Ep. 181 – Insulin Resistance, Explained with Dr. Morgan Nolte

I am delighted to have Dr. Morgan Nolte joining me today! Dr. Morgan is a passionate board-certified clinical specialist in geriatric physical therapy. She is the founder of Weight Loss for Health, an online course, community, and coaching program to help women in c and postmenopause reduce insulin resistance for sustainable weight loss and disease prevention.

Dr. Morgan is dedicated to helping women feel empowered, confident, and in control of their health. She teaches women how food, fasting, stress, sleep, exercise, and mindset all play a role in reducing insulin resistance.

The key to maintaining long-term weight loss and health is living a low insulin lifestyle. That requires unlearning old weight loss beliefs and overcoming self-limiting thoughts. Thoughts determine emotions. Emotions determine actions. Actions determine results.

In this episode, we dive into maintaining weight loss, the role of insulin in the body, understanding macros, overcoming insulin resistance, and keeping your brain healthy after mid-life. Dr. Morgan also shares some actionable tips for overcoming limiting beliefs and maintaining weight loss. Stay tuned to learn what Dr. Morgan has to share in our interesting and informative conversation today!

“The more insulin sensitive we are, the healthier we are.”

Dr. Morgan Nolte

IN THIS EPISODE YOU WILL LEARN:

• Dr. Morgan unpacks the false dogmatic dieting principles with which many women struggle.
• Why do we need to change from the caloric model of obesity to the insulin model?
• What we need to understand about macros.
• Which macros are the most satiating?
• Why do you need to forget about the food groups?
• Lifestyle changes can help reverse insulin resistance.
• Some key roles insulin plays in the body.
• What happens in the body when cells cannot communicate with the insulin hormone?
• The benefits of a low-carb diet and intermittent fasting.
• Why it is vital to get enough sleep.
• How stress causes weight gain.
• What will happen to you if you fail to manage your blood sugar dysregulation?
• What women in their forties and fifties need to do to maintain their brain health.
• Understanding the limiting beliefs that could impact weight loss and some tips for overcoming those beliefs.
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Connect with Dr. Morgan Nolte

On her website

On Instagram and YouTube

Reshape Your Health Podcast

Books mentioned:

The Big Fat Surprise by Nina Teicholz

The Obesity Code by Jason Fung

Why We Get Sick by Benjamin Bikman

The XX Brain by Dr. Lisa Mosconi

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website
• Check Out Dry Farm Wines: www.dryfarmwines.com/cynthiathurlow

About Everyday Wellness Podcast

Welcome to the Everyday Wellness podcast with Cynthia Thurlow! Cynthia is a mom of 2 boys, wife, nurse practitioner, and intermittent fasting and nutrition expert. She has over 20 years experience in emergency medicine and cardiology, but pivoted to focus on food as medicine. She loves to share science-backed practical information to improve your overall well being and is grateful to be interviewing leaders in the health and wellness field.  Her goal with Everyday Wellness is to help her listeners make simple changes to their everyday lives that will result in improved overall wellness and long term health.

Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health and wellness goals and provide practical strategies that you can use in your real life. And now here’s your host Nurse Practitioner Cynthia Thurlow.

Cynthia: Today, I’m delighted to have Dr. Morgan Nolte, who is a passionate board-certified clinical specialist and geriatric physical therapy. She’s the founder of Weight Loss for Health, an online course community and coaching program to help women in perimenopause and post menopause, reduce insulin resistance for sustainable weight loss and disease prevention. She’s dedicated to helping women feel empowered, confident, and in control of their health. She teaches women how food, fasting, stress, sleep, exercise and mindset all play a role in reducing insulin resistance. Welcome, Morgan. It’s so good to connect with you.

Dr. Morgan: Thank you, Cynthia. Always nice to connect with you, too.

Cynthia: Yeah, and so, as I was kind of thinking about our conversation this morning, the thing that really stood out is the amount of diet dogma, nutrition dogma that is really worked against us in many ways. Not only as clinicians because we’re both trained, licensed clinicians but what we learned in school, and what we very likely taught our patients in the beginning of our career is largely just proven and actually wrong. So, let’s unpack diet dogma. What are some of the dogmatic principles that you feel like women struggle with the most?

Dr. Morgan: Okay. Well, I think the first one is calories, obviously. I think that we have an obsession with calories and depending on which “diet” women go on, that can be translated as points. So, that’s the first thing that we have to overcome is that, weight loss is not about lowering your calories. It’s really about lowering your insulin. You can lose weight by cutting calories, but you’re going to be hard pressed to keep it off. I think that’s really where a lot of women, where the rubber hits the road is they’re like, “Well, I can lose weight but I can’t keep it off.” So, calories is number one and we can dig in as much of the sciences you want behind this.

The second is eating fat. I grew up in the 90s, and we had regular Cheez-Its and low-fat Cheez-Its, regular everything and low fat everything. We have become afraid of eating fat, and that again stems from the caloric model of obesity. Because compared to protein and carbohydrates, fat has more calories per gram. So, we thought, “Well, if the goal is to eat low calorie, you can eat less fat and more food overall.” But it’s just false, because you’re not looking at how your body actually works. So, that’s the second thing. This is a broad stroke overview, here is that eating fat will make you fat. It’s not true.

