Well, April was tough (I’ll explain the reasons in another email or blog post), but I’m hoping for sun and flowers in May. So, let’s kick the good times off with more educational material on the plague of our times: insulin resistance!
Two weeks ago, I completed filming for my Insulin Resistance course for a company that plans to launch in Fall 2025. We filmed over three full days and got 10 hours of content. The course pulls together everything I know about insulin resistance and metabolic health (there are over 100 references). We talk about food, of course, and exercise, but also the impacts of sleep and stress on our metabolic health.
We discuss self-compassion, motivation, and mindset in the 10-hour session (which should be edited down to about 6 hours, hopefully). We also address common obstacles using the Theory of Change model and other tools from my psychotherapy practice. This is because insulin resistance is a holistic problem that must be addressed holistically, through mind, body, behaviours, emotions, and biochemistry.
A few weeks ago, I released a podcast interview with Dr. Ali Chappell, PhD, on her Low-Insulin Lifestyle. It garnered much interest, probably because we’re all trying to clear away the food noise and figure out how to eat and nourish ourselves in this metabolically deranged day and age.
I received many questions about the podcast, so I decided to release a sister episode, a (much) shorter version of my insulin resistance course, that provides more details on how to approach healing your metabolic health.
I even created a PowerPoint for the occasion. Think of it as a free, access-anytime webinar to help educate you about insulin resistance.
Talia: [0:01] Hello, everybody. I am Dr. Talia Marcheggiani.
Talia: [0:06] I’m a naturopathic doctor and a registered psychotherapist now. And last podcast, we interviewed Dr. Ali Chappell, who talked about the low-insulin lifestyle that got a lot of attention, a lot of interest. So a.
Talia [0:30] And the podcast was all about the impact of certain foods on our insulin levels with this underlying theme of insulin resistance. And I decided to do a presentation today on insulin resistance, the plague of our times. I recently just recorded a 10-hour course for a project that should be released this fall. I also have a microbiome course with the same company. A 10 hour it was 10 hours of filming on insulin resistance um and it was a it was an amazing course i had a lot of fun producing it we filmed it over three days and i feel like it was just a very holistic course where we talked about diet and we also talked about obviously exercise and sleep and stress and but we even rolled in things like self-compassion and motivation, and overcoming obstacles and long-term management, the stages of change. And it was just this all-encompassing, very holistic course. I’m really excited to let you know when it comes out. And so based on that research that I did, I had hundreds of references. And one of the people that I reference is Dr. Ali Chappell. But based on that, I decided to do a presentation on insulin resistance itself.
Talia: [1:52] Because insulin resistance is the plague of our times. So ultimately, all of the health fluencers and everyone that’s talking about health is in some way or another addressing insulin resistance. And if they’re not, then they’re missing a huge layer of what’s going on with our health. Ever since, you know, doing my course, thinking about insulin resistance in a more holistic, but also in a deeper way. I’ve come to understand, and trying the low-insulin lifestyle and looking at the impact of insulin on my body, I’ve come to really appreciate the level at which insulin resistance plays a role in our health and conditions like adrenal fatigue or, you know, even estrogen dominance, these kind of naturopathic conditions that tend to have different names over time, you know, candida overgrowth, SIBO. I’m not saying those conditions are only insulin resistance,
Talia: [2:56] but my stance is insulin resistance until proven otherwise. And we’ll get into why in a second. So I’m Dr. Tali Markajani, metabolic doctor, and let’s get into it. [3:16] So insulin resistance let’s just do a quick overview because we didn’t really get into this with the dr ali chapel of course i mean she had a lot of great analogies but essentially insulin is a peptide so a series of protein of amino acids that creates a protein it acts like a hormone in the body its main function is glucose control so insulin’s job is to shuttle glucose from the blood into our cells. When we eat, we break down the carbohydrates from our food. This raises our blood sugar. And insulin’s job is to make sure that our blood sugar stays within a normal range. When our blood sugar goes too high, our body doesn’t like that. That’s toxic to the body.
[3:56] But we also need sugar for energy. So insulin’s job is to get that sugar into the cells through the cellular receptors. So it’s like a lock and key. You have insulin, the hormone or peptide that, you know, enters into the lock of the cell receptor. And it makes all of these different things happen within the cell, allowing glucose to get in. Glucose goes into the mitochondria. It does the whole, remember the glycolysis, the Krebs cycle, and then it moves along the electron, well, the NADH and all of the components that are produced, move along the electron transport chain with the power of oxygen, and make ATP, which is the energy currency of the cell. So our body uses glucose for energy.
[4:48] So insulin’s job is to make sure that glucose can get into the cell or it can be used for energy, but it also keeps glucose within a range in our blood. It prevents glucose from going too high in the blood.
[5:00] Now, when we become insulin resistant, one of the mechanisms is that we are spiking our glucose too often, so we need to call on insulin too often. And even though you need insulin to survive, if your pancreas, the hormone that makes insulin, or sorry, the organ that secretes insulin, if it’s not functioning, you don’t make insulin, such as in the case of type 1 diabetes, juvenile diabetes, you waste away and die unless you inject insulin into your body to do the important work of allowing your body to absorb, allowing your cells to get glucose. But when you have healthy functioning pancreas and you’re calling on insulin over and over again to manage repeated blood sugar spikes this can create some resistance in the cell where instead of having in this example you have two receptors on the cell now your cell takes one away and you just have one receptor and it’s harder to stimulate that receptor you need more insulin in order to do that. So then your insulin levels start to climb, and eventually your body has a hard time managing glucose levels.
[6:15] This starts off in muscle cells and fat cells and liver cells, where there’s a whole other cascade that we get into in my course. I don’t know if it’s relevant here, but essentially fat cells become overstuffed, because when your body needs somewhere to put that glucose and if it’s not burning it, it starts to turn it into fat. So it loads fat cells up with glucose that gets turned into fat. Then those fat cells become so overstuffed and insulin resistant that they start leaking fat. This creates inflammation in the body, elevates triglycerides, and it starts to create an inflammation, causes more insulin resistance. And there’s a whole bunch of vicious cycles that can occur with this imbalance in our body. Because one of the things that my friend and I were talking about, my friend who’s a medical doctor, whose clinic I used to rent, she was like, why would this happen? Like, why would our body respond in this way? Why do we, you know, rather than establish homeostasis where everything stays within a healthy balance, why does our body kind of spiral that when you have all these blood sugar spikes, you know, it’s hard for our body to figure out what to do. And I think it exposes this weak point in our physiology, because our bodies were designed and evolved through millennia of periods where starvation was commonplace. And it’s only in the modern era…
[7:38] That we’re exposed to so much caloric density in our diets. And there’s a bunch of other things that have occurred in our diets over the last hundred or so years, and that is the increase in processed food and endocrine disruptors, chemicals in our environment that trigger inflammation and that mess up our insulin receptors. We’re a lot more sedentary. We don’t have the muscle sink anymore that we used to.
[8:06] We’re a lot more stressed and we are consuming a lot more refined starch and sugar. And as a result of sort of the 1970s shift in our diet that told us to consume five to 11 servings of grains a day and to restrict our fat and our animal foods. So ultimately our protein. So our diet became very carbohydrate heavy and deficient in other macronutrients like fat and protein. We became more sedentary. We became more stressed. So these are just a few things. And stress is another cascade. So cortisol’s job is to raise, it has lots of jobs, but cortisol stress hormones job is to raise our blood sugar. So that calls on insulin in the absence even of food to try to bring blood sugar under control. So you create this vicious cycle when you’re extremely stressed out. When you have a lot of inflammation in your body, that triggers a release of cortisol to manage the inflammation, which again triggers insulin to be released. And inflammation independently can cause insulin resistance. And again, you know, and then the more insulin resistant you are, the more inflammation you have because the more your fat cells leak, and then the more insulin resistant you become.
[9:22] Sarcopenia, So being skinny fat or not having enough muscle on your body, you don’t have this great glucose regulator of muscle that helps to manage blood sugar that often works independently of insulin. And then again, you become more insulin resistant, starting off in the muscle, and this creates this cascade where your body is storing more fat and not making muscle. You know and then this blood sugar roller coaster where if you’re repeatedly spiking your blood sugar then your insulin is being called on to bring blood sugar down that triggers hunger and cravings for sugar and so on and so on um so because of all of these different things, we are 88 to 94 percent depending on the study that you look at insulin resistant so in our society, 88% of people, or up to 94%, according to some sources, are insulin resistant. And this does not mean that you have diabetes or pre-diabetes even. You can have completely normal sugar.
[10:34] And so this is often missed. Okay, so this is really important because we don’t test fasting insulin on a regular basis, which when we’re looking at the hormone insulin, that indicates more accurately if we’re insulin resistant than just simple blood sugar.
[10:53] And insulin resistance, it has a lot of different impacts on the body. So one of the big ones is Alzheimer’s disease or otherwise termed type 3 diabetes. So the inflammation and the effect of getting energy into our brain can cause dementia. And so, you know, it used to be thought that Alzheimer’s was caused by plaques and tangles in the brain. And so drugs were geared towards reducing these plaques and tangles, but turns out that they are more likely smoke present at the fire, or even maybe even fire trucks present at the fire. They may actually be there to support the brain, but the brain’s damage is occurring because of insulin resistance. So both insulin in and of itself is toxic to the brain cells, and then ultimately when blood sugar is not controlled, that’s toxic to brain cells.
[11:50] So ultimately, we’re not able, when we’re insulin resistant, we’re not able to access energy, right? So our body is not good at bringing glucose into our cells. And therefore, you know, and eventually we end up with elevated glucose. But even before that, we’re not able to access that glucose. So think about it being a case of you’re storing energy because insulin is a storage and anabolic hormone, you’re storing energy very easily, but you’re not able to tap into that energy to break it down. And so you’re sort of starving in the land of plenty.
[12:27] Mental health issues, there’s a whole field that’s emerging called metabolic psychiatry that looks, and a lot of, in this field, there’s a lot of studies on the impact of ketogenic or extremely low-carb diets on mental health, so things like depression, anxiety, and ADHD, but also schizophrenia, bipolar disorder, so some of the more severe mental health conditions. And a lot of really amazing results have come out in a few studies that have been done. And so some theories about this is that things like depression, anxiety are the result of energy poverty in the brain. So the brain is unable to really access glucose properly. ADHD being one example of glucose hypometabolism. So the brain is not able to really use glucose. and it, you know, becomes dependent on this sort of ups and downs of glucose.
[13:29] And then in order to get energy, so there’s another vicious cycle that possibly can occur that in order to get energy, individuals with this type of glucose hypometabolism seek sugar in their environment. They rely on sugar and so they’re constantly spiking their blood sugar in order to like perk their brains up.
[13:50] Cardiovascular so these cardiometabolic diseases so and when we talk about metabolic health or metabolism we’re referring to insulin resistance metabolism is our body’s ability to use food for energy so glucose fat protein and insulin is a key hormone that allows us to use that that food especially carbohydrates for energy, and to store that energy in our cells. So any disease that’s associated with the cardiovascular system, which is impacted by insulin resistance, or any sort of metabolic issue, so obviously type 2 diabetes, but also cardiovascular disease, stroke, atherosclerosis, heart attack, hypertension, you know, any heart issue. And this is because insulin is inflammatory, And so it creates inflammation in the blood vessels. It also shifts our cholesterol balance. And so what we often think of as a disease related to consuming cholesterol or consuming a high-fat diet, bacon, cheese, is actually, in fact, likely driven by the inflammation and high insulin levels that are a result of insulin resistance. And so this creates an issue with how our body is metabolizing energy and our inflammation levels.
[15:15] Insulin resistance impacts our reproductive health, hormonal health, and sexual health. PCOS, polycystic ovarian syndrome, is an insulin resistance condition that causes infertility and other symptoms, hormonal imbalance, so more testosterone-like symptoms, and lack of ovulation. Erectile dysfunction is related to insulin resistance, which creates more viscous blood and prevents blood flow to the reproductive or sexual organs.
[15:45] Again, because we need energy for everything in our body. So anything that is highly dependent on energy, our liver function, our brain function, our cardiovascular health, our muscular health, all of these organs that require a constant energy turnover are going to be energy impoverished in the presence of insulin resistance because insulin is not functioning properly to allow us to access our energy from food. So instead, we’re just storing the energy for fat as fat, and we’re not breaking it down. Many cancers are also associated with insulin resistance because many cancers feed off of glucose. And then again, insulin is an anabolic hormone, causes the growth of things. Yes, you need anabolic hormones. You need there to be anabolism or the growth of things to store, to build, but you need a balance of both. You need to also be able to break things down so that you can tap into something called autophagy, where you’re clearing out damaged and dead cells. You’re able to clear out, you know, cancerous cells or precancerous cells, and you’re able to engage in repair as opposed to always storing, storing, and building.
[17:06] So we have a lot of different symptoms of insulin resistance because it affects every cell in the body and therefore it affects every hormone in the body or every organ in the body. And because insulin is a hormone, our hormones talk to one another. We have a very reductionistic view in medicine. So we like to just look at like, what does one hormone do? What does insulin do? And then that’s the end of it. And what happens when you replace it or what happens when you take it away?
[17:38] So in the case of type 1 diabetes, that kind of makes sense. The pancreas isn’t producing insulin, so you have to inject insulin into your body. There you go. Cut and dry. So a lot of things in medicine have this reductionistic kind of solution, and we can look at them reductionistically more or less, and more or less we can solve them reductionistically. But insulin resistance is a cascade, it’s a network, it’s a holistic issue.
[18:03] It is involved with these vicious cycles. As our body’s trying to compensate for an imbalance, it creates more imbalances, right? So, you know, we’re stressed, and so there’s insulin resistance that’s caused as a result of that, and then that insulin resistance causes more stress because we can’t access our energy and we can’t mount a proper stress response and that causes it. So it’s like this vicious cycle that then starts to impact our inflammation levels and our cravings and our sleep. And so we have this whole mess that’s impacting all of our organs, our behaviors, our psychology, our emotions, our mental health, as well as our physical health and our behaviors. So when we look at insulin resistance, it’s impacting everything. It impacts our skin. We get things like skin tags, right? So, we get random growths of the skin, turnover of the skin, inflammatory conditions of the skin, like psoriasis, eczema. A condition called acanthosis nigricans is the kind of this darkening or purplish pigmentation of the skin is really common sign of insulin resistance. Rosacea, a key symptom of insulin resistance is this is visceral fat. So fat around the organs, particularly the liver, the pancreas, this is like a harder inflammatory fat. It’s not the type of fat you can pinch.
[19:22] Um, but you will be storing all kinds of fat with insulin resistance, but this key is the visceral fat. And we can measure visceral fat by, you know, roughly by doing a waist to hip ratio, where you, you know, you trace a tape measure around either the thinnest part of the waist or the belly button, whatever makes most sense to measure. And then you measure the widest part of your hips. You divide the waist by the hips. Or is it the other way around? It’s a bigger number on top of a smaller number on top of a bigger number. And then it should be 0.7 or less.
[20:00] Um so right so the idea is that you have a waist that’s smaller than your hips, and if it’s large and so this is for women i believe the number is one is one for men um and and the idea is that you you know the the larger the waist or the bigger the waist circumference the more likely you have visceral fat and the more likely there’s insulin resistance there’s also visceral fat often shows up on the face. So we often have facial fat when we have visceral fat in it. It’s because of some inflammatory mechanisms. In blood work, we see elevated fasting insulin. Very interesting, and this is a huge feature in the Dr. Ali Chappell interview, but also something really frustrating in my work as a naturopathic doctor, that we simply don’t test fasting insulin. So I do as an ND, but it is never tested in routine blood work. People are often gaslit into being told that their blood sugar is fine, so they don’t need to test it, or for whatever reason, they don’t need to test it. It’s a relatively cheap test. I order it as part of a comprehensive panel, but individually, it’s about $30 plus a lab fee.
[21:15] And it tells you, quite frankly, are you insulin resistant? Because if you’re insulin resistant, the first thing that happens is your fasting insulin starts to go up. And your fasting insulin causes its own set of problems. Like I said, it encourages fat storage and it prevents the breakdown of energy. Your body is saying, store, store, store, store, store, don’t spend. So you’re not spending energy and therefore you’re in this kind of energy impoverished state. You’re more inflamed. You’re having a harder time managing your other hormones. So testing fasting insulin is very, very helpful because you’re not always going to see an elevated fasting sugar when you have insulin resistance. Eventually, your fasting sugar, once your insulin is no longer functioning at all and it cannot control your blood sugar, you’ll start to see an increase in blood sugar. And so this represents a later stage on the continuum of insulin resistance, the latest stage being a diagnosis of type 2 diabetes.
[22:21] Which is where your blood sugar is now at a point that it’s a cutoff. I believe it’s 6.5 millimoles per liter. And so you’ve hit this arbitrary cutoff, and now you have type 2 diabetes. But in the meantime, the cascade or the problem of insulin resistance, nothing special changes when you have type 2 diabetes. It’s only a point at which your blood sugar reaches a certain number, but the underlying root of disease may have been manifesting for 15 to 20 years, and that is this insulin resistance where the cells are no longer responding properly to insulin, and you’re seeing an increase in insulin levels. Even earlier than an increase in fasting insulin is an increase in postprandial insulin. So you consume a meal of starch or sugar, it’s about seven you can do a glucose challenge where you consume 75 grams of glucose it’s this disgusting drink they have you drink and then you measure your insulin and your glucose at 30 minutes at an hour at two hours and you will see the very very earliest stages you’ll see this rise in insulin after like a very high rise in insulin after consuming the sugary drink, your blood sugar will be normal but your insulin will start to rise and actually, this is the stage of insulin resistance that I found myself on in another patient who was experiencing a lot of weight gain, seemingly out of nowhere.
[23:51] And, you know, she hadn’t really changed much. She was kind of in like perimenopause. She had a relatively sedentary job, but was eating otherwise healthy and was just noticing a ton of weight gain. So we did her fasting insulin and tested her HOMA-IR,
[24:08] the homeostatic measurement assessment of insulin resistance. So it’s a measure of insulin resistance that looks at your fasting insulin and your fasting glucose, and it gives you a number to tell you the relationship between the two of them. So we did this patient’s fasting insulin, and it was actually quite low, and we calculated her HOMA-IR, because her blood sugar was obviously normal. She did not have diabetes or type 2 diabetes. And we did the HOMA-IR, and that was also normal. She was quite insulin sensitive when we just looked at her fasting levels. But how often are we fasted during the day right and this is part of the problem, because I don’t know about you but when I wake up I eat and then I keep eating until I go to bed and I do a pretty good job of spending 12 hours in a fasted state most nights meaning that, you know if I eat my breakfast at 7 I try to stop eating by 7 p.m at night so that I just give my digestive system and my body a chance to repair and reset and not just be digesting constantly.
[25:18] And it also gives my insulin a chance to settle down. But for the other 12 hours, you know, if I’m getting a large spike of insulin after eating, then I might be in this kind of high insulin state all day long. And when I fast, my insulin looks normal, but that’s not the state that my body normally lives in. So we had the idea of not doing a glucose challenge, but having her just eat a normal, healthy meal and then testing her fasting insulin an hour later. And we did find that her fasting insulin was elevated. Well, it was her postprandial insulin was elevated.
[25:55] So that would be the very, very first stage of insulin resistance. And some people notice that visceral fat is even the first stage. Before you even start to see insulin on blood work in the numbers, you see the symptoms where you’re just noticing this increase in waist circumference, and the driver of that would be insulin. This often happens during the perimenopausal transition because estrogen and progesterone, more estrogen than progesterone, but both of them to some extent, have an impact on our insulin sensitivity. So estrogen makes us more insulin sensitive. And when you go through perimenopause and your estrogen levels start to decrease, you become just de facto more insulin resistant without changing anything. And this is why so many women present with the concern of increased abdominal fat. They’re like, I haven’t done anything. I’m noticing this change in my body composition, and it’s so frustrating, and I don’t know what’s going on. And we do look at estrogen, obviously, whether it’s hormone replacement or other things that we can do. But the big thing to consider is, okay, there may be a time, this might be a time now to refocus on insulin. What was working for you in the past?
