The Low Insulin Lifestyle with Dr. Ali Chappell, PhD on the Good Mood Podcast

The Low Insulin Lifestyle with Dr. Ali Chappell, PhD on the Good Mood Podcast

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.

Check it out and let me know what you think!

Episode Chapters

0:05 

Introduction to Insulin

2:22 

Dr. Chappell’s Journey with PCOS

4:06 

Research and the Low Insulin Lifestyle

6:04 

Reassessing Medical Approaches

9:45 

Challenges of Measuring Insulin

10:50 

Insulin Resistance and Dietary Implications

13:35 

The Vicious Cycle of Insulin

18:57 

Insulin Resistance in Pregnancy

20:53 

The Impact of Insulin on Women

24:12 

Dairy and Its Effects on Insulin

29:15 

Protein Sources and Insulin Response

34:47 

The Importance of Balanced Nutrition

39:33 

Study Findings on Insulin Management

51:06 

Miscarriage and Insulin’s Role in Fertility

53:03 

Glucose vs. Insulin

54:29 

FDA and App Development

56:50 

Study and Research Insights

59:24 

GLP-1 Drugs Discussion

1:06:49 

Managing Cravings and Appetite

1:10:45 

Long-term Effects and Sustainability

1:17:21 

The Role of Fruit in Diet

1:21:38 

Bounce Back Blueprint

1:31:37 

Insulin Resistance and Dietitians

1:32:44 

Men’s Health and Insulin Resistance

1:36:55 

The Conspiracy of Insulin Testing

1:42:10 

Final Thoughts and Resources

Transcript

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.

Navigating the Healthcare System

Navigating the Healthcare System

I, like most of my colleagues became a naturopathic doctor because of my own extremely disempowering experiences with the healthcare system. 

In my late teens and early 20s I was suffering from what I now know were a series of metabolic and hormonal issues and I, like almost all of my patients and colleagues experienced confusion, gaslighting, frustration and a complete lack of answers for what I was dealing with. I tell my story more in depth in other places, but I was told to “stop eating so much”. I was told everything was normal in bloodwork (or simply not called back). I was weighed incessantly. I was chastised for doing my own research (I had to–no one would tell me anything). I was interrupted, cut off and dismissed. 

And so, I did what most of my colleagues do–I got educated. I went to school. First for biomedical sciences and then, when that degree left me with more knowledge gaps than answers (and no one who would indulge, let alone answer, my questions), I became a naturopathic doctor. 

Throughout my 8 years as a practicing ND, I have encountered thousands of similar stories of disempowerment and confusion and frustration. We patients are trained to see our doctors when we feel depressed, fatigued, or debilitated by PMS, menstrual pain, headaches, and mood issues. Most of us don’t care what answer we get–fine, if it’s a medication I need, I’ll take it! But if we experience lack of benefit from the solutions and a lack of answers, then what? I’ve heard this story over and over. 

And so, like many of my colleagues I use the privilege of my education to help me navigate the system. I ice a sore foot for 2 days and then get an x-ray (picking a non-busy time to visit the ER). I take the orthopaedic surgeon’s advice with a grain of salt and implement my own strategies for bone healing. I ask for the bloodwork I need (and know my doctor will agree that I need) and pay for the rest out of pocket. I know my doctor’s training and I understand her point of view and I don’t get frustrated when diet and nutrition or lifestyle are never mentioned. I don’t get upset if my doctor doesn’t have an explanation for symptoms that I now know are related to functioning and not disease, and that it is disease which she is trained to diagnose and prescribe for. 

And thankfully, my experience with the healthcare system has been quite limited as I’m able to treat most things I experience at home and practice prevention. 

My good friend, who is a naturopath as well, and who has given me permission to share her story, had the same experience up until this summer. She too used the healthcare system quite judiciously and limitedly until a series of stressors and traumas landed her in in-patient psychiatric care (i.e.: a psychiatric hospital) for a psychotic episode–her first. 

…And until she started experiencing debilitating gastroesophageal symptoms that were beyond what one might consider “normal.” 

And in both cases she sought help from the medical system. She told me recently that her experience was quite different from the ones she’d had in her 20s when her long-standing parasite was misdiagnosed as IBS and she was repeatedly dismissed by doctors. She told me “I’ve been having great experiences with the healthcare system. It’s not like it was before. My doctors have listened to me. They’ve been helpful. Yes, they’ve recommended drugs but when I tell them that I don’t want to take the medications because I know what they do and how they work and don’t think I need them, they respect that. They treat me like I’m a real person. They’re all our age, too. The procedures are more state-of-the-art. The facilities are pleasant. Something has changed in healthcare.” 

I know that my friend’s experience might be different from yours. I’m not saying her experience is universal. In fact, if I reflect on my interactions with the fracture clinic in St. Joe’s hospital in Toronto, I had a fairly good experience as well (except for long wait times and booking errors). Sometimes medical trauma can blind us to reality–sometimes we aren’t willing to re-evaluate our assumptions until someone points out a piece of reality that is hard to deny. I actually haven’t had a direct negative experience with healthcare in years– and yet I had chalked that up to the fact I rarely need to use it. 

But my friend had had two quite intense experiences and came away from them feeling positive about the care she received. I wondered what was different. Here are my thoughts. 

Medical care has evolved. It is inevitable that this happens. Sometimes we might have just had a bad doctor, or someone who was having a bad day or maybe was triggered by our experience. I sometimes think not knowing how to help triggers doctors—I think this might have been the case with the doc who told me to eat less. She might have felt helpless and incompetent at not being able to help me and projected those feelings onto me as a “difficult patient”. 

Ultimately health professionals got into their field to “help people”. If you’re not helping people you might feel triggered. But then, if you’re a competent professional, and I believe most are, you look for new ways to help. You open your mind to other practitioners, like NDs. You might not understand why or how what they do works, but “whatever works.” 

Healthcare is constantly evolving, and so is the way we communicate its advancements. My friend’s experience highlights how much has changed—not just in medical technology and treatment approaches, but also in how healthcare professionals engage with patients. As understanding deepens and patient-centered care becomes the norm, it’s crucial to share these stories in ways that foster trust and transparency.

Doctors are increasingly open to new studies on nutrition. They recognize treatment gaps in their care and in medical knowledge and guidelines. Nutrition and alternative practices are entering mainstream and are dismissed as “woo woo” less and less, particularly by doctors who embrace science and research. 

With the evolving landscape of medical care, doctors and health professionals are adapting to new perspectives and approaches to help their patients effectively. Acknowledging that some past encounters might have been influenced by various factors, professionals are increasingly open to alternative practices and unconventional methods. They are embracing the significance of research and scientific advancements, often exploring innovative solutions such as the MAS Test to bridge treatment gaps and enhance patient care. By incorporating cutting-edge tools like the MAS Test, doctors are demonstrating a commitment to understanding diverse approaches, ensuring they provide comprehensive and personalized healthcare solutions to their patients. This openness to holistic methods and ongoing research not only enriches medical knowledge but also fosters a more inclusive and effective healthcare system for everyone.

I always say, when picking a doctor pick one that listens, that is curious and that is humble. I strive to be these things, although it’s not easy. Practicing medicine is as much an art as it is a science–we need to be able to not only admit but carry with us the absolute truth that we do not know everything. It is literally impossible to know everything. The body and nature will constantly present us with mysteries on a daily basis, but the gift of being a clinician is that we are constantly learning. 

“I don’t know, but I will try to find out” should be every doctor’s mantra (along with Do No Harm). 

In a busy and overloaded system we need to help healthcare workers help us. This means being informed. My friend is highly informed and educated in healthcare. I believe her healthcare providers could sense this. She was respectful in denying medications and wasn’t pushed (because she had informed reasons that the healthcare practitioners ultimately agreed with, “no, you shouldn’t go on a PPI long-term, that’s right” “yes, anti-psychotics do have a lot of side effects, and taking them is a personal choice”). 

A significant element of my medical trauma was the feeling of disempowerment. I was completely in someone else’s hands and they were not communicating with or educating me. I was left feeling lost and hopeless. Empowerment is everything. It allows you to communicate and make decisions and weigh options. You know what healthcare can offer you and what it can’t. 

Of course we can’t always be empowered, especially when we’re very sick and when we’re suffering. In this case, having advocates in your corner are essential. Perhaps it’s having an ND who can help you navigate the system, think clearly and help you weigh your options. 

I also recognize that it is hard to be empowered in emergencies. Fortunately, modern medicine handles emergencies exceptionally well. Still, in this case, having an advocate: friend, practitioner or family member, is an incredible asset. 

Physicians are burned out. Patients are burned out. I believe this is because of responsibility. Neither the medical system nor the individual can possibly be solely responsible for your health. I believe that responsibility is better when shared. We need help. We can’t do things alone: we need someone’s 8+ years of education, diagnostic testing, clinical experience and compassion. We also need our own sense of empowerment so that doctor’s don’t succumb to the immense pressure of having to fix everyone and everything. 

