In this episode, I am speaking with Dr. Ritamarie Loscalzo about metabolic syndrome, diabetes, insulin resistance and blood sugar issues.
Table of Contents
In this podcast, Dr. Loscalzo and I discuss:
- The shocking fact that about 92% of the population is now struggling with their metabolic health and the health issues that this inevitably causes.
- The lifestyle habits responsible for causing metabolic damage.
- The signs and symptoms of metabolic disease (and are you on the slippery slope?)
- Which elements of nutrition are KEY to preventing metabolic syndrome, insulin resistance, diabetes, etc? Is there one ideal diet for this?
- If coping with excess glucose in the cells is the issue, is eating low-carb the obvious answer, or just sidestepping the real causes? Or rather, is losing body fat the key to making improvements?
- The value of using a continuous glucose monitor to check how blood-sugar is affected by our food, stress, sleep, etc.
- Can intermittent fasting be helpful (even for women)?
- The connection between blood sugar levels and thyroid issues.
- Dr. Loscalzo’s top three most important strategies for addressing insulin resistance and getting blood sugar levels under control
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Transcript
Ari: Hey there, this is Ari. Welcome back to the Energy Blueprint Podcast. I am very excited to share today’s episode with you. It’s with my friend Dr. Ritamarie Loscalzo, who is the founder of the Institute of Nutritional Endocrinology and has more than 30 years of clinical experience using science-based nutritional and natural approaches for successfully correcting the imbalances that lead to chronic disease.
She’s one of the top natural health experts that specialize in metabolic syndrome, diabetes and insulin resistance, and blood sugar issues. We’re going to talk a lot about that, that the focus of this episode is going to be all around that. This episode was a lot of fun. I really enjoyed my conversation with her, and I think you’re going to get a lot of value from it, so enjoy. Welcome to the show, Dr. Loscalzo, such a pleasure to have you.
Dr. Loscalzo: I am so glad to be here, Ari. It’s just a pleasure to be here. I love what you do and I love your podcast episodes. They really get into the nitty-gritty, so I’m excited about what we get to explore today.
Is insulin resistance the most prevalent metabolic dysfunctions in today’s world
Ari: Me too. Let’s start off by having you do a broad overview of how you conceptualize the big picture of what are the key metabolic disturbances, imbalances, dysfunctions that are going on in the majority of the population today, and how you conceptualize the main causes of that?
Dr. Loscalzo: That’s a great question, and we could go on for days on that, but we’ll keep it to a level- [crosstalk] [laughs]
Ari: I know. Give me the high-level, quick, punchy overview.
Dr. Loscalzo: Well, there was a study in 2018 that said 88% of the population is metabolically unwell. More recently, it was done again, it’s 92% of the population is metabolically unwell. I think that what I see as an underlying cause of so many people’s problems is imbalanced blood sugar and disordered insulin, blood sugar regulation, and their ability to actually get fuel where it needs to go. I know you talk a lot about mitochondrial dysfunction as a cause of energy problems, but one of the biggest problems is you got to get the fuel into the mitochondria, and that relies on good insulin and blood sugar control.
Ari: Let’s talk insulin resistance then. Insulin resistance is central to what you’re getting at there?
Dr. Loscalzo: Absolutely, yes.
Ari: How do you conceptualize the causes of insulin resistance? What is actually driving insulin resistance? We know it’s a huge epidemic, it’s extremely common, as you just said, it’s really the vast majority of people have at least some degree of insulin resistance, if not full-blown diabetes. What is driving that?
Dr. Loscalzo: I’m going to just take a step slightly back before we go forward with that. You said, in some degree of insulin resistance, if not full-blown diabetes. A good percentage of the population has full-blown diabetes, probably 18% to 20%. Then we have that in between area that the medical diagnosis is insulin resistance. Then there’s all the rest of the people that are falling before that diagnosis, but they’re year after year after year making their situation worse. I call that pre-insulin resistance. From a non-medical-
Ari: I think when you said the diagnosis is insulin resistance, did you mean to say the diagnosis is pre-diabetes?
Dr. Loscalzo: Well, they say pre-diabetes, but there’s an ICD-9 code for insulin resistance. They’re told, “You are pre-diabetic, but technically it’s, “You’re insulin resistance,” and hemoglobin A1C above 5.6 and fasting blood sugar above one 10 on three consecutive occasions. There’s a way that you’re supposed to diagnose it, but that’s already, there’s been lots of damage done to the system. What I want to talk about is how we help people who are pre-insulin resistant, pre-diabetes to change things so they never become insulin resistant and may never have the risk of diabetes. Fair?
Ari: Sure.
Dr. Loscalzo: What causes it.
Ari: Maybe I’ll clarify on behalf of the insulin-resistant people who might be thinking, “Well, what about me? I want to be helped too.”
Dr. Loscalzo: It all applies to you too.
Ari: Cool.
Dr. Loscalzo: We’re just hoping to catch people before they get to the insulin-resistant stage. It all applies, whether you’re a diabetic, whether you are insulin-resistant, or whether you’re pre-diabetic or pre-insulin resistant. It all applies. It’s really a dysregulation of the body’s ability to take the glucose from the food that you eat and transport it into the cells where the mitochondria do their thing and make energy, and where the cells can actually heal, repair, detox. That’s a breakdown in that mechanism. That breakdown can be detected long before you go to the doctor and they say, “Hey, you’re pre-diabetic.” Long before that, like decades before.
It’s really important that people recognize that because once you’re diagnosed with insulin resistance, or further, diabetes, but even insulin resistance, there’s already been retinopathies happening, damage to the retinas in the eyes, there’s already neuropathies, damage to the peripheral nerves, there’s already damage to the kidneys, and there’s damage to the lining of the blood vessels, which can lead to out-of-the-blue stroke, out-of-the-blue heart attack, like, “You are not a risk factor for it,” when indeed they are if we were looking in the right places to help solve that.
Ari: Got it.