[27:16] Given now that your estrogen is lower, is likely not going to cut it anymore. And we need to start shifting lifestyle in the direction of supporting insulin sensitivity.
[27:28] So other signs in the blood are, you know, fasting glucose, obviously, when you’re in the later stages will start to be elevated. And then elevated triglycerides. Triglycerides are part of a cholesterol panel. They are the fat in the blood. So this is when the fat cells become overstuffed, particularly in the liver, we start to see an elevation in fasting triglycerides. And, you know, it’s funny because sometimes patients will come in and they’re like, my doctor says I have, I’m thinking of one patient in particular, she said, my doctor said I have high cholesterol. And so we looked at her blood work and actually have two patients with the exact same thing. Two had elevated, they both had elevated liver enzymes, showing that there’s something going on with their liver. Their liver is not happy. Their liver is experiencing inflammation. The liver is struggling in some way. That’s what elevated liver enzymes tend to tell us. And, you know, their liver’s not working properly. There’s some inflammation in the liver. The liver’s not able to process these triglycerides. And they both had elevated triglycerides. And that was the only thing abnormal in their cholesterol panel.
[28:36] And their doctor put them on a statin, which we know’s main job is to reduce LDL, cholesterol, one of the cholesterols, but total cholesterol as well.
[28:46] And, you know, has an impact on triglycerides, but not a large impact. And it’s not the therapy, in my opinion, for elevated triglycerides. It’s certainly not the first line that I would recommend. I would recommend first supporting the liver, figuring out what’s going on there. In one case, it was Tylenol overuse. In another case, it was insulin resistance that was causing fatty liver. So it’s first supporting liver and then addressing insulin resistance if it’s present. And in one patient, it was. But certainly not a statin. It’s not addressing the root or even the issue. And again, this is reductionistic, right? It’s like cholesterol, statin.
[29:27] Ignoring the fact that there’s a lot of different things going on in a cholesterol panel. And statin may be the answer for some particular people who make a lot of LDL cholesterol and they have scary high levels despite having low inflammation. And even then in that case, I would argue that we might not be that concerned about their LDL if they have low inflammation and they’re insulin sensitive. But those people would probably be the people who would benefit most from a statin just to keep them from overproducing the LDL cholesterol that they genetically overproduce. The other thing that we’ll see in blood tests are inflammatory markers elevated, and these can be elevated for various reasons, and they won’t always be elevated in insulin resistance, but we tend to see inflammation, and so that would be a reason to look at why there’s elevated inflammation.
[30:20] And you know other symptoms that we see insulin resistance affects our brain so we have brain fog it affects the health of the blood vessels we get hypertension or high blood pressure we see mental health issues for various reasons we know depression is an inflammatory condition in the brain there’s low levels of inflammation that create this um kind of like low mood an issue with serotonin and dopamine metabolism that presents the symptoms of depression, right? Low mood, sadness, apathy, you know, disinterest in things that previously brought you joy, anxiety, we know has a lot to do with this blood sugar rollercoaster triggering the autonomic nervous system.
[31:08] We get fatigue when we’re insulin resistant because we can’t, again, we can’t access our energy properly. We have difficulty losing weight because we are constantly telling our body to store, store, store, and not use. We get fatty liver and fat on the organs. I am convinced that adrenal fatigue, until proven otherwise, is insulin resistance. And my friend actually came to this conclusion when she went on the low insulin lifestyle. After I introduced her to Dr. Allie Chappell, she was like, she’s like, I no longer get that crash from 2 to 4 p.m. And she’s like, so what I thought was adrenal fatigue that I was managing with like salt and adrenal herbs and stuff like that was in fact insulin resistance. And it’s interesting too, because a lot of the adaptogenic herbs, the adrenal herbs, a lot of them have, I mean, one of the impacts of cortisol is to raise our blood sugar. So a lot of these adaptogenic herbs will raise blood sugar and it gives you kind of this boost, right? And that’s that 2 to 4 p.m. crash. We always tend to gravitate towards sugar or carbohydrate snacks during that time, unless you can take a nap or something. But it’s like this sugar crash that we get. And again, when you’re insulin resistant, you know, you’re having trouble managing your blood sugar. Maybe you had a lunch that had too many carbohydrates, you got a huge insulin spike, and then you get this huge crash from 2 to 4 p.m.
[32:30] Estrogen dominance. Again, you know, this whole sort of, PCOS thing where we’re putting on more body fat and our estrogen level, like, you know, we have heavier periods or more painful periods or, you know, this weight gain. So, even though estrogen increases insulin sensitivity, a lot of these symptoms of excess fat gain or heavy periods or irregular periods that we would tend to call estrogen dominance, this might be, in fact, insulin resistance, PMS, PMDD. Again, that’s not a known fact that those conditions are caused by insulin resistance, but knowing that insulin resistance messes with your hormones, messes with energy production, messes with your neurotransmitters, with your brain function, with your liver, which is responsible for processing hormones like estrogen. It affects your digestive system, which we know digestion is a highly energy-intensive activity. So if you’re not able to access and use your energy, you’re going to have issues with things that require a lot of energy, like digestion, like reproductive health and sexual health, hair growth, skin health, all of these things.
[33:49] So it’s sort of like every symptom in some way we could argue is connected to insulin resistance and so my advice is when patients are presented with a whole bunch of things as we do a fasting insulin test as part of routine blood work in order to assess and also given that 88 to 94 percent of us have some sort of metabolic dysfunction it’s fair to say we should definitely rule this out because the norm would be, or at least the common thread would be insulin resistance, is having some role to play in what someone’s experience is.
[34:29] So the blood sugar rollercoaster, throughout most of my naturopathic practice, I’ve been harping on this idea of blood sugar because our body does not like to have high blood sugar. This is toxic, and it doesn’t like low blood sugar, right? Low blood sugar triggers cortisol, triggers an autonomic fight or flight response, right? The sympathetic nervous system response, and that triggers cortisol, and then your blood sugar goes up, and then you’re craving, and you’re going on this roller coaster. And this is the case with anxiety. I see it time and time again um you know anxiety until again until proven otherwise is a blood sugar roller coaster phenomenon brain fog adrenal fatigue all this is connected to our blood sugar and supporting blood sugar has been really important in my naturopathic practice to support people with mental health concerns and then you know as a psychotherapist um.
[35:33] Psychotherapy is extremely effective it’s an amazing tool and modality and we really we get deep and we sort through the emotional experience and and you know the how we think and our self talk and our boundaries and we do all that stuff and uh you know but then if there’s, if a if a psychotherapy client is like having a croissant for breakfast and then a sandwich for lunch, you know, there’s only so much psychotherapy we can do without really addressing their blood sugar.
[36:09] So, you know, so many of us are on this blood sugar roller coaster day in and day out, right? You wake up and then you’re kind of nauseous and you’re anxious and that’s low blood sugar. It’s your cortisol trying to kick into gear. Then you have, you know, the typical breakfast. I, When I was a kid, I would have cereal and skim milk, like sugar cereal often. And I don’t know how I survived. But yeah, I was like daydreaming. I was like not focused. I couldn’t, you know, figure out what was going on in math. Yeah, and then I remember we had lunch and I probably made myself a sandwich. Sometimes it would have meat in it. There’d always be a sugar treat. It wasn’t a horrible lunch, but yeah, it was back in the 80s or 90s. It was kind of the height of our nutrition disaster.
[36:58] And so, so many of us still do that, right? Cereal for breakfast or toast or croissant or just kind of a carb breakfast, you know, something easy on the stomach. You wake up, you don’t have much of an appetite. You’re anxious. You just want to eat something quickly, a banana, whatever. So, your blood sugar goes up and then your body releases insulin, it comes crashing down, and then over time, you become insulin resistant because insulin stops responding effectively to, or sorry, the cells stop responding effectively to insulin. So, you need more and more insulin to create the same effect on cells. So, you end up with high insulin levels, and this triggers more sugar cravings, and so on and so on.
[37:39] And this impacts our brain. We can’t think clearly. We have brain fog. We feel anxious. we feel stressed out, we feel irritable, and we suffer from inflammation. So the blood sugar roller coaster, horrible. There’s always this New York Times article that I reference, and it’s called, Do You Have Decision Fatigue? And it talks about these parole board members who would make weird decisions just right after lunch, like that 2 to 4 p.m. They were like, I don’t know, Some guy was caught stealing and like, you know, same offense. And then all of a sudden there’d be this different parole decision right after lunch. And then when they gave them a snack, everything kind of settled. So they decided, they figured out that this decision fatigue they were having where they just couldn’t make a decision, they couldn’t think clearly, was caused by low blood sugar. And, you know, blood sugar is important. Our brain needs a steady stream of consistent energy. And so if we’re on a blood sugar roller coaster and our blood sugar is dipping, our brain is starved of nutrients and we can’t think, you know. And if your brain is particularly sensitive to this, you know, so someone with neurodivergence, anxiety, depression, you’re going to experience this all the more profoundly.
[39:03] And it’s going to feel impossible to make a decision. You’re going to feel completely overwhelmed. You’re going to feel like you cannot handle what’s going on. Um you know i had a uh another patient i’m thinking of who you know always struggled with mental health his whole life things would be good good good and then like kind of in the afternoon would get this hit of depression really profound existential depression that left him like feeling like if i don’t medicate this like i can’t function it’s horrible and we determined that yeah like that he it was a blood sugar crash ultimately blood sugar was low he hadn’t eaten for a while lunch wasn’t that substantial and breakfast wasn’t that substantial so he was going on this blood sugar roller coaster and so many of us in north america we backload our food so we eat our biggest.
[39:57] Best meal at dinner and we spend the rest of the day on a blood sugar roller coaster so i preach this all the time i’ve talked about this in courses and i was really jealous when i discovered as many of you’ve heard the glucose goddess so somebody whose entire brand is focused on blood sugar and her whole thing is that she puts on a continuous glucose monitor so this is something that measures creates these graphs here that show your blood sugar going up after you eat and she’s showing you all these different like permutations and combinations of of food and how food impacts blood sugar and so that’s really cool and i was really jealous just like five million followers. I’m like, why didn’t I think of this?
[40:37] Even the name Glucose Goddess, genius. She does a lot of good work. She’s a biochemist. I have referred tons of patients to her work.
[40:45] And so things that she talks about are, you know, apple cider vinegar prevents you from getting this glucose spike, the sour in the vinegar, the acidic acid, it helps to kind of slow this glucose absorption.
[41:00] When you add fat, fiber, and protein, so she calls this putting close on your carbs, it tends to blunt the glucose response. So fiber, how does that work? Well, fiber, it kind of creates this coating and it’s harder to access the glucose. So you don’t get this crazy spike of glucose into your bloodstream.
[41:25] But we’ll talk about what fat does in a second. And, you know, so, but, you know, to regulate blood sugars, if you’re just looking at blood sugar, then this makes sense because you’re, if you’re adding clothes to your carbs, you know, you’re, you’re adding fat and protein to your carbs, you’re not going to get this huge blood sugar spike, which is great.
[41:44] So you’re not going to be on this blood sugar roller coaster. It also slows and delays gastric emptying, so the sugar that you’re eating is sort of metered out over time. So again, you’re maintaining this steady glucose level, and that’s great. And we’ll talk really quickly about the blood sugar impact of food. There’s different ways to measure this. So you have the glycemic index. The glycemic index is like how quickly does a food spike your blood sugar? So glucose straight glucose has the highest glycemic index, like table sugar, pretty high because it’s just a glucose and fructose molecule. Your body, your digestive system splits that and then it absorbs the glucose. Starch as well, like white rice or white bread, these are, starch is a long chain of glucose. And again, when you cook it, it kind of breaks it apart. And when you digest it, it breaks into individual glucose molecules, spikes your blood sugar. When you add fiber to it, you get a slower rise in glucose. So, you know, I don’t know what has, like, I mean, brown rice is going to have a lower glycemic index because of the fiber on it.
[42:57] The glycemic load is probably a better measurement because it takes into account how much sugar is in the food. So, for example, watermelon has a high glycemic index. The sugar raises your blood sugar very quickly, but there’s not a lot of sugar in watermelon when you’re eating a normal serving. Watermelon has a lot of fiber and a lot of water, and it also has some good nutrients, too. So the glycemic load is ultimately what Glucose Goddess is looking at. In her graph, you’re seeing, okay, you’re having chickpeas, and you’re seeing both the index, I guess, because you’re seeing, okay, how quickly does her, and this is her body, how quickly does the glucose rise in her blood, and how long does it stay elevated?
[43:43] And so she shows in this case just chickpeas, which have a lot of starch in them. They also have some fiber and some protein, but not as much protein as people think. So the starch is broken down in the chickpeas, and you get this rise in glucose. And then she says, oh, if you mix, if you blend it, you’re pulverizing the fiber, and so you’re actually accessing the carbohydrates more easily. So you’re increasing the glycemic index. So look at that. Look how much faster my blood sugar rises. And then she says, but if you consume hummus, you add fat to your blended chickpeas. Look at that. You barely get a rise in blood sugar. So, wow, that’s so cool.
[44:26] So, ultimately, adding fat lowers the glycemic index, and it looks like the glycemic load. But, so I always had this suspicion, because one of the things we are not measuring is the insulin index, right? So we’re not measuring insulin at all with a continuous glucose monitor. We’re not looking at all at how insulin looks after eating. And this normally is fine because usually when glucose goes up, insulin goes up, and when glucose is flat, insulin is flat, but not always because there’s a few foods that will spike insulin or that will impact insulin but not impact blood sugar.
[45:13] And what happens when we spike insulin is we actually see, because insulin’s job is to lower blood sugar. So under this glucose goddess post is this is where I first was exposed to Dr. Allie Chappell, where she reminds us that adding fat to starch enhances the insulin response. And this is the reason you see a drop in glucose on your graph. And she’s like, I saw a similar post with bread and butter. And so adding butter to your bread doesn’t make your bread healthier, but it will flatten your glucose response so you’ll have a prettier continuous glucose monitor graph because your insulin is being spiked and that’s flattening the glucose response but it’s insulin that’s causing the issue i mean insulin is what’s causing fat storage insulin is what’s preventing you from accessing your carbohydrates to burn them and accessing fat stores to burn for energy.
[46:08] And so yeah and you know it’s okay so it’s not like i didn’t know this um but i guess i didn’t understand the impact of it and this is an important lesson for me even a holistic practitioner a naturopathic doctor who routinely tests people’s insulin levels who understands the importance of insulin who has seen elevated homa ir in all types of people who is looking at insulin resistance and considering that as a factor and assessing symptoms of it. But I was looking at it as kind of an isolated thing that can occur. I was not looking at it as like a blanket issue that is occurring across all of my patients and should be assessed in essentially everyone who have the symptoms and some signs of it.
[46:53] But yeah, I was aware of insulin and the impact of insulin on food. And I was even aware of the insulin index, which looks at the impact food has on our insulin levels. So how food spikes insulin. And I knew that, yeah, obviously white bread is going to spike your insulin because it spikes your sugar and that spikes insulin. But I also knew that things like skim milk were potent generators of insulin or created an insulin release. And so, I kind of knew, okay, you know, stuff that doesn’t necessarily have a lot of sugar has an impact on insulin levels. And so, what we know is that carbohydrates have a high insulin index, right? So, starchy carbohydrates, starches and sugar.
[47:46] Protein actually has a moderate impact on insulin. So, it will not spike your glucose. So, it’s not going to change your glucose monitor, but it will have an impact, a moderate impact, about 20% release on your insulin.
[48:02] Fat will not have an impact on insulin or blood sugar. So if you consume olive oil, if you just drink a bunch of olive oil, it’s not going to do anything to your insulin and it’s not going to do anything to your blood sugar. But when you add fat to starch, it will accentuate an insulin response.
[48:20] So it is going to impact fat storage. And we knew this from adding fat and sugar was a potent way to store fat. So, you know, so this was something that I knew, but I never really kind of connected this to Glucose Goddess’s work. And so I thank Dr. Allie Chappell, and this is how I found out about her. So Allie Chappell, her, she created, because she works with PCOS, she created this idea of like, okay, foods that spike insulin are starches. Okay. So rice, not just white rice all rice bread flowers you know potatoes sweet potatoes um so kind of like tubers and grains essentially and legumes sugar so table sugar added sugar but also whey protein so unfermented dairy so milk um you know whey protein powder because whey protein stimulates a peptide called IGF-1 or insulin-like growth factor 1. And again, we know that insulin is a storage hormone. So whey protein is used for muscle building because we need insulin. We need IGF-1 to stimulate muscle protein synthesis.
[49:40] But if we’re trying to keep our insulin levels down, maybe we should be weary or maybe we should just be aware of the fact that whey protein can stimulate an insulin release and it won’t have any effect on your continuous glucose monitor. This was a whole debate that Dr. Allie Chappell got into and we’ll talk about
[49:57] it when we talk about protein in a second. It was also part of my conversation with her, And I think it’s a little bit where we differ, but I’ll get into that. Foods that don’t spike insulin are non-starchy, colorful fruits and vegetables. Okay, so leafy greens, colorful stuff.
[50:17] Fruits contain fructose, so they don’t have as much, rather than glucose, which is what starch is made of. So it doesn’t have as much of an impact on our blood sugar levels and our insulin. Our liver converts fructose into glucose eventually, but it doesn’t create this big glucose spike and an insulin spike. You will see a rise on a continuous glucose monitor when you consume fruit, but you’re not seeing as much of a rise in insulin. And fruit also has fiber, so it’s managing the glycemic index. And it doesn’t have that much sugar fruit, so it also has sort of a moderate glycemic load. So a good way to get carbohydrates if you’re trying not to spike your insulin is from fruit and vegetables non-starchy vegetables so animal protein again a moderate impact on insulin about 20% that of starches fermented dairy so she recommends this in limited quantities it’s about a cup of greek yogurt or an ounce of cheese nuts and seeds don’t impact insulin so you know which is you can have tons of almonds whatever and fats have no impact on insulin so it’s ultimately this kind of paleo diet where you’re not including legumes and you’re not including potatoes. And so there’s a lot of research she’s done on this.
[51:36] I’m sorry, my face is covering some of it. But so there’s three studies that she conducted and a randomized control trial. And it was on women with PCOS. So I would love to see this study extended to, I would love to see it extended to mental health because there’s some research on ketogenic diets for mental health. And my story that I’ve shared on my blog is that, you know, before Christmas of 2024, I kind of just was going through a funk and I just said, you know what, screw it. Like I’ve been avoiding gluten for forever. And I just don’t want to anymore. So I just went back to eating bread and it was glorious. I had a great time. I had brie. I had baguettes. Like I had sandwiches. It was amazing.
[52:27] But my body was not happy, and I had horrific brain fog. That was the first thing I noticed, and all this water retention, inflammation, I just felt horrible. So after Christmas, I said, you know what? I need a bit of a reset. My gut is not happy. My brain is not happy. And I did a ketogenic diet, more specifically the carnivore diet. I wanted to try it. I just wanted to simplify things.
