Ep. 183 – Uncontrolled Blood Sugar Imbalance Complications with Dr. Ritamarie Loscalzo

Your trusted source for nutrition, wellness, and mindset for thriving health.

I am excited to have Dr. Ritamarie Loscalzo, an internationally recognized expert in nutritional endocrinology, joining me on the podcast today! Dr. Ritamarie is a doctor of chiropractic with a master’s degree in nutrition and certifications in herbal medicine, acupuncture, and Heart Math. She is deeply committed to transforming our broken disease-management system into a health care system in which practitioners are skilled at finding the root causes of health challenges and using the wisdom of nature combined with modern science to restore balance to the body.

Dr. Ritamarie burned out in her early twenties and experienced many health problems. She wondered if her diet might be causing her problems, so she turned to the sphere of holistic natural medicine for solutions. She learned a lot and was able to heal. So, she became passionate about using nutrition to help others make choices for better health. She founded the Institute of Nutritional Endocrinology to train doctors, nurses, nutritionists, health coaches, and other practitioners in the science of rebalancing hormones and restoring energy with nutrition and lifestyle approaches.  

In this episode, she shares her story and we unpack insulin resistance, explain how to manage it, and talk about how intermittent fasting impacts blood sugar and helps overcome pre insulin resistance, insulin resistance, diabetes, and metabolic syndrome. We also dive into successfully navigating perimenopause, menopause, and a plant-based keto diet and discuss the benefits of lifestyle medicine. Be sure to stay tuned for today’s educational and information-packed podcast!

“In helping myself, I learned all sorts of amazing things, and I was able to heal.”

Dr. Ritamarie Loscalzo


  • Dr. Ritamarie talks about how she developed a passion for using nutrition as lifestyle medicine and became interested in managing blood sugar.
  • The link between blood sugar imbalance and sudden heart attacks.
  • The value of lifestyle medicine.
  • What are the signs and symptoms of pre-insulin resistance?
  • How do you maintain ketosis while following a plant-based diet?
  • What is the problem with most of the fats on supermarket shelves?
  • Find the carb-macro ratio that works for you.
  • Why are whole food fats better for you than oil?
  • Intermittent fasting is vital for optimizing your health and positively impacting the pre insulin and insulin resistance phases.
  • How a woman’s diet and metabolic health impact how she experiences perimenopause and menopause.
  • What happens to the brain that makes women more susceptible to type-3 diabetes as they enter menopause?
  • Why is it critically important to get enough sleep?How does exposure to endocrine-disrupters in your home and personal care products negatively impact your hormonal health?


Reinvent Healthcare

Connect with Dr. Ritamarie Loscalzo

On her website

On Facebook – Dr. Ritamarie or Institute of Nutritional Endocrinology (INE)Practitioners

On Instagram

On YouTube

Connect with Cynthia Thurlow

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 had the opportunity to connect with an internationally recognized expert in Nutrition Endocrinology. Dr. Ritamarie Loscalzo is an amazing resource on the science of rebuilding hormones and restoring energy using nutrition and lifestyle approaches. We dove deep into pre-insulin resistance and how to manage it, why things have changed so substantially for her since she started clinically practicing 20 to 30 years ago. The impact of intermittent fasting on blood sugar, and how it can help overcome not only pre-insulin resistance, but insulin resistance and diabetes, as well as metabolic syndrome, how to successfully navigate plant-based keto and what that looks like for her. We also dove into perimenopause and menopause and the impact of lifestyle medicine. I hope you will enjoy this podcast.

Well, Dr. Ritamarie Loscalzo, I’m so excited to have you on the podcast today. And largely, because I feel like this concept of metabolic flexibility or inflexibility really diving deep into what blood sugar regulation really represents because I think for many, many people, they said they associate that blood sugar issues are just related to nutrition. So, I’d love for you to start by sharing for the listeners, how you got so passionate or became so passionate about really using nutrition as lifestyle medicine and how you became particularly interested in blood sugar management? Because I’m sure for you as I have over the last 20 plus years, you’ve seen profound changes in the health of your patient population as well. So, welcome.

Dr. Ritamarie: Absolutely. So happy to be here. I’m so glad we got this on the books. So, yes, I’m passionate about nutrition and I’m passionate about helping people to make choices. Every day, we have all these crossroads, right? We get to make choices and I hate to even think about how many choices we get to make as my mind will get blown. But by the end of the day, we have decision fatigue from all the choices we get to make all day. What I found got me into nutrition was, I got unhealthy in my early 20s, burned out, and gut problems, and stomach problems, and throat problems, and head problems. I mean I was like falling apart at age like 24. Like a lot of us who get into the more holistic natural medicine sphere, it was like from a need. It was like, “What am I going to do?” Take this med, take that med, take this med. I’m 24 years old, what’s it going to be like when I’m 50 or 60?

Oh, well just don’t worry about it, just don’t worry about it. Finally, actually, I don’t even know where the question came from asked. Could it be my diet? And of course, this was back in the 80s, of course not–. And so, I’m always up for a challenge. I decided I’m going to find out for sure. So, I set out to actually help myself and in helping myself I learned all sorts of amazing things and I was able to heal. I thought, “Okay, I’ve got to get out of my computer profession and into the health profession, so that I can help others, so that, it wasn’t so hard.” That’s how I got into this. The interesting thing was, the thing that got me over the hump, I tried all kinds of things, the allergy eliminations, and hypoglycemic diets, and this and that, what really got me over the hump was fasting. That was before fasting was popular. So, I had to kind of. “I fasted. I fast–“

Cynthia: [laughs]