The third thing is that, if you’re full, you won’t lose weight. This is a tricky one because it took me a while of coaching before I realized I said, “I’m recommending that you eat these many calories, these many macros, and you’re consistently under eating by about half, why are we doing that?” She had followed these Intuitive Eating principles. “Eat when you’re hungry, stop before your full.” I said, that is a load of garbage. Because if you are overweight or obese like over seven out of 10, almost eight out of 10 Americans are, I believe 85% of adults are insulin resistant. Your satiety and hunger hormones are messed up. So, if you’re trying to lose weight with Intuitive Eating principles and you’re finding that it’s not successful, it’s because your strategy doesn’t match the problem. So, that’s another thing is, you trying to rely on Intuitive Eating alone. So, that’s not going to fix this root cause problem of too much insulin. So, essentially, she was afraid to feel full and she’d say, “I had the chicken, and I had the stuff, and I just felt really full.” I said, “Good, you should feel full, you should fuel your body.” But in her mind, that was a limiting thought and so we have to get over those types of things.

Another one, mini meals, five to six, seven times a day of eating because that keeps your metabolism up. When you get to the science of, how does your metabolism actually work? That’s called the thermogenic effect of food. You do burn a little bit of calories with digesting food. However, losing weight is not about calories. It’s about insulin. Eating five to six times a day while perhaps you might have a greater thermogenic effect of food, it doesn’t matter because you’re spiking, you’re raising your insulin multiple times a day.

Another thing when we go back to the fat, I think, as I’m a geriatric physical therapist and I’m much more geared towards the health benefits, the long-term health benefits and weight loss, and one another false dogma would be that high LDL cholesterol, high total cholesterol in and of itself caused heart disease. So, we know that eating high fatty foods, saturated fat specifically raises cholesterol. So, that’s one of the reasons where everywhere you look online, the American Heart Association, the NIH, all these major players who we think are credible, they say eat a diet low in saturated fat because it raises cholesterol and cholesterol causes heart disease. Well, that was a false premise and you had Nina Teicholz and I recently had her on my podcast as well. Her book, The Big Fat Surprise, that’ll give you the lowdown on the fat-cholesterol link there. I think that that’s another false dogma that women have to get over. If they want to lose weight and keep it off is, I can eat fat, my cholesterol can go up, that is okay. That does not mean that I’m unhealthy, that does not mean that I need a statin. Actually, statins raise insulin resistance, so, you’re compounding one problem on another.

I think that another big diet dogma when we’re talking about calories, because pretty much all of these stems from the caloric model of obesity and we need to change that to the insulin model of obesity. But that’s the ‘cardio is king.’ If you’re wearing– If you have an Apple watch or a Fitbit, it’s not counting– it’s counting your steps, it’s counting your calories. So, we were led to believe if I eat 250 calories less a day and I burn 250 calories more a day, I’ll have a 500 calorie a day deficit. That’s 3,500 calories a week. That’s one pound of fat a week, I’ll lose one pound. It doesn’t work. It does not work. So, when we’re talking about insulin resistance, we have to also question exercise in and of itself as a tool for weight loss.

Dr. Fung, I am a huge fan of his work, and I love the code and I think it’s The Obesity Code book. He said that, “Exercise is good for us and we should do it every day just like brushing our teeth, but don’t expect to lose weight.” That’s the truth. So, when we’re talking about the caloric model of obesity, cardio was king because you could burn more calories. When we’re talking about the insulin model of obesity, it’s completely different. Really strength training is key and I like to use walking or stretching as a way to lower cortisol, lower stress, which will help reduce insulin. So, those are some of the major diet dogmas. They all pretty much stem from the incorrect caloric model of obesity. I hope that answered that question pretty well.

Cynthia: No, you did a beautiful job. I think for a lot of women, they fervently embrace the calorie model. Even when I’m teaching fasting, either in a one-on-one capacity or in a group, 99.9% of time, the first couple of days they were like, “How many calories should I eat?” If I tell someone that as a middle-aged woman, I never count my calories. Even though, my goofy very tech savvy scale likes to tell me because of my age and the muscle mass and the water weight, this is how many calories I should eat, I pay zero attention to calories largely because most of what I eat is unprocessed, lot of animal-based protein, a lot of vegetables, a lot of non-starchy vegetables. But when we’re talking about what our body recognizes, so let’s unpack. You touched on the macros piece. I think this is really, really important for people to understand and to hear that certain macronutrients, like protein are the most satiating. So, when we talk about Intuitive Eating and how some people really don’t have the hormonal communication working properly in their bodies, protein is definitely one of those things you want to aim for the protein piece, and then layer in the rest.

I remind people that a lot of women as one example are really attracted to ketogenic diets because their father, their brother, their husband, their best friend lost a bunch of weight and most people, and we can unpack this as well, overconsume their healthy fats and I always say too much of any one thing is not beneficial. So, let’s focus on the macros as it pertains to what’s most satiating because I think if you’ve been following a lot of the nutritional advice given out by most healthcare providers, my goodness, by the American Heart Association, American Cancer Society, they’re still very pro-grain carbohydrate focused, and that– I always love sharing this and certainly you live in middle America, so you can definitely speak to this. Farmers give their cattle, prior to slaughter, they give them grains because it fattens them up and it raises their insulin level. So, you know really unpacking the fact that, if you are listening to most governmental guidelines, the food guide pyramid is kind of made way from my plate, it is very focused on carbs. Most of us if not all of us should be eating a whole heck of a lot less.