[52:49] And I just wanted to give my gut a reset. And there’s actually a benefit. This is very counterintuitive and an aside, but there is a benefit. There’s documented evidence that just restricting fiber can actually help digestion. For me, it was a good reset. I don’t think we should avoid fiber forever. Maybe some people with particular health concerns need to, but for me, it was a good reset. So I did the carnivore diet for about three months and I felt my mental health was fantastic. I felt my brain fog clear in like 24 hours and it felt magical but one of the things with carnivore diet is it’s very hard because you’re you don’t have any carbohydrates in your diet at all you don’t have what we what’s called muscle glycogen which is this stored starch-like molecule in the muscles that allows us to burn energy quickly and also retain some water in the muscles so one of the very common symptoms that people experience on a ketogenic diet, especially a carnivore diet, is like a lot of thirst and issue with water balance and muscle fatigue. So I felt that. I felt like I didn’t have strong endurance.
[53:57] I felt, you know, and then at a certain point, I just felt like food was just very brown and I was not so much craving, but I liked the idea of colorful fruits and vegetables and juicy like apples and stuff so my friend um started doing the low insulin lifestyle because i was i was discovering it around the time that i was doing carnivore i was writing my course.
[54:23] On insulin resistance and um.
[54:27] And, uh, and she was trying to do the carnivore too, but it was breastfeeding. And so it wasn’t working out. She, it was affecting her, her milk supply. So she decided to try this and she was, she was like, you know, I feel great. I don’t have any cravings. You know, by day three, like I’m really, really full and satisfied. And again, it’s because you’re able to tap into your energy because your insulin levels are low. So you’re using your body’s energy stores. Um, And, you know, I was also kind of stagnant on carnivore. And so the big aha moment I had was that I was mixing whey protein into yogurt almost every day to get this kind of hydration.
[55:07] And also the whey protein was kind of sweet. And it was a fast way to, you know, instead of having to like cook meat and chicken and eggs, it was something quick that I could have as a snack when I wanted food. So I was having whey protein almost every day. And so I wasn’t experiencing any weight loss. And I was, you know, it kind of, I wouldn’t exactly crave things, but I don’t know. Something just didn’t feel right. So I switched to this, I started adding back in fruits and vegetables. And it felt really, really good. And it felt very sustainable. And I started reflecting on things I’ve tried in the past, things that were successful for me, ways of eating, paleo, particularly comes to mind as something that felt very wholesome and holistic and satisfied my nutrient needs. And I was like, you know, what works about paleo was probably this. Fruits and vegetables, animal protein and fat, nuts and seeds.
[55:58] And, you know, I looked back at my life and, you know, my particular response to carbohydrates and likely having something called reactive hypoglycemia, where you get a big insulin response. Your insulin is, you get a big insulin response essentially after eating. So, you’re not carbohydrate sensitive. In other words, you’re carbohydrate intolerant, right? The glucose tolerance test, you get this big spike of insulin after you consume carbohydrates.
[56:27] I don’t think that I’ve ever really been glucose tolerant and I don’t know if that’s my Mediterranean genetics I don’t know what’s going on with that but then you know putting the pieces together so I think a lot of people really resonated with this idea because when I sent an email out and shared the Dr. Ali Chappell interview a lot of people were like responding and I mean I think that a lot of people were seeing this as like the next new diet right because the the tagline is in two months women lost with PCOS lost 19 pounds and they didn’t restrict what they were eating they ate all that they wanted from a number of foods fruits non-starchy vegetables and fruits animal proteins also some plant-based proteins tofu edamame hemp nuts and seeds and fats and so they ate everything they wanted they didn’t restrict at all. They were told not to exercise just to standardize, but exercise would actually probably have enhanced their results.
[57:31] And yeah, they had great weight loss. Weight loss that is not typical in a lot of studies. You know, you can expect maybe 11 pounds in four months on a calorie-restricted diet. You can expect maybe something like 11 pounds in six months on a ketogenic diet or intermittent fasting, things like that. So 19 pounds in two months, unrestricted, is pretty incredible. Eating all the fruit you want, because people are always kind of wary about fruit, and we like fruit and nuts and seeds, and these are kind of foods that are appealing.
[58:08] So yeah, it was this great tagline. A lot of people were writing to me, how should I do this? What should I do? I think for me, the biggest thing, it’s not so much weight loss. It’s the digestion feels great. Brain feels good. Energy feels good. I’m not constantly hungry like I always have been. I was like pounding back protein to prevent myself from eating constantly. It’s like always with kind of this food noise in the background. I don’t have that on this. And I feel very satisfied. And you get all of the nutrients that you need. It’s not that grains and legumes are bad for you.
[58:43] It’s just that they contain starch and you can have all of the you can easily get the nutrients that you need from fruits vegetables animal animal proteins and animal foods and so it’s this kind of comprehensive feels very holistic diet you know um.
[58:58] So there’s lots of different studies that were done. Her classic kind of PhD study, she just did the diet for a test drive. Another study, they looked at how much fat people were burning after they consumed a high-fat, high-calorie shake. So before they were on the low-insulin lifestyle, the insulin in their body prevented them from tapping into fat. So they were just essentially burning sugar and then hungry, burning sugar and then hungry, and storing fat. But after the two months of the low insulin lifestyle, they were able to burn fat. And so this is also supporting consistent energy levels, you know, in the brain and in the body and reduced hunger and cravings. Because you’re able to tap into your energy stores. You’re able to tap into fat. You’re able to be what we call metabolically flexible, where you burn sugar. When you’re done burning the sugar, you burn fat.
[59:52] And so you’re no longer, you’re off now the blood sugar rollercoaster where you just burn sugar. Than cray sugar burn sugar cray sugar burn sugar cray sugar um another study looked at time to conception because it’s pcos so the goal for many people was fertility and it was about 85 days was the average time to conception and another study looked at standard treatment so it was like a mediterranean diet exercise metformin calorie restriction all in one group and the other group did the low insulin lifestyle and the Mediterranean diet people gained a third of a pound in two months and the low insulin lifestyle people, they lost their 17 to 19 pounds. They had people do diet diaries a couple times. So again, no restriction. My thing that I always think about with the diet diary is if I was a participant and you asked me to fill out a diet diary, I probably would, it would influence how I eat that day for sure. I wouldn’t eat like the pound of bacon or binge on a bunch of nuts and seeds if I knew I had to record it. So I think you can maybe assume.
[1:01:00] And I haven’t, you know, Dr. Ali kind of agreed with this, but I don’t know if, you know, she fully did. You can maybe assume that it was sort of their best day. And that would be, you know, like an average really lower calorie day. But the diet diaries showed that they were consuming about 1400 calories again they’re not counting they’re not tracking they’re just eating what they want from the amount of foods that they’re allowed again you could eat like all bananas technically you could eat all bacon like, but they were they were sort of and this is also the thing when we’re eating whole foods because ultimately fruits vegetables and animal protein these are our whole foods that we find in nature You, you know, get some lettuce that’s growing from the ground, you pull an apple off a tree, you kill a chicken or eat its eggs, right? These are like whole foods, they come from the foods in nature, whereas like, you know, rice, yeah, it’s still a whole food, it’s not that processed, but it still requires this kind of refining and processing to get it to something that you can eat.
[1:02:10] And so when it turns out that when we’re eating these whole foods it it has a very satiating effect in part because of its impact on our insulin levels and our ability to kind of be metabolically flexible but we also are like kind of able to to tap into our body and what it needs, And there’s been studies on this in babies, actually. And they found that, like, yeah, your body can kind of ask for the nutrients it wants. So it’s like, do you want an apple? So that’s kind of more of a sugary thing. Or do you want something savory, which would be like chicken? And they actually ended up eating quite a bit more protein than the typical, you know, woman that I see in my practice.
[1:02:57] They’re eating about 95, 90, 94 grams of protein a day without trying to track and emphasize protein. And I think the reason for this is because, yeah, you’re either eating kind of like a sweet food, or if you want a savory food, you’re going to go for protein. It just, because you just have these whole foods to draw from, you’re probably going to do about at least a quarter of your foods are going to be these animal proteins. And so then you end up eating about 25% of your calories from protein, about 30% came from carbs, about 90 grams of carbs. So that is a low carb diet that they were naturally eating. Again it’s very very hard to get a lot of carbs when you’re just eating fruit and vegetables because there’s only so many apples you can eat there’s only so many grams of carbs in broccoli or something like that whereas yeah if you eat a cup of rice you’re getting a huge dose of starch and they were actually eating quite high fat so about 45 percent of their calories were coming from fat so it’s a higher fat diet a moderate protein diet and a low carb diet and that’s just naturally what people gravitated to when they were given those foods to eat. So really cool. I think I probably eat more than 1,400 a day. Definitely, actually. But this was ultimately what resulted in their weight loss. But they were also able to tap into the fat because their insulin levels were low. And they had a 50% reduction in their insulin levels after two months.
Speaker0: [1:04:25] So, really impactful research-based lifestyle, you know, and I would love to see, I think there’s going to be more in the works of this lifestyle, but I would love to see some research on it for mental health. I know that the PCOS patients, they filled up quality of life questionnaires, and they did have a positive impact on their mental health. Um but you know i don’t know if they were doing they weren’t doing like um you know gad sevens and stuff like that measuring their anxiety their depression like phq9s like measuring their mental health specifically they were measuring like quality like you know their tendency to binge eat went down their irritability and impulsivity went down so kind of their food behaviors and how that relates to mental health all improved but there wasn’t i don’t as far as or any specific like mental health symptoms. Although subjectively, if you talk to them, I’m sure that they would probably have good things to say about how they felt mentally and emotionally. Yeah. So, the thing, the protein question, so there was a lot of controversy. I don’t want to, like, draw more attention to it, but Dr. Allie Chappell was involved in this debate around whey protein.
Speaker0: [1:05:41] And the main argument was, so in my podcast, she was talking about how whey protein is a waste product, and whey stimulates IGF-1, so it stimulates insulin, and that’s not good for us. And so on the low insulin lifestyle, they’re told no whey protein, they’re told limited amounts of fermented dairy or so that they don’t overly impact their insulin levels. And, you know, and then we get all these great results. So, okay. So yeah, whey protein highly stimulates insulin. And so she recommends against it. And then she also says, you know, I think we emphasize protein too much. And I will tend to, so this is what we see, right? So I have been harping, just like the blood sugar thing, I’ve been harping protein, protein, protein, you need to eat more protein. Look at someone’s dietary, you’re not eating enough protein. You’re, you know, a perimenopausal woman with insulin resistance, you need to eat more protein. I will actually, when working with diet with people, I will tell them to eat protein first. And I see memes all over the place now.
Speaker0: [1:06:48] Where it’s like, you know, eating protein is a full-time job. It’s so hard to eat protein. And then you have protein cereal and protein bread and protein pancakes. And it’s usually whey protein that they add to that to get the protein.
Speaker0: [1:07:01] So Dr. Allie is like, whey is a waste product and it’s, you know, impacting your insulin levels. So avoid it.
Speaker0: [1:07:10] And then she had a debate with somebody who said, okay, you’re looking at the mechanism. You don’t like that whey has an impact on insulin, but what’s the impact on metabolic health when people consume whey protein? And so there are studies that show either no effect or maybe it’s beneficial. And the reason it would probably be beneficial, me without having looked in depth at the studies, I would assume that adding whey protein would be beneficial because whey protein stimulates muscle synthesis, right just like insulin does but the protein in way and the impact on insulin is a potent stimulator of protein muscle synthesis okay so when you have more muscle that’s going to positively impact your metabolic health especially if you’re strength training, further adding more protein in people who are largely protein deficient because most people are not getting enough protein i mean now maybe they are because protein has become a marketing thing. People are tending not to get enough protein because the guidelines were always to get 0.8 grams per kilogram of body weight, which we now know is like the minimum to prevent muscle wasting. And it’s not enough to be well muscled. And so we have this epidemic of low muscle and insulin resistance.
Speaker0: [1:08:34] So yeah, when you start adding protein to people who are protein deficient, doesn’t really even matter where the protein comes from, that’s going to have a positive effect on them, even if it’s stimulating their insulin, because they’re probably stimulating their insulin anyways, if they’re eating like a high starch diet, and then maybe they’re not eating as much starch, because they’re full now, they’re eating protein, so a whole bunch of things. The thing with nutritional science is it is not reductionistic by definition. It’s very, very hard to just change something and get an effect. Like when you have a drug trial, you know nobody starting off a drug trial has taken or ever seen this drug before and then you take half of the participants and you give them the drug and the other half you give a blind placebo right so if there’s an effect you know it’s probably because of the drug especially if it happens to the group that got the drug and not the group that didn’t but when you give even if you’re doing a randomized control trial when you give one group whey protein and the other group let’s say i don’t know just like, I don’t know, a placebo powder, like if they’re deficient in protein, that’s going to have an effect and it’s going to change a whole bunch of stuff. And then adding more protein, which is something that our body requires, it’s not a drug that’s like a novel thing added to your body. It’s like, you know, you’re getting something that has a physiological effect on a lot of different body systems, impacts your behaviors in the way that you eat, and impacts the macronutrient.
Speaker0: [1:10:00] Makeup of your food because you’re getting protein, right? So, you’re getting extra protein. So, a whole bunch of things happen when you add whey protein. So, I don’t know if it’s fair to say, like, I appreciate knowing that whey protein stimulates insulin because I would rather consume hemp protein or pea protein or a type of protein powder that doesn’t impact my insulin levels because I don’t want to spike my insulin. You know, but after a hard workout, if I really want to like, get jacked, I might do whey protein with like, you know, glucose, to be honest, and get a huge insulin spike, but put that insulin to work building muscle. So there’s a time and a place for it. But what we do know is that so Dr. Ali Chavez kind of like, you know, you don’t need that much protein. But there is quite a bit of research around the importance of protein. So, you know, 30 to 50 grams of protein per meal. And again, you don’t need 50 grams at a meal, but 30 is great. Stimulates muscle protein synthesis, and that supports our metabolic health. It regulates our blood sugar, partly yes, because it does impact our insulin. But if you’re having just animal protein, it’s not having a huge impact on insulin levels.
Speaker0: [1:11:15] And, you know, the more muscle we have on our body, the more longevity we have, you know, the less our risk of dying from anything. Muscle is a glucose sink, so it soaks up glucose at rest, but really goes into overdrive at soaking up glucose when you’ve just worked out. And in fact, you don’t need insulin to bring your glucose down when your muscles are working. So this is the advice where you take a walk after dinner, you start working your muscles and you don’t eat even insulin to get the glucose into the muscles and store it as muscle glycogen. Further, we store about 400 grams of carbohydrate as muscle glycogen. It’s a huge like reservoir of glucose that doesn’t have to go into fat cells, doesn’t have to overstuff them. So the more muscle you have, the better glucose sink you have. And then you have this quick burning energy.
Speaker0: [1:12:08] So the more muscle you have the better and you need protein to you need two things to stimulate it when you’re at an adult you need um protein so lysine specifically branching amino acid and you need resistance training so you need to like have a stimulus on your muscle to to create muscle um and we know there’s lots and lots of studies on protein forward diets so diets that deliver about 0.8 to one gram per pound, not kilogram of ideal body weight per day. So it’s almost double the previous recommendations of 0.8 grams per kilogram. So we’re saying 0.8 to one gram per pound. I just aim for one gram per pound of body weight. And so if you distribute that over the course of a day, a course of across three meals, then maybe, yeah, if my ideal weight is 150 pounds, and I’m trying to stimulate muscle and decrease body fat, then yeah, I’m probably aiming for about 50 grams per meal.
Speaker0: [1:13:11] You know, there’s studies shown by Dr. Cabot-Leon that are like not new studies from the early 2000s, where when, you know, people had like a bigger protein breakfast, a decent protein lunch, a decent protein dinner, versus a group that had like a really crappy low-protein breakfast, and their biggest meal was dinner, they lost more body fat, lost less lean mass when they were engaging calorie restriction. And there, you know, there’s another study that shows, you know, low-protein diet, low-protein plus exercise, high-protein diet, high-protein plus exercise. And the best group, of course, was high-protein and exercise, but the second best was high-protein.
Speaker0: [1:13:54] In terms of body fat lost and lean mass preserved. So a lot of benefits to having protein. Does that mean go eat like protein cereal? Honestly, like my answer to the memes where it’s like, I’m working overtime trying to get enough protein. My answer to that is like, just eat meat. Just eat meat. We’re so scared of meat. If you eat meat, chicken, fish, eggs, you’ll get enough protein if you eat like a decent serving you know a five ounce serving at every meal or if you’re tofu and edamame those are great too and you can also do hemp protein powder or collagen powder um it’s collagen is not a complete protein but who cares when you’re mixing it up with other you don’t need to worry about complete protein when you’re getting complete protein across your day in my opinion um so yeah when you’re doing a low insulin lifestyle because really all you have is like animal foods and fruit and vegetable you’re naturally probably going to eat more protein because what are you going to put in your burrito bowl um you can’t put rice in there can’t put tortilla so you’re going to probably put a lot of ground beef uh maybe you’re going to put um a bunch of different salad ingredients avocado and yeah so the savory the salty is going to come from the ground beef and so then you’re getting enough protein.
Speaker0: [1:15:13] And you know people always ask about people are scared of animal protein and i think it’s because of this, again, all the brainwashing and gaslighting that we’ve had from the 1970s on about having a high-carb diet and not eating animal. And the fact is, our diet is largely plant-based in North America. And it’s, that’s not, turns out, plant-based isn’t the right heuristic for a healthy diet. A plant-based diet that’s like made of whole foods, sure, that could be good for you. Um but it’s probably going to be heavier on starch and if it’s not then you have a very limited amount of protein foods to draw from so yeah it is possible to do a low insulin lifestyle on a vegetarian or vegan diet it’s just your your protein sources are going to be very very limited and then maybe yeah you should definitely be doing hemp protein powders and things like that if you want to try it um but fun fact is somebody who i was really like watching.
Speaker0: [1:16:10] What’s her name it’s a health influencer that is like a fruititarian so all she consumes is or like raw raw fully raw christina so she has these beautiful like platters of fruit she gets to eat all this food because all she so she is doing a low insulin lifestyle vegans vegan version lots of nuts and seeds and fruits and vegetables so uh she’s just not eating any animal product and she’s surviving but I think she started adding protein powder in recently um so yeah so very interesting um.
Speaker0: [1:16:44] You know, kind of debate that happened. But I think that, you know, we definitely want to eat enough protein. And I, you know, in my course, I suggest, you know, starting with protein first, because the thing with that is, you know, it’s less about restriction, which can be really helpful, especially if you, so if you struggle with insulin resistance, chances are you’ve done a diet before, you know, because if you have difficulty losing weight, you’ve probably tried something to try and lose weight, whether it was fasting, whether it was Weight Watchers, whether it was something. So you’ve done restriction before, you’ve counted calories, you’ve tracked your macros, you’ve done something like that. So telling you to eat less of something, I mean, yeah, that’s helpful, especially if it’s like don’t eat any starch, particularly if you have really strong insulin resistance.
Speaker0: [1:17:36] But, you know, I like to suggest protein forward first, because it feels less restrictive, you’re focused on eating something, you can always eat it at the end of the day if you you know weren’t focused like you can always have like a protein smoothie or something at the end of the day or a steak if you’re like i didn’t i didn’t you know follow it today or had a busy day versus like having to reverse, overeating or eating something that you weren’t allowed to so it has this, positive frame. And it will displace other macronutrients in other foods. You feel more satiate, your blood sugar is more stable, your brain has, you know, more continuous glucose control. It increases tyrosine, which increases dopamine, which supports motivation, reduces cravings, supports executive functioning. There’s all these positive benefits to adding protein. and so it’s not the only thing it’s not just protein and nothing else it’s just my first step often when patients come in and we need to start working on lifestyle foundations, lifestyle foundations are it’s hard to get someone to do big changes right away.
