Today I have the honor of connecting with Temple Stewart! She is a registered dietician specializing in low-carb dieting for women’s weight loss.
I have spoken on the stage with Temple several times over the last year, and she is delightful! In this episode, she shares her background, and we dive into how she was able to reverse her PCOS and Hashimoto’s by adopting a low-carbohydrate ketogenic diet. We discuss food psychology, woke nutrition, whether or not “if it fits your macros” is a good philosophy, issues surrounding the traditional allopathic nutrition model, and challenges related to nutrition research. We also get into plateau busters and share five ways to measure success other than the scale.
“We need to open our eyes and be more open-minded about preventative care and understanding that there are a lot of tools at hand.”
– Temple Stewart
IN THIS EPISODE YOU WILL LEARN:
- How Temple transformed her life by using nutrition as medicine.
- Which foods tend to provoke inflammation in the thyroid gland in women?
- How people’s relationships with food play into the work Temple does.
- Temple shares her thoughts on woke nutrition.
- Temple dives into some of the big issues with the allopathic nutrition model.
- I share some interesting statistics related to American health.
- How creating consumer awareness will hopefully lead to consumers demanding more for their health regarding food supply and health care.
- Why is it so challenging to do nutritional research?
- Temple shares a starting point for addressing weight loss resistance.
- What carbohydrate reduction or restriction does for us metabolically.
- The benefits of following a carnivore diet.
- Why do we need to read food labels and become aware of where sugar may sneak into our diets?
- Temple shares her favorite ways to break plateaus.
- Five ways to measure success other than the scale.
Connect with Cynthia Thurlow
Connect with Temple Stewart
Metabolical, by Robert Lustig
Cynthia Thurlow: Welcome to Everyday Wellness podcast. I’m your host Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
Today, I had the honor of connecting with Temple Stewart. She is a registered dietitian specializing in low-carb dieting for women’s weight loss. I’ve had the opportunity to speak on several stages with her in the last year. She’s absolutely delightful. We dove deep into her background and her history of PCOS and Hashimoto’s that she was able to reverse with adopting a low-carbohydrate ketogenic diet. We discussed food psychology, Woke Nutrition, whether or not if it fits your macros as a good philosophy, the issues surrounding traditional allopathic models of nutrition, challenges related to nutrition research, weight loss resistance, plateau busters, and five different ways to measure success other than the scale. I hope you will enjoy this conversation as much as I did recording it.
Welcome, Temple. I’ve been so excited to connect with you.
Temple Stewart: Yeah, I’m so honored to be here. Thank you. I’ve listened to your podcast, so it really is a delight to be able to be on it.
Cynthia Thurlow: Yeah. We actually met in Las Vegas last year at the Keto event and then our paths crossed again in Austin and then again in New York City. So, I feel really fortunate to have interacted with you in three different locations at three different events. I’d love for you to share with listeners a bit about your background. So, for everyone that’s listening, you are a registered dietitian, but you’re also in Naturopathic Schools. You’ve now relocated to another part of the country. And I love your story. You really have a pain to purpose story, how you yourself healed your body with nutrition along that journey with a couple of different little bumps along the way. Things that kind of got you focused on looking at nutrition as medicine.
Temple Stewart: Yeah, it’s been quite the journey, but I feel really honored to have walked it because I think it really helps me when I’m having clients with real life problems and I can say, “I’ve been there, I understand what that feels like.” It all really started probably my second year as a student dietitian. I was following all the guidelines and to become a registered dietitian, we’re obviously taught the conventional dietary approach, lots of whole grains, limited red meats, the typical stuff that we all know. And so, I was following that and I was just getting sicker and sicker and bigger and bigger, and I was having more and more hormonal issues and I was so baffled because I’m doing what I’m being taught, yet I’m having all these issues and I really can’t solve it.