Dr. Morgan: Yes. So, I think what’s important when it comes to macronutrients is to understand that that’s the fuel that your body uses. You never go get your blood checked for calories, right? You can’t get a CBC and get a calorie reading. You can get a CBC with glucose, and insulin, and HDL, all these things. So, that’s one thing that I wanted to dovetail on the caloric conversation is, they’re just a unit of measurement, and they mean nothing to your body. So, I like to think of macronutrients as the big umbrella. I talk with my hands. I don’t know if this is going on YouTube but if it is, here we go. So, I talk with my hands. Umbrella is macronutrients, the major nutrients that we need. There’re three main kinds. There are carbohydrates, there are proteins, and there are fats. So, what’s important to recognize is that each of those categories will affect insulin differently. Under those categories, there are subcategories. So, I’m keeping this broad stroke. Under carbohydrates– because I can get in the weeds.

Under carbohydrates, we have starches, we have sugars, and we have fiber. There are subcategories, I’m not going into those today. It’s too weedy. [laughs] So, when we’re talking about what spikes insulin, what spikes glucose, that’s going to be your starches and your sugars. When we’re eating foods that have a lot of starch or sugar, such as pasta, bread, potatoes, white rice, those kinds of things, that’s going to be the most insulin spiking foods that we can eat. Fiber has a negative effect on insulin. That’s why when we eat “whole grains,” those are going to be a little bit better for us, but still pretty unnecessary in our diet as a whole. Like you said with the protein, we have to focus on protein. Geriatric PT, I see firsthand the effects of sarcopenia or muscle wasting as we age. I know that there are two components, a little bit more than this, but two build healthy muscle and maintain it as we age. Adequate protein including the dose and the timing and strength training. When we’re talking about how does protein impact insulin, it’s a moderate effect. But it’s not directly through blood sugar, it’s actually through hormones in your gut. So, that’s what causes the insulin release to protein.

Then the last is fat and I think it’s very important to understand here. There are healthy kinds of fat and there are unhealthy kinds of fat. The trans fats and the processed poly omega-6 fatty acids, did I say that right? [crosstalk] I think I did.

Cynthia: Yeah, the PUFAs, yep.

Dr. Morgan: The PUFAs, yeah, I say them PUFAs. Those processed omega-6 fatty acids like corn oil, soybean oil, cottonseed oil, all of those ones, those are going to be inflammatory. We get too many of those in a processed diet. So, trans fats, and then the PUFAs, the processed– those ones we want to reduce. Omega-3 fatty acids, saturated fats, omega-9 fatty acids, and unprocessed omega-6 fatty acids, all of those I consider the healthy kinds of fats. However, your body cannot make protein from carbohydrates or fats. We have to prioritize protein if we want to build and maintain healthy muscle mass as we age and here’s the deal when we’re talking about insulin resistance, you become more insulin sensitive when you have more insulin receptors to receive that insulin. How do we do that? Well, you can build your muscle mass. Muscle is a huge deposit for glucose. We store a lot of glycogen in our liver and our muscles. So, the more muscle mass we have, quite frankly, the more food that we can eat. The more insulin sensitive we are, the healthier that we are. So, that’s why in any meal, I recommend prioritizing protein. I aim for the high end. If people want to know, I do one gram per ideal pound of bodyweight per day. I think, you’re in line with that and Dr. Lyons is in line with that. It’s a little high, but I like to aim high and if you miss by a little bit, that’s fine at least you’re getting it.

The other important thing is dopes and that’s what a lot of people don’t recognize is, for adults, you need at least 25 to 30 grams of high-quality protein at a time for optimal muscle protein synthesis. That means building muscle. While protein does cause a moderate insulin response it’s okay because it improves insulin sensitivity down the road to help maintain that muscle mass. Now, when we’re talking about fat as a macronutrient, that’s going to have the lowest insulin response. So, if you’re eating things like olive oil, avocado oil, nuts, those do not have a very high insulin impact and that’s why people go on the ketogenic diet and they see a lot of fat loss, because they’re eating so much fat, they’re keeping insulin low. But I think where they get in trouble here is they have that black and white mindset that all or nothing mindset, which is another diet dogma that we can talk about and they can sustain it. So, when we’re talking about macros, that’s the big overview. You really want to prioritize protein, fill in the gap with healthy fat and fiber in some people.

I think there’s differing opinions on fiber. I tolerate it well. I like it. I like foods that have fiber and like berries, non-starchy vegetables, I do a lot of those. Then you really do want to reduce the starches and the added sugars in your diet. When we’re looking at the MyPlate, you know, how are we talking about that? I think that it says, “Non-starchy vegetables or vegetables, and then it has whole grain, fruit, protein,” and I looked at it, and I said, “Where is the fat and why is three quarters of this plate is carbohydrate?” So, forget about the food groups, forget about vegetables, beans and legumes, whatever, carbs, proteins, fats, and then you learn the subcategories, and you learn which ones are good for insulin, i.e., which ones have a low insulin response, which ones have a high and bias your food towards the lower ones.

I think that made so much sense to me. I really dug into this after I had my three-year-old son. Because I couldn’t lose weight, because I was eating Clif bars that had as much sugar as a Snickers bar and I thought to myself, if I went through all of the schooling and never learned about insulin resistance, my patients don’t have a clue, my parents don’t have a clue, and everybody needs to know about insulin resistance, and it’s so much simpler like cuts through all the noise. So, I like to say, if your initial litmus test for whether or not a food is healthy is you look at the package and you say, “How many calories does this have, how many grams of fat does this have?” If that’s your old litmus test, your new one should be, “How will this food affect my insulin?” Once you understand macronutrients, you can understand how a food product will affect your insulin, and you can read through the BS marketing, and you can read through the back of the panel and look at the grams of sugar, the grams of carbs, and then the ingredients list to determine if this is a whole real unprocessed food high in fiber, fat, healthy fats and proteins that will keep your insulin low or like a bunch of–

I just worked with a lady the other day and she was doing profile by Stanford, but you can look at Weight Watchers, Nutrisystem, Optavia, all this stuff has a bunch of junk in it. A bunch of sugar, a bunch of unhealthy oils, and so you can just read through the marketing and make your own health decisions because it does start with food. But there are other aspects to living a low insulin lifestyle that I think is important. So, when we’re talking about diet dogma, I think that’s another one, that it’s only about what you eat, and it’s not because there are a lot of other lifestyle factors that come into play, when we’re talking about reversing insulin resistance by living a low insulin lifestyle. So, food is just one and I think that’s a broad stroke overview of my nutritional approach.