My sister in law is an ER nurse and once remarked (when asked if the ER was busy and chaotic) “people need to learn self-care”. She didn’t mean self-care as in bubble baths. She meant: learning how to manage a fever at home, when a cut needs stitches or how to determine if a sore ankle is a sprain, strain or break. A lot of people were coming in with colds—self-limiting, non-serious infections that could easily be treated at home. This was burning her out. Of course, she meant, go to the ER if you’re not sure. But, there are many non-grey areas in which we can feel empowered to manage self-limiting, non-serious health conditions as long as we know how to identify them or who to go to for answers. 

Education is power. In a past life (before becoming an ND and while studying to become one) I was a teacher. I am still a teacher and in fact the Latin root of the word doctor, docere, means “to teach.” Healthcare is teaching. No doctor should say “just take this and call me in the morning” and no patient should accept this as an answer. We have the right to ask, “what will this pill do? When can I stop taking it? How does it work?” This is called Informed consent: the right to know the risks and benefits of every single treatment you’re taking and the right to respectfully refuse any treatment on any grounds. 

You have the right to a second opinion. You have the right to say, “Can I think about this? I’d like to read more about it.” You have every right. You have the right to bring a hard question to your doctor, like “do I really need this statin? A study in Nature found that the optimal cholesterol level for reduced all-cause mortality is around 5.2 mmol/L, which is much higher than mine. Do I really need to be on something that lowers my cholesterol?” 

If we can’t speak to our doctors, we turn to Google. Being a good researcher is a skill. This is what I was trained to do at naturopathic medical school and in undergrad. How can you tell if a study is a good study? Does the conclusion match the results? What does this piece of research mean for me and my body? Your doctor should be able to look at you and answer your questions to your satisfaction. This is basic respect. 

You deserve to access the results of your blood tests and be walked through the results, even if everything is “normal”. Even a normal test result tells a story. We deserve transparency. 

I was once told in a business training for healthcare practitioners (NDs, actually) that “people don’t want all the information. They don’t want to know how something works. They just want you to tell them what to do.”

Now, I sincerely disagree with this. In my experience, patients listen vividly when I walk them through bloodwork, explain what I think is happening to them and try to describe my thought process for the recommendations I’m making. I’m sure a lot of what I say is overwhelming–and then I try to put it differently, and open the conversation up to questions to ensure I’m being understood. Again, doctor as teacher, is a mantra we should all live by. There are few things more interesting than learning how our bodies work. In my experience, patients want to know! 

When our bodies occur as a mystery, we are bound to live in fear. We are bound to feel coerced and pressured into taking things that our intuition is telling us to wait on, or seek a second opinion for. When we are scared to ask our doctors questions or take up their time, we end up having to deal with our concerns on our own. When we are dismissed we end up confused and doubting ourselves. We end up disconnected from our bodies. We are anxious. We catastrophise. We give away our power to strangers. 

Empowerment is everything. It helps us connect to our bodies. It strengthens our intuition. We know where to go or who to go to for answers (or at least a second or third, opinion). We can move ahead with decisions. (i.e.: “I’m going to take this for 8 weeks and if I don’t like the side effects, I will tell my doctor that I want to wean off or ask for another solution”). We are aware of the effects and side effects of medications. We are aware of our options. We know if something isn’t right for us. We can make food and life style choices in an informed and empowered way. We can feel in our bodies who is trustworthy. We can trust ourselves and our bodies. 

When patients are empowered, I believe doctors experience less burnout. The responsibility is shared evenly among patients, friends, family and a circle of care of helpers. No one faces the entirety of the weight of their health alone. No one should. 

Empowerment and health don’t mean that you’ll be completely free of disease, or that your body will never get sick, or that you will be pain and suffering free. We all get sick. However, empowerment can help you notice something is off. Increased awareness helps you advocate for yourself to get the care you need in a timely fashion. It helps you take necessary steps, even if you’re afraid. You might be less afraid when you have more information. You might have more hope when you know all your options. 

Empowerment in healthcare is everything. And here’s the thing: your doctor wants you to be empowered. Empowered patients are fun to work with. They ask good questions. They are respectful. They are open. They give us practitioners an opportunity to learn. My friend experienced this. I’m sure she was a joy of a patient to work with because she was knowledgeable, alert and present. She maintained her own power. She asked questions when she was unsure. She knew what questions to ask. She knew where to go for answers on her own time. She knew which information was relevant for her practitioners to know. She knew how to ask for time and space before making a decision. She knew how to maintain her sense of autonomy. Most of all, empowerment gives us the strength to find a new practitioner if the therapeutic relationship we’re in isn’t respectful or supportive. 

I believe we get into the helping professions to help–to heal, to learn and to alleviate suffering. We all swore an oath to “do no harm”. 

What do you think? How has health empowerment helped you navigate your own healthcare? 

Following the Science

Following the Science

Is medicine a science?

The short answer is it’s an applied science.

We’ve been hearing quite a lot about The Science these days. So, what is science? How does science guide medical practice and naturopathic medicine?

The science council defines science as, “the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence.”

The answer is, science is a methodology.

It is applied in medicine through Evidence Based Medicine (EBM) which starts with the individual patient and incorporates: clinical expertise, scientific evidence (that best that exists according to a hierarchy), and patient values and preferences.

“Evidence medicine is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.”

The Evidence-Based Pyramid


‍In EBM, evidence exists in a hierarchy, represented by the Evidence Based Pyramid (shown above). Animal studies are at the bottom, case reports (clinical anecdotes) somewhere in the middle and randomized control trials and meta-analyses (the Gold Standard of evidence) at the top.

Dave Sackett (the Father of EBM) et al. write in the British Medical Journal (1996),

“Good doctors use both individual clinical expertise and the best available external evidence and neither alone is enough.”

In addiction to scientific evidence, EBM must incorporate:

  • Patient values
  • A bottom-up approach (it is patient-centred, not guideline-centred)
  • The needs of the individual (EBM is not a one-size-fits-all formula)
  • Clinical expertise
  • The best available evidence: this does not mean using only randomized control trials. Sometimes the best evidence we have are case reports, historical and traditional use of an herb or animal studies. We still owe our patients the opportunity to see if a treatment works for them, especially if the risk of a given treatment is low.

As clinicians, we use our knowledge in different ways. We start with an assessment of the individual in front of us. This assessment takes into account the factors that influence this patient’s life, their lifestyle, their health condition and their overall health goals.

We then turn to clinical experience, research, our scientific knowledge and guidelines.

We share this information with our patient. Our job is to educate and convey the options so that the individual can provide informed consent. How does this knowledge fit into the patient’s life? How does it inform their choice?

Science is not a set of values. It is not a religion. We do not follow it.

Science provides us with a methodology for seeking the answers to questions we might ask about how the principles of nature, including the human body, are organized.

Science encourages us to ask questions and testing hypotheses in order to find answers.

It is never settled.

Most of all, science doesn’t tell us how to use scientific knowledge.

Our choices are governed by our goals, preferences and values.

So, “follow the sicence?”

No. Follow your goals, preferences, values and dreams.

And use science to help guide your way.

Reference:

Sackett, D. L., Rosenberg, W. C., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71–72.

Crafting an Anti-Inflammatory Lifestyle

Crafting an Anti-Inflammatory Lifestyle

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.

Should I Take Anti-Depressant Medication?

Should I Take Anti-Depressant Medication?

In September of 2019, Jakobsen, Gluud and Kirsch published a review in the British Medical Journal: Evidence-Based Medicine entitled “Should antidepressants be used for major depressive disorder?” (1)

Their conclusion was this: 

“Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects.”

Now, before we move on with what drove them to make this seemingly radical conclusion, I want to be clear:

I am not stigmatizing medication.

All of those who take medication for depression have asked for help.  

Asking for help is important. 

Asking for help is brave. 

And, whatever help works for you is the right kind of help. 

But imagine this; imagine you are a pretty decent swimmer. 

You’ve practiced swimming all your life. You’ve gotten lots of experience swimming in pools, lakes, and oceans. You know how to swim, just like you know how to cope with turmoil. But, despite your strength, one day you find yourself drowning.

“No, I’m not drowning,” you might say at first. “I can’t be drowning. I know how to swim! If I’m drowning, it means I’m a failure… 

“What will everyone think?” 

And so you continue to splash around a bit, until it becomes undeniable. You gasp some water-filled air. Your head submerges and you think, indeed, “I’m drowning.” 

When you get your head above water you call for help. 

This takes a lot.

It’s not easy to admit that you need help. 

It’s not easy to overcome that little voice that tells you that asking for help is troubling other people, admitting defeat, showing weakness—and whatever else that darned little voice thinks it means. 

“HELP!” You exclaim, louder this time—little voice be damned. 

“HEEELP!”

And someone on shore sees you. They have a life-preserver in their hands and they throw it your way. 