Speaker0: [1:18:47] Um in my course too we talk about like what happens when you have to eat out what happens when you go to someone’s house what happens how do you say no to people who offer you their pecan pie you know so there’s a lot but if your if your goal their first goal is just to increase protein it’s like you can hand you can navigate all of that stuff you know you just focus on protein and just see what changes and that’s like a good way to start thinking about food and tracking food and not thinking about restriction and then you’re not hungry so you don’t have that same association of like i’m gonna do a thing to be healthy and it’s gonna result in me being, frigging hungry, which was my association my entire life. So on the low insulin list, I don’t find that I’m hungry, actually, I’m very satiated. But, you know, it can be something to wrap your head around to be like, I can’t have starch. So what’s starch in? And what can I eat? And what’s the list? And what’s the grocery? So what am I going to, how am I going to have tortillas? How am I going to do this? So Dr. Ali Chavali uses a lot of almond flour. But yeah, so I think protein has a very important place in supporting metabolic health.
Speaker0: [1:19:49] Now putting it all together um you know so i think when a patient comes in the first thing is we do an assessment we may do some testing and we come up with an individualized plan right so, yeah you can take this and run with it you can just google the foods but again it’s like no starch no sugar no unfermented dairy and then you can have you know all the fruits and vegetables all the animal protein. I will say that a patient that I saw recently, you know, she was like, she’s like, I’m going through perimenopause. I have brain fog. I have no energy. I’ve got all of these symptoms. I’m gaining weight and I can’t lose it. I just, I feel like garbage. My mental health is terrible. And I just, I want to, you know, rehaul my health. And so we talked with the low insulin lifestyle because she had other signs of insulin resistance.
Speaker0: [1:20:46] We didn’t measure insulin, but we definitely have a plan to do that. Cost is a factor in terms of blood testing. And we want to just test everything together. So she already had a lot of signs of insulin resistance. She had high triglycerides, low HDL or good cholesterol, some inflammatory markers, and actually was starting to get elevated hemoglobin A1C or blood sugar was starting to go up. So it was kind of in the at-risk range. So, okay, we, you know, we don’t have a baseline insulin test, but let’s go ahead with, you know, treating insulin resistance. So, I recommended low insulin lifestyle. She was already doing lots of strength training, had a good exercise routine. And she came back and she’s like, I feel amazing. Within three days, everything transformed. My symptoms are all better. What are you eating? And she’s like, well, I’m eating quinoa every day and I’m eating lentils every day.
Speaker0: [1:21:38] So, and I’m eating chickpeas. so you don’t have to be perfect in other words is that um you know so there’s an individualized approach i didn’t have the heart to tell her that those foods were not didn’t belong on the plan but if it’s working why be more restrictive right if you can have there’s lots of benefits to having lentils lentils have iron they have fiber they have there’s another protein source quinoa it creates variety you’re allowed you feel better because you can eat these different foods you can replace rice with it.
Speaker0: [1:22:08] You know, I like this lentil flatbread that I make. So if you don’t need to be that restrictive, if you don’t need to do zero starch, then great. So we’re looking kind of at an individualized plan. Like, what are you already eating? How can we tweak things? Maybe we start with more protein. Maybe we start removing some starches. Maybe it’s just sugar that we deal with. Maybe we say, you know what, don’t worry about fruit. Eat all the fruit you want. In fact, when you eat fruit, it’s helping address a sugar craving and then you’re craving candy less and you’re having less binges. We’re looking at the individual and we’re bringing all the features together. So yes, you can just try a diet on your own. That’s great. But I am always concerned that it just becomes another diet that we try. And then we meet the same internal or external obstacles and we feel bad about ourselves and that triggers that shame and that triggers that that feeling of defeat and you cheat on it and you don’t have someone to help you reframe that that it’s not a cheat it’s just like okay like whatever you know so you know how do we approach this individually is is always so important um i think my face is covering it but essentially the low insulin lifestyle is no starch and sugar you know increasing protein fat and fiber and strength training two to three times a week so adding in strength training supporting muscle building.
Speaker0: [1:23:34] That’s very important, right, is building that muscle. There’s a whole section on muscle and exercise in my insulin resistance course. Diet, yes, is really important, but it only has one, it’s only one core, like one part of the course. And then a huge part of my course is on stress management and like regular movement, lifestyle, like, you know, stuff that supports your mental health. Again, it’s like, yeah, insulin resistance is good for your mental, healthy insulin levels supports your mental health but supporting your mental health like with these self-care practices like for me it’s getting out in nature practicing hobbies socializing reducing your stress getting to sleep on time sleep support um all of that is also good for your stress levels which is good for your insulin levels so you can like reverse these vicious cycles you lower your inflammation, maybe there’s certain supplements that can help right if you’re not sleeping supplements for sleep, if you have sugar cravings, there are supplements that can support that. Supplements for muscle health.
Speaker0: [1:24:37] Again, I say this in my course too. I mean, interestingly, I’m a huge advocate for lifestyle. I think it’s lifestyle really that is going to have the biggest impact on our health. And a lot of it requires a little bit of an entire reframe, right? Especially if we’re living in a chronic disease state, like insulin resistance, and especially if it’s been longstanding, then yeah there’s a lot of connections and associations and identity patterns even that need to change and that’s scary and that’s huge and because we’re social creatures and we’re we’re not just biological creatures we’re social and we don’t like eat in isolation and we are a product of you know the people around us and how they and how healthy they are and how they behave that just going on of, you know, changing your lifestyle, not that easy. It’s an entire identity shift oftentimes. It’s huge habit change, you know. So supplements often are a way to get people’s nutrient levels up where they feel better, where their body works better. And that can be positive motivation for and physical energy, you know.
Speaker0: [1:25:51] Positive mental and emotional and physical energy and motivation to make some changes, you know, whether it’s going for walks, because now you’re not so exhausted, because you slept better, or you just, your adrenals are functioning better, your brain is functioning better. So now you can make decisions like going for a walk after dinner, and now you can eat more protein, that makes you feel better. And then you think, well, okay, nothing, you know, I still would like to, I still have visceral fat, I’m still experiencing X, Y, and Z symptoms, So maybe I’ll consider now reducing my starch or taking out starches, right? So there’s so many approaches and ways in, you know?
Speaker0: [1:26:29] And I think in a huge part of my course was around self-compassion and shame and addressing obstacles, you know, so individually, what is helpful to you? Where do you start on the journey? Like, what’s important for you? What is your blood work say? What is, you know, waist circumference, all these different things? Like, what’s your starting point? What do you already do that’s working for you? What are you doing that might not be working for you? And a lot of it, you don’t know, right? Like, a lot of it is we don’t know. And there’s so much confusion in the nutritional space and you know protein no protein starch no starch bananas no bananas can I eat fruit can I not what about nuts what about seeds what’s this portion oh it’s just about your macros actually it doesn’t matter just calories in calories out.
Speaker0: [1:27:13] There’s so much and so all of that could be true for a specific person right maybe for one person it is calories that’s the thing now you know you’ve done you know all of these different things and that’s where you’re stuck. It really actually may be we need to just track calories, you know? It’s probably not the majority of people, but I, you know, it could be that person. But maybe that person’s not interested in tracking calories, that that’s highly triggering, unpleasant.
Speaker0: [1:27:40] Like if you’re like me, you don’t want anything to do with that anymore. So what else could we try? You know, do you do better by just saying, okay, like, again, I’m talking about myself, no starch, no sugar, you know, no way. Okay, perfect. Just tell me what I can’t eat and I won’t eat it and that’s fine. Um, so, you know, what works for the person? Um, or is it like, you know, your nutrition is dialed in, but you don’t move and that’s what we need to work on.
Speaker0: [1:28:07] Or is it a case of, you know, again, nutrient deficiencies are big. Um, I see them a lot in my practice and they will be an obstacle to feeling better, you know, um, zinc deficiencies or B6 deficiencies or, you know. So, yeah, so there’s an entirely holistic approach, essentially, in which we’re addressing things.
Speaker0: [1:28:35] And yeah, so that’s it, everyone. So if you have questions, reach out, connect at tallyandeed.com. If you’re following on YouTube, like and subscribe, please. I have lots of ideas. I have lots of plans. And I think, you know, subscribers, questions, engagement would really help me with the execution. I’m happy that I released this. I’ve been thinking about this for a while. April has been quite the month. It’s been terrible, quite frankly. But the foundation of low-insulin lifestyle and movement have actually been very helpful for me, keeping me afloat.
Speaker0: [1:29:16] So I think that’s, you know, I can say that when put into practice, it works. It’s possible to, at your lowest point, follow this lifestyle, and it helps, you know. And again, these are all things that I like to work with people on. You know, if you’re at your lowest point, like what’s the minimum that you can do? Like how do we get you out of it? How do we help you out of rock bottom? You know? And then, and this is a huge thing in psychotherapy is like people often come in with a rock bottom kind of chronic problem that distracts them from the deeper work that they want to actually do. Like, you know, examining childhood patterns and, you know, our schemas, things that we, you know, we have like our kind of chronic surface problem so that we don’t go into the deeper traumas that, you know, influence us and keep us stuck. So a lot of cool stuff. I know the economy is scary, but if you have benefits in Ontario, in Quebec.
Speaker0: [1:30:23] And I believe Nova Scotia for psychotherapy. Yeah, reach out. I am offering naturopathic medicine and psychotherapy in Ontario and other provinces that my psychotherapy license is good in. And yeah, I would love to work with you. If you have benefits, use them because this is how we get out of tough times is with support and help. And, yeah, I know that, yeah, it’s scary to spend money, but if you have it covered, I would suggest going for it. I’d love to help. Yeah. Like I said, I’m going to look into offering membership and a course, like a very holistic course. I released one back in 2020, I think, called Good Mood Foundations. And so I’m looking at making Good Mood Foundations 2.0. And this Good Mood Foundations is going to have sections on nervous system regulation, self-compassion, attentiveness and observation when it comes to our body, as well as nutrition, lifestyle. We’re going to talk about the microbiome. We’re going to talk about hormones and menopause. Like, it’s going to be truly holistic.
Speaker0: [1:31:42] And, you know, it’s my way of allowing you to access this information and walking you kind of through my brain for a very low price if you don’t have coverage. Or just if you need support. You need, like, more information. You like to digest more information. you know it’s hard to get it all from just one-to-one sessions because we have limited time together so you get that individual support where we’re like really getting into the nitty gritty but maybe you want kind of the overview that you can consume on your own and maybe you want a community so you know give me suggestions i run my courses right now from thrive cart um i would love to get like a community membership thing going so we’ll talk more about that soon, and I’m going to be writing a lot more. So yeah, make sure that you’re in my email list because that’s where I’m going to reach out to you about new things that are coming up and writings and things like that. So thank you for listening. Let me know your questions and comments, you know, leave a comment below or reach out at connect at taliand.com. If you live in Ontario, I’d love to work with you. Take care, everybody.
Hannah Hepworth, of the Anxiety Revolution Podcast, and I team up to discuss a natural and functional approach to managing anxiety.
In our talk, featured in her 2019 Anxiety Revolution Summit, a series of talks with integrative mental health practitioners and experts, we discuss circadian rhythms, the body’s stress response and the HPA (hypothalamic pituitary adrenal) axis, and blood sugar, and their role in anxiety.
Click the link to listen to this 30-minute interview. Let me know what you think!
I review my adventurous year of living on the Low Carb High Fat Ketogenic Diet.
I’ve always had a sweet tooth.
I remember binging on Halloween candy as a kid, stuffing one tiny chocolate bar after another into my mouth, as fast as my little fingers could unwrap them, trapped in some kind of sugar-filled trance.
“Never get between Talia and her food!” My family would joke when my blood sugar would crash between meals and I’d rage towards the fridge for a snack to keep me sane.
I remember digging into the little bags of cheese popcorn reserved for school lunches, finishing off one after another and then hiding the wrappers in their big Costco box so that it would look like it was still full, the way rebellious teens top up empty vodka bottles with water.
I can gain weight with the drop of a hat (but also put on muscle fairly easily), and it takes concentrated effort and dedication to take it off.
After a period of temporary stress and bagel-related weight gain, I decided to embark on a bit of experimentation. Work was getting busy and I wanted to supply my brain with constant energy without having to take snack breaks every few hours. Also enticed by anecdotes of shattered weight loss plateaus, I decided to “go Keto”.
I like experimenting with diet. Like many health-conscious people, finding the right nutrition regime for me has been a process. In my teens I started controlling portions and switching out white breads for whole grain rye and Jolly Ranchers for carrot sticks. In my early 20’s, I was vegetarian. I tried being vegan for a while before deciding it was a disaster for my health when I began to experience nutrient deficiencies, weight gain, and hormonal issues.
Later on, I followed my naturopathic school classmates to a modified Paleo diet (keeping in some gluten-free grains and legumes), then moved to a more traditional Paleo diet (taking out the grains and legumes), before going back to the modified version (which is probably the best eating style for me—more on that later).
For the most part, my diet is comprised of whole foods, with lots of vegetables, but in the Fall of 2016, when this all began, I was in a pretty Standard North American place when it came to food intake. At the time I was suffering from IBS, some issues related to subclinical PCOS, and fatigue. I was also starting to see some signs of impaired glucose control.I wasn’t feeling good and I was in need of a kind of reset of sorts.
I was interested in seeing how relying on ketone bodies for fuel would help my body, mental performance, and improve my blood glucose control and symptoms. I have a family history of type II diabetes and I wanted to do what I could to prevent insulin resistance and metabolic syndrome. Drastic times call for drastic measures, I thought.
Ergo, The Ketogenic Diet.
About the Diet:
The Classic Ketogenic Diet was first developed in the 1920’s to treat children with medication-resistant epilepsy.
When our brains are starved of glucose, their preferred fuel source (our brains use up 60% of the body’s glucose), the liver creates ketone bodies from stored or dietary fat that the brain can use as a substitute source of energy.
One of these ketone bodies, beta-hydroxybutyrate, is thought to be a particularly therapeutic molecule for the brain, conveying anti-convulsive benefits, thereby helping to reduce the incidence of seizures in children who don’t respond to medication.
However, the original Ketogenic diet is more extreme than the general health and weight loss-aimed diet we see described in recipe books these days. The Classic Ketogenic diet consists of about 90% of calories coming from fat. In order to achieve that, followers need to severely restrict their protein intake, and virtually eliminate all dietary sources of carbohydrate, which drastically limits their nutrition choices.
Since, the benefits of beta-hydroxybutyrate are being studied for other neurological disorders, such as Parkinson’s disease, dementia, migraine headaches and narcolepsy. It’s being looked at as a potential treatment for mental health conditions, like autism and depression, and metabolic disorders such as type II diabetes, and even to increase the efficacy of chemotherapy and radiation treatments in cancer. Other studies are looking at its role in improving cognitive function in mice and humans.
Some research shows that beta-hydroxybutyrate can expand lifespan by interacting with genes that slow aging. It is also shown to confer anti-inflammatory and antioxidant benefits.
In the 1970’s, Dr. Atkins responded to the high-carbohydrate, low-fat dogma of the nutrition world at the time, by bringing a modified Ketogenic diet into vogue. Restricting all forms of carbohydrates and encouraging a consumption of the still-vilified high-fat foods like bacon, eggs and cheese, Atkins affirmed that people could lose weight by eating fat, as long as they restricted carbohydrates at the same time.
The modern version of the Ketogenic Diet is slightly more health-conscious, promoting a higher intake of vegetables. The current diet restricts carbohydrates to under 20 to 50 grams per day, and encourages a high fat intake and a moderate protein intake, in order to encourage the body to turn to fat as its primary source of fuel. The current version of “Keto” is less strict than it’s initial epilepsy-treating incarnation, with anywhere from 60-85% of its calories coming from fat.
My Version of Keto:
I started the whole journey by tracking my food intake (using My Fitness Pal). My aim was to consume 20 grams of net carbs, or less, per day to push my body into using fat-turned-to-ketone bodies as a its primary fuel source.
Net carbs are calculated by subtracting dietary fibre from total grams of carbohydrates. For example, 1 cup of raw broccoli contains 6 grams of carbs. 2.5 of those are fibre. Therefore, the net carbs in broccoli are 3.5, which would count towards my net carb goal of 20 grams per day.
This isn’t easy. Take a look at any package of food you regularly consume. 1 cup of cooked oatmeal contains 23 grams of net carbs: 3 grams over my entire daily allotment. Therefore all high-carb foods like grains, legumes, starchy nuts, all fruits, and some starchier vegetables, were off limits.
Many people opt to test their blood, breath or urine for ketone bodies to determine whether or not their bodies are in ketosis. I dabbled in this, using the urinalysis strips in my clinic to test for urinary ketones. However, even though I was sticking to the diet, the strips would mostly turn up negative for ketones.
There are a few reasons why ketone strips may not be a reliable marker for ketosis. Firstly, the don’t test for beta-hydroxybutyrate, which is the main ketone body utilized by the brain, but acetoacetate, another ketone body produced in the liver.
Secondly, urinalysis strips only test for urine ketone spillover. They don’t necessarily reflect blood levels, and they won’t pick up the ketones that are being utilized as fuel by the body. If cells are absorbing all the ketones the liver produces, urine testing may not be positive.
The most accurate, albeit more expensive, method for testing ketone bodies is through a skin-prick test that analyzes blood levels of beta-hydroxybutyrate.
While I knew that the urine strips weren’t highly accurate, not having my state of ketosis validated was discouraging. I was often left in doubt over whether things were “working”. I wondered if there was some other mechanism going on. Was my body finding carbohydrates from someplace else? Did I have Small Intestinal Bacteria Overgrowth that was digesting my fibre and allowing me to absorb it somehow? Were my blood ketones being used up somewhere else (by the yeast in my gut, for instance)?
I did have signs of being in ketosis that I could watch for, however. When I avoid carbs, or fast for a few days, I start to develop a metallic taste on the tip of my tongue. It’s not a common sign of ketosis, a more common sign is a “nail polish” or “paint thinner” taste in the back of the throat, but still a symptom that some people report.
Keto Flu:
During the first few days of switching to Low Carb High Fat, I had to white knuckle through a phase realistically termed the “Keto or Low Carb Flu”. This horrible phenomenon is thought to be a result of the body switching from burning glucose as its primary fuel source to adapting to ketone body production. There is often a painful adjustment period for brains that have to learn how to rely on ketones for their main fuel source after a lifetime of glucose abundance.
It was nasty. I felt intense hunger and sugar cravings, nausea, dizziness, and weakness—it truly was a “flu”.
I knew that I had spent most, if not all, of my life as a sugar burner. Before Keto, I would crave food even just two hours after a full meal. I would often feel “hangry”: dizzy and shaky in between meals, and irritable if made to wait for food for too long. I had been existing between carb-dense meals, experiencing insanity-inducing reactive hypoglycemia between my regular sugar fixes.
The more I read about others’ experiences, the more I was assured that the keto flu symptoms were actually a sign of my body healing. I was becoming adapted to other fuel sources, which was a good thing, I thought.
So, I muscled through and followed the online advice: I consumed more fat to provide more fuel to my brain, including medium chain triglyceride (MCT) oil, which is quickly absorbed by the lymphatic system and turned into ketones by the liver, and I consumed electrolytes, which are more rapidly excreted from the bodies of low carb dieters.
For some people, Keto flu can last for days, for others it lasts weeks. For me, the Keto flu thankfully only lasted two days, after which my body began to adjust and my cravings for sugar went down. I began to feel more energy, which felt encouraging.
Daily Meal Plan:
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
I’d have my second meal of the day in the mid-afternoon, around 2 to 3 pm, for which I’d consume a few cups of cruciferous vegetables, like broccoli or cabbage, with a fatty cut of meat like ground beef, chicken thighs, or salmon, all topped with liberal amounts of fat from coconut, olives, avocados, or grass-fed ghee. I made a lot of batch-cooked grain-free curries and stews.
If I had a third meal or snack in the day, it would be another serving of fat: a handful of macadamia nuts or a hunk of creamed coconut.