The primary causes of insulin resistance
Dr. Loscalzo: Your original question was what causes it? I will say life in the modern world causes it. The food that people are eating, or rather the non-food that people are eating. I don’t even like to call some of the stuff people eat food, it’s highly processed, now the new term is ultra-processed food crap, food lookalikes that we’re deceiving the body into thinking is nourishing because it’s providing calories, lots of them, by the way, and it’s destroying the system. The food is a huge, huge one.
Sympathetic overload. We’re in the state of constant fear. Everybody’s trying to get you into a fear mode so you spend more money. There’s the financial fear, there’s the health fears and everything, that puts the body into fight-or-flight mode, which is the sympathetic nervous system, a branch of the autonomic nervous system. There’s a sympathetic fight-or-flight and parasympathetic. Rest, digest, heal, reproduce, all the cool stuff that can’t happen very effectively when we’re in fight-flight. That’s the stress piece of it.
There’s the lack of sleep. I know you talk a lot about sleep in your work, how important sleep is. Lack of sleep. It’s known that even one bad night of poor sleep in an otherwise healthy person can cause temporary insulin resistance. What about decades worth of poor sleep in an otherwise unhealthy person? It’s a prescription for a disaster. We have the stress, we have the lack of sleep, we have the poor diet, and I would say couch potato society.
People are sitting around and watching TV, eating Cheetos, drinking wine to drown their pain, and they’re getting sicker and sicker while they worry about getting sick and catching the latest thing that’s going around. It’s that the fear that everybody lives in and the lack of movement. Of course, on the other extreme, we have the people who are weekend warriors, who are doing nothing during the week and they’re killing themselves on the weekend. There’s a balance. You talk a lot about hermetic stress, there’s that little bit of stress that’s good, that a lot of stress, not so good.
Then, of course, the toxins. The environment is getting more and more polluted and toxic, even though there’s more awareness about it. There’s not a whole lot being done to remove the toxicity from the hair care products, the skin care products, the rugs, the furniture, everything that were around, the paints, and EMFs, of course, that’s part of the toxicity. All of that stuff comes together and creates a perfect storm for insulin/glucose dysregulation, metabolic unwellness, which these are not like studies in some alternative journals.
The University of North Carolina published this based on research, and all the medical journals, that based on criteria that you or I would probably think are lame criteria that we would tighten it up, that 88% in 2018, and now more recently, 92% of the population is metabolically unwell.
Ari: Got it. The insulin resistance component itself is the problem. Let me preface by saying, because I don’t want this to be perceived as like a got-you moment or something like that, but there’s controversy around how people conceptualize insulin resistance. There are some people saying, “Oh, it’s a real problem, the cell is resistant to the insulin. Wouldn’t it be great if the cell was more sensitive to the insulin and those nutrients could get into the cell more effectively?”
There’s other people saying, on the other end, and there’s papers on this showing that the insulin resistance is generated by signals in the cell. Basically, that there are too many nutrients inside of the cell and it is intelligently making itself resistant to more nutrients flowing in because in excess of nutrients in the cell is actually damaging to the cell. There’s a whole bunch of layers I could add, but I’ll stop there and ask you where you land on that spectrum of those positions?
Dr. Loscalzo: Yes and yes. [unintelligible 00:10:37] That’s why the cells get damaged and that can cause insulin resistance. The receptors, the GLUT2 receptors and some of those other little pieces on the cell membrane that get damaged, there’s lack of nutrients that we need, like magnesium and chromium and some other nutrients that need to transport the insulin in.
Part of it is that the cells– I always tell people it’s like the cells are going like this, “No, no, no, no more,” because the damage that the extra– When you say nutrients, it’s mostly glucose that we’re talking here. Somebody’s been on a high glucose diet, a high starch diet, converting into glucose, and we’re getting all of this sugar into these cells. We have glycation that happens, stiffening of the cells, breakdown of the cells, and they put up their hands and go, “No, enough’s enough.”
The issue with that, and just to throw a little bit into the mix, is that what they found is that the cells that line the blood vessels, the endothelial linings, they don’t become insulin resistant. For some reason, they are like, “Oh, we need those nutrients.” Then they get glycated, they get stiff, they can’t do their function because they get damaged by the excess insulin. I think both are really the issue. I don’t think there’s an argument one way or the other. I think it’s both.
The fatty acids and metabolism link
Ari: There is also another aspect of this, which I think is the fatty acids component to it, and I think is generally neglected. I think the toxicity of excess of high blood sugar levels, both in the blood and excess blood sugar in the cell itself, and with glycation, as you just said, I think is pretty well appreciated. There’s a lot of literature on it, there’s a lot of awareness on it. I think less fewer people are aware of the elevations in free fatty acids, which are also toxic to the cell in the diabetic person and also contribute to the insulin resistance.
I was just listening to a podcast with Iñigo San Millán, who’s an exercise physiologist that I’d like to have on the show, who’s doing some really interesting work around mitochondria. He studies diabetics and he studies high-level athletes. What’s really interesting is the way he talks about the contrast between the two. In a way, he basically says that their cells, their muscles, and their overall metabolisms are essentially opposite ends of the spectrum. We can look at high-level athletes, especially endurance athletes, as an example of what healthy metabolic function, healthy muscle function, and healthy mitochondrial function in particular should look like.
One of the things that stands out– there’s many differences, but one of the big things is there’s three to four times as many mitochondria in the muscles of an athlete compared to a diabetic. Literally, 300% to 400% more mitochondria in there.
Dr. Loscalzo: A lot more.
Ari: The fat burning and sugar burning capacity of them is far greater. The engine and how much fuel it can consume is far greater. If you think about that and this issue of the excess building up in the blood, if you’ve got a bigger engine that’s guzzling a lot more fuel, you’re much less likely to build up a chronic excess.
There’s one other interesting thing that he said, it’s called the athlete paradox. What they find is that when they examine the muscle cells of diabetics and they examine the muscle cells of athletes and they examine normal people who are not high-level athletes, they find that there’s, what are called intracellular lipid accumulation. Basically, big globs of fat that accumulate in the cells next to the mitochondria in diabetics that are not present in healthy normal people who are not high-level athletes. Then when you look at high-level athletes, they also have the presence of these big globs of fat next to their mitochondria.
Dr. Loscalzo: Interesting.
