker1: [1:32:10] Terrible. It’s flashy.
Speaker0: [1:32:12] You can tell I’m very passionate about this.
Speaker1: [1:32:14] This is so good. This is so informative. I think people are really going to love this. My last question is, you know, about men. So I know your research is PCOS. We’re talking more broadly about insulin resistance. I think what’s really beautiful about your research is that it’s done on women because so much is not done on women at all. And so conventional advice like intermittent fasting, cold therapy, all this stuff that’s so great and influencers are recommending may not be great for women who have different hormones, different considerations.
Speaker1: [1:32:42] But this is like these are results done on women. And everybody who’s done a diet with their male partner knows like he loses like 50 pounds, I lose one, you know? Yeah. But my friend wanted to know if if this applies to men, which I think the answer is obvious. But yeah.
Speaker0: [1:32:59] I mean, it applies to everyone. Right. Kids, pregnant women, men, everything. Because for men, you know, one of the bigger issues is around the age 35, they start to have a reduction in testosterone. Right. Let’s call it menopause. They start to have a reduction in testosterone just naturally, which coincides with an increase in insulin. So a lot of times they’ll see that they’re having Dabod, which may not be anything to do with what they are changed in their eating or exercise. But when you have higher insulin, you start to gain weight and a large part of that goes to your stomach.
Speaker0: [1:33:31] And more so, that’s even more problematic with that is that when you have more fat tissue, That fat tissue has an enzyme called aromatase. And what happens is testosterone gets converted to estrogen into that fat tissue. So now not only do you have this natural decline in testosterone, but now whatever testosterone is left and being pumped out is getting turned into estrogen, right? So you have a, that’s what’s causing men to have low testosterone. And the only therapy we’re giving is to do testosterone injections or testosterone replacement therapy, but you’re not getting to the real reason why they have the low testosterone in the first place.
Speaker0: [1:34:13] That’s one of the problems, but that also leads to erectile dysfunction because now you have more chronic inflammation, which inflames, you know, all of your vascular system, but also, you know, having lower testosterone. So all of that kind of compounds to lead to erectile dysfunction, which is one of the earliest symptoms of insulin resistance in men. People, I had no idea. A third of men experience erectile dysfunction. That is a very early sign of problems. Before they have anything wrong with their labs, before anything happens, if they’re experiencing erectile dysfunction at an early age, it’s not just psychological. There is definitely something wrong going on. So that’s something I would say if you’re having a husband that’s experiencing that, they need to probably go get a workup. But, you know, the other thing is like sperm, high insulin and that chronic inflammation leads to changes in the sperm. So, you know, if you’re trying to get pregnant, you need to be following it. But so does he. He needs to have the healthiest sperm he can have. And that starts with, lowering insulin, making sure there’s not enough testosterone, making sure there’s not chronic inflammation. So I shared earlier, my husband, he’s part Hispanic. His dad died of a massive heart attack at the age of 41.
Speaker0: [1:35:28] And he was about 200 pounds when we started dating. He’s 5’11”. And he has now, I mean, that’s been 10 years, 10, 12 years since we started dating. And he is, he’s at 175 and has stayed at 175 like completely and he’s not perfect I told I told you that he doesn’t realize you can eat a pint of ice cream in more than in different settings like he just eats the whole thing so he’s not perfect but he is very very you know if he goes up a little bit he stays strict for like a few weeks and he’s back down and it’s just you know very even keel And I will say, you know, we, there was a study in 1966. So back in 1966, where they said fasting insulin is the strongest predictor of heart disease, strongest predictor of heart disease in the Lancet in 1966. So he went to his cardiologist like two months ago, because I told him, I was like, you know what? I don’t care that you look healthy. You obviously have genetic history. You need to go and start getting work up with your cardiologist. He’s 38. And uh, he went and he asked his doctor his cardiologist to test his insulin levels and she literally said I don’t think you can test insulin Wow And he was like, yeah, I know you can test insulin. She goes, I don’t know how to do that I’m gonna have to go talk to my colleagues.
Speaker1: [1:36:50] In 1966, so right before the low-fat cholesterol kind of paradigm.
Speaker0: [1:36:55] Everything. We have known for decades on decades that insulin is a problem, and yet here we are in 2025, and we’re not measuring it. And their excuse is that, well, the assays aren’t predictable. Then develop a better assay. That’s not the answer. It’s just like, oh, well, we can’t measure it.
Speaker1: [1:37:15] What? I mean, there’s developments for type 1 diabetes, So they must have figured out how, I mean, we can isolate insulin. We can make the peptide. We can inject it in people. We have long act, we have all kinds of insulin.
Speaker0: [1:37:27] We know how to do it. You can pee on a pregnancy test and it will measure a certain small hormone in your blood in a few seconds. And you’re saying we can’t develop assays for insulin? I mean, it’s mind-blowing. But I think personally, it’s probably a little bit of a conspiracy because if we start managing the insulin, then how are we going to treat the cancer? And who’s going to make money on treating the cancer? and the Alzheimer’s and the diabetes and the weight loss.
Speaker1: [1:37:51] Yeah, like all of our health issues go away.
Speaker0: [1:37:53] The testosterone replacements. I mean, all of the health care would go away. Yeah.
Speaker1: [1:37:58] Everybody’s talking about this idea of metabolic health, metabolic disease, and this is exactly what you’re working with. And I was just listening to Andrew Huberman. I know we’re almost at our time, but he’s talking about, he’s like, you know, a lot of my friends follow this really great diet, and he was describing your diet. I don’t think he knew about your diet. Hopefully he will one day. But he was like, yeah, lots of fruits and vegetables and proteins. From animals and they feel great and everything’s great and their cravings are managed and so we all intuitively know that’s the way to eat eat plants and animals
Speaker0: [1:38:26] Less processed nuts and seeds and like things that are just yeah normally available like people don’t realize as how the amount i think i used ai because i said okay imagine that all of human evolution was one year how long have we been eating starches and dairy? And if you were to do that, what would your guess be? If all of human evolution was compacted into one year, how long do you think we have actually as a species been eating starch or dairy?
Speaker1: [1:39:03] It’s, I mean, I have a little bit of knowledge. In like the 12-hour clock, it’s like the last second or something like that. So I imagine it’d be like the last month.
Speaker0: [1:39:14] Two and a half seconds. Yeah. Oh, wow. We have been eating starches and dairy for two and a half seconds and so when people are like we’ve been eating bread from the beginning of history i’m like no no no no and.
Speaker1: [1:39:28] It was different bread and we had different we had different like
Speaker0: [1:39:31] A different bread and we also didn’t eat bread we ate bread when we became societies and we didn’t want to have to look for our next food and that makes sense and that’s great we built societies but we also work we we exercised a lot more we were just active right like we were going out and bothering that around that.
Speaker1: [1:39:49] Time we had like bad bone structure like things changed not you know all of these diseases ran rampant and
Speaker0: [1:39:56] Right like we there is nothing that’s naturally available to us that spikes insulin fruits people are like oh well like you know the fruits today are so big they’re not the same well, Have you ever seen a fruit tree that’s like heavy with fruit? If you were like a hunter-gatherer or like an ancient person and you just happened upon this fruit tree, you might sit there and eat three or four apples. Like who cares if an apple today is this big when you just would eat, several of them you know like that’s and they’re like oh well they’re sweeter i’m like no no no i spent two two weeks in the amazon when i was 18 and that fruit is unadulterated and is sweeter than i’ve ever tasted in a grocery store so it’s not because it’s sweeter it doesn’t matter that it’s bigger fruit has always been very available i live in the coast the orange trees here get so full of oranges that the branches touch the ground i mean fruit would have always been available to us vegetables would have always been available to us like my parents are drowning in pecans we live in texas i mean the amount of pecans and they have six countries at their house like these are foods that would have just been available to us you know and it’s like, going and gathering enough oats to make your morning bowl of oatmeal that you cooked in the microwave for 90 seconds and added milk and honey to.
Speaker1: [1:41:18] You don’t you don’t know how to do that like you know how to pick an apple you can theoretically imagine how you kill an animal, but how you make oats, even what an oat looks like when it’s growing, nobody knows, right?
Speaker0: [1:41:30] No, and it would have just been wild oats, right? Like you would have had to go forever to find enough oats to like put in your bowl and then somehow make it, I mean, steel cut oats take forever to cook and just, it wouldn’t have been part of our life. And now people think nothing of a bowl of granola and skim milk, which is just oats and sugar and milk or a bowl of oatmeal with, milk and honey in it and they’re like oh it’s oatmeal it’s like um it’s so much more than oatmeal it’s a bowl of glucose you know and it’s hard for people to get their head wrapped but hopefully with the this conversation they understand
Speaker0: [1:42:08] a little bit more behind what’s going on yeah.
Speaker1: [1:42:11] I think minds will be blown so really one why i wanted to talk to you i wanted to be like listen to this conversation to patients who are like what like you know but um dr ali any last thoughts? Any last words? Thank you so much.
Speaker0: [1:42:23] No, I think that, you know, I think we covered everything and more. People might need to watch this on 2X to get this.
Speaker1: [1:42:31] Yeah, watch it a couple times. I might have another episode kind of going over the signs with PowerPoints to kind of like reinforce what we talked about. But yeah, this is really great.
Speaker0: [1:42:41] Yeah, I think the free webinar, right? That free webinar I have on YouTube, I think it really helps also just, you know, put some perspective i have a free guide on my website with kind of all the foods that you can eat freely of um and then yeah so and i have i have the app coming out i’ll have tons of free education um it’ll have a subscription because that’s just you know part of the world we live in but if you want to access some of the tools and resources but a lot of the education will be free so perfect i’ll.
Speaker1: [1:43:08] Link to everything in the show notes for people to check you out and to follow you so your website and your instagram um is that the best place people can find you kind of website Yeah,
Speaker0: [1:43:16] I think I’m not very active on any other social platform. I can only handle one. But Instagram is where I’m at. Yeah, where I do the most.
Speaker1: [1:43:25] Thank you so much. This has been so great.
Speaker0: [1:43:27] Thank you for having me. Love it.
It’s day one of my period and I’ve been healing a broken foot for 6 weeks. The weather is overcast, thick, humid and rainy.
My body feels thick and heavy. Clothing leaves an imprint on my skin–socks leave deep indentations in my ankles. My face and foot is swollen. My tongue feels heavy. My mind feels dull, achey, and foggy. It’s hard to put coherent words together.
I feel cloudy and sleepy. Small frustrations magnify. It’s hard to maintain perspective.
My muscles ache. My joints throb slightly. They feel stiffer and creakier.
This feeling is transient. The first few days of the menstrual cycle are characterized by an increase in prostaglandins that stimulate menstrual flow and so many women experience an aggravation of inflammatory symptoms like depression, arthritis, or autoimmune conditions around this time. You might get. a cold sore outbreak, or a migraine headache around this time of month. The phenomenon can be exaggerated with heavy, humid weather, and chronic inflammation–such as the prolonged healing process of mending a broken bone.
Inflammation.
It’s our body’s beautiful healing response, bringing water, nutrients, and immune cells to an area of injury or attack. The area involved swells, heats up, becomes red, and might radiate pain. And then, within a matter of days, weeks, or months, the pathogen is neutralized, the wound heals and the inflammatory process turns off, like a switch.
However, inflammation can be low-grade and chronic. Many chronic health conditions such as diabetes, arthritis, PMS or PMDD, depression, anxiety, migraines, even bowel and digestive issues, have an inflammatory component.
As I tell my patients. Inflammation is “everything that makes you feel bad”. Therefore anti-inflammatory practices make you feel good.
Many of us don’t realize how good we can feel because low-grade inflammation is our norm.
We just know that things could be better: we could feel more energy, more lightness of being and body, more uplifted, optimistic mood, clearer thinking and cognitive functioning, better focus, less stiffness and less swelling.
Obesity and weight gain are likely inflammatory processes. Insulin resistance and metabolic syndrome are inflammatory in nature. It’s hard to distinguish between chronic swelling and water retention due to underlying low-grade chronic inflammation and actual fat gain, and the two can be closely intertwined.
It’s unfortunate then, that weight loss is often prescribed as a treatment plan for things like hormonal imbalances, or other conditions caused by metabolic imbalance. Not only has the individual probably already made several attempts to lose weight, the unwanted weight gain is most likely a symptom, rather than a cause, of their chronic health complaint. (Learn how to get to the root of this with my course You Weigh Less on the Moon).
Both the main complaint (the migraines, the PMS, the endometriosis, the depression, the arthritis, etc.) and the weight gain, are likely due to an inflammatory process occurring in the body.
To simply try to cut calories, or eat less, or exercise more (which can be helpful for inflammation or aggravate it, depending on the level of stress someone is under), can only exacerbate the process by creating more stress and inflammation and do nothing to relieve the root cause of the issues at hand.
Even anti-inflammatory over the counter medications like Advil, prescription ones like naproxen, or natural supplements like turmeric (curcumin) have limiting effects. They work wonderfully if the inflammation is self-limiting: a day or two of terrible period cramps, or a migraine headache. However, they do little to resolve chronic low-grade inflammation. If anything they only succeed at temporarily suppressing it only to have it come back with a vengeance.