Eating this way made me feel like Obama and his grey suits—I didn’t have to plan my meals too carefully. All I had to do was eat fat. My food was so calorie dense and my blood sugar so stable that I didn’t need to eat often. This meant that I didn’t need to worry about bringing food with me everywhere I went; one meal could satiate me for half the day. Hunger was never an emergency situation, as it had been in the past. Hunger would come on very slowly, and it would never be “hanger”; my already low blood sugar had nowhere to dip to. If I needed more food, I could always wait until I got home to eat.
More Benefits:
Within a few days, my PCOS- related cystic acne cleared. I also felt slimmer as some water retention deflated. This felt good. Our body stores carbohydrate in the form of glycogen in the liver and muscles. Glycogen stores retain water.
When glycogen stores are used up, a rapid 5 or more pound drop in weight can occur. This is the “water weight” that people talk about losing when they first begin some kind of nutrition plan.
It’s also common to notice a drop in water weight from a decrease in inflammation, when embarking on a new eating plan. I know that I am sensitive to certain carbs and dairy and, because those things were out of my diet overall (although Keto can certainly include high-fat dairy products for those who can tolerate them), the water retention caused by chronic inflammation seemed to clear.
Although it seems to attract people primarily for its hip-slimming potential, the Ketogenic diet probably does not cause weight loss in and of itself. Instead, the diet encourages a passive reduction in calories by stabilizing blood sugar and insulin levels, while promoting the intake of highly satiating foods containing protein and fat. Ketone bodies also have appetite-suppressing effects. Therefore, it’s probably a calorie deficit that causes the weight loss, rather than any specific biochemistry in the diet itself.
I didn’t lose much more weight than the water weight. However, my mood was brighter. I would wake up in the morning looking forward to the day, which often doesn’t happen in the winter. I felt more sustained energy throughout the day, and really enjoyed the decreased appetite, which led to more productivity.
I felt fine consuming two meals a day, able to get through hours of back-to-back patient visits without needing a snack or a break. It was actually incredible to need so few meals; it was like becoming another person, one no longer ruled by sugar cravings. I was like a camel, switching to stored fuel when the fat from my last meal had run out, and the transition was seamless. There was no wall to hit, and no hypoglcyemic crash to be seen.
I also noticed less bloating and digestive issues, probably from the lack of fermentation in my gut and the reduction in foods that tend to aggravate IBS, like certain vegetables, fruit, and legumes.
However, all was not roses on the Keto diet. While the first few months were dreamy, the longer I stayed on it the more I started to notice changes in my body that indicated the honeymoon period I was enjoying wasn’t going to last.
The Microbiome:
The research is in: human beings probably need 10 servings of fruits and vegetables a day (roughly 5 cups), or 800 g, a day to get the most heart disease, stroke and cancer-preventing benefits that diet can afford us. The International Journal of Epidemiology concluded that, if the correlations found in their February 2017 study were causal, almost 8 million lives might have been saved in 2013 if everyone in the world had simply consumed their fruits and veggies.
It’s one thing all diets, even the faddy ones, agree on—from the Paleo Peeps, to Plant-Based Hippies, to Raw Macrobiotic Sun Worshippers, to Whole Foods Michael Pollen Omnivores, to the dejected nagged-at husband pushing brusselsprouts around on his plate—fruit and vegetables are good for you. You should eat them. If you’re a typical North American, you should probably eat more than you’re eating. The health value of everything else we eat seems to be up for debate: red meat, saturated fat, soy, bread, coffee. The benefits of eating enough fruits and vegetables, however? There’s no contest.
It’s hard to pick one way in which fruits and vegetables are so health protective. It could be because of their high concentrations of micronutrients, reducing the risk of common nutrient deficiencies, like magnesium and vitamin C. It could be because, if you’re filling your body with a kilogram of fruits and vegetables a day, you probably aren’t scarfing down an entire medium-sized pizza and supersized orange pop as well—there just isn’t room. It could also be the antioxidants they contain that protect cells against free radical damage, protecting DNA. Or perhaps its the fermentable fibres present in fruits and vegetables that feed our invaluable microbiome.
The problem with keeping net carbs under 20 grams a day was that I needed to restrict my fruit and vegetable intake. I was eating no fruit at all, and staying away from the starchier veggies, like carrots and beets. I still stuck to my beloved leafy greens and crucifates, but even eating 2 to 3 cups of those guys a day would push me to the upper limits of my carbohydrate intake, which meant I couldn’t eat them as liberally as I had been.
Getting enough vegetables and (any) fruits on the keto diet is hard, if not impossible. This can impact our ability to get the micronutrients we need, but also enough fermentable fibres from vegetables like garlic, onions, yams, Jerusalem artichokes, and legumes, which provide food for our microbiome.
Feeding our gut bugs is important. They benefit us in numerous ways, from digesting out food, to calming inflammation, to fuelling gut cells by producing a short-chain fatty acid called butyrate. They help our immune systems function optimally. They produce neurotransmitters for our brains to work. They balance our stress responses and our circadian rhythms.
Jeff Leach, at the Human Microbiome Project speculates that the lack of dietary fibre in most low-carb diets may impact the health of the microbiome in negative ways by depriving the gut bacteria of their preferred food sources, as well as altering the acidity of the colon and intestines. He cites this article, in which obese subjects on a high-protein and low-carb diet had lower levels of butyrate in their bodies and intestines, likely due to decreased diversity in their guts.
There are, however, some studies that suggest that a Ketogenic diet can improve the microbiome in children with epilepsy, and autism, and some speculation by the researchers that that may be how the diets treat these conditions. However, since these studies are not done in “healthy” children, with an already healthy microbiota, it’s hard to extrapolate the findings to the healthy adult population.
Then there’s the fact that most studies that look at high fat diets and their impact on the microbiome are mostly done in rats. Of course, rats aren’t humans, despite there being relative genetic similarities. In these animal studies, researchers refer to “a high fat diet” when in fact they mean a high fat, high sugar diet. The sources of fat in these “high fat” mouse diets are often corn, margarine, or soy oil, which we know are highly inflammatory and offer few if any health benefits.
In other words, many studies on “high fat” diets are not looking at a relatively balanced Ketogenic diet that consists of vegetables, proteins, and healthy sources of fats from avocados, coconut, fish, olives, nuts and seeds and grass-fed meats.
Context is important as well. Is it the high fat diet that causes a reduction in gut diversity or the absence of fibre? This one mouse study showed that simply providing the mice with fibre in addition to their high fat diets decreased their risk of obesity.
I felt that my gut initially improved in the first few months on Keto: the diet was low in foods that aggravate me: namely refined carbs, sugar, gluten and dairy, as well as some of the fermentable fibres that can aggravate IBS. However, it never fully healed. After a few months, I started to notice the symptoms of bloating and digestive irregularities coming back.
Candida, a yeast that resides in the gut and can overgrow in the intestines in some people, especially the immunocompromised, causing symptoms of fatigue, IBS, and weight gain, among a variety of other symptoms, can survive on ketone bodies. Yeasts have mitochondria of their own. Some species of gut bacteria can consume protein, bile salts and even fats.
Contrary to what many claim, a Ketogenic diet doesn’t necessarily “starve out” the bad gut bugs. Combined with the lack of fibre to feed the beneficial gut bacteria and promote more bacterial diversity, a prolonged Ketogenic diet may be a recipe for gut dysbiosis.
Hormones:
Throughout my year spent in ketosis, I definitely noticed an improvement in my insulin signalling and glucose control, especially in the first few months. Looking at my blood work in March, after about a year of the Ketogenic diet (and then having been off it for a few months), my fasting insulin was very low and fasting blood glucose levels were in the low-optimal range. HOMA-IR, a calculation that is used as a marker of insulin resistance, was also low, indicating good insulin sensitivity.
I personally believe that this means that my risk for getting metabolic syndrome or type II diabetes is low, as long as I maintain this level of insulin sensitivity by watching the glycemic load of my diet and my stress levels.
The metabolic flexibility awarded to me from my year in ketosis also proved to be invaluable. Now, I no longer fear fasting and I can survive on other fuel sources besides sugar. My brain knows how to tap into stored and dietary fat more efficiently, and use those for energy. Even when not following any sort of low-carb diet, I noticed that I could survive between meals while travelling in Southeast Asia for two months, whereas normally I would have had to exist on unhealthy, sugary snacks.
However, after a few months on the diet, I began to notice a decline in my menstrual health. My cycles began to get longer, and soon I started missing periods. I noticed more hair falling out in the shower and more cystic acne developing on my chin. When I ran my blood estrogen and progesterone levels, I was surprised to see that their levels were very low.
We know that insulin, while often vilified as a “fat storage” hormone is actually responsible for storing everything, including nutrients. It also correlates with estrogen levels and the conversion of T4, one of our thyroid hormones, to its active friend, T3, which runs our metabolism. Insulin builds muscle, bone and brain cells. Very low insulin levels, in my case, were contributing to amenorrhea and a disruption in my sex hormones.
This wasn’t good.
While not quite the same as Intermittent Fasting (IF), Keto is often grouped into the same category because of its similar impact on blood glucose and insulin. The difference is that Intermittent Fasting induces ketosis through periodic food restriction, as opposed to carb restriction. Keto and IF often go hand in hand, however. The reduced hunger and high-nutrient density of the foods eaten on a Ketogenic diet often lend well to practicing intermittent fasting. It did in my case—I was only eating two main meals a day.
I always found it interesting, however, that most proponents of intermittent fasting are men. The male body appears to thrive in the fasted state, getting a boost of growth hormone and norepinephrine, both of which provide men with energy, motivation, and an improved sense of well-being.
This hormonal change may be a remnant of our ancestral hunter-gatherer days where it would be an advantage to feel motivated and energized to go out and hunt during periods of food scarcity.
I don’t think female bodies experience exactly the same effect. Some preliminary animal research tends to suggest that as well.
A few rat studies indicate that fasting may impair female insulin sensitivity, and induce amenorrhea, or missed periods. Female bodies rely on a consistent influx of calories and carbohydrates to stimulate insulin, which plays a role in stimulating thyroid hormones and estrogen, to continue to ovulate. Another study showed that fasting tended to “masculinize” female rats, lowering their female hormones, and increasing their levels of androgens, the male sex hormones, like testosterone.
Of course, these studies were done on fasted rats, which cannot be fully translated to the effects of Intermittent Fasting and Ketogenic diets on women. However, some of these findings did validate my experience, which certainly wasn’t being validated in the podcasts and blog posts I was exposed to, largely written and followed by men.
I did experience positive hormonal effects: the increased insulin sensitivity and lowered blood glucose. However, I was not happy about my irregular cycles and estrogen deficiency.
Therefore, I decided to increase my carbohydrate intake, returning to a more moderate Paleo diet that consists of some fruit, starchier vegetables and legumes. After a few months, my periods returned to normal, my skin cleared up, my hair stopped falling out, and my thyroid hormones, estrogen and progesterone levels all returned to their optimal ranges.
I have still have low fasting insulin levels, suggesting that the Ketogenic diet did help to reset my insulin sensitivity and that this effect may be lasting.
Metabolic Health:
After a year of doing the Ketogenic diet, and then a few months of returning to a moderate-carb paleo diet, I tested my cholesterol levels and inflammatory markers. My HDL cholesterol (the “good” cholesterol, to put it very simply) was high, my triglycerides (a risk factor for heart disease) were very low, and my LDL cholesterol (the “bad” cholesterol that statin drugs target) was also low. My inflammatory markers: C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR), were also low.
While it is typically the monounsaturated fats, like olive oils and avocados, that are associated with increased levels of the heart-protective HDL cholesterol, even saturated fats from coconut oil can raise HDL. LDL is often lowered by these healthy monounsaturated fats, however saturated fats, even healthy ones, can raise LDL in certain individuals.
All else being equal, higher levels of LDL may not be as big of a problem as we think. Especially in the context of low risk factors, like low inflammation, absence of smoking and a healthy body weight. What’s more, the triglycerides and cholesterol/HDL ratio may be more important factors for determining heart disease risk. Further, assessing LDL particle size may also provide those concerned about their LDL levels with more information concerning their cardiovascular health. That being said, it is important to be aware that some of the fats present in a Ketogenic diet have the potential to raise blood levels of LDL in certain susceptible individuals, and that not everyone’s blood lipid results will look like mine.
Triglyceride levels are associated with liver function, and generally reflect dietary sugar, fructose and refined carbohydrate intake, rather than fat intake. Reducing refined dietary carbohydrates like white grains, flours and sugars is a good strategy for reducing triglyceride levels and reducing heart disease risk.
Some individuals can experience elevated levels of inflammation on a Ketogenic diet, depending on the quality of foods consumed. A Ketogenic diet low in fibre that fails to feed the microbiome; high in foods that a person may have an individualized sensitivity to (such as dairy, eggs, nuts or soy); or high in inflammatory fats like trans fats, and industrial oils like canola and corn oil, may all contribute to increased inflammation.
That being said, certain ketone bodies like beta-hydroxybutyrate may have anti-inflammatory properties. Many of the fats consumed in a mindful, whole foods Ketogenic diet, such as olives, avocados, seeds, salmon, and coconut, are also anti-inflammatory.
I found my blood markers a good indicator of the power of a high-fat, low-carb diet to, at least in my case, improve HDL cholesterol and lower triglycerides, fasting insulin and fasting glucose levels. Whether I needed an entire year in ketosis, or whether I even needed to actually enter ketosis to receive these benefits, isn’t clear. Perhaps I could have gotten the same results by moderately lowering my carb intake while increasing my dietary intake of healthy fats.
Modified Ketogenic Diets:
While I do think I benefitted from entering into ketosis, I would not necessarily recommend a Ketogenic diet to patients unless to achieve some sort of therapeutic goal, such as improved insulin resistance, or for adjunct cancer care, to reduce inflammation, or to improve severe depression, migraines, or narcolepsy.
However, there may be a benefit to cyclical Ketogenic diets for memory and cognition, and increased life span in mice. Cyclical Ketogenic diets involve entering ketosis on alternate weeks. On the other weeks, participants return to a normal, whole foods diet that contains higher amounts of carbohydrates. In this case, individuals gets the benefits of beta-hydroxybutyrate production and increased metabolic flexibility on their weeks on, while also being able to eat a high amount of fermentable carbs and fibres on their weeks off, essentially getting the best of both worlds.
Adding medium chain triglycerides to food may also confer health benefits, similar to being on a Ketogenic diet. One study showed that adding MCT oil to a high-carb breakfast (pasta), reduced appetite in men. This is likely because, after burning through the glucose in the pasta, the men’s brains were able to access the ketone bodies that were made readily available by burning the MCT oil. This kept their brains fuelled and their bodies satiated for longer.
The men eating pasta and MCT oil in the study had a ketone blood level of 0.3, which is similar to that obtained from a diet that derives 10% of its calories from carbohydrates, which is an essentially a very low-carb, if not Ketogenic, diet. This may indicate that simply adding MCT oil to a moderate to low-carbohydrate diet, may confer some of the benefits of having a slightly higher rate of circulating ketone bodies without having to follow a strict diet. Again, following this strategy, you can get the best of both worlds: consume a diet high in fibre, while also getting a steady flow of ketone bodies to the brain.
Other interesting areas of research are the use of supplemental, or exogenous, ketones for therapeutic use, however the area is new and not something I currently recommend in my practice (although this may change when more research begins to emerge and better supplements enter the market).
My Plan Moving Forward?
I’m happy that I gave the Ketogenic diet a try, but now I’m back to my more modified Paleo diet, aimed at promoting gut health, optimizing my micronutrient intake, regulating hormones, and supporting my energy levels. I now consume berries and apples, legumes, starchier vegetables and lean proteins more often and aim to get 10 servings of fruits and vegetables a day, with 8 to 9 of servings coming from vegetables, as opposed to fruit.
I currently start my day with a smoothie with berries, an avocado, spinach and protein powder. For lunch I have some sort of protein, fat, and tons of veggies. I eat more often than when I was in ketosis: about 3 meals a day with a vegetable and fat as a snack, or no snack at all in between, depending on my schedule.
My total daily carbohydrate intake falls around 100 grams a day with a net carb intake between 50 to 70 grams a day, depending on the fibre content of the vegetables, seeds, and legumes I’ve eaten that day. I try to get upwards of 30 grams of dietary fibre per day.
I avoid all sugar, including sweeter fruits like tropical fruits, and dried fruits, like dates. I especially stay away from refined sugars, even “natural” coconut sugars and agave. I avoid processed carbohydrates and flours. I mostly avoid grains, except when travelling or visiting someone’s house, getting my carbs from starchy vegetables and tubers, legumes and berries. I continue to avoid dairy (which I’m sensitive to), gluten, and processed industrial oils like canola, corn, and soy oil.
Right now, rather than focussing on macronutrient ratios, I’m directing my food intake towards obtaining the Recommended Daily Allowances of the micronutrients that run all of our cellular reactions, and the fibres that feed a healthy gut microbiota. I use an app called Cronometer to track this.
I definitely eat more fat than before, adding MCT oil to my morning smoothie, especially on days when I need to stay full and focused for longer. I also aim to do at least 12 hours of fasting a day, trying to get in 16-18 hour fasts where I can, ending dinner at 4pm, for example. I no longer do regular long bouts of Intermittent Fasting, particularly not when I’m feeling stressed and burnt out.
Would I Recommend the Ketogenic Diet to Patients?
One of the main tenants of Naturopathic Medicine is “Do no harm”. While it may seem like making diet and lifestyle recommendations are relatively benign therapies, I believe that they do have the potential to do physical and psychological harm, particularly if they are strict recommendations.
Following a strict diet may have health benefits, but it also may isolate us from friends and family, frustrate us and restrict our intake of certain nutrients, like fibre, vitamins and minerals. This is one of the reasons I do not ever advocate a Vegan diet, although if patients are following one already, I believe in guiding them to optimize their nutrient intake.
Furthermore, at least in my personal experience, the cure was stronger than the disease. I probably didn’t need to do the Ketogenic diet for so long; this was evidenced by the hormonal imbalances that I began to experience towards the end of my year on the diet.
However, particularly for patients who are suffering from metabolic syndrome, type II diabetes and insulin resistance or PCOS, there may be some powerful benefits to entering ketosis in order to dramatically reverse metabolic dysfunction. In this case, a modified regime combining Intermittent Fasting and cyclical Ketogenic diets could be beneficial.
Of course, it all depends on where patients are at in their nutrition journeys. Sometimes I meet patients who require, and respond well to, more heroic lifestyle interventions. Other times I meet patients relying on several sugary treats a day to get them through. In these cases, simply tweaking their diet in small ways, using baby steps may also have powerful disease-risk-reversing effects.
In the past I used to suffer from “hanger”, feeling hungry and irritable if going more than a few hours without food. Now my body is adapted to fasting, going prolonged periods without food—and I feel all-the better for it.
When I was a kid, no one ever had to convince me to finish my dinner. Perpetually “hangry” (hungry and angry), I was the Tasmanian devil of snacking, vacuuming up whatever food substances crossed my path, leaving wrappers and crumbs in my wake. “Never get between Talia and her food,” my brother facetiously coined when, like a voracious bull, I would bully my way into the kitchen to fix myself an emergent after-school snack. From the moment I was born, it seems, going more than two hours without eating was a physical impossibility. “I’m sick with hunger,” I would complain whenever my blood sugar levels dipped.
Now I sit here writing this article, in my adult incarnation, comfortably having abstained from eating for more than 14 hours. Whereas before I couldn’t go more than 2 hours without some kind of sugary snack, my body is now adapted to thriving during prolonged periods without food—and I feel all-the better for it.
“Eat a snack every 2-3 hours to keep blood sugar stable and lose weight,” dieticians and nutritionists often advise . However, as we dig into the disease prevention, anti-aging and weight management research, we learn that there may be benefits to going without food for prolonged periods.