Ari: What’s interesting about this is you can look at a snapshot in time but it doesn’t tell the full story. The full story is that the flux, the energy flowing in and out is very different. The high-level athlete has an adaptation to the need for so much fuel to power all the activity, their body has built up stores of that and builds them up almost on a daily basis, essentially. It goes from depleting them to rebuilding them on a daily basis in preparation for the next bout of activity, again, as an adaptation for better fuel burning during exercise.
The diabetic has similar-looking big globs of fat next to their– and the overweight person, similar globs of fat next to their mitochondria and their muscle cells, but it’s static and the globs of fatter just sitting there not being burned-
Dr. Loscalzo: Sitting there.
Ari: -and then producing all these inflammatory molecules and ceramides and all these things that are disrupting mitochondrial function and damaging overall metabolic function. Anyway, just wanted to add those pieces to this story because I was excited to learn that piece of the story. I didn’t know that this whole thing about the athlete paradox, but I think it ties nicely- [crosstalk]
Dr. Loscalzo: That’s real interesting. I have to look into that more. It’s interesting because we know that trained muscle picks up the insulin much better. That’s what it’s doing. It needs to grab all that fuel to put it in there. We know that, and that’s part of becoming metabolically healthy, is creating muscle cells that can grab on and allow the insulin to do its job. I think it’s important.
I think that fatty acid thing, a fatty acid buildup is going to happen when there is caloric excess because that’s what happens. We take the calories, we can’t get them in as glucose and we create that. Sometimes that happens in folks who are not really overweight, they’re just insulin resistant, because what’s going to happen to that sugar that’s in the blood? We’ve got to store it. There’s just so much you can store as glycogen and then it gets converted into free fatty acids and stored as fat.
I don’t know that there’s any one answer to how this is, and the more we study it, the more we see the biochemistry and we see it. I think my bottom line is people are eating garbage, they’re eating too much too much processed fat. Not that fat is bad, but too much processed fat, highly heated, oxidized [unintelligible 00:17:44] et cetera. They’re eating too much sugar, too much starch, too many empty calories, and they’re eating too much and not exercising enough. All of this stuff comes together as a perfect storm for insulin resistance.
How caloric excess affects your health
Ari: You mentioned caloric excess there, and that already clues me into some of your thinking and where you stand on some of the hotly debated issues of the dietary cults in the last few decades. There are some people who have– This is a bit of a chicken and an egg thing. There are some people who have made the argument that insulin resistance is generated by insulin itself. You consume carbs, you have spikes of insulin, and this is the primary cause of insulin resistance.
There are other people who argue along the lines of what we were talking about a few minutes ago, that insulin resistance actually is an intelligent adaptation that results from chronic energy excess, chronic caloric excess, and the accumulation of excess body fat and leaky fat cells resulting in this chronic energy surplus in the bloodstream and cells are trying to protect themselves from it.
The first camp also of the people who say it’s all about carbs and insulin spikes that are driving diabetes, which is actually a surprisingly common belief among the general population, generally, the dietary authors, dietary gurus that argue for that also tend to argue that calories are not important and that it’s only insulin levels and carbs that matter. If you lower your carbohydrate levels and eat a low carb or a keto diet, then you’re lowering insulin levels and that’s the primary thing that’s regulating body fatness rather than calories. What’s your take on that landscape?
Dr. Loscalzo: It depends. We are all a little bit different metabolically and some people tolerate certain things, and there’s genetics. I did another episode where we talked about the fat FTO genes and some of that stuff, where it affects how the body handles starch. Some people don’t handle fats very well, some people don’t handle carbs very well, some people don’t handle either.
I happen to be blessed, if you will, with a hunter-gatherer thrifty gene, so starches [unintelligible 00:20:26], they don’t do well for me. Then I also have this FTO gene where I don’t handle too much fat. You have to find that sweet spot in the middle which works for the individual. I believe there is no one-size-fits-all when it comes to diet, when it comes to lifestyle, when it comes to things.
I believe that there are certain things that everybody is going to do poorly with. All the ultra processed foods, although there’s some people living to be 100, smoking, drinking and being on ultra processed foods, but genes play in there. We have to look at genes, we have to look at the diet, we have to look at the stress levels, and I can’t tell you how many people go through– I have a program that’s called the Sweet Spot Solution, and we’re trying to find that sweet spot for each individual.
“Now, I don’t understand why am my insulin resistance? Why am my sugar so high?” Blah, blah blah. “I’m eating really well.” You’re not eating as well as you could for your genotype, but also, “What about your sleep?” “Well, [unintelligible 00:21:25] “What about your stress levels?” “Well, you know,” blah, blah, blah. “What about your movement?” “Well, I have a bum knee, so I don’t know.”
There’s all these other factors. As I’ve gone through taking thousands of people through this program and looked at their numbers, it makes a difference. For some people, they could just do the food and they get these tremendous results. Another person, all they have to do is start sleeping and they get the tremendous results. Some people have to do it all. We really just need to make healthy choices in all of these aspects of our lives, have the right nutrients, don’t allow ourselves to get into nutrient depletions, which happens from poor food choices, it happens from poor microbiome, it happens from so many other things. I think we just have to look at all the factors.
I think that one of the most overlooked factors is this blood sugar. Go to the doctor, functional medicine doctor or standard doctor, and you have hot flashes, they’re going to run tests on your sex hormones and give you something to make them better, whether it’s an herb or a drug or a bioidentical, but we’re not looking at why did those sex hormones go bad? Not because she’s 51-years-old, it’s because there’s other imbalances that have most likely been there for a long time that now are coming to fruition because nature did this thing where suddenly we’re losing some of the ability to handle this stuff.
We can’t just look at the presenting symptom, we have to look at the basis. I believe that in over 30 years of clinical practice, I’ve seen this over and over again, that if we don’t address the blood sugar and we don’t address microbiome imbalances, I don’t care how much black cohosh and hawthorn berry and whatever else you give somebody, their problems aren’t going to go away because you’re not addressing the real underlying cause.
