My Notes From the Functional Health Summit
An Interview with Dr. Ritamarie Loscalzo
The Hidden Dangers in Your Belly Fat: How to Correct the Hormone Imbalances that Are Putting You at Risk.
What I find because of the diets we see the processed foods that people eat it’s a fast food nation of grabbing and eating on the run. Even if it’s good food were grabbing and eating on the run and this creates imbalances in the body. I think it starts with this fundamental flawed approach to eating, it throws things off and puts a strain on our body to keep our blood sugar balanced. It’s critical to keep our blood sugar balanced so that all the systems in the body get a proper supply of sugar, of nutrition to keep them running. Blood sugar imbalances are rampant, I see insulin resistance and pre-insulin resistance not generally recognized by the conventional medical community and just starting to make it to the functional medicine realm. It’s before we get to the state where our blood tests say we have insulin resistance. Insulin is this critical hormone that keeps your blood sugar nice and steady and that keeps a steady flow of fuel into your brain cells, your muscle cells, liver cells, digestive system cells that keeps them flowing and doing their thing. Once the sugar goes from the blood into the cells then the mitochondria take over and turn them into energy assuming we have the right nutrition and mechanism going on there. If we don’t get the sugar into the cells it doesn’t matter how well the mitochondria are working were going to be tired, brain fog and accumulate belly fat and fat in other areas because the sugar can’t get into the cells and be used as fuel and just gets stored as fat. The common complaints that we hear from day to day is I eat OK, I’m not eating too many calories but I’m still accumulating weight as I age, I’m more tired, my brain is not functioning as well as it should.
I like to start there helping people get their blood sugar balanced more so than just those day to day nuisance complaints. Imbalances of blood sugar we know the end result of that could be diabetes and a lot of complications with that so it’s more than just a nuisance or cosmetic. With the build up of extra fat it’s really a dangerous situation when we allow the blood sugar to get out of control. I find that most people I see have some sort of blood sugar imbalance that may not be picked up on the standard routine blood test but it’s there nonetheless and it’s impacting their function.
Insulin resistance is the state where we have plenty of sugar in the blood and we have plenty of insulin but the insulin is no longer able to take in the sugar and take it into the cells and that’s because the cells have developed what’s known as insulin resistance. It could be that there is damage to those receptors it could be that’s it’s been flooded for so long with sugar because of the highly processed diet, the highly processed starches, sugars and fruit juices and other things. They can get tired and damaged by excess insulin and they shut down. In medicine it’s usually recognized if the blood sugar is above 100 or below 120 that’s the threshold, I’m saying the fasting blood sugar when you first get up in the morning. Anything below 100 is not considered insulin resistance and by some doctors that’s considered normal except in functional medicine we know that when it’s getting close to 100 it’s not normal anymore it’s a warning sign. It’s actually more than a warning sign people are at risk when the blood sugar is between 90 and 100 and were finding more and more studies to support that.
In medicine insulin resistance is considered between 100 and 120, your fasting blood sugar, every doctor measures that on a routine blood analyses it goes above 120 it’s diabetes. What they don’t tell people is if those numbers are in that range you have been hiding a problem for a very long time. Diabetes doesn’t start one day and your blood sugar doesn’t go from 119 to 121 and your officially diabetic that’s been a process that’s been happening. What happens in that stage below the 90 to 100 range people can be in that range for a long time. Even if their fasting range is completely normal in the 70s or 80s they can be showing signs of insulin resistance because what’s not measured on a routine test is what does your body do in response to food. If you take in a donut for example we would expect that the sugar goes up high but with somebody with normal glucose and balance it won’t. Over time it will because your exhausting the system and taxing the system but in a perfectly normal system they can eat pure sugar and the sugar doesn’t go up above 110. We know this from glucose tolerance tests where you go to the doctors office and pay them a whole lot of money to feed you this sugar syrup and you sit there for 6 hours while they poke you every half hour and test your blood to see what your sugar levels are doing. A lot of people have gone through that and it can be miserable, people who have good balance can eat pure sugar and it doesn’t change. If you want to see if your in that pre-insulin resistance state you look at what’s happening in that 2-6 hour period immediately after you eat something up to 6 hours.
