I am excited to introduce a new podcast episode (I know it’s been a while). I’ve been deep in the weeds of research about insulin resistance for a course I’m working on (for a health education platform that I’m very excited to tell you more about in the coming months).
I came across Dr. Ali Chappell, PhD, when researching my course. She helped hit home for me this idea that we’ve been focusing too much on blood sugar when the real focus for better metabolic health, body composition (i.e., weight management), energy and mood needs to be on INSULIN.
For years, I’ve been telling patients to “put clothes on their carbs” by adding fat and protein to higher-carb meals to regulate blood sugar. I’ve also recommended whey protein for protein powders. I didn’t realize this was the wrong approach for supporting metabolic health when someone is dealing with insulin resistance (as many of us are).
While these foods and practices DO regulate blood sugar, they don’t minimize the root of blood sugar and insulin resistance issues, which is insulin spikes.
You might have heard of the “glycemic index,” which tells us how much a food spikes blood sugar. Well, there is also something called the “insulin index.” Dr. Ali Chappell, PhD, decided to look more deeply into this concept when developing a lifestyle to treat her PCOS, an insulin resistance hormone condition, and the number one cause of infertility in women.
She found genuinely remarkable results in herself and decided to turn to science to test her theory.
In this podcast, we discuss her research done on women with insulin resistance and PCOS. These women got incredible results, losing an average of 19 lbs and reducing their fasting insulin levels by 50% in 2 months—eating all the nuts, fruit, vegetables, fat, and animal proteins they wanted. In this study, the women counted no calories, carbs, protein, or macros. They just avoided foods that spike insulin. It’s very simple.
This research has been repeated three times, and a randomized control trial is set to be published soon. In this trial, the lifestyle was tested against conventional medical advice for PCOS and insulin resistance (eat less, exercise more, and take medication).
We talk about the science of insulin resistance and how food impacts insulin, why we need to start focusing on insulin as a medical community, and how to take back your life, manage your appetite, and stop cravings—all the good things—so you can live with lower inflammation, better mood, and better energy.
We might have discussed this lifestyle plan if you’ve seen me in the past few weeks.
This podcast is a must-listen if you’re struggling with
Abdominal weight gain and difficulty losing weight
low energy
hunger and cravings
considering Ozempic or other GLP-1 medications
PCOS and other insulin-resistance conditions
Have seen high insulin, high blood sugar, or high cholesterol on your bloodwork
have hypertension, insomnia, energy crashes throughout the day, irritability
inflammatory conditions (anything that ends in “itis”)
a family history of Alzheimer’s and dementia
a family history of cardiovascular disease
…and so on and so on- everyone can benefit as 90% of us are insulin resistant, and I’m becoming more and more convinced that conditions like “adrenal fatigue” or menopausal weight gain are due to elevated insulin levels affecting our bodies’ ability to get energy and burn fat.
I’m so excited that Dr. Ali agreed to speak with me and that she was so generous with her time and information.
Speaker1: [0:02] So welcome, Dr. Ali Chappell. Thank you for meeting with me.
Speaker0: [0:06] Thank you for having me.
Speaker1: [0:07] Yeah, and how I found you, just for the audience to know, is I was on a very popular Instagram account about glucose regulation. We may not mention the name, and that shows a lot of continuous glucose monitoring. And one of the things that it highlighted was if you combine, like if you eat if you combine chickpeas with fat, you get less of a glucose spike. And I was drawn, my attention was drawn to your comment. And you had a very thorough, very interesting comment about how, I know, partly why that glucose spike is reduced is because when you combine starches and fats together, you get this big insulin spike, which is lowering your glucose. And it, you know, as a naturopathic doctor, you know, I think, you know, we pay a lot of attention to insulin resistance, we pay a lot of attention to blood sugar, glucose, metabolic health, but there’s something about how the medical community and even natural health doctors tend to frame everything about glucose, you know, and this is a very popular Instagram account. Everyone loves it. It’s like all about how to lower your glucose. And we forget that it’s actually insulin that we’re trying to regulate. And so then I started following you, you know, read your book, read your research. And so I’m really excited to have you on.
Speaker0: [1:25] It’s my favorite topic.
Speaker1: [1:26] Yeah.
Speaker0: [1:27] I, Sometimes I get a little frustrated when I scroll through Instagram because it is this very glucose-centric, but that’s not just Instagram, that’s the medical community as well. So I think we’re turning a page and I think we’re moving in the right direction from a medical perspective, but we’re not there yet completely.
Speaker1: [1:47] Yeah, like we’re hearing the word insulin mentioned more, but it’s still all about glucose. And so maybe we can start by you explaining a little bit about, you know, blood sugar, insulin resistance and insulin, you know, and I mean, I told you in the email and in our communication that my audience knows, they have a bit of a background about insulin resistance, but it’s always helpful to hear it again. And also for newcomers that are just joining, it would be helpful for them to hear a bit of an explanation.
Speaker0: [2:14] Yeah. Well, maybe I’ll start with how did I even get into this, right?
Speaker0: [2:19] And where did Um, you know, I have PCOS. I started having symptoms at 14, just a lot of weight gain and acne. And at 21, uh, and I had one period a year. Um, and at 21, I was studying to be a dietitian, never heard of PCOS. I went to the on-campus clinic and a women’s health nurse practitioner diagnosed me and basically said, well, you need to lose weight, which every dietitian loves to hear.
Speaker0: [2:46] And that, you know, I need to watch my weight. And, you know, here’s a brochure and a pat on the back and here’s some of my pentacle pills. And that was, that was it. And I was like, how does my diet and my ovaries have anything to do with each other? Like I literally am about to graduate with a bachelor’s in nutrition. I’ve never heard of PCOS. So that really where I started researching this and was like, it has all to do with insulin resistance. And at that point, the only thing I knew about insulin was, you give it to diabetics to lower their blood sugar. That was all I knew. So it was understanding really how insulin is the driving factor of PCOS. So then I thought, okay, well, what raises your insulin levels? And that really led me down this journey of, well, okay, so there are certain foods that raise insulin, even if they don’t raise blood glucose. And what does that mean? And what are those foods? And that is really what started this journey. So, you know, I incorporated this kind of what low insulin diet, although I just don’t like the word diet. It’s kind of a four-letter letter word, especially because I struggled with binge eating for so long because of PCOS and because I couldn’t lose weight. So I called it a low insulin lifestyle.
Speaker0: [3:52] And that really started the journey. It worked, you know, it was amazing results for myself, you know, with acne and, you know, helping me lose weight. And so that’s when my PhD advisor was like, well, why don’t you just do a study
Speaker0: [4:05] and see if it works for other people? And so, you know, I was very lucky. I got grant from the Laura W. Bush Institute for Women’s Health Research, you know, a prestigious research scholar grant for $25,000, which allowed me to kind of start the study. And that really, the results were, you know, better than I could have expected. I was working with a reproductive endocrinologist, and she was sending only all of her patients. And so that really led down this journey. So now we’ve been, we’ve done three studies now, a randomized control trial. And So here’s what that is kind of what’s launched this whole low insulin lifestyle and all the data to support it. But, you know, I think when you start with understanding that over the past several decades, more than that, probably.
Speaker0: [4:52] Medical establishment focuses on glucose, and they don’t really care about how you lower glucose. They just want glucose within a normal range. And so that has led to the development of many, many drugs, pharmaceutical drugs, that stimulate the pancreas to make more insulin, right, in an effort to lower blood glucose. And once that patient’s glucose is in the normal range, they get a glurine check, and they’re off on their way, and they’re healthy.
Speaker0: [5:19] But the problem with that is that so many people, their pancreas is just overworking so hard to keep that blood glucose in the normal range that there’s a class of medications I’m sure you’re familiar with called sulfonylureas, and they stimulate the pancreas to make insulin. And yes, the glucose levels normalize, but the long-term side effects of these medications are pancreatic cancer and worsened insulin resistance. Because when you’re raising insulin levels in the blood, you’re going to have worse health outcomes. And so we’re now beginning to realize that it wasn’t ever the glucose that was the problem. It’s always been the insulin.
Speaker0: [5:58] And so I try to explain it as, imagine you hire somebody to fix your foundation of your home. And they come in and all they do is patch the cracks in the wall, right? And they fix the cracks. So you don’t see the foundation, you know, the cracks anymore. And you’re like, they’re like, all right, it’s fixed. And you’re like, did you really fix it or did you just fix the symptom? Because that’s the problem. Glucose imbalance is a symptom of an insulin problem. And so I think now, finally, we’re starting to really turn the page and say, well, you know, if I’m not measuring insulin, then how do you really have the full picture of what’s going on in the background to make that blood sugar go well? Does that make sense?
Speaker1: [6:42] Yeah. Yes, definitely. Yeah, it’s infuriating, as you said. I mean, people will have all the symptoms, which I’m sure we’ll talk about, of high insulin, insulin resistance, but their blood sugar will be normal, even ideal. Their HbA1c will be ideal. And then it’s like, okay. So often what I have to do when people bring in blood work if we’re not ordering it ourselves is like kind of look peripherally at the signs and symptoms like, oh, you have high triglycerides, you have low HDL. Oh, you’ve noticed weight gain, you’re not sleeping. So it’s looking at kind of all around it when we could just directly measure insulin. It’s not very expensive.
Speaker0: [7:18] It’s not, but you know, there’s some problems with that. So historically it was using what are called immunoassays, which are We’re not always very consistent, but now we’re using mass spectometry, which is very consistent, very accurate. So a lot of the providers and the things, why the reason that measuring insulin isn’t in standard practice guidelines is because they say that the results are not necessarily always accurate, and so they don’t want to test that. That’s not true anymore, right? We have devices that can measure hormones in urine using your phone. And you’re telling it, we can measure insulin accurately in the blood.
Speaker0: [7:58] The second problem is that we haven’t developed standard normal ranges. Okay, so if you go and get your insulin tested today, whether it’s through Quest or wherever, all of them are going to have a different range of normal and they’re all wildly inaccurate. So they’ll say that anything between 3 and 30 micro units per milliliter are normal. Like anything over eight is considered to be too high. And some even say even above six is too high, but eight is as a more well accepted, you know, they’ve been, they’ve done some studies looking at this and over eight really is where you, it sets you up for, you know, problems. So for somebody, I’ve had plenty of people say, well, I have all these symptoms, but I’m not insulin resistant. And I’ll say, well, did you get your insulin tested? And they said, yeah, it was 22. I’m like, well, that’s three times higher than it needs to be, you know, but we don’t have the standard normal ranges. So until we have mass awareness that testing insulin is important, normal ranges so that people actually know what is and is not considered a problem, then I think we just, and also just the general education of the healthcare community that measuring insulin is the other part of the conversation and even a bigger and more important part than just glucose um because otherwise people are just walking into a house and you know assessing the foundation by whether or not there’s cracks in the walls and that’s just not how you do it.
Speaker1: [9:27] Yeah and i think too um knowing how to treat it right because a lot of people and and also for the canadians eight uh is about 42 or 50 in the standard units so people looking at their blood ever being like that.
Speaker1: [9:45] But still, you know, the ranges in the SI units go up to 300. And I have seen people over that range, but not commonly. But often people will have a HOMA IR value that is abnormal. So it’s a little bit more nuanced and helpful, which is a calculation with fasting glucose, fasting insulin. But another part is just knowing how to treat it because people are told like, well, you’re already eating well, very general term, and moving. So let’s just watch and wait until you have type 2 diabetes, and then we’ll give you drugs for it, basically.
Speaker0: [10:22] That’s absolutely what’s happening. And that’s where really the issue is. And what I’m trying to do is that the standard nutrition recommendations don’t really work for insulin resistance, because they’re not focused on minimizing insulin spikes. So I’d always like to use this like an orange with thumbtacks. I don’t know if you saw that post on my profile.
Speaker1: [10:49] Yeah, that was good.
Speaker0: [10:50] Yeah, I thought I.
Speaker1: [10:50] Was stealing your idea from my course I’m doing. It’s a great vision.
Speaker0: [10:54] The more education gets out there, the better. So, you know, I kind of show this orange with these thumbtacks. And I say, well, this is a cell. And these thumbtacks are your insulin receptors. And when you eat foods that spike insulin, and I’m gonna say insulin, not glucose, although sometimes they’re together and sometimes they’re not, but we’ll talk about that later, is that when you eat foods that cause these insulin spikes.
Speaker0: [11:16] Those receptors become overwhelmed with all the insulin in circulation, and they start basically saying, whoa, whoa, whoa, I’m overwhelmed. I’m going to start removing these receptors from my surface. And when that happens, there are fewer receptors where insulin can bind and pull glucose in because the only way they get glucose out of the blood is to have insulin bind to a receptor and it pulls the glucose into the cell. Well, if you have less receptors, then you have less ability to get glucose from the blood.
Speaker0: [11:45] Well, pancreas then says, hey, wait, there’s too much sugar in the blood. We can’t have all this sugar in the blood. So it sends out more insulin. And that kind of starts this vicious cycle. So now you’ve got the pancreas compensating for these reduced number of receptors, which then makes more receptors disappear. And here you are eating every two hours foods that are causing more insulin spikes. And it really causes this huge vicious cycle because more insulin in the blood means more of the food you’re eating is going to be stored as fat as compared to used. And it also means your metabolism is going to slow because your brain says, whoa, my cells are starving. We don’t get enough glucose. I don’t know where my next meal is coming. I’m going to slow everything down so that we don’t have to start burning muscle for energy. And that’s when you go take naps. And that’s when you have chronic fatigue. So all of it really starts with what you’re eating and whether it’s spiking your insulin, because that is the stimulus that gets the snowball rolling.
Speaker0: [12:50] And then, you know, at that point, the problem that most people find is that they will have all these symptoms. And like you said, their glucose will be normal because your pancreas is still able to secrete enough insulin. It just… It just can’t get the job done. It can keep the blood glucose level stable for long enough, but eventually it starts to get out of hand. I think of like the I Love Lucy episode. I’m dating myself. But, you know, when they’re in the chocolate factory and they’re like, oh, this is okay. Like, we’re good. And then the machine like starts going and they’re like, whoa, whoa, whoa, I can’t keep up to date. But that’s basically like your blood sugar, essentially, where it starts to
Speaker0: [13:32] get too out of control and they no longer can get it managed. The pancreas can’t manage it. So I hope that I like to give these visuals so that we understand like what’s happening below the surface.
Speaker1: [13:42] Yeah, I often use the like beach ball. It’s like, OK, your beach ball, you’re pushing it down. But the more buoyant it is, the harder you have to push. So the amount of insulin is telling us how hard are basically is your pancreas working to keep your blood sugar where it is. So your HbA1c is, let’s say, 5 percent or your fasting glucose is 5. These are the Canadian units, which is normal, which is ideal. But there’s two people with the same blood sugar. One may have really high insulin pressing down on that fasting glucose and someone else may have low insulin. So their cells are a lot more sensitive. And so it’s like only when you can no longer suppress it, then you start to see rises in blood sugar. And then you start to, you know, have your doctor call you in to say, hey, you’ve pre-diabetes, you know.
Speaker0: [14:29] Yes. I think that’s the other thing. I wish that the diabetes community would come up with different terms for the different types of type 2 diabetes, right? Because if you’re just measuring a glucose, well, you don’t know if that person’s making so much insulin, it’s just not working very well. Or if their pancreas is, I call it a lazy pancreas, if you saw in my book, right? Or they have a lazy pancreas. So, you know, I think there’s quite a bit of people now talking about these very thin people who say, I’ve always struggled to gain weight. I’ve never been able, I’ve never had to struggle with my weight, but now I’m pre-diabetic. What’s going on? Well, and that also is kind of, and I talked about how you can’t look at other people and say, well, look, they, you know, Asian people eat all this rice and they’re very skinny. And how can they get away with it? It must be good for you. Oh, they have a definite, a very different metabolism. They can’t make enough insulin, right? They’re not going to gain weight no matter what they do. So, you know, it’s just, it’s like we need a type A, a type 2A and a type 2B.
Speaker1: [15:29] Yeah, that’s true. Yeah, it should be called different things ultimately because it’s, yeah. I mean, one of the things I was seeing in practice, not so often, but my type 2 diabetic patients were being prescribed insulin, which is wild, right? Because you’re getting more of the thing that’s driving the disease process is very short-term, short-sighted thinking based on a paradigm that’s not, the whole paradigm is shifted off of what’s actually true, which is weird. Because it’s not that hard to just shift it to more accurate, which is what you’re doing.
Speaker0: [16:04] And even if you have, let’s say you have a lazy pancreas, right? You can’t make enough insulin to keep up with the food that you’re eating. Giving them a medication like a sulfonylurea to just force that poor little overworked, you know, pancreas to make even more insulin is like kicking a dog while it’s down. Like it can’t keep up. And now you’re going to force it to make more. And all that’s doing is going to lead to beta cell failure. And then they are going to have to take insulin because their pancreas is going to be so worn out, it can’t function anymore. And that does happen to the other group too, right? I mean, eventually their pancreas is like, I’m retiring. I’m done. I’ve been overworked for so many years. I’m just not, I’m just, I’m just done. And then they then become. So I wish that we could get to a point where diabetes management is insulin management and not glucose management. But there’s just a lot of education that would have to be done, I think.
Speaker1: [16:58] Yeah. And I think, you know, you were coming at it from your own experience, which is having PCOS, which for anyone listening, if you don’t know, polycystic ovarian syndrome, which is a condition of insulin resistance. But it’s often not framed that way or treated that way. I mean, one of the therapies is metformin, which is a diabetes drug. But, you know, people are also prescribed, like, testosterone blockers and anti-androgens and birth control to regulate the period, which, you know.
Speaker1: [17:31] But, yeah, and I think, yeah, a lot of conditions that are not being flagged as being insulin-resistant conditions, you know, and again, this is kind of more of that same problem. And how insulin resistance can affect you know aside from sort of diabetes it has all of these other symptoms in the body potentially Alzheimer’s weight gain and these changes in in menopause and perimenopause that can increase insulin levels that can contribute to all these symptoms that people notice like I’m having difficulty sleeping you know I’m irritable my I’m noticing all this weight gain and I haven’t changed my diet or I haven’t changed my exercise and all these really frustrating symptoms that people are just left to deal with on their own. And they’re told to exercise and diet more, which is difficult because as you mentioned, you’re fatigued, you have all these cravings, your blood sugar’s cycling, your insulin is spiking and it’s making you starving and tired. And so, yeah, we’re sort of missing a huge opportunity to treat people.
Speaker0: [18:38] You know, if, first of all, insulin resistance affects 89% of U.S. Adults, but just as many, you know, abroad as well, as well as children, you know, insulin resistance really starts in the womb.
Speaker0: [18:52] So before a mom even gets pregnant, they’ve done studies where they can take
Speaker0: [18:56] insulin in a mom before she even conceives. And it will predict whether her female child would have early puberty because when they have too much insulin over the course of pregnancy, and pregnancy is a natural state of insulin resistance because insulin resistance helps you store fat and it helps you grow. And so insulin resistance is super important in pregnancy. But if you already had too high before you even got pregnant, then you’re even higher. And that leads to the baby to have genetic changes that leads them to over-secrete insulin. And your breast milk, because milk has insulin in it, it’s what helps cause insulin resistance in a newborn baby because insulin resistance is important in newborn babies because what are they doing? They’re growing and they’re storing fat. So that breast milk is helping do that because their pancreas isn’t advanced or mature enough to make enough insulin, so they’re getting their insulin from the breast milk, which happens from cow’s milk too. We can talk about that later.
Speaker0: [19:58] So, you know, they’ve even looked at moms who have high insulin levels. Their breast milk has higher insulin levels, which means that baby’s getting more insulin from the mom. And that leads them to this spiral. So when we look at all these intervention programs for young kids who are overweight and obese, the intervention is like almost too late by that point. The intervention needs to start in the reproductive age women to get them as healthy as possible before they even have a baby.
Speaker0: [20:24] But you know I say all that to say you know.
Speaker0: [20:28] There could be nothing more important than insulin management because, like you said, especially menopause is the same thing. It’s this very, I wouldn’t say natural phase of insulin resistance, but it is. I mean, when estrogen drops, insulin rises, and they start having all these symptoms, including cardiovascular disease. That’s why heart disease risk increases after menopause.
Speaker0: [20:49] And it’s definitely something that we’re missing, for sure.
Speaker1: [20:53] Mm-hmm. Yeah, I also in my course talk a lot about these sort of vicious cycles of inflammation driving insulin resistance and vice versa. And then you mentioned like muscle breakdown in order to get glucose levels normalized, which, you know, reduces some of our insulin sensitizing capacity because we have less muscle. And so there’s all these, you know, stress and how that affects our blood sugar and how that affects our insulin. And so we’re kind of caught in these like snowballs and, you know, which also resists kind of very basic treatment recommendations like, oh, just eat less, exercise more. Eat less, exercise more. Yeah, exactly.
Speaker0: [21:33] So, you know, that kind of goes back to this journey and what I just realized and what I understood about what foods really spike insulin. And so I think, you know, I can get wrapped up in how bad insulin is and what it causes and all these things. And people are sometimes like, OK, I get it. But like, what do I do? So, you know, the thing about insulin is that first, what we’ve been teaching for nutrition perspective, you know, all through my dietetic education and everything was more whole grains, more beans, less meat, more low-fat dairy. I think that’s been pretty much the advice that we’ve been given. And the problem with that is that, you know, when you look at whole grains and beans and sweet potatoes, they’re all starches, right? And starch is the only carbohydrate source that is pure glucose. Now, of course, those foods give you protein and fiber and vitamins and minerals, right? But they also give you lots of starch. I mean, a third of a cup of quinoa is 36 grams of starch. That’s a lot of starch. Well, the problem with that is because starch is essentially just made up of pure glucose. Pure glucose chains, that’s what starch is. So when you eat that and you break all those glucose molecules up, all that is doing is causing a huge insulin spike. So when people say, well, we should be able to have some starch, it’s not that this is a never thing.
Speaker0: [23:00] It’s like telling somebody with a peanut allergy that they should be eating peanuts because they’re healthy for them. When you’re insulin resistant, it means you’re glucose intolerant. That is essentially the medical term to our glucose intolerant. That’s why we give them glucose tolerance tests. And if you fail that, which most people do, it means you’re glucose intolerant. So the last thing you want to be doing is eating sources of pure glucose, right? That’s not going to really help you towards your goal. So when you think about carbohydrates, it’s not about limiting your total carbohydrates or having to count them. It’s simply getting them for foods that are lower in glucose, which are non-starchy vegetables and whole raw fruit versus starches. And the other thing is that, yes, those foods give you fiber and protein and vitamins and minerals, but you can get all of those same vitamins, minerals, protein, fiber in more insulin friendly options. So that’s one component that’s kind of against conventional nutrition recommendations that’s part of a low-insulin lifestyle is limit the starches as much as you can. Eat as many carbs as you want just from fruits and veggies. The second is around dairy.
Speaker0: [24:13] So remember, breast milk, the purpose of breast milk is to provide insulin and insulin growth factor. Insulin growth factor is this very, very potent growth hormone.
Speaker0: [24:24] In infancy, it’s so important. It’s what helps babies double their length and triple their weight in the first year. It’s the most rapid time of growth. I mean, just look at the clothing sizes. Anybody who has a head of baby sees that these babies are growing. But adults, or really even after infancy, were not growing really. that much. The next time that IGF-1 or insulin growth factor levels increases, again, is during puberty when we’re growing. You don’t want, you know, insulin growth factor, IGF, you don’t want IGF levels to be high throughout the lifespan because IGF-1 is the strongest predictor of cancer risk because cancer at its most basic is an overgrowth of cells, right? And so that’s just a growth hormone that’s telling your cells to grow. So milk provides both insulin and insulin growth factor. And cow’s milk provides even more than human milk because look at how much a cow has to grow. So from a milk perspective, milk is very, very insulin spiking because you’re essentially just drinking insulin. Okay. Now, the second component of dairy that’s very insulin spiking are the proteins in milk. So the proteins in milk are whey and casein. They have a very unique amino acid profile. They’re the most concentrated sources of branch chain amino acids, which are essential. You need them to build muscle.
Speaker0: [25:46] You don’t need to overdo them because overdoing branch chain amino acids causes excessive insulin secretion. And there’s tons of research looking at branch chain amino acids and type 2 diabetes. So, you know, that really begs this question of, well, we have whey protein in everything. I mean, when one walks down the-
Speaker1: [26:04] So popular you know protein cereal it
Speaker0: [26:07] Is in everything and the reason it’s in everything is because it’s a waste product from the dairy industry to make one pound of cheese it makes nine pounds of whey waste and they didn’t know what to do with it all so in the 70s and 80s somebody was like oh let’s powder this and dry it and we’ll aggressively market it to the fitness industry and you know it’ll be a high protein we’ll market it as protein and put it in everything because it’s a waste product and it’s they couldn’t they’re not allowed from the environmental protection agency if that still exists um they’re not allowed to pour it down the rivers because it killed all the fish because it causes algae bloom so they literally didn’t have anything to do with it um and so they started marketing it to people and it’s now a multi-billion dollar industry so now you look at, anything and everything. And it has whey protein in it, not because it’s healthy, but because it’s very abundant, if you can imagine.
Speaker1: [27:06] I’m so guilty of recommending it. And there’s also this conflicting, I think you made a good point about how it’s not like people get confused and they get wrapped up in emotional. And so for anyone listening, it’s not about like foods being, it’s not about like quinoa being bad. It’s about what your underlying health concerns and health goals are and whether it’s appropriate like glucose you’re not glucose tolerant just like someone who can’t consume peanuts they’re not peanut allergy but it’s some right and so when we hear of like branch chain amino acids and whey protein stimulating protein muscle synthesis it’s like okay that is appropriate for that context maybe but if we look at the context of someone who’s insulin resistant you don’t need to be spiking your insulin and this could be working gains too and this is what I was on a keto diet which we’ll probably talk about and I was like why am I not really getting that great results while I was mixing my whey protein into some yogurt high fat yogurt natural yogurt and I was like when I read your stuff I was like oh okay that’s why I’m starving after I have this
Speaker0: [28:18] Well, and let’s go back to, because I do get a lot of criticism when I make posts about whey protein from the bodybuilding community, because let’s talk about why is it effective for stimulating muscle growth?
Speaker0: [28:30] Because it spikes insulin and it spikes insulin growth factor. And those are growth hormones. I mean, they’re not that different than anabolic steroids. An anabolic steroid means growth hormone. And insulin and IGF-1, especially IGF-1, is a growth hormone. So if you’re eating things, I mean, there are some bodybuilders who are just injecting IGF-1. Like that’s now part of the doping, the doping, like where the Olympic Association is now measuring blood levels of IGF-1 to determine whether people are doping. That’s how strong of a growth hormone it is.