That’s when I started jumping around diet trains, tried veganism a little bit, tried all these things, that ultimately led to a PCOS diagnosis when I got down to the root of it. And I was told nothing about my diet, I was literally handed metformin, spironolactone, and birth control and told to move along and to let this OBGYN know when I was ready to get pregnant, he would send me to a fertility clinic. I was 21 at the time, maybe 22 at the time. I’m thinking I’ve been healthy my whole life. I’m a Division 1 soccer player. Like all these things, this can’t be happening to me and I’m not going to take this as an answer. And so, that’s really ultimately when I started to do the deep dive into what can I do to heal my body naturally.
I started reading books. Why We Get Sick by Dr. Bikman, The Obesity Code by Dr. Fung, and it completely transformed my life and it also transformed the way I was acting as a dietitian because I wasn’t seeing results with my veterans either and my patients either. And so, it was a huge journey but ultimately I’m thankful for the PCOS diagnosis because I don’t think I would have ever found low-carb keto without it.
Cynthia Thurlow: Yeah, and it’s really interesting. We’ve had Dr. Felice Gersh most recently here talking about PCOS and her book PCOS SOS is, I think, truly the best book written talking about PCOS and really looking at is stemming from inflammation and oxidative stress and insulin resistance. This is the piece that I think so many clinicians are missing with these young women. I myself didn’t realize I had PCOS until I tried to get pregnant. I remember my GYN, who was on top of things, clearly we’re charting and she could see that I had this luteal phase defects and not enough progesterone and she said, “I bet you have PCOS.”
The kind of conventional way of dealing with PCOS prior to conception is contraception, oral contraceptives, the pill, and then still not fixing the root cause. And then you go on to take, or at least I did, I took Clomid and did IUI to get pregnant and still didn’t realize that insulin resistance, even though I was thin. They missed these diagnoses in women and it really sets them up for a constellation of long-term problems. It’s my understanding that you also were diagnosed with Hashimoto’s. How many young women and middle-aged women for that matter, have Hashimoto’s and you were able to successfully reverse that, put it into remission with diet alone, which I think is incredibly encouraging.
Temple Stewart: Yeah, I was. They were kind of back to back and I forget that one because I reversed that one kind of first, but yeah, it was PCOS. Some of the symptoms I was still struggling with were the fatigue, my hair was falling, just all the typical thyroid stuff. Again, kind of the same thing of like, you’re going to just need to go on Armour, levothyroxine, and there’s no dietary patterns that can fix this. At that point, I had already basically reversed PCOS. I was kind of like you know what? I’ve done this once, I’m going to do it again, and started doing the research with that too.
Within a few months, my antibodies were down below 9, which is where they should have been. I was feeling fantastic better than I had felt in years. That’s when I really got not frustrated, but I was just like, “How many other women are out there who spend years and years and years of suffering, not living their best life, because they don’t know that they can take control of this and really fix it on their own.” I’m not saying conventional medicine isn’t helpful or medication isn’t, but it absolutely isn’t. It has a place, but ultimately, nutrition, lifestyle, some of these things are more powerful in a lot of ways.
Cynthia Thurlow: Absolutely. What do you find in your given patients right now? What do you find in terms of inflammatory foods, foods that will provoke inflammation with their thyroid gland? I have a couple that I usually recommend women stay away from in particular, but I’m curious to know if they’re the same that you say.
Temple Stewart: Yeah, definitely gluten would be top number one and some of the cross reactives for gluten. And so, a lot of women just have no idea that that can be so damaging for any autoimmune, really. That’s usually the first thing I’ll say, “Look, if you’re going keto anyway, it’s pretty easy to get rid of this one or low carb.” So that’s one of the first ones. Sometimes I see my women have some issues with dairy as well, and of course, your typical seed oils. The more and more that keto has gotten popular, we know that these seed oils are in all these keto products.