The issue then, is to uncover the root of the inflammation, and if the specific root can’t be found (like the piece of glass in your foot causing foot pain), then applying a general anti-inflammatory lifestyle is key.
The first place to start is with the gut and nutrition.
Nutrition is at once a complex, confusing, contradictory science and a very simple endeavour. Nutrition was the simplest thing for hundreds of thousands of years: we simply ate what tasted good. We ate meat, fish and all the parts of animals. We ate ripe fruit and vegetables and other plant matter that could be broken down with minimal processing.
That’s it.
We didn’t eat red dye #3, and artificial sweeteners, and heavily modified grains sprayed with glyphosate, and heavily processed flours, and seed oils that require several steps of solvent extraction. We didn’t eat modified corn products, or high fructose corn syrup, or carbonated drinks that are artificially coloured and taste like chemicals.
We knew our food—we knew it intimately because it was grown, raised, or hunted by us or someone we knew—and we knew where it came from.
Now we have no clue. And this onslaught of random food stuffs can wreck havoc on our systems over time. Our bodies are resilient and you probably know someone who apparently thrives on a diet full of random edible food-like products, who’s never touched a vegetable and eats waffles for lunch.
However, our capacity to heal and live without optimal nutrition, regular meals that nourish us and heal us rather than impose another adversity to overcome, can diminish when we start adding in environmental chemicals and toxins, mental and emotional stress, a lack of sleep, and invasion of blue light at all hours of the day, bodies that are prevented from experiencing their full range of motion, and so on.
And so to reduce inflammation, we have to start living more naturally. We need to reduce the inflammation in our environments. We need to put ourselves against a natural backdrop–go for a soothing walk in nature at least once a week.
We need to eat natural foods. Eat meats, natural sustainably raised and regeneratively farmed animal products, fruits and vegetables. Cook your own grains and legumes (i.e.: process your food yourself). Avoid random ingredients (take a look at your oat and almond milk–what’s in the ingredients list? Can you pronounce all the ingredients in those foods? Can you guess what plant or animal each of those ingredients came from? Have you ever seen a carageenan tree?).
Moving to a more natural diet can be hard. Sometimes results are felt immediately. Sometimes our partners notice a change in us before we notice in ourselves (“Hon, every time you have gluten and sugar, don’t you notice you’re snappier the next day, or are more likely to have a meltdown?”).
It often takes making a plan–grocery shopping, making a list of foods you’re going to eat and maybe foods you’re not going to eat, coming up with some recipes, developing a few systems for rushed nights and take-out and snacks–and patience.
Often we don’t feel better right away–it takes inflammation a while to resolve and it takes the gut time to heal. I notice that a lot of my patients are addicted to certain chemicals or ingredients in processed foods and, particularly if they’re suffering from the pain of gut inflammation, it can tempting to go back to the chemicals before that helped numb the pain and delivered the dopamine hit of pleasure that comes from dealing with an addiction. It might help to remember your why. Stick it on the fridge beside your smoothie recipe.
We need to sleep, and experience darkness. If you can’t get your bedroom 100%-can’t see you hand in front of your face-dark, then use an eye mask when sleeping. Give your body enough time for sleep. Less than 7 hours isn’t enough.
We need to move in all sorts of ways. Dance. Walk. Swim. Move in 3D. Do yoga to experience the full range of motion of your joints. Practice a sport that requires your body and mind, that challenges your skills and coordination. Learn balance both in your body and in your mind.
We need to manage our emotional life. Feeling our emotions, paying attention to the body sensations that arise in our bodies—what does hunger feel like? What does the need for a bowel movement feel like? How does thirst arise in your body? Can you recognize those feelings? What about your emotions? What sensations does anger produce? Can you feel anxiety building? What do you do with these emotions once they arise? Are you afraid of them? Do you try to push them back down? Do you let them arise and “meet them at the door laughing” as Rumi says in his poem The Guest House?
Journalling, meditation, mindfulness, hypnosis, breath-work, art, therapy, etc. can all be helpful tools for understanding the emotional life and understanding the role chronic stress (and how it arises, builds, and falls in the body) and toxic thoughts play in perpetuating inflammation.
Detox. No, I don’t mean go on some weird cleanse or drinks teas that keep you on the toilet all day. What I mean is: remove the gunk and clutter from your physical, mental, spiritual, and emotional plumbing. This might look like taking a tech break. Or going off into the woods for a weekend. Eating animals and plants for a couple of months, cutting out alcohol, or coffee or processed foods for a time.
It might involve cleaning your house with vinegar and detergents that are mostly natural ingredients, dumping the fragrances from your cosmetics and cleaning products, storing food in steel and glass, rather than plastic. It might mean a beach clean-up. Or a purging of your closet–sometimes cleaning up the chaos in our living environments is the needed thing for reducing inflammation. It’s likely why Marie Kondo-ing and the Minimalist Movement gained so much popularity–our stuff can add extra gunk to our mental, emotional, and spiritual lives.
Finally, connect with your community. Loneliness is inflammatory. And this past year and a half have been very difficult, particularly for those of you who live alone, who are in transition, who aren’t in the place you’d like to be, or with the person or people you’d like to be–your soul family.
It takes work to find a soul family. I think the first steps are to connect and attune to oneself, to truly understand who you are and move toward that and in that way people can slowly trickle in.
We often need to take care of ourselves first, thereby establishing the boundaries and self-awareness needed to call in the people who will respect and inspire us the most. It’s about self-worth. How do you treat yourself as someone worthy of love and belonging?
Perhaps it first comes with removing the sources of inflammation from our lives, so we can address the deeper layers of our feelings and body sensations and relieve the foggy heaviness and depression and toxic thoughts that might keep us feeling stuck.
Once we clear up our minds and bodies, and cool the fires of inflammation, we start to see better—the fog lifts. We start to think more clearly. We know who we are. Our cravings subside. We can begin to process our shame, anger and sadness.
We start to crave nourishing things: the walk in nature, the quiet afternoon writing poetry, the phone call with a friend, the stewed apples with cinnamon (real sweetness). We free up our dopamine receptors for wholesome endeavours. We start to move in the direction of our own authenticity. I think this process naturally attracts people to us. And naturally attracts us to the people who have the capacity to love and accept us the way we deserve.
Once we start to build community, especially an anti-inflammatory community—you know, a non-toxic, nourishing, wholesome group of people who make your soul sing, the path becomes easier.
You see, when you are surrounded by people who live life the way you do–with a respect for nature, of which our bodies are apart–who prioritize sleep, natural nutrition, mental health, movement, emotional expression, and self-exploration, it becomes more natural to do these things. It no longer becomes a program or a plan, or a process you’re in. It becomes a way of life–why would anyone do it any other way?
The best way to overcome the toxicity of a sick society is to create a parallel one.
When you’re surrounded by people who share your values. You no longer need to spend as much energy fighting cravings, going against the grain, or succumbing to self-sabotage, feeling isolated if your stray from the herb and eat vegetables and go to sleep early.
You are part of a culture now. A culture in which caring for yourself and living according to your nature is, well… normal and natural.
There’s nothing to push against or detox from. You can simply rest in healing, because healing is the most natural thing there is.
Whenever I sit with a new patient for an initial intake, I ask about cravings.
From my many conversations about food, appetite and cravings, the most common responses are cravings for salt, or sugar, with many people falling on one end of the preference than the other: “I’m a salt craver” or “I’ve got a sweet tooth”.
However, cravings are so much more than that.
I believe that they are a beautifully intricate process, in which our body is trying to speak to us about what it needs.
Our cravings often feel like random urges, but they can reveal deeper insights into our body’s needs.
A sweet tooth, for instance, might be more than just a love for desserts—it could signal anything from a need for quick energy to an emotional response tied to comfort and nostalgia. While indulging in sugary treats can be a joyful experience, it’s also important to strike a balance.
Our bodies have developed taste receptors to detect quality nutrients from the environment. While these days sugar is abundant wherever you turn, during our hunter-gatherer times, it was a relatively scarce and highly sought after taste–the taste of ripe fruit, rich with nutrients, the taste of quality calories from carbohydrates, which may have been scarce in times of food shortage or famine.
Salt or “savoury” or umami cravings, often represent a need for more protein. Unfortunately, many of my patients who crave salt (and often calories) find themselves the bottom of a bag of chips, rather than grilling up a chicken breast.
Our modern environment doesn’t necessarily set us up to adequately translate and respond properly to certain cravings. Salted chips were probably not a thing in a natural environment and the only way to satisfy a salt and savoury craving would have been through hunting, consuming meat, or eggs and poultry.
When I was travelling in Colombia I was obsessed with broccoli–it was like I couldn’t get enough of it.
The same thing happened on a month-long trip to Brazil in 2019. Broccoli is rich in vitamin C, sulphur, and certain amino acids. It’s also a decent source of calcium. I’m not sure what nutrient I may have been lacking on my travels, but it’s possible that those cravings meant something for my body. And so I honoured them–I sought out broccoli like it was a magic elixir of health and ate as much of it as I could.
After developing significant iron deficiency after spending a few years as a vegetarian, I became suddenly attracted by the smell of roasting chicken from a local Korean restaurant I was passing by while walking the streets of Toronto.
The wafting smell of roasting poultry was majestic and impossible to ignore. It didn’t smell like sin, or temptation–my body betraying my moral sensibilities or whatever else we often accuse our cravings of—it smelt… like health.
There was no doubt in my mind as the delicious fumes touched my nostrils that I needed to honour my body and start eating meat again. I did and my health and nutrient status has never been better.
Patients will report craving carbs and chocolate the week before their period. The eb and flow of estrogen can affect serotonin levels. A large dose of carbs allows tryptophan, the amino acid that forms the backbone of serotonin, to freely enter the brain. This explains the effect “comfort foods” like starchy warm bread and pasta have on us, creating that warm, after-Thanksgiving dinner glow.
Chocolate is rich in magnesium, a nutrient in which many of us are deficient, that is in higher demand throughout the luteal phase of our cycle, or our premenstrual week.
Cravings are not just nagging, annoying vices, thrust in the path to greater health and iron discipline. They’re complex, intuitive and beautiful. They may be important landmarks on the path to true health and wellness.
Disciplines like Intuitive Eating and Mindful Eating have based themselves on the idea that our bodies hold intuitive wisdom and our tastes, cravings and appetites may be essential for guiding us on a road to health. Through removing restriction and paying more attention to the experience of food, we may be better guided to choose what foods are right for us.
The book The Dorito Effect outlines how our taste cues have been hijacked by Big Food. Like having a sham translator, processed foods stand between essential nutrients and the signals our bodies use to guide us to them. A craving for sweet that might have led you to ripe fruit, now leads you to a bag of nutrient-devoid candy that actually robs you of magnesium, and other nutrients in order to process the chemicals. A craving for salt and umami, or hunger for calories leads you to polish off a bag of chips, which are protein-devoid and laden with inflammatory fats, and only trigger more cravings, and shame.
It’s no wonder that we don’t trust our cravings– we live in a world that exploits them at every turn.
Clara Davis in 1939 was curious about the instintual nature of human cravings and devised a study that was published in the Canadian Medical Assoication Journal (CMAJ). The study was called Self-Selection of Diets by Young Children.
Clara gathered together 15 orphaned infants between 6 to 11 months of age who were weaning from breast-feeding and ready to receive solid food for the first time. These infants, before the study had never tried solid food or supplements. They were studied ongoing for a period of 6 years, with the main study process was conducted over a period of months.
The babies were sat at a table with a selection of simple, whole foods–33 to be exact. The foods contained no added sugars or salt. They were minimally cooked. Not all 33 were presented to each baby at each meal, however the babies were offered an opportunity to try everything.
The foods they were offered were water, sweet milk, sour (lactic) milk, sea salt, apples, bananas, orange juice, pineapple, peaches, tomatoes, beets, carrots, peas, turnips, cauliflower, cabbage, spinach, potato, lettuce, oatmeal, wheat, corn meal, barley, Ry-krisp (a kind of cereal), beef, lamb, bone marrow, bone jelly, chicken, sweetbreads, brains, liver, kidneys, eggs, and fish (haddock).
The nurses who were involved in running the study were instructed to sit in front of the infants with a spoon and wait for them to point at foods that they wanted. The nurses were not to comment on the choices or foods in any way, but wordlessly comply with the infants’ wishes and offer them a spoonful of the chosen foodstuff.
Throughout the study Davis noted that all the infants had hearty appetites and enjoyed eating.
At first, the babies showed no instinct for food choices, selecting things at random, and exploring the various foods presented to them. All of them tried everything at least once (two babies never tried lettuce and one never explored spinach). The most variety of food choices occurred during the first two weeks of the study when they were presumably in their experimentation phase.
Their tastes also changed from time to time, perhaps reflecting some hidden, internal mechanism, growth spurt or nutritional need. Sometimes a child would have orange juice and liver for breakfast (liver is a source of iron, and vitamin C from the orange juice aids in its absorption), and dinner could be something like eggs, bananas, and milk.
Many infants began the study in a state of malnourishment. Four were underweight and five suffered from Rickets a condition caused by extremely low vitamin D. One of the babies with severe Rickets was offered cod liver oil in addition to the other food options. Cod liver oil is a rich source of vitamin D.