I actually have my patients and people that take my group coaching programs buy a glucose meter similar to what diabetics have and we have them test it. Where a lot of people are resistant at first once they see it and start to feel empowered about making food choices based on how their bodies reacting, people absolutely love it and the results are phenomenal. We see people test their blood sugar and let’s say they have a perfectly normal range of 80 and they eat a meal and within 15 minutes the sugar goes up to 110 and within 30 minutes it goes up to 130 and after 40 minutes it goes up to 150, if it comes back down after 2 hours to the 100 range their considered perfectly normal but their not because their range has gotten way too high. In that period when that blood sugar was going up way too high 120 – 140 damage is happening in the body that’s similar to the long term damage that we see in diabetics like peripheral neuropathy. Damage in the nerves that goes down to the fingers and the toes and retinopathy which is damage to the retina. Study after study that as soon as that blood sugar goes up above 120 there’s damage that’s happening and the longer it stays above 120 there’s more and more damage to the peripheral nerves and the retina. People are putting themselves at risk even though their blood tests look normal because their insulin is out of control. This is why when people get diagnosed with diabetes and all of a sudden within 5 years they get diagnosed with these problems it’s because it’s been going on for years. If we can empower people to start testing their own blood glucose we can empower them to alter the course and prevent that progression to diabetes because then were catching it decades before conventional approaches would pick it up. We are looking at the functional change and their bodies ability resiliently to control blood sugar within a certain range.
They are showing these signs this belly fat won’t go away and this exercise isn’t helping I keep accumulating this belly fat it’s often because of those surges in sugar. The insulin is being impotent in being able to lower the sugar and we have prolonged periods of elevated sugar which causes a lot of the nerve damage. Prolonged periods of elevated insulin because it’s trying really hard the pancreas goes more and more, it just keeps putting out more insulin and the insulin starts doing damage to the vascular system. A lot of tissues will protect themselves so they become insulin resistant to protect themselves from the damage of insulin the muscle tissue, liver tissue they all become resistant, the liver not as much as other places. The endothelium the lining of the blood vessels they will become resistant to insulin they stop the damage from excess insulin which is stiffening, lack of elasticity and that contributes to high blood pressure. That contributes to the risk of heart attack and stroke because you have a buildup of plaque and an inelastic vascular system that can’t expand and contract based on the need for more blood flow.
Glycation end products AGE are from the sugar itself we can measure this with a hemoglobin A1C and that measures the glycation of the red blood cells, basically how sugar coated are your red blood cells. When they get sugar coated we have this combination of effects where the red blood cells get stiff and brittle, they can have these little spikey ends that can damage the endothelium lining of the blood cells. In addition we have this lack of elasticity in the lining based of the levels of insulin so it’s a double whammy with the high sugar and the high insulin. It causes a twofold effect where both can accelerate the risk of cardiovascular disease.
With belly fat what’s happening is the sugar is accumulating and the pancreas is putting out more and more insulin but it’s ineffective and the critical cells become resistant, the muscles and the organs but the fat doesn’t become resistant. Once the sugar is elevated for a long enough period of time and it’s not going into the cells to be utilized, just as if you ate way to much sugar more than you needed and you burn it, instead it gets stored away as fat and the most common area to store it is the belly. People always want to blame people who are overweight that they just eat too much, I find they are not eating much at all. Their not eating an excessive amount of calories but because of the insulin resistance and because of the macronutrient balance of those calories, the excessive carbs to protein to fat, they may end up with this problem and their eating just barely enough to maintain. Some of these people are eating 1200 calories a day and their gaining weight and their exhausted all the time because of the calories that their eating not being used for energy their getting stored as fat. That’s a problem their exhausted, their brain gets foggy, they get accumulation of belly fat and it’s like this no win situation. Their starving even though their eating because nothing is getting into their cells, not nothing but just a small percentage.
We are finding now that there are several areas of the brain that becomes insulin resistant and now your not fueling your brain which is the control center for everything. It’s a domino effect of what can fall apart, addition to that foggy, can’t think straight, unmotivated kind of feeling. They are even talking Alzheimer’s as insulin resistance of the brain and termed type 3 diabetes. The diet and the stress levels that contributes to this, there’s a damage that happens to the hippocampus from the stress of real life and the circulating blood sugars and the cortisol levels go up. In addition there’s leptin resistance that develops as a result of the insulin resistance and other factors. The hypothalamus is supposed to detect the level of leptin which controls appetite and it gets resistant to the leptin which damages the effects that the hypothalamus has on maintaining clarity. It’s a domino effect and the neurotransmitters suffer because the brains not getting tissue and the neurotransmitter can’t fire, the synapsis can’t fire appropriately. The stress inhibits cortical function, high level cortical function because it thinks it’s a flight situation activating the primitive brain, the limbic systems, and turns off the high level function which we need to solve these problems that are causing the stress in the first place. We need to stop and focus on the appropriate response to the problem.