Your shame is peppered with relief—and gratitude: there’s an answer to all this suffering. You thrust your hand towards the life preserver, grasping it with a firm bravery.

Only, it starts to sink. It’s full of holes. 

“What’s the matter?” The person waiting on the shore exclaims, as you continue to struggle, “Don’t you want help?” 

The shame returns. Hopelessness joins it. 

I advocate for mental health awareness. I advocate for perpetuating the message that it’s ok to talk about mental illness. It ok to admit you need help.

I believe the following:

Depression is not a a sign of weakness. 

It’s not a sign that you are defective. 

It’s not a sign that you haven’t learned proper coping skills, or that your coping skills are defective, or that you’re fragile. 

It’s also not fixed by simple solutions like eating salad, running or putting “mind over matter”. 

Depression happens to a lot of us. 

It affects 300 million people globally. It is the leading cause of disability world-wide, with a lifetime prevalence of 10 to 20%. This means that 1 in 5 people will experience depression in their lifetimes. 

We all know someone who suffers. Maybe you suffer. 

And a lot of people ask for help. The National Health and Nutrition Examine Survey (NHANES) in 2017 found that 1 in 8 people over the age of 12 are taking an anti-depressant, a 65% increase over the last 15 years. 

This means that 65% more of us are asking for help. 

That’s a lot of life preservers. 

So, just how effective is this help? 

First, we need to understand how the efficacy of anti-depressants are measured. 

The symptoms of depression are subjective. This means they are not observable. There is no imaging that shows if someone is depressed. There are no blood tests for depression. There are no physical exams.

Therefore, to assess the presence and severity of depression, clinicians use questionnaires. The most commonly used depression questionnaire is The Hamilton Depression and Rating Scale (HDRS), a 52-point checklist that assesses various symptoms of depression and rates them on a scale of no-depression to severe. 

When patients with depression first see a family doctor or psychiatrist they are often issued the HDRS and given a score. 

Let’s use Janet’s story as an example. Janet first came to see her psychiatrist two years ago. She wasn’t sleeping and yet felt sleepy all the time. She’d gained weight but had no appetite. Her entire body was sore, as if she had the flu. She’d lost interest in all of the activities that used to fire her up. She’d lost interest in everything. 

After a few weeks of feeling progressively worse, Janet began to be plagued by thoughts of suicide. This scared her. She went to her family doctor, who referred her to a psychiatrist. 

Janet’s HDRS score was 25. This meant she was moderately to severely depressed. 

Janet was given an anti-depressant, a Selective Serotonin Re-uptake Inhibitor (SSRI). She was told it would correct her “brain imbalance”, and treat the cause of her symptoms. Janet was relieved that there was a solution. 

If an anti-depressant can decrease the HDRS by 3 points, then the medication “works”.  Or at least the results are statistically significant.

However, if Janet’s symptoms improve by 3 points, from a score of 25 to, say, a score of 22, how does she feel? 

Not much different, it turns out. 

To experience “minimal improvement”, a decrease in symptoms that someone with depression would notice, say an increase in energy, an improvement in sleep, or a change in mood, a patient’s HDRS score would need to decrease by at least 7 points.

This means the Janet would need to bring her HDRS down to 18 or lower before she starts to feel noticeably better. 

Studies show that anti-depressants, on average, don’t do this. 

Some randomized control trials do show that anti-depressants decrease the HDRS score by at least 3 points, which is still registered by patients as having no perceptible effect, but the results are mixed.

A large 2017 systematic review showed that anti-depressants only decreased patients’ HDRS by about 1.94 points (2) and another large study published in the Lancet (3) also failed to show that anti-depressants produce a statistically significant effect, let alone a clinically significant one.

In addition to the minimal changes in symptoms, anti-depressant research is also polluted with for-profit bias. Most studies are conducted or funded by the drug companies.

This makes a difference: an analysis showed a study was 22 times less likely to make negative statements about a drug if the scientists worked for the company that manufactured it (4). 

Studies at high-risk of for-profit bias were also more likely to show positive effects of a drug (5). 

Another limitation of anti-depressant trials is the lack of active placebo control. In Randomized Control Trials, participants are sorted into two groups: an active group, in which they receive the medication, and a placebo group, in which they receive an inert pill. 

The goal of this process is to control for something called the “meaning response”, or “placebo effect” where our expectations and beliefs about a therapy have the potential to affect our response to it. 

Remember that depression, as I mentioned before, is a condition made up of subjective symptoms. 

If I asked you to rate your energy on a scale of 1 to 10, how would you rate it? What if I asked you tomorrow? What if I asked you after giving you a drink of something that tastes suspiciously like coffee? 

Because of its subjective nature, and the subjective questionnaires, like the HDRS, that measure it, depression is very susceptible to the placebo response. 

Therefore, it’s important to control for the placebo response in every trial assessing anti-depressants. 

But it might not be enough to just take a sugar pill that looks like an anti-depressant.

SSRI medication produces obvious side effects: gastrointestinal issues, headaches, changes in energy, and sleep disturbances, to name a few. 

When a patient taking a pill (either placebo or active treatment) starts to feel these side effects, they immediately know which group they have been randomized to, and they are no longer blinded. 

This can be solved by giving an “active placebo”: a placebo that produces similar side effects to the active medication. Unfortunately anti-depressant trials that use active placebo are lacking. 

But what about the people who DO benefit from anti-depressants? 

Janet knew a few. She had a cousin who also suffered from depression. He took medication to manage his symptoms. He’d told her many times that he just wasn’t the same without it. 

Perhaps you, reading this article have found benefit from an anti-depressant medication. Perhaps you know someone who has: a family member, or a friend. Maybe it was their lifeline. Maybe it’s yours. 

According to Jakobson et al., there are indeed some people who benefit from anti-depressants. Anecdotally we know this to be true. However, the results of large studies show minimal to no benefit from medication, on average. 

This means that some people might benefit; we know that some do. It also means that an equal number of people are harmed. 

In order for the net effect of anti-depressant medication to be close to zero, an equal number of people experience negative effects that outweigh the positive effects seen in others. 

So, while some may have already tried medication and benefited from it, those considering medication won’t know if they’ll be in the group who benefits, or the group who is harmed.

The side effects of anti-depressant medication are often underrepresented. In the Lancet study, adverse effects were neither recorded nor assessed (3).

The most common side effects include gastrointestinal problems, sleep disturbances, and sexual dysfunction. More serious side effects, like increased risk of suicide, are also possible. Some of these effects may persist even after the medication is stopped.

Anti-depressant trials are short-term. Most trials assess patients for 4 to 8 weeks, while most people take anti-depressants for 2 years or longer.

Anti-depressants also put people at risk of physiological dependence and withdrawal. 

Withdrawal symptoms can occur a few days, or even weeks, after tapering anti-depressant medication. They sometimes last months. 

Withdrawal symptoms are often mistaken for depressive relapse. This can make it difficult, or even impossible, for patients to come off medication. This is worrisome considering the lack of research on long-term medication use.

It is sometimes argued that anti-depressants are more effective, or even essential, for severe depression, however the evidence for this is lacking (4).

In their paper, Jakobson, Gluud and Kirsch conclude that, based on the evidence, anti-depressants show a high risk of harm with minimal benefit.

Before prescribing them, Jakobson et al recommend more non-biased, long-term studies that use active placebo, and honestly assess the negative effects of the medications.

They recommend that studies use improved quality of life and clinically meaningful symptom reduction, not just statistical significance, as standards for treatment success. 

Despite these conclusions, SSRIs remain a first-line treatment for major depressive disorder. They are also prescribed for conditions like severe PMS, IBS, anxiety, grief, and fibromyalgia, or other pain conditions. 1 in 8 adults in North America are taking them. 

As a clinician who focuses in mental health, I am not against medication.

I have seen patients benefit from SSRI or SNRI medications. Sometimes finding relief with medication when nothing else worked. 

My clinical practice keeps me humble. 

If a patient comes into my practice on medication, or considering medication, I listen. I ask how I can support them. I answer questions to the best of my ability. I trust my patients.

Patient experience trumps clinical papers. 

However, for every patient who benefits from medication, just as many experience negative side effects, or no effect. I trust their experiences too.

I also trust the experiences of the patients who have been trying for months, or years, to wean off medications.

Let me repeat it again: depression is real. Asking for help is hard. And it’s important. 

Depression is a multi-factorial condition. 

This means that it stems from hundreds of complex causes. This is why it’s so difficult to treat. This is why so many people suffer.

Let me also repeat: depression is not easily fixed. 

There is no one solution, and there are certainly no ONE-SIZE-FITS-ALL solutions.

So, if you or someone you care about is suffering from depression, what can you do? 

First, get help. This is not something you can get through alone.

Second, seek lots of help: gather together a team of professionals, family and friends. You can start with one person: your family doctor or a naturopathic doctor, and then assemble your support network.