The infant selected cod liver oil often for a while, after which his vitamin D, phosphorus and calcium blood levels all returned to normal range, and x-rays showed that his Ricket’s healed.
It is often thought by parents that children, if left to their own devices will eat themselves nutrient-deficient. While that may be true in todays’ landscape of processed frankenfoods, the infants in Davis’ study consumed a diet that was balanced and high in variety. They got 17% of their calories from protein, 35% from fat and 48% from carbohydrates and intake depended on their activity levels.
During the 6 years in which the infants’ eating habits were under observation, they rarely suffered from health issues. They had no digestive issues, like constipation. If they came down with a cold it would last no more than 3 days before they were fully recovered.
In the 6 years, they became ill with a fever only once, an outbreak that affected all of the infants in the orphanage. The researchers noticed their appetites change in response to the illness.
During the initial stages of the fever, they had lower appetites. And, once the fevers began to resolve, their appetites came back with a vengeance. They ate voraciously, and it was interesting that most of them showed an increased preference for raw carrots, beef and beets–which may indicate a need for vitamin A, iron and protein, which are needed for immune system function and recovery.
The habits of the infants to crave and select medicinal foods during times of fever and nutrient deficiency is such compelling evidence of Clara Davis’ craving wisdom hypothesis—were their bodies telling them what they needed to heal?
The self-selected, whole foods diets seems to have a positive impact on the mood and behaviours of the babies, all of whom were living full-time at the orphanage.
A psychiatrist, Dr. Joseph Brennemann wrote an article on them entitled “Psychologic Aspects of Nutrition” in the Journal of Pediatrics on their mood, behaviour and affect, “I saw them on a number of occasions and they were the finest group of specimens from the physical and behaviour standpoint that I have even seen in children of that age.”
In our world we often try to mentalize our food choices: going vegan or low-fat, counting calories, or reducing carbs. We time our eating windows, fast, or try to exert discipline and will over our bodies’ inherent desires.
So often my patients need to be coached through food eliminations, or given meal plans and templates. The art of listening to the body: properly identifying hunger, thirst, fatigue, inflammation, and even emotions like boredom, anxiety, sadness, anger, and hurt, can be a long process.
And yet, I wonder if we clear our palates and offer them a variety of whole, unprocessed, fresh foods, if our bodies will settle into their own grooves–perhaps our health will optimize, our bodies will be able to more readily communicate what they need, our taste receptors and cravings will adjust, and our cravings and appetite will serve the purpose they were meant to–to tell us what we need more of and what need less of or not at all.
I wonder if we listen, what our bodies will tell us.
I wonder if we let them, if our bodies will exhibit the pure instinctual wisdom of nature and the quest for harmony and homeostasis that lies at the heart of our natural world.
Quentin Crisp says, “Repeat yourself loudly and often” and so I’m repeating myself on blood sugar regulation.
I guess if I had to leave a legacy in the world of natural health and lifestyle medicine, if I could sum everyone’s problems down to one key major concept and one key take-home action plan it would be: blood sugar regulation and: eat protein.
Last week was pretty busy in my little homegrown virtual naturopathic practice and I found myself repeating myself loudly (well, in a normal volume voice) and definitely often, the importance of eating protein at every meal and the connection between their symptoms and blood sugar with virtually every patient I saw.
All of my patients last week seemed to be suffering from some combination of the following symptoms:
Fatigue, anxiety, overwhelm, disrupted, restless, and non-restorative sleep, sugar cravings, emotional eating, binge-eating/stress-eating, nausea and bloating, PMS, migraines, low focus and concentration, low libido, low motivation, poor exercise recovery, and weight gain/puffiness/body image issues.
Of course, many of these symptoms were presented as being unrelated to the other. Perhaps stress and stress-eating were related, but sugar cravings and low motivation weren’t necessarily related in my patients’ minds. Neither were their sugar cravings, overwhelm and low libido.
And yet, the common thread that connects all of these symptoms is, you guessed it: blood sugar.
I explained to one patient: even if I gave you a magic wand, that you could wave to make all of your life’s problems disappear, you would probably still be feeling that deep, disconcerting, restless, anxious, “all-is-not-well” feeling in your gut. The reason for this? Blood sugar dys-regulation.
Our body has certain physiological mechanisms that it likes to keep tightly regulated. Among them are blood levels of our sugar (which controls the amount of fuel our brain has for its minute-to-minute functioning), carbon dioxide, salt, and water. When these levels drop in the body we start to feel off. Our stress response is triggered.
Imagine the feeling of holding your breath, as carbon dioxide starts to build up in your blood, you’d pay someone a million dollars to be able to take a breath. Similarly, if you’re seriously thirsty it’s likely all you can think about.
When our blood sugar drops, we feel terrible. The symptoms are anxiety, shakiness, fatigue, low mental energy, burnout, decision fatigue, waking up in the middle of the night, irritability, dizziness and weakness, and an unsettled, doom and gloom feeling. Most of all, however, we crave sugar.
Despite all of the symptoms my patients were expressing last week, one of the main issues they were contending with were sugar cravings. “I just don’t have the motivation to cook a meal”, one patient expressed, “and so I end up eating a bag of chips for dinner, even though I’m not really hungry.”
“You are hungry,” I explained, “the hunger is just not manifesting in the way that you’re used to.
Let me repeat this loudly, ala Quentin Crisp: if you ever find yourself at the end of a bag of chips, or a plate of cookies, or a pile of donuts–you were hungry.
Eating disorder expert Tabitha Ferrar highlights a phenomenon in people recovering from anorexia as “mental hunger”. Physical hunger, the grumbling, gurgling, empty feeling in your stomach is the result of ghrelin and gastric motility, which builds up when leptin levels fall and our stomach is physically empty and creates what many of us assume are the sensations of “true hunger”.
However, these symptoms require energy form our body to produce. This is the reason why people with hypothryoidism are constipated–gastric motility takes metabolic energy.
If your body is malnourished, such as the case of anorexia, or even chronic stress and under-eating throughout the day, we often don’t get these signals of “true” hunger.
Our bodies simply don’t have the battery power to create these symptoms. And yet, we need nourishment, particularly we need to elevate our blood sugar to supply our brains with energy.
And so our body sends our signals of “mental hunger”, that feeling of “I can’t stop thinking about the chips in the cupboard”, that often leads to mindless binging as our body tries to replenish its reserves.
If you’re craving sugar, emotionally eating, devouring chips in the afternoons or evenings, or feeling decision fatigue/ or “lack of willpower”, you might need to start focussing on your blood sugar.
Blood sugar dysregulation is also tightly connected to our moods. Think of our body’s homeostatic mechanism as a tightly regulated machine, a fuel gauge on our body’s resources, which are needed in times of stress. When our blood salt, sugar or water levels dip, and our blood CO2 levels rise, we start to feel uncomfortable. This can be remedied by drinking water, sighing, deep breathing, or eating something. When these levels fluctuate and we fail to notice, our body releases stress hormone.
Cortisol is our stress hormone, but it’s also the hormone that plays a role in blood sugar regulation. When blood sugar dips beyond homeostatic levels, cortisol steps in to save the day. Low blood sugar is a stressor on the body. This might look like morning anxiety, feeling tired and wired, waking in the middle of the night unable to fall back asleep.
Again, you might not feel hungry during these moments–just overwhelmed, anxious, irritable, unsettled, weak, dizzy, and fatigued.
You’re in a fight with your partner. You’ve been cleaning out the garage and it’s hot out. You’re annoyed at the way he breathes, at the slow methodical way he goes through your stuff. The mess feels overwhelming, the heat feels stifling. You leave in a huff, ready to set fire to the entire operation.
Grumbling and fuming, you go inside. You take a breather, you eat something, you exhale deeply, you drink some water.
Gradually, as your body starts to shift into physiological neutral, your perception starts to change. The garage feels slightly more tolerable. It’s really just above moving one box at a time, going through it and then starting on the next one. You can do it.
Before you know it, you’re done.
When blood sugar is low our prefrontal cortex, the “ego”, “decision-maker”, executive functioning, planning and cognitive part of the brain, becomes depleted. We might call this “decision fatigue”, “willpower fatigue” or “ego depletion”.
“Administering glucose completely reversed the brain changes wrought by depletion…
“When glucose is low, [your brain] stops doing some things and starts doing others. It responds more strongly to immediate rewards and pays less attention to long-term prospects.”
In essence, you stop being able to make calm and effective decisions.
Brain sugar levels (the brain uses up 60% of available blood sugar) directly contribute to the feeling of being “solid”–able to make rational decisions, to respond to fears and anxieties, to emotionally regulate, to make competent and calm decisions.
When our blood sugar levels dip we start to spiral: we might think erratically, gloomily, catastrophically, and irrationally.
I had a patient who crashed at 3pm everday after school, when his major depression would “come back”. I asked him what he had for lunch, to which he replied he often worked through lunch. Breakfast was a croissant or piece of toast.
His first real (and only) meal was at dinner. The rest of the day was a sea of grazing on ultra-processed foods, sugar and white flour. No real food in sight.
Scarfing down an emergency granola bar every time blood sugar drops is one solution, however whenever we eat carbohydrates on their own, particularly the quick-release carbs like white sugar, or refined grains, our blood sugar spikes. Soon after, insulin is released, causing it to drop again.
Many of us start the day without food, or with a measly breakfast of toast or cereal, or some other carb-only meal. As I tell patients, though, a serving of carbohydrates is not a real meal.
You know what I mean: a bagel for breakfast, a sandwich and pb for lunch, a plate of pasta for dinner. Carbs, while an important part of a complete meal, are completely inadequate at keeping you fuelled for the hours of mental, emotional and physical labour you engage in between meals.
Does this mean you should eat low-carb? No, not necessarily.
What it means is that a meal contains fats, carbs, and protein. Therefore all meals, especially breakfast, and even snacks, should combine those three macronutrients to assure proper fuelling and blood sugar regulation.
When you eat a proper meal in the morning, your blood sugar rises slowly. It requires less insulin to get the fuel into your cells. Your blood sugar is metered out slowly throughout the next few hours instead of being rapidly absorbed.
This means no more spikes and crashes–in blood sugar, energy, mood or cravings. A proper meal provides hours of calm focus, more willpower, and more ability to concentrate and emotionally regulate.
Instead of just toast in the morning, add about 20g of protein to your meal: a scoop of protein powder, 3-4 eggs, a piece of chicken, 3 tbs of collagen powder– in essence, have a proper meal.
Then, for lunch do it again–have a chicken breast on your salad, or a piece of salmon or beef.
Make yourself a smoothie with protein powder. Have a cold soak oats with collagen powder. Make yourself an omelette. Have a bean soup with 1 cup of beans.
Substitute your wheat or rice pasta (which is just carbohydrate) for a legume pasta made of mung bean or lentils, or black beans, which contain fibre and protein and are easier to make into a fast, complete meal.
When patients start having complete meals, starting with breakfast, their change in mood is often dramatic. They feel more mentally and emotionally stable. They have more energy.
Often we feel we get our second wind in the evening: (“I’m more of a night owl”). But so many of us work through our morning meals and only sit down to a complete meal at dinnertime. Maybe your “second wind” is actually just your first wind, purchased from the proper meal you had when you finally sat down and nourished your body.
What about intermittent fasting? Whenever I speak about breakfast there’s at least one DM or question, or “but I thought that…” and the topic of intermittent fasting almost always comes up.
Giving the body a break from eating is a good idea. For about 12 hours, if possible, stop eating.
This usually means stopping eating 3 hours before bedtime and creating an eating window from something like 7am to 7pm.
12:12 (12 hours of fasting and 12 hours of eating) can be great for resting the digestive system and supporting sleep. However, many of my patients use more extreme version of “intermittent fasting”, such as the 16:8 (16 hours fasting and 8 hours feeding) as a go-ahead to skip breakfast.
They wake up and get through the morning on coffee (with cream and sugar, which isn’t actually a real “fast”), and then eventually binge on sugar and chips after dinner, when they finally give their bodies permission to eat. It’s rare that they see the connection.
Most of us attribute the feelings of lack of control around food an issue with emotional eating and willpower. I find that in 99% of cases, “emotional eating” us usually just a result of blood sugar dys-regulation, protein deficiency and under-nourishing earlier on in the day.
A morning without food is a stressor on the body. Female bodies in particular respond to stress by becoming more insulin resistant, which further affects blood sugar dys-regulation and affects metabolic health–this is not what you want.
If you’d like to restrict your eating window, research shows that removing any after-dinner snacking (when our bodies are naturally more insulin resistant) is the way to go.
It’s also important to take a Protein Inventory. Sometimes I just have patients track their protein intake on a website or app like cronometer.com
The exercise is often enlightening, as patients are able to see how the protein density of their diet connects to their mood and energy.
I often get them to track their food for a few days to a week and then ask them: How do you feel on a higher protein day, where you meet your nutritional needs vs. a low protein day? What is your energy like? Your sugar cravings? Your mood? Your mental focus and clarity?
Conditions like OCD, ADHD, depression, anxiety, PMS, PMDD, cognitive issues, dementia, diabetes, pre-diabetes, weight gain, and bipolar all have roots in blood sugar regulation.