Dr. Ritamarie: You don’t tell people that they think you’re anorexic. One of my sisters actually gave me a book when I was visiting them, and she snuck it into my backpack, and it was about Anorexia: Starving for Attention or something. So, she actually thought, even though, it’s the healthiest I’d ever been in my life that I had an eating disorder. So, I decided to go back and learn about this. The more I learn about the impact of food on the body, and the impact of toxins on the body, and the toxins in the food, and blood sugar came apparent because I’d heard about hypoglycemia. But nobody really talked what was really going on with that– oh, just eat every two hours– just eat every two hours. The more I started studying this and as I started to see patients, I realized, I actually started having them get a blood sugar meter. This was a long time ago before you can get them on every corner. I was like, “I wonder, what’s going on?” I would find that people were having these weird erratic blood sugar swings. It wasn’t hypoglycemia. There was hyperglycemia and then hypoglycemia and some of them–

It was just hyperglycemia. It was just high blood sugar that was causing them to feel the way we always labeled hypoglycemia. I realized, “Huh, there’s something going on here.” The sugar’s in the blood, but it’s not getting into the cells. It’s not getting into the muscle cells, it’s not getting into the brain cells, and that really is diabetes in the end stage, but nobody was even close to being labeled diabetic because their fasting glucoses were so good. So, I started looking at that. As I started to get people to adapt their diets, and their lifestyle, and their activities to what they were seeing on the meter, we started to see amazing changes. I started getting people going, “No, no, no, eating every two hours, actually, eating more time between– spending more time between having some longer fasting periods, even people who weren’t open to doing extended fasting, could goes four to six hours between their meals, could go 12 to 18 hours, and then night. So, this was a long time before intermittent fasting became popular. But I started to see great results with people. So, that’s what really got me into it.

The other thing that I discovered and I honestly believe that both of my parents were victims of undiagnosed blood sugar imbalance. They both died very early of heart attacks. The more I started researching like, “What causes sudden death from heart attack and the most common cause is insulin resistance?” So, then, I start looking at that and well, they had all the signs, all the outward signs of insulin resistance. Then, I started looking at genes. I started to look what, can’t look at their genes, because they’re no longer with us. But I can certainly look at my genes as a reflection. There weren’t as many, not very serious cardiac-related genes, but there are lots and lots and lots of blood sugar imbalance-related genes. So, I started putting it together and I’m like, “They didn’t know that they had a blood sugar imbalance.” The blood sugar imbalance out of control caused some of the later signs– or the later complications of diabetes, but hey hadn’t even been diagnosed yet.

So, I coined the term ‘pre-insulin resistance.’ Because we know that insulin resistance is diagnosed when people’s blood sugar is consistently over 100, and then metabolic syndrome, when they start to have all the lipid abnormalities, I’m like, “What is that period of probably 20 to 30 years before it gets diagnosed where we can intervene as health practitioners and help people to make changes to prevent them from going into what I call the bad signs of diabetes, blindness, amputation, and dialysis?” Like who wants that. But all of those things, the complications, the retinal changes, the kidney changes, neuropathy changes, all of those things are happening long before the diagnosis of diabetes and that’s where we can intervene as individuals and as practitioners.

Cynthia: There’s so many good points there. So, really talking about the value of lifestyle medicine, and I know certainly during my nursing and nurse practitioner training, even though, I trained at a big research hospital, at the time, it was like diabetes was thought of it in buckets. Like there’s hypoglycemia, which they looked at as being very benign, there was insulin resistance, there was diabetes. At that time, there was quite a bit of autoimmune type 1, and then not quite as much of type 2 and there was this bucket methodology of you know, this is when you get diagnosed with diabetes, and there’s this gray area in between, and I think about how many missed opportunities. I know of all my experience as an NP, prior to leaving clinical medicine five years ago was in cardiology, and I know for myself, I kept saying to my peers, “This can’t be all we have to offer these patients.” Because we would have, what we termed vascular paths.

On my last podcast with Dr. Philip Ovadia, who’s a cardiovascular surgeon, we were talking about what that represents, and it’s kind of head-to-toe inflammation and vascular disease from their carotid arteries all the way to their toes with vascular disease. So, the recognition that we are having all these missed opportunities as you said, 20 to 30 years before someone’s fully diagnosed with diabetes, this timeframe in which this blood sugar dysregulation, and let’s also be very clear, everyone that’s listening, you should know you’re fasting insulin, you should know your numbers, and if you don’t, you should be asking for them because way before your fasting blood sugar or your glucose becomes abnormal, your fasting insulin will become abnormal first. That’s the starting point. Because I can’t tell you how many women will come to me and they’ll say, “I can’t lose weight and it’s all this weight loss resistance focus,” I’ll, you know, ask them to get labs done through their primary’s office and more often than not, they have a fasting insulin that is way abnormal and I remind them, if insulin is high, you’re not burning fat. It’s almost like, you know, you open up the refrigerator and there’s a surplus of food, so you can’t get to the freezer, that’s Jason Fung’s analogy to get to the fat.

When people are working with you or even this awareness that you had way ahead of the rest of us, so I have to really give you kudos that you were putting those pieces of puzzle together and trying to change the tide, the genetic susceptibility that you refer to with your parents. Certainly, when I look at my grandparents, everyone had cardiovascular disease, and what I really think was at least with my grandmothers, I think was really [unintelligible [00:10:34] especially, as they were getting older, it just became more and more likely that they were going to become insulin resistant. But before we even get to that, I would love for us to talk a little bit more about, what is this pre-insulin resistance stage? What does it look like, what are the symptoms people can experience so that they can, if they’re listening, think to themselves, “Okay, I’m in this pre-insulin resistance state, what are the things I need to be thinking about, what do I need to be doing in terms of advocacy?” Because that’s one platform that I really like to stand on is that the more you know, the better you do.

There’s no point in digging your heads in the sand, we have to be proactive. We need to know these numbers. I love that you were using glucometers way before it became in vogue or more fashionable knowing what those numbers and those values represent can allow people to make better choices. Frankly, change some of their lifestyle choices, I mean, we’ll dive more into this later, but what would be some of the things that a client or a patient would be reporting to you that would lead you to believe that they are in this pre-insulin resistance state?