Choose people you trust: people who listen, provide you with options, and seek your full informed consent

It is important to work with a healthcare team who take into account the factors that may be contributing to your symptoms: brain health, gut health, life stressors, nutrition, inflammation levels, presence of other health conditions, sleep hygiene, family history, contributing life circumstances, such as grief, trauma, or poverty, and who lay out various treatment options while filling you in on the risks, benefits and alternate therapies of each.

Medication may be part of this comprehensive treatment plan, or it may not. 

It is brave to ask for help. 

And I believe that bravery should be rewarded with the best standard of care—with the best help. 

References: 

  1. Jakobsen JC, Gluud C, Kirsch IShould antidepressants be used for major depressive disorder?BMJ Evidence-Based Medicine Published Online First: 25 September 2019. doi: 10.1136/bmjebm-2019-111238
  2. Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and trial sequential analysis. BMC Psychiatr2017;17:58
  3. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet2018;391:1357–66
  4. Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med2008;5:e45.doi:10.1371/journal.pmed.0050045
  5. Ebrahim S, Bance S, Athale A, et al. Meta-Analyses with industry involvement are massively published and report no caveats for antidepressants. J Clin Epidemiol2016;70:155–63.doi:10.1016/j.jclinepi.2015.08.021
A Letter to Myself at 32

A Letter to Myself at 32

I often encourage my patients to write a letter to themselves on their birthdays for the following year using a website called FutureMe.org, where you can post-date emails to yourself to any date in the future. This exercise is great to do on any day, really. Tomorrow is my birthday. I’ll be 32. Here is my letter. 

This is it.

This is your life.

As Cheryl Strayed wrote, “The f— is your life. Answer it.”

There are some things that you thought were temporary, mere stepping stones on your way to someplace better, that you now realize are familiar friends, ever present in their essence, but varying in their specific details.

For instance:

1) You will ride buses.

You will never escape the bus. For a while taking the bus was seen as a temporary stop on your way to something else (a car?). You took the bus as a pre-teen, excited to finally be allowed to venture to parts of town alone. As a student, you took the bus to the mall, laughing at the ridiculousness of Kingston, Ontario, once you’d left the protective bubble of the student community, completely inappropriately, yet affectionately (and ignorantly) called The Ghetto.

You will visit other ghettos, also by bus, that are far more deserving of their names. However these ghettos will instead have hopeful names such as El Paraiso, or La Preserverancia. Those who live there will persevere. So will you.

Buses will take you over the mountains of Guatemala, to visit student clients in Bogota, Columbia. To desirable areas of Cartagena. You’ll ride them through India. They will carry you through Asia, bringing you to trains and airports.

You’ll ride buses as a doctor. You’ll ride the bus to your clinic every day.

Sometimes, on long busy days in Toronto, it’ll seem like you’ll spend all day trapped in a bus.

The bus is not a temporary reality of your life. The bus is one of the “f—s” of your life. You’ll learn to answer it. You’ll learn to stop dissociating from the experience of “getting somewhere” and realize you are always somewhere. Life is happening right here, and sometimes “right here” is on the seat of a bus. Eventually you start to open up, to live there. You start to live in the understanding that the getting somewhere is just as important as (maybe more than) arriving.

We breathe to fill our empty lungs. Almost immediately after they’re full, the desire to empty them overwhelms. Similarly, you board a bus to get somewhere, while you’re on the bus, you start to understand.

You’re already here.

Maybe you’ll graduate some day, to a car.

But sooner or later, you’ll board a bus.

And ride it again.

2). You’ll experience negative emotion, no matter who you are or what your life circumstance.

Rejection, worthlessness, sadness, and heart break, are constant friends. Sometimes they’ll go on vacation. They’ll always visit again.

You will never reach the shores of certainty. You will never be “done”. You may take consolation in momentary pauses, where you note your confidence has found a rock to rest its head against. But you’ll grow bored of your rock (it is just a rock, lifeless, after all). You’ll then dive back into the deep waters of doubt, risk despair, and swim again.

Happiness isn’t a final destination. Instead, it’s a roadside Starbucks: a place to refuel, and maybe passing through is an encouragement you’re headed in the right direction.

3). The people in your life are like wisps of smoke.

They will come and go. Some of them will simply whiff towards you, visiting momentarily. Their names you’ll hardly remember. You’ll share ice cream and one deep, healing conversation about love that you’ll remember for years to come. You’ll reflect on this person’s words whenever you consider loving someone again.

You’ll remember the ice cream, the warm sea breeze, the thirst that came afterwards, the laughter. But it will be hard to remember his name… David? Daniel? You won’t keep in touch, but you’ll have been touched.

There will be others who come to seek your help. You might help them. You might not. They might come back regardless, or never return. Many times it will have nothing to do with the quality of your help. Or you.

Sometimes the smoke from the flame will thicken as you breathe oxygen into it. People will come closer, you’ll draw them in, inhale them.

Sometimes you’ll cough and blow others away.

You’ll wonder if that was a wise choice. You’ll think that it probably was.

Does a flame lament the ever-changing smoke it emits? Does the surrounding air try to grasp it? Do either personalize the dynamic undulations of smoke, that arise from the candle, dance in the fading light and dissipate?

Flames don’t own their smoke. They don’t seem to believe that the smoke blows away from them repelled by some inherent deficiency in them. Flames seem to accept the fact that smoke rises and disappears, doing as it’s always done.

4). Not everything is about you.

There will be times when failure lands in your lap. You’ll wonder if it’s because there is some nascent problem with you, that only others can see. These failures will tempt you to go searching for it.

You’ll find these faults. These deficiencies. In yourself, in others, in life itself.

You’ll wonder if it explains your failures. You’ll wonder why the failures had to happen to you.

You think that people can smell something on you, that your nose is no longer able to detect, like overwhelming perfume that your senses have grown used to, but that assaults the senses of others around you.

Failure and rejection, cause your heart to ache. Your heart aches, as all hearts do. The hearts of the virtuous, famous, heroic, and rich ache just as hard. The hearts of those who have committed evil deeds also split apart. (The only hearts that don’t may be the truly broken, the irredeemable. And those people are rare.)

You will experience joys. Your heart will mend and break, a thousands times.

And it has nothing to do with you.

5). Success is not a final destination.

There are no destinations. You will ride buses, you will feel happy, you will feel joy. You will try. You will succeed.

And you won’t.

You’ll pick up the pieces of your broken heart. You will mend them. You will flag down the next bus.

You will board it.

You will grasp—you can’t help it. Grasping will only push the wisps of smoke away, causing it to disappear in your hands. This will frustate you, but you’ll keep doing it.

Over and over.

And failing.

You’ll grasp some more and come up empty, thinking that it is because something is wrong with me. There is lots wrong with you.

There is lots right with you.

Most things have nothing to do with you. (That might be just as painful to accept

But healing as well.)

No one said healing didn’t hurt. Sometimes it f—ing hurts! But, as Cheryl Strayed wrote, “the f— is your life”.

And answering it is your life’s process.

Contrast Showers for Immunity, Inflammation, Mood, Pain and Weight Loss

I talk about contrast showers for boosting immunity, lowering inflammation, mood, pain and weight loss.

Hello everyone, my name is Dr. Talia Marcheggiani, I’m a naturopathic doctor and today I’m going to talk about hot and cold contrast showers. As naturopathic doctors, one of our modalities is hydrotherapy. Hydrotherapy comes from naturopathic medicine’s roots, using hot and cold water to make changes to circulation, hormonal functioning and immune functioning. I’m going to talk about some of the science behind hot and cold contrast showers.

This is something I recommend to my patients to increase their immune activation, decrease autoimmunity, improve mood and hormonal functioning, as well as increase circulation and there’s some evidence that it might help with weight loss as well.

So, firstly, things like exercise and hot and cold therapies induce a little bit of stress. There’s two kinds of stress: distress, which is sort of that chronic, cortisol-fuelled stress that a lot of people come in with, in a state of burnout that’s causing things like inflammation, and mental-emotional illness, and autoimmune issues, and dysbiosis, and then there’s something called eustress, which is more like exercise, cold therapy: short, small bursts of stress that actually up-regulate proteins and genes in our body to combat stress. These genes are involved in DNA repair, increase antioxidant synthesis, and the antioxidants that our body makes are far more powerful than the ones that you’re going to get from food or supplements.

So, by upregulating these genes, we can protect ourselves from cancer, neurodegenerative disease, and other chronic diseases. It’s really powerful stuff, this is called a “Hormetic” response, hormesis, where small stressors mount bigger responses by the body than is needed to deal with those stressors and overall we’re better off; there’s this net beneficial effect. This is one of the proposed mechanisms for some of the antioxidants or flavonoids in green leafy vegetables. It’s not that they provide us with antioxidants, it’s that they encourage our body to make antioxidants due to the small, toxic load that they present to us. And so there’s some evidence that getting short bursts, or longer bursts of cold, very cold, will increase a hormone called norepinephrine. Norepinephrine is involved in depression and mood. Norepinephrine is a catecholamine and it increases the sympathetic nervous system, which is that fight or flight nervous system. When boosted in small amounts, it can actually elevate mood and so a lot of anti-depressant medications also induce, or inhibit the reuptake of norepinephrine. So these are called SNRIs and they include things like Venlafaxine and Cymbalta. So there’s some evidence that norepinephrine increases 2-3 times after only 20 seconds of immersion in cold water. There’s a connection between norepinephrine lowering pain and inflammation and increasing metabolism and there’s some anecdotal evidence and one study, at least, was done to show that cold immersion therapy actually decreased symptoms of depression.