Speaker0: [29:06] For somebody who’s like taking a walk around the block and then coming home
Speaker0: [29:09] for a whey protein shake is not only counterproductive, but possibly worsening. And so that’s the thing is you’re going to the grocery store and you’re buying these protein pancakes thinking, well, there must be better than regular pancakes. And actually they’re worse because it’s the same processed flour, but now you have processed flour with whey protein in it. And that manufacturer of those protein pancakes paid nothing for that whey protein because it was just a waste product. And they’re charging you more for it because you think it’s healthier because it says high protein. I mean, it’s just, and even then, even if you’re not buying the protein pancakes, it’s in everything. I love Birch Bender’s pancake mix, the keto pancake mix. Well, they recently reformulated their recipe to add whey protein in it, but it’s not high protein. It’s not a high protein food. They added whey protein as an additive for who knows what. So it’s just, it’s literally in everything. And it’s like, why would, you know, to think about it, even in one cup of milk, right, if you just get a cup of milk.
Speaker0: [30:12] 20% of the protein in a cup of milk comes from what? Only 20%, which is probably biologically being like, well, we want these babies to grow, but like, let’s keep it kind of regulated, right? Let’s not make the whole thing just this huge insulin spike. But yet now we’re concentrating it and adding multiple scoops to a propotein shake and having way more branched chain amino acids and insulin spike than nature ever intended. And it’s scary. So, you know, that’s kind of the whole thing about dairy. But I’m not dairy free. Because, and I’ll, sorry, you had a question.
Speaker1: [30:52] No, no, no, go ahead. No, I think, well, yeah, go ahead.
Speaker0: [30:55] Yeah. I’m not dairy free. You would think, well, obviously she doesn’t eat dairy. No, because fermented dairy, when you think about Greek yogurt and cheese, to make Greek yogurt and cheese, you have to remove all the way. Okay. That’s why they’re, that’s why Greek yogurt is very thick compared to other types of yogurt. Skier is very thick compared to other, like regular Yoplait yogurt or whatever at the store. It’s kind of runny. That’s because it still has a lot of whey in it. Same thing with cottage cheese. It has a lot of whey in it because whey is liquid. But Greek yogurt and cheese, the way to make those is to completely remove the whey. So you’re just left with casein. Now, casein still raises insulin and insulin growth factor, but when you ferment those, the bacteria changes those branched-chain amino acids to branched-chain ketoacids. It changes the actual structure of those branched-chain amino acids, which lowers that insulin response. So when you look at these studies that look at dairy and health, they all will say, well, yogurt’s still good for you and people see a benefit because you have the probiotics from the fermentation, but you also have fundamentally changed the insulin component, the insulin spiking component of that casein. So you have a much more insulin friendly product. So I still, so it’s Greek yogurt and I recommend full fat because if you take out the fat, what are you concentrating? The protein.
Speaker1: [32:23] And the sugar.
Speaker0: [32:24] Protein is, yeah. So you want the fat in there because you don’t want so many dairy proteins. You know, dairy proteins, their biological purpose is to stimulate insulin. So I still recommend that if they’re going to, you know, for a low insulin lifestyle, we recommend getting rid of all dairy except full fat Greek yogurt and aged cheese.
Speaker1: [32:44] Yeah, which is great because it still gives you, like you said, there’s a lot of studies where it’s like, you know, yogurt can reduce belly fat, so it can be confusing for people when they hear. But I was going to say when you were talking about whey protein and the insulinemic effects, if you are monitoring your glucose with a continuous glucose monitor, adding whey protein would probably lower your glucose. Yeah.
Speaker0: [33:11] Yeah. And so that’s another thing. It’s so funny. I get, I get these people that are like, you don’t know what you’re talking about. I wear a continuous glucose monitor and it doesn’t spike my glucose. I’m like, I didn’t say it spiked glucose. Whey has no glucose in it. It’s not going to affect your glucose. It’s going to drive insulin. But you know, one of the things that protein also does naturally is it also, this might be too sciencey and we don’t even have to get into But.
Speaker0: [33:37] You know, you have glucagon also, right? So you have insulin and glucagon. And when glucagon rises, it releases glucose from the liver. And so they’ll say, oh, well, it increases glucagon, which makes people more full for longer. And that’s all true. But the reason it stimulates glucagon is because if it doesn’t, a person’s going to be hypoglycemic. It has to have that glucagon release the glucose into the bloodstream so that it doesn’t overcompensate and drive the blood sugar down too low. Does that make sense? So you have a net neutral of glucose because you’re releasing more glucose into the bloodstream from the liver, but you’re also blocking, you know, pushing glucose down lower because you’re trying to drive it into those cells. That’s why it’s great for muscle building but you don’t whey protein after a workout yes you need insulin to drive muscle growth and get those amino acids into the cells to build um but that’s like whey protein is like starting a fire and throwing gasoline on it like you can start a fire without gasoline yeah it may be faster with gasoline but you’re going to cause potentially a lot more.
Speaker0: [34:44] Problems than you intended by doing that. So yeah, definitely if people want to have a protein powder, I recommend foods with a much more balanced amino acid profile like egg white protein is great. My husband loves J-Rob. We’re not affiliated. That just seems to be a really good one. J-Rob egg white protein is good. Bone broth protein powder is also a good one or if they’re plant-based um, hep C protein is, uh, is a good one as well.
Speaker1: [35:14] Okay. Yeah. Thank you. That’s good. What about pea proteins? People ask me this all the time. So often they’ll remove the starch, although peas would naturally have starch, but do you know about the branch amino acid?
Speaker0: [35:26] Well, they are not going to have many. They are, they do have some, so they are like a complete protein, although that’s not even necessary. Like you don’t have to have every single protein source have to be a complete protein every time. As long as you’re eating a variety of protein foods, you’re going to get all you need. So when people say, well, bone broth protein is not a complete protein, you’re going to be fine. But with pea protein and brown rice protein, yes, they do remove the starch. So from an insulin spiking perspective, it’s better. It’s okay. It’s just that they’re very processed, right? They go through a very extensive processing to remove all that starch so that you can get that concentrated protein. Whereas hemp seed protein is just hemp seeds, Right now, it does top taste like the inside of a lawnmower, so you better like that earthy taste.
Speaker1: [36:19] It’s pretty rough, but you can doctor it up and make it taste pretty good.
Speaker0: [36:23] Or you can just sprinkle hemp seeds into your smoothie and they don’t have a taste at all. But the same thing with like now they’re coming out with these new protein powders like almond protein powder and pumpkin seed protein powder. They’re just processed to remove all the extra fat which you should be getting anyways because fat is good for us but it concentrates the protein because everybody is so obsessed with getting more protein getting more protein but i’d like to challenge that a lot of that came from the marketing of the whey protein powder industry um that’s interesting to make people think they needed 200 grams of protein a day yeah.
Speaker1: [37:02] I mean well and also and i’m definitely guilty of pushing the protein thing. But when people have high insulin, like generally just high fasting insulin, I mean, you’re already kind of set up to technically build muscle.
Speaker0: [37:17] Yeah.
Speaker1: [37:18] That’s a big complaint.
Speaker0: [37:19] Yeah.
Speaker1: [37:20] People are like, I easily put on muscle. I just can’t lose weight. It’s like, well, okay, then you don’t need whey maybe.
Speaker0: [37:27] No, you definitely don’t need whey. I hope that I don’t ever sound like I don’t think protein is important. Protein is absolutely important. I do not track protein at all. I did track one day just to see like, what do I get? I’m curious, you know, and I had about 95 grams of protein and that’s like from peanut butter. I love shelled, I love shelled edamame and like, you know, for lunch, I eat a pound of frozen vegetables that I put in a pan and I cook it in some avocado oil and I throw shelled edamame, like a half cup of shelled edamame and I sprinkle some grated Parmesan cheese and some toasted a pecan and it’s like this big and I will eat the whole bowl. And it’s like 30 plus grams of protein just for that. You don’t really need to track it as long as you’re being mindful that every meal you’re having fruits and veggies, you’re having something protein and you’re having some fat, you’re going to be fine. I think this idea of these excessive protein goals came from the fact that the only way you can meet that goal is by using protein powder, which then plays into the industry, you know?
Speaker1: [38:33] Yeah, I mean, we’ll get into this, but I think I was going through one of the studies where it showed sort of the macronutrient results because they had people do diet diaries. You had people do diet diaries a couple times during the two months. And yeah, they were eating about 90 grams a day, which is a lot of people struggle to get that much. And I wonder if maybe there’s something about kind of removing the food noise by having like, OK, here’s the foods that you’re eating. And, you know, a huge chunk of that is protein foods. Um maybe there’s something about how starch kind of changes our appetite or or our satiety so we’re not really interested in protein but yeah it’s interesting that we’re kind of falling into it you know
Speaker0: [39:13] They i mean these were patients who were you know very overweight they their average fasting insulin was 31 now remember it needs to be eight so their average fasting is eight or less Their average
Speaker0: [39:26] fasting insulin was 31 and their A1C was 5.2 or 5.3, like totally normal. If they went to the doctor, the doctor would be like, you’re healthy as a horse. I don’t know why you’re having all these symptoms, you know, come back when you’re in bed. Right. That’s basically what they’d be told. And behind the scenes, their insulin is three or four times higher than it needs to be. And we basically said, okay, well, you’re going to follow this plan. You’re going to eat as much as you want, whenever you want. at these foods that don’t spike insulin. Non-starchy vegetables, whole fruits, you know, lean proteins. We didn’t even stress the lean on the protein, but we were like, just trim visible fat. By no means do you need to eat egg whites. Like eat the eggs. Make sure you’re getting lots of healthy fats. I even was encouraging them. I was like, I want you to eat a whole medium avocado every day. Like I want you to make that a goal.
Speaker0: [40:19] And that was it, right? And then we told them, you’re gonna, first eight weeks, we want you to not eat anything on this list of insulin spiking foods. Also, you can have either Greek yogurt or cheese, but only one serving a day. And you could have red wine. If you want to, because it’s a sustainability, am I saying red wine is a health food? No, but… It is part of like just having something that’s sustainable that you can have as a treat and they could have an ounce of dark chocolate. And, you know, what’s really important is we didn’t allow them to exercise. And not the exercise is, of course, important. And we recommend exercise for a clinical research study. You have to make sure that the results they’re seeing are from the diet changes and not that exercise. So they couldn’t exercise. And that was it. You know, and two months later, they lost 19 pounds. They had a 50 percent reduction in insulin. They had a 50-plus percent reduction in HOMA-IR. They had a 35% drop in triglycerides. I mean, two months. Their testosterone levels went down by 25% because they had PCOS. I mean, it was crazy. The results and those results have been extended to all of the studies that we’ve done. And what was great was that they did these diaries. And so for whoever’s listening who hasn’t read the studies, their average calorie intake was just around 1,400 or 1,500 a day. I mean, again, not counting calories, eating whatever they wanted, their carb intake.
Speaker1: [41:42] As many nuts as you want.
Speaker0: [41:43] As many nuts, as much fruit, whatever they want.
Speaker1: [41:46] Red meat.
Speaker0: [41:46] Red meat.
Speaker1: [41:47] Yeah.
Speaker0: [41:49] And one girl told me, she’s like, I ate an entire pack of bacon. I know I wasn’t supposed to do that, but I kind of like just binged on a pack of bacon.
Speaker0: [41:58] I’m not saying bacon’s healthy. You should not eat bacon. It was uncured bacon, thankfully. But because their body is able to burn that fat, it wasn’t just circulating in the blood causing triglycerides, right? And so their fat intake was very high, right? I think they had 70-plus grams of fat, which coming from avocados, the actual breakdown was it was largely monounsaturated. It was coming from nuts and avocados and oils and whatnot. So, you know, that’s the thing. It’s when people get their appetite hormones more regular or regulated, they just don’t feel as hungry. I mean, that is one of the most common in the very first place. Testimonials that people tell me is when I make an, when I take an insulin first approach, not glucose, not calories, not protein. When I take an insulin first approach and insulin levels lower, your appetite hormones regulate. And they’re like, I’m just not hungry. Like I can’t believe that I have no cravings for anything. Like I’m just content and satisfied. It’s like, because your body can access your stored body fat now. And it doesn’t need to force you to eat all the time because prior it was like okay you have a lot of fat in here but like I can’t use it so I need you to keep eating because that’s the only thing I can use for energy, and now it can tap into that fat stores and so it’s like oh I’m good I don’t you can eat if you want but like I’m good yeah that’s essentially what your brain is saying.
Speaker1: [43:22] Yeah I remember reading that thing in the 1400 I was like wow because you’re eating ad libina which means just whatever you want like you can eat as much of all those allowed foods I mean there’s restrictions for the dairy in terms of portions but nothing else has portion restrictions and so people are kind of naturally settling into 1400 calories which i wonder if i mean on a diet diary day i probably wouldn’t eat my pound of bacon so it might oh no not be she didn’t report
Speaker0: [43:49] That that was not on the diet.
Speaker1: [43:50] I think that’s probably maybe like i’d be on my best behavior so that might be a little i don’t know if you agree it might be like lower than what they were eating um but they were the weight loss And I know it’s not all about weight loss, but I think it’s so difficult to lose weight when you’re insulin resistant. And a lot of like ketogenic diets and kind of zone diets, I’ve been looking at a lot of research for a course that I’m producing on insulin resistance. And 19 pounds in two months is like amazing. With no exercise. With no exercise. And no counting, no tracking, no restriction. They’re not restricting. I mean, they’re taking out certain foods. So maybe there’s an element of, you know, psychological restrictions like that. But you’re not hungry is the point, you know.
Speaker0: [44:37] And did you read our second study was really, you know, not to get too sciencey, but I think it really helps explain this concept is that, you know, we had patients get under this machine and it basically just measures oxygen and how much you breathe in and out. And it tells you whether you’re burning fat or carbs. I know science is cool. So it tells you whether you’re burning fat or carbs. Well, you know, these patients were coming in after not eating for 12 hours and they were coming in and they were burning almost no fat. Like even after fasting for all night long, their body still had so much insulin in their system that they couldn’t burn their fat. And then after that, we gave them this very high shake, high fat shake. It was just basically an insure that I added 70 grams of fat to butter melted.
Speaker1: [45:22] And also, they’re probably suffering 12 hours of no eating and they weren’t burning fat.
Speaker0: [45:28] Well, it was just that they hadn’t eaten since 7 p.m. the night before. They came in the morning. They, you know, we took them there at rest to see how much were they burning, how much fat were they actually burning after not eating for 12 hours, which most people should be only burning fat, right? You’re not, you haven’t eaten in a while. Like, you should be getting your energy from fast stores. None. They drink this high fat shake. Basically shows they stored all that fat from the shake and just burned the little bit of sugar that was in the Ensure. And that was it. All right. After eight weeks, they come in to do it again, burning almost all fat because now their insulin has dropped after the eight weeks of following this approach. They’re burning almost all fat. They drink the high fat shake, burn almost, you know, their fat burning from that after five hours was significantly higher than before. And it just shows while you go tell a patient with insulin resistance that the only way that they’re going to reverse insulin resistance is to lose weight and eat less and exercise more and come back, you know, and they’re like, I can’t even burn fat when I’m eating nothing. And it’s true. Like I lived to that. That’s why I was a binge eater. Like I would eat nothing because I was like, nothing else works. I’ll just stop eating. And then you eventually get to a point where you eat everything and then you just have this terrible cycle. But, and it’s, it’s so validating. I mean, that study was just so validating to the people who are like, I am doing everything and nothing is working.
Speaker0: [46:56] Um and then you know like just for the randomized control trial i’ll just say it was a it was an independent study right because with research like you have to have an independent group that can replicate your findings because that’s just that’s just important like i can’t run all the studies and be like this is so great somebody else has to do the same thing and see what they find um and they did they did a randomized control so half the patients just did general nutrition they They followed the NIH nutrition guidelines, which was more whole grains and beans and more low-fat dairy, and eat less and exercise more, and they got put on metformin.
Speaker1: [47:32] So they also had exercise and they had metformin.
Speaker0: [47:35] And exercise. And the other group just followed our plan with no exercise. And this was during COVID. So, I mean, this study started January of 2020. So you’ve got a lot of cortisol going along. You’ve got all these things happening. People stuck at home. And the group that followed our plan lost an average of 17 pounds. During COVID.
Speaker1: [47:58] When everyone gained the COVID-19.
Speaker0: [47:59] When everybody gained the weight. So they had, on average, it was between 12 and 17 pounds. And the group on the metformin and eat less and exercise more was, they gained a third of a pound. And their insulin levels went up. So it was just, yeah. So it really just is continuing to validate this. We’re missing the wrong biomarker, right? Insulin is really the only thing that matters and we’re just ignoring it. And it’s frustrating.
Speaker1: [48:26] I think, too, in that study, if I remember correctly, the control group, so like the high grains group, was also in a calorie deficit. Like they were told to eat 500 calories less. So they were supposed to be losing a pound per week kind of thing. And then they were exercising.
Speaker0: [48:43] Like everybody else. Yeah. They tried it because they were just standard nutrition advice, that control group. So the group that did the study was a group of reproductive endocrinologists. And they basically said, we just treated them like every other patient we treat. We have a brochure it talks about, you know, it’s just based on like the NIH nutrition information, eat less and exercise more. And if their fasting insulin was too high, which was pretty much everyone, we gave them metformin. And that was like just the standard of care. Like that’s what every other patient, except for most patients go to fertility clinics. We’re not getting their insulin tested because most fertility specialists don’t even understand that that’s the reason why these patients aren’t getting pregnant. And so, yeah, they just submitted the paper for publication. And so hopefully we’ll have that data published soon. But it was really great to have a completely independent group replicated. That study independently.
Speaker1: [49:39] Yeah, so how many studies are there in total? There’s three, I believe.
Speaker0: [49:44] So the three actual prospective clinical studies, one of those was a case series because out of the 24 patients in the original study, about 10 of them, not everybody was trying to get pregnant, first of all. Some of these patients were just trying to lose weight or improve their symptoms. But 10 of the patients, even though they, you know, were infertile, they had issues with pregnant, were getting pregnant. They were seeing a fertility specialist, which should say a lot. They got pregnant very quickly. And we had some, we had probably four or five patients who had to drop out of the study because they got pregnant in the two-month study. And they actually, so the fertility specialist wrote that up as a case series to said, you know, they talked about each patient. It was like, this patient has been infertile for this time. They’d done these different things and essentially showed that the average time to conception in these patients was 86 days after starting this lifestyle change. 86 days.
Speaker1: [50:42] That’s the average. So it had sooner. Yeah.
Speaker0: [50:45] And it blows my mind. You know, I have a friend, a couple of friends who have PCOS. And they, one of them had five miscarriages in like an 18-month period. And her doctor would refuse to test her insulin. And he said, your A1C is normal. You don’t need to test your insulin. Like, refused.
Speaker0: [51:06] And, I mean, it just blows my mind. It just blows my mind.
Speaker1: [51:09] Yeah, I think in your, there’s a lecture that you have on YouTube where you talk about how high insulin can increase the risk of miscarriage and pregnancy complications. So it’s not even just about getting pregnant. It’s also what the high insulin does to the health. Yeah.
Speaker0: [51:24] And that’s not even just PCOS. I mean, you know, that’s there was this really awesome study out of Columbia University, this group that their fertility division and their maternal fetal medicine department that was that does a lot of research on miscarriage. And this was published in Fertility and Sterility, which is, you know, the biggest fertility journal. And what they did is they said, okay, we’ve been testing glucose and A1C standard when somebody comes in with recurrent miscarriage, which means they’ve had at least two miscarriages within account, two repetitive miscarriages. And so they were like, but we’re testing their glucose and their A1C and it’s normal and it’s not necessarily associated with a higher risk of miscarriage. So what they did is they took some of these, they had patients who miscarried, and they took some of these early placenta cells, okay, and they put them in a petri dish, and they exposed them to either high levels of glucose or high levels of insulin.
Speaker0: [52:26] And what they found was that high glucose levels did absolutely nothing to those early placental cells. Nothing. High levels of insulin was as toxic to the developing placenta as chemotherapy drugs. And yet somebody comes in with recurrent miscarriage, and we don’t even test insulin. We only test glucose. And so that group alone, I mean, they’re a huge fertility center in back Columbia. And they were like, we’re missing the boat. In our clinic, we’re going to start testing insulin in every person. So it’s just, there are people that are out there talking about it,
Speaker0: [52:59] but it just hasn’t made it fully there.
Speaker1: [53:04] Yeah, it’s like it needs to kind of just, like, it’s like a Venn diagram. We’re not quite focusing in properly on what we should be. Yeah, and so back to the results. I mean, amazing. Like, people are getting pregnant. They’re losing consistently. Like, it’s not, I mean, I have a friend who’s started your program. Um, she’s on like day five and she’s like giving me a daily update. She’s like, I was so hungry. Now she’s like, I’m not hungry anymore. I feel amazing. I’ve lost just like half a pound, like almost a pound a day. It’s wild. She’s just like dropping. It’s just coming off. Your body’s like
Speaker0: [53:40] Can actually access that stored fat and do what it’s supposed to do, which is. Burn it for energy.
Speaker1: [53:47] And this is her like trying carnivore and keto just before and it wasn’t really working. And she was like, she’s trying to breastfeed. It wasn’t, you know, so this is like she’s like mind blown. And so she was telling me to ask you certain things. But, you know, I was when I was kind of selling her the protocol, I was like, no, she’s legit. She’s like, she’s repeated these results. It’s not just, you know, a one time study where people lost a bunch of weight. Like this is it’s a consistent result. where people are losing 17 to 19 pounds in two months by following this plan, you know, so you don’t have like a super loser in your group or something like that that’s doing the results.
Speaker1: [54:24] So it’s pretty miraculous. Like it really is amazing. Yeah.
Speaker0: [54:29] Well, so, you know, I don’t know if I don’t share it too much on my page yet, but I am working with the FDA. So I don’t know if you’re aware of that. So I’ve been working with the FDA for the last year. I’ve met with them five times. I have my next meeting with them in a week and a half because I’m trying to get my this app. So I’m launching an app. So it will officially be launched on May 19th. It is in the app stores right now. Do not. We’re still working on the back end, but we have to make it to get it in the app store and then we’re working on it. So I haven’t told anybody it’s there. It’s it’s there. It’s not really functioning yet. So we are officially launching it on May 19th. But one of the things that we’re trying to or that I’m trying to do is get FDA cleared as a what is called a software as a medical device. People have heard of software as a service, whatever. So now the FDA regulates this type of medical device, which is a software. So apps are considered software as a medical device. So, you know, there’s a few that are approved for diabetes, some that are approved for depression. So this would be the very first approved for insulin resistance or PCOS.
Speaker0: [55:34] But, you know, I have to do this big study. right? You have to do a big, study, uh, to support that clearance. Um, and I have an entire independent group, a different independent group. So, um, I’m very, very proud to say that my, the PI or the person who’s basically the ringleader of this study is, um, Dr. Timothy Garvey. He’s the director of obesity research at, um, University of Alabama, Birmingham, which is a huge research center. Um, he’s an, you know, internationally known endocrinologist. So he is taking the study and like, I have a dermatologist dermatologist, a clinical dermatologist at University of Texas. I have an obstetric neurologist who’s doing all of like the mood evaluation changes after using this. She’s at Baylor. I have another dietitian, PhD dietitian who’s out in California. So, I mean, it’s truly independent, right? Like I can’t have anything to do with it. And so, and they’re basically where they’re having patients use our app. So, they’ll use the app for eight weeks, follow the guidance. It has recipes and meal plans and all the things. And after eight weeks, we test their blood before and after and submit it to the FDA for approval. So we’re hoping to have that next year, which would really just be, you know.
Speaker0: [56:50] Amazing for patients and amazing to like really have this become like the standard treatment for insulin resistance is an insulin first approach.
Speaker1: [57:02] Yeah like to just have your doctor be able to give you that advice it’ll actually work so it’s motivating you feel a lot better you’re not as hungry um you’re even your taste buds change because you’re like you’re you’re interacting with whole foods that aren’t spiking your insulin so your like cravings and your appetite are all regulated and oriented towards what the food that you’re getting as opposed to like random you know you’re not ending up at the bottom of a bag of potato chips because you’re like blood
Speaker0: [57:30] Sugars drain i need more glucose and i can’t get it and i need to eat this.
Speaker1: [57:34] Yeah and
Speaker0: [57:36] So that’s why you know i don’t necessarily i don’t necessarily condemn the use of the glp1 drugs because GLP-1 is an important appetite hormone. And tons of data, research has shown that when people have high insulin levels, they have lower GLP-1 because insulin is a master hormone. It affects everything, including your appetite hormone. So when insulin is off, your appetite is really unregulated. And the GLP-1 drugs are kind of just like bypassing that whole system just to like flood the body with GLP-1 so that you don’t feel as hungry, which is fine. But the thing is is that if you were just to focus on this you would increase naturally levels the glp1 because insulin is suppressing that you know so um that’s where i’m like you can you could do that that drug but you have to realize like you’re not fixing the problem and the problem’s going to come back the appetite problem the weight problem is going to come back until you fix the underlying hormonal problem cause of why you are hungry all the time in the first place you know Yeah.
Speaker1: [58:40] Yeah, because, I mean, the problem, I think, it’s a common criticism with those drugs is that it can be a really important tool. I mean, some people have a lot of weight to lose, you know, it’s causing a lot of problems. But if you’re just having less Doritos, like it’s just about appetite suppression, and you’re not shifting your dietary patterns, and you’re not kind of using it as an opportunity to learn and to change things, then you’re either stuck on them forever, getting nutrient deficient and losing muscle mass, or you’re just going to gain the weight back. So you have to kind of change things. So it’s why not try the diet first, the exercise first, and then use them as a tool if you have like 300 pounds to lose or something.
Speaker1: [59:22] You know, if you have a lot of weight to lose, maybe they could be helpful. But yeah. That’s what Dr.