Dr. Ritamarie: Well, it is a lot of the common things. We see, you mentioned one already that no matter what I do, I can’t seem to lose weight. That’s one of the early things. Fatigue, like just waking up out of bed, first thing in the morning, you’re tired. Late in the afternoon, especially, late in the afternoon that 3 o’clock slump that everybody thinks is normal. That’s a sign of pre-insulin resistance. The other thing would be that craving for food after a meal, like I need something sweet. Just a little something sweet, because the body can’t get the sugar from the food into the cells adequately because of this insulin resistance state. So, craving more, so there’s those kinds of basic things that almost everybody experiences from time to time, and they are signs of this dysfunction that can lead to much more serious things.

But I always tell people, it can lead to but if you’re experiencing these symptoms, there’s already some things inside that you’re not seeing. There’s thickening of the– of the lining of the blood vessels, and they get stiff, so they can’t handle like “Let’s run to the bus stop thing.” They can’t handle that thing anymore because they’re stiff from all that insulin in the system. There’re other hormonal imbalances that are very much interrelated with insulin. So, thyroid imbalances, people who are just struggling with getting their thyroids working. It’s not going to work with all that insulin in the system because insulin actually doesn’t just cause insulin resistance, it causes thyroid resistance, estrogen resistance, progesterone resistance, leptin resistance because of the damage it does to those receptor cells. So, it could be so many different kinds of symptoms that are results of this dysfunctional blood sugar that may have started when you were 14 and couldn’t go more than 15 minutes without eating. It could be going on, and on, and on, and on until it gets to the point where it becomes diagnosable.

Cynthia: I think that when I reflect back on what I used to say to patients, I always say, when I was a baby nurse and a baby nurse practitioner, and that was back when we used to tell our patients to eat less and exercise more, and that we needed to focus on their caloric consumption and fat was bad, and when you take fat out of foods, I’d like to remind people that they add a lot of sugar and processed crap. So, one of the greatest travesties I think that has manifested over the last 50 plus years is the bastardization of healthy fats and how critically important it is that we are and obviously it’s really dependent on the individual.

Some people metabolize fats and break them down better than others, but the PHO fats, when I think back to the 1990s, when I was just getting out of college, and there were all these non-fat, low-fat cheeses, and yogurts, and I just think, oh, it makes me shudder when I think about what we used to eat, but grateful that we now know better. But I still think there’s a lot of misnomers about the macros piece. So, I know, you are particular specialty, you are a plant-based keto aficionado, but let’s touch on the macros because I think for a lot of people, macros are protein, fat, and carbohydrates, but I think, it’s really essential for people to understand that carbohydrates should be like a small portion of what we’re eating or the carbohydrates really come from non-starchy vegetables. They shouldn’t be, you know, that the processed carbs that get so many of us into trouble.

Dr. Ritamarie: Exactly. I personally, even though, I can maintain ketosis most of the time like a nutritional ketosis, I eat a lot of carbs in the way of fibers in the non-starchy vegetables. So, my lunch today was a big bowl of cooked cabbage with flax oil on it and some parmo which has hemp seeds and some other things on it. Delicious, very filling and fair amount of carbs, but it’s all the non-processed. It’s not the carbs that are going to raise my blood sugar. So, I think that carbs, they get a bad rap now, but carbs from vegetables, and that’s where I move in the direction of a keto-based type of diet that has a lot of carbs from vegetables. A lot of standard keto-type diets they shun vegetables, because oh, no, except for lettuce, you get too much carb there, and in fact what we find is, people can maintain beautiful states of ketosis if that’s what you’re striving for, not everybody needs to or should. But beautiful states when they’re eating lots of vegetables, and then leaving out the grains and the other kinds of things, especially, the processed and the crackers.

It doesn’t mean we can’t have crackers and bread. So, I teach people how to make bread from cauliflower, flaxseeds, chia seeds, some nuts and seeds, and vegetables that make this amazing bread by putting it in a dehydrator. They get the mouthfeel of their favorite foods, but they maintain all those healthy fats. Going back to what you said about fats, the good fats, the bad fats, like the fats that are in most of the foods that are on the shelves are processed, highly processed, hydrogenated, oxidized, they’re causing free radical damage in the body, and damage to those receptors– those insulin receptors, but other hormone receptors that we need to keep in shape. So, the fats are good and yes, some people don’t have gallbladders and you have to adapt to how much they can have, and how much they can have at times, and I don’t believe in strict macro ratios that, “Oh, yes, you should be eating 80:10:12 or whatever 80:10:10 or 75:25 whatever that might be.

No, there’s no one carb macro ratio that works for everyone. It’s finding what works for you and those tools like a ketone meter, like a blood sugar meter, or like a continuous blood sugar meter, and then just how does this feel, how’s the energy, how’s the weight, all that stuff plays in, and we’ve become our own little experiment labs.

Cynthia: That’s really important and I love that you touched on bio individuality that we, as a society want to be told, you need to eat this proportion of carbs, and this proportion of fats, and this proportion of protein. When I tell women to experiment, it freaks them out. They’re like, “Wait a minute,” I always say try to hit your protein macros.” That’s clearly an important point to really focus on for satiety and use that as a condiment, because unfortunately I think whether you’re plant-based or you do eat animal-based protein, I think, there’s this misnomer that when people are doing ketogenic diets that they need to add copious amounts of fat. I would like to remind them that if the animal-based protein you have, whether it’s salmon or ribeye steak already has some healthy fats that you don’t have to then add two avocados.

That’s where I think people– There’s this incredible misnomer and I know that you graciously have come in and done some teaching around plant-based keto in some of my groups. But I think there’s this misnomer about how to use ketogenic diet in a way that is going to optimize hormones as opposed to overwhelm your body with too much fuel, because let’s be clear, you can be eating those really healthy fats, but if your quantities are more than what your body can process, that’s usually problematic.