One of the things we need to do is to be able to manage our state, to be able to manage which part of the autonomic nervous system which is the automatic nervous system where we respond automatically without thinking. This controls heart rate and respiration there are two major branches there the parasympathetic and the sympathetic. The sympathetic is what we need when were running away from tigers it mobilizes and gets all of our resources running, it helps elevate the blood sugars. That’s another piece even if were eating a pristine diet but were stressed out all the time we can wind up with insulin resistance because high levels of stress hormones cause us to breakdown protein tissue in the body and turn it into sugar so we can run away from the tiger. I like to get people to move from the sympathetic state to the parasympathetic state which is where the healing, growth and repair happens, this is where you are if your meditating or calm. That puts you in the parasympathetic state which is where you can actually start to heal this.
One of the first things I teach people is a process in heart map it’s called quick coherence, I like to call it my mini vacation. I go to the beach when I’m feeling that way to recreate that mini feeling of ease and joy for others it might be the mountains. That recreates the chemistry and puts you in the parasympathetic state, once you practice enough you can shift yourself from sympathetic to parasympathetic state with just breath, it’s miraculous and doesn’t take a lot of work. It’s not like meditation where it takes thirty minutes, it’s awesome but what do you do the other 23 hours of the day. With breath you can intersperse it with everything you do, you can do it every thirty minutes or every hour whenever you need to, you can consciously shift from a destructive state to calm. Another thing with the heart map when your feeling that stress coming on and your sitting at your desk is to stop take a few breaths and do some exercise, you have all this sugar in your body, the extra blood pressure, your heart rates elevated, your breathing is elevated do some exercise to get rid of that. Stand up and do some squats, if there is a staircase nearby run up and down the stairs. Short bursts of energy can mobilize your system to start burning that sugar instead of storing it this will go a long way. The one technique is to help you not get in that state or to shift you out of that state quickly, the other is once you’ve gotten into that state to help you mitigate the damage. Those are two things that are non food related, of course food and nutrition is a huge piece of it.
Food varies from person to person depending on their state problem foods for some could be fresh fruit, not that it caused them to get there but when their in that state where it’s out of balance, that’s not the typical for most. The obvious is sugar, fruit juice, toast, gluten, for some it will be whole grains, brown rice or flour products. I have a set of guidelines for people for safe foods they are your fresh whole non starchy vegetables, green leafy vegetables, brassica vegetables, sea vegetables. For some nuts and seeds usually like coconut, avocado, almonds, as long as their fresh not roasted and salted and preferably soaked and germinated so their easier to digest by the body. Grains are not that great for most people, some people do great with quinoa or lentils but beyond that some of the legumes can make it go up depending on how far along the person is. I like to take people through a 30 day metabolic reset where they keep their food intake down with the foods that keep their blood sugar down to 110 or below. If somebody starts out diabetic we have to adjust for that but the average person not diagnosed with diabetes who may have a marginally elevated blood glucose or normal your allowed to eat anything that keeps your blood sugar in this range as long as it’s not hydrogenated fats, oxidized fats or processed foods. There are certain no’s but we find what’s best for the patient, I try to empower people to be able to tell for themselves.
People not willing to test with the finger prick I have them do the standard blood chemistry and look at not just their glucose but the hemoglobin A1C or their fructosamine which will give us that degree of glycation. It’s normal to have 5% of your blood cells sugar coated 4 1/2% or less might actually be having too low a blood sugar from time to time and that’s really rare. The norm where medicine looks at you might be going into insulin resistance is somewhere around 5.7 but what that means is your average blood glucose is somewhere around 120 and that’s too high and your getting some of those spikes that raise the risk of the retinopathies and neuropathies. You really want to keep the average under 110 after meals and my patients are very successful at it and the results are pretty amazing I have seen 11 inches of shift in their body in a month or 25-30 pounds, one woman lost about 75 pounds in 4 months. She went back to her regular doctor and her Hashimoto’s was gone and she no longer had to take hydrocortizone for her pituitary and off her blood pressure medication all in 4 months. It’s more than just the diet it’s those short bursts of exercise and sleep is very important. Insulin resistance is triggered by lack of sleep that’s also a big piece, and the stress with the heart map, we also look at the timing of their meals. Not eating too close to bedtime, not skipping breakfast, not having too much carbs in the morning that can throw you off for the rest of the day. There’s a lot of little things that’s why we teach a program for that.