Cynthia: No and I think, it’s so important for people to hear this from multiple healthcare professionals. You know the hormone hypothesis or clearly the hormone connection and insulin is but one of many, one of the things that I think is really important for women to understand, especially, women as they’re getting closer to middle age, perimenopause which for a lot of people, it’s after 35 that our sex hormones start shifting, and we can start seeing little glimpses of what’s to come. But I like people or women frankly to understand that, just where we are and our menstrual cycle can impact whether or not we are more insulin sensitive or insulin resistant. For example, in our follicular phase when we have more estrogen, tends to be a much more insulin sensitive hormone versus progesterone, which tends to be a much more insulin resistant hormone, and what I see happening for many women as they’re getting closer and closer to menopause, they’re becoming increasingly more insulin resistant. Part of its, you touched on and alluded to sarcopenia, this muscle loss of wasting which will happen unless you work against it. It is a proven fact.

I was actually in Whole Foods this morning looking at all the meat and reminding myself when I was looking at MRI scans and it showed like what sarcopenic muscle looks like, muscle loss with aging versus younger muscle, there’s a lot of marbling. When you think about, when you’re sitting down with that fatty steak, it’s because there’s a lot of marbling and that marbling, that replacement of muscle tissue with fat tissue, adipose tissue changes the way that that muscle functions. So, I always like to touch on the nuances of other hormones and certainly, if you’re leptin resistant, the whole concept of Intuitive Eating will be lost to you because the communication, and I’m oversimplifying it, between your gut and your brain is disconnected. That’s why sometimes you’ll see very morbidly obese people that they’re sitting down to have a very large meal and they might have had 3,000 or 4,000 calories but their body and their brain doesn’t even register that they’re even full. So certainly, the satiety piece.

The other hormones, estrogen and progesterone, there’s so many hormones that play a role with this, cortisol. I always say if you’re not sleeping is one example but let’s focus on insulin because I think for many, many people and I include also a lot of healthcare professionals, we forget how much insulin is impacted. If 88% of Americans are metabolically unhealthy, that means 88% of Americans are either overweight or obese, which means there’s 12% of us that are metabolically healthy, which is astounding to me and beyond troubling.

Let’s talk about what are some of insulins key roles and then let’s talk about what happens as our cells become less able to communicate with the hormone of insulin like what actually starts to transpire in the body because this is really key. For anyone who’s listening who’s struggling with weight loss resistance or really frustrated with some of the dogma principles that many of us grew up with, this is really, really important to understand so that you can be successful, so that you can move beyond what you’re struggling with right now. I’m sure this happens to you as well, Morgan. Every single day on social media, every single day in my emails, I’m getting questions from women who are stuck or who are frustrated, and that’s why the hormone piece is really critically important.

Dr. Morgan: Mm-hmm. That’s important to recognize in and of itself insulin is a vital hormone. It’s an anabolic hormone, meaning, it builds. I like to remind people that every single cell has insulin receptors, which is pretty rare as far as hormone receptors go. So, insulin can impact every cell of the body and one of the main roles is to allow glucose to move from the blood stream– so blood sugar, so move from the bloodstream into the cells to be stored. So, stored for energy. It’s very important to recognize what happens when we don’t have insulin. If we think of a type 1 diabetic, they don’t have insulin. Well, what happens? They lose a bunch of weight, and they become emaciated, and their blood sugars are very high because their cells are starving. So, if your sugar cannot get into your cells, they’re hungry all the time. So, they’re eating a bunch, but they’re essentially urinating out all of the sugar, all of this energy because their cells can’t use it.

In order to be metabolically healthy, your sugar has to be able to get into your cells. Your body likes to maintain a state of homeostasis. It does not like to change. It likes those blood sugars to be in a tight range of about 70 to 90 to 100. After a fasting glucose, if you have over 100, you’re in the pre-diabetes range. What I would love to see healthcare providers do is check for fasting insulin because we know that that can predict diabetes decades before glucose, it’s just harder to test. So, that’s why we focused on glucose testing because it’s more readily available and easy. Dr. Bikman’s book by Why We Get Sick is really good. He provides really good information and guidelines for how to get insulin tested. So, what happens then is when we become more and more resistant to insulin’s effect, our sugar has a harder time getting into the cells.

Now, I’m talking about someone without type 1 diabetes now. Our pancreas needs to make more and more insulin to get the same job done, so, compare it to an alcoholic. They might get a buzz after two drinks when they first start drinking, and then they need four drinks, and then they need stronger drinks, and then they need six drinks, and then they can tolerate it pretty well. No problem. So, they’re functional alcoholic sometimes. That’s what happens with insulin. So, if you eat five to six meals a day and you have sugar and starch in all of those meals, that’s like having five to six drinks a day, your body just gets used to it and it needs more and more insulin. Now, insulin is the primary hormone responsible for your body set weight. So, while the levels of insulin in your blood are going up, it’s signaling to your brain to gain weight. This is very simplified but that’s essentially what happens. That’s really the role that insulin plays. It’s responsible for moving glucose from the bloodstream into the cells to be stored for energy.