Dr. Ritamarie: Absolutely, that’s going to be problematic. The other thing that I’m a big fan of is whole food fats. So, the fat should come from the whole food and not from oil. Oil is just like white flour. We shun like, “Oh, that’s white, that’s a white carb bagel or whatever.” It’s the same thing with fat. You eat oil, where’s the rest of the food, where’s the other macros that were in that food to begin with? The omega-3 fats, yeah, great in flax, but what about the protein like hemp seeds. Hemp seed oil versus hemp seeds, big difference. There’re all kinds of minerals, there’s protein, and when you take away all the fiber, it’s just fat. It’s really– and there’s times for it, and I said I put some flax oil on my cabbage and usually don’t. Usually, I put more like ground up something, but I was in a hurry, so I just put some flax oil on it. But I recommend for people who are underweight, and who have that high metabolism, and they just can’t fit that much food in their stomachs, yeah, in that case, therapeutically, using fats is good. Using MCT oil, when people have that damaged lining, and they have some brain issues, you might need that. But if you’re overweight, oil is not your friend. Oil is not your friend. It’s not going to fill you, it’s just going to give you calories, and it’s going to thwart your weight loss process.

Cynthia: Well, I’m glad that you stated that because I feel like that’s the discussion that’s not often had with women that if you are aiming to lose weight or you’re trying to lose weight, you’re really measuring those fats and the best example I can give is, where I see the slippery slope are cheese and nuts, and my listeners know this and I remind them like, I love macadamia nuts.

Dr. Ritamarie: Yeah.

Cynthia: I love a salted macadamia. It makes me very happy. But I will literally pull a quarter cup scoop out, put it in a bowl, and I’m done. The rest goes back. My family laughs at me and I have two very athletic teenagers, I have a very athletic spouse, and it’s to remind them like, I am one of those people like, I have to be really careful about my fat portions not because I’m at an unhealthy weight, but I just acknowledge that for me fats are so nutrient dense that I have to just be careful. So, I remind people, you know, whether you’re listening or you’re watching the recording, it’s really important that we’re just cognizant of those portions because they’re much more nutrient dense. I love that you touched on the oil piece. Although, it’s interesting because I feel like keto has given a lot of people license to go overboard with even the animal-based fats like lard, and tallow, and duck fat.

The example that I like to give is that I was in this very fancy New York restaurant, and I decided, you know, I’m having a steak, and I’d the option having duck fat fries, do you know how sick I felt from eating the duck fat fries. I didn’t feel good and I was like it’s not the steak. Steak is not what bothered my stomach or bothered me for that matter, but it was just too much like the fats were just way too heavy. Even though, I was in this fancy restaurant, who’s to say those fats may not have been oxidized or may have been processed in a way that my body was just like, “Timeout do not eat more of that.”

Dr. Ritamarie: Yeah.

Cynthia: So, I’m grateful that you addressed that because that seems to be, for many people, they assume, it’s a license like, “I can eat all the fats I want unlike oil.”

Dr. Ritamarie: All if that I want. [crosstalk] the calorie thing, the calorie balance makes a difference.

Cynthia: Absolutely.

Dr. Ritamarie: Yeah.

Cynthia: So, let’s talk a little bit about you know, intermittent fasting is obviously something that you embrace, I embrace. Obviously, you were on to this strategy way earlier than I was. But when we’re talking about eating less often, how can this impact those that are in this pre-insulin resistant state as well as those who are insulin resistant? Because I will oftentimes get questions, just genuine questions from people saying, “My husband has kidney disease and he’s insulin– he has diabetes. It’s insulin resistant [unintelligible [00:22:49] has diabetes. And I myself am becoming insulin resistant, how can this be safe for me?” and I always point them towards Jason Fung and say, Jason Fung has tons and tons of research and work in this area.

But reminding people that insulin resistance is at the basis of nearly every health issue we see, high blood pressure, PCOS, infertility, and unfortunately now we’re seeing rampant infertility, but if 88.2% of the population and that was based on 2018 UNC Chapel Hill study, and this is probably 90% at this point after the pandemic last two years. But I really think it’s important for people to understand how eating less often can positively impact those metabolic issues that we’ve alluded to all these hormonal imbalances that drive exacerbation of insulin resistance, and then ultimately into a diagnosis of diabetes.

Dr. Ritamarie: A couple of things here. When you have space between your meals, it allows the insulin levels to go back down to baseline. When insulin is elevated as you mentioned earlier, you just can’t burn fat. We naturally allow the insulin to go down. What does that do? Well, these poor receptors that have been bombarded by insulin for all this time, they actually get arrest, and they actually can heal in between. We know that in the space between the meals and that intermittent fast period, ketones go up. They just naturally do because the sugar’s going down, and the blood glucose definitely goes down, and what are you going to burn? “Oh, let’s just burn some fat found some on the hip. Okay, let’s just get it there.” That’s the other thing people don’t realize with keto diets is, if they’re not combining it with some intermittent fasting, and they’re just eating fat all day long, when does the body have a chance to burn the fat on your body? It’s going to burn fat when there’s no glucose in there to burn, but it’s going to go for the fat that’s in the bloodstream before it goes for the fat that’s on the hips. So, it’ll burn whatever you give it so that space between allows the body to set up.

In addition, it allows the digestive tract to settle down because the digestive tract doesn’t want to constantly be bombarded, how does it get efficient at metabolizing the food, digesting, breaking it down, absorbing it when it’s constantly being bombarded? Conditions like SIBO, way better, because SIBO, though, there’s actually this thing in the small intestine called the migrating motor complex, and that moves the food along. While the migrating motor complex starts to get activated at somewhere like three and a half to four hours after a meal, so that magic happens three and a half to six hours, let’s just say or 18 hours depending on how long you’re fasting, and it starts to move things along. So, it improves symptoms of SIBO where stuff just gets stuck in the small intestine, the bacteria don’t move down to the large intestine where they really belong, and then they start to ferment and produce all this methane and all this stuff that creates, well a big bloat, and gas, and all that. So, there’re so many things that benefit when we just leave a little bit more space between the meals.