Blood sugar dys-regulation, over time can start to result in insulin resistance (often detected far before any changes to lab blood glucose start to show up).
Insulin resistance is the process in which the cells stop responding to insulin, requiring more insulin to be released. This causes inflammation and weight gain and, over time, elevated blood sugar. Insulin resistance can contribute to mood and hormonal issues, cognitive issues, like dementia, and metabolic conditions over time. This is definitely something you don’t want.
If you think you might have insulin resistance (characterized by sugar cravings, fatigue, abdominal weight gain, difficulty losing weight, hormonal issues, mood issues, low energy, and cognitive issues) consider getting your fasting insulin and fasting glucose tested. These two numbers can give you a HOMA-IR score, used to gauge insulin resistance, so you can work to reverse it before it progresses to pre-diabetes and type II diabetes.
If your test results indicate insulin resistance or early signs of type 2 diabetes, taking action as soon as possible is key to managing and even reversing the condition. Lifestyle modifications, such as adopting a whole-food, low-glycemic diet, engaging in regular physical activity, and prioritizing sleep, can significantly improve insulin sensitivity. In some cases, medication may be necessary to help regulate blood sugar levels effectively.
Often insulin resistance, inflammation and stress are a never-ending cycle and all need to be addressed, with blood sugar regulation as a key strategy to getting your body’s insulin signal working again.
Signs that your metabolic health is healing are more energy, less cravings, better mood, better sleep, and some weight loss (which usually starts occurring about 6 weeks into a lifestyle change program).
Low calorie diets can also be a significant stressor on the body affecting blood sugar. Making sure that your fat and protein intake are sufficient (aiming for about 1 g of protein per lb of body weight for an active person) is essential to regulating blood sugar, cravings, mood and energy.
So, how do you take control of your sugar cravings today?
Here are some places to start:
Start your day with a complete breakfast that includes fat, carbs and 20 g of protein
Eat full meals regularly throughout the day
“front-load” your calories, eating 60% or more of your food before 1pm
Aim for 1 g of protein per lb of body weight, or 90g of protein as a minimum
Track your protein intake along with your mood, energy levels and cravings so that you can have more agency over your food choices, dietary patterns and symptoms.
Have ready-to-grab protein sources like pumpkin seeds, eggs, protein powder, legume pasta, precooked chicken breasts, canned salmon, and so on.
If you’re going to try Intermittent Fasting start slowly, begin by avoiding late-night snacking or snacking before dinner.
Finally, book an appointment if you feel ready to support your metabolic health and get your nutrition right to support your hormones and mood!
For more on how to regulate your blood sugar (as well as nutrient levels and inflammation levels) to eat for your mood, check out my course Feed Your Head:
“The problem with depression is, you can’t see the end.”
Depression is like a ditch. Sometimes you head into and get stuck, but you manage to wiggle out. Other times you’re in a major rut and can’t get out at all. In those cases you need to call someone. It happened to me once. I was driving in the winter to a hiking spot and I thought that a flat-looking patch of snow was the side of the road and before you know it I’d driven into a ditch. I couldn’t get out. I tried gunning it, putting rocks under my tires, getting a friend to push. Eventually I just had to call someone. Within a few minutes, a tow truck came. The man driving it unceremoniously and unemotionally told me to put the car in neutral. He hooked a giant chain to my bumper. He yanked me out of the ditch. And then he drove off. Roadside assistance. In my last post I said something akin to “health is not emotional”. It’s sometimes just an equation. With patients I educate them on their prefrontal cortex, on brain inflammation, on Polyvagal Theory and the nervous system and how depression is a normal response of the nervous system to abnormal circumstances, and how to they can work with their body and environment to get the help they need to yank them out of the ditch. But I also talk about the people around us. We need them. We need them to be our prefrontal cortexes (because when you’re depressed or anxious yours isn’t working at full capacity–you CAN’T just yank yourself out a ditch, you need a tow truck, a chain and an unceremonious dude who knows what to do). You need a strategy. You need a hand. You need help.
Just like getting out of a ditch requires outside help, navigating depression and mental health challenges often means reaching out to someone who knows how to guide you through. It’s not a weakness—it’s a recognition that sometimes you need a strategy, a hand, and a steady presence to help you find your footing.
Therapy isn’t about being told what to do—it’s about working with someone who understands the underlying patterns and can help you create a plan to move forward. Depression can make even the simplest tasks feel insurmountable, but having someone to listen, validate your experience, and help you develop tools to regulate your nervous system makes all the difference.
Depression often feels like an insurmountable barrier, making it hard to see beyond the immediate struggles. It’s essential to recognize that this condition is not a personal failing but a natural response of the nervous system to overwhelming circumstances.
By understanding the interplay between brain inflammation, the prefrontal cortex, and the nervous system through frameworks like Polyvagal Theory, patients can gain insights into their experiences and find ways to support their mental health effectively. This knowledge can empower individuals to take proactive steps, but it’s also crucial to remember that overcoming depression frequently requires external support.
With the right support and strategy, individuals can find their way through challenging times and work towards regaining their mental well-being. Who’s your support team? Who are the people around you?
I talk to my patients about bringing their loves ones on board to help them set up systems to regulate their nervous systems, nourish their brains and bodies (don’t even think for a second that I didn’t have a snack to munch on while waiting for the two truck–this fact is not even metaphorical. You NEED a literal snack to fuel your brain), and reduce inflammation.
There is a theory of depression that it is an ADAPTIVE state meant to get us through a difficult time.
Famine. Capture by a predator. Infection or illness. Isolation from the group.
These may have been the historical hunter-gatherer inputs that caused depression but now it seems that depression can be triggered anytime our bodies are in a perceived or real “stuck” state with no way out.
Many, if not most, or all, depressive episodes I’ve worked with follow a period of intense anxiety. Our body’s stress response burns out, we can no longer “get away from danger” and we shutdown and collapse.
We turn inwards. We immobilize. We ruminate (possibly as a way to THINK our way out of danger).
This is why the 2a serotonin receptors that encourage “active coping” or things like BDNF, which is involved in making new brain cells, have important roles in the treatment research for major depression.
I’ll bet you’ve been told you have a disease, though. Something incurable that you’ll deal with your whole life.
But what if, rather than a disease, depression is a STATE you visit, and sometimes get stuck in that follows anxiety, stress and certain triggers?
How might that change the way you see yourself and your mental health? How might that change the way you seek solutions to how you’re feeling?
“The Adaptive Rumination Hypothesis by Andrews and Thomson posits that depression is not a pathology but a set of useful complex thoughts and behaviours that enable troubled people to withdraw temporarily from the world, deliberate intensively about their social problems, and devise solutions.”
From the Psychiatric Times
The major problem with depression that keeps us stuck in the state is when we turn our rumination back on ourselves and engage in self criticism.
Hannah Hepworth, of the Anxiety Revolution Podcast, and I team up to discuss a natural and functional approach to managing anxiety.
In our talk, featured in her 2019 Anxiety Revolution Summit, a series of talks with integrative mental health practitioners and experts, we discuss circadian rhythms, the body’s stress response and the HPA (hypothalamic pituitary adrenal) axis, and blood sugar, and their role in anxiety.
Click the link to listen to this 30-minute interview. Let me know what you think!
In order to make sense of the world, people create stories. It is our greatest gift and most fragile weakness.
Boy meets girl, they fall in love, they encounter difficulties that they eventually overcome. It brings them closer. They live happily ever after—the classic love story.
Stress has a classic story too: cortisol, the “stress” hormone, is released during stress. It wreaks havoc on the body. Lowering stress helps lower cortisol.
However, when it comes to human hormones, telling stories in a linear narrative is impossible.
Hormones are signalling molecules in the body. They are produced by endocrine organs, such as the adrenal glands, the brain, and the ovaries. They travel through the bloodstream to impact the expression of genes on distant tissues, which impacts how our bodies function.
Production of norepinephrine in the adrenal glands as a response to stress can make your heart race, your pupils dilate, your hands to shake, and your senses become hypervigilant—when a perceived threat or danger activates the release of this hormone, your entire body pulsates under its influence.
Hormonal stories are hard to fit the human desire for narratives. Their relationships with our genes, bodily systems, receptor binding sites, and each other make their actions too complicated to be described linearly. Instead they act like webs, or tangled networks of intricate connections.
When hormone levels rise in the body, beyond our delicate homeostatic balance, a phenomenon, called “resistance”, can occur. With resistance, cells reduce their responses to the hormones that interact with them.
When telemarketers keep interrupting your dinner at 6pm, eventually you stop answering the phone.
When certain hormones continue to call at the surface of cells, stressing the body’s capacity to respond, our cells simply stop answering.
Many of us ask, “what happens when I pull this thread here?” when learning about one hormone that we’ve blamed all our woes on. We tug the thread, without considering the entire web of connections, and our actions affect the entire system.
Our hormones exist in an ecosystem where everything hums and flows together, as a unit. It’s impossible to lay out explanations for their actions in a linear fashion.
Hormone stories flow like a Choose Your Own Adventure novel—a hallway with many doors that snake down long corridors and meet again, and interconnect.
Go through the door marked “estrogens”, and you encounter serotonin, cortisol, progesterone, insulin, thyroid hormones, leptin, BDNF, dopamine, norepinephrine, and many others.
Hormones are the conductors of your body’s personal orchestra, composed of thousands of musicians, a complex musical score, highly-trained arms, fingers, and mouths manipulating instruments: a million moving parts working together in harmony.
The best we can do to understand the entire interplay is to slow down the action, take a snapshot of it, and to try to understand why these symptoms are occurring in this individual.
Symptoms of Hormone Imbalances
Because hormones affect absolutely every system of our body, I am always attuned to the possibility of hormonal imbalances in my patients.
It helps to look at hormones in terms of their symptom patterns rather than how any one hormone affects us in particular.
Common signs of hormonal imbalance are:
Fatigue, low libido, restless sleep, depression and anxiety, waking at 2 to 4 am, a high-stress lifestyle, and brain fog might indicate cortisol imbalance.
PMS – and the more severe related condition, PMDD – infertility, fatigue and low libido, missed and irregular periods may be related to fluctuations in the hormones estrogen and progesterone, or low estrogen and progesterone levels. Many of these symptoms could also be related to estrogen dominance, in which estrogen is either high or normal, and progesterone is low.
Endometriosis, a family or personal history of female cancers, anxiety and panic attacks, heavy and painful periods, frequent miscarriages, infertility, fibroids, fibrocystic breasts and weight gain around the hips and thighs can indicate estrogen dominance.
High levels of male sex hormones like testosterone, irregular periods, weight gain, acne, and hair loss may indicate a female hormone condition called PCOS.
Fatigue, brain fog, difficulty losing weight, puffiness, constipation, dry skin and hair, and low body temperature can be signs of hypothyroidism.
Symptoms of reactive hypoglycemia, such as feeling dizzy, anxious and shaky between meals, sugar cravings, weight gain around the abdomen, difficulty losing weight, and low morning appetite, night-time carbohydrate cravings, and binge eating can all be related to insulin resistance and poor blood sugar control.
In my naturopathic practice, I see common patterns of symptoms that indicate certain hormonal imbalances.
These patterns often represent vicious cycles where our body is stressed beyond a capacity to balance these interconnected webs of chemical interactions, causing further imbalance.
Cortisol
Speaking of stories, here’s one I hear often.
You wake up in the morning, exhausted. Your brain is in a fog and you don’t feel alive until a cold shower or double espresso knock you out of your stupor.
Things get a bit better once you get moving, but you wonder why your energy never fully bounces back.
You used to play sports in university, you think to yourself. Now just thinking of sports makes you tired.
Is this what getting older feels like? You’re in your 30s.
The days at the office stretch on forever. Concentration and focus are difficult. You see a coworker whose name, you realize with horror, can’t be brought to mind.
You’ve known her for a year. Cynthia? Sylvia? Your brain hurts.
In the afternoon you think longingly of napping, but instead take your place in the long line for coffee and something carb-y like a cookie.
When it comes time for sleep you are either out like a light or find it hard to turn your mind off; you’re tired, as always, but also wired.
Sleep doesn’t feel restful, and you often wake up, sleepless, at 2-4am in the morning.
When your alarm rings a few hours later, the cycle begins again.
Cortisol, one of our stress hormones, has a circadian rhythm. Its levels are highest in the morning, about an hour after waking. Cortisol promotes energy, alertness and focus. It is also a potent anti-inflammatory hormone.
Cortisol is what makes us feel alive in the morning, bouncing out of bed like Shirley Temple and her curls.
Throughout the day our cortisol levels slowly dwindle (unless a major stressor causes them to spike abnormally). They are lowest in the evening, when melatonin, our sleep hormone begins to rise, inducing feelings of sleepiness, preparing us for a night of rest.
Our modern day society, however, calls on cortisol to perform more than its fair share of work. Cortisol is around when we’re hauling ourselves out of bed after an inadequate night of rest.
Cortisol fuels gym workouts, gets us to our meetings on time, allows us to meet deadlines, tolerates traffic jams, responds kindly to tyrannical bosses, and makes sure the kids get to all their after-school events.
Cortisol is made in the adrenal glands, two endocrine glands located on each kidney, in response to signals from the brain that perceive stress in our environments and bodies.