Now, when that’s broken, we can develop what’s called leptin resistance. Leptin is that hormone released by our fat cells that usually says, “I have enough fat, reduce your appetite. Stop eating. Let me use some of this energy that’s already available.” But when we have high levels of insulin and we store a lot of fat, we’re going to release a lot of leptin, and then we have persistently high levels of leptin which leads to leptin resistance, and we’re back to that buffet that you spoke of with someone who doesn’t need the 3,000 to 4,000 calorie meal, but they’re eating it because their satiety hormone is not working. To fix that, you have to fix the root. You have to fix the insulin resistance and you do that in one of two ways. You can reduce the amount of insulin required and/or you can improve insulin sensitivity. So, why I love intermittent fasting so much is it does both. That’s really one of the strategies where if you’re not putting food in your mouth, hormones or cortisol and whatnot but typically you’re going to need less insulin if you’re not putting any food in your mouth. And it also just improves the sensitivity of the cells to insulin.

Another thing that we can do is just, again, eating that low carb– lower carb lifestyle, not necessarily thinking of it as a diet, but thinking of it as a lifestyle, you can add strength training to build muscle and improve insulin sensitivity. We have to focus on stress management, oh my goodness. We have to focus on good sleep because that’s when your hormones, when you’re sleeping is that regenerative hormone phase, where your human growth hormone goes up and we build muscle. When we’re not getting adequate sleep, you’re not getting enough growth hormone that goes down with age anyways, and I think why perimenopause– menopause, when they have the hot flashes, they’re waking them up, and they’re gaining all this fat, well, it’s like a five-edged sword. It’s not even a double-edged sword because their estrogen is going down, which you already spoke of is protective against insulin resistance, and estrogen is protective against belly fat. So, after menopause, women are going to see that fat redistribution from their subcutaneous stores are pretty much on that like under the skin, above the muscle to the visceral store around the belly and they’re thinking, “What’s happening?”

Well, your estrogen is going down, so your insulin resistance is going up, and if you’re chronically getting sleep deprivation from hot flashes or stress, your growth hormone is not as high as it should be. So, you’re not building the right muscle and you’re reducing your insulin sensitivity there as well. I think COVID, goodness, that should have been– the COVID 15 should have been a really clear indicator that stress does contribute to weight gain and I think we should talk on that. Because when we’re stressed, our cortisol is released, right. Cortisol is okay. If we need to fight a saber-toothed tiger or flee a saber-toothed tiger back in the day, we needed cortisol because it gave us blood glucose so that our muscles could have energy. But now, it’s an email, it’s a text, it’s something on social media that gets us riled up, is the kid crying in the corner while you’re trying to be on a Zoom call, not speaking from experience there, but– [laughs]

Cynthia: [laughs]

Dr. Morgan: So, that really raises our blood sugar, but then we’re sitting at a desk. Again, your blood sugar can be removed from your bloodstream to store through demand or insulin. So, you need to move your body, go for a walk, exercise, make those muscles pull the glucose in, or insulin has to be released to push it in and allow it in and that’s what happens. You’re stressed, your cortisol goes up, you sit at your computer, you might emotionally eat because insulin resistance increases carb cravings we know that. Because the cell– it’s just like a type 1 diabetic that’s hungry all the time. The cells have a harder time getting that energy. So, it’s just a five-pronged sword when we’re talking about weight loss, but when you just filter it down to that litmus test again, how does stress impact my insulin, how does sleep deprivation impact my insulin, how do carbohydrates, protein, fat, exercise, toxins? You had a great episode recently on toxins. When all of those are filtered through the question of how will this affect my insulin, you can have a clear answer for how it’s going to affect your weight. Because insulin is in charge of your body fat and your weight. Did that adequately answer the question of– I don’t think that we quite dovetailed on chronic disease and insulin resistance.

Cynthia: Well, [crosstalk] I think, it’s important– not to interrupt you, I think it’s important for people to understand that it’s annoying when we put on five or 10 pounds, but if you continue on that path there are more concerning things that can be in your future. So, I think it’s a good segue into talking about we know that as women get older, they’re more prone to insulin resistance and certainly if they’re not on hormonal replacement therapy and that’s a whole tangential rabbit hole discussion that we can have. But we start thinking about, there’s a great book I just read and I’ve been talking a lot about it on social media, The XX Brain by Dr. Lisa Mosconi, and so really understanding that women are protected from so many health issues until they go through menopause and so if your blood sugar and insulin are not properly balanced in your 40s and 50s, you are going to exponentially increase the likelihood, you will develop type 3 diabetes which is Alzheimer’s, so cognitive dysfunction.

We know women’s brains in their 40s and 50s determine what their brain health and cognitive function health is like in their 60s, 70s, and beyond. So, this is really, really important for people to understand that insulin resistance begets other health issues and certainly we want to do everything we can, and it doesn’t matter how old you are. Everyone can do something. That’s the message we want to share is that, this is a public health emergency, and we want you to be as informed as possible, and we’re going to give you some actionable tips to do when you finish listening to this podcast. But let’s talk through briefly like, what are some of the sequelae– what are some of the complications that occur if we don’t address insulin resistance, and part of the problem and it’s interesting, over 20 years ago, before I met my husband, my boyfriend at the time was an MD-PhD and was here doing a postdoc fellowship, and I was talking to one of his colleagues that was at the University I was studying at, and they both said, “Americans do a terrible job with preventative health.” This is 20 years ago. And I didn’t disagree with them.