A lot of times it’s just adjusting diet in terms of, “Okay, yeah, you’re following keto, but you’re still eating a lot of these inflammatory seed oils through these keto fake foods.” That’s a really helpful one for them to switch off as well. But I would say gluten, dairy, and then the seed oils tend to be like my top three. And then really with Hashimoto’s, as you know it’s very helpful to get rid of a lot of the toxins, stop drinking tap water. We could probably go on and on about some of the more, “crunchy things” to do to help that, but I just see a huge improvement with just gluten alone half the time.
Cynthia Thurlow: Yeah, and it’s interesting how gluten is snuck into our diet so innocuously. That’s why I think it’s important to read those food labels, ask questions, because we probably, even if we are excluding gluten from our diet. We get passive exposure in restaurants or eating at friends’ houses. And so, I’ve got to the point now where I just tell people, if I go to a restaurant, I just say I have an allergy and then they take it a little more seriously.
Temple Stewart: Yeah, 100%, I do the exact same thing. It really is the passing on the plates, the passing on the grill, everything you can be exposed, especially when you’re not in control of the cooking, etc.
Cynthia Thurlow: Absolutely. And so, let’s pivot a little bit and talk about food psychology, because I know in your work and certainly in my work that the psychology around food is incredibly impactful. When we’re looking at our relationships with food and how we perceive food to be, some people look at food as fuel, some people look at food as comfort. I’m sure that we probably share very similar populations that we work with, but some of the food rules that people grow up with or dietary constraints or their food relationships, how does that play into your work?
Temple Stewart: Oh, I mean, it’s a huge portion. I feel it’s very difficult. Diet may be the single handedly most difficult thing to change in a lot of people, because it truly is ingrained into the culture, the way that they were raised, people have happy memories and sad memories, and it all can come back to food and food behaviors. So, yes, it’s absolutely something we can address. It’s one of those things that there isn’t like a blanket way to address everyone all the same. We always have to look at the individual. What have they gone through? What were they raised like? What culture were they in? Have they experienced childhood trauma around food? Did something happen to them that causes them to use it for comfort?
It’s like a very investigative process of figuring out each individual’s kind of main driver of what their food behaviors. I really encourage my clients to either get help with this or some great food therapists and people that really specialize in this that can really dig deep, but also just telling my clients, “Look back on your life. Where did this problem arise? What happened to you? Did you experience any trauma? Where do you think this started to become an issue and then treated at its root cause?” Because there’re tons of strategies of hack this and a tip for this and that’s all great, but until you really address some of the root issues, whether that’s low self-esteem, low confidence, all of it, it’s important to fix that first, especially if you want long-term results.
Cynthia Thurlow: I think it’s really important for people to just be honest with themselves and fully transparent. I find when I’m really digging in deep with clients and patients, when they start sharing about how they were rewarded with food growing up or maybe they didn’t have the support system they needed from their parents or their loved ones. And so, food was something they could do in secrecy and private that made them feel good. I’ve had women describe carbohydrate dense foods as feeling like they’ve had a hug. So that serotonin boost, at least temporarily. It’s really understanding that, working with practitioners that are going to take the time to get a good history, that are really going to talk to you about your relationship with food, I think is a really important first step.
Temple Stewart: Yeah, absolutely. It oftentimes is really eye opening for clients too because they’ve struggled with this problem but haven’t really thought about why. Yeah, I think that’s the first step in creating a long-term success in a client.
Cynthia Thurlow: What are your thoughts on Woke Nutrition? Things like if it fits your macros.
Temple Stewart: Yeah, as a dietitian, I get trolled a lot on this in Instagram and TikTok and stuff because I don’t believe in it. I think it can be really damaging. I think things like if it fits your macros for especially a diseased individual that may be struggling with Hashimoto’s or diabetes or anything, I think it can be a total disaster. Same thing with the movement that’s going around that you can be healthy at every size. Yeah, you can. There’s a chance that you are healthy, but to say that to everyone, there’s going to be a significantly more majority that’s not healthy at every size. So, yeah, there’re several different dietary methods in this Woke Nutrition platform right now that I think are really creating a disaster.