If someone doesn’t respond we will do nutrient testing but chromium is critical so I put everyone on that right from the start and magnesium is another one. We look at their fatty acids, especially DHEA has been found to be very important for the whole insulin resistance cycle. I look at what nutrients they need and we have a whole list after their doing things for about 2 weeks we might add some other things like lipoic acid, berberine it’s been shown in studies it works better than metformin for keeping blood sugar down. There’s a lot of nutritional pieces we go into when I work with people in my 10 week program. The testing is expensive and a lot of times you don’t have to do it, the amazing magic that chromium does for people is pretty dramatic.
When the blood sugar goes way up suddenly the insulin kicks into gear and then stores all that sugar back as body fat sometimes the sugar levels go way back down and we have something called reactive hypoglycemia. In a normal healthy person the blood sugar is going to go up and down, it goes below and the body triggers a release from the pancreas of a hormone called glucagon and it brings it back up and then insulin brings it back down. There’s a balancing act going on and we don’t even notice it. When those mechanisms get broken they get overtaxed that balancing doesn’t happen, so the blood sugar goes down or it goes down really rapidly or you get a huge influx of sugar and the insulin rips it down stores it as fat and the blood sugar goes way down that’s perceived by the body as major stress. When the blood sugar gets too low the system says it’s ok the glucagon is not doing it’s job let’s call in the big guns let’s call in the cortisol and the cortisol will bring the sugar back up. The cortisol gets released from the adrenal it’s the major adrenal hormone other than adrenalin which is that quick burst cortisol it’s more that long term stress management. Cortisol comes in and it raises that blood sugar and sometimes it overshoots the mark and we have insulin again coming in to try to bring it down and the cortisol again to bring it up, we have this up and down up and down and it’s creating a stress on the adrenal. There’s a lot of damage that this extra cortisol can cause, all the wonderful things that cortisol is supposed to do in situations of stress is now detrimental when your in non critical stress, nonphysical outside stress like this. We cause the adrenals to burn out after a time because they just can’t do it anymore they just can’t create any cortisol anymore. A lot of times it’s also a lack of nutrition because of this up and down they don’t have enough C and B vitamins, zinc and magnesium and some of the other core nutrients that are critical for adrenal function.
We have the blood sugar feeding into the adrenal stress the adrenal stress feeding into the blood sugar and then we have all those external factors like the diet. It could be gut inflammation, an infection somewhere, there’s all these stressors that come in and create a viscous cycle and we wind up with accumulation of belly fat, brain fog and damage to the vessels that increase the risk of cardiovascular disease and cancer. People don’t think about blood sugar imbalance and cancer but it creates an increase of cytokines and other inflammatory markers that are very damaging and can increase the CRP, the C-reactive protein which can increase the risk of cardiovascular disease and cancer. This is a viscous cycle that we can break by looking at what is stressing out the system, what are the dietary and environmental stressors, what are the lifestyle and emotional stressors, what are the internal stressors like infections and things like that. When we look at controlling the stressors everything starts working normally again. It’s easier said than done, sometimes it takes working with people on a baby step approach making little changes. Sometimes we do a metabolic reset it’s what we do with the blood sugar balancing program or doing some adrenal stress testing and really effecting in helping the body be more balanced in the output from the adrenals. Or doing both of those together and we can’t leave out digestion because it’s critical for everything and sleep there’s so many factors here. We used to get 9 hours of sleep and now 80% of people get under 6 hours of sleep it’s crazy and when we don’t sleep we don’t repair, even one night of poor sleep can contribute to temporary insulin resistance. It’s only temporary when it’s one night occasionally of lack of sleep but long term insulin resistance when it’s consistent.
The first thing you should do is focus on eating real food that’s not from a package, can or jar, and spending time throughout the day to just stop, breath and appreciate, find things to appreciate. We spend too much time focusing on things that are not right, when you stop, breath and find things to appreciate it shifts the biochemistry. It also helps us make better choices because were not operating from being stressed and you can make choices from a feeling of power instead of feeling bad give me some Cheetos.
Dr. Ritamarie web page drritamarie.com
Her page for tons of information on the adrenals adrenalrecharge.com
Her page for tons of information on blood sugar byebyeb4.com
M.Scherker medical researcher
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