There’s also these things called hot and cold shock proteins, heat shock proteins and cold shock proteins. So, for example, one is called RBM3, which is a cold shock protein, and these proteins can actually help increase longevity and they can actually help decrease incidences of neurodegenerative diseases and neurodegeneration, so something like Alzeimer’s disease or Parkinson’s disease, which can help us with health longevity, so staying healthier into our later years.

We know that inflammation is one of the drivers of the aging process. Probably the primary driver of the aging process, and one of the main factors in chronic, debilitating disease, and, especially in my focus, mental health, there’s more and more researching coming out that inflammation, low levels of inflammation in the brain, is the main cause of mental health conditions, such as depression, and anxiety, bipolar disorder, OCD, ADHD. There’s these low levels of inflammation that contribute to the symptoms of low mood and by increasing norepinephrine, through small bursts of cold and increasing those cold shock proteins, we’re actually able to combat these mental health conditions. Norepinephrine decreases inflammation by decreasing a cytokine called TNF-a that is known to increase inflammation in the body and in the brain. TNF-a can cross the blood brain barrier and it can inhibit serotonin synthesis and it can actually also increase neuro-inflammation, causing symptoms of mental health disorders.

There’s some studies that cryotherapy, for rheumatoid arthritis actually decreased pain significantly. And there’s also some studies that being in cold water, that cold shock, can actually increase the immune system activation. It’s good to increase our immune system activation if our immune cells are behaving properly. If our immune cells are attacking ourselves, then we want to decrease the immune response. But having higher levels of lymphocytes, especially cytotoxic T lympthocytes that are involved in killing cancer cells, is a very positive thing and that’s been shown to increase in people that underwent cryotherapy, or really acute, short exposure to intense cold.

There’s also an ability to lose weight when exposed to cold, over the long term. There’s a man called Ray Cronise who lost over 80 lbs by just habitually exposing himself to mildly cold temperatures. And one of the mechanisms for this weight loss is through non-shivering thermogenesis, in which the cells in the mitochondria uncouple proteins that make energy and they dedicate all the stored energy in fat to making heat. Kind of like cutting your bike chain. So instead of biking, you’re not moving forward, but you’re generating energy and you’re generating heat. And so our body will do this when it’s slightly cold that it can increase heat. Our body is always striving to maintain constant temperature, between 1 or 2 degrees. This process is regulated by norepinephrine, which rises acutely as soon as we’re exposed to just a few seconds of cold. This can be 40-50 degree water. And then I already mentioned that short, cold exposure can increase the production of antioxidants. Our mitochondria are constantly creating reactive oxygen species and reactive nitrogen species. This is just a product of normal cell metabolism. These become toxic, though and damage DNA if our body doesn’t also produce anti-oxidants to clear out those reactive oxygen species and reactive nitrogen species. The cold induces a little bit of a stress that increases our metabolism that increases the reactive oxygen and nitrogen species in our mitochondria and therefore our body is incited to up-regulate the enzymes that create those powerful anti-oxidants that I talked about that are far more powerful than the ones that you can get from food: vegetables, fruits, vitamin C supplement. A couple of these enzymes are glutathione reductase and superoxide dismutase, which are very powerful to our cells.

There’s some evidence that hot and cold therapy can increase muscle mass, can increase muscular strength and aerobic endurance. So this is great for athletes post-workout to lower inflammation and improve muscle regensis. And then, it can also increase something called mitochondrial biogenesis, which is the production, or the replication of more mitochondria in the tissues, especially the muscle tissue. So our body will increase the mitochondria content, the mitochondrial mass, in muscle tissue under certain conditions. These conditions are mainly fasting, exercise, and hot and cold shock.

So, what I’ll recommend to my patients, somebody who’s suffering from low immunity, so they’re getting frequent colds and flus, or maybe autoimmunity, or maybe just general inflammation and pain, brain fog sluggishness adrenal fatigue, that kind of sluggish lethargy from depression. So it’s more the sluggish depression, I’ll recommend hot and cold showers.

So what you do is, in your shower, either during your shower, during your regular cleaning routine, or after your shower is done, and you’ve already washed your hair and everything, you’re going to turn the water on to a reasonably hot temperature, so not so hot that it’s scalding, and you’re going to leave that hot water on for 30 seconds to 1 minute. When that’s done, you’re going to turn the shower to as cold as you can tolerate. So with my patients I often coach them to start with a lukewarm temperature before going whole hog and doing cold. And this is just to coax the body into that stress response that we want, that short, quick stress response that’s going to do all those good things: up-regulate anti-oxidant production, increase norepinephrine, decrease inflammation, increase mitochondria synthesis, burn fat. So you’re going to try and make it as cold as possible, for 20 to 30 seconds, and then you’re going to cycle back and forth at least 5 to 10 times, always end on cold, and then, when you’re done, towel off and keep warm.

There’s some evidence that doing this before bed can actually increase REM sleep and help you sleep more soundly without waking up in the middle of the night. We all know that a good sound sleep is going to set the tone for the next day and your energy for the next day. And then there’s also some evidence that doing this in the morning can increase your energy and alertness throughout the day, so it’s almost like this same practice at different times of day impacts our circadian rhythms differently and can give us more of what we want: either more profound sleep or more daytime energy.

So, that was hot and cold showers, my name is Dr. Talia Marcheggiani and you can check out my website at taliand.com or contact me at connect@taliand.com . A lot of this research came from Dr. Rhonda Patrick at foundmyfitness.com .

 

The Therapeutic Order of Naturopathic Medicine

The Therapeutic Order is a tool that helps guide naturopathic treatment approaches. I explain how naturopathic doctors’ healing philosophy might differ from the conventional medical model.

Hi, guys, I’m Dr. Talia Marcheggiani and I’m recording to you guys from my clinic in Bloor West Village and today I’m going to talk about some myths about naturopathic medicine, especially regarding our relationship with conventional medicine and medications and, in order to talk to you about that, I want to talk to you about something called the Therapeutic Order. So the therapeutic order is from our traditional roots in the formation of the profession of naturopathic medicine. This is one of our philosophical ideas about how to treat somebody that comes in our door and how people should be treated in terms of the medicine that we practice. And this is a 7-step process, or a hierarchy, of what our treatment goals are for seeing somebody. And the reason that I’m relating the Therapeutic Order to medications is because one of the steps in this hierarchy of the Therapeutic Order is pharmaceutical medication. And so I feel that, in naturopathic medicine, most of us, and certainly in our philosophy, in regards to medication, it’s not that we don’t agree with medication or surgery or conventional treatments, it’s our agreement about when they’re implemented and it’s also about our efforts to treat patients before the need for surgery or medications arises. And so, the Therapeutic Order is a system of interventions and we go from lower-force interventions to higher force interventions and the first step in the Therapeutic Order is to remove obstacles to health.

In modern healthcare, both naturopathic and conventional medicine strive for the same goal—restoring and maintaining a patient’s well-being. Naturopathic doctors emphasize prevention and addressing the root causes of illness before resorting to pharmaceuticals or surgical interventions. This approach aligns with the Therapeutic Order, ensuring that treatment starts with the least invasive methods first. However, when necessary, medications play a crucial role in managing conditions that require immediate intervention. The key lies in knowing when to integrate pharmaceutical solutions within a broader health plan rather than relying on them as the first line of defense.

So, anytime someone walks into my office, and is displaying certain symptoms, I’m always looking for, what are the obstacles that their body is facing when it’s trying to achieve its optimal state of health and wellness. Our bodies have evolved over 300 billion years, from whatever our common ancestor was, that first created life, we’re this result of a lineage of survivors, if we’re here on the planet today. And so our bodies have evolved amazing mechanisms to preserve our health and well-being to ensure that our genes are carried on to future generations. So when somebody is coming in in the initial stages of disease, and so this may manifest for you as just this subclinical feeling of “imbalance”, for lack of a better word, there’s often an obstacle in the way. And a big obstacle that often presents itself in my patients’ lives is stress. That’s one that’s huge and that’s the reason that I talk about it so often. Another is toxic burden from our environment. Things like pesticides, plastics, smog pollutants in our air, in our water, in our food, that can also cause an obstacle to health or just give our bodies some extra things it has to deal with that divert it from its job of making us feel and look our best. And another thing, of course, is diet that’s inadequate, that’s not providing us the nutrients that we need or a diet that’s providing us with anti-nutrients, so it’s preventing us from absorbing the vitamins, the minerals and the macronutrients that we need to function optimally.