Cynthia: Throwing away our bodies are designed to thrive and that’s why I take some humor when individuals will say, “Oh, intermittent fasting is a fad.” I said, “Well, actually, dates back to biblical times, it’s part of all the major religions,” and obviously, I was raised Roman Catholic and it was part of we did around High Holidays, and certainly something that I was accustomed to, it wasn’t something we were doing regularly. But I do love that you touched on that mitochondrial efficiency. So, mitochondria are the powerhouses of our cells, and we know if people are chronically ill or they’re becoming insulin resistant, the mitochondria are not able to be as vibrant, that contributes to the fatigue and a lot of the symptoms that you had described earlier.

The MMC, the migrating motor complex is one of my favorite things to talk about and I always kind of liken it to a streetsweeper. It really can’t function to move things along in the gut unless you’ve given your body time to digest its food and to have this restful period. So, when people are fearful of fasting, I just remind them that digestive rest, even if just 12 hours a day, if you go from dinner to breakfast the next day, you’re still doing profoundly important things in the body. There was a recent study done by Satchin Panda and it was looking at meal frequency. So, it was this app in a phone, so super easy. We’re all tech obsessed. What was interesting when they looked at people with the highest degree of meal frequency was up to 10 times a day. So, imagine eating 10 times a day, anyone that’s listening, please do not be eating 10 times a day.

Dr. Ritamarie: Don’t. [laughs]

Cynthia: It’s a recipe for metabolic syndrome, and insulin resistance, and diabetes. It’s like prescription had A + B = C.

Dr. Ritamarie: Yeah.

Cynthia: And so, when I was looking at the research because I was presenting at an event last month, and I thought to myself, “If every person listening just eat less often, if the word fasting triggers you or makes you uncomfortable, gosh, just don’t eat snacks, don’t eat after dinner, don’t use the holidays as a slippery slide into gaining.” I think the average I read was one to two pounds per week in between Halloween and [crosstalk].

Dr. Ritamarie: Yeah, that sounds about right.

Cynthia: That’s kind of a scary statistic to me because given the fact we know that we have a largely metabolically unhealthy population to start with, we don’t want to be worsening that. We want to be doing things that can improve that, and so, I think fasting is such an easy or eating less often depending on what appeals to you more [crosstalk]

Dr. Ritamarie: Eating less often, meal spacing.

Cynthia: Yes, meal spacing [crosstalk]

Dr. Ritamarie: [unintelligible [00:28:29] meal spacing.

Cynthia: Yeah, it’s like a word by any other name, but really critically important for optimizing health. I feel like kindred spirit connection to you about the MMC. That is just one of my favorite parts of the digestive system that I like to talk about because if you’re eating all the time, your body can’t get rid of things that don’t belong and your digestive system cannot be optimized. One of the things I find when I’m working with women, because I’m at this point where I just work with women, is how many people when they just stop eating as frequently, all these symptoms go into cravings– so, simply cravings, energy issues, brain fog, etc. Now, I think, it’s important and we were talking about this before we started recording in the context of intermittent fasting, in the context of talking about women, what are some of the specific things women that are in perimenopause five to 10 years preceding menopause which is 12 months without a menstrual cycle, and there’s still women that are confused about that.

I think, it’s largely because healthcare professionals do such a crummy job managing women at middle age. I say that with like reverence and respect, because I know that’s not intentional. but I really feel like this population of women are so forgotten about, but the insulin sensitivity, the metabolic flexibility is even more important at this stage of life, and if you think I’m kidding, there was a recent study that was done that correlated the degree of hot flashes a woman experiences in perimenopause and menopause with a degree of insulin resistance she experiences. So, this is another area that I hope we can touch on because it is so, so important. So, if you think nothing else, if you are north of 38 years old, really north of 35, you’re entering a different stage in your life where you have to be much more conscientious about how you manage your blood sugar, how you look at nutrition, and meal frequency, and sleep, and stress, and all these aspects of health.

Dr. Ritamarie: Right. It’s interesting. Everybody thinks that that’s the norm. When we go through menopause, we gain weight, we get irritable, we get cranky, we can’t sleep, and we have hot flashes all the time, and nobody wants to be around us. It’s just inevitable that we’re going to go through that. But in reality, it’s not inevitable. Those are signs of disordered menopause. Usually, the dysfunctions that are happening don’t just start when you hit 48, and your periods start to get further apart. They start like in your 30s.

Cynthia: Yeah.

Dr. Ritamarie: We just saw it. It starts in your 30s and that’s where we start to take care of that metabolic health. There’s a big difference between– well, there’s a big impact of how the brain is affected by estrogen based on insulin. So, if there’s too much insulin and there’s insulin resistance, we’re not going to see the estrogen, the same estrogen response let’s just say. So, we know that in menopause, it’s not like it’s too little estrogen or too much estrogen, it’s that fluctuation of estrogen. If we have too much insulin and we’ve affected estrogen receptors, then all bets are off as to how we’re going to have symptoms, when we’re going to have symptoms. So, what I find is, if I can get people on better diets before they hit that perimenopausal age, I got like through menopause, fortunately, I changed my diet around a lot, because based on my 20s and teens, I would have been in bad trouble, but I made very serious changes to my diet in my 20s.

By the time I hit menopause, it was like, “Oh, wait three months apart, oh, six months, oh, that was 12 months apart. Okay, done.” There were no symptoms. No symptoms. I kept saying, “I wonder what a hot flash feels like.” I’m kind of cold today. Maybe, I should reach for a hot flash. Maybe I think, “No, no, no, you don’t want one of those.” I don’t even know what it feels like to have a hot flash. Because I never had them. I don’t know what it’s like to like suddenly not be able to sleep because I never had that happen. It wasn’t like I was this perfectly healthy person my whole life. I made the shifts early enough on to really affect that and it’s not like nobody else in my family ever had those. So, it’s not like, “Oh, she’s just genetically lucky.” No, it’s not that either. I think it’s those epigenetic modifications to the genes we have through the diet, the lifestyle, what we eat, when we eat, how we sleep, how much we space our meals. The earlier you start to make those changes, the more likely you are to have this menopausal, yeah, what is that? I don’t know. I just don’t have periods anymore. Yay, way you go.