Common signs and symptoms of blood sugar issues and insulin resistance
Ari: Got it. How would somebody know that they have blood sugar issues and insulin resistance? What are some of the signs and symptoms of that?
Dr. Loscalzo: The sad part is some of the signs and symptoms are the common things that we see most people have. Excess belly fat because because that’s where it gets stored when we’re in that mode. We get [unintelligible 00:23:46] adipose around the belly, so we get the belly fat. We have brain fog, because what’s happening, we’re not getting all this sugar and fuel that we’re eating into the actual cells. We have exhaustion, fuel is not getting into the cells to fuel them.
Some people, it shows up as things like skin rashes and gut issues and other things like that or other hormones go out of bound. Thyroid issues are commonly associated with blood sugar issues, and it’s almost like epidemic the number of people who have thyroid issues these days. We have to look backwards and not to say, “Here’s your T4, go ahead have a good life.” We have to look at that and say what’s causing that. I have seen literally people who got their blood sugar under control and within four months went off of thyroid medication that they’d been on for 40, 50 years.
Ari: Wow.
Dr. Loscalzo: They’ve been diagnosed with Hashimotos, and with the blessing of their doctor who said, “You don’t need this anymore,” lost all the weight, created this healthy body in four months because her little linchpin cause was this blood sugar that never got addressed.
Ari: Wow. What are some of the key things that someone can do to address those blood sugar issues? How do you conceptualize the key root causes there that need to be addressed to fix that problem?
Dr. Loscalzo: Absolutely. Good. Here’s the thing, we want them to learn to test. The doctors aren’t going to say, “Let’s test your blood sugar to see if you have pre-insulin resistance.” They’re going to do the fasting blood sugar once a year on the annual and say, “Huh, your blood sugar’s now 110, you’re creeping up, I think you’re pre-diabetic. What should we do?” This was the person I just mentioned to you that happened to her. She was 65-years-old. She went in for her– and they said, “Oh, your blood sugar’s like 112,” or something. She said, “Oh, what does that mean?” He said, “Oh, you’re pre-diabetic.”
She was perked up because she had family members who were diabetic, and she goes, “Oh, well, how do I prevent becoming diabetic?” She said, “Oh, you can lose weight. Come back in six months, and if you’re diabetic, we’ll put you on medication.” [unintelligible 00:25:55] She thought that was a really dumb idea. She found me. We worked through my program, but that’s the kind of stuff that you can see shifting, so they should be learning to test their own sugar.
I start people off by teaching them how to do their own sugar. When I first started doing this, the only way you could do it was prick your finger every 15 minutes to see where your peaks and valleys were. Now with CGMs becoming popular, nobody ever heard of a CGM, Continuous Glucose Meter, before, I don’t know, four or five years ago, I was wearing them and recommending them and people had never heard of them before. Now everybody and their brother is wearing a CGM.
It’s become popular, thankfully, because it gives you the ability to see what does your food do to your blood sugar? What does your stress do to it? How do you respond to exercise? How do you respond to good sleep versus bad sleep? We get to actually empower the people. We get to actually have the power to change the things that are issues for them. I could say to you, “Ari, go ahead and get off all the sugars and the starches,” and you go, “I’m already doing that. Well, I’m still in insulin resistant, what’s going on?”
We look at you and [inaudible 00:27:06] two hours after having this argument with my partner, where we yelled and screamed at each other, and, “Huh, look what happened to my blood sugar?” or “This is what happened when I ate that donut that I normally don’t eat, but every now and then I cave and I do. Look what happened to my blood sugar.” It’s really empowering. It gives people the ability to determine what’s causing their blood sugar to be out of balance and then bring it back in balance.
The benefits of insulin-sensitizing agents
Ari: Okay. How do you feel about insulin-sensitizing agents, things like metformin, berberine, cinnamon, chromium, things of that nature?
Dr. Loscalzo: Sure. I think they’re good. I think metformin’s on the extreme because it’s a medication, it has some issues on the liver and all, but the natural ones that sensitized, that can be included as part of your diet, cinnamon [unintelligible 00:28:08] you’re pouring on stuff.
Berberine is a little bit more like halfway between the food versions and the pharmaceutical because it does have a therapeutic effect. You could take goldenseal and Oregon grape and some natural substances that contain it, but I think they’re good. I think that chromium gets depleted big time. Their liver gets strip mined of all the chromium, the soils are not that great in it anymore, and so people are low in chromium because of the insulin spikes.
Magnesium’s another one that we do. We look at Omega-3s like DHA, which seems to have a good effect on sensitizing, but I also have a four-page handout of pictures of all the herbs and foods and how they affect. [unintelligible 00:28:50] has an effect, green leafy vegetables, blueberries. There’s all kinds of foods that actually resensitize the cells to insulin. I’m a fan. The last resort would be a pharmaceutical like metformin because I haven’t seen that we have anybody, at least in my program when they’re following, they haven’t needed it. Many of them go off of it because they no longer need it because they get it under control with food and thoughts and lifestyle and all that.
The link between body fat and insulin resistance
Ari: Got it. Where do you put weight loss in this picture? If excess body fat itself is a major contributor, driver, cause of insulin resistance, how do you prioritize that in the way that you approach the treatment of resolving high blood sugar levels and insulin resistance?
Dr. Loscalzo: Well, here’s the thing, high body fat will cause or contribute to insulin resistance, but high levels of insulin contribute to excess body fat. People who are not overeating, who are eating, even some of them eating low calories for what they should be burning, they’re still having packing on the weight because of the kinds of calories. That’s where a calorie is not a calorie is not a calorie. Somebody could be eating, let’s say, 1,000 calories a day of avocado compared to 1,000 calories a day of bread, it’s going to have a hugely different effect on their body.
Ari: That’s true, but is it because of the insulin or is it because of a number of other factors? Because there are studies like Kevin Hall’s Metabolic Ward studies, where they precisely control for calories. If they take people, they put them on a 1200-calorie diet that’s very high carb, very low fat diet, or a precisely equal 1200-calorie diet that is extremely low carb and high fat and they create radically different amounts of insulin in response to those meals, but then they track them, and then 6 weeks, 8 weeks, 12 weeks later they have the same amount of fat loss.