And some naturopathic doctors will focus on the energetic aspect, the spiritual aspect. So, is the person in front of them pursuing a meaningful life, do they feel satisfied with their work, are they satisfied with their relationships. So, anytime one of these major pillars of our health is lacking that can also present an obstacle to us feeling our best. And oftentimes the obstacle is a mental-emotional one, even if the symptoms that are manifesting are physical.

So, another video that explains this is my wheel of balance video in talking about stress and when I work with mental health, a stage to mental health promotion is emotional wellness, which is why I use that term so often, rather than focusing on eradicating or eliminating or managing symptoms of mental “illness”—and I prefer to say mental health conditions, rather than mental illness—how can we improve our emotional wellness, how can we improve our mental wellness, as opposed to focusing on disease.

Most naturopathic doctors will focus on this level, this will be inherent in our philosophy we’re always going to be looking for what the obstacles are that are in the way of our patients’ achieving symptom-free lives or a life of low or no symptoms, and a life of abundant wellness and energy, and healthy weight management and healthy mood and all of the things that indicate robust health. This will always be inherent in our philosophy.

The second step in the Therapeutic Order is to stimulate the Vis, so this is the “vis medicatrix naturae”, which is Latin for the healing power of nature, which may seem a little bit woo woo to some people, but you can think of the Vis as metabolism or homeostasis, and this is the idea that our body is primed for optimal health, and our body is always striving to maintain balance. And there’s this idea in naturopathic philosophy that sometimes this inherent energetic mechanism that causes life and all living beings, that sometimes it needs to be stimulated and oftentimes the therapies to do this are more in the energetic realm. So things like homeopathy and acupuncture and hydrotherapy as well, so using water and various temperatures to increase metabolism, hormonal balance, homeostatic balance and blood flow, so those are all scientific terms for what I think the Vis attempts to describe.

So, I tend also to use diet in this realm and herbs. I believe that herbs, and there’s some research for this, some evidence that herbs are modulating, that herbs, as opposed to drugs, kind of seek where things are lacking and they balance our hormonal milieu, our hormonal landscape, more than a medication, which is man-made and an example of this is that some people supplementing with straight vitamin A experienced some negative outcomes in large studies that were done. But if you eat foods that are high in vitamin A, those negative symptoms from vitamin A supplementation seem to balance themselves out and that’s because there are some nutrients present in vitamin and nutrient-rich foods that we haven’t discovered yet and that seem to act synergistically with other chemicals, natural chemicals, that are present in those foods. And so, by taking nature into our bodies through forest bathing, so physically being in nature, or through the consumption of plants and natural substances, I believe that we receive some of those messages from nature. And I can get into this in future videos. I find that herbs have intelligence behind them. And that’s not necessarily woo-woo or pseudoscientific, there’s some research for sure that show that herbs modulate through their anti-inflammatory effects, their anti-oxidant effects, and their hormone-balancing effects, in ways that pharmaceuticals don’t do to the same extent.

So, these two stages, when patients are coming in and we’re focusing our treatment, we’re removing obstacles and stimulating the body’s capacity to heal and you can think about this. If you break a bone, we’re definitely going to remove the obstacle, which is whatever broke the bone in the first place, and then we’re going to promote the body’s ability to heal. It’s not conventional medicine that heals the bone, we simply align the bone so that it can fuse together. It’s the body that heals it. So, we’d be promoting the healing of that tissue with some of the nutrients that the body needs. So this can be applied no matter how serious the medical condition, but definitely it will always be implicit in our treatment plans and how we look at the body. And sometimes that’s enough, if somebody is just coming in with a general feeling of imbalance or, you know, someone who’s coming in with a good state of health, without a loss of apparent symptoms that just wants to manage their health in general, then we’ll kind of stop there, but we might teach you some ways to detoxify, to encourage a healthy diet, and the healthy consumption of health-promoting foods and we’ll let you sort of maintain that on your own.

But what often happens is that people are coming in, because we’ve been taught in our culture in North America and Canada, especially, to come in and seek medical care when we’re feeling ill, a lot of the time people will come in with some kind of issue, so some specific symptoms, and oftentimes these symptoms are apparent or located within one organ system. And so the third step in the Therapeutic Order is to strengthen weakened systems. So this might be somebody who’s coming in a liver issue and this may be a diagnosed issue, or based on their symptoms, we’re noticing some impairment in the liver in general. And so we take treatment a step further and we start to focus on actually repairing the tissues that are present in the liver and so we’ll be using some, perhaps, liver detoxification, some more intense diets, so diets that are geared more to therapeutics, and using some herbs and nutrients to clean out the liver.

We can also use some of our energetics, at this stage, acupuncture, homeopathy, hydrotherapy, self-care practices, and we’ll definitely be removing obstacles to cure, so high-sugar diets, or overconsumption of alcohol, or a high toxic burden. We’ll be looking at those things as well, but we’re also taking it a step further and specifically focusing on the liver in this case.

At this stage of treatment, acupuncture therapy becomes a powerful tool to complement the healing process. By targeting specific points in the body, acupuncture helps to balance energy flow, reduce inflammation, and promote the body’s natural healing abilities. This approach is particularly beneficial for those dealing with chronic conditions or weakened systems, as it provides a holistic method to address underlying issues.

And this is something that I see most of in my practice, is people coming in with hormonal imbalance, with a mental health condition, with digestive issues, skin issues, hair falling out, and so we’re ordering labs, we’re targeting specific organ systems, and we’re, maybe not necessarily putting these symptoms into a diagnostic category, that would be diagnosed by a conventional doctor, so sometimes these are still subclinical, but there’s definitely symptoms present, people are suffering and they’re noticing a change and they’re probably have already sought help with their medical doctor and maybe were told everything was fine, or maybe they received a diagnosis.

The 4th stage in the Therapeutic Order is to correct structural integrity. So, if our posture, if our alignment is off, then our health is not going to work properly, there’s not going to be proper nerve conduction, there won’t be proper circulation, there won’t be proper functioning of our organ systems. If our rib cage is collapsed, we won’t be breathing properly and we won’t be oxygenating our tissues. If our pelvis is out of alignment we won’t experience proper digestion and digestive regulation. And I often refer out for this stage, I might refer to an osteopath or a chiropractor, or a physiotherapist or massage therapist. I might so some acupuncture myself, but typically for structural correction, I’ll refer to another practitioner and I myself see a massage therapist, chiropractor, osteopath and do quite a bit of hydrotherapy and work on aligning my body through yoga and things like that because of its importance and just general health maintenance.

Correcting structural integrity is essential not only for pain management but also for ensuring the body’s systems function optimally. A professional physiotherapist plays a vital role in this process, offering tailored exercises and manual therapies to improve posture, mobility, and strength. They assess the alignment of your body and identify any areas of restriction or dysfunction. Through targeted treatments, physiotherapists work to restore balance and proper alignment, helping to prevent issues from becoming chronic or leading to further complications. By focusing on the body’s structural health, physiotherapists ensure that everything from nerve conduction to organ function is supported.

While this is the 4th stage in the Therapeutic Order, I often recommend that it be implemented as some kind of healthcare strategy that focuses on structural integrity be implemented early on or as a maintenance, especially because we’re so sedentary and we spend so much time in front of our computers and often engage in repetitive exercise. Working on structural integrity management is so important.

The 5th stage in the Therapeutic Order is the use of natural substances to restore and regenerate. And so this is a little bit like symptom management, if you can imagine that. The objective of naturopathic medicine is not necessarily to fix a specific disease, which is often confusing, because we have a very disease-focused healthcare system, not necessarily a health-focused one. And so we’re sort of indoctrinated into this view that if you don’t have a diagnosis that you’re healthy, or that health is the absence of symptoms, which is certainly not the philosophy of the world health organization who believes that health is a mixture of our mental and spiritual and emotional and physical wellbeing and not simply the absence of disease, however we do have a sickcare system rather than a healthcare system, and so we’re educated not to go to the emergency room or your family doctor unless you feel like it’s serious enough to warrant a diagnosis and, if it’s not, then you’re often sent home and told everything’s fine. And patients will always come in having told me that their labs are fine. And they are, they’re fine in the framework of not requiring a diagnosis, or pointing to necessary pathology, but they’re certainly not fine in the sense that not things that we can improve on and that are not giving us warning signals of what could come in the future.

We often focus on disease prevention and healing the body rather than focusing on the symptoms or the pathology. We’re looking for the underlying cause. However, sometimes we get far enough along that we do need to manage symptoms, otherwise people aren’t going to notice benefit. And, so, further along the disease process, further along the naturopathic order we need to reach. To manage the diseases. These are a little bit higher-force interventions, rather than sort of encouraging tissue repair, like we were doing in the 3rd stage of the Therapeutic Order, now we’re focusing more on managing symptoms, managing inflammation through herbs that are going to calm it down quickly, and detoxify quickly, and we’re going to manage headaches with herbs, that are just generally anti-inflammatory. So we’re going to be looking at symptom-management. And so a lot of the time we’ll do that in conjunction with the other 4 stages of the Therapeutic Order, but this time there is a heavy focus on keeping symptoms under control for better quality of life and to move the needle further.