When stress hormones levels are too high we experience a “tired and wired” feeling. During this time we might feel we thrive better under stress: workouts boost our energy, we have a hard time quieting down and we rarely feel hungry.
We might still struggle with weight gain, however, especially the abdomen and face, where cortisol tends to encourage fat deposition.
We might feel tension—tight muscles and shoulders, and body pain, as muscles clench up, preparing to fight or flee.
Chronic stress is associated with high levels of cortisol. We work long hours, late into the night. We go, go, go. This may give us a “high” or it may feel exhausting and depleting.
Many of us can exist in this state for months and even years. Sometimes a compounded stressor such as a divorce, accident, or loss, can tip us over the edge into a depleted, burnt out state.
Burnout, often following a period of prolonged stress, can be associated with low cortisol signalling. Our bodies have simply stopped being able to produce the stress hormones necessary to meet the needs of our daily lives, or glucocorticoid receptors in the brain and body cells, have stopped responding to cortisol.
Just as cell can be become resistant to insulin, they can also become resistant to cortisol. Too much (or even too little) of a hormone can cause cells to start ignoring their signalling, resulting in symptoms of low levels of the hormone in some areas of the body and high levels of the hormone in others.
Cortisol is a complicated molecule. It both encourages the stress response, but also turns it off, when levels reach a certain point.
Often, cortisol levels that are too low result in an impaired stress response, preventing our fight or flight system from properly shutting off—cortisol resistance can lead to further stress hormone disruption.
The result of an imbalance in cortisol, otherwise termed Hypothalamic Pituitary Adrenal (HPA) Axis dysregulation is weight gain, fatigue and brain fog, inflammation and immune system activation, digestive issues, restlessness, impaired sleep, decreased cognitive function, and mental health conditions, such as anxiety and depression.
When cortisol levels are low, the body makes adrenaline and noradrenaline to meet our needs, which often leads to anxiety and feeling shaky and nervous, contributing to symptoms of anxiety.
Cortisol also influences the function of our sex hormones, thyroid hormones, and our blood sugar. Imbalances in any of these other hormonal systems can be a result of an impaired HPA axis.
Cortisol Testing
The two main ways to assess the body’s levels of cortisol are through serum (blood tests) and saliva.
A study found both tests were equal when it came to diagnosing Cushing’s disease, a condition of highly elevated cortisol.
One of the advantages to salivary cortisol testing is the ability to obtain multiple samples in one day to be able to view a patient’s cortisol curve, in which cortisol peaks approximately one hour after waking and declines throughout the day.
The cortisol curve is measured by assessing 4 samples of salivary cortisol taken at 4 key points during the course of one day. It measures free cortisol, which may only represent about 5% of total cortisol in the body.
While salivary cortisol levels can be a good starting point for assessing the cortisol curve, it doesn’t tell us everything about the health of the glucocorticoid receptors or HPA system as a whole.
High cortisol levels may be seen in patients with low cortisol signalling, such as depression, anxiety and chronic fatigue. Errors in obtaining salivary cortisol samples (such as not taking samples at the right time) can lead to falsely low cortisol readings.
In my opinion, this makes symptoms and health history the most valuable tools for properly assessing HPA axis function.
Cortisol and Melatonin
Melatonin, our sleep hormone, also operates on a circadian rhythm. It is released by the pineal gland in the brain and induces sleep. Its release corresponds to a drop in cortisol levels at the end of the day.
That release is impeded by artificial light exposure at night, lack of daytime sun exposure, alcohol, stress, and HPA axis disruption, among other lifestyle and environmental factors.
Melatonin, like other hormones, can be tested for in blood, urine and saliva, but I find more value in assessing for sleep quality and quantity by taking a thorough health history while also restoring a patient’s sleep hygiene and HPA axis regulation.
Many patients with sleep issues can benefit from a trial of supplemental melatonin to see if that helps their sleep. Taking it 2 to 3 hours before bedtime to coincide with the body’s natural melatonin surge and taking a prolonged-release version to promote sleep maintenance are two strategies I use for helping patients sleep better.
Working on sleep and circadian rhythms is also beneficial for restoring HPA axis functioning.
The “Female” Hormones: Estrogen and Progesterone
The most prevalent female sex hormones are estrogen and progesterone. These two hormones eb and flow in distinct ways throughout a woman’s monthly cycle.
Estrogen creates an “M” shape, rising at the beginning of the cycle to its first peak around ovulation, half-way through the cycle. At this time women typically experience their best mood, energy, and motivation, perhaps noticing a rise in libido.
After ovulation, estrogen dips a little bit and then rises, peaking again about a week before a woman’s menstrual cycle is due.
After this, estrogen takes a nosedive, reaching low levels around the time that menstruation begins: Day 1 of the menstrual cycle.
Progesterone, on the other hand is largely absent the first half of the cycle, before ovulation. Then, it begins a steady climb to peak with estrogen, about a week before the arrival of the next period.
After peaking, just like estrogen, progesterone then takes a dip, which stimulates the uterine lining to shed, resulting in menstruation, in which the entire cycle begins again.
PMS and PMDD
My practice is populated by women who experience various forms of grief at different stages of their monthly cycles.
Many of my patients experience PMS, and the more severe PMDD (Premenstrual Dysphoric Disorder)—which is characterized by intense mood swings, irritability, depression, or anxiety, panic attacks and psychosis in the most severe cases— up to two weeks before their periods.
The mood changes in PMS and PMDD are associated with fluctuations in the hormones estrogen and progesterone, which can wreak havoc on our brain chemistry.
Estrogen has a beneficial effect on mood, increasing dopamine and serotonin action in the brain. Dopamine and serotonin are two antidepressant, feel-good neurotransmitters.
Estrogen also increases something called Brain-Derived Neurotrophic Factor (BDNF) a chemical that stimulates the growth of brain cells. This can boost memory, concentration, and cognition, as well as positively influence mood.
Progesterone breaks down into a chemical called allo-pregnenolone, which acts like GABA, a calming neurotransmitter, in the brain. Bioidentical progesterone therapy is often used as a treatment for anxiety and insomnia.
When estrogen and progesterone levels surge and drop suddenly, drastic fluctuations in mood can occur. Cravings for sweets, crying, lack of motivation, or severe anxiety can all occur when hormones drop right before a period is due.
However, elevated levels of estrogen can also be problematic. Estrogen stimulates dopamine, which typically makes us feel good, gives us energy, and helps to motivate us. In genetically vulnerable women, elevated levels of dopamine can cause excess irritability, low stress tolerance, and even mania or psychosis.
Estrogen also slows the recycling of the stress hormones epinephrine and norepinephrine, which can lead to symptoms of acute stress and anxiety, when dysregulated.
This means that dramatic rises and falls in estrogen throughout a woman’s cycle can cause her to feel irritable and anxious one week and unmotivated and depressed the other.
Smoothing out hormonal ups and downs can be a key factor in regulating a woman’s menstrual cycles and soothing her mood and emotions throughout the month.
Perimenopause and Menopause
Perimenopause is characterized by a declining production of the ovarian hormones estrogen and progesterone.
Estrogen levels tend to rise and fall dramatically throughout a woman’s remaining cycles, while progesterone levels tend to stay low.
The result of these changes are symptoms like hot flashes, night sweats, brain fog, fatigue, and depression when estrogen levels suddenly tank, and increased stress and anxiety when estrogen levels abruptly spike.
During this time, cycles may become irregular. Some of my patients comment that their periods are incredibly light one month and the heaviest of their lives another.
Some get periods every few months and some notice increased frequency, even spotting between cycles, or have a full-blown period every two weeks in more extreme cases.
Weight gain tends to drift from the thighs and buttocks to the abdomen. Once pear and hourglass-shaped figures begin to resemble apples.
Fatigue is a common symptom. Women may experience poor sleep due to night sweats from estrogen deficiency, and anxiety from insufficient progesterone.
What a joy, right?
Many of these perimenopausal symptoms are a relatively modern phenomenon, stemming from a dysregulated HPA axis.
After cessation of periods, it’s the job of the adrenal glands to take over sex hormone production. However, if the HPA system is preoccupied with organizing a stress response, this can affect the production of other hormones.
Impaired Estrogen Clearance
Many women struggle with symptoms that are related to relatively high levels of estrogen, often caused by impaired estrogen clearance.
These conditions include heavy and painful periods, fibrocystic breasts, or conditions like fibroids or endometriosis.
Chronically elevated estrogen levels also include a risk of certain hormone-associated cancers, such as breast cancer.
These women may experience irritability and anxiety through estrogen’s interaction with stress hormones, and also from a relative deficiency in progesterone.
A relatively high level of estrogens compared to progesterone is termed “Estrogen Dominance”.
Estrogen is normally cleared through the digestive system: the liver and intestines.
A sluggish and congested liver causing a slower rate of hormonal clearance (think of it like a clogged drain), an increase in environmental toxin exposure, or an overconsumption of alcohol, can slow the liver’s ability to regulate estrogen levels in the body.
Constipation and a dysbiotic gut can also impair estrogen clearance.
Symptoms of estrogen dominance include stubborn weight gain, typically around the hips and thighs, heavy and painful periods, tender and painful breasts, fibrocystic breasts, endometriosis, uterine fibroids, acne, cyclical mood swings, especially premenstrual anxiety and panic attacks, and irregular menstrual cycles.
Low Progesterone
Aside from impaired estrogen clearance, another pattern of estrogen dominance is low progesterone.
In this case, estrogen levels are normal or even low (as in the case of menopausal or perimenopausal women). However, an even lower progesterone level still results in a pattern of relative estrogen dominance.
This can cause some of the same symptoms as excess estrogen (anxiety, irritability, heavy and painful periods, weight gain, PMS, fibroids, fibrocystic breasts, etc.).
Low progesterone can also be a culprit in unexplained infertility or early term miscarriage, as progesterone maintains the uterine lining in pregnancy.
Progesterone is released from the ovaries after ovulation. Lack of ovulation, therefore, is a primary reason for low progesterone levels. Anovulatory cycles can occur in women with polycystic ovarian syndrome, women with high levels of physical and emotional stress, or women entering menopause.
Some progesterone, however, is also made in the adrenal glands, where it can be eventually turned into cortisol, aldosterone (a steroid hormone involved in salt-water balance in the body) and androstenedione (a male sex hormone), eventually making testosterone and estrogen.
Women with high cortisol demands due to chronic stress may shunt the progesterone made in their adrenal glands to producing other hormones that support the stress response.
Not only can stress alter ovulation and fertility through various other mechanisms, it can also rob the body of progesterone, directing any progesterone made towards cortisol production.
Testing Estrogen and Progesterone
Estrogen and progesterone can be tested reliably in saliva, blood and urine.
Month long salivary hormone testing of estrogen and progesterone can be an easy and effective way to track the eb and flow of these hormones throughout a women’s menstrual cycles.
In this test, women obtain a saliva sample every 3 to 5 days for the duration of the month to track how estrogen levels corresponds with progesterone and how both hormones rise and fall.
In my practice, however, I often start by running blood tests. I test hormones on day 21 (of a 28-day cycle) to coincide with progesterone’s peak. This can help us calculate the progesterone to estrogen ratio and establish whether the cause of estrogen dominance symptoms is high estrogen or low progesterone.
Blood tests offer the option of looking at estrone, which is a more problematic form of estrogen, as well as estradiol (the most common, metabolically active estrogen in the body). In blood we can also look at LH and FSH, two hormones produced in the brain and ovaries that orchestrate ovulation.
FSH tends to be high in women in menopause or perimenopause, while LH tends to be elevated in women with Polycystic Ovarian Syndrome (PCOS).
Dried urinary metabolite testing, or DUTCH, is an effective way to understand how hormones are broken down and processed by the body. Looking at the entire hormone breakdown pathway provides a more in-depth look at the complexity of hormones in a woman’s cycle, and can guide treatment in specific, useful ways.
The “Male” Hormones: Testosterone
Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility (and the most common endocrine disorder) in women of reproductive age. It affects about 10% of menstruating women.
PCOS is a collection of various symptoms and complex hormonal causes. However, it is characterized by missed periods, anovulation, male-pattern facial hair growth, especially on the upper lip, chin, breasts and abdomen, and the presence of cysts on the ovaries.
Other common symptoms of PCOS are weight gain, estrogen dominance, male-pattern hair loss (on the crown of the head), insulin resistance, infertility, and acne, especially hormonal cystic acne on the jawline.
PCOS is characterized by elevated levels of testosterone, a male sex hormone, or “androgen”, on blood work.
Acne, weight gain, infertility, and hair loss are the main symptoms that bring women with PCOS into my office.
PCOS is a complex process that involves an overproduction of testosterone in the ovaries coupled with insulin resistance. Therefore, balancing blood sugar through diet and lifestyle can have a major impact on symptoms.
The conventional treatment for missed or absent periods is oral contraceptives, which of course doesn’t treat the underlying cause of anovulation. That’s why women with PCOS often seek naturopathic and functional medical solutions to treat the root cause.
Testing for PCOS
When I meet a new patient with PCOS, I often test her blood for estradiol and progesterone levels at Day 21 of her cycle. A very low progesterone level may indicate that she has not ovulated that cycle.