Dr. Loscalzo: Interesting. I haven’t looked at those particular studies. The studies I’ve looked at talk about the timing of the calories, like are they eating the calories early in the day? Are they eating the calories later in the day? I think the bottom line is we need to eat healthier calories.
Ari: For sure.
Dr. Loscalzo: When I look at a lot of those studies, they’re giving everybody– the 1,200 calorie high fat is like gut canola oil as part of it, and the high carb is not quinoa, it’s bread and pasta and things like that. I haven’t seen one of those studies that I really felt comfortable that the food choices weren’t contributing, even if they were equal, whether it was crappy fats and crappy sugars and they both had the same effect on the body versus-
The DIETFITS Study and calories
Ari: There’s literally only one well-designed study that was a long-term study. This is one of the best low-carb versus low-fat studies. There’s literally only one study where the food quality was excellent. This is pretty much the best low-carb versus low-fat study that’s ever been done. It’s called the DIETFITS Study. It’s notable for a couple of reasons, it had a huge number of participants in the, I think it was 600 or 6,000 participants. It was a huge group of people, which, for people listening, that that gives the study very high power when it has so many subjects, and it was done for an extremely long period of time.
Most of these kinds of studies are done for like two weeks, four weeks, six weeks, maybe [inaudible 00:33:06], this was done for a year. The reason, also, to your point that you were just making, this is a study where they actually gave good dietary advice in both camps, both low-carb and low-fat camp, and they said in both camps, “Eat whole unprocessed food,” and they gave them guidelines for what are good nutritious food choices. You don’t have avocados versus donuts. You don’t eat healthy fats versus the worst carbohydrates, that’s not a good comparison, but if you start comparing avocados versus blueberries or avocados versus [unintelligible 00:33:46] or carrots or something, now you’ve got a fair comparison.
Anyway, they found after a year that there were no significant differences between the low-carb and low-fat groups, but having said that, within the overall averages, there were some individual differences. There were individuals who lost much more weight on the low-carb or the low-fat diets who responded much better to one or the other. It speaks to the bio-individuality of people and their responses to it. Anyway, all of that is a digression, but it’s just speaking to the studies that evaluate different diets that are relatively equal in calories and macronutrients, but differ in their levels of insulin.
Dr. Loscalzo: I agree that that would be what I would predict the results of a study like that would be because there’s so much variation and we’re looking at the overall, but you said there were individual differences and that’s where I’m a big fan of bio-individuality, let’s look at what’s happening, let’s look at the insulin over time, and that’s a piece that’s so missing in so many of the studies, but also clinical trials and everything else. That just plays into, eat whole healthy foods, find the right balance for your body and then go with it.
For me, I found I do better with a moderate fat, very low carb diet. If I eat too much fat, I just gorge out on– Avocados I can eat a lot of, but if I gorge out on nuts and seeds then I tend to gain weight on that, even if the calories aren’t that high. If I eat too many blueberries or quinoa or any of that stuff, then my blood sugars are fluctuating and I tend to gain weight on that. You have to find it for yourself, and I believe the best way to do that is to monitor. You get the A1C checked, you get the insulin checked, and you do postprandial glucoses, and it makes a huge difference, and then we adjust the parameters based on the individual person.
Ari: I have a quick anecdote on the– This has actually been insightful for me because I believed for a long time that when eating a very healthy diet of more nutritious whole foods, it’s very difficult to gain weight, but I have two dogs, and admittedly, this is a dog study, not a human or a dog anecdote, not a human one, but it’s interesting nonetheless.
Normally, I’m very active with my dogs. I take them for a lot of walks, I run my dogs, but recently, my female dog was pregnant and gave birth to puppies and then we just went through a spaying procedure with her. She actually went into her first heat right before we were about to spay her. My male dog got her pregnant. My wife didn’t have the heart to spay her shortly after she was pregnant, and then we went through the whole pregnancy and puppies. Anyway, it’s a long story.
All of this is to say that my female dog went through periods where she wasn’t eating very much. Also with post-surgery with the spaying, she wasn’t eating very much and I had to keep her on the leash for walks. I wasn’t able to take them off the leash and run them like I normally do. My male dog was eating her food because she was leaving a lot of her food behind. He would go over to the food that she left behind and start eating it. Even though they eat an absolutely pristine diet, they eat food better than most humans do, far better-
Dr. Loscalzo: I believe it.
Ari: Really, really high quality food, and it’s actually mostly a carnivorous diet. It’s mostly meat, small amounts of veggies, no significant amounts of carbs because I believe that’s an appropriate diet for dogs. My male dog, with the combination the lack of the intense running and the eating a bit more food or having access to a bit more food, he’s put on probably six or eight pounds, which is significant in a 45-pound dog. That’s a lot of weight, and so he’s much thicker. He’s got a big– I wouldn’t say a big belly, but he’s put on a lot of fat compared to how lean he is normally.
Anyway, even with mostly meat and vegetables diet, the combination of you remove the intense exercise, you start to eat a little bit more, even that will shift the scales pretty significantly.
Dr. Loscalzo: I think it does that in humans as well. I just think that a lot of people have this perception, I’ve worked with people like this, where, “Oh, I’m going to go on this keto diet, it was recommended,” and they’re gaining weight on it. Then they look and go, “Oh, that bulletproof coffee you’re drinking in the morning is 600 calories,” and, oh, that’s in your fasting window. [crosstalk]
Ari: Yes, I’m fasting because I can have 600 calories of fat, but it still counts as fasting.
Dr. Loscalzo: Exactly. There’s misinformation. Of course, we all want to buy what we want to buy. We want to be able to eat whatever we want, whenever we want, in whatever quantity we want.
Ari: Then be baffled while we’re not losing fat.
Dr. Loscalzo: Exactly, and why we don’t feel good or why we’re tired or whatever- [crosstalk]
Ari: I reserve the right to say that I’m doing everything right and be baffled by why I’m not losing fat.