And the 6th step of the Therapeutic Order is similar to the 5th, except we’re using pharmacological devices and so it’s not that we’re against pharmacology and medications in naturopathic medicine, at all, we simply want to encourage patients to come and see us before things get to the point where you require medications and I certainly believe and I think even many conventional practitioners agree with me on this, that medications are probably too widely prescribed or over-prescribed. And this may be that there are no other solutions and, as a clinician, you want to help the person sitting in front of you and aren’t really sure how to go about that. So somebody comes in to your office who has depression and you’re going to reach for the selective-serotonin reuptake inhibitor, the SSRI, the Prozac or Cipralex, you’re not going to tend to risk using herbs or focusing on diet or digestion or those kind of things, you’re going to use this “proven method” and you’re going to implement that right away, whereas my philosophy would be to, depending on how serious the case is, to implement other interventions and make sure that our terrain is being treated, that we’ve removed some obstacles to cure, we’ve encouraged spiritual and life-meaning pursuits and we’re stimulating the body’s own healing mechanisms and anti-inflammatory mechanisms, and that maybe we’re directly targeting the brain with some nutrients and some vitamins and that we’re making sure structural integrity is there, and that we’re even using some herbs to manage depression because we know that St. John’s Wort works very similarly to an anti-depressant in terms of its efficacy. And then, if those things are not working or not having enough of an impact, then we might talk about an SSRI, depending on how severe the case is.

And I say this not to create a stigma around medication use at all. Every single body is different and everybody’s going to need a different treatment concoction and it’s never going to be just one treatment or very rarely will it just be one panacea, no matter how much we wish that there were, it’s going to be a few things that we need to implement to help manage our own health, so that’s when we’ll reach for the pharmaceuticals, when the natural treatments are not having enough of an impact, or the disease process has progressed far enough.

And then the last is the use of high-force interventions, so surgery, radiation and chemotherapy. When you’re diagnosed with cancer, then it’s definitely appropriate to do radiation and chemo or to excise the tumour, or if there’s joint degeneration to the extent that it can’t further be repaired, and you can’t sort of prevent it any longer, because you’ve reached the point where the cartilage in your joint is damaged, then a joint replacement is appropriate. It’s not that we’re against these things either, it’s that we believe in trying as hard as we can to prevent them from being necessary. But when appropriate, they’re definitely a gift that we have in our culture and the time that we live in that we can use these kinds of things to improve our quality of life and to get us back on track in terms of our health. And so very rarely will I see somebody who requires this stage of intervention, even naturopaths that work with cancer, their focus is not to treat cancer with natural therapies but to support the whole patient and to improve the outcomes of the high-force interventions, often an obstacle to healing from cancer is that patients aren’t able to finish their course of chemo due to the side effects, and so a lot of the natural therapies can help boost the efficacy of the medication and reduce the side effects and make patients feel better, so that they’re able to complete their treatment and then have better outcomes. So, at these two, the last two stages, where we’re using medications and high-force interventions, natural medicine is working to support the terrain and to support the body, through the therapies, through the side effects and to also encourage the therapies to work better.

And just to recap, the stages of the Therapeutic Order are first, number one, remove the obstacles to health, number two, stimulate the Vis Medicatrix Naturae, or stimulate homeostasis, improve our body’s self-healing mechanisms through applying nutrients, or looking at energetics, or using herbs to balance our systems and promote proper hormone balance. And the third is to strengthen weakened organ systems, focusing on one organ that may be the culprit in causing symptoms in particular, and really using nutrients that target that organ and the tissues that that organ has. Number four is to correct structural integrity, creating proper alignment and healing the musculoskeletal system through things like chiropractic medicine, osteopathy, massage therapy, even hydrotherapy and acupuncture, doing exercise like yoga as well fits under there. And number five is to use natural substances to restore and regenerate, so this is using natural substances to work directly with symptoms, to promote healing, but in patients that are further along the road to pathology and maybe already have a diagnosis of some health condition. And number six is to use pharmaco-substances to halt progressive pathology, so these are palliating, they’re stopping disease, they’re treating somebody who is either not responding enough or whose disease has progressed far enough that natural therapies are no longer strong enough. And then the seventh stage of the Therapeutic Order is to use high-force invasive modalities, such as surgery, radiation and chemotherapy and, again, these are removing the disease. Often that stage is usually life or death situations, we’re working to remove what’s causing a danger to our body and to our ability to survive. And so naturopathic medicine cover this whole spectrum. We have therapies that cover the whole spectrum of these stages and we’re working to treat the whole person not focusing on the disease or the symptoms, but looking at the person in front of us, and taking into account their lifestyle their preferences, their unique individuality and genetic expression and individual expression. My name is Dr. Talia Marcheggiani, I’m a naturopathic doctor and I work at Bloor West Wellness in Bloor West Village in Toronto. Take care.

Estrogen Dominance, Hormone Balance and the Mirena IUD

In response to my very popular article about the Mirena IUD and how that can upset hormone balance, or further an existing imbalance, I talk about a condition called “estrogen dominance” can result in hormonal symptoms, such as PMS, infertility, weight gain and anxiety.

Hello everyone, my name is Dr. Talia Marcheggiani. I’m a naturopathic doctor with a special focus in mental health and hormones, especially women’s hormones.

So, today I’m going to talk about an article I wrote about a year and a half ago that gotten a lot of activity online and it’s called “Let’s Talk Mirena: Anxiety and Hormone Imbalance”. I wrote the article because I was seeing a few patients who had the Mirena IUD and a series of similar symptoms. So, anxiety, panic attacks, and just a general sense of hormone imbalance. And when we ran their labs, when I looked at the levels of progesterone in their blood, they had very low progesterone. So I wrote an article about this and about the phenomenon of “estrogen dominance” that we naturopaths talk about a lot. And I got this resounding response online, so even today, sometimes, I’ll get a couple emails a day of people expressing their experiences and their agreement with the article and their confusion and frustration and anxiety around some of the symptoms that they’ve been experiencing since getting the IUD.

So, the reason I wrote the article is not because I don’t agree with the Mirena IUD. I’ve written another article called “Having a Healthy Birth Control Experience” in which I state that as a form of contraception, a hormonal birth control and a hormonal implant such as the IUD can be really great measures against unwanted pregnancy, because their efficacies are very very high—I think the Mirena IUDis about 99%pregnancy avoidance— and you don’t need to think about it, you don’t need to take a pill every day, so for some women this is ideal.

The issue is that a lot of women are being prescribed the Mirena IUD as a solution for Estrogen Dominance. And so what I find in my clinical practice, and I’ll talk more about estrogen dominance in the course of this video, but what I find in my clinical practice is, because it doesn’t address the underlying cause, and because it’s hormonal in and of itself, and it adds more hormones to the body, in a specific location, the uterus, and because it doesn’t address the underlying imbalance, it either worsens or ignores the condition of estrogen dominance, causing symptoms to get worse and women to feel frustrated and lost and then write to me.

Mirena is often prescribed to women with heavy and painful menstrual bleeding. So, this could be a diagnosis of endometriosis, or ovarian cysts, or just symptoms that they’re experiencing. So a lot of them might be experiencing iron deficiency because of the heaviness of the bleeding and a lot of women are out of commission for a couple of days every month because their period is so heavy and uncomfortable and they feel weak and they’re in pain and maybe they deal with really intense PMS. Some of my patients deal with PMS for 2 weeks out of the month, which is crazy and super uncomfortable.

Conventional medical doctors prescribe the Mirena IUD to combat these symptoms because with birth control and the IUD, one of the side effects is really light periods and some people don’t even get their period at all on Mirena and so you can imagine, if you’re period is this time of the month where you can’t go to work and you’re just basically hemorrhaging from the insides, then it would be a massive relief to not have to deal with a period anymore for 5 years, which is how long the hormones last in Mirena.

But one of the issues is that we need to look at the cause of these symptoms. Oftentimes these symptoms are caused by a difference in estrogen and progesterone, so these are two of the main female sex hormones. One of the things that happens in conditions like endometriosis or heavy and painful periods is that the estrogen is high in relation to the progesterone in the body. And so this is really apparent in a condition like endometriosis where there’s often high estrogen and also fibroids. So both of those cause terrible periods, and they need to be ruled out when periods are heavy and uncomfortable. And then there’s ways that we can deal with that as naturopaths.

But even without an underlying health condition, just primary dysmenorrhea, that’s not caused by another diagnosis is often the result of estrogen dominance.