One of the things they hearkened on was, you wait until someone has diabetes. You don’t get on top of them when you start watching the creep of glucose and back then we weren’t testing fasting insulins, but we were looking at hemoglobin A1c, we were looking at fasting blood sugar, and we were looking at postprandial, so post meals, and we were looking at glucose tolerance tests which are horrible to go through. I have to agree with that. I think we’re really seeing the byproduct of us not being proactive enough as healthcare professionals, patients not knowing enough to demand and ask for these tests, and asking for example, a fasting insulin is not a weird test, and your healthcare professional should know how to interpret it and will give you some guidelines. But let’s touch on what happens when we don’t manage blood sugar dysregulation, insulin resistance, etc. What is in our future?

Dr. Morgan: Absolutely. Well, again weight gain, obesity is in the future. But elevated blood sugars increase inflammation in the walls of your vessels. Inflammation and elevated blood sugars will lead to diabetes, heart disease, osteoarthritis, Alzheimer’s disease as you spoke of now, it’s commonly often called type 3 diabetes. Because there’s a thing called peripheral insulin resistance in your body, but there’s central insulin resistance in your brain. Your brain cells are sensitive to insulin as well. That’s really what got me going here. So, as a geriatric PT, I’d go in and I would do these chart reviews before an eval because I’m nothing if not thorough, and-

[laughter]

Dr. Morgan: -I’d always notice, “Why do all of these people not only have high blood pressure or heart disease by that time I saw them? Why do they have diabetes and high cholesterol as well?” So, I essentially followed the symptoms, I followed the leaves, and I followed the tree trunk, and then I got to the root cause, and I’m like, “Oh, my gosh, it’s insulin resistance. It’s insulin. Why are we not focusing here to fix all of this other stuff?” You’re going to kill the most birds with one stone if you know which question to focus on, and so I think that’s a huge problem in medicine today, and especially in the field that I’m in with geriatric care. Often, I’ve worked with people in their 70s, 80s, 90s in geriatric physical therapy, they do not have the cognitive ability, they do not have the physical ability to care for themselves anymore properly. So, a recent example, I did what’s called starter care on a woman with type 2 diabetes and it’s a huge problem for polypharmacy, my goodness. So, she had close to 30 medications, she went to the hospital, and they discharged her without her fast-acting insulin, without an order for that. So, I get to her house and it’s close to 300 with no order for fast-acting insulin.

You want to talk about healthcare costs and rehospitalization rates, medication errors is a huge problem. So, we’re all focused on reducing this rehospitalization rate and I’m like, “Why don’t we help these people not get sick in the first place? Why don’t we educate their caretakers on why perhaps administering fast-acting insulin and then giving her a grilled cheese sandwich is not the optimal strategy to manage her diabetes? Why don’t we just do this basic health education that should be required in schools?” But it’s not and unfortunately because of the repetition of false weight loss dogma, it’s not common sense either. So, I think that we have to take full responsibility, put our big girl pants on as my grandma always says, “Put your big girl pants on-”

Cynthia: [laughs]

Dr. Morgan: -and take responsibility for our health, and take responsibility for really digging through the research as we have. I have not met another professional that is in line with I am regarding pretty much everything on health as I have with you.

Cynthia: Thank you.

Dr. Morgan: Yeah, but there are some big problems and I see it firsthand. I thought to myself, “Who’s helping the people in the gray zone of healthcare?” The people that aren’t clinically sick, but they’re certainly not healthy. I think another thing that as healthcare providers we have to take further ownership here. A lot of healthcare providers are chronically stressed, chronically sleep deprived, poor nutrition, poor physical activity, and patients are looking to healthcare providers to be an example. So, I think this should be a call to arms for healthcare providers to lead by example. If you want to help your patients you need to first help yourself and I think that that is the most powerful thing that a healthcare provider can really do for their patients is to set a good example. [crosstalk]

Cynthia: I think that’s important. Yeah, now it’s interesting. So, the listeners know my backgrounds in ER medicine and cardiology. I remember there were days towards the end of me working in cardiology, where I was so sad to write 10 to 15 prescriptions for someone in clinic. I definitely got to the point where I would say, “I would love to help you not be on so many medications.” But part of the problem is we have conditioned our patients to expect a pill to take away their symptom instead of doing the hard work because it is much harder for me as a clinician to sit down and teach you harder in the sense that it takes more time to teach you about the value of high-quality sleep, the value of eating a nutrient dense diet, of proper stress management, of just physical movement and activity, of the value of connection with others. I just did a podcast with Jon Levy talking exactly about how we as humans really need to be connected and think about how many of your geriatric patients are isolated and how sad they are.

Dr. Morgan: Especially during COVID.

Cynthia: Yeah. I think that’s, broken heart syndrome, which is an actual syndrome. It’s called takotsubo cardiomyopathy. It happens in cardiology and I wonder how many deaths that were attributable to COVID were really a manifestation of the degree of loneliness, which this is a whole separate conversation. But I agree with you wholeheartedly that we as healthcare professionals need to serve as an example for our patients. I laughed when I trained in Baltimore, one of the hospitals that I worked at. When I was a nurse, it was a big cardiovascular center. I think this is probably what got me so interested in cardiology and some of the cardiovascular surgeons. This is back when people could still smoke on the campus, they would sit outside with their fried chicken and their cigarettes, and I always said to the other staff, I was like, “That’s a terrible example. They’re going to go operate on someone and bypass arteries that are clogged, and there they’re smoking.” I’m like, “This is a terrible example.”