We also test LH and FSH. A high LH:FSH ratio can be indicative of PCOS even if cysts are not present on an ovarian ultrasound.
Other important tests that are often ordered are free testosterone and DHEA-S, another male hormone made in the adrenal glands.
Glucose control and insulin resistance can be assessed by looking at fasting blood glucose, fasting insulin and HbA1c (a marker that looks at long-term glucose control).
Prolactin, another hormone released by the pituitary gland, can sometimes be elevated in anovulatory women with PCOS.
A 4-point salivary cortisol test may be useful in women with PCOS who are also experiencing symptoms of cortisol dysregulation, which can contribute to insulin resistance and affect ovulation and hormone regulation, particularly progesterone production.
Prolactin
Prolactin is a hormone released by the pituitary gland to promote milk production after child birth.
However, some women will have elevated levels of prolactin in blood, despite not currently pregnant or breastfeeding.
Called hyperprolactinemia, elevated prolactin may be a cause of anovulation, mimicking some symptoms of PCOS and menopause, including hot flashes, absent or irregular periods, infertility and even milk discharge from the breasts.
Hyperprolactinemia may be caused by low calorie diets, liver issues, hypothyroidism, and issues with the pituitary gland itself.
Prolactin can be tested in blood. If levels are elevated, an MRI must be conducted to rule out a physical issue with the pituitary gland, such as a tumour.
Oxytocin
Oxytocin is a hormone produced in the brain and secreted by the pituitary. It aids in childbirth. Also termed the “love hormone,” it’s associated with feelings of intimacy and connection.
While high and low levels of blood oxytocin can be possible in men and women who are not pregnant or breastfeeding, the clinical applications of it are not fully known.
Thyroid Hormones
The thyroid, a butterfly-shaped gland on our neck, is the master thermostat of the body, controlling heat and metabolism. It pumps out thyroid hormones T4 and T3, which tell cells to burn fuel, creating energy and heat.
Because our thyroid hormones interact with the cells in every body system, symptoms of hypothyroidism, or low thyroid function, can be incredibly diverse.
Common symptoms of hypothyroidism are weight gain or inability to lose weight, fatigue and sluggishness, brain fog, hair loss, low body temperature, constipation, dry skin and hair, puffiness, infertility, and altered menstrual cycles, such as missed periods or heavy periods.
Aside from autoimmunity, other causes of low thyroid function can be HPA axis dysregulation and chronic stress, a very low calorie or very low carbohydrate diet, sudden weight loss, a deficiency in nutrients needed for thyroid function such as iron, zinc, iodine and selenium, and a body burden of environmental toxins such as heavy metals.
Testing Thyroid
To assess thyroid function, conventional doctors will test a hormone called Thyroid Stimulating Hormone, or TSH. TSH is not a thyroid hormone, but a hormone made in the brain that urges the thyroid to pump out the thyroid hormones T3 and T4. It gives doctors an indirect measure of thyroid regulation.
When TSH levels are high, this suggests that thyroid function is sluggish; the brain needs to send a louder signal to get an unresponsive thyroid to work.
However, TSH is only a periphery marker of total thyroid function, not giving us the whole picture. Also, TSH ranges on conventional lab tests may fail to pick up some cases of subclinical hypothyroidism or impending cases of autoimmune thyroid conditions, otherwise termed Hashimoto’s Thyroiditis, which is the most common cause of hypothyroidism.
To properly assess thyroid function in someone with symptoms of thyroid dysfunction, a slightly elevated TSH, or a family history of Hashimoto’s, I will order a thyroid panel: a blood test measuring TSH as well free thyroid hormone (T3 and T4) levels.
It’s also important to assess for autoimmune thyroid conditions by testing for anti-thyroglobulin and anti-thyroperoxidase antibodies. Both of these antibodies, when elevated, suggest the presence of an autoimmune thyroid condition.
Insulin
Some of the most common hormonal dysfunctions I see in my practice are insulin resistance and reactive hypoglycemia: blood sugar imbalance.
These issues often lie at the heart of other hormonal imbalance patterns, such as irregular menstrual cycles or HPA axis dysregulation.
When we eat, glucose enters our bloodstream, providing fuel for our cells. Insulin helps our cells access this hormone, spiking with each meal.
The higher the meal is on the glycemic index (i.e. the more sugar or refined carbohydrate it contains), the higher our post-meal blood sugar and insulin spikes will be.
Without insulin, we would slowly lose energy and die, unable to get precious glucose into our cells. Individuals with type I diabetes cannot make insulin. They must inject it daily to keep their cells fuelled and blood sugar stable.
For the rest of us who do make insulin, large blood sugar spikes after a meal can be problematic.
Insulin is a storage hormone. It helps energy get into cells, and it helps build muscle and brain cells, but it also blocks the breakdown of fat cells, blocking weight loss.
Insulin also drives down blood sugar levels. When blood sugar rises too quickly after a meal, a large insulin response can drop blood sugar levels too drastically, causing reactive hypoglycemia, or feeling “hangry” (hungry, angry, irritable, tired, light-headed, weak and dizzy) in between meals.
Individuals who experience hypoglycemia feel irritable, shaky, dizzy and anxious between meals. They often suffer from anxiety and panic attacks, and feel hungrier at night.
They may wake up in the middle of the night, as their bodies are unable to go 8 hours (the length of a decent night’s sleep) without food. This causes them to wake up, restless and perhaps anxious, in the early hours of the morning.
These individuals, paradoxically, rarely feel hungry at breakfast time.
I often see anxious patients wake from a restless sleep and toss back only a coffee in the morning, skipping breakfast due to slight morning nausea.
At 10 am, feeling ravenous and shaky, they might scarf down a high-glycemic bagel or croissant. Later on, they’ll enjoy a light lunch—maybe a sandwich—often feeling foggy and lightheaded after eating it.
At 2 to 4 pm, they may feel like an afternoon nap, instead indulging in a coffee and sweet treat to buy them some energy for the remaining hours of the work day.
Finally, after enjoying a larger dinner once they get home, they find themselves snacking all night long. Their bodies are finally urging them to ingest the nutrients they were lacking throughout the day.
They then fall into bed, feeling full, restless and wired, and the cycle begins again.
When our blood sugar falls, we not only feel hangry, weak, and crave processed carbs, our HPA axis also gets stimulated.
Cortisol, a glucocorticoid, can help our body control blood sugar, bringing it into the normal range after insulin sends it tanking too low.
This drop in blood sugar, therefore, needlessly triggers a stress response from the adrenal glands, which can further worsen anxiety, HPA axis dysregulation, and glucocorticoid resistance.
When blood sugar and insulin are spiked repeatedly for days, months, and years on end, cells stop responding attentively to insulin’s signal. Like our response to a pesky telemarketer, cells eventually stop picking up the phone when insulin calls.
However, cells still need insulin. More and more insulin must be released to trigger the same response from insulin resistant cells. This makes cells even more resistant, as they require even more insulin release the next time blood sugar rises to get glucose into the cell for fuel. And so the cycle becomes vicious.
Elevated insulin levels cause inflammation, fat gain, fatigue, depression, reactive hypoglycemia, and HPA axis dysregulation. The more resistant our cells become to insulin, the more cortisol must be called on to maintain blood sugar levels.
PCOS is also characterized by higher insulin levels. This prevents ovulation, causing infertility and female hormone imbalance.
When insulin resistance persists, type II diabetes, where the body is no longer able to keep blood sugar in a safe range, develops.
Type II diabetes is characterized by chronically high blood sugar—which poses a danger to small blood vessels, and is a potent inflammatory condition, increasing the risk of heart disease—and elevated insulin.
It affects almost 10% of the adult population and is the 7th leading underlying cause of death in North America, costing 350 billion dollars a year to manage in the United States alone.
Insulin-related weight gain can affect female hormones, as fat cells make estrogen in the body, leading to estrogen dominance.
Insulin also interacts with a hormone called leptin, which is created by fat cells in response to calorie intake. When body fat levels get too high, cells can become leptin resistant. The body no longer senses dietary calorie intake, leading to increased hunger. This exacerbates the problem of weight gain and insulin resistance.
Testing for Insulin Resistance
When I meet a patient who is presenting with stubborn weight gain, estrogen dominance and stress, I assess their blood for insulin resistance by looking at blood levels of fasting insulin and fasting glucose.
With these two values a calculation that measures insulin resistance, called the HOMA-IR, can be performed. This can give us a baseline measure of how well the body is compensating to control blood glucose.
I also run HbA1c, which looks at glucose levels over 3 months. I will often run a blood cholesterol panel, and inflammatory markers, such as CRP.
Insulin resistance often puts all of our hormones on a rollercoaster, which becomes very difficult to get off of unless we prioritize the diet and lifestyle interventions that address blood sugar control.
Assessing Hormones
When presented with a patient suffering from a complicated symptom pattern, I begin by taking a thorough health history in which we investigate:
Energy levels,
Sleep quantity and quality,
Mood and mental health history,
Period health history,
Family history,
Dietary intake and exercise,
Health risk factors like smoking, alcohol use, and past health history.
Depending on how clear the patient’s symptom picture presents, we may opt to make some changes before testing, to gauge their body’s response to an increase in nutrient intake.
Then, if necessary, I will order a comprehensive blood work.
Blood testing might include a thyroid hormone panel, and an in-depth look at female hormones, fasting insulin and fasting blood glucose, and other markers that help us assess health, such as cholesterol and inflammatory markers, or nutrient levels.
Patients requiring a more comprehensive view of their cycles may opt for month-long salivary testing. Others may opt for a dried urine test that looks at hormonal breakdown in the body.
A Sample Case
Jenny (name changed for privacy) came to me feeling fatigued and anxious.
She had suffered from anxiety periodically as a teen, but now at age 46 she was experiencing bimonthly panic attacks that seemed to occur cyclically; the panic would come around ovulation and premenstrually.
It was hard to tell, however, because Jenny also claimed that her periods were “all over the place”. One month they were heavy and painful, causing her to take time off work, crouched on the bathroom floor in agony. Other months she barely noticed them, experiencing some light spotting, if anything at all.
Very troubling to her was her major mood volatility, which she described like a “switch” that would suddenly flip on or off, causing her to breakdown at work or pick fights with her family.
Then, almost as suddenly, the cloud would lift and she would be her cheerful, friendly, loving self again.
It was maddening, both to her and those living with her during these darks times, she said.
She also noticed disrupted sleep and weight gain around the abdomen, which seemed to ignore her intense workouts and strict dietary regime.
Jenny was highly accomplished at her high-pressure job and commented that she thrived on being busy and achievement oriented.
I tested Jenny’s blood estradiol, estrone, progesterone, LH, and FSH levels one week before her next expected period, had her fill out a weekly diet diary, and gave her some recommendations about sleep and supplement intake.
Jenny’s blood revealed elevated FSH, indicative of impending menopause (FSH encourages the ovaries to ovulate, as TSH encourages the thyroid gland to make thyroid hormone). She also had low estradiol, and low progesterone, but elevated levels of estrone, the more problematic of the estrogens.
According to her labs and history, Jenny was experiencing estrogen dominance and perimenopause. Many of her symptoms were stemming from elevated estrone, low progesterone and a disrupted HPA axis.
Together, we worked on her diet to provide her body with the nutrients needed to make hormones and to support her brain, mood and adrenal glands.
We used herbs and dietary nutrients to promote liver estrogen clearance and to support Jenny’s adrenal glands.
We addressed the stress in her life, encouraged relaxation, and made sure her body was supported in its ability to make and respond to cortisol.
After a few months, Jenny reported a reduction in hot flashes, better sleep and feeling calmer. She had a reduction in her waist line and better energy and mood.
Our hormones, when imbalanced, can cause vicious cycles in the body that trap us in a state of worsening imbalance.
Through correctly assessing these common hormonal patterns through a health history and appropriate testing, and then making diet, lifestyle and supplement suggestions addressed at stopping these cycles, naturopathic doctors can address underlying hormonal issues that might be causing these complex and troublesome patterns of hormone disruption.
I review my adventurous year of living on the Low Carb High Fat Ketogenic Diet.
I’ve always had a sweet tooth.
I remember binging on Halloween candy as a kid, stuffing one tiny chocolate bar after another into my mouth, as fast as my little fingers could unwrap them, trapped in some kind of sugar-filled trance.
“Never get between Talia and her food!” My family would joke when my blood sugar would crash between meals and I’d rage towards the fridge for a snack to keep me sane.
I remember digging into the little bags of cheese popcorn reserved for school lunches, finishing off one after another and then hiding the wrappers in their big Costco box so that it would look like it was still full, the way rebellious teens top up empty vodka bottles with water.
I can gain weight with the drop of a hat (but also put on muscle fairly easily), and it takes concentrated effort and dedication to take it off.
After a period of temporary stress and bagel-related weight gain, I decided to embark on a bit of experimentation. Work was getting busy and I wanted to supply my brain with constant energy without having to take snack breaks every few hours. Also enticed by anecdotes of shattered weight loss plateaus, I decided to “go Keto”.
I like experimenting with diet. Like many health-conscious people, finding the right nutrition regime for me has been a process. In my teens I started controlling portions and switching out white breads for whole grain rye and Jolly Ranchers for carrot sticks. In my early 20’s, I was vegetarian. I tried being vegan for a while before deciding it was a disaster for my health when I began to experience nutrient deficiencies, weight gain, and hormonal issues.