We humans spent much of our evolutionary history hunting and gathering with extended periods of food scarcity. Our bodies adapted to survive through, and perhaps even thrive and depend on, periodic fasts. We now live in a society that enjoys food abundance: with 24-hour convenience stores and fast food restaurants at our disposal, we rarely go hungry. This recent lifestyle change may contribute to the increase in the diseases of excess that afflict modern bodies.
Ancient healing systems like Ayurvedic medicine and Traditional Chinese Medicine have long recognized the benefits of fasting for purifying and healing the body. Today, a body of research is accumulating that suggests that fasting may help treat diseases like multiple sclerosis and cancer, reduce the risk of chronic metabolic diseases, such as diabetes, battle dementia and cardiovascular disease, and reverse the effects of aging, helping us live longer.
What Happens During Fasting:
Human physiology fluctuates between two modes: the fasted and the fed state. After eating, a hormone called insulin rises in response to the intake of dietary carbohydrates and, to a lesser extent, protein. Insulin allows glucose to enter cells where it can be used for energy. Insulin encourages the storage of body fat and glycogen—a molecule stored in the muscles and liver that can be broken down quickly for energy. Insulin is an anabolic hormone that promotes tissue building and growth.
Our bodies are in the fed state, or postprandial state, for up to 4 hours following a meal, when blood sugar and insulin levels rise and the body begins to store food energy. 4-6 hours after eating, our bodies enter the post-absorptive state. Insulin and blood sugar levels fall, and blood sugar is maintained through the breakdown of liver and muscle glycogen. At the 10-12 hour mark post-meal, the body enters the fasting state. At this stage, glycogen stores have been depleted and blood glucose is maintained through a process called gluconeogenesis: glucose is created from fat, lactate and protein. In the fasting state, the body taps into fat stores to create ketone bodies, which are used for fuel.
Approximately 24-48 hours after a meal, the body enters a state called autophagy (or self-eating). The body breaks down old, damaged cells into their proteins and reuses them to build new cells or for fuel, through gluconeogenesis. Autophagy has gained the attention of researchers who recognize its benefits for managing inflammation, slowing the effects of aging, and treating various chronic diseases, such as autoimmune disease and cancer—more on this later!
Fasting to Treat Cancer:
Valter Longo, PhD, at the Longevity Institute at the University of Southern California, examined the effects of 2 to 4-day fasts on patients with cancer who were undergoing chemotherapy. The study found that several days of fasting improved the efficacy of chemotherapy, while reducing its side effects, protecting healthy, non-cancerous cells. Healthy cells responded to the periods of food restriction by shutting down, protecting them from the toxicity of the chemotherapy. Cancer cells don’t have such a response, leaving them susceptible to the chemotherapy. “Cancer cells are dumb cells,” says Dr. Longo.
The fasting period not only improved the effects of cancer treatments, it stimulated the regeneration of the immune system through the creation of progenitor stem cells. Fasting cleared out damaged immune cells and cancer cells through autophagy and new cells were regenerated upon re-feeding. Dr. Longo and his team found that up to 40% of the immune system is rebuilt in mice after a fasting and re-feeding cycle.
Fasting Mimicking Diets:
Recognizing the difficulty in going 3 days without food, Dr. Longo developed a 5-day “Fasting Mimicking Diet” that allows for the consumption of about 700-1000 calories per day in the form of small snacks. The Fasting Mimicking Diet is low enough in calories, protein and carbohydrates to mimic the physiological conditions and benefits of fasting like autophagy, ketone body production, beneficial stress response, and cancer cell starvation.
Mice given the Fasting Mimicking Diet (FMD) lost 30% of their body weight through the breakdown of body fat and clearing away of old, damaged cells. When the mice were re-fed, their blood, brain and bone cells were rebuilt. The mice who underwent the Fasting Mimicking Diet had rejuvenated immune systems, decreased incidences of cancer, reduced body fat, improved cognitive performance, decreased inflammation, and increased lifespans.
Fasting to Treat Autoimmunity:
Research in mice showed promising results in using the Fasting Mimicking Diet to treat multiple sclerosis, a debilitating autoimmune condition that attacks the nervous system. When following the diet, immune cells that were attacking the brain and spinal cord were destroyed. Upon re-feeding, new progenitor stem cells were created that repopulated the immune systems of the affected mice, and aided in repairing the damage to the brain and spinal cord. The Fasting Mimicking Diet resulted in a 20% reduction in autoimmunity in mice with multiple sclerosis.
A study that examines the effects of the Fasting Mimicking Diet on humans with Crohn’s Disease, an autoimmune disease the affects the digestive system, are currently underway.
Fasting to Reverse Aging:
Autophagy, the process of removed and recycling old and damaged cells, is a new area of research for reversing the effects of aging. Autophagy alleviates the body burden of senescent cells that have stopped dividing but are still robbing the body of essential nutrients and energy.
When cells become senescent, they release inflammatory mediators, which can damage neighbouring cells and cause inflammation and disease. Cellular senescence is thought to be one of the primary mechanisms by which we age. As we age, more cells become senescent, causing age-related inflammation. A study found that inflammation is the primary factor that drives the aging process, damaging DNA and contributing to various diseases, such as cardiovascular disease, diabetes, arthritis, cancer, and autoimmunity.
The process of fasting and re-feeding stimulates the production of new, healthy progenitor stem cells in the immune system. Mice and human volunteers who underwent cycles of the Fasting Mimicking Diet had decreased numbers of myeloid cells, the inflammatory immune cells that become more numerous as we age, and increased numbers of cytotoxic T cells, which protect the body against viruses and cancer.
Fasting promotes longevity through its inhibition of Insulin-like Growth Factor -1 (IGF-1), a growth factor that promotes cellular growth, and prevents the death of senescent cells. Growth factors are important for growing babies and children, developing fetuses, boosting muscle, and growing new brain cells. However, growth factors like IGF-1 are negatively associated with longevity because of their potential to stimulate the growth of cancer and prevent autophagy. Mice whose growth factor-dependent genes were removed, or “knocked out”, lived 40-50% longer and suffered from less diseases as they aged. IGF-1 is stimulated by protein and carbohydrate intake; it is elevated in the fed state and inhibited when fasting.
Healthy humans who underwent cycles of the Fasting Mimicking Diet had lower risk factors that were associated with cardiovascular disease and diabetes, such as lowered blood pressure, reduced CRP (a marker of inflammation in the blood), and reduced fasting blood glucose levels. These markers remained improved even after the subjects returned to a normal diet, which indicates that fasting may help reduce the risk of chronic diseases, such as diabetes and heart disease, promoting health longevity and increased lifespan.
Fasting for Energy and Resilience to Stress:
Hormesis is the process in which the body’s response to a stressor like the slightly toxic flavonoids in plants, intense exercise, or extreme temperatures, benefits the body as a whole. Hormesis is one of the reasons that exercise and green leafy vegetables are so good for us; they impose minor stressors on the body, boosting its healing properties, and improving resilience.
Fasting, in addition to other positive stressors, up-regulates a stress-response gene called FOX03. When FOX03 is activated, it produces proteins that reduce inflammation, increase anti-oxidant production, repair DNA, and increase cellular energy production through the creation of new mitochondria. Humans with a more active version of the FOX03 gene have an almost 300% chance of living to be over 100 years old.
Fasting also promotes a process called mitophagy. Similar to autophagy, mitophagy involves removing and recycling damaged mitochondria that are no longer able to effectively produce energy. Through activation of the FOX03 gene, more mitochondria are created to replace the old, improving energy production. The creation of new mitochondria only occurs in response to exercise, extreme temperatures, and periods of fasting.
Fasting for Weight Loss:
It doesn’t take a researcher to figure out an obvious truth about fasting: when you don’t eat, you lose weight. Dr. Jason Fung, MD, a Toronto-based nephrologist, prescribes fasting to his obese and diabetic patients. In his book, The Obesity Code, Dr. Fung discusses how the old paradigm of restricting calories for weight loss—eating 1500 calories a day while burning 2000, for example—is out-dated and ineffective for keeping weight off longterm. Dr. Fung argues that fat storage and breakdown are not the result of a simple calories in minus calories out equation, but the performance of a hormonal orchestra conducted by insulin. Insulin stores fat and glycogen, while inhibiting the release of fat breakdown. The body only begins to tap into its glycogen and fat stores when insulin drops during the post-absorptive and fasting phases after a meal. Once it depletes its glycogen stores, the body burns fat as its main source of fuel as long as insulin levels remain low.
According to Dr. Fung, fasting is superior to caloric restriction diets because it keeps insulin levels low for long enough to allow the body to deplete its glycogen stores and tap into fat. Fasting also releases surges of growth hormone, which prevents muscle loss, and norepinephrine, which boosts energy and feelings of well-being. Unlike caloric restriction diets, studies have shown that metabolism increases during and after fasting, preventing weight regain. Dr. Fung argues that fasting can spare muscle, boost metabolism, increase energy, and increase feelings of well-being, making it an effective tool for lasting weight loss.
Ways to Fast:
While the health benefits may be numerous, fasting isn’t easy. The first time I tried a prolonged fast, all I could think about was food. Food was everywhere and the people around me seemed to be eating all the time. My body, accustomed to being constantly fed, wasn’t too happy with the sudden metabolic switch I was demanding from it. Many of our metabolisms have been trained to run on dietary carbohydrate and glycogen as their primary fuel sources, making the first few hours to days of fasting a challenge. However, there are many ways to ease into the practice of fasting. You can obtain Dr. Valter Longo’s Fasting Mimicking Diet kit from a healthcare provider through ProLon, or practice small intermittent fasts, such as Time-Restricted Feeding.
Time-Restricted Feeding:
A researcher at the Salk Institute in Califoronia, Dr. Sachin Panda, PhD, found that restricting eating time had amazing health benefits in mice. Mice were fed an unhealthy diet of lard and sugar. The mice, as you might expect, had shorter lifespans and a variety of health problems: diabetes, obesity, and heart disease. However—and this part is miraculous—when Dr. Panda and his team restricted the time the mice were fed the exact same crappy diet to 12 hours (instead of allowing them to eat whenever they wanted), none of the negative health benefits occurred; the Time-Restricted Fed mice were 70% leaner, lived longer and were free from diabetes or heart disease.
Further investigation revealed that restricting feeding time to 8-12 hours a day, resulted in mice that had less body fat, improved muscle mass, decreased inflammation, increased cardiovascular function, increased mitochondrial function, higher levels of ketone body production, increased cellular repair processes and anti-oxidant production, and increased aerobic endurance. It was when the mice ate, not what they ate, that conferred these health benefits.
North Americans, on average, eat on a 15-hour clock. We seem to eat constantly, stopping only to sleep. To study the effect of Time-Restricted Feeding on humans, Dr. Panda had human participants restrict their food intake to 12 hours a day; if the volunteers had their first sip of coffee at 7 am, they were told to cease all food intake by 7pm. After the completion of the 16-week study, the volunteers lost 3-5% of their body fat without making a conscious change to their diets. The participants reported sleeping better and feeling more energized in the morning. They noted that their overall calorie consumption decreased by about 20% without effort.
Research into Time-Restricted Feeding indicates that allotting at least 12 hours a day to fasting boosts the body’s repair mechanisms, improves digestive function and motility, provides time for the body to switch to ketone body production (which tends to happen 10-12 hours after a meal), improves blood sugar control, regulates appetite, and enhances stress resilience. Taking a break from eating allows the body to invest its energy into repair, rather than digestion. The best part about Dr. Sachin Panda’s research is its simplicity; to obtain all of the benefits, simply avoid after-dinner snacks!
Intermittent Fasting:
Similar to Time-Restricted Feeding, Intermittent Fasting plays with the ratio of fasted to fed hours. Proponents of Intermittent Fasting refrain from eating from 12 to 23 hours within a 24-hour period. A common ratio of fasted to fed time is 16 to 8 hours: fasting for 16 hours a day and eating within an 8-hour window. For example, if breakfast is at 8am, then those following a 16:8 intermittent fast stop eating by 4pm in the afternoon.
Alternate Daily Fasting or the 5:2 Diet:
Studies with mice and human subjects found that alternating daily food intake, or following a 23:1 fast (having just one meal a day) every second day, was effective for weight loss. The protocol is beautifully simple: every second day either fast completely or indulge in only one meal. While people tend to eat more on their “fed” days, they don’t seem to make up the calories that are lost on the fasting days, resulting in an overall reduction in calories and weight loss.
Water Fasts:
It’s estimated that we need to fast for at least 36 hours to get the autophagy benefits, which makes water fasting a powerful therapeutic and anti-aging practice. Water fasting is simple: withstand extended periods, usually 3 to 5 days, but often longer, only consuming water.
The longest recorded water fast was 382 days, performed in 1973 by a 27-year old male who weighed 456 lbs. During the months he fasted, the 27-year old consumed only water and a multivitamin and, according to the study published on him, experienced “no ill-effects”. While water fasts can have amazing therapeutic benefits, it is advised that they be medically supervised.
Ketogenic Diets:
Ketogenic diets are high-fat diets that restrict carbohydrates and limit protein, and can mimic the low-insulin conditions of fasting. Because carbohydrates and protein are restricted, the body is forced to turn dietary fat into ketone bodies, which it can use for energy.
Ketone bodies, especially beta-hydroxybutyrate, produced from either dietary or body fat, have important therapeutic uses. They provide more energy for the brain than glucose, which can have benefits for memory, mood, concentration and cognitive performance. Ketogenic diets have been recommended for treatment-resistant epilepsy, and diseases associated with cognitive decline like Alzeimer’s and Parkinson’s. More recently ketogenic diets have been recommended for mental health conditions, such as depression and anxiety.
Ketone bodies also help cells resist oxidative stress, preventing cellular damage, which makes ketogenic diets of interest to cancer researchers because or their ability to starve cancer cells of protein and carbohydrates, while fuelling healthy cells.
Ketogenic diets can deliver many of the benefits of fasting because of the low-insulin, low growth factor conditions they induce. When a person becomes “keto-adapted”, able to burn ketone bodies efficiently for fuel, the transition to fasting is easy. For this reason, ketogenic diets and fasting often go hand-in-hand.
Cautions:
While fasting can deliver many health benefits, it can impose a temporary stress on the body for those who haven’t adapted to ketosis or prolonged periods without food. Therefore, it’s important to fast under the supervision of a medical professional, especially if deciding to embark on an extended fast.
Before deciding to fast, the individual’s energy levels and vitality, health status, hormone regulation (those who are taking insulin should practice extreme caution when fasting), age, health history, and health goals, should all be considered. A woman of fertility age will have different health goals than a 72-year old woman with type II diabetes. The former may want to preserve body fat and promote fertility and ovulation, while the latter may want to reduce her insulin and growth factor levels, and lose weight in order to promote health longevity.
Fasting may not be appropriate for everyone. For example, those who are underweight, pregnant, breastfeeding or suffering from an eating disorder should not fast. Fasting in women of reproductive age has the potential to produce hormonal imbalances such as hypothalamic amenorrhea (irregular or absent menstrual cycle). Fasting can exacerbate or cause dysregulation in stress hormones, particularly cortisol, known as “adrenal fatigue”, and potentially effect thyroid function, as a result of the body’s starvation response. Fasting while under the pressure of chronic mental and emotional stress is probably not a good idea. Working with a professional and listening to your body are key elements to doing fasting right.
However, when used correctly, it can be a simple, free, powerful therapeutic tool for healing the body, treating chronic disease, and promoting longevity.
A naturopathic doctor offers tips for navigating the often contradictory and confusing world of modern human nutrition.
As soon as we start to feel comfortable with our grasp of human nutrition—which foods are healthy, which ones are unhealthy, and how to eat a balanced diet for optimal health—a new study gets published that shatters our once-felt sense of confidence.
Confusingly contradictory health claims constantly appear in the news, like the American Heart Association’s vilification of coconut oil. The vegan diet-promoting documentary What the Health, currently trending on Netflix, turns convention on it head by assuaging our fears of refined sugar, instead blaming animal protein, eggs and dairy for the worldwide diabetes epidemic. Even I find myself doubting the 15 years I’ve spent studying and working in the field of human health every time paradoxical nutritional data is uncovered.
When I was in high school, I remember patting myself on the back for choosing fat-free options, hoping the leanness of my food would encourage leanness of my flesh. I gave up meat, understanding that I was making a healthier choice; I was told that meat, fat and cholesterol were all culprits of heart disease. I tried giving up eggs and dairy, trying on veganism in order to minimize my impact on the environment. I did an elimination diet while at naturopathic medical school, removing gluten. When my colleagues started reading about the Paleo Diet—grains were the enemy all along, while meat was good for us—I slowly began to embrace a “primal” diet. I started removing myself from the influence of decades’ worth of poorly conducted research and began welcoming saturated fat back into my life. Fat was fine; it was carbs that were the root of all disease. Atkins had gotten it right from the beginning. Eventually I cut out all carbs and sugar and tried a ketogenic diet, eating lots of fat, moderate amounts of meat, and some vegetables.
My journey brings me here, to my Facebook newsfeed, which has been infiltrated with articles condemning coconut oil and saturated fat for raising LDL cholesterol and contributing to cardiovascular disease. “But I thought it was healthy!” Friends, family and patients cry, tearing their hair out in confusion over the news. Some patients have watched Netflix’s What the Health, a documentary from the makers of Cowspiracy, which asserts that sugar’s link to type II diabetes may not bas as strong as previously thought.
The flip-flopping is frustrating for sure, especially for those of us who are committed to living healthy lives for as long as possible. But before we toss our tubs of coconut oil and liquid stevia drops in the garbage and start pulling out the white sugar and margarine again, we should consider how nutritional research is conducted. Let’s entertain different traditional, holistic viewpoints on food and nutrition in order to learn how to feed our bodies optimally.
The Problem with Nutritional Research
There are several problems with how we study nutrition. One of the challenges lies within science itself; scientific studies, by their very nature, attempt to isolate all of life’s complexity down to two variables in order to study them while nutrition, as it’s practised in the day to day lives of human beings, consists of an infinite number of important factors that are often not taken into account.
Most human diet studies are epidemiological. Researchers follow populations of people for years, tracking what they eat and noting how many diseases they get over time. They then synthesize the data to create story. For instance, how much fibre did the people who had heart disease eat? Did those who avoided gluten have a higher risk of diabetes?
In order to assess dietary intake, most epidemiological studies use Food Frequency Questionnaires, or FFQs. Study participants are asked how often they eat certain foods (such as chicken) per week. They are asked to check a box, from “none” to “more than 6 times a week”. As a clinician interested in how my patients’ nutrition may be affecting their health, I assess diet in a few different ways. In the initial appointment, I ask my patients to recall everything they’ve consumed in the past 24 hours to get a rough overview of how they typically eat. Then, between the first and second appointments, I have my patients track their foods in a diet diary over the course of one to two weeks. The accuracy with which my patients report their food intake from the day before depends on their memories, perceptions, and diligence in recording, among other things, and this can compare drastically with their diet diaries that are recorded in real time. Not only do the mundane memories of daily meals evade us, we are often found guilty of deceiving ourselves based on how we feel we should be eating, rather than how we actually are. I find it hard to believe that participants are filling out FFQs accurately.
Also, the stories that epidemiological studies create from the data establish correlation, not causation. With many correlations (like one of my favourites: ice cream consumption and drowning—both occur in summer) there is often no direct relationship. If assessing the connection between fat intake and diabetes, a good study will take into account all meaningful variables, such as how often the participants exercised, or whether they had existing cardiovascular disease. However, considering all the possible factors that might effect the relationship is virtually impossible. For instance, what was the status of the gut flora of the participants? What was their antioxidant or mineral status; were they magnesium deficient? Were they consuming meat that was pasture-raised or corn-fed? How high was their daily toxic exposure? Did they experience chronic stress? How well were they sleeping? What were their levels of inflammation like? And so on.