A lot of the times I’ll get clients that have tried them and have gained 30, 40, 50 pounds, their A1cs have gone up three points. And it’s just like, whoa we need to be able to be honest enough with people that, yes, it might be uncomfortable, but I think we can do it in a loving way where we tell them the truth in efforts to help them, not to hurt their feelings or be disrespectful. To me, not being open and honest with someone is the least loving thing you can do. Especially about their risk, their health risk and all of that. So, as a dietitian, I feel a little bit like I’m the black sheep of the family when it comes to this because I don’t buy into it, I don’t promote it. That’s where a lot of nutrition and dietetics has moved, is don’t ever make anyone uncomfortable. It’s okay to have everything in moderation. Sugar isn’t going to cause that much problems and it’s just not true and ultimately, I think it harms people in the long run.
Cynthia Thurlow: No, I think it’s such a good point and it’s interesting. There’s one individual who I will not call out on Instagram, who every Saturday buys a big thing of donuts. This individual says, “This is my higher carb day and I’m going to eat all these donuts.” That’s fine because this individual is metabolically flexible. But the people that are watching these stories and watching this, if it fits your macros, I think it’s destructive. It’s not to suggest that you don’t have a higher carbohydrate day if you’re carbohydrate cycling, but you’re going to get more from whole foods source carbohydrate than you are from this highly processed, hyperpalatable, seed-laden sugar bomb. The other piece that I think is important, and I say this often, is if you can’t moderate, then you eliminate.
There are people like, I can eat a piece of dark chocolate. I cannot just eat a cookie or a piece of cake. Like my brain, when it gets that flour, even if it’s a gluten free flour product, my brain goes. “More, I want more, I want more.” It’s much easier for me just to not have those things in my home. Of course, around the holidays, I will have a piece of pie, I will have a piece of cake, I will get rid of them afterwards. But I think it’s important for people to understand that whole concept of if it fits your macros, I think, it’s particularly destructive. Being healthy at every size, I agree with you. Being respectful and direct and honest and forthright with our patients and clients is so critically important. And then really understanding that finding an alternative.
Like, I had Mark Cucuzzella on this past week and he’s so funny. He was saying, “Get 90% dark chocolate and I can guarantee you it’s so rich you can’t eat more than one square.” And so, really understanding the less sugar that’s in something, the less addictive, the less dopaminergic, the less dopamine pleasure seeking behavior will come out of that. I think that’s important to make that distinction.
Temple Stewart: I 100% agree and I love that you mentioned the moderator versus abstainer aspects, because it is true. A lot of people don’t know what they are. They don’t know if they’re a moderator or abstainer, but they’re really abstainers. They keep falling into that binge cycle. It’s like, “Well, this is why is because you don’t do well with these foods as an abstainer.” I think that it’s a huge concept that’s good for people to understand as well.
Cynthia Thurlow: Yeah, absolutely. You and I are the byproduct of the traditional allopathic medical model. We both openly talk about the fact there’re a lot of good things that our traditional model does. We are superlative with emergencies. We are superlative with surgeries. We don’t do such a good job with prevention and chronic disease management. What do you think are some of the big issues with the traditional allopathic nutrition model?
For everyone that’s listening, understanding that registered dietitians really are at the crux of being nutrition pros, like, within that model. I know when I was rounding on patients and I call for a nutrition consult with the RDs in the hospital, some of whom more aligned with us and then many of whom who are not, and we can talk about my registered dietitian that suggested my patients eat six bananas a day. And I was like, “No, no, no.”