Speaker0: [59:26] Gardy wants to do, right? He’s like, after we do this study, you know, if you would be interested in sponsoring another study to look at patients on GLP-1 drugs who also follow this plan, right? Because taking a GLP-1 drug actually stimulates insulin secretion. And so if you’re eating foods causing even more insulin secretion and you’re in a calorie deficit because you’re not eating as much, you’re just eating less of insulin spiking foods, you’re actually losing muscle because it goes back to the body not being able to burn fat. And so it needs to make up that calorie deficit somewhere and it’s going to pull from your muscle. So that’s really why you’re seeing a lot of muscle mass on these drugs. And so when you, he was like, if we could pair something like this with the GLP-1 drugs, then while you’re getting your own appetite hormones more regulated, you have this. And then when you come off of it, you don’t see such a huge shift in making, you know, wanting to go back to eating all the time because now you’ve fixed the underlying cause. That is how those GLP-1 drugs should be used. But they’re not being used because they’re not giving the right information. They’re not giving the right education. And they’re sending them home telling them to eat more whole grains and beans and low-fat dairy and then they’re just in this cycle of bad. And so if we could come out with that data, I think it would be, you know, life-changing, I think.
Speaker1: [1:00:46] That’d be really interesting. Yeah, it’d be interesting to see, like, what people actually, I’m wondering if there’s data on, like, what do people end up eating when they’re on a GLP-1? Like, what are their macronutrient spreads? Because people tend to lose appetite for, like, high-fiber foods, protein foods. Like, you don’t want satiating foods. You want just kind of easy to absorb, easy to digest. You’re nauseous. So you’re probably going to go for more starchy foods i would assume but
Speaker0: [1:01:12] Well except for now everything it’s like well you need to be a you need to be making eating more protein so you don’t lose so much muscle mass it’s like the reason they’re thought the reason they’re losing muscle mass is not because they’re not drinking whey protein shakes like in fact that might worsen it so it’s it’s that message and so now you’ve got all these food companies that are going about to come out with tons of protein rich snacks because they’re trying to attack they’re trying to attach themselves to the people who are taking these drugs who are trying to eat more protein and those snacks are just the same processed crap with now processed way back i saw that that there’s like very like.
Speaker1: [1:01:57] Big food is trying to design foods that kind of override the natural appetite suppression so that you still stay addicted so it’s like a whole hot mess
Speaker0: [1:02:07] I don’t know if it’s that or they’re just trying to appeal to this new customer who’s like well i’m not really hungry but i have to get my protein in so i’m gonna eat this protein snickers and it’s gonna be better for me so it’s just, and it’s sad and it’s scary and you know that’s that’s where we’re going because everything you scroll on instagram one time and all it talks about is if you don’t get 50 grams of protein for breakfast and you can just kiss your biceps goodbye. And it’s like, hmm.
Speaker1: [1:02:37] Yeah. But maybe, yeah.
Speaker0: [1:02:39] I’m not saying protein is important. I’m saying you don’t need 50 grams.
Speaker1: [1:02:44] Yeah. Like if you’re, yeah, regulating your insulin levels, are you just, are you going to be better at using and maintaining your muscle mass and burning fat instead of burning your muscle, you know, the protein from your muscle to make glucose?
Speaker0: [1:02:58] Yes.
Speaker1: [1:03:00] Like those people, those sugar burners in your, in the study that you referenced were probably just breaking down their muscle mass.
Speaker0: [1:03:06] Yeah they’re breaking down like shake yes the amino acids that they because you know when you eat protein it your body breaks it down into the amino acids and then it uses those whatever it needs right whatever amino acid it needs to build whatever that is whether it’s hair because there’s like you know whatever amino acids they need at the time for those things so that’s like an amino acid pool which is why every single food you eat doesn’t have to be a complete protein because it’s just getting broken down into these bricks right and they’re just pulling the bricks as they need them. But that’s what’s happening is that those sugar burners were essentially just burning yesterday’s excess protein that he didn’t need, which because a lot of times we’re eating more protein than we actually need. Not everybody. Some people are not. But now I feel like people are.
Speaker0: [1:03:51] Putting a scoop of whey protein into their Greek yogurt, which is like a lot of protein in one sitting. And it’s just breaking that down into those bricks that they can then use for energy if they can’t get enough body fat. So that’s basically what they were doing because you can break amino acids down into like essentially glucose and just burn that. So metabolism is very complex, right? It can definitely overwhelm people.
Speaker0: [1:04:16] But I think at the end of the day, if it if it seems excessive it probably is um and if it seems too good to be true it probably is like going back to the instagram account on glucose regulation you know if you are adding there’s this idea of food combining of if you add if you’re going to eat carbs you need to make sure you add fat or proteins to it and it will make sure that your glucose doesn’t rise too fast and sure, there are all kinds of beautiful CGM reports that will support this message that as long as you add butter to your bread, then it will be okay because your glucose doesn’t rise. But what that’s doing is when you have a lot of fat and a lot of glucose in the bloodstream at one time, it actually, the fat, I remember my biochemistry teacher in college said, When you have too much fatty acids and too much glucose in the bloodstream at one time, what that does is it’s like throwing gum in a lock. Those fatty acids block the insulin from working. So then the pancreas does what?
Speaker0: [1:05:28] Sends out even more, right? So you have this huge insulin spike happening in the background, which is driving that blood glucose down. So what you see on your CGM is adding butter to my bread stopped that glucose spike. That’s so great. But what you don’t know in the background is the insulin bomb that happened to keep that glucose level normal. And that’s what the problem is. So, yeah.
Speaker0: [1:05:52] It’s unfortunate because I think now 5 million people think that as long as they add peanut butter to their ice cream or their, you know, whatever, that it’s like better. Again, I’m going to do that. It’s more nuanced than that.
Speaker1: [1:06:07] Yeah, like I, this is why yours have blew my mind because I, I was sort of recommend, I mean, there is a separate benefit to regulating blood sugar, obviously, but it, it, the story is more holistic. Think it makes more sense in the context of insulin because insulin is damaging. So it’s like not about regulating blood sugar at the expense of insulin spikes. It’s, but you know, so I would recommend to people, okay, you’re addicted to donuts and you’re going to get a donut nut to put some peanut butter on it to regulate it. And there’s a bit of like maybe delayed gastric emptying or delayed release of glucose. But when I saw your comment, I was like, yeah, I knew this from biochemistry, but for some reason didn’t put it together.
Speaker1: [1:06:49] And it may speak to, to give myself some compassion and credit, it may speak to just how we’re so not focused on insulin, even in holistic space.
Speaker0: [1:06:58] Like you said, there is an aspect of managing glucose. That’s true. But if you are managing the insulin, then it’s working well. It’s working, it’s doing what it needs to do. And you don’t really need to focus on the glucose. So I have a lot of people say, well, if I have commented to that post or sent me direct messages, they’re like, well, so does that mean that I should just, well, what if I want to eat gummy bears? Like, is it worse to add almonds to my gummy bears or just eat the gummy bears by themselves? And I said, well, this is the actually, what you need to realize is that, you know, if you want it, if you want to eat Oreos, do it infrequently and enjoy them. And if you want to dip them in peanut butter, do it because it’s delicious but don’t lie to yourself that the peanut butter has somehow made the oreos better for you because it didn’t and it actually was probably worse but it’s it’s more about enjoying the foods you want to eat and enjoying them and not feeling like you have to add something to it to make it better because then you’re then you’re mentally thinking well oh i can just i’ll eat you know whatever i’ll eat the bread because i’ll just put the butter on it and it will cancel it out that is just human nature and that is what people do because their cgm tells them that that’s better and that’s just not the case and so it’s it’s not necessarily that that eating it by itself is good by any means but i don’t think anybody needed to tell you that eating gummy bears wasn’t good for you right i’m trying to tell you that yeah adding almonds doesn’t make them better yeah.
Speaker1: [1:08:27] It’s like just let them serve their purpose which is
Speaker0: [1:08:30] Just serve their purpose enjoy them enjoy them and try make them as infrequently as possible because life is meant to be lived, enjoy the things occasionally, but, adding protein and fat. And like you said, with the delayed gastric emptying, my challenge to that is ideally what you want is you want insulin to be released after a meal, help bring your blood and then you want it to come down, right? And you want it to be low so that between meals, you’re pulling fat from your body fat. And then it goes up again after a meal and then it comes down. And then after dinner and while you’re sleeping, it’s low. I mean, that’s really the idea, ideal. You want it to go up and then back down, up and then back down quickly.
Speaker0: [1:09:09] When you are adding protein to gummy bears now you’re adding like you know some cheese to gummy bears or something what that’s doing it is delayed delaying that gastric emptying but it’s not, it’s not getting rid of the glucose you’re still going to absorb all the glucose from those gummy bears but now you’re just doing it over time well what does that mean that means glucose levels are higher in the system for longer and insulin levels are higher in the system for longer right versus just having it go up and then come back down i’m not saying you should just eat the gummy bears you shouldn’t eat gummy bears but if you do just do it because you like it and try to do it as least less frequently as possible but if otherwise if you’re just eating fruits and vegetables and nuts and seeds and proteins and all of that then you would eat your insulin would come up moderately do what it needs to do and then come back down versus you know eating a biscuit with eggs on it. Like, okay, it’s not going to have a huge glucose spike, but now you’re just going to have glucose higher for longer as it slowly enters the bloodstream. Does that make sense? Yeah, it does. And then really at the end of the day, there is no way that you’re going to slice it, cut it or whatever. Starch is going to lead to higher glucose and there’s nothing you’re going to add to it that is going to make it better. So if you have to have it, enjoy it. Don’t lie to yourself that doing something has made it better for you. Just move on and try to do better at the next meal. That’s my advice.
Speaker1: [1:10:31] Drink water. Yeah. And also, if you’re healing insulin resistance in the background, you’re able to kind of come down again, right? You’re dealing with this cause.
Speaker1: [1:10:40] So maybe you’ve better tolerance for those random spikes and you eat your Oreos and you get done.
Speaker0: [1:10:46] And your liver is better able to clear that insulin from the blood. So like one of the studies that that influencer likes to use a lot is a study that shows, well, if you add protein and fat to starch and sugar, it leads to lower glucose levels. Well, yes, but in the exact same study, it talks about how insulin levels rose 52%, in the same period, right? And part of that was because it increased insulin secretion, and part of that was in decreased insulin clearance. Because when you add the fat and the protein to your fat and the starch, the body’s like, well, I can’t get rid of this glucose or this insulin. I have to have this insulin here because something has to get rid of this glucose. So that’s why it increases insulin secretion and prevents the liver from actually getting rid of excess insulin from the blood. So you just have more insulin, right? More insulin means less less blood sugar. So, you know, if you read the article, it says that very, very blatantly. Like, I think it was on like the sixth line. It was like, it increases insulin secretion and decreases insulin clearance. And it’s like, you’re.
Speaker1: [1:11:50] Yeah, but you’re an insulin researcher. So you’re like, you see it right away, but everyone else is like, that’s great. Higher insulin is what we want, right? That’s, that’s what we do with our job.
Speaker0: [1:11:59] Exactly. I commented on her post like a year ago, or this person’s post like over a year ago. And I said something to that effect. I was like, you can’t manage a glucose and just ignore the insulin. And I think she has some moderators. And one of her moderators said, she’s not an insulin expert. She’s a glucose expert. And I was like.
Speaker1: [1:12:17] Like, okay.
Speaker0: [1:12:18] Okay, I have to walk away.
Speaker1: [1:12:20] I know everyone knows exactly what we’re talking about. I mean, there’s no reason to not say the name, but it’s funny too, because the approach isn’t, like, clinically, when I’m working with people, it’s not an easier approach necessarily. Like, you know, I actually had one patient I’m just thinking of who, you know, we got blood work back, she’s insulin resistant, I started educating her on what that means. And she’s like, you’re not going to make me follow the, you know, this influencer stuff, are you? Where it’s like, you know, fiber before your meal, which is maybe not a horrible advice. And like adding, it’s like, you’re not going to make me follow that, are you? But when I’m recommending the low insulin lifestyle, which I have been doing, actually, a lot of people are like happy to receive it. Like it’s, there’s something very validating about understanding the symptoms. And the diet is very manageable for people, like kind of psychologically. You can eat what you want. It’s logical. It makes sense. It’s not like like low FODMAP diets. There’s certain fruits and vegetables that people don’t categorize that you’re allowed and you’re not allowed. At this one, it’s you’re allowed all the fruit you want, all the non-starchy vegetables, all the animal protein, your six ounces of Greek yogurt or an ounce of cheese, all the fat you want and avoid sugar. And then you have like it’s a very little it’s a small blur that I send people.
Speaker0: [1:13:36] Yeah, it’s a small little thing. And there’s always, you know, you have allulus and monk fruit and all these other things. So you can still have those. I cook with almond flour all the time. I mean, I make almost, I have tons of stuff with almond flour. I mean, I make Cheez-Its. Like I just mix almond flour and egg and some cheddar cheese and I roll it out and I air fry them. And it’s like, you know, so I, there are so many, and that’s part of, you know, what will be on the app is just hundreds of recipes, like things like this to really help. And I’m, I’m not doing a plug, but I’m just saying I am coming out. A guidebook, because I feel like the original book is very silency, but in a layman’s perspective. And if we need to stop, we can. I mean, I’m good. But… Is this guidebook that’s like, if, okay, you know, this is a lot of science. I like to know, and it’s important to know, but I want to know, like, how do I really incorporate this? And some people want something tangible. So in the next month or so, I’m launching a guidebook, which is like, it really still goes into the details of the studies and the data and the science, but with more pictures, less words, more, you know, recipes, meal plans, how to eat at restaurants, what to do in the holidays, how to build a grocery list, how to read a nutrition label. Like, I mean, just kind of like this more reference guide that’s more tangible for people who don’t want to use an app. You know, they can have a book, be very colorful. They can set it in their kitchen and like reference whenever they want. So that’s, I think will help be helpful too.
Speaker1: [1:14:59] It’s so good. Yeah. It’s your Instagram account is great too. You have lots of good recipes. Like, but I think, I think one thing we might’ve missed is why is fruit allowed? Because I think people might be wondering that. I don’t know. Okay.
Speaker0: [1:15:11] So fruit is part glucose and part fructose. Now, fructose gets a very bad reputation for good reason. Too much fructose overwhelms the liver, leads to fatty liver, which is like high fructose corn syrup. So fructose in large amounts, really bad. Actually, just a history lesson. One of the reasons why they came out with high fructose corn syrup, aside from it just being very cheap and very sweet, was because it had less glucose. They thought it would be better for diabetics. Because it wouldn’t lead to the same glucose response. Does that make sense?
Speaker1: [1:15:43] Yeah. They didn’t realize that. We’ll throw this in. It’ll be great.
Speaker0: [1:15:47] What could go wrong? It’ll be so healthy. And then they were like, oh, this was a problem. They don’t care. They still add it to everything. But we know that excess fructose is a problem. Now, whole fruit.
Speaker0: [1:15:58] Well, sorry. The good thing about fructose in its naturally occurring form amounts is that it requires zero insulin release for metabolism. So fructose does not elicit any insulin relief. So that’s, again, why they thought, oh, high fructose corn syrup would be great, but no. So the amount of fructose in a whole raw fruit is not going to overwhelm your liver, right? You have that fiber. It is going to slow that digestion. So you’re getting a slow trickle of the fructose instead of just, you know, a soda. So because it’s part fructose and because fructose does not elicit any insulin response, fructose as a whole has a lower insulin response. Now, fruit still has glucose and you still might see something on your CGM or something, but it’s still going to be far less than, you know, having a whole apple as compared to a third of a cup of quinoa is very different, right? And so the amount of glucose in a whole apple is maybe 10 grand. It’s like 6 grams of fructose, about 10 grams of glucose, whereas 36 grams in a third of a cup of quinoa. So it’s really just thinking about that perspective is that fruit doesn’t have that huge insulin response because it’s part fructose.
Speaker0: [1:17:22] And I always like to tell people, too, agave nectar.
Speaker0: [1:17:27] Is worse than high fructose corn syrup. Agave nectar is 90% fructose. High fructose corn syrup is only 55% fructose. So you’re drinking straight fructose when you’re having agave nectar. So I just try to tell people just because it’s natural sugar doesn’t necessarily mean that it’s better.
Speaker1: [1:17:47] Yeah, that’s a good point. Yeah. And I think one thing that you stress is that there’s no limits on fruit. So people are eating as much food as they want, which when I hear that, I’m like, Dr. Allie, I don’t think you know me. Like maybe you’ve done research, but maybe you haven’t met people like me. Like I could eat a lot of fruit if you’re just going to let me go. But it looks like people were eating about 90 grams of carbs, which is fairly low carb. And your desire, yeah, kind of.
Speaker0: [1:18:14] Your desire goes down. You’re like, I eat fruit every day, but I probably eat like, I don’t know like two pieces of fruit maybe like sometimes one sometimes two sometimes more but again it’s one of those things where you’re just full you’re eating a lot of fiber you’re eating a lot of fat and protein and you just like fruit is great but you’re just not as hungry and you’re definitely not as hungry for carbs so it’s just one of those where you still eat them but it’s not one of those like I want to eat you know this whole bowl of fruit you just have your your taste buds and your appetite changes.
Speaker1: [1:18:48] Yeah, this is so good. What have you seen beyond two months? I don’t know if you’ve tracked people or worked with people or just in personal experience. How long does it typically take for people to get their insulin into the normal range? It looked like people’s HbA1c was all normalized after two months.
Speaker0: [1:19:06] It was normal to begin with. Yeah.
Speaker1: [1:19:10] Sorry, their HOMA-IR. HOMA-IR was what I wanted to say.
Speaker0: [1:19:12] Yeah, yeah. So we haven’t done any studies beyond eight weeks. Okay. Right. Just from financially, right? The longer the study it is, the more money. And even the new study, it’s called the Lilac study, the Lilly App clinical study. The Lilac study is also eight weeks. Because from research, it’s hard to like do these. Now, after the eight weeks, we will give the participants the ability to say, would you be interested in continuing to follow this? and, you know, continuing to even just report patient-reported outcomes, like how their acne has changed. There’s some of these very validated, like, PCOS quality of life surveys that we’ll administer once a month just to continue to keep that data, have them self-report their weight once a month. You know, so I’m excited about doing more research. You know, part of the revenue from our company as a whole will go to continuing to provide more funding for research because I want to do all kinds of, you know, research. But.
Speaker0: [1:20:13] Beyond what after you know eight weeks like I have quite a few Instagram influencers like one girl I think she’s lost she went from like 190 and now she’s 135 she’s pregnant right now so but she’s she’s been following me for over a year a year and a half um and then a personal friend or a family friend of mine she was four foot 11 and 190 and she’s now 135 and she’s that’s been two and a half years and she’s been like just steady at 135 and she she had a stroke like 10 years ago and her doctor now took her off all of her meds because her her blood levels of everything are normal so it is sustainable because it teaches you to think about food in a different way you’re not thinking about of calories and i need to eat more i need to exercise to burn off something it’s it’s thinking of it you know in a different way and i i’ve plenty of people that are like i’ve lost so much weight i’ve gotten around i got rid of all of my fat clothes because i have no concern that i’m ever going to keep it off like i i have no no issue um or others will say i’ll go on vacation and like i’ll do whatever i want but it’s okay because i come home and i get right back on it and the water weight that i’ve gained is off in a week you know and i’m back right back to my normal so it’s like you can still enjoy your life um and have those moments where you can just.
Speaker0: [1:21:35] Eat what you want as long as you know what your default is. You’re going to come home and you’re going to get back on your default and you’re going to give your pancreas a break from the damage you just did. I don’t want to say damage. From the enjoyment that you’ve had and then you’re going to go back and you’re going to give your pancreas a break. So I have what’s called a bounce back blueprint that I put in the it’s like, you’re going to wake up you’re going to drink a bunch of water or you’re going to go for a long walk. Like how to get back into all right I’m going to get back into mine.
Speaker1: [1:22:04] That’s good. Yeah, it’s good from kind of like, like a binge eating perspective, right? It’s like, okay, like, no all or nothing thinking, just get back on it. And, and, you know, you’re not, I think you’ve talked about the keto diet. And this is because you’re eating carbs, and you’re just getting your carbs from fruit and vegetables. You’re not like, going on vacation, getting out of ketosis, then having a switch back in going through that whole metabolic process,
Speaker0: [1:22:29] Like you’re just a few weeks.
Speaker1: [1:22:30] Yeah, you’re just okay, I’ll just I’m just probably going to eat a lot of bananas the first day until everything regulates and then and then my appetite will settle and I’m not having to like metabolically switch in that way that, you know, can cause side effects for people or this idea of like, you’re either in it or out of it.
Speaker0: [1:22:50] Because ketosis is I mean keto basically lowers insulin that’s what it’s that’s what it’s doing it’s just doing it in a very aggressive way and when your insulin lowers that that low and you don’t have any glucose that you’re eating your body has no choice but to switch over and burn only fat which is what is releasing those ketones and what your body is using but, That that leads to that keto flu, because until your insulin level is lower enough to where you can burn that body fat, your brain is like, I don’t have anything here. Like, I don’t have enough glucose. I don’t have enough fat to eat to use because your insulin is too high. You really have to wait until you get to that switch where you can lower insulin and you can start burning all that body fat. But here is this more of a middle ground because your insulin levels are lowering, but you still have some glucose that you’re eating from the fruits and the vegetables. So it’s more of like what’s called metabolically flexible you’re you’re you’re able to burn glucose when you need to and then your insulin levels fall and then you can burn some body fat and then you eat again and you can burn some glucose and then you can burn some body fat you’re just your body is and that’s a term like that’s an actual term metabolic flexibility that you are flexible and that you can burn whatever it is that you need um most people can’t do that right most people can’t burn body fat can’t burn fat for energy um and then keto it’s just a very aggressive way of lowering insulin and wanting to just never have a glucose well you don’t really have to do that right like you can there is a middle ground yeah.
Speaker1: [1:24:17] Which is yeah which is so refreshing to see and like you know it’s well received like people love it like oh i can have as much fruit okay because we’re told often that fruit is bad and everything is confusing you know
Speaker0: [1:24:30] Because it’s glucose right they think oh if carbs are bad carbs are bad like think of it more of like how it’s affecting your metabolism, right? And how you’re, and people think of metabolism as just like how many calories you burn every day. No, no. Metabolism means how you use the food that you eat for energy or store it as fat. And if you’re eating foods that are constantly forcing insulin release, then you’re storing it as fat. You know, that’s just what’s happening. So, and eating big breakfast to boost your metabolism, that’s, eat when you want if you’re not a breakfast person don’t eat breakfast right like this is getting rid of every single food rule there is one rule if it spikes your insulin you should avoid it as much as you can if it doesn’t spike your insulin eat it whenever you want you know that is there is one rule you know and that really it makes people feel refreshed like the amount of, brain space that I don’t spend on food because I just and you know for 10 plus years the amount I mean the amount of time I spent worried about food and calories and carbs and working out and protein and everything else like it’s just like free up your brain for other things in life that bring you joy you know that’s really the most important thing.
Speaker1: [1:25:52] Yeah I can relate to that so much you know and even the being a sugar burner like being metabolically inflexible when I first learned about it I was like yeah that’s me every two hours I need to eat and it feels like you’re not you know especially if you’re if you are a calorie like I was a calorie tracker for a while and I’d be like how am I burnt like if this has 500 calories why am I hungry you know based on this whole calories in calories out all the biochemistry that you learn like I should be full for i don’t know longer than two hours i’m not burning 500 calories sitting here and studying um and so when i learned about that i was like oh yeah i’m not accessing the fat from my food or my body i’m just running on sugar it’s like a bat like a car with a race car engine or something i’m like burning all the gas out and having to refuel constantly and it’s mad
Speaker0: [1:26:40] And this is nine out of ten i think it’s like four out of ten kids they did a study you could test the insulin levels of a five-year-old right now. And it will tell you whether they’re going to be overweight, have type early diabetes, a five-year-old. And they did finger pricks at school for like thousands of kids. And they measured them. They followed them over the course of like, I think, 10 years or so. And they said the number one strongest predictor of early, you know, adolescent obesity was elevated fasting insulin at age five. And it’s so sad. It is. There’s so much to be done. And I will say, people are going to be like, well, why are people not talking about this? Why are doctors not talking about this? Why are you measuring it? I can tell you in one very simple way. Because the only time that clinical guidelines actually change is when somebody foots the bill. And it’s usually Big Pharma. So when Big Pharma came out with cholesterol-lowering drugs, they had the teams that worked with the clinical societies. They worked with the insurance companies. They worked on developing the standard ranges because they had a solution to a problem that they needed to make sure that everybody understood the problem so they would buy the solution.
Speaker1: [1:28:02] Mm-hmm.
Speaker0: [1:28:03] And unfortunately, there is no drug in development for lowering insulin levels. And so because of that, there is nobody footing the bill for increasing access to this information, to making sure that we have standard ranges, to make sure the insurance companies are reimbursing for this. I mean, it is, it takes deep pockets to do that. And the only people who have pockets deep enough are big pharma. And there’s no drug on the horizon to lower insulin. And that is the reason. Because they have huge field forces to go out and educate every single doctor about you need to measure this and why. And look at our data. And this is so important. And look at the outcomes for people who lower than, there’s nobody doing that.
Speaker1: [1:28:40] Yeah. It was a whole task force around fat, cholesterol. It was like decades of people all getting together and deciding on these guidelines. And, you know, and that I’m just thinking about the kid with high insulin who, you know, let’s say the parents are like, OK, we’re going to put some effort in and we’re going to look at your diet and we’re going to follow the guidelines. We’re going to put, you know, pay attention to labels and we’re going to probably be eating our six.
Speaker0: [1:29:05] We’re going to eat whole grain.
Speaker1: [1:29:09] Yeah. Which, you know, so it’s like we take our effort, our best intentions and then we’re we’re not applying the right interventions. And people give up you
Speaker0: [1:29:19] Know yes and then they’re like but whole grains are good for you i’m not saying that they don’t have nutrition that doesn’t mean they’re good for somebody with glucose intolerance which is essentially almost everyone so you know yeah they think that they have the best intentions they go to the store they buy the whole grain goldfish instead of the regular goldfish and they buy the protein special K because it has more protein and low calories and they mix it with the low fat skin milk. And literally every single one of those choices could not put more insulin into the system. I mean, it is literally flooding it. And it’s like, Oh, there’s another dietitian influencer on, on Instagram. And she basically was like, if your kid is struggling and you should, if they want to have KFC and they want to eat the biscuits, you just need to make sure that you give them the chicken leg with the biscuit because the chicken leg gives you the protein and the fat. And so that’ll offset the biscuit. I mean, this is a dietitian. She has hundreds of thousands of followers and it’s just maddening. It’s maddening and so and i feel like nobody can win for losing because they’re just they’re like i’m following all this advice and my kid’s getting worse or you know and it’s just yeah.