The trouble with studying nutrition and disease is that, when it comes to health, context matters; context may be all that matters. For instance, while we know that barbecued meat can produce carcinogens that potentially lead to cancer, a study found that when the meats were seasoned with rosemary the carcinogenic load of the meat was neutralized. It’s nearly impossible to form a complete picture when we insist on studying isolated factors, leaving out many important details.
Animal studies, while allowing for tighter control (we don’t ask mice to report their diets, we just feed them), are also flawed. Firstly, mice and humans are completely different species with different nutrient requirements. However, animal study designs can also be problematic. Animals are given lard and white sugar to assess the effects of a high fat, high sugar diet on their health—their diets are exaggerated for the purpose of the study. Human beings, however, eat burgers, cake, and ice cream. We don’t eat single nutrients like fat and sugar, we eat food. If a mouse gets sick on a diet of lard and table sugar is it because of the foods it was eating, something he wasn’t eating, or some other unforeseen factor? There may be a huge difference between eating a high-fat diet with no vitamins and minerals, and eating a high-fat diet that contains complete nutrition.
A third method for studying human nutrition is through randomized control trials, or RCTs. In RCTs humans are randomized into a group that receives an intervention, like a dietary plan, or a control group that is told to follow some other diet or just eat normally. These trials control as many variables as possible, but the timeframe for these studies is often too short to garner meaningful information about health outcomes, which may take years to manifest. It is also difficult to get participants to stick to meal plans. Further, it’s hard to establish consensus for each diet being studied. For example, when assessing the nutritional merits of the Paleo diet, how many servings of vegetables should participants be told to consume? How many grams of fat? What types of fat?
It’s important that we can use studies to seek answers to our questions about the relationship between nutrition and health. However, due to its many limitations, nutritional research can only take us so far. This is why one study may indicate that high sugar diets contribute to diabetes risk, while another study finds no relationship.
A New Food Guide
If we can’t trust research studies to tell us what to eat, who do we trust? Surely we can’t rely on Canada’s Food Guide, with it’s outdated recommendations that simultaneously overemphasize grains and dairy, while continuing to uphold archaic views on fat. Primarily created in the 40’s to help Canadian families ration their food during the war, the Food Guide was not necessarily created to promote the optimal health of those who follow it.
Dr. Ray Cronise, a former NASA scientist, outlines a food pyramid in his paper to help organize food into nutrient content. I often borrow his pyramid to depict nutritional balance to my patients.
Ray’s pyramid is composed of four circles, three that form the base of the pyramid, forming the three main groups of macronutrients: protein, fat, and carbohydrates, and foods that are composed primarily of each. The circle at the top represents the foods that contain a higher number of micronutrients: vitamins and minerals, which are mainly non-starchy vegetables like leafy greens.
Protein-rich foods include meat and animal products, including fish, eggs and dairy. Fat-rich foods include nuts, seeds and oils like coconut oil, avocado and olives. Carbohydrate-rich foods include starchy vegetables like potatoes, grains, legumes and fruit. Ray concedes, however, that none of these foods are composed of a single macronutrient; animal products often contain a significant amount of fat; nuts and seeds also contain protein and carbohydrates; and legumes and grains contain some protein as well.
Ray points out that most diets, particularly the Standard American Diet, is bottom-heavy. North Americans generally over-consume macronutrient-rich foods that are higher in fats, carbs, proteins, and calories in general, and under-consume micronutrient-rich foods like fruits and vegetables. Because of this, North Americans consistently fail to meet the levels of vitamins, minerals and antioxidants essential for optimal bodily function.
It seems that even “healthy” diets tend to focus on the bottom of the pyramid, restricting certain groups of foods while making up the balance by over-emphasizing others. Paleo and low-carb dieters often fixate on the right side of the pyramid, including animal products, nuts and seeds, but avoiding grains and legumes, while vegan and vegetarian diets concentrate on the left side of the pyramid, eschewing all animal products and getting protein from grains, legumes and nuts instead.
One thing all healthy diets seem to emphasize, however, is fruit and vegetable consumption. When studying the merits of a vegan or paleo diet, it is the non-starchy, micronutrient-rich vegetables that may confer most of the health benefits, regardless of the carb, fat and protein content. Therefore, Ray recommends focusing on the top of his food pyramid, eating as many vegetables as possible, while eating a balance of foods from the base.
Since we rarely eat pyramids, I often depict this balance for my patients using a plate. I divide the plate into four quarters. One half of the plate is dedicated to colourful vegetables, with at least a full quarter dedicated to greens. The other two quarters of the plate are divided into starches: grains, legumes, tuberous vegetables, and proteins: meat, dairy, eggs, fish, or legumes. Oils and fats can be used to cook with or added to the meal in the form of avocados, nuts and seeds.
Listening to the Body as Guide
So, while Ray’s advice to eat as many green and colourful vegetable as we can while eating a balance of the foods at the bottom of the pyramid is sound, how can we establish what the right balance is for us? Many of us will have vastly different requirements for the macronutrients: carbs, fat and protein. My body has an energy demand that is different from that of my 6′ friend who lifts weights daily, or my 90-year old hypertensive, mainly sedentary Italian grandmother. As a naturopathic doctor, who believes in an individualized approach to health, I tend to reject top-down dietary recommendations that ignore the variabilities among people.
A friend of mine, having damaged his health through a string of restrictive dieting, argues that all food—even refined sugar and saturated fat—has a place in a healthy diet. He believes our bodies are designed to crave fat, protein and carbohydrates in ratios that promote optimal health. He writes in his book that we can eat whatever we want as long as we eat intuitively and avoid foods laden with “fake” flavours and processed oils, like corn oil, that confuse our internal cues and hunger signals. He also argues, like the filmmakers in the Netflix documentary, What the Health, that there is no evidence that refined sugar causes diabetes, and that diets based on avoidance of certain foods are detrimental for health.
While I’m not convinced that refined sugar deserves to be completely cleared of all charges, I agree that mindful and intuitive eating may be the key to maintaining balance. Healing with Whole Foods by Paul Pitchford places awareness and physical activity at the base of its Integrative Food Pyramid. The idea is that we need to first establish the foundations of movement and mindfulness before we begin to talk about food intake. As my friend says, perhaps the key is tuning in to our own internal physiological and emotional cues through mindfulness, paying attention to hunger and cravings, rather than measuring calories, carbs, protein, or fat grams.
Following our internal cues may be difficult, as the book TheDorito Affect outlines. The author points out how certain foods are engineered to override our hunger and satiation signals and monopolize our cravings, leading us to overeat. Therefore, if we’re going to follow our body’s signalling, mindfulness is a requirement, but so is following the advice of Michael Pollen, author of The Omnivore’s Dilemma, who famously tells us to “Eat food. Not too much. Mostly Plants.”
Pollen urges us to stick to foods that resemble something we might encounter in nature: eat foods our grandmothers would recognize; purchase foods that come from a plant, not foods that are made in one; and to stick to whole foods or packaged foods with five listed ingredients or less. Pollen also encourages us to cook and prepare as much of our own foods as possible. Do you have a craving for potato chips, ice cream, or dark chocolate? Feel free to indulge, as long as you make it yourself using the raw, natural ingredients. The theory is that, when the body is given clean, whole food, it regulates its hunger and satiety signals to communicate to you exactly what it needs.
Heal the Individual
When it comes to whole foods, I believe that there are no “good” or “bad” foods, generally speaking. Observational studies that examine how traditional societies ate suggest to us that saturated fat, animal protein, dietary cholesterol, and carbohydrates all have a place in a balanced diet. However, when it comes to diet, especially therapeutic diets, it’s my job to consider the individual and their health context: there are no good or bad foods, but some foods are better or worse for certain people, and some may even be better or worse for certain people at certain points along their health journeys.
When I am helping my patients calm inflammation, heal their digestive systems, clear their skin, or manage autoimmune disease, I often recommend identifying food sensitivities and eliminating those foods from the diet. Oftentimes these foods need to removed only temporarily, but sometimes foods may need to be removed indefinitely. Patients with insulin resistance, such as in the cases of obesity, PCOS, diabetes or metabolic syndrome, often do well on a low-carbohydrate diet to restore insulin sensitivity. Again, these anti-inflammatory, reduced-carbohydrate diets may only be required until hormonal balance is restored. Older adults concerned with promoting longevity, or patients undergoing cancer treatment, may do better restricting protein to lower their levels of growth factors, while athletes and stressed out adults may require higher amounts of protein to promote muscle building, or to synthesize mood-regulating neuro-chemicals. A woman who is stressed, depressed, exhausted and iron deficient may feel much better increasing her dietary intake of red meat to help regulate her nervous system. Another woman, with a family history of colon cancer, may do better avoiding it.
Endless factors need to be taken into account when we consider which dietary style is right for us. Our health goals, health status, nutrient status, digestive system health, immune system health, liver functioning, insulin sensitivity and hormone balance, levels of stress, toxic load and inflammation are just some of the things that I consider when making lifestyle recommendations for my patients. Lifestyle preferences, tradition, culture, religious backgrounds, cooking abilities, time constraints, and other factors, will also all play a role in our food choices and eating habits.
Our emotional connection to food and our ethics also matter. While veganism is certainly not a diet I recommend, if consuming animal products is out of line with one’s morals, then following a vegan diet may be the healthiest way for them to live in accordance his or her beliefs. Similarly, someone with a history of disordered eating may need to lift all food limitations, even junk food, in order to heal his or her relationship with food and hunger.
Investigations into the eating patterns of traditional societies tell us that human beings thrive on a variety of different diets. Optimizing diet for the individual goes beyond following the latest research or government and industry-funded health recommendations. It involves eating a variety of natural, whole foods, learning to pay attention to the body’s hunger signals, and even working with a health professional who uses diet to help promote health and manage disease on an individual level.
Current research suggest that gluten can increase systemic inflammation, contributing to a worsening of mental health symptoms, as well as other inflammatory conditions, such as pain and autoimmune disease.
Transcript:
Hello, you guys, my name is Dr. Talia Marcheggiani and I’m recording to you guys from my clinic in Bloor West Village. It’s call Bloor West Wellness Clinic, in Toronto, Ontario, Canada. And today, I’m going to talk to you guys about how a gluten sensitivity might be the underlying cause of your mental health conditions or other inflammatory conditions such as arthritis, migraines and digestive symptoms like IBS.
One of the reasons that I’m recording this video is because gluten is a really hot topic in the health and wellness industry and you’ve probably encountered your own versions of gluten-free food, or articles on the internet about how gluten is this evil toxin and there’s a lot of misconceptions around this and so I’m going to just talk a little bit about what gluten is and my own journey with cutting gluten out of my diet and how I came to that space where I was willing to do the experimentation and cut it out and see what my results were.
So, gluten isn’t a toxic substance per se, I mean there’s opinion around this in certain circles based on what it can do and how it affects the immune system and the results it can have on digestion, if you have sensitivity to it. But, what gluten is, is it’s a protein complex; it’s a bunch of proteins that are found in grains—wheat, rye and barley. And the protein complex consists of different proteins called gliadins. I might use gliadin and gluten interchangeably; it’s the same thing.
And, so, there is a health condition called Celiac Disease that’s a very serious health condition; it’s an autoimmune condition where the body attacks an enzyme called transglutaminase that’s involved in processing gliadin molecules. So this is not a reaction to gluten, per se, it’s an autoimmune reaction that’s caused by, that’s caused any time the body comes into contact with gliadin or gluten.
And celiac disease is a very serious health condition, it affects about 1% of the population, but there’s some room there for debate. So, some people think that you acquire celiac disease as you go on, and there’s evidence for that. And also, some people think that there’s a great underestimation of how many people are affected by celiac disease, that the number is higher than 1%, but that a lot of the cases do undetected.
And so celiac disease is diagnosed by blood tests. We’re looking at transglutaminase and endomysial antibodies, but the gold standard diagnosis is doing an intestinal biopsy. So, that’s how you find out if you have celiac disease, or not. So some people have done a blood test and they’ve tested negative for celiac disease, but are exhibiting some of the symptoms and so an intestinal biopsy will tell you yes or no definitively whether you have it or not.
Now, whether someone with celiac disease should avoid gluten or not isn’t really the debate here, I mean, that’s obvious. So, if you have celiac disease you have to avoid gluten 100%, it can’t be in your diet. You can’t even have a crumb of it. You have to use special toasters, or toaster bags, for your gluten-free toast. You have to make sure that your oatmeal hasn’t been contaminated by gluten. You can’t shop at Bulk Barn because there could be cross-contamination with gluten-containing substances. So, it’s almost like an allergy, you really have to be careful about coming into contact with gluten. And when people avoid gluten, if they have celiac disease, then that disease is managed.
So, whether someone with celiac should avoid gluten or not is not up for debate. What is is in this grey area, which is what you’ll be reading about online and that you’ll hear certain professional say is kind of myth, is this idea of non-celiac gluten sensitivity or gluten sensitivity. These are people who don’t have celiac disease, but for one reason or another notice that, when they take gluten out of their diet, they feel better. And when they reintroduce gluten they feel worse. And the symptoms are complex, just like in celiac disease. So, in celiac, people can get rashes, they can get joint pain, they can experience brain fog, they can experience brain damage, they can get arthritis, they can start getting other conditions such as thyroid conditions and so the symptoms are so wide-spread because of the inflammation that is triggered by eating gluten, and this is also the case with non-celiac gluten sensitivity—people who avoid gluten.
So, my story was that when I was a student at the naturopathic college, one of the things that I was exposed to in first year was this idea about elimination diets and leaky gut, which I’ll explain in a bit more depth, but you might have heard me write or talk about leaky gut. And, this idea that things like gluten or dairy could be contributing to some symptoms that I was experiencing and that a lot of patients were experiencing, and that taking these foods out in a systematic fashion, so doing a really clean diet, or a “hypoallergenic diet”, or a diet that’s basically chicken, rice and maybe some spinach, that that would heal a lot of the complaints that I and many others were experiencing, but that probably gluten was implicated in that.
So I was really resistant to this for at least two years. So, I wasn’t an early adopter at all to this idea, a lot of my classmates got the information, they went out and they started eliminating a lot of these foods from their pantries and they tried eliminations just for fun—well, for fun and also to experiment and to heal themselves and to “walk the talk”, as we say. But, I was living with my Italian grandmother and I would have toast for breakfast, I’d have pasta for probably lunch and dinner. I was getting gluten in my diet a lot and the idea of taking it out and resisting those familial pressures was—I just didn’t want to deal with it.
But, throughout the first couple of years of school I was also getting migraines on an almost weekly basis. And these migraines would take me out for the entire day. So, for the entire day I’d be throwing up, lying in the dark with a cloth on my head, trying to take some Advil, or something to mitigate it, but this was a chronic thing that I was going through.
Best case scenario, I’d get these once a month, but they were things that I was getting often. And I also had this life-long problem with bloating, these kind of IBS symptoms, like gas and bloating and, when I first started the naturopathic college, it was amazing to me that that was something we were talking about, because I’d kind of written that off as just being something, a peculiarity or particularity about my body that I’d just have to live with and it didn’t even occur to me that something that wasn’t considered a “disease”, per se, could be something that warranted attention and that had a treatment that went along with it, and a cause.
So I was kind of intrigued by that idea, like “oh, you mean I don’t need to be bloated?” and that, even though I’m not sick, like I’m healthy, I don’t have a disease, I don’t have high cholesterol or some of autoimmune disease, or type one diabetes, or something like that, but that the idea that an imbalance, or symptoms that were uncomfortable could be treated was totally new and exciting for me.
And so there was this intrigue in being gluten-free, but also this resistance to it.
And then, I think I was at a talk at school where we were given—it was sort of an information session, we were given free samples of a 7-day detox that involved shakes. And so, I did that because I had this free box, probably worth about $80 and I just decided, “ok, well I’m going to do this detox, it will be good for me. It will be sort of my introduction to eliminating a lot of these foods. It’ll be easy.” And it was really difficult. The first two days I had massive headaches as I was withdrawing from a lot of the things I was addicted to, such as caffeine, sugar and, probably, gluten, as well. But that sort of set the stage because I felt a lot better after that process, even after only that week of eliminating the foods. And so, when I started introducing the things I was eating normally back in, such as pasta and bread, I felt a lot worse. So, that discrepancy kind of woke me up to the idea that maybe these foods aren’t that great for me. And then I began a process of elimination and noticed really good results. I mean I don’t get migraines any more. It’s very very rare, and it’ll be a combination of weather and other factors and stress and overwork. But, that once-a-week, or even once-a-month, being in the dark with a cloth on my head, no noise and vomiting all day: that’s in the past. And now when I reintroduce gluten I can maybe tolerate a bit of it, but I definitely notice a difference in my energy levels, in my digestion, and just in my mental functioning and in my mood when I make a habit of having it more often. So, I’m basically grain and gluten-free and have been so for about 4 or 5 years.
So, why is gluten bad? Why gluten? Why is that an issue? The obvious answer is that it’s so present in our society. So, in North America, gluten is one of the main staples in our diets. So, pasta for lunch, bread or a sandwich for dinner, and toast for breakfast, or cereal. We’re getting gluten as a main source in our diet, in wheat, very often. And so, when we’re exposed to certain foods continually, we become more susceptible to an immune response against those foods.
But also, gluten has, we see in the mechanism of celiac disease, there are these, this genetic predisposition to react to gluten. And so on immune cells, and we know that our digestive system is the gateway between our bodies and the external environment. And so, how our immune system kind of “educates” itself is by sampling things from the environment and deciding what’s us—and we shouldn’t attack ourselves, because that creates an autoimmune issue—what’s us, what’s ourselves and what’s food, what’s useful to the body, what’s supposed to be incorporated into the body as fuel—and what is not helpful for the body, what is toxic, what is foreign, and what we need to defend against, like bacteria and viruses.
So, our digestive system is kind of involved in sampling from the environment, deciding and showing those pieces of the environment to the immune system, and letting the immune system decide what it’s going to do about these things.
So, when we’re eating foods we’re kind of presenting them to the immune system. And our immune cells have different receptors, so they’re called receptors, but they’re sort of like, you can describe them as like locks for keys or little sort of antennae that feel out the environment. And so people with the receptors, HLA-DQ2 and HLA-DQ8 receptors, on their immune cells, those people tend to react and to connect those receptors with gliadin molecules, so gluten molecules, and that signals an immune response from the body. And when the body thinks it’s come into contact with something that it needs to trigger an immune response against, so that means something foreign, something threatening to us and to our health, then a whole inflammatory pathway starts to take place.
So, think about when you get a cold. You come into contact with the virus and the reason that that virus doesn’t kill us is because our immune system reacts to it. When you get a cold, depending on what virus you’re in contact with, you might get the swollen throat, and the pain, and maybe a fever, and maybe some mucus production, some runny nose. You might feel tired because it takes a lot of energy to mount an immune response like that.
So, when we’re experiencing inflammation, it’s really useful for us, because we’re killing off the things that could kill us, basically we’re at war with something from our environment, but it also doesn’t feel great to be in that state. And so we get into trouble when we’re in an inflammatory state and it’s not for the right reasons, like that we’re trying to attack something (acutely) and get rid of it.
So, a lot of people have these receptors. So even though only 1% of people react to gluten in the sense of celiac disease, about 30% of people express these HLA-DQ2/8 receptors on their immune cells. And so, coming into contact with gluten on a regular basis could be problematic for these people and it could trigger some inflammation.