Cynthia: Well, isn’t that a great way to reframe because I think on so many levels and I was talking about this with our friends this past weekend, there’s so much shame for many women to even talk about aging, they’re uncomfortable talking about the fact their body’s changing, they’re uncomfortable talking about middle age, God forbid they say the M word, the menopause word. On many levels, I want to help as I know you have changed the narrative around healthy aging, and on so many levels, I think perimenopause is the time where we can turn the ship around, like it gives you a lot of opportunities to make some significant changes. I was classic, you know, worked a very demanding job as a nurse practitioner for this large cardiology group. My husband traveled a lot, my kids were little, I was over exercising, not realizing that in my early 40s, I couldn’t do the really strenuous conditioning classes at 5:30 in the morning and think I could round on patients all day, and then not get enough sleep at night. Then these inflammatory foods that we think of as being fairly benign that are not.

For many people, if you have one autoimmune issue are more likely to develop a second and I developed psoriasis very mildly after being treated for Lyme. Then in my early 40s, I was diagnosed with hypothyroidism, and I was told it was because of a heavy metal issue, but came about several years later was I realized, even though, my antibodies were never positive, very few people have an underactive thyroid that’s not contributed to by autoimmune issue. So, if you’re a woman listening, and you’re in perimenopause, and you’re told your thyroid is underactive, and it’s not Hashimotos, I cry BS because it’s such a small percentage of people. But the point I’m trying to make is that, even people who in my mind, I had a very healthy lifestyle, but perimenopause was the time that I had to make some significant adjustments, and had I not been hospitalized for 13 days, I would say my perimenopause experience after that was pretty benign. I didn’t have hot flashes, I wasn’t gaining weight, my sleep provided, I took care of stress management and exercise properly was fine, especially removing these inflammatory foods, but I think it’s really important for people to understand that we have control over a whole lot more than we realize-

Dr. Ritamarie: Absolutely.

Cynthia: -that menopause doesn’t just happen to us. We have the ability on so many levels to change the course of our health history to make things better for ourselves. I meet women who have debilitating hot flashes to the point where they tell me, they soak their sheets, they’re sweating so badly, they have to change their clothes in the middle of the night, their room is as cold as a “meat locker.” But they’ve gotten very accustomed to sweating throughout the day profoundly and profusely, and so they have to wear moisture wicking clothing. Can you imagine how horrible that would be to have to go about your existence. If you look at the research, they talk about the degree of insulin resistance. There’s this strong correlation with, you know, correlation is not causation. However, we know that if we look at the research, these are people who are not as metabolically healthy, they’re more likely to have significant symptoms heading into menopause.

Dr. Ritamarie: Yeah. It’s interesting to watch because we accept certain things as the norm. And so, we accept the diet, we accept the snacking, oh, yeah, eat every two hours, we accept that it’s normal to have that crash in the middle of the afternoon. We accept that it’s normal for women to crash at menopause. What I’d like to change the narrative around is that it’s really– if you can go through menopause in a healthy way, it’s one of the most exquisite experiences because I personally came into my power at that time. I felt much more confidence, much more ability, much more committed to what I really wanted to do. Yeah, the kids are a little older, they’re not quite hanging on mama all the time, and Mama can like go, “Whoa, what’s next for me?” And I really felt like I stepped into my power. That’s when I really started to move my business in the direction that I wanted my business to move in.

Cynthia: Isn’t it amazing that there’s no coincidence the way our lives kind of the trajectory with which our lives will align with what’s going on in our personal lives? Certainly, there’s no way that I could be where I’m in my business with a two-year-old and a four-year-old and God bless the women that are able to do that, but it was a time in my life where I would not have had the bandwidth to be able to do that. Let’s talk a little bit about what happens and this is important, I talk a lot about brain health, I talk a lot about a great book by Dr. Lisa Mosconi called The XX Brain which for me completely flipped the lid on the role of estrogen, estradiol, progesterone, and brain health. What happens to our brains and what makes women more susceptible to type 3 diabetes as they enter menopause? I know, you and I know the answer, but I think it’s important for the listeners to hear this, because this is why each woman listening needs to be concerned about brain health and needs to be conscientious about lifestyle as medicine entering menopause. Even in perimenopause, recognizing how much our brain cells need to be fueled by things that are, you know, the optimized fuel for brain health.

Dr. Ritamarie: Yeah, this whole type 3 diabetes is relatively new concept these days. When you and I went to school, we learned that the brain doesn’t require insulin. The sugar just gets right in, so there’s no desire, no need. What we’re finding out the latest research is that, indeed the blood, the brain does need it, and the brain does get insulin resistance. Especially, things like the hippocampus, which is that short-term memory focus. A lot of dementia, a lot of Alzheimer’s, and other sorts of dementia where the memory just like plummets down is actually insulin resistance of the brain, which they’re calling type 3 diabetes. So, if you’ve been just going along and eating the jelly beans at Easter and the chocolate whatever is it at Halloween, and then all the pies, and all the cookies at Christmas, and you just think that that’s the normal way of life. It is the normal way of life in the US anyway and it leads to the “normal disease patterns.” So, the brain like neurodegenerative disease is considered like, well, it just happens, right?