Speaker1: [1:30:38] I really feel like it doesn’t work or i’m broken work or yeah
Speaker0: [1:30:41] I made a i made a post recently that we go to conferences we go to the big conflict the big fertility conference and whatnot and i i have i’ve had many doctors tell me fertility specialists tell me i don’t send my pso my pcos patients to dieticians anymore because they come back worse than they started because that they get told eat more whole grains and beans and low-fat dairy and they come back and they’re heavier than they started yeah i.
Speaker1: [1:31:03] Have a patient i’m thinking with prediabetes who’s already on like maxo and the metformin dose and her dietician is like okay when your blood sugar drops because you’re on metformin and you’re not diabetic so your blood sugar is going too low and it’s but you know metformin is lower in blood sugar it is lung insulin a little bit but not enough and uh it’s like just have a candy. Take candies with you and have candies to bring your blood sugar up. I put a diabetic patient.
Speaker0: [1:31:28] It’s just granola bar. Like, oh my God.
Speaker1: [1:31:31] Terrible. So it’s just, and even she was like, this isn’t working. I feel like trash. Like, I’m not going to go anymore.
Speaker0: [1:31:38] Dietitians do not understand insulin resistance. It’s not taught in school. I mean, I graduated in from my bachelor’s in 2009. So that was a long time ago. And I was really hopeful that they’d at least caught up with the data. But I have another follower who’s currently getting her bachelor’s in nutrition. She’s like, The only thing I’ve learned about insulin is that you give it to diabetics to lower their blood sugar and that’s it. Like they do not learn about this. So if everything looks like a hammer, if all you have is a hammer and everything looks like a nail, everyone’s getting the same advice. Yeah.
Speaker1: [1:32:10] Terrible. It’s flashy.
Speaker0: [1:32:12] You can tell I’m very passionate about this.
Speaker1: [1:32:14] This is so good. This is so informative. I think people are really going to love this. My last question is, you know, about men. So I know your research is PCOS. We’re talking more broadly about insulin resistance. I think what’s really beautiful about your research is that it’s done on women because so much is not done on women at all. And so conventional advice like intermittent fasting, cold therapy, all this stuff that’s so great and influencers are recommending may not be great for women who have different hormones, different considerations.
Speaker1: [1:32:42] But this is like these are results done on women. And everybody who’s done a diet with their male partner knows like he loses like 50 pounds, I lose one, you know? Yeah. But my friend wanted to know if if this applies to men, which I think the answer is obvious. But yeah.
Speaker0: [1:32:59] I mean, it applies to everyone. Right. Kids, pregnant women, men, everything. Because for men, you know, one of the bigger issues is around the age 35, they start to have a reduction in testosterone. Right. Let’s call it menopause. They start to have a reduction in testosterone just naturally, which coincides with an increase in insulin. So a lot of times they’ll see that they’re having Dabod, which may not be anything to do with what they are changed in their eating or exercise. But when you have higher insulin, you start to gain weight and a large part of that goes to your stomach.
Speaker0: [1:33:31] And more so, that’s even more problematic with that is that when you have more fat tissue, That fat tissue has an enzyme called aromatase. And what happens is testosterone gets converted to estrogen into that fat tissue. So now not only do you have this natural decline in testosterone, but now whatever testosterone is left and being pumped out is getting turned into estrogen, right? So you have a, that’s what’s causing men to have low testosterone. And the only therapy we’re giving is to do testosterone injections or testosterone replacement therapy, but you’re not getting to the real reason why they have the low testosterone in the first place.
Speaker0: [1:34:13] That’s one of the problems, but that also leads to erectile dysfunction because now you have more chronic inflammation, which inflames, you know, all of your vascular system, but also, you know, having lower testosterone. So all of that kind of compounds to lead to erectile dysfunction, which is one of the earliest symptoms of insulin resistance in men. People, I had no idea. A third of men experience erectile dysfunction. That is a very early sign of problems. Before they have anything wrong with their labs, before anything happens, if they’re experiencing erectile dysfunction at an early age, it’s not just psychological. There is definitely something wrong going on. So that’s something I would say if you’re having a husband that’s experiencing that, they need to probably go get a workup. But, you know, the other thing is like sperm, high insulin and that chronic inflammation leads to changes in the sperm. So, you know, if you’re trying to get pregnant, you need to be following it. But so does he. He needs to have the healthiest sperm he can have. And that starts with, lowering insulin, making sure there’s not enough testosterone, making sure there’s not chronic inflammation. So I shared earlier, my husband, he’s part Hispanic. His dad died of a massive heart attack at the age of 41.
Speaker0: [1:35:28] And he was about 200 pounds when we started dating. He’s 5’11”. And he has now, I mean, that’s been 10 years, 10, 12 years since we started dating. And he is, he’s at 175 and has stayed at 175 like completely and he’s not perfect I told I told you that he doesn’t realize you can eat a pint of ice cream in more than in different settings like he just eats the whole thing so he’s not perfect but he is very very you know if he goes up a little bit he stays strict for like a few weeks and he’s back down and it’s just you know very even keel And I will say, you know, we, there was a study in 1966. So back in 1966, where they said fasting insulin is the strongest predictor of heart disease, strongest predictor of heart disease in the Lancet in 1966. So he went to his cardiologist like two months ago, because I told him, I was like, you know what? I don’t care that you look healthy. You obviously have genetic history. You need to go and start getting work up with your cardiologist. He’s 38. And uh, he went and he asked his doctor his cardiologist to test his insulin levels and she literally said I don’t think you can test insulin Wow And he was like, yeah, I know you can test insulin. She goes, I don’t know how to do that I’m gonna have to go talk to my colleagues.
Speaker1: [1:36:50] In 1966, so right before the low-fat cholesterol kind of paradigm.
Speaker0: [1:36:55] Everything. We have known for decades on decades that insulin is a problem, and yet here we are in 2025, and we’re not measuring it. And their excuse is that, well, the assays aren’t predictable. Then develop a better assay. That’s not the answer. It’s just like, oh, well, we can’t measure it.
Speaker1: [1:37:15] What? I mean, there’s developments for type 1 diabetes, So they must have figured out how, I mean, we can isolate insulin. We can make the peptide. We can inject it in people. We have long act, we have all kinds of insulin.
Speaker0: [1:37:27] We know how to do it. You can pee on a pregnancy test and it will measure a certain small hormone in your blood in a few seconds. And you’re saying we can’t develop assays for insulin? I mean, it’s mind-blowing. But I think personally, it’s probably a little bit of a conspiracy because if we start managing the insulin, then how are we going to treat the cancer? And who’s going to make money on treating the cancer? and the Alzheimer’s and the diabetes and the weight loss.
Speaker1: [1:37:51] Yeah, like all of our health issues go away.
Speaker0: [1:37:53] The testosterone replacements. I mean, all of the health care would go away. Yeah.
Speaker1: [1:37:58] Everybody’s talking about this idea of metabolic health, metabolic disease, and this is exactly what you’re working with. And I was just listening to Andrew Huberman. I know we’re almost at our time, but he’s talking about, he’s like, you know, a lot of my friends follow this really great diet, and he was describing your diet. I don’t think he knew about your diet. Hopefully he will one day. But he was like, yeah, lots of fruits and vegetables and proteins. From animals and they feel great and everything’s great and their cravings are managed and so we all intuitively know that’s the way to eat eat plants and animals
Speaker0: [1:38:26] Less processed nuts and seeds and like things that are just yeah normally available like people don’t realize as how the amount i think i used ai because i said okay imagine that all of human evolution was one year how long have we been eating starches and dairy? And if you were to do that, what would your guess be? If all of human evolution was compacted into one year, how long do you think we have actually as a species been eating starch or dairy?
Speaker1: [1:39:03] It’s, I mean, I have a little bit of knowledge. In like the 12-hour clock, it’s like the last second or something like that. So I imagine it’d be like the last month.
Speaker0: [1:39:14] Two and a half seconds. Yeah. Oh, wow. We have been eating starches and dairy for two and a half seconds and so when people are like we’ve been eating bread from the beginning of history i’m like no no no no and.
Speaker1: [1:39:28] It was different bread and we had different we had different like
Speaker0: [1:39:31] A different bread and we also didn’t eat bread we ate bread when we became societies and we didn’t want to have to look for our next food and that makes sense and that’s great we built societies but we also work we we exercised a lot more we were just active right like we were going out and bothering that around that.
Speaker1: [1:39:49] Time we had like bad bone structure like things changed not you know all of these diseases ran rampant and
Speaker0: [1:39:56] Right like we there is nothing that’s naturally available to us that spikes insulin fruits people are like oh well like you know the fruits today are so big they’re not the same well, Have you ever seen a fruit tree that’s like heavy with fruit? If you were like a hunter-gatherer or like an ancient person and you just happened upon this fruit tree, you might sit there and eat three or four apples. Like who cares if an apple today is this big when you just would eat, several of them you know like that’s and they’re like oh well they’re sweeter i’m like no no no i spent two two weeks in the amazon when i was 18 and that fruit is unadulterated and is sweeter than i’ve ever tasted in a grocery store so it’s not because it’s sweeter it doesn’t matter that it’s bigger fruit has always been very available i live in the coast the orange trees here get so full of oranges that the branches touch the ground i mean fruit would have always been available to us vegetables would have always been available to us like my parents are drowning in pecans we live in texas i mean the amount of pecans and they have six countries at their house like these are foods that would have just been available to us you know and it’s like, going and gathering enough oats to make your morning bowl of oatmeal that you cooked in the microwave for 90 seconds and added milk and honey to.
Speaker1: [1:41:18] You don’t you don’t know how to do that like you know how to pick an apple you can theoretically imagine how you kill an animal, but how you make oats, even what an oat looks like when it’s growing, nobody knows, right?
Speaker0: [1:41:30] No, and it would have just been wild oats, right? Like you would have had to go forever to find enough oats to like put in your bowl and then somehow make it, I mean, steel cut oats take forever to cook and just, it wouldn’t have been part of our life. And now people think nothing of a bowl of granola and skim milk, which is just oats and sugar and milk or a bowl of oatmeal with, milk and honey in it and they’re like oh it’s oatmeal it’s like um it’s so much more than oatmeal it’s a bowl of glucose you know and it’s hard for people to get their head wrapped but hopefully with the this conversation they understand
Speaker0: [1:42:08] a little bit more behind what’s going on yeah.
Speaker1: [1:42:11] I think minds will be blown so really one why i wanted to talk to you i wanted to be like listen to this conversation to patients who are like what like you know but um dr ali any last thoughts? Any last words? Thank you so much.
Speaker0: [1:42:23] No, I think that, you know, I think we covered everything and more. People might need to watch this on 2X to get this.
Speaker1: [1:42:31] Yeah, watch it a couple times. I might have another episode kind of going over the signs with PowerPoints to kind of like reinforce what we talked about. But yeah, this is really great.
Speaker0: [1:42:41] Yeah, I think the free webinar, right? That free webinar I have on YouTube, I think it really helps also just, you know, put some perspective i have a free guide on my website with kind of all the foods that you can eat freely of um and then yeah so and i have i have the app coming out i’ll have tons of free education um it’ll have a subscription because that’s just you know part of the world we live in but if you want to access some of the tools and resources but a lot of the education will be free so perfect i’ll.
Speaker1: [1:43:08] Link to everything in the show notes for people to check you out and to follow you so your website and your instagram um is that the best place people can find you kind of website Yeah,
Speaker0: [1:43:16] I think I’m not very active on any other social platform. I can only handle one. But Instagram is where I’m at. Yeah, where I do the most.
Speaker1: [1:43:25] Thank you so much. This has been so great.
Speaker0: [1:43:27] Thank you for having me. Love it.
In order to make sense of the world, people create stories. It is our greatest gift and most fragile weakness.
Boy meets girl, they fall in love, they encounter difficulties that they eventually overcome. It brings them closer. They live happily ever after—the classic love story.
Stress has a classic story too: cortisol, the “stress” hormone, is released during stress. It wreaks havoc on the body. Lowering stress helps lower cortisol.
However, when it comes to human hormones, telling stories in a linear narrative is impossible.
Hormones are signalling molecules in the body. They are produced by endocrine organs, such as the adrenal glands, the brain, and the ovaries. They travel through the bloodstream to impact the expression of genes on distant tissues, which impacts how our bodies function.
Production of norepinephrine in the adrenal glands as a response to stress can make your heart race, your pupils dilate, your hands to shake, and your senses become hypervigilant—when a perceived threat or danger activates the release of this hormone, your entire body pulsates under its influence.
Hormonal stories are hard to fit the human desire for narratives. Their relationships with our genes, bodily systems, receptor binding sites, and each other make their actions too complicated to be described linearly. Instead they act like webs, or tangled networks of intricate connections.
When hormone levels rise in the body, beyond our delicate homeostatic balance, a phenomenon, called “resistance”, can occur. With resistance, cells reduce their responses to the hormones that interact with them.
When telemarketers keep interrupting your dinner at 6pm, eventually you stop answering the phone.
When certain hormones continue to call at the surface of cells, stressing the body’s capacity to respond, our cells simply stop answering.
Many of us ask, “what happens when I pull this thread here?” when learning about one hormone that we’ve blamed all our woes on. We tug the thread, without considering the entire web of connections, and our actions affect the entire system.
Our hormones exist in an ecosystem where everything hums and flows together, as a unit. It’s impossible to lay out explanations for their actions in a linear fashion.
Hormone stories flow like a Choose Your Own Adventure novel—a hallway with many doors that snake down long corridors and meet again, and interconnect.
Go through the door marked “estrogens”, and you encounter serotonin, cortisol, progesterone, insulin, thyroid hormones, leptin, BDNF, dopamine, norepinephrine, and many others.
Hormones are the conductors of your body’s personal orchestra, composed of thousands of musicians, a complex musical score, highly-trained arms, fingers, and mouths manipulating instruments: a million moving parts working together in harmony.
The best we can do to understand the entire interplay is to slow down the action, take a snapshot of it, and to try to understand why these symptoms are occurring in this individual.
Symptoms of Hormone Imbalances
Because hormones affect absolutely every system of our body, I am always attuned to the possibility of hormonal imbalances in my patients.
It helps to look at hormones in terms of their symptom patterns rather than how any one hormone affects us in particular.
Common signs of hormonal imbalance are:
Fatigue, low libido, restless sleep, depression and anxiety, waking at 2 to 4 am, a high-stress lifestyle, and brain fog might indicate cortisol imbalance.
PMS – and the more severe related condition, PMDD – infertility, fatigue and low libido, missed and irregular periods may be related to fluctuations in the hormones estrogen and progesterone, or low estrogen and progesterone levels. Many of these symptoms could also be related to estrogen dominance, in which estrogen is either high or normal, and progesterone is low.
Endometriosis, a family or personal history of female cancers, anxiety and panic attacks, heavy and painful periods, frequent miscarriages, infertility, fibroids, fibrocystic breasts and weight gain around the hips and thighs can indicate estrogen dominance.
High levels of male sex hormones like testosterone, irregular periods, weight gain, acne, and hair loss may indicate a female hormone condition called PCOS.
Fatigue, brain fog, difficulty losing weight, puffiness, constipation, dry skin and hair, and low body temperature can be signs of hypothyroidism.
Symptoms of reactive hypoglycemia, such as feeling dizzy, anxious and shaky between meals, sugar cravings, weight gain around the abdomen, difficulty losing weight, and low morning appetite, night-time carbohydrate cravings, and binge eating can all be related to insulin resistance and poor blood sugar control.
In my naturopathic practice, I see common patterns of symptoms that indicate certain hormonal imbalances.
These patterns often represent vicious cycles where our body is stressed beyond a capacity to balance these interconnected webs of chemical interactions, causing further imbalance.
Cortisol
Speaking of stories, here’s one I hear often.
You wake up in the morning, exhausted. Your brain is in a fog and you don’t feel alive until a cold shower or double espresso knock you out of your stupor.
Things get a bit better once you get moving, but you wonder why your energy never fully bounces back.
You used to play sports in university, you think to yourself. Now just thinking of sports makes you tired.
Is this what getting older feels like? You’re in your 30s.
The days at the office stretch on forever. Concentration and focus are difficult. You see a coworker whose name, you realize with horror, can’t be brought to mind.
You’ve known her for a year. Cynthia? Sylvia? Your brain hurts.
In the afternoon you think longingly of napping, but instead take your place in the long line for coffee and something carb-y like a cookie.
When it comes time for sleep you are either out like a light or find it hard to turn your mind off; you’re tired, as always, but also wired.
Sleep doesn’t feel restful, and you often wake up, sleepless, at 2-4am in the morning.
When your alarm rings a few hours later, the cycle begins again.
Cortisol, one of our stress hormones, has a circadian rhythm. Its levels are highest in the morning, about an hour after waking. Cortisol promotes energy, alertness and focus. It is also a potent anti-inflammatory hormone.
Cortisol is what makes us feel alive in the morning, bouncing out of bed like Shirley Temple and her curls.
Throughout the day our cortisol levels slowly dwindle (unless a major stressor causes them to spike abnormally). They are lowest in the evening, when melatonin, our sleep hormone begins to rise, inducing feelings of sleepiness, preparing us for a night of rest.
Our modern day society, however, calls on cortisol to perform more than its fair share of work. Cortisol is around when we’re hauling ourselves out of bed after an inadequate night of rest.
Cortisol fuels gym workouts, gets us to our meetings on time, allows us to meet deadlines, tolerates traffic jams, responds kindly to tyrannical bosses, and makes sure the kids get to all their after-school events.
Cortisol is made in the adrenal glands, two endocrine glands located on each kidney, in response to signals from the brain that perceive stress in our environments and bodies.
When stress hormones levels are too high we experience a “tired and wired” feeling. During this time we might feel we thrive better under stress: workouts boost our energy, we have a hard time quieting down and we rarely feel hungry.
We might still struggle with weight gain, however, especially the abdomen and face, where cortisol tends to encourage fat deposition.
We might feel tension—tight muscles and shoulders, and body pain, as muscles clench up, preparing to fight or flee.
Chronic stress is associated with high levels of cortisol. We work long hours, late into the night. We go, go, go. This may give us a “high” or it may feel exhausting and depleting.
Many of us can exist in this state for months and even years. Sometimes a compounded stressor such as a divorce, accident, or loss, can tip us over the edge into a depleted, burnt out state.
Burnout, often following a period of prolonged stress, can be associated with low cortisol signalling. Our bodies have simply stopped being able to produce the stress hormones necessary to meet the needs of our daily lives, or glucocorticoid receptors in the brain and body cells, have stopped responding to cortisol.
Just as cell can be become resistant to insulin, they can also become resistant to cortisol. Too much (or even too little) of a hormone can cause cells to start ignoring their signalling, resulting in symptoms of low levels of the hormone in some areas of the body and high levels of the hormone in others.
Cortisol is a complicated molecule. It both encourages the stress response, but also turns it off, when levels reach a certain point.
Often, cortisol levels that are too low result in an impaired stress response, preventing our fight or flight system from properly shutting off—cortisol resistance can lead to further stress hormone disruption.
The result of an imbalance in cortisol, otherwise termed Hypothalamic Pituitary Adrenal (HPA) Axis dysregulation is weight gain, fatigue and brain fog, inflammation and immune system activation, digestive issues, restlessness, impaired sleep, decreased cognitive function, and mental health conditions, such as anxiety and depression.
When cortisol levels are low, the body makes adrenaline and noradrenaline to meet our needs, which often leads to anxiety and feeling shaky and nervous, contributing to symptoms of anxiety.
Cortisol also influences the function of our sex hormones, thyroid hormones, and our blood sugar. Imbalances in any of these other hormonal systems can be a result of an impaired HPA axis.
Cortisol Testing
The two main ways to assess the body’s levels of cortisol are through serum (blood tests) and saliva.
A study found both tests were equal when it came to diagnosing Cushing’s disease, a condition of highly elevated cortisol.
One of the advantages to salivary cortisol testing is the ability to obtain multiple samples in one day to be able to view a patient’s cortisol curve, in which cortisol peaks approximately one hour after waking and declines throughout the day.
The cortisol curve is measured by assessing 4 samples of salivary cortisol taken at 4 key points during the course of one day. It measures free cortisol, which may only represent about 5% of total cortisol in the body.
While salivary cortisol levels can be a good starting point for assessing the cortisol curve, it doesn’t tell us everything about the health of the glucocorticoid receptors or HPA system as a whole.
High cortisol levels may be seen in patients with low cortisol signalling, such as depression, anxiety and chronic fatigue. Errors in obtaining salivary cortisol samples (such as not taking samples at the right time) can lead to falsely low cortisol readings.
In my opinion, this makes symptoms and health history the most valuable tools for properly assessing HPA axis function.
Cortisol and Melatonin
Melatonin, our sleep hormone, also operates on a circadian rhythm. It is released by the pineal gland in the brain and induces sleep. Its release corresponds to a drop in cortisol levels at the end of the day.
That release is impeded by artificial light exposure at night, lack of daytime sun exposure, alcohol, stress, and HPA axis disruption, among other lifestyle and environmental factors.
Melatonin, like other hormones, can be tested for in blood, urine and saliva, but I find more value in assessing for sleep quality and quantity by taking a thorough health history while also restoring a patient’s sleep hygiene and HPA axis regulation.
Many patients with sleep issues can benefit from a trial of supplemental melatonin to see if that helps their sleep. Taking it 2 to 3 hours before bedtime to coincide with the body’s natural melatonin surge and taking a prolonged-release version to promote sleep maintenance are two strategies I use for helping patients sleep better.
Working on sleep and circadian rhythms is also beneficial for restoring HPA axis functioning.
The “Female” Hormones: Estrogen and Progesterone
The most prevalent female sex hormones are estrogen and progesterone. These two hormones eb and flow in distinct ways throughout a woman’s monthly cycle.
Estrogen creates an “M” shape, rising at the beginning of the cycle to its first peak around ovulation, half-way through the cycle. At this time women typically experience their best mood, energy, and motivation, perhaps noticing a rise in libido.
After ovulation, estrogen dips a little bit and then rises, peaking again about a week before a woman’s menstrual cycle is due.
After this, estrogen takes a nosedive, reaching low levels around the time that menstruation begins: Day 1 of the menstrual cycle.
Progesterone, on the other hand is largely absent the first half of the cycle, before ovulation. Then, it begins a steady climb to peak with estrogen, about a week before the arrival of the next period.
After peaking, just like estrogen, progesterone then takes a dip, which stimulates the uterine lining to shed, resulting in menstruation, in which the entire cycle begins again.
PMS and PMDD
My practice is populated by women who experience various forms of grief at different stages of their monthly cycles.
Many of my patients experience PMS, and the more severe PMDD (Premenstrual Dysphoric Disorder)—which is characterized by intense mood swings, irritability, depression, or anxiety, panic attacks and psychosis in the most severe cases— up to two weeks before their periods.
The mood changes in PMS and PMDD are associated with fluctuations in the hormones estrogen and progesterone, which can wreak havoc on our brain chemistry.
Estrogen has a beneficial effect on mood, increasing dopamine and serotonin action in the brain. Dopamine and serotonin are two antidepressant, feel-good neurotransmitters.
Estrogen also increases something called Brain-Derived Neurotrophic Factor (BDNF) a chemical that stimulates the growth of brain cells. This can boost memory, concentration, and cognition, as well as positively influence mood.
Progesterone breaks down into a chemical called allo-pregnenolone, which acts like GABA, a calming neurotransmitter, in the brain. Bioidentical progesterone therapy is often used as a treatment for anxiety and insomnia.
When estrogen and progesterone levels surge and drop suddenly, drastic fluctuations in mood can occur. Cravings for sweets, crying, lack of motivation, or severe anxiety can all occur when hormones drop right before a period is due.
However, elevated levels of estrogen can also be problematic. Estrogen stimulates dopamine, which typically makes us feel good, gives us energy, and helps to motivate us. In genetically vulnerable women, elevated levels of dopamine can cause excess irritability, low stress tolerance, and even mania or psychosis.
Estrogen also slows the recycling of the stress hormones epinephrine and norepinephrine, which can lead to symptoms of acute stress and anxiety, when dysregulated.
This means that dramatic rises and falls in estrogen throughout a woman’s cycle can cause her to feel irritable and anxious one week and unmotivated and depressed the other.
Smoothing out hormonal ups and downs can be a key factor in regulating a woman’s menstrual cycles and soothing her mood and emotions throughout the month.
Perimenopause and Menopause
Perimenopause is characterized by a declining production of the ovarian hormones estrogen and progesterone.
Estrogen levels tend to rise and fall dramatically throughout a woman’s remaining cycles, while progesterone levels tend to stay low.
The result of these changes are symptoms like hot flashes, night sweats, brain fog, fatigue, and depression when estrogen levels suddenly tank, and increased stress and anxiety when estrogen levels abruptly spike.
During this time, cycles may become irregular. Some of my patients comment that their periods are incredibly light one month and the heaviest of their lives another.
Some get periods every few months and some notice increased frequency, even spotting between cycles, or have a full-blown period every two weeks in more extreme cases.
Weight gain tends to drift from the thighs and buttocks to the abdomen. Once pear and hourglass-shaped figures begin to resemble apples.
Fatigue is a common symptom. Women may experience poor sleep due to night sweats from estrogen deficiency, and anxiety from insufficient progesterone.
What a joy, right?
Many of these perimenopausal symptoms are a relatively modern phenomenon, stemming from a dysregulated HPA axis.
After cessation of periods, it’s the job of the adrenal glands to take over sex hormone production. However, if the HPA system is preoccupied with organizing a stress response, this can affect the production of other hormones.
Impaired Estrogen Clearance
Many women struggle with symptoms that are related to relatively high levels of estrogen, often caused by impaired estrogen clearance.
These conditions include heavy and painful periods, fibrocystic breasts, or conditions like fibroids or endometriosis.
Chronically elevated estrogen levels also include a risk of certain hormone-associated cancers, such as breast cancer.
These women may experience irritability and anxiety through estrogen’s interaction with stress hormones, and also from a relative deficiency in progesterone.
A relatively high level of estrogens compared to progesterone is termed “Estrogen Dominance”.
Estrogen is normally cleared through the digestive system: the liver and intestines.
A sluggish and congested liver causing a slower rate of hormonal clearance (think of it like a clogged drain), an increase in environmental toxin exposure, or an overconsumption of alcohol, can slow the liver’s ability to regulate estrogen levels in the body.
Constipation and a dysbiotic gut can also impair estrogen clearance.
Symptoms of estrogen dominance include stubborn weight gain, typically around the hips and thighs, heavy and painful periods, tender and painful breasts, fibrocystic breasts, endometriosis, uterine fibroids, acne, cyclical mood swings, especially premenstrual anxiety and panic attacks, and irregular menstrual cycles.