[laughter]
Dr. Loscalzo: Until we look at it more closely, and you or I would look at that and go, “Yes, you’re not exactly doing everything right.” There’s so much misinformation out there and I would say that businesses are preying on people’s desire for the quick fix, “Just give me a pill, I’ll take the pill and everything will be fine, and I can continue to go to McDonald’s and eat Dunkin Donuts and everything will be fine because there’s a pill for that.” The reality is there is no pill for that. There’s nothing that replaces doing the work. Dogs and animals in nature, they tend to just say lean because they’re moving, but they’re also just eating whatever nature has provided for them. Most dogs, like you said, your dog eats better than most humans do because you don’t feed them junk. People are like, “Oh, give the dog a treat.” They’re giving them some little grainy sweetened thing that’s has nothing to do with healthy dog.
My dog doesn’t get treats. My dog eats very similar to that. It’s meat and vegetables, basically, that’s with a little bit of salmon oil sprinkled on top for omega three. That’s what my dog eats. She’s in good shape. They will overeat if you give it to them. We don’t give the dog access to that. The only people food she gets, and she could overeat these, she loves cashews. She’ll hear us, getting into the cashew jar and she’s like, “Give me cashews.” People and domesticated animals will overeat and they will eat the wrong stuff. Then it changes the taste buds and it changes the whole hypothalamus and its ability to regulate appetite.
Ari: To that point and to the points you were making earlier, what makes us way more likely to overeat to the point of actually creating a chronic energy surplus and putting on excess body fat is it has to do massively with the quality of the food. If we eat a thousand calories of avocados and blueberries and lettuce and carrots and fish and chicken and things of that nature, or if we eat a thousand calories of donuts and cookies and cakes and process crap rich in combinations of flower and vegetable oils and processed fats and sugar, now those thousand calories act totally different in our system as far as our satiety and hunger levels are a concern, because those first thousand calories might be quite satiating and keep us full and energetic for a long period of time. The second thousand calories, you’re going to go through that like it’s nothing and then you’re going to be hungry for more. You have this tendency to then eat much– the total amount of calories that you will eat when you are eating that type of food is far greater.
Dr. Loscalzo: It’s far greater because he body’s waiting for the food. Where’s the food? You just fed me all these calories, but where are the nutrients? Our bodies are smart and they will put out more. We need more, we need more. Unfortunately, the more that tends to come in is more of the same instead of like a big plate of broccoli. It’s like, oh, I found that when my kids were little. I found that through my own experience. They were little like four and newborn.
You go from one thing to the next and I’d make myself a big meal and I’d sit down to eat it, but I think, “Why am I so hungry? I’m still so hungry. What is wrong with me?” Then I’d go find my plate of food is still sitting on their table and I’d be looking for what can I put in quickly to give me a bunch of calories so that I have the energy and I’d reach for, I don’t know, a piece of gluten-free bread or I’d reach for a bunch of nuts or other things like that.
I would still be hungry, hungry, hungry. I remember one day going, “I’m going to need broccoli right now. I have time. They’re occupied. I’m going to just make myself a big pot of broccoli and just eat it.” Bingo. Whatever it was. A hundred calories worth of broccoli gone, appetite gone. My body had the nutrients in addition to the calories or without the calories actually. We tend to eat calorie rich foods looking for satiation. We should be looking at nutrient dense foods for the satiation.
Then for people who have the problem, which I don’t have of, I just keep eating this nutrient dense food, but I keep losing weight. Then we say, we got to put some olive oil on that broccoli, add some extra calories so that you have some calories there. For the majority of us, we don’t have that problem. It’s a great way to lose weight is to eat very, very, very nutrient dense foods. Your body goes, “I’m full. I can’t eat anymore.”
Dietary quality
Ari: We’re getting into this dietary quality issue now. Let’s get into the controversial territory of the different dietary cults and where you land in this spectrum. I suspect, based on all the– I’m smiling because, obviously, I know your work to some extent and I can tell based on the way you’re talking about all of this whole topic that you’re not an extremist and you’re not very dogmatic about only one camp. Let me just ask, are you vegan? Are you with the vegans or are you with the carnivores?
Dr. Loscalzo: Well, I’m definitely not with the carnivores because they think plants are bad. A lot of vegans are loading up on empty calories. Wonder Bread is vegan, for the most part, I think it still is, but there’s a lot of unhealthy. There’s the junk food vegans and then carnivores at the other extreme. I personally follow a plant-based diet 100%. I haven’t been eaten animal products in 35 years. I’m still standing. Still have energy. Oh. In my sixties and could still run and jump and play. My brain is still on fire. That works for me.
Ari: Fire in a good way, just to clarify.
Dr. Loscalzo: I’m fire in a good way. Not fire inflammation.
Ari: Not with inflammation.
Dr. Loscalzo: Yes, exactly. On fire because it’s like every time I hear something, it makes the connections. Here’s the thing; I personally, my diet is more of a plant based keto type diet. I don’t do the carbs. I have a handful of blueberries here and there. I will occasionally have a bite of quinoa or whatever, but I mostly eat fats and vegetables. I eat lots of avocados and olives in coconut. I don’t eat a lot of oil because I think oils are not whole foods. I’m into whole foods.
People are like, “Oh, whole foods. What about the healthy oils?” I don’t think there are any healthy oils, but there’s times therapeutically that somebody needs the oils for the extra calories to deal with healing inflammation in their gut, whatever. My personal diet is lots and lots and lots and lots and lots and lots of vegetables, fermented foods, cashew, coconut, whatever, yogurts and lots of kim cheese. I just had a lunch. My lunch today was big bowl of kimchi with fermented– What did I have on there? Dicon and ginger with a whole bunch of sprouts.
Big bowl full of sprouts. Then I threw some tahini and avocado on top. That was my fat. That was so satiating. It was hours and hours and hours ago, it was very filling. That’s a typical meal. Typical day for me is lots of fermented foods, lots of sprouts and lots of greens and then as many of the colorful veggies as I can get my hands on. Then the fats, the whole food plant based type fats. I thought that I’m a purist and I don’t ever do oil, but I try not to do oil because it’s not a whole food and it’s got everything extracted. Why? My opinion, why use olive oil when you can eat olives and get way more nutrition from them?