Later on, I followed my naturopathic school classmates to a modified Paleo diet (keeping in some gluten-free grains and legumes), then moved to a more traditional Paleo diet (taking out the grains and legumes), before going back to the modified version (which is probably the best eating style for me—more on that later).
For the most part, my diet is comprised of whole foods, with lots of vegetables, but in the Fall of 2016, when this all began, I was in a pretty Standard North American place when it came to food intake. At the time I was suffering from IBS, some issues related to subclinical PCOS, and fatigue. I was also starting to see some signs of impaired glucose control.I wasn’t feeling good and I was in need of a kind of reset of sorts.
I was interested in seeing how relying on ketone bodies for fuel would help my body, mental performance, and improve my blood glucose control and symptoms. I have a family history of type II diabetes and I wanted to do what I could to prevent insulin resistance and metabolic syndrome. Drastic times call for drastic measures, I thought.
Ergo, The Ketogenic Diet.
About the Diet:
The Classic Ketogenic Diet was first developed in the 1920’s to treat children with medication-resistant epilepsy.
When our brains are starved of glucose, their preferred fuel source (our brains use up 60% of the body’s glucose), the liver creates ketone bodies from stored or dietary fat that the brain can use as a substitute source of energy.
One of these ketone bodies, beta-hydroxybutyrate, is thought to be a particularly therapeutic molecule for the brain, conveying anti-convulsive benefits, thereby helping to reduce the incidence of seizures in children who don’t respond to medication.
However, the original Ketogenic diet is more extreme than the general health and weight loss-aimed diet we see described in recipe books these days. The Classic Ketogenic diet consists of about 90% of calories coming from fat. In order to achieve that, followers need to severely restrict their protein intake, and virtually eliminate all dietary sources of carbohydrate, which drastically limits their nutrition choices.
Since, the benefits of beta-hydroxybutyrate are being studied for other neurological disorders, such as Parkinson’s disease, dementia, migraine headaches and narcolepsy. It’s being looked at as a potential treatment for mental health conditions, like autism and depression, and metabolic disorders such as type II diabetes, and even to increase the efficacy of chemotherapy and radiation treatments in cancer. Other studies are looking at its role in improving cognitive function in mice and humans.
Some research shows that beta-hydroxybutyrate can expand lifespan by interacting with genes that slow aging. It is also shown to confer anti-inflammatory and antioxidant benefits.
In the 1970’s, Dr. Atkins responded to the high-carbohydrate, low-fat dogma of the nutrition world at the time, by bringing a modified Ketogenic diet into vogue. Restricting all forms of carbohydrates and encouraging a consumption of the still-vilified high-fat foods like bacon, eggs and cheese, Atkins affirmed that people could lose weight by eating fat, as long as they restricted carbohydrates at the same time.
The modern version of the Ketogenic Diet is slightly more health-conscious, promoting a higher intake of vegetables. The current diet restricts carbohydrates to under 20 to 50 grams per day, and encourages a high fat intake and a moderate protein intake, in order to encourage the body to turn to fat as its primary source of fuel. The current version of “Keto” is less strict than it’s initial epilepsy-treating incarnation, with anywhere from 60-85% of its calories coming from fat.
My Version of Keto:
I started the whole journey by tracking my food intake (using My Fitness Pal). My aim was to consume 20 grams of net carbs, or less, per day to push my body into using fat-turned-to-ketone bodies as a its primary fuel source.
Net carbs are calculated by subtracting dietary fibre from total grams of carbohydrates. For example, 1 cup of raw broccoli contains 6 grams of carbs. 2.5 of those are fibre. Therefore, the net carbs in broccoli are 3.5, which would count towards my net carb goal of 20 grams per day.
This isn’t easy. Take a look at any package of food you regularly consume. 1 cup of cooked oatmeal contains 23 grams of net carbs: 3 grams over my entire daily allotment. Therefore all high-carb foods like grains, legumes, starchy nuts, all fruits, and some starchier vegetables, were off limits.
Many people opt to test their blood, breath or urine for ketone bodies to determine whether or not their bodies are in ketosis. I dabbled in this, using the urinalysis strips in my clinic to test for urinary ketones. However, even though I was sticking to the diet, the strips would mostly turn up negative for ketones.
There are a few reasons why ketone strips may not be a reliable marker for ketosis. Firstly, the don’t test for beta-hydroxybutyrate, which is the main ketone body utilized by the brain, but acetoacetate, another ketone body produced in the liver.
Secondly, urinalysis strips only test for urine ketone spillover. They don’t necessarily reflect blood levels, and they won’t pick up the ketones that are being utilized as fuel by the body. If cells are absorbing all the ketones the liver produces, urine testing may not be positive.
The most accurate, albeit more expensive, method for testing ketone bodies is through a skin-prick test that analyzes blood levels of beta-hydroxybutyrate.
While I knew that the urine strips weren’t highly accurate, not having my state of ketosis validated was discouraging. I was often left in doubt over whether things were “working”. I wondered if there was some other mechanism going on. Was my body finding carbohydrates from someplace else? Did I have Small Intestinal Bacteria Overgrowth that was digesting my fibre and allowing me to absorb it somehow? Were my blood ketones being used up somewhere else (by the yeast in my gut, for instance)?
I did have signs of being in ketosis that I could watch for, however. When I avoid carbs, or fast for a few days, I start to develop a metallic taste on the tip of my tongue. It’s not a common sign of ketosis, a more common sign is a “nail polish” or “paint thinner” taste in the back of the throat, but still a symptom that some people report.
Keto Flu:
During the first few days of switching to Low Carb High Fat, I had to white knuckle through a phase realistically termed the “Keto or Low Carb Flu”. This horrible phenomenon is thought to be a result of the body switching from burning glucose as its primary fuel source to adapting to ketone body production. There is often a painful adjustment period for brains that have to learn how to rely on ketones for their main fuel source after a lifetime of glucose abundance.
It was nasty. I felt intense hunger and sugar cravings, nausea, dizziness, and weakness—it truly was a “flu”.
I knew that I had spent most, if not all, of my life as a sugar burner. Before Keto, I would crave food even just two hours after a full meal. I would often feel “hangry”: dizzy and shaky in between meals, and irritable if made to wait for food for too long. I had been existing between carb-dense meals, experiencing insanity-inducing reactive hypoglycemia between my regular sugar fixes.
The more I read about others’ experiences, the more I was assured that the keto flu symptoms were actually a sign of my body healing. I was becoming adapted to other fuel sources, which was a good thing, I thought.
So, I muscled through and followed the online advice: I consumed more fat to provide more fuel to my brain, including medium chain triglyceride (MCT) oil, which is quickly absorbed by the lymphatic system and turned into ketones by the liver, and I consumed electrolytes, which are more rapidly excreted from the bodies of low carb dieters.
For some people, Keto flu can last for days, for others it lasts weeks. For me, the Keto flu thankfully only lasted two days, after which my body began to adjust and my cravings for sugar went down. I began to feel more energy, which felt encouraging.
Daily Meal Plan:
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
I’d have my second meal of the day in the mid-afternoon, around 2 to 3 pm, for which I’d consume a few cups of cruciferous vegetables, like broccoli or cabbage, with a fatty cut of meat like ground beef, chicken thighs, or salmon, all topped with liberal amounts of fat from coconut, olives, avocados, or grass-fed ghee. I made a lot of batch-cooked grain-free curries and stews.
If I had a third meal or snack in the day, it would be another serving of fat: a handful of macadamia nuts or a hunk of creamed coconut.
Eating this way made me feel like Obama and his grey suits—I didn’t have to plan my meals too carefully. All I had to do was eat fat. My food was so calorie dense and my blood sugar so stable that I didn’t need to eat often. This meant that I didn’t need to worry about bringing food with me everywhere I went; one meal could satiate me for half the day. Hunger was never an emergency situation, as it had been in the past. Hunger would come on very slowly, and it would never be “hanger”; my already low blood sugar had nowhere to dip to. If I needed more food, I could always wait until I got home to eat.
More Benefits:
Within a few days, my PCOS- related cystic acne cleared. I also felt slimmer as some water retention deflated. This felt good. Our body stores carbohydrate in the form of glycogen in the liver and muscles. Glycogen stores retain water.
When glycogen stores are used up, a rapid 5 or more pound drop in weight can occur. This is the “water weight” that people talk about losing when they first begin some kind of nutrition plan.
It’s also common to notice a drop in water weight from a decrease in inflammation, when embarking on a new eating plan. I know that I am sensitive to certain carbs and dairy and, because those things were out of my diet overall (although Keto can certainly include high-fat dairy products for those who can tolerate them), the water retention caused by chronic inflammation seemed to clear.
Although it seems to attract people primarily for its hip-slimming potential, the Ketogenic diet probably does not cause weight loss in and of itself. Instead, the diet encourages a passive reduction in calories by stabilizing blood sugar and insulin levels, while promoting the intake of highly satiating foods containing protein and fat. Ketone bodies also have appetite-suppressing effects. Therefore, it’s probably a calorie deficit that causes the weight loss, rather than any specific biochemistry in the diet itself.
I didn’t lose much more weight than the water weight. However, my mood was brighter. I would wake up in the morning looking forward to the day, which often doesn’t happen in the winter. I felt more sustained energy throughout the day, and really enjoyed the decreased appetite, which led to more productivity.
I felt fine consuming two meals a day, able to get through hours of back-to-back patient visits without needing a snack or a break. It was actually incredible to need so few meals; it was like becoming another person, one no longer ruled by sugar cravings. I was like a camel, switching to stored fuel when the fat from my last meal had run out, and the transition was seamless. There was no wall to hit, and no hypoglcyemic crash to be seen.
I also noticed less bloating and digestive issues, probably from the lack of fermentation in my gut and the reduction in foods that tend to aggravate IBS, like certain vegetables, fruit, and legumes.
However, all was not roses on the Keto diet. While the first few months were dreamy, the longer I stayed on it the more I started to notice changes in my body that indicated the honeymoon period I was enjoying wasn’t going to last.
The Microbiome:
The research is in: human beings probably need 10 servings of fruits and vegetables a day (roughly 5 cups), or 800 g, a day to get the most heart disease, stroke and cancer-preventing benefits that diet can afford us. The International Journal of Epidemiology concluded that, if the correlations found in their February 2017 study were causal, almost 8 million lives might have been saved in 2013 if everyone in the world had simply consumed their fruits and veggies.
It’s one thing all diets, even the faddy ones, agree on—from the Paleo Peeps, to Plant-Based Hippies, to Raw Macrobiotic Sun Worshippers, to Whole Foods Michael Pollen Omnivores, to the dejected nagged-at husband pushing brusselsprouts around on his plate—fruit and vegetables are good for you. You should eat them. If you’re a typical North American, you should probably eat more than you’re eating. The health value of everything else we eat seems to be up for debate: red meat, saturated fat, soy, bread, coffee. The benefits of eating enough fruits and vegetables, however? There’s no contest.
It’s hard to pick one way in which fruits and vegetables are so health protective. It could be because of their high concentrations of micronutrients, reducing the risk of common nutrient deficiencies, like magnesium and vitamin C. It could be because, if you’re filling your body with a kilogram of fruits and vegetables a day, you probably aren’t scarfing down an entire medium-sized pizza and supersized orange pop as well—there just isn’t room. It could also be the antioxidants they contain that protect cells against free radical damage, protecting DNA. Or perhaps its the fermentable fibres present in fruits and vegetables that feed our invaluable microbiome.
The problem with keeping net carbs under 20 grams a day was that I needed to restrict my fruit and vegetable intake. I was eating no fruit at all, and staying away from the starchier veggies, like carrots and beets. I still stuck to my beloved leafy greens and crucifates, but even eating 2 to 3 cups of those guys a day would push me to the upper limits of my carbohydrate intake, which meant I couldn’t eat them as liberally as I had been.
Getting enough vegetables and (any) fruits on the keto diet is hard, if not impossible. This can impact our ability to get the micronutrients we need, but also enough fermentable fibres from vegetables like garlic, onions, yams, Jerusalem artichokes, and legumes, which provide food for our microbiome.
Feeding our gut bugs is important. They benefit us in numerous ways, from digesting out food, to calming inflammation, to fuelling gut cells by producing a short-chain fatty acid called butyrate. They help our immune systems function optimally. They produce neurotransmitters for our brains to work. They balance our stress responses and our circadian rhythms.
Jeff Leach, at the Human Microbiome Project speculates that the lack of dietary fibre in most low-carb diets may impact the health of the microbiome in negative ways by depriving the gut bacteria of their preferred food sources, as well as altering the acidity of the colon and intestines. He cites this article, in which obese subjects on a high-protein and low-carb diet had lower levels of butyrate in their bodies and intestines, likely due to decreased diversity in their guts.
There are, however, some studies that suggest that a Ketogenic diet can improve the microbiome in children with epilepsy, and autism, and some speculation by the researchers that that may be how the diets treat these conditions. However, since these studies are not done in “healthy” children, with an already healthy microbiota, it’s hard to extrapolate the findings to the healthy adult population.