Low Progesterone
Aside from impaired estrogen clearance, another pattern of estrogen dominance is low progesterone.
In this case, estrogen levels are normal or even low (as in the case of menopausal or perimenopausal women). However, an even lower progesterone level still results in a pattern of relative estrogen dominance.
This can cause some of the same symptoms as excess estrogen (anxiety, irritability, heavy and painful periods, weight gain, PMS, fibroids, fibrocystic breasts, etc.).
Low progesterone can also be a culprit in unexplained infertility or early term miscarriage, as progesterone maintains the uterine lining in pregnancy.
Progesterone is released from the ovaries after ovulation. Lack of ovulation, therefore, is a primary reason for low progesterone levels. Anovulatory cycles can occur in women with polycystic ovarian syndrome, women with high levels of physical and emotional stress, or women entering menopause.
Some progesterone, however, is also made in the adrenal glands, where it can be eventually turned into cortisol, aldosterone (a steroid hormone involved in salt-water balance in the body) and androstenedione (a male sex hormone), eventually making testosterone and estrogen.
Women with high cortisol demands due to chronic stress may shunt the progesterone made in their adrenal glands to producing other hormones that support the stress response.
Not only can stress alter ovulation and fertility through various other mechanisms, it can also rob the body of progesterone, directing any progesterone made towards cortisol production.
Testing Estrogen and Progesterone
Estrogen and progesterone can be tested reliably in saliva, blood and urine.
Month long salivary hormone testing of estrogen and progesterone can be an easy and effective way to track the eb and flow of these hormones throughout a women’s menstrual cycles.
In this test, women obtain a saliva sample every 3 to 5 days for the duration of the month to track how estrogen levels corresponds with progesterone and how both hormones rise and fall.
In my practice, however, I often start by running blood tests. I test hormones on day 21 (of a 28-day cycle) to coincide with progesterone’s peak. This can help us calculate the progesterone to estrogen ratio and establish whether the cause of estrogen dominance symptoms is high estrogen or low progesterone.
Blood tests offer the option of looking at estrone, which is a more problematic form of estrogen, as well as estradiol (the most common, metabolically active estrogen in the body). In blood we can also look at LH and FSH, two hormones produced in the brain and ovaries that orchestrate ovulation.
FSH tends to be high in women in menopause or perimenopause, while LH tends to be elevated in women with Polycystic Ovarian Syndrome (PCOS).
Dried urinary metabolite testing, or DUTCH, is an effective way to understand how hormones are broken down and processed by the body. Looking at the entire hormone breakdown pathway provides a more in-depth look at the complexity of hormones in a woman’s cycle, and can guide treatment in specific, useful ways.
The “Male” Hormones: Testosterone
Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility (and the most common endocrine disorder) in women of reproductive age. It affects about 10% of menstruating women.
PCOS is a collection of various symptoms and complex hormonal causes. However, it is characterized by missed periods, anovulation, male-pattern facial hair growth, especially on the upper lip, chin, breasts and abdomen, and the presence of cysts on the ovaries.
Other common symptoms of PCOS are weight gain, estrogen dominance, male-pattern hair loss (on the crown of the head), insulin resistance, infertility, and acne, especially hormonal cystic acne on the jawline.
PCOS is characterized by elevated levels of testosterone, a male sex hormone, or “androgen”, on blood work.
Acne, weight gain, infertility, and hair loss are the main symptoms that bring women with PCOS into my office.
PCOS is a complex process that involves an overproduction of testosterone in the ovaries coupled with insulin resistance. Therefore, balancing blood sugar through diet and lifestyle can have a major impact on symptoms.
The conventional treatment for missed or absent periods is oral contraceptives, which of course doesn’t treat the underlying cause of anovulation. That’s why women with PCOS often seek naturopathic and functional medical solutions to treat the root cause.
Testing for PCOS
When I meet a new patient with PCOS, I often test her blood for estradiol and progesterone levels at Day 21 of her cycle. A very low progesterone level may indicate that she has not ovulated that cycle.
We also test LH and FSH. A high LH:FSH ratio can be indicative of PCOS even if cysts are not present on an ovarian ultrasound.
Other important tests that are often ordered are free testosterone and DHEA-S, another male hormone made in the adrenal glands.
Glucose control and insulin resistance can be assessed by looking at fasting blood glucose, fasting insulin and HbA1c (a marker that looks at long-term glucose control).
Prolactin, another hormone released by the pituitary gland, can sometimes be elevated in anovulatory women with PCOS.
A 4-point salivary cortisol test may be useful in women with PCOS who are also experiencing symptoms of cortisol dysregulation, which can contribute to insulin resistance and affect ovulation and hormone regulation, particularly progesterone production.
Prolactin
Prolactin is a hormone released by the pituitary gland to promote milk production after child birth.
However, some women will have elevated levels of prolactin in blood, despite not currently pregnant or breastfeeding.
Called hyperprolactinemia, elevated prolactin may be a cause of anovulation, mimicking some symptoms of PCOS and menopause, including hot flashes, absent or irregular periods, infertility and even milk discharge from the breasts.
Hyperprolactinemia may be caused by low calorie diets, liver issues, hypothyroidism, and issues with the pituitary gland itself.
Prolactin can be tested in blood. If levels are elevated, an MRI must be conducted to rule out a physical issue with the pituitary gland, such as a tumour.
Oxytocin
Oxytocin is a hormone produced in the brain and secreted by the pituitary. It aids in childbirth. Also termed the “love hormone,” it’s associated with feelings of intimacy and connection.
While high and low levels of blood oxytocin can be possible in men and women who are not pregnant or breastfeeding, the clinical applications of it are not fully known.
Thyroid Hormones
The thyroid, a butterfly-shaped gland on our neck, is the master thermostat of the body, controlling heat and metabolism. It pumps out thyroid hormones T4 and T3, which tell cells to burn fuel, creating energy and heat.
Because our thyroid hormones interact with the cells in every body system, symptoms of hypothyroidism, or low thyroid function, can be incredibly diverse.
Common symptoms of hypothyroidism are weight gain or inability to lose weight, fatigue and sluggishness, brain fog, hair loss, low body temperature, constipation, dry skin and hair, puffiness, infertility, and altered menstrual cycles, such as missed periods or heavy periods.
Aside from autoimmunity, other causes of low thyroid function can be HPA axis dysregulation and chronic stress, a very low calorie or very low carbohydrate diet, sudden weight loss, a deficiency in nutrients needed for thyroid function such as iron, zinc, iodine and selenium, and a body burden of environmental toxins such as heavy metals.
Testing Thyroid
To assess thyroid function, conventional doctors will test a hormone called Thyroid Stimulating Hormone, or TSH. TSH is not a thyroid hormone, but a hormone made in the brain that urges the thyroid to pump out the thyroid hormones T3 and T4. It gives doctors an indirect measure of thyroid regulation.
When TSH levels are high, this suggests that thyroid function is sluggish; the brain needs to send a louder signal to get an unresponsive thyroid to work.
However, TSH is only a periphery marker of total thyroid function, not giving us the whole picture. Also, TSH ranges on conventional lab tests may fail to pick up some cases of subclinical hypothyroidism or impending cases of autoimmune thyroid conditions, otherwise termed Hashimoto’s Thyroiditis, which is the most common cause of hypothyroidism.
To properly assess thyroid function in someone with symptoms of thyroid dysfunction, a slightly elevated TSH, or a family history of Hashimoto’s, I will order a thyroid panel: a blood test measuring TSH as well free thyroid hormone (T3 and T4) levels.
It’s also important to assess for autoimmune thyroid conditions by testing for anti-thyroglobulin and anti-thyroperoxidase antibodies. Both of these antibodies, when elevated, suggest the presence of an autoimmune thyroid condition.
Insulin
Some of the most common hormonal dysfunctions I see in my practice are insulin resistance and reactive hypoglycemia: blood sugar imbalance.
These issues often lie at the heart of other hormonal imbalance patterns, such as irregular menstrual cycles or HPA axis dysregulation.
When we eat, glucose enters our bloodstream, providing fuel for our cells. Insulin helps our cells access this hormone, spiking with each meal.
The higher the meal is on the glycemic index (i.e. the more sugar or refined carbohydrate it contains), the higher our post-meal blood sugar and insulin spikes will be.
Without insulin, we would slowly lose energy and die, unable to get precious glucose into our cells. Individuals with type I diabetes cannot make insulin. They must inject it daily to keep their cells fuelled and blood sugar stable.
For the rest of us who do make insulin, large blood sugar spikes after a meal can be problematic.
Insulin is a storage hormone. It helps energy get into cells, and it helps build muscle and brain cells, but it also blocks the breakdown of fat cells, blocking weight loss.
Insulin also drives down blood sugar levels. When blood sugar rises too quickly after a meal, a large insulin response can drop blood sugar levels too drastically, causing reactive hypoglycemia, or feeling “hangry” (hungry, angry, irritable, tired, light-headed, weak and dizzy) in between meals.
Individuals who experience hypoglycemia feel irritable, shaky, dizzy and anxious between meals. They often suffer from anxiety and panic attacks, and feel hungrier at night.
They may wake up in the middle of the night, as their bodies are unable to go 8 hours (the length of a decent night’s sleep) without food. This causes them to wake up, restless and perhaps anxious, in the early hours of the morning.
These individuals, paradoxically, rarely feel hungry at breakfast time.
I often see anxious patients wake from a restless sleep and toss back only a coffee in the morning, skipping breakfast due to slight morning nausea.
At 10 am, feeling ravenous and shaky, they might scarf down a high-glycemic bagel or croissant. Later on, they’ll enjoy a light lunch—maybe a sandwich—often feeling foggy and lightheaded after eating it.
At 2 to 4 pm, they may feel like an afternoon nap, instead indulging in a coffee and sweet treat to buy them some energy for the remaining hours of the work day.
Finally, after enjoying a larger dinner once they get home, they find themselves snacking all night long. Their bodies are finally urging them to ingest the nutrients they were lacking throughout the day.
They then fall into bed, feeling full, restless and wired, and the cycle begins again.
When our blood sugar falls, we not only feel hangry, weak, and crave processed carbs, our HPA axis also gets stimulated.
Cortisol, a glucocorticoid, can help our body control blood sugar, bringing it into the normal range after insulin sends it tanking too low.
This drop in blood sugar, therefore, needlessly triggers a stress response from the adrenal glands, which can further worsen anxiety, HPA axis dysregulation, and glucocorticoid resistance.
When blood sugar and insulin are spiked repeatedly for days, months, and years on end, cells stop responding attentively to insulin’s signal. Like our response to a pesky telemarketer, cells eventually stop picking up the phone when insulin calls.
However, cells still need insulin. More and more insulin must be released to trigger the same response from insulin resistant cells. This makes cells even more resistant, as they require even more insulin release the next time blood sugar rises to get glucose into the cell for fuel. And so the cycle becomes vicious.
Elevated insulin levels cause inflammation, fat gain, fatigue, depression, reactive hypoglycemia, and HPA axis dysregulation. The more resistant our cells become to insulin, the more cortisol must be called on to maintain blood sugar levels.
PCOS is also characterized by higher insulin levels. This prevents ovulation, causing infertility and female hormone imbalance.
When insulin resistance persists, type II diabetes, where the body is no longer able to keep blood sugar in a safe range, develops.
Type II diabetes is characterized by chronically high blood sugar—which poses a danger to small blood vessels, and is a potent inflammatory condition, increasing the risk of heart disease—and elevated insulin.
It affects almost 10% of the adult population and is the 7th leading underlying cause of death in North America, costing 350 billion dollars a year to manage in the United States alone.
Insulin-related weight gain can affect female hormones, as fat cells make estrogen in the body, leading to estrogen dominance.
Insulin also interacts with a hormone called leptin, which is created by fat cells in response to calorie intake. When body fat levels get too high, cells can become leptin resistant. The body no longer senses dietary calorie intake, leading to increased hunger. This exacerbates the problem of weight gain and insulin resistance.
Testing for Insulin Resistance
When I meet a patient who is presenting with stubborn weight gain, estrogen dominance and stress, I assess their blood for insulin resistance by looking at blood levels of fasting insulin and fasting glucose.
With these two values a calculation that measures insulin resistance, called the HOMA-IR, can be performed. This can give us a baseline measure of how well the body is compensating to control blood glucose.
I also run HbA1c, which looks at glucose levels over 3 months. I will often run a blood cholesterol panel, and inflammatory markers, such as CRP.
Insulin resistance often puts all of our hormones on a rollercoaster, which becomes very difficult to get off of unless we prioritize the diet and lifestyle interventions that address blood sugar control.
Assessing Hormones
When presented with a patient suffering from a complicated symptom pattern, I begin by taking a thorough health history in which we investigate:
Energy levels,
Sleep quantity and quality,
Mood and mental health history,
Period health history,
Family history,
Dietary intake and exercise,
Health risk factors like smoking, alcohol use, and past health history.
Depending on how clear the patient’s symptom picture presents, we may opt to make some changes before testing, to gauge their body’s response to an increase in nutrient intake.
Then, if necessary, I will order a comprehensive blood work.
Blood testing might include a thyroid hormone panel, and an in-depth look at female hormones, fasting insulin and fasting blood glucose, and other markers that help us assess health, such as cholesterol and inflammatory markers, or nutrient levels.
Patients requiring a more comprehensive view of their cycles may opt for month-long salivary testing. Others may opt for a dried urine test that looks at hormonal breakdown in the body.
A Sample Case
Jenny (name changed for privacy) came to me feeling fatigued and anxious.
She had suffered from anxiety periodically as a teen, but now at age 46 she was experiencing bimonthly panic attacks that seemed to occur cyclically; the panic would come around ovulation and premenstrually.
It was hard to tell, however, because Jenny also claimed that her periods were “all over the place”. One month they were heavy and painful, causing her to take time off work, crouched on the bathroom floor in agony. Other months she barely noticed them, experiencing some light spotting, if anything at all.
Very troubling to her was her major mood volatility, which she described like a “switch” that would suddenly flip on or off, causing her to breakdown at work or pick fights with her family.
Then, almost as suddenly, the cloud would lift and she would be her cheerful, friendly, loving self again.
It was maddening, both to her and those living with her during these darks times, she said.
She also noticed disrupted sleep and weight gain around the abdomen, which seemed to ignore her intense workouts and strict dietary regime.
Jenny was highly accomplished at her high-pressure job and commented that she thrived on being busy and achievement oriented.
I tested Jenny’s blood estradiol, estrone, progesterone, LH, and FSH levels one week before her next expected period, had her fill out a weekly diet diary, and gave her some recommendations about sleep and supplement intake.
Jenny’s blood revealed elevated FSH, indicative of impending menopause (FSH encourages the ovaries to ovulate, as TSH encourages the thyroid gland to make thyroid hormone). She also had low estradiol, and low progesterone, but elevated levels of estrone, the more problematic of the estrogens.
According to her labs and history, Jenny was experiencing estrogen dominance and perimenopause. Many of her symptoms were stemming from elevated estrone, low progesterone and a disrupted HPA axis.
Together, we worked on her diet to provide her body with the nutrients needed to make hormones and to support her brain, mood and adrenal glands.
We used herbs and dietary nutrients to promote liver estrogen clearance and to support Jenny’s adrenal glands.
We addressed the stress in her life, encouraged relaxation, and made sure her body was supported in its ability to make and respond to cortisol.
After a few months, Jenny reported a reduction in hot flashes, better sleep and feeling calmer. She had a reduction in her waist line and better energy and mood.
Our hormones, when imbalanced, can cause vicious cycles in the body that trap us in a state of worsening imbalance.
Through correctly assessing these common hormonal patterns through a health history and appropriate testing, and then making diet, lifestyle and supplement suggestions addressed at stopping these cycles, naturopathic doctors can address underlying hormonal issues that might be causing these complex and troublesome patterns of hormone disruption.
Since publising the original article about the Mirena IUD on this blog, thousands of women have come out of the woodwork writing to me asking for help.
When I originally wrote the article, I was spurned on by my observations of the women in my practice who had experienced a rise in estrogen dominance and low progesterone after the insertion of their IUDs (which were often inserted to treat hormone imbalances!).
At that point I never imagined that so many women would be affected by the IUD, or that even more were suffering from so many hormonal symptoms that drastically affected their lives and health.
It makes sense: our society does not set us up for proper hormonal function.
Our diets are carbohydrate-heavy, promoting insulin resistance and blood sugar dysregulation, which impacts our ovaries’ ability to make estrogen properly.
An excess amount of body fat produces more estrogen in the body and acts as a reservoir for the toxic estrogens in our environment.
We lack many of the micronutrients necessary to process our hormones properly, such as vitamin D, B vitamins, magnesium, zinc, omega 3 fatty acids, glutathione, and amino acids.
Many of us have impaired or suboptimal liver function, or sluggish digestion, which keeps hormones in our bodies around longer than they should be.
A dysbiotic gut has the tendency to turn estrogen in the gut back “on”, putting it back into circulation when it was otherwise on its way out of the body.
Stress alters our hormonal function, including our ability to make progesterone, DHEA-S, convert thyroid hormones, and process estrogen properly.
Xenoestrogens in our food and environment, from plastics, fragrances, pesticides, and processed soy products, contribute to overall body burden of the hormones in our body, throwing off our delicate balance, and contributing to symptoms.
The result of all this is that many women suffer from hormonal imbalances.
10% of women have some form of PCOS, or Polycystic Ovarian Syndrome, characterized by the body’s inability to properly make progesterone or estrogen, instead making loads of male hormones, like testosterone. PCOS alters fertility, promotes weight gain, and causes things like unwanted facial hair growth, acne, and missed periods. PCOS is often connected to stress and insulin resistance.
Many women in my practice suffer from PMS or PMDD, experiencing often debilitating symptoms sometimes even two weeks before their periods begin. They might get migraines, intense cravings for sugar, and massive mood changes, such as anxiety, intense irritability, or devastating depression. Panic attacks can occur at this time as well. Many of them comment that their mood and personalities flip once their hormones levels reach a certain point, causing them to act like different people. This can jeopardize their relationships with spouses and children, coworkers, friends and family.
Tender and painful breasts, or breast lumps, are also common in many of these women.
Acne, weight gain, stress, fatigue, disrupted sleep, depression and anxiety are all symptoms I see in women with hormonal imbalances.
Many women have horrific cycles, experiencing painful and heavy periods that often cause them to miss days of work every month. Many of these women struggle to keep their iron levels in the optimal range, suffering from hair loss, fatigue and weakness.
Many women are diagnosed with fibroids, or endometriosis, or are concerned about their risk of female cancers like breast, ovarian, uterine and cervical cancer.
All of these symptoms are often linked to relatively higher levels of estrogens compared to progesterone, sometimes termed Estrogen Dominance by functional medical practitioners who look at the underlying causes of bodily imbalances.
I feel terrible that I can’t help more of the women who write to me. My license prevents me from giving advice to those who live abroad, especially to non-patients over the internet. It’s a shame, however, because oftentimes the solutions are relatively simple, despite how complicated many of these symptoms might seem.
I’m hoping that this article can provide some direction to many of the women who suffer.
Firstly, I want to state that I am not against birth control or even the Mirena IUD (or other IUDs, for that matter). The vast majority of women with the IUD tolerate it. For many women with debilitating heavy periods and endometriosis it can be the only viable solution that makes life tolerable.
In my social practice at Evergreen, many of the women I see experiencing homelessness, drug addiction, or PTSD from relationship trauma, rely on the efficacy of IUDs to prevent unwanted pregnancies. Their lives often don’t allow for them to remember to consistently take pills every month.
Many women don’t tolerate combination birth control because of a history of blood clots, female cancers, or migraine headaches associated with their periods, and therefore the Mirena IUD, which is progesterone only, is a safe alternative for preventing unwanted pregnancy.
That all being said, many women do suffer on the Mirena IUD (or other forms of birth control). They were perhaps put on the Mirena to deal with some of the above symptoms of hormonal imbalance, or for contraception. Many of them noticed that their symptoms became worse after insertion of the IUD.
How the Mirena IUD and Birth Control Works:
The Mirena works by secreting small amounts of progestins, a synthetic form of progesterone, into the uterus and surrounding tissues. While it is not fully known how the Mirena works, the end result is a suppression of ovulation. This results in either very light periods or a complete cessation of periods until the IUD is removed (after 5 years when its hormones run out).
It is important to say here that, while birth control can certainly treat the symptoms of hormonal imbalances, it does not correct them.
All forms of birth control, with their synthetic versions of the hormones estrogen and progesterone, simply induce further hormone imbalances in the body. They introduce versions of hormones that may suppress or alter symptoms (such as heavy and painful bleeding, or acne), but the versions of hormones are not fully recognized by the body and therefore don’t fully replace all the hormones’ important functions, such as mood regulation, immunity, or blood sugar balance.
The effects of both altering the body’s natural hormonal balance, while ignoring the underlying cause of hormonal issues, is often what causes symptoms to continue or worsen.
For example, women with PCOS are prescribed birth control to manage acne or promote monthly periods. However, when women with PCOS miss periods, it is because they are not ovulating. The missed periods are not the problem; the lack of ovulation is.
Despite that, many women with PCOS experiencing amenorrhea (or missed cycles) will be prescribed birth control. However, birth control does not address the underlying cause of amenorrhea. It simply further suppresses ovulation (because its main purpose is to prevent unwanted pregnancy).
The periods you get while on birth control are not periods. Periods from birth control are withdrawal bleeds. After 21 days of taking hormonal pills, pills are stopped or replaced with placebo pills. The withdrawal of hormones in the pills induces a bleed that resembles a period, but is not one.
Hormonal contraception does not correct hormonal imbalance, it imposes further hormonal imbalance to manage symptoms. This is not always bad!
But it is an important difference.
Many women do require symptom suppression, particularly if their symptoms are severe. Many individuals in my practice experience periods so heavy that the only way for them to get through the month is with an IUD. Genetic variability in how our bodies process hormones can make us susceptible to intense hormonal symptoms, through no fault of our own.
In my opinion, however, it is important to attempt to address the underlying cause and to set our bodies up for better hormonal regulation, making as many changes as our lifestyles will allow.
What You Can Do About It:
If you are like any of the people I described above who seek my help, there are a few things that you can do to get started on correcting hormones.
Working With a Professional:
The first thing I advise is finding a licensed naturopathic doctor or functional medicine practitioner who understands hormones, can order lab tests, and will address the underlying cause of your hormonal imbalances by taking the time to fully understand your body and lifestyle.
This practitioner might be a naturopathic doctor (you can find one in North America by looking one up at naturopathic.org), or a medical doctor, a chiropractor, or a highly skilled nutritionist or nurse practitioner. Research this person well, read their articles, and perhaps book in with them for a complimentary meet and greet.
Testing:
I often test patients using simple blood tests, on day 21 of their cycles (or about 7-9 days before they expect their next period).
I will test their blood, looking for anemia, will test iron and B12 levels, homocysteine (to gauge their ability to methylate), vitamin D, cholesterol (to see if their diets are promoting proper hormone synthesis), estradiol, estrone (the more toxic, problematic estrogen), progesterone, free testosterone, a thyroid panel, fasting glucose and fasting insulin (to calculate insulin resistance using something called the HOMA-IR), HbA1C (to look a long-term blood glucose control), FSH and LH (two hormones made in the brain that talk to the ovaries and orchestrate the menstrual cycle), DHEA-S, to name a few.
Some women will require more testing. Others will require less.
These labs are interpreted from a functional perspective. Even though you are in the “normal” ranges (which take into account the entire population, many of which are not healthy—they are seeing their doctors, after all!), these blood markers may not be optimally balanced, giving us an opportunity to correct things before they go further.
Testing allows us to match symptoms to underlying imbalances and to be able to properly direct treatment protocols. Women with estrogen dominance may be experiencing high levels of estrogen and normal progesterone, which indicates a body burden of estrogen or impaired liver and digestive system clearance. Other women may be experiencing normal levels of estrogen but low progesterone, indicating a failure of their bodies to ovulate, due to high stress, and PCOS (or the Mirena IUD and birth control pill).
Other options for hormonal testing are month-long salivary hormone testing, or DUTCH testing, which looks at hormone breakdown in the urine. I sometimes run these tests, but find that blood testing is useful, accurate, and more cost-effective.
Treatment:
Once you understand your individual hormonal situation through testing (and through working with a practitioner who is putting the testing together with your symptoms and health history), your practitioner may recommend a variety of treatments.
I personally combine diet and lifestyle with key herbal and nutritional supplements, to target what is going on under the surface with my particular patients.
These treatments may include herbs that boost ovulation, aid liver detoxification, or regulate the stress response. I might recommend nutraceuticals that encourage methylation, or aid in hormone production.
My treatments take into account the individual’s symptoms, labs, diet, lifestyle, and any other health issues she may be facing like fatigue, digestive disturbances, or poor sleep.
What You Can Do Today:
Barring more individualized assessment and advice, there are some best lifestyle practices that can help most women balance their hormones better, whether they are still using birth control to control and address their hormonal symptoms or prevent pregnancy.
Diet:
When it comes to diet and hormone support, we need to ensure that we are balancing blood sugar, boosting liver detoxification pathways, promoting hormone synthesis, and supporting digestion, especially if experiencing constipation.
Consume more leafy greens: kale, spinach, collards, beet greens, arugula, etc. Eat 1-2 cups of these foods every day. Leafy greens contain active folate, which boosts methylation and detoxification. They also contain magnesium which is essential for hormonal regulation as well as 300 other important biochemical reactions in the body that balance mood and hormones.
Consume more cruciferous vegetables: broccoli, cauliflower, brussel sprouts, cabbage, bok choy, etc. Eat 1-2 cups of these foods every day. Crucifates help the body make glutathione, and contain indole-3-carbinole, which helps eliminate excess estrogens from the body. Broccoli sprouts are potent players in these pathways. Consume them as often as possible.
Ensure adequate dietary fibre intake: I often recommend ground flaxseeds or chia seeds in smoothies, avocados, fruits and vegetables and legumes (if tolerated) to make sure that women are having regular bowel movements to clear excess estrogens out of the body. 2 tbs of ground flaxseed (or more) every day can help balance estrogen levels and promote daily bowel movements.
Balance blood sugar: consume protein, fat and fibre at every meal. Avoid refined starches and flours. Avoid all sugar, even natural sugar like maple syrup, coconut sugar, cane sugar, honey, agave, etc. Try stevia or avoid sweets. Limit carbs (grains, legumes, root vegetables like potatoes or sweet potatoes, to 1/2 cup to 1 cup per meal). Only consume whole grains like quinoa, buckwheat, steel cut oats, millet, and teff. Cook them yourself!