Of course, you can’t put olives in the pan and then saute your vegetables in it, but you can do that with water. Anyway, that’s my personal diet. I work with people to find their ideal diet. I call it the food religions. Which of the food religions do you need to follow to some extent? I think that people are really– oh, they’re scared of food. They hear this doctor talk about no lectins and this other doctor talk about no oxalates and then this other one talk about low sulfates and these other people, and they go, “What’s left? Let’s just eat meat.”
Ari: Don’t forget now there’s people even demonizing things like sulforaphane and some of these, the actual phytochemicals that have hundreds or thousands of studies talking about anti-cancer, neuroprotective properties, all other beneficial properties; mitochondrial protective and properties that stimulate mitochondrial biogenesis as well. You’ve even got people out there demonizing those compounds.
Dr. Loscalzo: There are people going to demonize everything and fiber. Like we don’t need fiber. That’s the carnivore style. No, we don’t need– [crosstalk]
Ari: We’re in a weird era of what’s being demonized at this moment in time. I think a lot of people don’t have the historical context to realize that these are fads that come and go. That there is a marketing– The incentives from a marketing and business perspective are always incentivizing a person to take a novel perspective to come up with some new thing. Everybody’s got it wrong. All the other, the vegans, the low carb people, the keto people, the paleo people, “No, everybody got it wrong. Really, it’s this other way of doing it. Lectins, tomatoes and lentils are the things that are killing everybody.” “No, it’s broccoli and curcumin that’s killing everybody and you got to get rid of all those plants. The kale, the lettuce is out to get you.”
Dr. Loscalzo: I have people reading t-shirts demonizing kale on their T-shirts. I saw that on YouTube video. I’m like, “Okay.”
Ari: It’s circa 2016, ’17, ’18, there was nothing left for anybody to demonize. All the other food categories had been taken, except for vegetables. Vegetables was the one thing that everybody could agree on. [crosstalk]
Dr. Loscalzo: One thing that everybody could agree on, right?
Ari: Whether you were an omnivore and you eat eight tons of meat or you were hardcore vegan, everybody could agree that vegetables were healthy. There was one thing that everybody agreed upon. Now we’re in an era where everybody’s afraid of or lots of people have been taught to fear vegetables.
Dr. Loscalzo: I never used to have to. I’d teach and I would say and eat this way and try this and try that. Now, before the questions come up, say, and if you’re sensitive to oxalates you can eat these vegetables instead of these. By the way, if you’re sensitive to oxalates, it doesn’t mean that they’re a bad food. It means that your gut is messed up and you’ve got to fix the problem in your body so that you can handle all these things. I teach people like these are religions. What is the best religion? Is it Buddhas, isn’t it? Is it Christianity, Catholicism, Methodist, whatever? What is the right religion?
Ari: Oh, Ritamarie, everybody knows the best religion. No, I’m just kidding.
Dr. Loscalzo: I’m waiting. I’m waiting. There’s religion and food we’ve done the same thing. I call it the food religions. You don’t want to be dogmatic. There is no one-size-fits-all diet that works for everybody. I can tell you the things that everybody should avoid. I can tell you that all the processed foods that are ultra processed and they have hydrogenated oils and they have ingredients that you can’t read that don’t belong. They belong in a chemistry lab not in a food that are in a kitchen.
Those are things everybody should avoid. Things that have heavy metal contamination, things that are white that have all the nutrients stripped away from them. All of those things pretty much we can all mostly agree. Probably not all of us agree on that they’re going to hurt most people, except the people with those genes of steel and can do anything and they live forever, but that’s not most of us.
Quite frankly, I don’t know about you, but I think if I took that chance and I said, “Oh, I’m like that guy over there.” That’s Russian roulette with your life. I’m not going to play that game. I’m going to look at my family and say, “There’s no old people in my family.” I’m going to do something different than they did because my genetics are not going to play me out to live to 100 and still smoke and drink and eat crap.
Ari: Absolutely. I want to be respectful of your time. Do you have a hard cutoff right now or can you go a bit longer?
Dr. Loscalzo: I can go a bit longer.
Intermittent fasting for women
Ari: Okay, great. There’s been some discussion in recent years since intermittent fasting and since keto came on the scene and became very popular. There’s been some discussion of male and female differences in responses to those. Some people have said that women are less tolerant of some of the more strict intermittent fasting or time restricted feeding approaches. I’ve seen a lot of reports of women who are on keto diets for extended periods of time who maybe initially had great results and then six months a year into it start to experience lots of problems. What’s been your experience with keto and intermittent fasting in men versus women or in women specifically?
Dr. Loscalzo: Here’s the thing. Women throughout the lifespan have a cyclical nature to their hormones. Men generally don’t. We have luteal phase, we have the– My brain just went dead.
Ari: Follicular.
Dr. Loscalzo: We have the follicular phase, we have the luteal phase, and the bodies in different hormonal states: estrogen high, estrogen low, progesterone high low. During those phases, there is good research that says that women do not do well. Women do not do very well doing longer fast more than 12 hours even during the second half the luteal phase of the cycle or at least within a week of their menses starting.
We have to respect that. We know that there’s an effect of fasting in ketones on LH and FSH. We have to respect that. Women have to find that right groove. Women do better with cycling their fasting versus men can just go, “I’m going to do an 18 hour day fast and do this every day,” and it doesn’t matter as much, although men can plateau as well. I think women do have to be conscious of that. Once they’re past menopause, then it’s not the same considerations.
We are not having those fluctuations, unless you’re taken bioidenticals in which case it changes, but we really do I think need to respect that and be conscious of that. Anything you do initially when you go from standard American diet to anything, somewhat even reasonably resembling a healthy diet, you’re going to get results at the beginning. Then it tapers off and then you need to customize it to you. I think that we need to just take all of this that way. What is that right phase for you and not get into the dogma of got to do the 18 hours.
I’m starving, I’m gaining weight now, but it’s not working anymore but I’m going to keep doing the 18 hours because that’s what worked at the beginning. We need to just retake that in respect. I know that for me, I like to do 16 hours but there are days when I am not going to make it 16 hours. There’s just no way. I have too much to do. I have too much brain power. I didn’t get enough sleep last night. Those things all play in and like, “No, I’ve got to eat something.” Now some people do better with time restricted eating later versus earlier.