Then there’s the fact that most studies that look at high fat diets and their impact on the microbiome are mostly done in rats. Of course, rats aren’t humans, despite there being relative genetic similarities. In these animal studies, researchers refer to “a high fat diet” when in fact they mean a high fat, high sugar diet. The sources of fat in these “high fat” mouse diets are often corn, margarine, or soy oil, which we know are highly inflammatory and offer few if any health benefits.
In other words, many studies on “high fat” diets are not looking at a relatively balanced Ketogenic diet that consists of vegetables, proteins, and healthy sources of fats from avocados, coconut, fish, olives, nuts and seeds and grass-fed meats.
Context is important as well. Is it the high fat diet that causes a reduction in gut diversity or the absence of fibre? This one mouse study showed that simply providing the mice with fibre in addition to their high fat diets decreased their risk of obesity.
I felt that my gut initially improved in the first few months on Keto: the diet was low in foods that aggravate me: namely refined carbs, sugar, gluten and dairy, as well as some of the fermentable fibres that can aggravate IBS. However, it never fully healed. After a few months, I started to notice the symptoms of bloating and digestive irregularities coming back.
Candida, a yeast that resides in the gut and can overgrow in the intestines in some people, especially the immunocompromised, causing symptoms of fatigue, IBS, and weight gain, among a variety of other symptoms, can survive on ketone bodies. Yeasts have mitochondria of their own. Some species of gut bacteria can consume protein, bile salts and even fats.
Contrary to what many claim, a Ketogenic diet doesn’t necessarily “starve out” the bad gut bugs. Combined with the lack of fibre to feed the beneficial gut bacteria and promote more bacterial diversity, a prolonged Ketogenic diet may be a recipe for gut dysbiosis.
Hormones:
Throughout my year spent in ketosis, I definitely noticed an improvement in my insulin signalling and glucose control, especially in the first few months. Looking at my blood work in March, after about a year of the Ketogenic diet (and then having been off it for a few months), my fasting insulin was very low and fasting blood glucose levels were in the low-optimal range. HOMA-IR, a calculation that is used as a marker of insulin resistance, was also low, indicating good insulin sensitivity.
I personally believe that this means that my risk for getting metabolic syndrome or type II diabetes is low, as long as I maintain this level of insulin sensitivity by watching the glycemic load of my diet and my stress levels.
The metabolic flexibility awarded to me from my year in ketosis also proved to be invaluable. Now, I no longer fear fasting and I can survive on other fuel sources besides sugar. My brain knows how to tap into stored and dietary fat more efficiently, and use those for energy. Even when not following any sort of low-carb diet, I noticed that I could survive between meals while travelling in Southeast Asia for two months, whereas normally I would have had to exist on unhealthy, sugary snacks.
However, after a few months on the diet, I began to notice a decline in my menstrual health. My cycles began to get longer, and soon I started missing periods. I noticed more hair falling out in the shower and more cystic acne developing on my chin. When I ran my blood estrogen and progesterone levels, I was surprised to see that their levels were very low.
We know that insulin, while often vilified as a “fat storage” hormone is actually responsible for storing everything, including nutrients. It also correlates with estrogen levels and the conversion of T4, one of our thyroid hormones, to its active friend, T3, which runs our metabolism. Insulin builds muscle, bone and brain cells. Very low insulin levels, in my case, were contributing to amenorrhea and a disruption in my sex hormones.
This wasn’t good.
While not quite the same as Intermittent Fasting (IF), Keto is often grouped into the same category because of its similar impact on blood glucose and insulin. The difference is that Intermittent Fasting induces ketosis through periodic food restriction, as opposed to carb restriction. Keto and IF often go hand in hand, however. The reduced hunger and high-nutrient density of the foods eaten on a Ketogenic diet often lend well to practicing intermittent fasting. It did in my case—I was only eating two main meals a day.
I always found it interesting, however, that most proponents of intermittent fasting are men. The male body appears to thrive in the fasted state, getting a boost of growth hormone and norepinephrine, both of which provide men with energy, motivation, and an improved sense of well-being.
This hormonal change may be a remnant of our ancestral hunter-gatherer days where it would be an advantage to feel motivated and energized to go out and hunt during periods of food scarcity.
I don’t think female bodies experience exactly the same effect. Some preliminary animal research tends to suggest that as well.
A few rat studies indicate that fasting may impair female insulin sensitivity, and induce amenorrhea, or missed periods. Female bodies rely on a consistent influx of calories and carbohydrates to stimulate insulin, which plays a role in stimulating thyroid hormones and estrogen, to continue to ovulate. Another study showed that fasting tended to “masculinize” female rats, lowering their female hormones, and increasing their levels of androgens, the male sex hormones, like testosterone.
Of course, these studies were done on fasted rats, which cannot be fully translated to the effects of Intermittent Fasting and Ketogenic diets on women. However, some of these findings did validate my experience, which certainly wasn’t being validated in the podcasts and blog posts I was exposed to, largely written and followed by men.
I did experience positive hormonal effects: the increased insulin sensitivity and lowered blood glucose. However, I was not happy about my irregular cycles and estrogen deficiency.
Therefore, I decided to increase my carbohydrate intake, returning to a more moderate Paleo diet that consists of some fruit, starchier vegetables and legumes. After a few months, my periods returned to normal, my skin cleared up, my hair stopped falling out, and my thyroid hormones, estrogen and progesterone levels all returned to their optimal ranges.
I have still have low fasting insulin levels, suggesting that the Ketogenic diet did help to reset my insulin sensitivity and that this effect may be lasting.
Metabolic Health:
After a year of doing the Ketogenic diet, and then a few months of returning to a moderate-carb paleo diet, I tested my cholesterol levels and inflammatory markers. My HDL cholesterol (the “good” cholesterol, to put it very simply) was high, my triglycerides (a risk factor for heart disease) were very low, and my LDL cholesterol (the “bad” cholesterol that statin drugs target) was also low. My inflammatory markers: C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR), were also low.
While it is typically the monounsaturated fats, like olive oils and avocados, that are associated with increased levels of the heart-protective HDL cholesterol, even saturated fats from coconut oil can raise HDL. LDL is often lowered by these healthy monounsaturated fats, however saturated fats, even healthy ones, can raise LDL in certain individuals.
All else being equal, higher levels of LDL may not be as big of a problem as we think. Especially in the context of low risk factors, like low inflammation, absence of smoking and a healthy body weight. What’s more, the triglycerides and cholesterol/HDL ratio may be more important factors for determining heart disease risk. Further, assessing LDL particle size may also provide those concerned about their LDL levels with more information concerning their cardiovascular health. That being said, it is important to be aware that some of the fats present in a Ketogenic diet have the potential to raise blood levels of LDL in certain susceptible individuals, and that not everyone’s blood lipid results will look like mine.
Triglyceride levels are associated with liver function, and generally reflect dietary sugar, fructose and refined carbohydrate intake, rather than fat intake. Reducing refined dietary carbohydrates like white grains, flours and sugars is a good strategy for reducing triglyceride levels and reducing heart disease risk.
Some individuals can experience elevated levels of inflammation on a Ketogenic diet, depending on the quality of foods consumed. A Ketogenic diet low in fibre that fails to feed the microbiome; high in foods that a person may have an individualized sensitivity to (such as dairy, eggs, nuts or soy); or high in inflammatory fats like trans fats, and industrial oils like canola and corn oil, may all contribute to increased inflammation.
That being said, certain ketone bodies like beta-hydroxybutyrate may have anti-inflammatory properties. Many of the fats consumed in a mindful, whole foods Ketogenic diet, such as olives, avocados, seeds, salmon, and coconut, are also anti-inflammatory.
I found my blood markers a good indicator of the power of a high-fat, low-carb diet to, at least in my case, improve HDL cholesterol and lower triglycerides, fasting insulin and fasting glucose levels. Whether I needed an entire year in ketosis, or whether I even needed to actually enter ketosis to receive these benefits, isn’t clear. Perhaps I could have gotten the same results by moderately lowering my carb intake while increasing my dietary intake of healthy fats.
Modified Ketogenic Diets:
While I do think I benefitted from entering into ketosis, I would not necessarily recommend a Ketogenic diet to patients unless to achieve some sort of therapeutic goal, such as improved insulin resistance, or for adjunct cancer care, to reduce inflammation, or to improve severe depression, migraines, or narcolepsy.
However, there may be a benefit to cyclical Ketogenic diets for memory and cognition, and increased life span in mice. Cyclical Ketogenic diets involve entering ketosis on alternate weeks. On the other weeks, participants return to a normal, whole foods diet that contains higher amounts of carbohydrates. In this case, individuals gets the benefits of beta-hydroxybutyrate production and increased metabolic flexibility on their weeks on, while also being able to eat a high amount of fermentable carbs and fibres on their weeks off, essentially getting the best of both worlds.
Adding medium chain triglycerides to food may also confer health benefits, similar to being on a Ketogenic diet. One study showed that adding MCT oil to a high-carb breakfast (pasta), reduced appetite in men. This is likely because, after burning through the glucose in the pasta, the men’s brains were able to access the ketone bodies that were made readily available by burning the MCT oil. This kept their brains fuelled and their bodies satiated for longer.
The men eating pasta and MCT oil in the study had a ketone blood level of 0.3, which is similar to that obtained from a diet that derives 10% of its calories from carbohydrates, which is an essentially a very low-carb, if not Ketogenic, diet. This may indicate that simply adding MCT oil to a moderate to low-carbohydrate diet, may confer some of the benefits of having a slightly higher rate of circulating ketone bodies without having to follow a strict diet. Again, following this strategy, you can get the best of both worlds: consume a diet high in fibre, while also getting a steady flow of ketone bodies to the brain.
Other interesting areas of research are the use of supplemental, or exogenous, ketones for therapeutic use, however the area is new and not something I currently recommend in my practice (although this may change when more research begins to emerge and better supplements enter the market).
My Plan Moving Forward?
I’m happy that I gave the Ketogenic diet a try, but now I’m back to my more modified Paleo diet, aimed at promoting gut health, optimizing my micronutrient intake, regulating hormones, and supporting my energy levels. I now consume berries and apples, legumes, starchier vegetables and lean proteins more often and aim to get 10 servings of fruits and vegetables a day, with 8 to 9 of servings coming from vegetables, as opposed to fruit.
I currently start my day with a smoothie with berries, an avocado, spinach and protein powder. For lunch I have some sort of protein, fat, and tons of veggies. I eat more often than when I was in ketosis: about 3 meals a day with a vegetable and fat as a snack, or no snack at all in between, depending on my schedule.
My total daily carbohydrate intake falls around 100 grams a day with a net carb intake between 50 to 70 grams a day, depending on the fibre content of the vegetables, seeds, and legumes I’ve eaten that day. I try to get upwards of 30 grams of dietary fibre per day.
I avoid all sugar, including sweeter fruits like tropical fruits, and dried fruits, like dates. I especially stay away from refined sugars, even “natural” coconut sugars and agave. I avoid processed carbohydrates and flours. I mostly avoid grains, except when travelling or visiting someone’s house, getting my carbs from starchy vegetables and tubers, legumes and berries. I continue to avoid dairy (which I’m sensitive to), gluten, and processed industrial oils like canola, corn, and soy oil.
Right now, rather than focussing on macronutrient ratios, I’m directing my food intake towards obtaining the Recommended Daily Allowances of the micronutrients that run all of our cellular reactions, and the fibres that feed a healthy gut microbiota. I use an app called Cronometer to track this.
I definitely eat more fat than before, adding MCT oil to my morning smoothie, especially on days when I need to stay full and focused for longer. I also aim to do at least 12 hours of fasting a day, trying to get in 16-18 hour fasts where I can, ending dinner at 4pm, for example. I no longer do regular long bouts of Intermittent Fasting, particularly not when I’m feeling stressed and burnt out.
Would I Recommend the Ketogenic Diet to Patients?
One of the main tenants of Naturopathic Medicine is “Do no harm”. While it may seem like making diet and lifestyle recommendations are relatively benign therapies, I believe that they do have the potential to do physical and psychological harm, particularly if they are strict recommendations.
Following a strict diet may have health benefits, but it also may isolate us from friends and family, frustrate us and restrict our intake of certain nutrients, like fibre, vitamins and minerals. This is one of the reasons I do not ever advocate a Vegan diet, although if patients are following one already, I believe in guiding them to optimize their nutrient intake.
Furthermore, at least in my personal experience, the cure was stronger than the disease. I probably didn’t need to do the Ketogenic diet for so long; this was evidenced by the hormonal imbalances that I began to experience towards the end of my year on the diet.
However, particularly for patients who are suffering from metabolic syndrome, type II diabetes and insulin resistance or PCOS, there may be some powerful benefits to entering ketosis in order to dramatically reverse metabolic dysfunction. In this case, a modified regime combining Intermittent Fasting and cyclical Ketogenic diets could be beneficial.
Of course, it all depends on where patients are at in their nutrition journeys. Sometimes I meet patients who require, and respond well to, more heroic lifestyle interventions. Other times I meet patients relying on several sugary treats a day to get them through. In these cases, simply tweaking their diet in small ways, using baby steps may also have powerful disease-risk-reversing effects.
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.