So much to your point, I think that we need to lead the charge, we need to be the ones that are really walking the walk, and that’s why I think the work that you’re doing and certainly the work that I’m doing is so really valuable because the thought of writing more prescriptions really was breaking my heart, which is why I pivoted away from that. So, when we’re looking at trying to make that shift, looking for healthcare professionals that can help guide you through this process, I think it’s really important to focus on the mindset piece as it pertains to weight loss resistance limiting beliefs because this is what I think sometimes can even be more problematic than the old nutritional dogma is just the belief in yourself or the lack of belief in yourself. So, I know you do a really beautiful job with this with your own patients.

So, let’s talk about limiting beliefs as they pertain to women, as they pertain to weight loss resistance or losing weight in general because there’s such a huge focus in society to elevate women who are skinny, and thin, and lose weight, and to be very critical and very derogatory towards women who are struggling to lose weight, and yet we don’t understand that there’s a lot more behind than just someone lacking the ability to stop eating. There’s so much more to it than that. The judgy– judgmentalism that I see on social media, I think I just came up with a new word.

Dr. Morgan: Judgmentalism?

Cynthia: Yes, judgmentalism, that was not purposeful. This degree of judgment of others when you don’t fully understand like their background, what they’re going through, their life experiences, there’s a lot that goes on that’s beyond just the food that you’re putting in your mouth for sure.

Dr. Morgan: I’m still learning. I’m going to be the first to admit that the only way that I have learned is through my own experience which is limited. I had to lose weight after I had a child. But I have not had to deal with decades of obesity like a lot of the people coming to me. And so, how I’ve really tried to learn is just reflective listening. Listening, reflecting, journaling, and trying to come back with tools that they can use and really trying to work out themes of limiting thoughts. We could do a whole another episode on common limiting thoughts.

Cynthia: Yeah.

Dr. Morgan: I think that we have to have the right strategy. I view weight loss is a coin with two sides. The first side is that low insulin strategy. But you also have to have the mindset and the behavior change strategies. This is why I developed my program so that I could teach, how you’re like, “I didn’t want to write these prescriptions I wanted to teach.” I thought, “What?” What I tell my geriatric patients 20 years ago, if I could sit down with them as long as I wanted, and share the information they need to know to get healthy. So, that’s what I did. But through that program, there’s coaching. I learned that just because you give someone the right strategy, it doesn’t mean they’re going to follow through. I thought, why? To me, it’s so cognitive. I’m such an intellectual person that when I know better, I do better. But for some people, they know what to do, and they’re not doing it, and they’re stuck, and they’re thinking, “Why am I self-sabotaging myself?”

I think– I’ll try to keep this brief and you can cut me off whenever you need. So, [giggles] I think it’s helpful to go over the stages of change and then I’ll teach you a little tool that we can use in each of those. When someone’s thinking about starting maybe intermittent fasting, or changing their diet, or starting an exercise program, whatever the change is, there’s different stages. There’s pre-contemplation, where it’s not even on your radar. Then you’re contemplating about it, you’re preparing for it, then you take action and you do it, I can’t do that with my finger for some reason, [giggles] and then, you’re going to maintain that habit, and then you’re going to relapse. That relapse is part of the process. We need to stop worrying about it so much. So, I think we’re going to come full circle here when we’re talking about weight loss myths or dogmas is that, there’s a losing phase and then there’s a maintenance phase. That’s a bunch of nonsense. You’re going to have to lose weight how you want to live the rest of your life. Otherwise, it’s going to come back on. You’re always in maintenance. So, I think that that’s one thing to consider.

But when we’re talking about limiting thoughts, I think the fear I came up with an acronym it spells out fear. I think this one is helpful for someone who knows they need to make a change, and for some reason cannot force themselves to take action or at least take action consistently. So, I like going through examples. The F is for these fear-based thoughts, and then the E is for emotion, A is for action, and R is for result. I was doing an Instagram Live. I don’t do these often, but I didn’t want to– Though I was working through this exercise with the lady, and she gave me permission to share a story, and I said, “What are you so afraid about? Why are you not taking the actions that you need to take to lose the weight?” She goes, “Honestly, I think two things. I don’t believe that I can do this, I don’t really believe that anything is going to work for me, I don’t. Deep down in my heart, I don’t think it’s going to work. I’ve tried everything, nothing works.”

Then the second one was, my weight is a protection. So, she’d had emotional trauma earlier in life and learned that if she was bigger and– if she was bigger that men would leave her alone. So, her weight was an emotional shield and it was a tool. She didn’t have the emotional tools required to let go of the weight and still protect herself and feel safe emotionally. So, this is the mindset piece. So, I kind of walked her through, I said, “Okay, so, we have these fears in our subconscious brain saying you can’t do this and further if you do do this, you’re going to be in danger emotionally.” What emotions do you think those fears drive? They drive apathy, they drive procrastination. Those are the two big ones that I run into. Apathy and procrastination, more fear, and excuses, you know, really.

Then what actions do those lead to, negative actions is what I call that, sitting on the couch eating potato chips and M&Ms, popcorn at night, not doing anything that you know you need to be doing, and then the result is you feel guilty, and you feel shameful because you’re not doing what you know you need to do for your health and further for your family’s well-being because it’s never about you. It’s always about your greater why. So, I think that’s a really powerful place to start is why, why is it important for you to change your behavior? Do it for them, do it for your kids, your grandkids, your spouse, your aging parents that you need to take care of? So, that’s the fear to really break down. That’s just one example and I think like a nice journal prompt is, “What fears do I have around losing weight, and then just pause and let it go and write it out?” and then say, “What emotions stem from those, what actions, what results?” That just brings some clarity.