Another thing that gluten does is create a leaky gut situation. So, I’ve talked about leaky gut before. Our intestinal cells, so our intestine is this long tube from our mouth to our anus, and it winds around and it goes from mouth to esophagus, to stomach, to small intestine, large intestine, and then rectum and anus, and different things happen along that process. And in our small intestine, we have these really long, they’re kind of like cylindrical cells. And, on one end, on the end that’s in contact with what we eat, there’s these little fingers, these villi that reach out into the environment and that maximizes our ability to absorb the things that good for us—the foods that we eat. And, in between—so, the villi kind of control, ok we’re going to break down the carbs, and we’re going to break down the amino acids, from proteins and we’re going to break down the fatty acids, and we’re going to absorb all of the ions and the minerals and the vitamins and we’re going to control how we take them in. We’re also going to control how we take in foreign substances, because we’re going to, remember, show them to the immune system and say “take a look, this is what’s in our environment. This is what you guys might need to prepare yourselves to defend against if this becomes a problem for us.”
And so, we really control, tightly, what we’re taking in through our intestine. So our intestine doesn’t just want to open up the gates and let whatever is outside in, it’s got these really specialized mechanisms for letting certain things into the body. And, so, between these intestinal cells. You imagine these cylindrical cells, almost like a hand, with little fingers, and they’re lined up all along your intestine. And between them are something called tight junctions. And so those, they might become more or less permeable depending on the state of the gut, and that’s controlled by something called zonulin.
Zonulin will open up that permeability and let things in between the cells. And lower amounts of zonulin will maintain a more closed environment. And so one thing that gluten has been shown to do, or gliadin, is increase levels of zonulin, which opens up our intestine to the external environment. And think about the things we eat. Think about the things that swallow, by accident or intentionally, the things in our environment that are toxic, or giant pieces of protein from foods. So, protein in and of itself can cause an immune reaction. We have children that are deathly allergic to peanuts and other nuts.
So, it becomes problematic when we have all this stuff just entering our body. And so gluten opens up the gut to allow all these things to enter the body. And so we end up mounting an immune response to things that would otherwise be harmless to us, like dairy, or eggs, those kind of things that are actually nutritious and helpful for our bodies. So, we start to enter this state. When we’re in a leaky gut state we start to enter a state of inflammation. And inflammation has widespread effects. In my case it was migraines and bloating and digestive symptoms, a foggier mind, foggier brain and lower mood as well. And in some people it can be bipolar disorder. It could be worsening of symptoms on the autism spectrum. It could be depression and it could be anxiety. And when we’re in that inflammatory state we have higher amounts of something called, they’re like excitotoxins, or endotoxins. And so these are toxins like lipopolysaccharides, or LPS, as it’s most often referred to, that trigger anxiety, they activate the limbic system, they activate the amygdala; these are fear centres in our brain.
We also have something called the Blood Brain Barrier (BBB). And that’s really similar to the intestinal barrier with the tight junctions, and that prevents things from getting into our brain that are in our bloodstream. So, it’s like we have this second wall of defence because our brain is so important to our survival and fluctuations in our brain chemistry have really disastrous effects. So we have this extra sort of layer called the BBB that prevents things from getting into our brain. And when we’re in a high inflammatory state, like when we’re exposed to gluten, we get these cross-reactions where what keeps our blood brain barrier intact starts to separate, so we get this leaky brain picture. So we’ve got a leaky gut and also a leaky brain happening. And so we’re getting these toxins, and we’re getting inflammatory mediators entering the brain.
And more research into depression and other mental health conditions has shown that inflammation might play a giant role in low mood. There was one study done with patient who were hospitalized for bipolar disorder. So, these were people who were in a psychiatric facility. And they measure their blood for antibodies against gliadin. And they found that there were elevated antibodies in these people. So, there wasn’t a control group, they weren’t testing against non-bipolar, or people that didn’t have a bipolar diagnosis, but they found that every single patient, who was diagnosed with bipolar disorder and was hospitalized, so their symptoms were severe enough to require hospitalization, had elevated levels of antibodies to gliadin. Then they retested them some time later and found that having high levels of gliadin, or even further rises in gliadin antibodies, predicted whether they were rehospitalized. So, we can infer from that that their symptoms worsened. And so we know that there is this connection between mental health conditions, you know, depression and anxiety and bipolar and even psychosis (and gluten sensitivity). Another study showed that there were high levels of antibodies in people who had psychosis and psychotic symptoms.
So, we know that there is this connection with mental health and with inflammation and that this inflammation can be worsened by a gluten sensitivity or gluten reactivity and that maybe 30% or more of people are susceptible to reacting to gluten in some kind of way. And that gluten just in and of itself might cause this leaky brain situation or leaky gut situation. So, one thing I do is that I don’t do this with every single patient that I see who comes in with depression or anxiety or stress. I mean I don’t jump right into prying gluten from their hands, because my own experience was that it took me literally two years to think about removing it and I had to come to it on my own. But, I might plant the seed, or we might do something like a trial run. Especially someone who’s got mental health symptoms, or is coming to me for mental wellness, and they also have digestive symptoms. I mean, those two things together are a clue that doing some elimination diet, or some leaky gut healing or removing foods like gluten could be a good idea.
But I might present the option to them. We find that most treatment does really need to have 100% compliance rate. So, some patients will come back and say, “you know, I kind of took gluten out, maybe 70-80%” and that’s really great, because I think that it sort of sets the stage for creating a gluten-free lifestyle and doing a gluten-free trial, but really what the research is showing is that we need to 100% take it out to allow the gut healing and the brain healing to occur and to lower those inflammatory mediators.
But, the good news is that it usually takes about 2 to 4 weeks to get symptoms to really come down. So, it’s not like you’re on this trial for life and you can go back to your pasta—if you don’t notice any change after 2 to 4 weeks, at all, then you can go back to your pasta with the peace of mind that this isn’t an issue for you. But, if you do notice some improvement after removing it, then it is something that we can investigate either down the line, when you’re ready, or something that you might want to consider. It’s sort of like planting that seed. But, I don’t pry out of my patients’ kicking and screaming hands. It will be something that we might work on down the road, and something that is always kind of on the table or on the back burner for future attempts and experimentation.
And so, the gold standard, when it comes to treating gluten sensitivity, is just to do an elimination, so take gluten out of your diet for about a month, 100% out, as best you can. There are blood tests that you can do and those can show an elevated antibody response to gluten or gliadin or wheat as well as other foods. The one I do on my patients looks at about 120 different foods. And this is great because having a piece of paper that shows you what your immune system is dealing with in the moment that you got the blood work done is useful. And people tend to, when it’s a blood test, it tends to hold more authority than simply the subjectivity of symptoms. But, really, the best way to see how gluten affects you or how certain foods are affecting you in your immune system is to do an elimination diet, remove it 100% from your diet, give your body some time to heal and then reintroduce it and see what it does to you once you’ve healed from the state that it’s put you in.
Doing that removal is important because the antibodies are only one part of the immune system and so when I’ve done a food sensitivity test on myself, I felt crappy because you have to eat the food for a while. So I was reintroducing gluten into my diet and I didn’t have a high gluten antibody. I had antibodies to other foods, but not gluten. So I kind of psychologically was like, “well, I guess I’m ok to eat it, then.” And went back to eating it a bit more regularly and then experienced really terrible symptoms and my mental health took a decline and then I had to take it out again.
So, the labs don’t necessarily tell the whole story. What does tell the whole story are your symptoms. So, taking gluten out for 2 or 4 weeks is what I recommend most people do. And, so how do you take it out? So, really what the goal is, because, and I’m saying this piece now because there were some articles that were floating around, it was a few months ago, but I’m sure they’re still around, that said, “going gluten-free is unhealthy. It’s dangerous.” And I was really confused by that because I was like, it’s not like wheat is this really important food in our diet that’s giving us all kind of nutrients. We fortify grains with things like folic acid and other B vitamins, like riboflavin. But, they’re not super nutritionally dense, and it’s not like we have a calorie deficiency where we need to get more carbs and calories. I’m not telling people to avoid spinach, or something that is really giving them a lot of nutritional currency, so why would it be harmful to take gluten out?
And then I realized how it’s often being taken out. So, you go to the grocery store and you find that there’s a whole gluten-free section. They basically have gluten-free breads or gluten-free Oreo cookies. And those gluten-free Oreo cookies are for, like, celiac children that want to join in with the rest of the group. They’re not like, “oh, I’m eating these gluten-free Oreo cookies. These are a healthy choice that I’m making.” It’s a substitute for a junky food. You’re substituting one junky food for another junky food, but the only thing is that you’re still maintaining your gluten-free status while on the substitution.
And when it comes to gluten-free breads vs. whole grain breads or whole wheat breads. Probably whole wheat breads have more nutritional bang for their buck; they’re higher in fibre, they have more nutrients. And gluten is a protein, which is what causes the immune system reactivity that it does, but if you don’t react to proteins, they’re healthy for us and we need them, because they contain the amino acids and they fill us up, and they do all the other things that proteins from other foods do. So, usually gluten-free bread doesn’t have very many proteins in it.
So, yeah, if you’re choosing between nutritional value of a gluten-free bread versus a whole wheat bread, then the whole wheat bread is better for you. So, we see this in people that do gluten eliminations and they’re kind of like, ok I’m going to take my wheat pasta and I’m going to have rice pasta instead. I’m going to take my gluten-free toast in the morning, or my gluten toast, my wheat toast in the morning and have gluten-free toast instead. So, that’s not the healthiest way to go about it. It might be a good way to transition when you’re trying to do an elimination. It gives you peace of mind, it allows you to still have your Oreos. It’s not creating a giant change, then that could be helpful. But really what we’re aiming to do is not just substitute wheat products, or gluten-containing products, for non-gluten-containing products and leave it at that, we’re trying to shift into a more traditional diet, like a Mediterranean diet or a Paleo diet, that’s higher in the fruits and the vegetables, and that’s higher in the healthy fats and that’s more protein-rich, and that the proteins are from better, cleaner sources. So, that’s the end goal. So, it’s not that we’re happy with patients eating rice flour and tapioca bread. It’s about switching to a cleaner and more sustainable diet that our bodies evolved to thrive on.
However, the immuno-reactivity of gluten is really what we’re trying to deal with when we’re going on a gluten-free diet, especially the 2 to 4 week trial run. And so what you’re doing on that 2 to 4 week period that’s allowing you to stay on gluten, if that involves gluten-free rice bread, then that’s another story and I think, as a naturopathic doctor working with people who are struggling to get rid of gluten and see if that’s an issue for them, I think that’s ok for the short term.
So, it’s not that going off gluten is bad for you, it’s how we do it. Are we changing our habits for better ones or are we kind of sustaining some of the same Standard North American Diet habits and just cutting the gluten out and thinking that that’s healthy for us, or that that’s going to cause weight loss, or whatever.
No, this is a different thing that I’m talking about. I’m talking about gluten as a root cause of inflammation that then leads to psychiatric disorders, such as bipolar, depression, and anxiety.
And, so one thing I’m going to say as well is that sometimes it’s not enough just to take out gluten and so what I do—or other foods that are suspect, right, so dairy could be another culprit in this or things like eggs, or soy. There’s many things that we could react to. But we often start with gluten. So, often taking the food out isn’t enough and we need to do some gut healing with things like l-glutamine, which I mention in my amino acid talk and also restoring the probiotic balance and doing some things that are just helping repair the gut, getting digestion back on track, getting your digestive motility moving through things like digestive enzymes and bitter herbs and things that like. And so, I’m just going to mention three probiotics that have been shown—they’re called “psychobiotics”. They’re nicknamed that because of the beneficial effects on mental health and in another lecture I was also talking about how the probiotics in our gut are also responsible for producing serotonin that our body has available to it, which we know is the “happy hormone”, that’s what the selective serotonin re-uptake inhibitors work on. So, getting the right balance of bugs in your gut could be just as effective, potentially, as taking an antidepressant medication. So, that’s really cool. But the three bugs that a lot of research has been done on are the Lactobacillus casei, Bifidobacteria longum and Lactobacillus helveticus, which has been shown in studies to actually decrease anxiety and to lower levels of cortisol, which we know is also implicated in depression and anxiety and probably other more serious psychiatric disorders.
So, I hope that was enlightening. We talked about how gluten can contribute to inflammation, leaky gut and thereby exacerbate or create mental health issues. How going gluten-free is not the same as going “whole foods” and how going gluten-free might be the answer or at least a part of your self-care process in healing from mental health conditions.
Thanks a lot, guys. I hope you’re having a good New Year, a good 2017, and I’ll see you soon.
My website is taliand.com and you can contact me at connect@taliand.com. I’m a naturopathic doctor and I focus on mental health and I work in Toronto, Ontario, at Bloorwest Wellness Clinic.
The gut-brain connection has gotten the attention of researchers and functional medical practitioners. I discuss, briefly, what research has shown us in regards to the complex realm of the microbiome and how depression may be a result of inflammation in the brain, stemming from inflammation in the gut.
My name is Dr. Talia Marcheggiani and I am a naturopathic doctor and mental health expert in Toronto.
Today we’re going to talk about the gut-brain connection and how that can influence your mental health symptoms.
I think we intuitively know that the gut and brain are connected. When you feel mental symptoms of anxiety we immediately notice the effects on our gut.
During times of stress, we know that we have indigestion, we’re more predisposed to things like diarrhea and irritable bowel syndrome.
Even anatomically there’s a nerve, called the Vagus nerve, that directly connects the brain to our digestive system.
This nerve is responsible for putting into that “rest and digest” state.
When this nerve is stimulated, our bodies start to secrete digestive enzymes, saliva starts to be secreted and we’re able to break down our food and absorb the nutrients from the food that we’re eating.
A lot of research has been going on, that you might be aware of, about healthy gut bacteria. And more and more people, especially medical doctors, happily, are prescribing probiotics anytime someone is prescribed antibiotics for a bacterial infection.
Scientists have started to study more about these gut bacteria. We know we have, like, 5 lbs of gut bacteria, sitting in our digestive systems. Over 100 trillion cells, this is more than 10x the amount of cells we have in our physical bodies, and more DNA than we have in our body.
We’re more bacteria than we are human!
And these gut bacteria, we can’t survive without without them, they influence the very physiology we experience and they definitely impact our health.
These bacteria are responsible for helping us digest our food, and for our mental and emotional wellness as well as keeping our immune system in check.
So, a disbalance in bacteria, or an increase in that negative, bad bacteria and not good strains of healthy bacteria, can lead to diseases like autoimmune disease or multiple sclerosis, or things like chronic fatigue syndrome as we’re seeing in research.
Scientists are starting to study more about how the bacterial balance in our gut can influence our mood and mental health.
These gut bacteria can actually produce serotonin. So that’s the happy hormone in the brain. And you may have heard of serotonin, especially if you suffer from depression or anxiety because your doctor might have recommended a kind of medication called SSRIs, or Selective Serotonin Reuptake Inhibitors, or a similar drug, SNRIs, like Venlafaxine, which is a Selective Serotonin and Norepinephrine Reuptake inhibitors.
This is based on on the Monoamine Hypothesis that there is this chemical imbalance in the brain. That your body is either not making enough, or absorbing enough or reacting to serotonin enough.
When we’re given these antidepressants, the idea is that we’re recorrecting this brain imbalance and that’s as much of the story as we’ve got. We don’t know why these brain imbalances are around.
So I think that, if we’re going to stick with this hypothesis, which is still controversial in science, we should look to the gut bacteria because we know that gut bacteria produces a significant amount of serotonin and, if we’re blaming depression and anxiety on serotonin deficiencies, why not look at the gut and find out how we can influence the balance of healthy gut bacteria so that we’re producing enough serotonin. Especially if we’re relying on drugs to correct the imbalance and we don’t have enough serotonin for the drugs to work properly.
Gut cells on their own produce 95% of the serotonin in the body so basically every single chemical that we have in our brain is produced or exists in the gut.
So, we need to be able to feed the gut cells so that they’re producing healthy amount of hormone we need to experience a healthy mood and live our lives in ways that are stress-free and energized and happy so that we can effective in our lives.
Mentally and emotionally, you might know this “gut feeling” that we talk about in language and that’s kind of permeated throughout cultures. So, we know that when we have this feeling in the gut that, it’s almost like an intuition. Some people will say, “I just knew it, because I felt it in my gut.” And I think that we’ve always had this intuition. We’ve always had this connection between what our mental state, our thoughts, beliefs and emotions are telling us and what our gut is telling us.
We think that we think with our brains and that all of the mental symptoms we experience are happening at the level of the brain, but because of this tight gut-brain connection, we know that’s not true.
People that have done brain studies actually find that we have thoughts before we have brain activity a lot of the time so, I wonder if we’re actually thinking with our gut, which is a revolutionary and radical thought, but we’re finding more and more evidence for this in science.
You may have heard of the condition called “Leaky Gut” or the more official, scientific term is “Intestinal Permeability”. Our gut is really selective about what it absorbs for good reason. What happens, though, when we’re experiencing chronic stress, or we use a lot of antibiotics or maybe eat things like high-sugar foods, caffeine, or a lot of alcohol, we can cause gut inflammation, which starts to allow bacteria, food toxins, or whole proteins from food into the blood, into the body by breaking down the integrity of the gut.
So, when it comes to health, for most health conditions, especially when there’s a few symptoms that seem disconnected and it’s hard to find the relationship between them, naturopathic medicine and, now, functional medicine and, hopefully soon, conventional medicine, begins to look at gut health.
So if I’m sitting across from a patient who has a long list of health symptoms that seems like they’re not connected and has digestive symptoms—and 40-60% of the population, in general has some kind of digestive symptom, whether it be bloating after eating, feeling fatigued after eating, just feeling like your food is sitting in your stomach and not really moving through, GERD, so acid reflux, heartburn, diarrhea and constipation, or those IBS symptoms, gas and bloating—when I sit across from a patient with any of those symptoms, the first place we go, in terms of treatment, is to look at the gut.
So how do you keep your gut healthy? There’s a few things. The first is to eliminate anything that’s causing gut inflammation, so this could be excessive caffeine and alcohol, excessive refined sugars, antibiotics without doing a probiotic immediately after or during an antibiotic treatment, chronic mental and emotional stress, or physical stress, and food sensitivities: something we’re eating that’s causing our immune system to react and our gut to become inflamed.
Ensuring a proper bacterial balance by either supplementing with a probiotic or eating a variety of fermented foods such as kefir, yogurt, kombucha or saurkraut, and making sure that we’re eating a variety of whole foods: whole grains, fruits and vegetables, and healthy fibres that are going to feed that healthy gut bacteria.
So, when it comes to mental health, such as depression and anxiety, chronic mental stress, even things like bipolar, OCD, conventional medicine tends to just look at the brain and blame the brain on the host of symptoms that patients might experience.
Naturopathic medicine looks at the entire body. And since we know that the gut and brain are connected, and our patients are simultaneously experiencing mental health symptoms and digestive symptoms, we definitely have to treat the gut.
For more information, you can visit my website at taliand.com, or send me an email at connect@taliand.com.
I work at Bloor West Wellness Clinic in Bloor West Village, in Toronto.
One of my favourite anti-health commercials on TV are the heartburn ones. My brother and I share a laugh while a woman is slapped by spicy spaghetti to prevent her from eating it and experiencing heartburn. The tagline asks, “Are your favourite foods fighting you? Fight back!” Why is this commercial so ridiculous? It’s the irony; if eating spicy, garbage food gives you heartburn then maybe, instead of “fighting back”… STOP EATING IT! Sometimes we take common sense for granted and, of course, using simple common sense would put Tums out of business.
Nothing quite says summer like the smell of a barbecue, a cool lakeside breeze, the stiff comfort of a wooden Muskoka chair, the company of a good book and, of course, a nice, cool bottle of bubbly beer.
In North American society, we are conditioned to believe that we should consume 1200-1500mg of calcium a day in order to prevent osteoporosis in our later years. Parents feel they are unfit if they do not forcefeed their children 3 servings of dairy products (almost a litre of milk) a day!
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