Avoid soy, particularly processed soy, like vegan burgers, or soy milk.
Consume omega 3 fatty acids in fatty fish like salmon and sardines, or nuts and seeds like flax and chia seeds, walnuts, and pumpkin seeds. Get 2-4 tablespoons of these nuts and seeds every day and 3-4 servings of fatty fish a week.
Consume animal products: eggs contain choline, which is essential for liver function, meat contains vitamins B6 and B12, which are essential for hormonal regulation and production. Cholesterol in animal products are the backbones of our sex hormones. Iodine, found in animal foods, regulates estrogen balance in the body. If possible, try to obtain organic animal products from pastured or free-range animals to boost omega 3 intake, to lower your impact on the environment, and to promote animal welfare.
Other Lifestyle Practices:
Boost progesterone production by managing stress:
Establish a self-care routine: plan regular vacations, even small outings, do meditation or yoga, take breaks from work, spend quality time with family, have a plan to get your work done on time, ask for help.
Sleep! Aim for at least 8 hours of sleep, and try to get to bed before 12am. Practice good sleep hygiene by avoiding electronics before bed, keeping the bedroom as dark as possible, and setting a bedtime and wake time, even on weekends. Body scan meditations and some key supplements can be helpful for resetting circadian rhythms. Regulating blood sugar can have a major impact on improving sleep. Talk to your functional medicine doctor or naturopathic doctor for individualized sleep solutions.
Eliminate exposure to toxic estrogens and boost estrogen clearance:
Avoid exposure to xenoestrogens: whenever possible use natural body products, deodorants and shampoos, or “edible” body products for face and hair. Avoid plastic water bottles and plastic food containers. Use natural cleaning products around the house. Avoid fragrances and processed foods, especially processed soy.
Encourage sweating: get regular exercise or engage in regular sauna therapy. If you don’t have access to a sauna, epsom salt baths can also work—anything that helps you sweat. Heat therapy has also been shown to benefit mood and the stress response.
Heal your digestion: make this a priority with your naturopathic doctor, so that you can absorb the nutrients from the foods you’re eating as well as encourage daily bowel movements and optimal microbiome balance.
Maintain a healthy weight: body fat is metabolically active and can increase overall estrogenic load. Work with your naturopathic doctor to manage your weight. We often attempt to lose weight to become healthy, however I find my patients have far more success (and fun!) getting healthy in order to lose weight. Healthy weight loss often involves managing stress, sleeping 8 hours a night, avoiding sugar and processed foods, and regulating blood sugar, as well as encouraging proper sweating and liver detoxification.
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I have been a vegan for 6 years. I also suffer from mental health conditions and possible hormonal imbalances. After doing some research on diets for anxiety and depression, I found that most of them include meat and animal products. I’m wondering: can my vegan diet be harming my mental health? I am primarily a vegan for ethical reasons and would hate to have to harm animals unless you think it’s absolutely necessary for promoting my mental health and wellness.”
Nutrition, especially where it pertains to more emotionally-charged topics like human health, the environment, or animal welfare, is surprisingly controversial.
I know that broaching this subject is a little bit like walking into a lion’s den (lions, for the record, are not vegans), therefore let me preface this conversation with a few disclaimers.
In writing about veganism and mental health, I’m not looking to get into a debate. I am writing to provide information for those who are wondering if it is possible to heal mental health and hormonal conditions, including women’s health conditions, thyroid conditions and adrenal conditions, while following an entirely plant-based diet.
If you feel that you might be triggered by this information and are not willing to approach this essay with an open mind, then this article is not for you.
Let me point out that I fully understand and sympathize with the ethical arguments for veganism. In my 20’s I was vegetarian for five years. For one of those years I was a vegan. Contrary to what some die-hard vegan fans have suggested, I did follow the diet “right” by eating whole foods, balancing the macronutrients of my meals (as best I could), and striving to eat enough. I eventually had to stop, but it was not because I “missed meat”.
While following a vegetarian diet, I took comfort in the fact that no animal had to die for me to survive. I loved the taste of plant-based foods and the ease of preparing them. I was satisfied in knowing that my diet was having a minimal impact on the environment.
(I also enjoyed bathing in the feelings of moral superiority that this diet earned me. However, that’s besides the point.)
Around that time, I read The Ethics of What We Eat by Peter Singer, which remains the single most thought-provoking book on human nutrition that I have read to this day (and I have read mountains of books on human nutrition).
In no way do I advocate for factory farming practices. I urge omnivores to consume the most ethically sourced meat, fish, eggs, and dairy that they can afford. Not only is sustainable animal farming better for animal welfare and for the environment, it is better for human health.
I don’t push for any single one-size-fits-all diet. I believe that an individual determines his or her “perfect” diet through experience. I carefully approach conversations about diet with my patients to avoid shaming their eating habits and pressuring them into a diet that they feel uncomfortable with.
That being said, it is my duty as a doctor to provide my patients with all the information they need to make empowered choices by drawing on the 15 years I have spent studying nutrition through formal education, and personal and clinical experience.
While it may certainly be possible to survive and, perhaps even thrive (depending on your genetics, most likely), on a vegan or vegetarian diet, there are major limitations to this diet that we need to face if we’re committed to supporting optimal mental and hormonal health.
The intention of this essay is to outline some of these limitations.
Protein quality and quantity:
Protein makes up 16% of the human body (62% is water). It is required for body structure: our bones, muscles, connective tissues, skin and hair.
Amino acids, which make up protein, comprise the hormones and neurotransmitters that regulate our mood and gene signalling.
Tryptophan, an amino acid, is used to make serotonin and melatonin, hormones that enable use to regulate our feelings of well-being and circadian rhythms, respectively. Cysteine is used to make glutathione, the main antioxidant of the body that neutralizes cancer-causing free radicals, prevents damage to our DNA, and protects us from the incessant chemical onslaught of our increasingly toxic lives. Glycine and GABA calm the nervous system, prevent over-activation of our brains’ fear centres, and soothe anxiety. Glutamine stimulates the nervous system and fuels our gut and kidney cells, allowing us to absorb the nutrients from our food and filter waste from our bodies.
The human body is essentially a protein sac filled with water that hums with the metabolic activity orchestrated by tens of thousands of enzymes, which are also protein.
When it comes to dietary proteins, not all are created equal. Foods that claim the title “complete proteins” boast all 9 essential amino acids that are not synthesized by the body and must be obtained exclusively from diet. Many vegetarian sources of protein are not complete proteins, and therefore protein-combining must be practiced to avoid deficiency in specific amino acids
Proteins also differ in their absorbability. Some vegan foods rich in protein contain anti-nutrients or fibres that make them difficult to digest. For example, the protein digestibility of whey (from dairy) or egg is 100%, meaning that 100% of the protein from these foods is absorbed. In contrast, only 75% of the protein in black beans is absorbed. Even more dismally, those who hope to get a significant source of their protein from the peanut butter on their morning toast are only absorbing about 52% of it.
The Recommended Daily Allowance (RDA) for protein is 0.8 g per kg of body weight for the average person. However, when it comes to supporting optimal health, the RDAs of important nutrients are set notoriously low. In my opinion, even higher nutrients are required for those with chronic health conditions such as mental health issues, chronic stress, hormonal imbalances, obesity, diabetes, cardiovascular disease, cancer, and autoimmune disease, to name a few.
For my patients I tend to recommend between 1.0 to 1.2 g of protein per kg of body weight per day. For those who are particularly active, who need to lose weight, and who are obtaining their protein from lower-absorbable sources, I may even recommend higher amounts. For women with conditions like PCOS, depression, and anxiety, I often recommend at least 30 g of protein per meal, especially at breakfast, to balance blood sugar, fuel neurotransmitter synthesis, sustain energy throughout the day, and promote optimal adrenal function. I believe the RDA for protein to prevent muscle wasting is set far too low. This is especially true if the protein sources are difficult to digest and of lower quality.
But what about claims that high protein diets can be detrimental to our kidney health? A one-year crossover study showed that active men who consumed very high amounts of protein—over 3 g of protein per kg of body weight—suffered no ill effects.
Getting adequate protein is difficult on a vegan diet but not impossible. Tracking your macronutrients and considering supplementing with a high-quality protein powder, may be required.
Understanding exactly how much protein your diet delivers is essential. For instance, while quinoa is a complete protein, containing all 9 essential amino acids, it only contains 8 g of protein per cup. One cup of black beans contains 39 g of protein but only 29 g are absorbed.
Furthermore, for conditions like PCOS that require managing carbohydrate intake, getting the protein without the additional carbs can be a challenge. Legumes typically contain a 3:1 ratio of carbs to protein—one cup of black beans contains 116 g of carbohydrates. This is often too high for the many women suffering from the mental health and hormonal issues that I treat in my practice, who often feel best when keeping their dietary carbohydrate intake well under 150 g a day.
Autoimmunity:
Chronic inflammation runs rampant in the bodies of many of my patients. More research is coming out showing that inflammation is at the root of most chronic health complaints, such as mental health conditions like depression and bipolar disorder, and hormonal conditions like PCOS and endometriosis. Cardiovascular disease and diabetes are recently thought to begin as autoimmune diseases, spurred on by chronic inflammation.
To manage conditions of autoimmunity and chronic inflammation, it is often appropriate to follow an “anti-inflammatory” diet that is low in allergenic potential.
For patients with hormonal issues, autoimmunity, gut issues, and mental health conditions (which research shows are inflammatory conditions are their root), reducing the diet down to leafy green vegetables, chicken, beef and fish can aid in lowering inflammation, healing the gut and restoring immune function. After a time, foods are slowly reintroduced, to find out what the body can tolerate.
Grains and legumes contain anti-nutrients like lectins and phytates that protect plants from being ingested and destroyed. Along with other common allergenic foods like dairy and eggs, grains and legumes, with their anti-nutrient content, have a high potential for irritating the digestive tract, causing gastrointestinal inflammation and immune system activation, leading to chronic inflammation that permeates the entire body.
The higher protein content in legumes like peas, black beans, lentils, and soy, and grains like wheat and corn, makes these foods staples in plant-based diets. Therefore, even attempting an anti-inflammatory elimination diet as a vegan is virtually impossible. Vegetarian diets are hardly better, as vegetarians often rely on dairy and eggs to balance their diet, both of which are common food sensitivities that can trigger autoimmunity and inflammation.
Vegan studies:
Doesn’t following a plant-based diet confer amazing health benefits, though?
While many studies of vegan and vegetarian diets show benefit for improving markers of various metabolic conditions, like diabetes and cardiovascular disease, it is important to keep in mind that most of these publications are comparing a diet rich in whole grains, vegetables, fruit, nuts and seeds with the Standard American Diet, with its grain-fed, hormone-pumped animal byproducts deep-fried in rancid corn oil.
Therefore, it makes sense that adding a few servings of micronutrient-containing fruits and vegetables to your daily nutritional intake will radically alter your health status. When I first began my foray into the world of plant-based living I felt amazing too. After a few months, though, the health benefits slowly faltered and I started to suffer negative health consequences: weight gain, fatigue, depression, hypothyroidism, IBS, and various nutrient deficiencies.
My health improved when I added some animal products to my vegetarian diet and removed dairy, grains and legumes. However, my experience is a mere anecdote.
To my knowledge there hasn’t been a study comparing a whole foods-based diet that includes ethically-sourced animal products with a whole foods vegan diet. I would be very interested in seeing such a study if it is ever conducted.
Individual variability:
Rich Roll, a vegan super-athlete, is often dredged up as an example of how the human body can thrive on a plant-based diet. However, more than his diet, Rich’s individual genetics may have more to do with his success as an athlete (and his training, clearly).
Even after 8 years of returning to omnivorous living with occasional iron and desiccated liver supplementation, my ferritin level (a measure of iron status) still only hovers around 44 (80 is considered optimal).
My constitution is that of Parasympathetic Dominance. This means I look at a piece of toast and gain 10 lbs. I tend to suffer from congestive lymphatic conditions and a sluggish metabolism. I tend to have low energy unless I constantly stoke my metabolic furnace. When stressed, I tend to gain weight and slip into lethargic depression. If not taking care of myself, I get headaches and suffer from hormonal imbalances.
Like other parasympathetic doms, I tend to have a higher requirement for dietary iron and crave red meat and leafy green vegetables. I seem to do better with a diet higher in protein and healthy fats.
Many of the people I work with fit this profile as well. My patients are highly creative and intuitive, but also suffer from mental health and hormonal conditions and are very susceptible to stress. I find that most do better through moderating their carbohydrate intake, ensuring high micronutrient and healthy fat consumption, and eating more protein, particularly from some red meat.
New research into MTHFR genes reveals that certain diets may have more health benefits for certain individuals. About 40-60% of North Americans are unable to convert folic acid (a synthetic nutrient added to multivitamins and fortified grains) into methylfolate, which is used for a chemical process called “methylation”.
Methylation pathways are involved in the fight-or-flight response; the production and recycling of glutathione (the body’s master antioxidant); the detoxification of hormones, chemicals and heavy metals through the liver; genetic expression and DNA repair; neurotransmitter synthesis; cellular energy production; the repair of cells damaged by free radicals; balancing inflammation through the immune response, controlling T-cell production, and fighting infections, to name a few.
Individuals with impaired MTHFR function often suffer from autoimmune conditions and mental health conditions, such as depression. They tend to feel better when avoiding grains that contain folic acid and eating green leafy vegetables that contain methylfolate. They require higher amounts of protein in their diet. They require higher levels of vitamin B12, which is also important for methylation, and choline, found in eggs and liver, which helps bypass methylfolate pathways, working as an alternative methyl donor. Choline is also necessary for estrogen metabolism.
Nutrients Deficiencies:
You thought I would lead with this, didn’t you? I’ll bet you were wondering when this would come up:
B12:
Of course it’s no secret that the vegan diet is essentially devoid of vitamin B12, an important nutrient for detoxification, methylation, neurotransmitter synthesis and energy metabolism. Animal sources are the only sources of B12. Our gut bacteria can make B12, but how much is absorbed in the colon for the body’s use is not clear.
B12 deficiency is serious. A friend of a friend of mine (no, but really) suffered permanent neurological damage, leading to seizures and almost death, from B12 deficiency. The neurological damage caused by B12 deficiency is irreversible (I’ve had patients who experience some improvement with restoring B12 levels, but it can take some time and the progress is not always linear).
B12 deficiency can have serious neuropsychiatric symptoms that mimic severe bipolar disorder or schizophrenia and that resolve once B12 injections are given. Horrific case reports tell stories of B12-deficient patients treated with rounds of electric shocks for their “treatment-resistant” psychosis, before the true cause of their symptoms was uncovered.
The blood reference range for B12 is roughly 130-500 pmol/L but I find that people don’t feel their best until their levels are over 600, and many experience severe B12 deficiency symptoms under 300. This means that if your doctor tells you that “your blood levels are normal,” your body could still be operating at a sub-optimal level of B12.
For vegans, supplementing with a good, absorbable form of B12 is non-negotiable. B12 from vegetarian sources, such as dairy products, is damaged in the pasteurization process and therefore supplementation may still be required.
Other nutrients:
B12 aside, other nutrients that are commonly deficient in vegan diets are iron, zinc, iodine, EPA and DHA, choline, vitamin A and vitamin D, to name a few.
Zinc is essential for immune function, skin health, neurogenesis (making new brain cells), memory and cognition, gut integrity, neurotransmitter synthesis, and hormonal health, among other essential functions.
Iodine is required for thyroid and ovarian function. It is also important for estrogen detoxification.
Iron is important for supplying tissues with oxygen, optimal thyroid function, and fertility. Menstruating women are commonly operating at a sub-optimal level of iron, resulting in fatigue, dry skin, chronic infections, and heavy periods.
Vitamin D regulates over 1000 different genes in the body. Supplementing with D3 is required for the 70-90% of North Americans who are deficient. Sadly, vitamin D3 supplements are all animal sourced, obtained from the lanolin in sheep’s wool. D2 from mushrooms is a vegan form of vitamin D that is likely not as effective as animal-derived D3.
Vegans are 75% more deficient than omnivores in vitamin D, which is alarming, considering how deficient most North Americans are—that’s 1000 vegan genes that aren’t being properly regulated!
EPA and DHA, omega 3 fatty acids found in fish and algae, are essential for cell membranes and brain function. While DHA can be made from ALA, found in flax and walnuts, many of us are not effective at converting it. Even the best converters among us only synthesize about 18% of our ALA into DHA. Further, the conversion of ALA to DHA requires zinc and iron, two nutrients that are typically deficient in vegan diets.
Even for omnivorous patients with mental health conditions, supplementation of EPA is often required for therapeutic benefit. Vegan supplements of algae-derived EPA and DHA exist, however, many of the studies that show benefit for fish oil supplementation in depression, bipolar and OCD require that the EPA to DHA ratio be 3 to 1 or higher. This high EPA to DHA ratio is not available in algae-sourced supplements that I have seen, making it almost impossible to derive enough EPA from vegan sources.
That being said, it is possible to supplement with iron bisglcyinate, iodine, zinc picolinate and vitamin A, inject methylcobalamin weekly, chug algae oil by the jugful, and drip vitamin D2 drops on your tongue and hope for the best.
You can pray to the methylation gods that your MTHFR enzymes are all operating at top speed so that your body doesn’t need to depend on protein and choline-dependent pathways for its liver function and DNA repair.
You can dump Vega protein powder into your smoothies and hope that you don’t have a sensitivity to grains and legumes (vegan protein powders usually contain some combo of rice, soy, and pea). You can obsessively track your macronutrients on My Fitness Pal.
You might still be ok.
There are a few people, the Rich Rolls of the world, who will claim that they feel great on an entirely plant-based diet. They do all of the above-mentioned things and feel amazing and I’m happy to hear it! However, I wonder how these genetically gifted individuals would fare if following a nutritionally complete whole foods omnivorous diet that contains grass-fed chicken, fish, meat, gelatin, eggs and, perhaps, dairy, in addition to a variety of plant foods.
If just one important nutrient pathway that depends on iodine, zinc, vitamin D, iron, B12, EPA or DHA is working sub-optimally, if you’re suffering from a hormonal condition, a mental illness, an autoimmune disease, or a digestive issue, then it’s possible that, if you follow a vegan or vegetarian diet, you’ll never feel as well as you’re meant to.
In the words of a vegan-turned-omnivore friend of mine, when disclosing why she decided to start eating meat again:
“I still love the environment and animals, of course, but I just love myself more.”
Polycystic Ovarian Syndrome, or PCOS, is the most common hormonal imbalance in women of reproductive age and can result in weight gain, infertility, acne, irregular cycles and unwanted hair growth. I talk about a naturopathic and functional approach to managing symptoms of PCOS and restoring hormone balance.
Hello, everybody. My name is Dr. Talia Marcheggiani. I’m recording to you guys from my clinic in Bloor West Village. It’s called Bloor West Wellness Clinic. And today I want to talk to you guys about one of my favourite conditions to treat when it comes to naturopathic medicine. And this condition is called Polycystic Ovarian Syndrome. And this is an endocrine, or hormonal condition, and it affects about 10% of women. It’s the most common cause of hormonal imbalance in women of menstruating age. And it’s a syndrome, so it’s not a disease. There’s a different constellation of symptoms that arise with it and this could be one of the causes of infertility in a lot of women. And because the symptom pictures are so diverse, it’s really hard for a lot of women to be suspected for a diagnosis of PCOS, or polycystic ovarian syndrome.
So, PCOS, the hallmark, the diagnostic criteria, based on the Rotterdam Criteria, is having either two of these three symptoms: anovulation or oligomenorrhea, which means having periods that are irregular. So, either having more than one period per month or missed cycles and long cycles of 6 weeks or more. The average female menstrual cycle is about 26-34 days, so having periods outside of that “normal” range could indicate one of the symptoms of PCOS. The other one is something called “hirsutism”, which is caused by high androgens, or male sex hormones, like testosterone or DHEA. And some of the symptoms of that are acne, so hormonal acne, those pustular, cystic acne that happens around the chin and jaw-line, or the chest and back. And “hirsutism”, which is the male-pattern hair growth, which is great, if you’re a woman, to have, which is the hair on the mustache and chin. So, you kind of sport a Frida Kahlo mustache and probably have to deal with that on the regular. Similarly, having hair loss on the scalp, is another sign. So, when you think of men, men will typically experience male-pattern hair loss, and hair-growth in the facial area.
And the third symptoms is the presence of cysts on the ovaries, which is diagnosed or sighted with a transvaginal ultrasound. There’s a scope placed through the vagina and an ultrasound is done to see if there are cysts on the ovaries.
It can also be diagnosed with lab work, so that’s not using the Rotterdam criteria, but there are two hormones that the brain makes that control the ovaries and these are called FSH, or follicle-stimulating hormone, and LH, lutenizing hormone. The brain makes the hormones and they tell the ovaries when to ovulate and the ovaries also make LH, lutenizing hormone after they’ve ovulated, or after the corpus luteum forms, after ovulation should happen, so whether the egg is fertilized or not, the corpus luteum will form.
And so PCOS is probable when you order labs and find that, so the FSH and LH should be almost the same, they should be at a 1:1 ratio and PCOS suspect when the LH to FSH ratio is 2:1 or higher. So you have either 2 or more times the LH than you have FSH. And this is because in PCOS, the ovaries will secrete a lot more LH and that is one of the reasons why they hypothesize that there are high androgens, because the LH can stimulate more androgen release.
So, there’s a “skinny PCOS”, so these are women with those symptoms that don’t experience obesity or metabolic syndrome, and then there’s the metabolic syndrome type of PCOS and in these patients there’s an insulin-resistance present, or a glucose-intolerance. And so these women will frequently experience hypoglycaemic crashes. They’ll also probably be on the obese side and really struggle to keep weight off and they’ll experience the low energy, the cravings for carbs. They’ll experience the hunger that comes two hours after a meal, despite having eaten an adequate amount of fat and protein, and this is really problematic for them because they’re set up for diabetes and for cardiovascular disease down the line. And then they’re also experiencing symptoms of obesity and they’re not super happy with how they look.
And we’re not exactly sure what causes PCOS in women. There’s evidence for it being heritable, so genetically passed on. There’s evidence for it being caused by insulin-dysregulation, and perhaps the ovaries are not responding properly to insulin. What insulin does, is it helps us take in fuel or glucose into our cells and, just like all the cells in our body, the ovaries require insulin to absorb glucose so that they can function properly. And so one of the theories of PCOS is that the ovaries are resisting insulin and the insulin is signalling them to grow, but they’re growing in the absence of proper fuel, or proper glucose as fuel and so they’re creating these follicles, or cysts.
And so, absence of periods, or irregular periods; male-pattern hair growth; obesity; infertility and then the presence of those cysts on the ovaries are all symptoms of PCOS. So, when we’re trying to get a diagnosis, we’ll send patients in for a transvaginal ultrasound. We’ll also look at their fasting blood glucose and fasting insulin. We’ll look at their progesterone and estrogen, because oftentimes these women are suffering from estrogen-dominance: there’s low progesterone and high estrogen in relation to the levels of progesterone. We’ll look at their FSH and their LH, and I’ll also check out their thyroid because oftentimes the symptoms of hypothyroidism and PCOS are overlapping and so I want to find out if there’s a thyroid pathology happening in the background.
So, one of the main reasons that women will come in with PCOS is because they’re trying to get pregnant, or they want to preserve their fertility in the future. They might come in for acne issues or the hair growth, or just to sort out their periods, but the main reason that they come in is fertility. And 40% of women with PCOS do experience infertility or fertility challenges. So this is a big issue for them.
And the reason I love treating PCOS in my practice is I find that, and this is sort of perhaps not technical or scientific, but I find that the personality of women with PCOS tends to be more phlegmatic, so they’re usually more agreeable, and happier and patients that really want to do good work and so it’s really enjoyable to work with them. But also, the reason I love treating patients with PCOS is because there are so many effective strategies that naturopathic medicine offers and I don’t see an equal amount of strategies in the conventional system.
And I’ll talk a little bit about some of the conventional therapies of PCOS. So, what happens is, in conventional therapy, is they kind of look at the symptoms in the syndrome spectrum and they kind of try to deal with each symptom individually. So they look at irregular periods and they’ll prescribe a birth control pill. So, like, “ok, we’ll just over-ride your own hormonal production and we’ll control your periods and get you cycling regularly”, which obviously doesn’t treat the underlying hormonal imbalance, because you’re just placing exogenous, fake hormones on top of the picture.
Or they’ll say, “ok, there’s blood-sugar dysregulation, so I’m going to prescribe a diabetic medication called ‘metformin’, which will help resensitize your cells to insulin”, which again is not the best strategy, although there’s some evidence to support that this helps. But, we’re not again treating the underlying issue of insulin resistance and metformin is pretty toxic to oocytes, or ovarian cells, so when you’re treating infertility you’re not setting the body up for healthy ovulation and producing a healthy baby. So, ehh, metformin.
And then we have, they’ll treat the high androgen symptoms, the hirsutism symptoms, the hyperandrogenism, by prescribing spironolactone, or Yas or Yasmin birth control pills, that block androgens. And, again, not the best strategy because it’s not treating the underlying cause, and there’s some evidence that Yas and Yasmin are one of the oral contraceptive pills that set you up for a higher risk of blood clots compared to other pills. So, women who are taking these are slightly higher than normal, compared to other birth control pills, risk of pulmonary embolism, deep vein thromboses, and those kind of blood clotting issues, which could be fatal. So, that’s an issue, right? And, again, not treating the underlying cause.
So there’s not that many great therapies and they’re not holistic. They’re not looking at the whole picture, they’re kind of reactionary and they’re just treating the symptoms. And then in terms of fertility, so women will undergo IVF treatments or they’ll be prescribed ovulation drugs like Clomid, which increase estrogen and get your body ovulating, kind of forcing ovulation to happen and again can be an issue because these women with PCOS are having sometimes an estrogen dominance picture, so their estrogen is high in relation to their low progesterone and so adding more estrogen-promoting drugs like clomid could just make life a mental and emotional disaster for these women while they still have the drug in their bodies. That could happen to a lot of women, but, again, not the best. It could achieve the end goal of getting pregnant, by increasing your chances, but we’re not looking at what’s going on.