Sometimes those fears are like little mice in a dark room. You turn on the light and they run away and that’s all it takes is “Oh, that’s why I’m not taking action. Now that I know that I can do better.” But for some people, it’s harder than that. These are deep roots in their brain that they’ve thought and so it might take some more psychological care counseling journaling to really get through to break through to the point where they’re ready to take action and I know we’re probably running short on time, so can I give one more little exercise.

Cynthia: Sure, absolutely.

Dr. Morgan: Okay, the clear exercise I think is helpful for people who are in the action maintenance or relapse phase, early relapse, and this just brings some clarity around why you’re not doing what you intended to do or why you emotionally eat at night when you said that you weren’t going to emotionally eat at night? This stands for circumstance and context. So, that’s the C. The L is for line of thought, E is emotions, A is actions, R is results. Perfect example for me that I continue to struggle with, but I’m working on it is late night snacking. So, what’s the circumstance and context? Kids are in bed. Dawson has always been so hard. I think I’ve talked to you about this last few times we talked, is so hard to put to bed. Then our little one year old, Leah, she’s fine. But still, you have to put them to bed and then you’re sitting on the couch, and you breathe [sighs] a moment to myself. So, the circumstances I’m tired, it’s the end of the day, and I’m a little bit stressed out. What’s my line of thought? And you probably just heard it. This is my time, I have a moment to myself, chocolate sounds really good, and it used to be popcorn every night. Now, at least I’m doing some lower insulin impacting foods sometimes. Sometimes, it’s still popcorn.

So, what’s the line of thought? It’s my time, I deserve this. I want a break. I’m bored. Again, these are heavy grooves and you have to get used to like, “What are those triggering thoughts for you and then what emotion stem from that?” I don’t care. A little bit is not going to hurt anything. I’ll start again tomorrow. So, again like that apathy is really or feeling restricted, feeling like, “Ah, I can’t do this diet anymore. I feel so restricted.” Well, then you’re going to lead to action of going and eating whatever you said that you weren’t going to eat at night, and then you have the result of not losing weight. ‘Period.’ So, you can take that clear exercise through anything. You know, overeating dessert at a party, skipping your workout, it just gives like a little framework to analyze your behavior and analyze your line of thinking, so that when I catch myself thinking, “Oh, it’s me-time. I am going to relax. I deserve a break.”

I can then immediately extrapolate that line of thought to, that’s great. Go have a cup of tea. Instead of “Oh, okay, let’s go have some cookies or let’s go make a brownie mug, whatever you want to do.” But when you start at the action, which is where so many weight loss programs start is do this, eat this, here’s your meal plan, and you don’t backtrack up to the belief. The fears or the lines of thought that lead to those actions, I think that’s really where something becomes unsustainable because they’re working against their own thoughts. So, we have to work on fixing those limiting thoughts. That’s the other side of the weight loss claim.

Cynthia: I think it’s a really important one to focus on and ironically when I did my graduate thesis, Prochaska and DiClemente’s Transtheoretical Model of Change was a large part of what we were working on. I think for many people, they feel it’s like a self-fulfilling prophecy. They feel guilty and the guilt drives the continued for decisions, and yet if we back up and do a little bit more work before we actually start making those changes, oftentimes, we can make them much more sustainable. I have to agree with you that weight loss is a complicated topic. It’s not as straightforward and linear as many of us want to believe that it is and I can’t tell you how many women over the years that I’ve worked with have shared with me, disclosed that. You mentioned you had that one client that, her weight was a protective mechanism and for a lot of people it is. Either because of traumas they’ve experienced, either major or minor traumas throughout their lifetime, because they just don’t feel like they have an outlet for stress relief. So, I think that looking at it from a psychological perspective is really combined with some of those lifestyle modifications is really the best way to tackle those challenging weight loss resistance issues. So, I could obviously speak to you for hours.

Dr. Morgan: I know. We’re like [crosstalk]

Cynthia: [crosstalk] it’s really been such a pleasure to connect with you-

Dr. Morgan: Well, thank you.

Cynthia: -and we’ll have to bring you back. So, let my community know how to connect with you. You have an amazing podcast yourself that I’ve been-

Dr. Morgan: Oh, thank you.

Cynthia: -very fortunate to have been on, you have a great YouTube channel. How can people connect with you? What’s the easiest way to reach you on social media?

Dr. Morgan: Sure. I’m most active probably on YouTube. I tried to do at least a couple of videos a month on there. They can just search Dr. Morgan Nolte. I’m @drmorgannolte on Instagram and then my website is weightlossforhealth.com. You can link up my email if they have any questions and it’s just mnolte@weightlossforhealth.com. But I think that you can tell I’m just so passionate about what I do, and I’m so passionate about spreading the word on insulin resistance, and also just really listening to the mindset blocks, and the beliefs, and developing tools and strategies to get the weight off so that they are not my patient in geriatric physical therapy when they’re 70, 80, 90 years old, because so much can be prevented and I’m so grateful to have had the chance to speak with you today and share this message.

Cynthia: Yeah, thank you so much. I look forward to our continued collaborations.

Dr. Morgan: Yes, me too. Thank you, Cynthia.

Presenter: Thanks for listening to Everyday Wellness. If you loved this episode, please leave us a rating and review, subscribe and remember tell a friend. And if you want to connect with us online, visit the link in the show notes.