And so the Mirena, because it’s made of only progesterone, can help with the uterine symptoms of estrogen dominance, which would be the heavy and painful periods. However, we have estrogen and progesterone receptors all over our body, not just in our uterus, and so when we’re putting hormones in one part of the body, and they’re not ending up in the rest of the body, we start to worsen that deficiency, or that relative deficiency in progesterone.

So women will mention, and one of the most common symptoms is anxiety and panic attacks, because progesterone this kind of calming effect on the central nervous system, on the brain, so it kind of chills you out and helps you handle stress.

Estrogen is a hormone that causes women to ovulate, so it’s a pro-ovulatory hormone and it also helps build up the uterine lining. So the more estrogen we have, the thicker the lining and therefore when we shed the lining during our period, the more we have to shed. So, more estrogen, the thicker the lining, the heavier and, by proxy, more painful the period.

Progesterone is a hormone that, in terms of reproduction, it helps us maintain the lining (of the uterus). So, if you ovulate and then that egg gets fertilized by sperm, then the egg gets implanted in the uterus and progesterone starts to increase, so pregnancy is a very progesterone dominant condition and one of the signs of a low progesterone state is when women who have been pregnant say that that’s the most balanced they’ve ever felt because progesterone is naturally higher in pregnancy.

Progesterone starts to rise when you become pregnant and that maintains the lining throughout the 9 months and then, after the 9 months, you have your baby. If the egg doesn’t become fertilized then progesterone rises for the last 2 weeks of the cycle and then it falls, along with estrogen, you shed your lining and then you have a period.

And for some women, they sail right into their periods. They have no PMS symptoms, they might feel a little bit bloated a couple of hours before and then they go to the washroom and go, “ok, look, there’s blood I’m having my period.” And for other women, it’s not the case, they get warning signs, like i said, before two weeks, so pretty much from ovulation to when their period happens. So, half of their life: 2 weeks out of every month.

And so, what happens with a lot of women is that there’s higher estrogen in relation to progesterone. So we call this “Estrogen Dominance”. And there can be three possibilities in this state. One is that estrogen is abnormally high and progesterone is normal, or optimal. Another is that estrogen is normal or optimal, progesterone is low, and a third option is that you have both at the same time: so estrogen is high and abnormal and progesterone is low and that’s more common than you think in a lot of women who are dealing with really severe symptoms, that divide between the two hormones is really off. And, as I mentioned before, prescribing birth control pill or Mirena IUD are not solutions because they’re not correcting the underlying imbalance. They’re not looking at the cause of why this imbalance is happening in the first place. Instead, they introduce foreign, fake or synthetic hormones into the system to try and correct the balance, but our body has a delicate balance and a delicate ecology and so when we try and shift that balance artificially sometimes we pay the price and we don’t necessarily feel balanced.

So, why does this occur? Why do people get estrogen dominance and how do you fix it? So, when it comes to the first situation, high estrogen, and normal progesterone, there’s a couple of reasons why estrogen might be high. So the first is exposure to foreign estrogen, or excess estrogens in the environment. And, so many of you may have heard of these “xenoestrogens”, or toxic estrogens, from sources such as BPA, so the lining of tin cans, or those plastic water bottles or baby bottles that everyone was throwing out and replacing with glass and stainless steel, which is a great idea. So, we’re in contact with these in the environment through the cosmetics, cleaning products, and some of the plastics that we hold and interact with on a daily basis. And paper receipts have this as well. So cashiers and people that handle receipts regularly are in contact with BPA. And it’s absorbed through the skin. So just this exposure to these toxic estrogens can activate estrogen receptors and it increases estrogen in the body. And that’s problematic. We know that these can also set the stage for hormonal cancers, like breast cancer, you might have heard of estrogen-receptor positive breast cancer, or ovarian cancer and endometrial cancer and cervical cancer. So these are all kind of these foreign estrogens influence the body’s hormones in a negative way causing growths.

The second reason why estrogen might be high is the reduced ability of the body to detoxify estrogens. So, when we’re done using the estrogen that we need, our liver cleans our blood of estrogen, then we dump the estrogen biproducts into the colon and then we eliminate them by having a bowel movement. And this is a normal process in lowering the toxic estrogen or the estrogen metabolites, the estrogen we don’t need anymore. And so when this process is either over-burdened by too many xenoestrogens, so those plastic estrogens, or limited in some way because our liver is trying to detoxify other things, such as alcohol, or tylenol, or some of these over-the-counter drugs, the liver just can’t handle the burden and so, in terms of treatment we need to bolster the liver’s detoxification abilities. And a lot of the time those two things exist at the same time: you’re getting too many foreign estrogens, we need to clean up the environment and the diet and make sure everything you’re getting is promoting a healthy estrogen metabolism.

And then, why progesterone might be low, which is the other arm or possibility of this estrogen dominance condition that I’m speaking of is stress, mainly. So, when we’re stressed out, and we’re dealing with a lot our body produces a hormone called cortisol and that’s the “stress hormone” that helps us deal with high amounts of pressure and stress. And a lot of the time stress is not perceived so, just this feeling of being tired and wired, disrupted sleep, sugar cravings around 3-4pm, having a difficult time getting up in the morning, feeling a little bit stretched thin, maybe feeling a drop in motivation, are all signs of chronic stress. So what happens is our adrenal glands, these pyramid-shaped endocrine glands that sit on top of the kidneys, they make cortisol. And when our body has more cortisol than it needs, or when it needs to make progesterone, it takes the cortisol and it makes progesterone with it. So it’s kind of like leftover cortisol that it’s not using gets made into progesterone. After ovulation, the ovaries also produce progesterone, but part of the progesterone production in the body come from the adrenal glands.

So you can imagine: if you’re stressed out and you’re spending all of your adrenal function on making cortisol you’re not going to have enough time or resources to make progesterone. So a lot of bringing up progesterone balance is by either lowering environmental stress or increasing adrenal function. We also look a nutrient deficiencies and we can also look at bringing pituitary balance by using an herb called vitex, which can help balance hormones and kind of right that estrogen-progesterone imbalance that might be going on.

So what happens when you give the Mirena, or you give an oral contraceptive to deal with this? Well, what happens is, there’s an imbalance and you induce another imbalance kind of over top. So, the body is still not making enough progesterone, there’s still too much estrogen, toxic estrogen, and what you’re doing is giving synthetic progesterone, which doesn’t have the same effects, progestins, synthetic progesterone, it doesn’t have the same effects as regular progesterone and often doesn’t work on the brain, so it doesn’t have that low anxiety effect, that calming effect, and it doesn’t prevent the estrogen-dominant cancers, it doesn’t help with ovarian cysts, it doesn’t manage endometriosis, other than stopping your periods, perhaps, if you’re reacting to it. And then you’re also, if you’re doing a combined oral contraceptive pill, you’re introducing more xenoestrogens to the body that your liver then has to clear out and that are going to cause more of those estrogen-dominant symptoms. And, in the colon we know that oral contraceptives can cause a bacterial imbalance, so a dysbiosis in the gut and potentially constipation and so that throws off our whole system. I’ve talked about how important that gut bacteria is for mental health and mood and just digestion and everything. So, more cells are in our gut than in the rest of our body. So our gut microbiome is super important to our health and well-being.

So, how does a naturopathic doctor address estrogen dominance? This is a big part of my practice especially because I see a lot of women with month-long PMS, acne, polycystic ovarian syndrome, so irregular periods, or missed periods, or they have a family history of hormone-dominant cancers and they’re trying to prevent these things from happening down the line, or they’re just having terrible periods. They’re having weight gain, or bloating, or anxiety that’s related to the period or really bad PMS, so mood swings, depression around their period or a condition called PMDD, which is really really severe depression right before the period.

So the first thing I do is order labs. And so your medical doctor might have done labs, gotten your estrogen and progesterone measured in your blood and your doctor might have said, “oh, it’s fine, it’s normal”, and this is true to the extent that when your medical doctor is evaluating your labs, they’re looking at massive reference ranges. So our reference ranges are a bit more narrow because we’re trying to look at the optimal levels for fertility and for feeling like your optimal, amazing self. We’re looking at, “is your estrogen within an optimal range, is your estrogen on the high side, and therefore, could be brought down? And does that match your symptom picture? Do you have estrogen dominance symptoms and a relatively high estrogen level? Is your progesterone lower than optimal to maintain a uterine lining in pregnancy, to not have a miscarriage in the first trimesters, etc. etc.” So we look at labs, and then we, using our natural therapies, we prescribe diet, supplements, and some lifestyle changes to help re-establish that hormonal balance.

So, if you have any more questions, just send me an email, at connect@taliand.com or check out some of the articles that I mentioned in this video.

Want to balance your hormones, energy and mood naturally? Check out my 6-week foundational membership program Good Mood Foundations. taliand.com/good-mood-learn

All About Naturopathic Medicine, An Educational Talk

In this video I give an education talk to a group of seniors at the Bernard Betel Centre about naturopathic medicine. I discuss our philosophy, education, what kinds of conditions we treat and answer some questions along the way.

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