And so, what happens, if when I first see a patient with PCOS, we’ll run the labs, or I’ll get the labs that their family doctor has run, if that was done recently, and we’ll take a look at their symptoms, so I’ll ask them how their periods are, and if they get PMS symptoms, and how often their periods come. And I’ll get them to track their periods, so I can see are they happening regularly, and they’re just very far apart? Or are they all over the place? We’ll look at their FSH and their LH, to see if they have that classic high LH to FSH ratio, and we’ll look at their insulin and fasting blood glucose and their testosterone. And I’ll ask them about symptoms, like acne and hair growth and we’ll talk about weight loss and if they’re getting those hypoglycaemic or insulin resistance symptoms. And we’ll talk about mood and emotions and digestion as well, which I talk about with all my patients, and energy and things like that, because we want to get a holistic picture and we want to —the reason is when I’m treating people I’m treating from the premise that it’s possible to be healthy and we can influence our health and the more I examine healthcare, and the healthcare model that is conventional, the more I doubt that that’s the premise that they’re standing on. Right? They’re kind of looking at making symptoms manageable, or maybe achieving outcomes or end goals, or preventing death and things like that, but they’re not coming at health conditions from a place of: “this person can influence the situation that they’re in through targeting and trying to understand the root cause of what’s going on, and then treating that.” So that’s where I’m coming at it. I’m looking at the whole picture, and I’m trying to understand this person’s unique hormonal imbalance and what the symptoms are that manifest from that.
Then it comes to choosing a treatment plan, so there’s lot of treatment that have a robust amount of evidence surrounding them and so you frequently hear people say that naturopathic medicine, or functional medicine, of these natural forms of medicine have no evidence and they’re pseudoscientific, well there’s tons of evidence for increasing fertility and improving PCOS using natural remedies, like nutriceutical remedies and herbal remedies.
So, first of all we have something called inositol. Inositol acts like a sugar in the body and what it does is it re-sensitizes the ovaries to insulin and serves as a fuel for the ovaries. And inositol doesn’t have much of a taste, it doesn’t have any side effects. It actually has some positive effects in helping with bipolar disorder and psychosis and those kind of mental health disorders, so if those are comorbid, then it’s great. If you have PCOS and you have bipolar, then inositol is a great choice. And with inositol, there’s some studies that show that in 3 months of supplementing with inositol periods have become regular, hyperandrogenism symptoms have gone down, so the acne and hair growth, and women had a 1 in 2 chance of getting pregnant. And then another 3 months of that, and their chances went up. So, inositol on its own is pretty powerful.
Another nutriceutical is N-acetyl cysteine, so NAC, which helps the liver clear out hormones and rebalance hormones and another great remedy for PCOS. We’re not exactly sure how it works, but there’s some theories about it rebalancing hormones, and perhaps through it’s antioxidant activity, because NAC creates an antioxidant, the main antioxidant in the body called “glutathione”. So, probably through its antioxidant activity, it’s helping the mitochondria, those fuel-houses for the cell, work better.
Another thing, when it comes to PCOS are some herbal remedies. So there’s an herb called vitex that helps establish a healthy hormonal estrogen and progesterone balance and that could be appropriate for some women. And there’s some studies using white peony and licorice that can help lower those hyperandrogenism symptoms. And then there are some herbs like saw palmetto that can help balance those high androgens as well, as they bind up testosterone and DHEA in the blood, so they increase something called sex hormone binding globulin (SHBG) and that can help clear out excess testosterone.
So those are just a few of these herbal and nutriceutical remedies that can be helpful in PCOS and I might prescribe some B-complex or some magnesium depending on how the adrenal glands are functioning and how hormones are cycling. And another thing we really like to do is tackle PCOS with diet and improve that blood-sugar balance if some of those insulin resistant symptoms or metabolic syndrome symptoms are there. And there’s a great study that shows that front-loading, so really increasing the calories that women are eating in the morning, having moderate calories at lunch and then having a lower or lighter dinner, kind of a snack for dinner, is really helpful in promoting fertility, lowering those androgens, resensitizing the ovaries and the other cells in their bodies to insulin and thereby resetting the hormonal stage. Really cool that this study just by changing your diet, although not the easiest change, is helpful for balancing hormones and you’re not doing something toxic, like the birth control pill or metformin, or something like that.
Also, a paleolithic diet, so changing the glycemic index of your diet by choosing fruits and vegetables that are lower on the glycemic index, so those leafy greens and adding fat and protein to every meal. It’s difficult as a vegetarian to shift hormones for the better and so I often recommend a more paleolithic diet to women, however, vegetarians, it is possible to increase your protein, it just takes a little bit more of conscious effort. And the reason that paleo diet is helpful is because it is lower glycemic index and has those higher fruits and vegetables with their antioxidant properties, but it also promotes the healthy fats and having an adequate intake of lean protein, such as your chicken, fish, lean beef, or eggs and even some dairy products depending on how someone tolerates that. And the last thing I’m going to talk about—this is just sort of a PCOS overview—the last thing I’m going to talk about is, with my patients I always work on self-care and stress relief because we know that the stress hormone cortisol can really mess up the other hormones in our body. It can contribute to insulin or worsen insulin resistance. It can worse that estrogen-dominance picture, it can prevent us from making enough progesterone because the progesterone and the cortisol pathway follows the same pathway and so that could be problematic if we need more progesterone but we’re using all of the resources to make it on making cortisol to deal with our stressful lifestyle. And a big part of managing PCOS, I find, is just getting cortisol under control and that might include increasing self-care, getting into things like yoga or meditation or doing some shin-rin yoku, like in the other video where I talk about Japanese Forest Bathing, so spending time in nature. That could be walking in the woods, or gardening, even watering a plant or hanging out with a pet or animal. Doing these things that feel nurturing and feel supportive to the mind and the emotions and help us face the daily stressors that we face with more resilience are all great strategies for managing hormonal health.
So, if you have any questions, just send me an email at connect@taliand.com or you can check out my website at taliand.com and my blog for other articles on hormonal balance, such as estrogen dominance, choosing an oral contraceptive pill, if you need one, and another article that I wrote about PCOS.
My mother tells a story about my childhood where she is standing in the kitchen, preparing dinner. I stand below her, tugging at her shirt, and begging for food.
“I’m hungry”, I say, according to her recollection of that moment and many others like it; she says that as a child I was always preoccupied with food. My constant yearning for something munch got to the point where every time she tried to cook dinner, I’d follow her to the kitchen, like a hungry dog, and persistently beg for food. I was insatiable, she claims. But, as an adult looking back I wonder, insatiable for what?
I remember that moment, but from the third person perspective. So I wonder if it’s as past events sometimes go, where the telling of a memory from an outsider’s perspective serves to reshape it in the imagination. I can feel the emotions, however, watching my 4-year old form tugging on my mother’s clothing, her body towering over me, her face far away. She stands at the stove. I remember feeling full of… what was that yearning? Was it for food? Was it hunger for physical sustenance or nutrition from some other source? I wonder if the constant, nagging hunger was an articulation, in 4-year old vocabulary, of the need for something else: attention, affection or reprieve from boredom. I remember being told at one point that my favourite show was on and felt some of the anxiety of missing what I was lacking dissipate: a clue.
As a child, adults occupy the gateway to food. As adults, the gateways take on another form. Perhaps it is anxiety about body shape or the guilt of knowing that eating too much of a certain kind of thing isn’t nutritious. Perhaps the barrier to sustenance is financial. However, when I stand now in the kitchen, bent over the fridge, arm slung over the open door, contemplating a snack, I know that I am making a choice. And, for myself, as for many others, it’s not always clear whether the call to eat is hunger and physiologically based.
In the west, we have an abundance problem. More and more adults are reaching obese proportions. Metabolic diseases of excess like diabetes and cardiovascular disease are increasing and more and more women are experiencing the hormonal dysregulation that can come from carrying more body fat.
While I don’t recommend aspiring to the emaciated standard that we see plastered on magazines, Pinterest ads or runways, I do think that, for many people, balancing energy intake with energy output could be beneficial for optimal health and hormonal signalling. Body fat is metabolically active. It also stores toxins and alters that way our body metabolizes and responds to hormones, insulin being just one example, estrogen being another. Therefore, conditions like PCOS, infertility, diabetes, PMS and dysmenorrhea, or certain inflammatory conditions might benefit from a certain amount of weight loss.
An addition here: this post is not about body-shame or even necessarily about weight loss per se. It’s about overcoming emotional eating patterns that might even derive from the same disordered patterns that manifest in anorexia or bulimia. The goal of this post is to bring more awareness to how we operate within the complex relationships many of have with food and with our own bodies.
There are many reasons why we eat and physiological hunger is only one of them. Tangled up in the cognitive understanding of “hunger” is a desire for pleasure, a desire to experiment, to taste, to experience a food, to share with family and friends, to enjoy life. There are also deeply emotional reasons for wanting food: to nurture oneself, as reward, to combat boredom and to smother one’s emotions like anxiety, depression, ennui, yearning for something else— we often eat to avoid feeling.
Health issues aside, I believe that Emotional Eating (as it’s so-called) is problematic because it dampens our experience of living. By stuffing down our emotions by stuffing our faces we prevent ourselves from feeling emotions that it might be beneficial for us to feel in order to move through live in ways that are more self-aware, mature, self-developed and meaningful. While some emotional reasons to eat might be legitimate (acknowledging your beloved grandmother’s hard work by having a few bites of her handmade gnocchi, for instance), many of the reasons we eat linger below the surface of our conscious mind, resulting in us suffering from the consequences of psychological mechanisms that we are unaware of. I believe in making choices from a place of conscious awareness, rather than a place of subconscious suffering.
In heading directly into the reasons I am tempted to emotionally eat, I’ve learned quite a lot about myself. I’ve ended up eating less, as I’ve become more aware of the non-hunger-related reasons that I reach for a snack, but that doesn’t have to be the end goal for everyone. I believe that just understanding ourselves through uncovering and analyzing the emotions that influence our everyday behaviours can have life-changing effects; it allows us to know ourselves better.
As I work through the process of understanding why I overeat, I’ve realized there are a few steps to address. I believe that there are layers to the reasons we enact unconscious behaviours and first, it is important to untangle the physiological from the emotional reasons for eating, understand what real hunger feels like, address the “logical” reasons for overeating and then, when ready, head straight into the emotions that might cause overeating to occur
Distinguishing between physiological hunger and emotional hunger:
The first step, of course, is to distinguish between physiological/physical hunger—the body’s cry for food, calories and nourishment—and emotional hunger. Typically, physiological hunger comes on slowly. It starts with a slow burn of the stomach, growling, a feeling of slight gnawing. It grows as the hours pass. For some it might feel like a drop in blood sugar (more on this later): feeling lower energy, dizzy and perhaps irritable. Physiological hunger occurs hours after the last meal, provided the last meal was sufficient. Usually, if one drinks water at this time, the physiological hunger subsides and then returns. Essentially, eating a meal or snack will result in the hunger vanishing and returning again still hours later.
Emotional hunger, however, is different. It starts with an upper body desire to eat. It might be triggered by commercials, social situations, or certain strong emotions. There might be cognitive reasons to eat (“I might be hungry later” or, “Oh! We’re passing by that taco place I like!”) that are not directly guided by the physical desire for sustenance. Emotional eating is often felt in the mouth, rather than the stomach. It might be brought on by the desire to taste or experience the food, rather than to fill oneself. The cravings might be specific, or for a certain food-source, such as cookies (this is not a hard and fast rule, however). Emotional hunger does not vanish from drinking water. Emotional hunger comes on suddenly, and is often not relieved by eating the prescribed amount of food (having a full meal); oftentimes we finish lunch only to find ourselves unable to get the cookies at the downstairs coffee shop out of our heads.
2. Settling hormonal reasons for overeating: serotonin, insulin, cortisol:
Not all physiological hunger, however, is experienced as the slow, gnawing, slightly burning, grumbling stomach sensation described above. Sometimes we experience the need to eat because our blood sugar has crashed, or our neurological needs for serotonin have gone up. We might eat because stress hormones have caused blood sugar to spike and then crash. We might also experience certain cravings for food because our physiological needs for macronutrients; like carbs, fat or protein; or micronutrients, like sodium or magnesium, have not been met.
Therefore, it becomes essential to address the hormonal imbalances and nutritional deficiencies that might be causing us to overeat. Oftentimes, getting off the blood sugar rollercoaster is the first step. This often involves a combination of substituting sugar and refined flours for whole grains, increasing fats and protein, and, of course, avoiding eating carbohydrate or sugar-rich foods on their own. It often involves having a protein-rich breakfast. I tend to address this step first whenever my patients come in and express feeling “hangry”: irritable and angry between mealtimes.
Often drops in brain-levels of serotonin cause us to crave carbohydrate-rich foods. This is very common for women experiencing PMS. In this case, balancing hormones, and perhaps supplementing with amino acids like l-glutamine, tryptophan and 5-HTP, can go a long way.
One of the questions I ask my patients who crave a snack at 2-3 pm (a mere 2-3 hours after their lunchtime meal), assuming their lunch contained adequate nutrients, is “Do you crave, sugar, caffeine, salt or a combination of the above?” Cravings for sugar or salt at this time might indicate a drop in cortisol and give us a clue, combined with the presence of other symptoms, that this person is in a state of chronic stress, burnout or adrenal fatigue. In this case, it is essential to support the adrenal glands with herbs, nutrients, rest, and consuming adequate protein during the afternoon crash.
Finally, when it comes to cravings for foods like chocolate, meat or nuts, or even specific vegetables (when living in South America I would experience over-whelming cravings for broccoli, funnily enough), I find it important to identify any nutrient deficiencies. It is common to experience a deficiency in something like magnesium, iron, selenium, zinc, and the fat-soluble vitamins A, D, E and K; and our bodies will do their best to beg us for the specific foods they’ve come to learn contain these nutrients. Either consciously eating more of these foods (like brazil nuts in order to obtain more selenium), preferably in their healthiest form (such as dark chocolate, as opposed to milk chocolate, to obtain magnesium), or directly supplementing (in the case of severe deficiency), often results in the cravings diminishing.
3. The Hunger Scale and food diaries:
One of the first things I have patients do is understand the Hunger Scale. There are a variety of these scales on the internet that help us cognitively understand the stages the body goes through on its quest to ask for food and it’s attempt to communicate fullness. Being able to point to certain levels of hunger and fullness and pinpoint those physiological feelings on the Hunger Scale allows us to further flush out the subtleties between a physical or emotional desire for food.
Food diaries, I find, can help bring more awareness to one’s daily habits. Oftentimes, keeping a food diary for a few weeks is enough for some patients to drop their unwanted eating behaviours altogether. Other times, it can help us detect food sensitivities and unhealthier eating patterns or food choices. It also helps me, as a practitioner, work off of a map that illustrates a patient’s diet and lifestyle routines in order to avoid imposing my own ideas in way that may not be sustainable or workable for that particular individual.
A word about diet diaries, however: when recording food for the purpose of uncovering emotional eating behaviours, I often stress that it is important to record every single food. Sometimes people will avoid writing in their diary after a binge, or outlining each food eating when they feel that they’ve lost control, writing instead “junk food”. Guilt can keep us from fully confronting certain behaviours we’d rather not have acted out. However, I want to emphasize that the diary is not a confession. It’s not, nor should it be, an account of perfect eating or evidence that we have healed. Keeping a diet diary is simply a tool to slow down our actions and examine them. It’s a means of finding out how things are, not immediately changing them into what we’d like them to be. This is an important reminder. The best place to start any investigation into being is from a place of curiosity. Remember that the point of this exercise is to observe and record, not necessarily to change, not yet; it is very difficult or even, I would argue, impossible to completely eradicate a behaviour if the reasons for engaging in that behaviour escape our conscious awareness.
Therefore, recording food allows us to begin to poke at the fortress that contains the subconscious mind. We start to slow down and uncouple the thoughts and emotions from the actions that they precede and, in doing so, develop some insights into how we work. It can also help to start jotting down other relevant points that might intersect with what was eaten. These pieces of information might include time of day, where you were, what thoughts were popping into your head, and how you felt before and after eating the food. As we observe, more information begins to enter our conscious experience, allowing us to better understand ourselves.
4. Pealing back the layers: Understanding the “practical” and logical reasons for overeating:
One of the things that I have noticed, through my own work with addressing emotional eating, is that there are often layers to the “reasons” one might overeat. Some of the first layers I encountered were cognitive, or seemingly “logical” reasons. For example, I noticed that before eating without hunger I might justify it by thinking “I need to finish the rest of these, I don’t want them to go to waste”, or “I’ll finish these in order to clean out the container”, or “I should eat something now so I won’t be hungry later”, or “I didn’t eat enough (insert type of food) today so I’ll just eat something now, for my health”, or “If I don’t have some (blank) at so and so’s house, she’ll be offended”.
When looking more closely into these justifications, I found them to be flawed. However, they were logical enough for me to eat for reasons other than to satisfy a legitimate, physiological yearning for nutrients. It’s interesting to see how the mind often tries to trick us into certain behaviours and how we comply with its logic without argument.
5. Addressing the practical reasons: Planning:
In order to address the first layer of rationale for eating when not hungry, I decided to do the following: I would plan my next meal and either have it ready in the fridge, or pack it with me to go, and then I would wait all day until I was hungry enough to eat it. I would repeatedly ask myself, every time I thought of reaching for my portions, “Am I hungry now?” And would answer that question with, “Is there a rumbling in my stomach? No? Then it’s not time to eat.”
I found it would often be a several hours later before my body would genuinely ask for the food. I also found that eating satisfied the physical hunger often much sooner than it took me to finish the food. I realized how I often eat much more food and much more often, than I genuinely need.
However, holding off eating until physical hunger arises takes a conscious effort that is often unsustainable. Few of us can move through our busy lives constantly asking ourselves how hungry we are and when, and then have food at the ready to satisfy that hunger with appropriate, healthy choices. Therefore, I used this practice as a mere stepping stone to move through the deeper layers of emotional eating. By addressing the rational and logical reasons for overeating, I was able to get in touch with the deeper, emotional (and, arguably, real) reasons for which I was eating without hunger.
6. Pealing back the layers: Understanding the deeper, emotional reasons for overeating:
For a while I would wake up, make myself a coffee, and then wait until I felt hungry. Sometimes the feeling would arise in a few minutes, sometimes it would take hours. Depending on what I’d eaten the previous day and what my activity levels were, I would often not get hungry until well into the afternoon. However, the thoughts of eating something would frequently persist. And when the thoughts came up, whereas before they would be satisfied by me having something to eat, I now resisted them. When I resisted the thoughts, their associated emotions would strengthen. I then decided to journal before reaching for food, especially when I wasn’t sure if I was actually hungry or not.
Journalling can help us pull up, process and make sense of some of our emotions. I would write about what I might be feeling—what I might be asking for that wasn’t food. Through doing this, emotional reasons for hunger began to surface. The more I held off eating, the stronger and more clear the emotions became. It was a deeply uncomfortable process. This is why we emotionally eat—removing the emotions is often far more pleasant than dealing with them.
Emotions that surfaced were anxiety, ennui, boredom, loneliness and sometimes even anger. However, boredom and a listless, almost nihilistic, sense of ennui were among the two most common emotions I realized that eating medicated for me. For me, eating was entertainment. It broke up the monotony of the day and gave my senses something to experience. It gave my body something to do: chewing, tasting and digestion. Not eating made that sense of boredom grow stronger.
7. Addressing the emotional reasons: Nurturing and preventing:
Knowing more about the root emotional causes for overeating allowed me to work more closely with the source of my behaviour. I find that the closer we get to the source, to the roots, the more effective we are at removing the weeds, or behaviours, from our lives. I knew now that if I didn’t want to overeat, I would have to prevent myself from getting bored. I would have to have checklists of things to do. I would stay active and engaged in life: in my work, my friendships, and the other non-food-related things that brought meaning to my life.
During this time, I did more yoga and meditated. I journaled and wrote. I also meditated on boredom. I traced it back to where I might have felt it in my life before and noticed themes of boredom in my childhood. I realized that the child tugging on her mother’s shirt and asking when dinner was ready was probably a child who needed something to do, a child who was bored.
8. Pealing back the layers further: Working directly with core emotions:
Going even further, we can begin to peal back the layers of the emotional reasons for overeating in order to avoid replacing one “addiction” with another—such as replacing overeating with over-busying oneself, distraction or overworking. I began to find other emotions that ran deeper than mere boredom. I also realized that whenever I had felt boredom in the past, there was a threshold, often filled with discomfort, that I would eventually surpass. Once surpassing this threshold, a well of creativity, or a plethora of interesting insights, would spring forth. I remember as a child I would create stories, or lie on my bed and stare that the ceiling of my bedroom, contemplating the nature of the universe. These beautiful moments had been made possible by boredom and my courage to not distract myself from it.
Working with a therapist, or doing some deep inner work, we can access the core beliefs and emotions that might cause these emotional reasons for overeating to exist. Oftentimes we encounter core beliefs whose effects spill out into other areas of our lives, preventing us from living fully and consciously. Working through these beliefs can be deeply satisfying and help us experience transformational self-growth.
9. Setbacks: Understanding Change Theory:
Finally, engaging in this process of self-discovery doesn’t follow the same pattern in every person. Some people may find that their reasons for overeating are dissolved as soon as they start recording the foods they eat (this is surprisingly common). Others might find that years of working with a therapist have resulted in a mere dent in their ability to eat in response to hunger and to stop unwanted eating behaviours. In most everyone progress is not linear.
Change Theory and the Stages of Change schema depicts the alteration of behaviours as cyclical, rather than linear. As we move through the stages, we enter a cycle of pre-contemplation, contemplation, planning, action and maintenance. Sometimes we fall out of the cycle and relapse. Many people working with behavioural changes and addictions prefer to rename relapse “prolapse”, claiming that prolapse is a necessary stage for continuing the cycle of change and that much is to be learned from failing at something. It is through observing how the world produces unexpected results, and then attempting to understand the unexpected while trying again, where learning takes place. We don’t really learn if we don’t fail.
Sometimes addictive behaviours, emotional eating included, worsen at a time when someone is on the verge of making a massive breakthrough. Sometimes poking at a new layer of the source of unwanted behaviour accompanies an exacerbation in the practice of that behaviour. Having curiosity and self-compassion throughout the process is essential. Savouring the increased self-awareness that comes with any effort to effect change in one’s life is part of the enjoyment of the experience.
In response to my very popular article about the Mirena IUD and how that can upset hormone balance, or further an existing imbalance, I talk about a condition called “estrogen dominance” can result in hormonal symptoms, such as PMS, infertility, weight gain and anxiety.
Hello everyone, my name is Dr. Talia Marcheggiani. I’m a naturopathic doctor with a special focus in mental health and hormones, especially women’s hormones.
So, today I’m going to talk about an article I wrote about a year and a half ago that gotten a lot of activity online and it’s called “Let’s Talk Mirena: Anxiety and Hormone Imbalance”. I wrote the article because I was seeing a few patients who had the Mirena IUD and a series of similar symptoms. So, anxiety, panic attacks, and just a general sense of hormone imbalance. And when we ran their labs, when I looked at the levels of progesterone in their blood, they had very low progesterone. So I wrote an article about this and about the phenomenon of “estrogen dominance” that we naturopaths talk about a lot. And I got this resounding response online, so even today, sometimes, I’ll get a couple emails a day of people expressing their experiences and their agreement with the article and their confusion and frustration and anxiety around some of the symptoms that they’ve been experiencing since getting the IUD.
So, the reason I wrote the article is not because I don’t agree with the Mirena IUD. I’ve written another article called “Having a Healthy Birth Control Experience” in which I state that as a form of contraception, a hormonal birth control and a hormonal implant such as the IUD can be really great measures against unwanted pregnancy, because their efficacies are very very high—I think the Mirena IUDis about 99%pregnancy avoidance— and you don’t need to think about it, you don’t need to take a pill every day, so for some women this is ideal.
The issue is that a lot of women are being prescribed the Mirena IUD as a solution for Estrogen Dominance. And so what I find in my clinical practice, and I’ll talk more about estrogen dominance in the course of this video, but what I find in my clinical practice is, because it doesn’t address the underlying cause, and because it’s hormonal in and of itself, and it adds more hormones to the body, in a specific location, the uterus, and because it doesn’t address the underlying imbalance, it either worsens or ignores the condition of estrogen dominance, causing symptoms to get worse and women to feel frustrated and lost and then write to me.
Mirena is often prescribed to women with heavy and painful menstrual bleeding. So, this could be a diagnosis of endometriosis, or ovarian cysts, or just symptoms that they’re experiencing. So a lot of them might be experiencing iron deficiency because of the heaviness of the bleeding and a lot of women are out of commission for a couple of days every month because their period is so heavy and uncomfortable and they feel weak and they’re in pain and maybe they deal with really intense PMS. Some of my patients deal with PMS for 2 weeks out of the month, which is crazy and super uncomfortable.
Conventional medical doctors prescribe the Mirena IUD to combat these symptoms because with birth control and the IUD, one of the side effects is really light periods and some people don’t even get their period at all on Mirena and so you can imagine, if you’re period is this time of the month where you can’t go to work and you’re just basically hemorrhaging from the insides, then it would be a massive relief to not have to deal with a period anymore for 5 years, which is how long the hormones last in Mirena.
But one of the issues is that we need to look at the cause of these symptoms. Oftentimes these symptoms are caused by a difference in estrogen and progesterone, so these are two of the main female sex hormones. One of the things that happens in conditions like endometriosis or heavy and painful periods is that the estrogen is high in relation to the progesterone in the body. And so this is really apparent in a condition like endometriosis where there’s often high estrogen and also fibroids. So both of those cause terrible periods, and they need to be ruled out when periods are heavy and uncomfortable. And then there’s ways that we can deal with that as naturopaths.
But even without an underlying health condition, just primary dysmenorrhea, that’s not caused by another diagnosis is often the result of estrogen dominance.
And so the Mirena, because it’s made of only progesterone, can help with the uterine symptoms of estrogen dominance, which would be the heavy and painful periods. However, we have estrogen and progesterone receptors all over our body, not just in our uterus, and so when we’re putting hormones in one part of the body, and they’re not ending up in the rest of the body, we start to worsen that deficiency, or that relative deficiency in progesterone.
So women will mention, and one of the most common symptoms is anxiety and panic attacks, because progesterone this kind of calming effect on the central nervous system, on the brain, so it kind of chills you out and helps you handle stress.
Estrogen is a hormone that causes women to ovulate, so it’s a pro-ovulatory hormone and it also helps build up the uterine lining. So the more estrogen we have, the thicker the lining and therefore when we shed the lining during our period, the more we have to shed. So, more estrogen, the thicker the lining, the heavier and, by proxy, more painful the period.
Progesterone is a hormone that, in terms of reproduction, it helps us maintain the lining (of the uterus). So, if you ovulate and then that egg gets fertilized by sperm, then the egg gets implanted in the uterus and progesterone starts to increase, so pregnancy is a very progesterone dominant condition and one of the signs of a low progesterone state is when women who have been pregnant say that that’s the most balanced they’ve ever felt because progesterone is naturally higher in pregnancy.