Oh, you’re 65, your brain’s just going to go downhill and like my brain’s better than it’s ever been at 65. Even though, I have genetics that should say I should have dementia by now. So, we need to nourish our bodies and our brains throughout life. It’s not just about keeping your blood sugar’s balanced and your insulin levels balanced to prevent heart attacks, which is the leading cause of heart attacks, to prevent the blindness that comes with retinopathy, to prevent the weight gain that comes with insulin resistance, but also to protect your brain. For most people that end up with dementia and loss of memory and if you’ve watched people go through it, it’s worse than physical dysfunction. Because it’s like you’re still in this body, but you don’t remember things and you can’t grasp for the information that you used to. So, I would say, early on, you start with the diet and the lifestyle processes that support this. We’ve been talking about intermittent fasting, getting the sugars out, getting the carbs out, sticking to carbs from green leafy vegetables and other non-starchy vegetables, which are loaded with nutrition, nourishing the brain with things like magnesium, and vitamin D, and chromium, and other things that support a healthy brain and body function.

But also, you touched on this a little bit, but I’ll go into a little more so important is sleep, and stress management, and exercise, but not excess exercise and you touched on, yeah, getting up at five in the morning when you have two little kids and trying to do this heavy-duty workout, and then going off to work, that’s over exercising. But the right amount of exercise helps to restore the sensitivity of those cells to insulin and so your brain and your body cells. It’s going to help your memory, it’s going to help your focus, it’s going to help your weight. So, it’s really just paying attention to all those lifestyle habits. Stress, holy cow, I mean stress in and of itself damages the hippocampus. Cortisol, glunk, glunk, glunk, damages this hippocampus part of your brain, which is important for memory. If you’ve ever noticed that when you’re stressed out and you’re looking for your keys, you’re like, “Where I put them? I had it a little while ago, I can’t remember I can’t remember.” Whereas if you just took a deep breath, and like, “Where did I leave my keys? Oh, they’re over here.” Because you can’t access the part of your brain that does higher level function when you’re in the state where cortisol is stressed out.

Then cortisol, stress hormone, what does it do? It looks for sugar sources in your body because it expects, “Oh, there’s a hungry tiger chasing me. I need to run away.” So, where do we have that? Breakdown some protein, breakdown some muscle cells, go to the liver, breakdown the glycogen stores, and procreate sugar into the blood. But then you’re not going anywhere. You’re sitting at your desk, you’re sitting in traffic, and that sugar then has to be stored somewhere. So, more insulin gets secreted, more insulin resistance, more fat gets stored around the bottom in the waist, especially. So, all of those things are things you can control early on and yeah, one at a time. Take it one step at a time and get them under control.

Cynthia: I think that’s critically important. I did a webinar a few weeks ago talking about sleep and really trying to identify why it’s so critically important, because I think many people think, “Oh, I’ll sleep when I’m retired, I’ll sleep when I’m dead, sleep isn’t important, I’ll catch up on the weekend.” I remind people, I think, it was– the statistics was, if you get less than six hours a night of sleep your ability to control your blood sugar diminishes by up to 60%. I always hear from people, “Oh, I’m genetically special. I don’t need as much sleep.” Well, even the people who have the SNPs, who have these epigenetic markers of genuinely not needing as much sleep, they still need 6.25 hours. So, I remind people like if you’re Martha Stewart person who insists they don’t need any sleep, sleep is one of the most restorative things you can do for your body. The whole glymphatic system, this waste and recycling process in the brain, there’s so much restorative things. Peaks and growth hormone, you miss out on all these benefits if you’re not prioritizing sleep.

And actually, I have a mom who’s retired but had a very, very successful career and I kept saying to my mom, “When you retire, you will lose the weight that you’ve been struggling with because your cortisol is so high.” I knew that that was driving a lot of the health concerns she was experiencing and sure enough, she lost 30 pounds honest to goodness when she retired. But it was one of the best things she could have done for her health amongst a myriad of other things. So, if you’re listening and you think that sleep isn’t important and stress management as Dr. Ritamarie talked about the impact of cortisol, but it also impacts your food choices. As I say all the time, when we’re stressed, we don’t crave broccoli, we’re going to crave junk and it’s going to be the hyperpalatable chips, and cookies, and ice cream, and I laugh because I have teenage boys. If I bring a half gallon of organic ice cream in the house, which they do have probably once a week, I laugh because it doesn’t last long. Even if I were to eat that food I don’t. They eat copious amounts and they can’t because their metabolisms are like hummingbirds. But the point is the lifestyle medicine piece is so, so critically important.

Now, I know that there are some other hidden sources of net impact on insulin resistance. We talked about some of them, stress and sleep. What are some of the other things like the personal care products we’re using or endocrine disruptors in our environment? I tried to get a lot of my guests to talk about these things, so that cumulatively over time, women that are listening or men that are listening will take a little closer look at the items they’re using in their homes or the things they’re exposed to. Let’s talk about that a little bit because I think that it seems very intangible, like people assume, “Okay, I get the food thing.” But what about the fact that I’m using a body lotion or I’m spraying perfume on my body or where I get my water from? How could that impact my hormones and especially your degree of insulin sensitivity?

Dr. Ritamarie: Yeah, so that’s a great question and it’s estimated. I don’t remember the exact number but somewhere in the hundreds of exposures to endocrine disruptors that the average person, mostly women, because they use more of them, but men are still exposed to a lot before they even leave the house in the morning between whatever’s in the air, whatever’s in the off gassing from their floorboards and there, what do they call that stuff, sheetrock, right and the paints and all that. And then, you’re slathering on all this stuff. If you read the ingredients, many of those are known endocrine disruptors. Meaning, they latch on to endocrine receptors. Remember, we talked earlier about endocrine receptor resistance is one of the, I think, it’s one of the most overlooked problems in our world and it affects the insulin receptors. It affects the ability of the cells to actually recognize insulin and take the sugars into the cell with it which increases the blood sugar and the level of insulin resistance. But it’s not just insulin. It’s related to estrogen, it’s related to progesterone. A lot of infertility is now thought to be related to the estrogen disruption in our world and we’re exposed to it.