I know the popular thing is just skip breakfast and start eating later but some people don’t do well with that. Some people need to eat that first meal within an hour of getting up and then they finish eating at three in the afternoon. If I stop eating at three in the afternoon and I start in the morning, I’m going to be fighting the appetite. It doesn’t work well for me. It’s easier for me to just start eating later and then have a shorter window. We all have to find our little groove and tune into the body when it’s telling you something, like, “This used to work and now it’s not.”
“Suddenly, this broccoli is so good and I’m eating three pounds of it a day and now I’m getting gas when I eat it.” Maybe you exceeded your body’s need maybe at the beginning. When we first make a shift to a new or healthier diet, you can just see changes. Maybe at the beginning you were so depleted before that three pounds of broccoli a day was exactly what you needed and now three pounds of broccoli is too much for you. I believe that we need to tune in that the body is the experiment lab. There’s studies out there and we can look at those and we can use those as guidelines but the ultimate is how is it affecting us here in the body and go from there.
How to find the optimal carb to fat ratio for you
Ari: Do you have any guiding principles or thoughts on how you would recommend someone to find their optimal carb to fat ratio of their diet?
Dr. Loscalzo: It’s really play with it. I don’t measure, I don’t say, “Oh, I eat an 80% fat diet today and 80 to 60% fat diet.” It’s really a matter of how does it affect? You start with something. You just start with, “I’m going to eat a meal that has very little carbonated. I’m going to eat protein and vegetables. That’s going to be my meal.” Then you do that and you go, “Let me see how the carb fits in with that. Let me see how this,” and you experiment. If you have a continuous glucose meter, I’m a big fan of those.
If you have a continuous glucose meter or your finger pricking, you can tell, but you can also tell by how do I feel? How’s my energy? How’s my brain function? How’s my gut function and it’s really tuning in. At first you make the changes. I always recommend people start and go slow. If you’re eating Cheerios for breakfast and sandwiches for lunch and pasta for dinner, you don’t just go and suddenly take it all away and go on vegetables and protein because it’s an adjustment. It’s an adjustment, but you can slowly pull the things out and add other things in and just find that groove. I teach a program I call it the fasting while feasting. It’s based on the studies that Dr. Valter Longo did on– [crosstalk]
Ari: It sounds very confusing.
Dr. Loscalzo: What? Fasting while feasting?
Ari: It sounds very confusing, this program.
Dr. Loscalzo: You get to have the benefits of fasting while you’re feasting. It’s very, very straightforward. I don’t know how I came up with the name of it but it came up with the name of it as I was talking to people I go, “I don’t feel like I’m fasting I feel like I’m feasting but I’m getting all the benefits. I’m in ketosis, et cetera.” That’s why we call it fasting while feasting. Basically, you’re eating within those ranges that he found in his studies but it’s real food. You’re eating real food and I map it out. You can do two meals a day or three and most people say, “I can’t eat all that food,” because it’s really nutrient dense food. By day four or five, they’re in major ketosis like three or four on their blood keto meter. Their blood sugars have dropped dramatically and they’re losing weight. You do this like once a month. You just do this five days of fasting while feasting, you get your body into this mode of fasting, and then it can get into that mode more quickly and you can get the healing properties of fasting without having to actually fast.
Ari: I love it. Final question, you’ve gone into a lot of great stuff so far in this in this conversation. I’m wondering if you could maybe give your top three most important strategies for addressing insulin resistance and getting blood sugar levels under control.
Dr. Loscalzo: Eat real food. Is that couch?
Ari: Yes, absolutely. Absolutely.
Dr. Loscalzo: Eat real food. Just don’t worry too much at the start of the carb-fat protein ratio, just everything you eat is real. It’s real food. That’s number one. Number two is get into bed. Don’t play with your health that way. There’s so many dangerous things that happen when you don’t get enough sleep and insulin resistance is one of them. Even one night of bad sleep cause temporary insulin resistance the next day. I just read a study recently, I don’t remember exactly who did the study, but it was from the book Why We Sleep by Matthew Walker. It was talking about how even a week of consecutive six hours or less of sleep puts somebody into the pre-diabetes numbers.
When you start to test them, they’re going to look like they’re pre-diabetic, even if they weren’t to start. It’s super critical. I would say eat real food, get real sleep, and the third one is I would say stay present and be mindful and have a mindfulness practice, whether it’s meditation HeartMath, something because there’s so much benefits to that. I have literally seen people test their fast their glucose, not their fasting glucose, just middle of the day glucose found what the number to be higher than they thought it should be, gone in and done some HeartMath or meditation or breathing, and boom, it drops down by 2030 points all at once. Really dramatic. Those are my top three.
Ari: Beautiful, beautiful. Thank you so much, Ritamarie. This has been an absolute pleasure to have this conversation with you. I’ve really enjoyed it. I hope to have you back. I know you have a lot more wisdom to share, and let people know where they can find you.
Dr. Loscalzo: Absolutely. I’m at drritamarie.com. For those of you who are health practitioners, we have a new website coming up probably by the time this airs, it’ll be up. It’s INE Method, inemethod.com and it’s for health practitioners. I’m on Instagram and Facebook and all those places at Dr. Rita Murray, Dr. Ritamarie.
Ari: Beautiful. Thanks so much, my friend. I look forward to our next conversation.
Dr. Loscalzo: Thank you so much. Appreciate it.
Show Notes
Is insulin resistance the most prevalent metabolic dysfunctions in today’s world (01:16)
The primary causes of insulin resistance (06:10)
The fatty acids and metabolism link (12:00)
How caloric excess affects your health (18:12)
Common signs and symptoms of blood sugar issues and insulin resistance (23:23)
The benefits of insulin-sensitizing agents (27:43)
The link between body fat and insulin resistance (29:23)
The DIETFITS Study and calories (32:00)
Dietary quality (44:32)
Intermittent fasting for women (53:09)
How to find the optimal carb to fat ratio for you (57:03)
Links
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