Progesterone starts to rise when you become pregnant and that maintains the lining throughout the 9 months and then, after the 9 months, you have your baby. If the egg doesn’t become fertilized then progesterone rises for the last 2 weeks of the cycle and then it falls, along with estrogen, you shed your lining and then you have a period.
And for some women, they sail right into their periods. They have no PMS symptoms, they might feel a little bit bloated a couple of hours before and then they go to the washroom and go, “ok, look, there’s blood I’m having my period.” And for other women, it’s not the case, they get warning signs, like i said, before two weeks, so pretty much from ovulation to when their period happens. So, half of their life: 2 weeks out of every month.
And so, what happens with a lot of women is that there’s higher estrogen in relation to progesterone. So we call this “Estrogen Dominance”. And there can be three possibilities in this state. One is that estrogen is abnormally high and progesterone is normal, or optimal. Another is that estrogen is normal or optimal, progesterone is low, and a third option is that you have both at the same time: so estrogen is high and abnormal and progesterone is low and that’s more common than you think in a lot of women who are dealing with really severe symptoms, that divide between the two hormones is really off. And, as I mentioned before, prescribing birth control pill or Mirena IUD are not solutions because they’re not correcting the underlying imbalance. They’re not looking at the cause of why this imbalance is happening in the first place. Instead, they introduce foreign, fake or synthetic hormones into the system to try and correct the balance, but our body has a delicate balance and a delicate ecology and so when we try and shift that balance artificially sometimes we pay the price and we don’t necessarily feel balanced.
So, why does this occur? Why do people get estrogen dominance and how do you fix it? So, when it comes to the first situation, high estrogen, and normal progesterone, there’s a couple of reasons why estrogen might be high. So the first is exposure to foreign estrogen, or excess estrogens in the environment. And, so many of you may have heard of these “xenoestrogens”, or toxic estrogens, from sources such as BPA, so the lining of tin cans, or those plastic water bottles or baby bottles that everyone was throwing out and replacing with glass and stainless steel, which is a great idea. So, we’re in contact with these in the environment through the cosmetics, cleaning products, and some of the plastics that we hold and interact with on a daily basis. And paper receipts have this as well. So cashiers and people that handle receipts regularly are in contact with BPA. And it’s absorbed through the skin. So just this exposure to these toxic estrogens can activate estrogen receptors and it increases estrogen in the body. And that’s problematic. We know that these can also set the stage for hormonal cancers, like breast cancer, you might have heard of estrogen-receptor positive breast cancer, or ovarian cancer and endometrial cancer and cervical cancer. So these are all kind of these foreign estrogens influence the body’s hormones in a negative way causing growths.
The second reason why estrogen might be high is the reduced ability of the body to detoxify estrogens. So, when we’re done using the estrogen that we need, our liver cleans our blood of estrogen, then we dump the estrogen biproducts into the colon and then we eliminate them by having a bowel movement. And this is a normal process in lowering the toxic estrogen or the estrogen metabolites, the estrogen we don’t need anymore. And so when this process is either over-burdened by too many xenoestrogens, so those plastic estrogens, or limited in some way because our liver is trying to detoxify other things, such as alcohol, or tylenol, or some of these over-the-counter drugs, the liver just can’t handle the burden and so, in terms of treatment we need to bolster the liver’s detoxification abilities. And a lot of the time those two things exist at the same time: you’re getting too many foreign estrogens, we need to clean up the environment and the diet and make sure everything you’re getting is promoting a healthy estrogen metabolism.
And then, why progesterone might be low, which is the other arm or possibility of this estrogen dominance condition that I’m speaking of is stress, mainly. So, when we’re stressed out, and we’re dealing with a lot our body produces a hormone called cortisol and that’s the “stress hormone” that helps us deal with high amounts of pressure and stress. And a lot of the time stress is not perceived so, just this feeling of being tired and wired, disrupted sleep, sugar cravings around 3-4pm, having a difficult time getting up in the morning, feeling a little bit stretched thin, maybe feeling a drop in motivation, are all signs of chronic stress. So what happens is our adrenal glands, these pyramid-shaped endocrine glands that sit on top of the kidneys, they make cortisol. And when our body has more cortisol than it needs, or when it needs to make progesterone, it takes the cortisol and it makes progesterone with it. So it’s kind of like leftover cortisol that it’s not using gets made into progesterone. After ovulation, the ovaries also produce progesterone, but part of the progesterone production in the body come from the adrenal glands.
So you can imagine: if you’re stressed out and you’re spending all of your adrenal function on making cortisol you’re not going to have enough time or resources to make progesterone. So a lot of bringing up progesterone balance is by either lowering environmental stress or increasing adrenal function. We also look a nutrient deficiencies and we can also look at bringing pituitary balance by using an herb called vitex, which can help balance hormones and kind of right that estrogen-progesterone imbalance that might be going on.
So what happens when you give the Mirena, or you give an oral contraceptive to deal with this? Well, what happens is, there’s an imbalance and you induce another imbalance kind of over top. So, the body is still not making enough progesterone, there’s still too much estrogen, toxic estrogen, and what you’re doing is giving synthetic progesterone, which doesn’t have the same effects, progestins, synthetic progesterone, it doesn’t have the same effects as regular progesterone and often doesn’t work on the brain, so it doesn’t have that low anxiety effect, that calming effect, and it doesn’t prevent the estrogen-dominant cancers, it doesn’t help with ovarian cysts, it doesn’t manage endometriosis, other than stopping your periods, perhaps, if you’re reacting to it. And then you’re also, if you’re doing a combined oral contraceptive pill, you’re introducing more xenoestrogens to the body that your liver then has to clear out and that are going to cause more of those estrogen-dominant symptoms. And, in the colon we know that oral contraceptives can cause a bacterial imbalance, so a dysbiosis in the gut and potentially constipation and so that throws off our whole system. I’ve talked about how important that gut bacteria is for mental health and mood and just digestion and everything. So, more cells are in our gut than in the rest of our body. So our gut microbiome is super important to our health and well-being.
So, how does a naturopathic doctor address estrogen dominance? This is a big part of my practice especially because I see a lot of women with month-long PMS, acne, polycystic ovarian syndrome, so irregular periods, or missed periods, or they have a family history of hormone-dominant cancers and they’re trying to prevent these things from happening down the line, or they’re just having terrible periods. They’re having weight gain, or bloating, or anxiety that’s related to the period or really bad PMS, so mood swings, depression around their period or a condition called PMDD, which is really really severe depression right before the period.
So the first thing I do is order labs. And so your medical doctor might have done labs, gotten your estrogen and progesterone measured in your blood and your doctor might have said, “oh, it’s fine, it’s normal”, and this is true to the extent that when your medical doctor is evaluating your labs, they’re looking at massive reference ranges. So our reference ranges are a bit more narrow because we’re trying to look at the optimal levels for fertility and for feeling like your optimal, amazing self. We’re looking at, “is your estrogen within an optimal range, is your estrogen on the high side, and therefore, could be brought down? And does that match your symptom picture? Do you have estrogen dominance symptoms and a relatively high estrogen level? Is your progesterone lower than optimal to maintain a uterine lining in pregnancy, to not have a miscarriage in the first trimesters, etc. etc.” So we look at labs, and then we, using our natural therapies, we prescribe diet, supplements, and some lifestyle changes to help re-establish that hormonal balance.
So, if you have any more questions, just send me an email, at connect@taliand.com or check out some of the articles that I mentioned in this video.
Want to balance your hormones, energy and mood naturally? Check out my 6-week foundational membership program Good Mood Foundations. taliand.com/good-mood-learn
I’m tucking away at the cake again because the people who’ve invited me for dinner have dessert. Dessert: the gluten-y, sugar-y, dough-y sweetness of relief from deprivation, the dopamine and serotonin rush when the food smashes against my lips, teeth and tongue and gets swallowed, in massive globs, into my stomach. The desire for more smashes maddeningly around my skull. Getting the next fix is all I can think about. I reach for another slice when no one is looking. I guess some people call this binging, a complete loss of control around “forbidden” foods. All I care about is devouring another bite, and feeling the euphoric blood sugar rush that flushes me with giddiness and good feelings before the shame sets in.
One I’ve begun to indulge, however, the voice demanding more exits stage left and is replaced with a little gremlin who fills my head with sneering and loathsome disparagement. It doesn’t speak in whole sentences, but rather in snippets, sentence fragments and hateful keywords. Sugarrr…. it hisses, gluten, bloating… FAT! Ugly, worthless…No control, no willpower, useless… failure…FAT! Not that the cake contains fat, but fat is what I will become when I allow the cake to become a part of me, the little evil voice suggests. Sometimes I can temporarily drown out his voice by eating more cake, which only makes him louder once all the cake is gone or my stomach groans with fullness.
I’ve come to realize that this cycle can be set off with feelings of boredom, anxiety and, most of all, hunger. A low-calorie diet, detox or a period of controlled eating leaves me susceptible to these binge lapses. It’s taken me the better part of 30 years to figure that out. However, stress can also send me to the pantry, digging out whatever sugary treats I can find. And so the cycle of loss of control followed by self-loathing begins.
The next day, or even within the next few hours, I feel fat.
Fat feels a certain way to me. It feels physical: puffy, bloated and sick. Most of all, it feels like I’ve done something wrong, that I am wrong. It brings with it feelings of lethargy and heaviness, not the light, perkiness I associate with health and femininity. I feel gross, unworthy of good things: attention, love, affection. I feel like I’ve failed. I feel like I’ve lost control of myself. For, if I can’t even control when I shove in my mouth, how can I have power over anything else in life?
However, a person can’t really feel fat. I mean, especially not after only a day of overeating.
And besides, fat is not a feeling.
Perhaps fat was a stand-in feeling for other difficult emotions my childhood brain couldn’t fully comprehend. Like the time I wrote in my diary, at the age of 8 years old, That’s it, I’m fat, I’m going on a diet. From now on, I’m only eating sandwiches. Funny and touching, but also sad, I wonder what 8-year-old me was really feeling when she claimed to feel “fat”. Perhaps she felt helpless, out of control, different from the herd and hopeless about fitting in.
If I pause to peer below the surface of “fat”, I find other words or cognitive connections that underlie it. When I feel “fat” I also feel out of control, worthless, lonely, like a failure. I sometimes feel sad and anxious. Sometimes I simply feel full, like I’ve fed myself, and as I’ve often heard repeated, “It’s important to leave a meal feeling a little bit hungry”, the feeling of being fed can induce feelings of guilt.
Everywhere we look, the media equates “healthy” with thin, glistening bodies. Fitness models with amenorrheic abs, bounce back and forth on splayed legs in front of a full make-up, costume, lighting and camera team to simulate the image of running through a field. “Losing weight” equals “getting fit” equals “being healthy”. As a society we’ve failed to ask ourselves what “health” might mean and instead deliver the whole concept over to impossible standards of beauty, making “health” as unachievable as the stringy bodies that represent it. While I intellectually know that this isn’t the case, that health comes in all sizes—and may actually hover around “plus” sizes, in actual fact—restriction has been imprinted in my brain as a sign of healthy self-control.
But, maybe the definition of health needs to come from digging within and asking the question What does health mean to you? Perhaps the body knows more than the marketing media does about what it needs for health. Maybe, just sometimes, it needs cake to be healthy. Maybe even the act of overindulgence is healthy sometimes.
Perhaps if I give my body enough of the healthy food and fuel it needs, it won’t go crazy the next time it sees cake. When we try to murder ourselves by holding our breath to stop our breathing, we pass out. The body deems us too irresponsible to control the precious task of breathing and so it turns the lights out on conscious breath control. Our very own physiology doesn’t trust our conscious thought if we abuse it. So, when I force my body to survive and thrive on restrictions, self-hate and negative talk, perhaps it induces a binge. Maybe I binge to survive. Or maybe my body loves cake as much as I do.
Instead of feeling like a failure, because I didn’t win the fight against my body, perhaps I should respectfully hand it back the reins and tell it, with my conscious mind, “I trust you, I respect you, I’ll listen to you more carefully from now on.”
And, like Marie Antoinette once granted her people, I can grant my body permission, and let it eat cake.
People seek out naturopathic doctors for expert advice. This immediately positions us as experts in the context of the therapeutic relationship, establishing a power imbalance right from the first encounter. If left unchecked, this power imbalance will result in the knowledge and experience of the practitioner being preferred to the knowledge, experience, skills and values of the people who seek naturopathic care.
The implicit expectation of the therapeutic relationship is that it’s up to the doctor to figure out what is “wrong” with the body patients inhabit and make expert recommendations to correct this wrong-ness. After that, it’s up to the patients to follow the recommendations in order to heal. If there is a failure to follow recommendations, it is the patient who has failed to “comply” with treatment. This “failure” results in breakdown of communication, loss of personal agency on the part of the patient, and frustration for both parties.
When speaking of previous experience with naturopathic medicine, patients often express frustration at unrealistic, expensive and time-consuming treatment plans that don’t honour their values and lifestyles. Oftentimes patients express fear at prescriptions that they had no part in creating, blaming them for adverse reactions, or negative turns in health outcomes. It’s common that, rather than address these issues with the practitioner, patients take for granted that the treatment plan offered is the only one available and, for a variety of reasons, choose to discontinue care.
One of the elements of Narrative Therapy—a style of psychotherapy founded by Australian Michael White—I most resonate with is the idea of the “therapeutic posture”. In narrative therapy, the therapist or practitioner assumes a de-centred, but influential posture in the visit. This can be roughly translated as reducing practitioner expertise to that of a guide or facilitator, while keeping the agency, decision-making, expertise and wisdom of the patient as the dominant source for informing clinical decisions. The de-centred clinician guides the patient through questioning, helping to reframe his or her identity by flushing out his or her ideas and values through open-ended questions. However, the interests of the doctor are set aside in the visit.
From the place of de-centred facilitation, no part of the history is assumed without first asking questions, and outcomes are not pursued without requesting patient input. De-centring eschews advice-giving, praise, judgement and applying a normalizing or pathologizing gaze to the patient’s concerns. De-centring the naturopathic practitioner puts the patient’s experiences above professional training, knowledge or expertise. We are often told in naturopathic medical school that patients are the experts on their own bodies. A de-centred therapeutic gaze acknowledges this and uses it to optimize the clinical encounter.
I personally find that in psychotherapy, the applicability of de-centring posture seems feasible—patients expect that the therapist will simply act as a mirror rather than doling out advice. However, in clinical practice, privileging the skills, knowledge and expertise of the patient over those of the doctor seems trickier—after all, people come for answers. At the end of naturopathic clinical encounters, I always find myself reaching for a prescription pad and quickly laying out out my recommendations.
There is an expected power imbalance in doctor-patient relationships that is taught and enforced by medical training. The physician or medical student, under the direction of his or her supervisor, asks questions and compiles a document of notes—the clinical chart. The patient often has little idea of what is being recorded, whether these notes are in their own words, or even if they are an accurate interpretation of what the patient has intended to convey—The Seinfeld episode where Elaine is deemed a “difficult patient” comes to mind when I think of the impact of medical records on people’s lives. After that we make an assessment and prescription by a process that, in many ways, remains invisible to the patient.
De-centred practice involves acknowledging the power differential between practitioner and patient and bringing it to the forefront of the therapeutic interaction.
The ways that this are done must be applied creatively and conscientiously, wherever a power imbalance can be detected. For me this starts with acknowledging payment—I really appreciate it when my patients openly tell me that they struggle to afford me. There may not be something I can do about this, but if I don’t know the reason for my patient falling off the radar or frequently cancelling when their appointment time draws near, there is certainly nothing I can do to address the issue of cost and finances. Rather than being a problem separate from our relationship, it becomes internal the the naturopathic consultation, which means that solutions can be reached by acts of collaboration, drawing on the strengths, knowledge and experience of both of us.
De-centred practice involves practicing non-judgement and removing assumptions about the impact of certain conditions. A patient may smoke, self-harm or engage in addictive behaviours that appear counterproductive to healing. It’s always useful to ask them how they feel about these practices—these behaviours may be hidden life-lines keeping patients afloat, or gateways to stories of very “healthy” behaviours. They may be clues to hidden strengths. By applying a judgemental, correctional gaze to behaviours, we can drive a wedge in the trust and rapport between doctor and patient, and the potential to uncover and draw on these strengths for healing will be lost.
De-centred practice involves avoiding labelling our patients. A patient may not present with “Generalized Anxiety Disorder”, but “nervousness” or “uneasiness”, “a pinball machine in my chest” or, one of my favourites, a “black smog feeling”. It’s important to be mindful about adding a new or different labels and the impact this can have on power and identity. We often describe physiological phenomena in ways that many people haven’t heard before: estrogen dominance, adrenal fatigue, leaky gut syndrome, chronic inflammation. In our professional experience, these labels can provide relief for people who have suffered for years without knowing what’s off. Learning that something pathological is indeed happening in the body, that this thing has a name, isn’t merely a figment of the imagination and, better still, has a treatment (by way of having a name), can provide immense relief. However, others may feel that they are being trapped in a diagnosis. We’re praised for landing a “correct” diagnosis in medical school, as if finding the right word to slap our patients with validates our professional aptitude. However, being aware of the extent to which labels help or hinder our patients capacities for healing is important for establishing trust.
To be safe, it can help to simply ask, “So, you’ve been told you have ‘Social Anxiety’. What do you think of this label? Has it helped to add meaning to your experience? Is there anything else you’d like to call this thing that’s been going on with you?”
Avoiding labelling also includes holding back from using the other labels we may be tempted to apply such as “non-compliant”, “resistant”, “difficult”, or to group patients with the same condition into categories of behaviour and identity.
It is important to attempt to bring transparency to all parts of the therapeutic encounter, such as history-taking, physical exams, labs, charting, assessment and prescribing, whenever possible. I’ve heard of practitioners reading back to people what they have written in the chart, to make sure their recordings are accurate, and letting patients read their charts over to proofread them before they are signed. The significance of a file existing in the world about someone that they have never seen or had input into the creation of can be quite impactful, especially for those who have a rich medical history. One practitioner asks “What’s it like to carry this chart around all your life?” to new patients who present with phonebook-sized medical charts. She may also ask, “Of all the things written in here about you, what would you most like me to know?” This de-emphasizes the importance of expert communication and puts the patient’s history back under their own control.
Enrolling patients in their own treatment plan is essential for compliance and positive clinical outcomes. I believe that the extent to which a treatment plan can match a patient’s values, abilities, lifestyle and personal preferences dictates the success of that plan. Most people have some ideas about healthy living and natural health that they have acquired through self-study, consuming media, trial-and-error on their own bodies or consulting other healthcare professionals. Many people who seek a naturopathic doctor are not doing so for the first time and, in the majority of cases, the naturopathic doctor is not the first professional the patient may have consulted. This is also certainly not the first time that the person has taken steps toward healing—learning about those first few, or many, steps is a great way to begin an empowering and informed conversation about the patients’ healing journey before they met you. If visiting a naturopathic doctor is viewed as one more step of furthering self-care and self-healing, then the possibilities for collaboration become clearer. Many people who see me have been trying their own self-prescriptions for years and now finally “need some support” to help guide further action. Why not mobilize the patient’s past experiences, steps and actions that they’ve already taken to heal themselves? Patients are a wealth of skills, knowledge, values, experiences and beliefs that contribute to their ability to heal. The vast majority have had to call on these skills in the past and have rich histories of using these skills in self-healing that can be drawn upon for treatment success.
De-centring ourselves, at least by a few degrees, from the position of expertise, knowledge and power in the therapeutic relationship, if essential for allowing our patients to heal. A mentor once wrote to me, “Trust is everything. People trust you and then they use that trust to heal themselves.”
By lowering our status as experts, we increase the possibility to build this trust—not just our patients’ trust in our abilities as practitioners, but patients’ trust in their own skills, knowledge and abilities as self-healing entities. I believe that de-centring practitioner power can lead to increased “compliance”, more engagement in the therapeutic treatment, more opportunities for collaboration, communication and transparency. It can decrease the amount of people that discontinue care. I also believe that this takes off the burden of control and power off of ourselves—we aren’t solely responsible for having the answers—decreasing physician burnout. Through de-centring, patients and doctors work together to come up with a solution that suits both, becoming willing partners in creating treatment plans, engaging each other in healing and thereby increasing the trust patients have in their own bodies and those bodies’ abilities to heal.
Premature Ovarian Failure no longer bears that name. It’s not a failure anymore, but an insufficiency. POF becomes POI: Premature Ovarian Insufficiency, as insufficiency is apparently a softer term than “failure”. For me, it’s another telling example of how our society fears the names of things, and twists itself into knots of nomenclature and terminology rather than facing pain head-on. In this case, the pain is derived from the simple fact that the ovaries do not respond to hormones, that they for some reason die at an early age and cause menopause to arrive decades before it’s due, leading to infertility and risk of early osteoporosis.
Insufficiency, for me at least, fails to appease the sensitivity required for naming a problem. It reminds me of a three-tiered scoring system: exceeds expectations, meets expectations, insufficient performance. These reproductive cells have not been up to task. They’ve proven to be insufficient and, in the end, we’ve labelled them failures anyway—premature ovarian disappointments. Our disdain for the bodies we inhabit often becomes apparent in medical jargon.
What expectations do we have for our organs, really? For most of us that they’ll keep quiet while we drink, stay up late and eat what we like, not that they will protest, stop our periods, make us itch or remind us that we are physical beings that belong here, to this earth, that we can sputter and shut down and end up curb side while we wait for white coats to assist us. Our organs are not supposed to remind us of our fragile mortality. When it comes to expectations overall, I wonder how many of them we have a right to.
In one week I had two patients presenting with failures of sorts. With one it was her ovaries, in another it was his kidneys, first his left, now his right. Both of them were coming to me, perhaps years too late, for a style of medicine whose power lies mainly in prevention or in stopping the ball rolling down the hill before it gains momentum. When disease processes have reached their endpoint, when there is talk of transplant lists and freezing eggs, I wonder what more herbs can do.
And so, when organs fail, I fear that I will too.
In times of failure, we often lose hope. However, my patients who have booked appointments embody a hope I do not feel myself, a hope I slightly resent. In hope there is vulnerability, there is an implicit cry for help, a trust. These patients are paying me to “give them a second opinion”, they say, or a “second truth”.
I feel frustration bubble to the surface when I pore over the information I need to manage their cases. At the medical system: “why couldn’t they give these patients a straight answer? Why don’t we have more information to help them?” At my training: “Why did we never learn how to treat ovarian insufficiency?” At the patients themselves: “Why didn’t he come see me earlier, when his diabetes was first diagnosed?” And again at the system: “Why do doctors leave out so much of the story when it comes to prevention, to patient power, to the autonomy we all have over our bodies and their health?” And to society at large: “Why is naturopathic medicine a last resort? Why is it expensive? Why are we seen as a last hope, when all but the patients’ hope remains?”
Insufficiency, of course, means things aren’t enough.
I feel powerless.
There is information out there. I put together a convincing plan for my patient with kidney failure. It will take a lot of work on his part. What will get us there is a commitment to health. It may not save his kidneys but he’ll be all the better for it. My hope starts to grow as I empower myself with information, studies some benevolent scientists have done on vitamin D and medicinal mushrooms. Bless them and their foresight.
As my hope grows, his must have faded, because he fails to show for the appointment. I feel angry, sad and slightly abandoned—we were supposed to heal together. Feelings of failure are sticky, of course, and I wonder what story took hold of him. was it one that ended with, “this is too hard?” or “there is no use?” or “listen to the doctors whose white coats convey a certainty that looks good on them?”
A friend once told me, the earlier someone rejects you, the less it says about you. I know he’s never met me and it’s not personal, but I take it personally anyways, just as I took it personally to research his case, working with a healing relationship that, for me, had been established since I entered his name in my calendar. In some way, like his kidneys, I’ve failed him. Since we’re all body parts anyways, how does one begin to trust another if his own organs start to shut down inside of him? Why would the organs in my body serve him any better than the failing ones in his?
I get honest with my patient whose ovaries are deemed insufficient (insufficient for what? We don’t exactly know). I tell her there aren’t a lot of clear solutions, that most of us don’t know what to do–in the conventional world, the answer lies mainly in estrogen replacement and preserving bone health. I tell her I don’t know what will happen, but I trust our medicine. I trust the herbs, the homeopathics, nutrition and the body’s healing processes. I admit my insufficiency as a doctor is no less than that of her ovaries, but I am willing to give her my knowledge if she is willing to head down this path to healing with me. Who knows what we’ll find, I tell her, it might be nothing. It might be something else.
It takes a brave patient to accept an invitation like the one above; she was offered a red pill or a blue pill and took a teaspoon of herbal tincture instead. I commend her for that.
There aren’t guarantees in medicine but we all want the illusion that there are. We all want to participate in the game of white coats and stethoscopes and believe these people have a godlike power contained in books that allows them to hover instruments over our bodies and make things alright again. Physicians lean over exposed abdomens, percussing, hemming and hawing and give us labels we don’t understand. The power of their words is enough to condemn us to lives without children, or days spent hooked up to dialysis machines. We all play into this illusory game. They tell us pills are enough… until they aren’t. This is the biggest farce of all.
I can’t participate in this facade, but I don’t want to rob my patient of the opportunity for a miracle, either. We share a moment in the humility of my honesty and admission of uncertainty. I know my patients pay me to say, “I can fix it.” I can try, but to assert that without any degree of humility would be a lie. How can one possibly heal in the presence of inauthenticity? How can one attempt to work with bodies if they don’t respect the uncertain, the unknown and the mysterious truths they contain? In healing there is always a tension between grasping hope and giving in to trust and honestly confessing the vulnerability of, “I don’t know.”
For my patient I also request some testing—one thing about spending time on patients’ cases and being medically trained is that you get access to information and the language to understand it. I notice holes in the process that slapped her with this life-changing diagnosis.
When her labs come back, we find she might not have ovarian insufficiency after all. Doorways to hope open up and lead us to rooms full of questions. There are pieces of the story that don’t yet fit the lab results. I give her a list of more tests to get and she thanks me. I haven’t fixed her yet, but I’ve given her hope soil in which to flower. I’ve sent her on a path to more investigations, to more answers. And, thanks to more information in the tests, I’ve freed her and her ovaries from the label of “failure” and “insufficient” and realized that, as a doctor, I can free myself of those labels too. The trick is in admitting, as the lab results have done in their honest simplicity, what we don’t know.
For the moment, admitting insufficiency might prove to be sufficient in the end.