Even if we’re both pretty conscientious about this, but there’s still stuff in our homes. My home was built like almost 30 years ago, and yeah, we repainted, and we put the low VOC paints or the no VOC paints, we took out the carpeting, and we put in bamboo. So, we’ve done a lot and we don’t use any commercial products. Yet still, there’s stuff. There’s still stuff, right, and we need to be careful about that. So, I look at it as control what you can control and just bless the rest. Because there’s stuff you can’t control. You walk outside and your neighbor just felt sprayed their trees, and their grass, and you have no control over that. But you do have control over what you use, and the foods you eat, and making sure that there’s none of these in those. So, there’s a list, is huge. The EWG has huge a list of endocrine disruptors in all your personal care products from makeup, your lotions, etc., etc. So, slather yourself with some pure organic coconut oil if you need lotion and look for there’s so many more available products, makeup and haircare and all that, that are organic, and that are free of these disruptors. I mean, years ago, when I first got interested in this, it was 35 years ago, there wasn’t much on the market.

Cynthia: I’ve got that and it’s interesting because I’m married to an engineer. So, his mindset is always I have to see the research and we were talking about we’re in this new home and what filtration system are we going to use? And so, I was coming at it from the angle of, do you realize that every woman that’s on oral contraceptives urinates into the water supply, and the water supply does not filter out these synthetic hormones. And so, you think about the net impact like yes, anything, most of what we use is organic, or it is pasture raised, or it’s wild caught. But when we think about water, we think about it being so benign. But the recognition is that there are no municipal water supply companies that I’m aware of that filter out hormones. So, we are all getting passive exposure to synthetic estrogens and progestogens, and I just think about the net impact of that alone is potentially catastrophic. So, when we think about the degree of PCOS, and infertility, and early sexual maturation in children, I’m hearing about eight and nine-year-old girls who are starting to have their menstrual cycles, poor things. And then, also young men who are maturing early or having breast bud development or getting you know more feminized development than masculine development, it just makes me scratch my head.

I know that we both have all boys. And so, from my perspective, it just really makes me look a little more thoughtfully at everything we’re exposed to. For anyone that’s listening, if that just sounds like woefully overwhelming, start with one thing. I always say. it’s like this domino effect. Once you know, you can’t unknow and so then you make the changes. But I can tell you it didn’t start with me changing everything all at once because for a lot of people, myself included that would be financially impossible. So, you know better, do better. So, it’s been slow and steady increments over the last 10 plus years. But on so many levels, I think that the awareness you mentioned EWG, which is Environmental Working Group is a great resource. They have a lot of resources both with personal care products, but also pesticide exposure that you get from even some varieties of fruits and vegetables. So, it is important to just be making yourself aware before you start diving down the rabbit hole. I would say, once you dive down the rabbit hole, you can’t come back out.

Dr. Ritamarie: No.

Cynthia: And that’s both good and bad. I think I view the world very differently now than I did when I was graduating from nursing school, I think in 1998. Certainly, back then, I viewed the world a whole lot differently than I do now.

Dr. Ritamarie: Yeah. You know it’s interesting because of the kids and also If you have kids, it’s hard to just like suddenly take everything away from them. My kids grew up from the time they were born with this crazy mama who didn’t know all this stuff and but it’s still interesting because by the time they got to be like teenagers and they wanted to wear deodorant. And I would say, “Well, here’s the seventh generation or the natural deodorant and they’d be like this stuff doesn’t work. I need Axe or whatever, my friends have it.” I’m like, “But it’s full of endocrine disruptors.” So, you have to just choose your battles sometimes, too. But I’d say, “If you’re going to use that stuff, you need to keep it outside and use it outside because I don’t want to smell it. I don’t want to smell you coming out of the room because I don’t want my body to be disrupted by it.” I try to educate them but so go slowly because your family members will revolt, if you suddenly yank out everything out from under them and say, we’re going clean now.

Cynthia: Yeah, well, I was laughing that my son had minor surgery this morning, and when he was coming back, and he’s six feet tall. So, we got him into the car, and as we’re driving home, he’s slurring his words, and he’s appropriate, he’s awake and alert– somewhat alert, and he says to me in a slurred way, “I want Chick-fil-A.” I was like, “Clearly–

Speaker 3: What can I say, I wanted some chicken from Chick-fil-A.

Dr. Ritamarie: [laughs]

Cynthia: Oh, I have to say, I was like clearly, he’s not in the right frame of mind, but it was just as fine, my husband and I had a good laugh over that. Now, I want to be super respectful of your time. Let my listeners know how to connect with you. You have incredible resources on your website, you have a lot of amazing books. One of the things that I really appreciate and value about you is that you are constantly putting out new ideas and ways that you can serve your community. Certainly, if you’re interested in plant-based keto, the things that Dr. Ritamarie has on her website, the recipes are delicious. You were talking about cabbage. Cabbage is probably one of my favorite vegetables to consume. In fact, I’m thinking about, I have eggroll and a bowl that’s made in the refrigerator that will probably be my dinner this evening. But how can our listeners connect with you, how can they learn more about you, and how you can serve the community?

Dr. Ritamarie: Absolutely. So, my main website is drritamarie.com. I also have a lot of resources for health practitioners. So, I train health practitioners who are looking to get into using natural means, doing functional lab testing, and learning how to use nutrition. I have an insulin resistance practitioner training and all that. So, if you go to drritamarie.com, if you reach me out on Facebook, I have two different pages out there. The Dr. Ritamarie page and the other is the Institute of Nutritional Endocrinology page. Podcast coming next month

Cynthia: Yay.

Dr. Ritamarie: Oh, baby, I’m excited. Yeah, we’re doing the podcast next month and I got a YouTube channel. So, there’s a lot of great information out there and I do put a lot of free information out there and have books and all that kind of stuff.

Cynthia: Awesome. Well, it’s been a pleasure to connect with you outside of our other community. We will make sure that we drop all of those links in the show notes and we’ll obviously have to have you back.

Dr. Ritamarie: Awesome. It’s been so much fun. I love talking about this. Thank you so much, 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.