Temple Stewart: Well, I think yeah, this is a huge topic. I think one of the biggest issues is just time itself. The way that conventional medicine has moved is we can’t really expect a lot of these doctors and nurse practitioners and all these people to be able to do preventative care like you said. They just don’t have time. The sheer amount of patients that they’re being forced to see for payouts and all of that is just, I mean, it can barely fit into words. And so, to expect them to do preventative care and treat the problem at hand, I think is a lot of pressure. I do believe that there are great doctors and nurse practitioners and dietitians out there. They just simply don’t have enough time and/or the patient themselves are just not interested in it. They’re in the hospital for some reason. They may or may not have taken care of their health and they may or may not be interested in preventative care.
So, I think there’s a huge time, money issue there as well. And I completely agree. Conventional medicine has saved my daughter’s life. It’s fantastic for emergency medicine. I think we need to open our eyes and be a little bit more open minded about preventative care and understanding that there’re a lot of tools at hand. There’re people like you and I. There’s so many great professionals. And I think conventional medicine needs kind of a come to Jesus meeting. Like, let’s use these people. We don’t need to feel the pressure of preventative medicine. Let’s send them out. Let’s start reimbursing these professionals that care about preventative care. I think it starts much deeper than probably what I’m scratching the surface of but, ultimately too I think there’s a lot of responsibility that comes down to the patient themselves. I don’t think that it’s a medical professional’s job to create motivation and to change people’s lives that don’t necessarily want it.
So, I think it starts ultimately with the patient themselves of where’s your motivation, give them the proper education, and then ultimately they’re the ones who are going to put the practice into the lifestyle. So, yeah, I could go on about conventional medicine probably more than you’d like, but I think ultimately, the more that we prop up conventional medicine and help people understand that you don’t have to live this way. Diabetes is reversible, PCOS is reversible and then getting those patients to the providers that can help them is a huge piece.
Cynthia Thurlow: Yeah, it’s interesting. Working in cardiology for 16 years, we had patients who were on 50 plus medications between cardiology and all the other specialties that they saw. And to me, it was always disheartening when I had to add more antihypertensives for blood pressure, had to increase someone’s insulin in the hospital, had to add more medications for their dyslipidemia or their lipid disorders. And I used to always try to get the conversation back to, we really could work on lifestyle. More often than not, my patients would say, “Cynthia, I’m not going to stop smoking, I’m not going to exercise, I’m not going to change my diet, so just give me the prescription.” I would always kind of be like, “Okay, this is the patient’s choice.” I’m trying to educate them. But I agree with you wholeheartedly that it really has to stem from the patient intrinsically wanting to make changes so that we can help facilitate that process.
As I was preparing for this podcast today, I wanted to just share with listeners some statistics that I was looking at. We are the 35th healthiest country in the world. We are ranked 46th in the world for life expectancy. The net impact of special interests and lobbyists on the USDA and Health and Human Services is undeniable. Robert Lustig had a really interesting quote. If anyone knows Robert, I’ve actually had a podcast with him. He’s this prolific pediatric endocrinologist who has kind of moved away from being in a teaching environment, but wrote an amazing book called Metabolical. He said, “Tasking the government agencies that manage America’s food production with crafting nutrition policy is akin to a fox in charge of the hen house.”
And so, really understanding that in many ways this is a top-down issue, it is not just a clinician issue, patient provider issue, it really stems from a government regulation issue, government policy, which in many ways reinforces some of the nutritional guidelines and recommendations that you and I are not aligned with in many ways. They’re very deficient in protein, they’re very oversaturated in carbohydrates, they incorporate a lot of these but seed oils which are bastardized, the wrong types of fats and so on a lot of levels. When I look at information like that, I find it so disheartening because even good people are trying to work within a system that is really designed to make it harder for us to practice in a way that encourages our patients to really lean into lifestyle as medicine as opposed to the sick care model that we’re really stuck in.
Temple Stewart: I could not agree more. I think absolutely it starts from the top down. As a student dietitian and I don’t want to say the group, but my first large dietetics conference that I ever went to, I was in my first year as a dietitian and I walked in and Coca Cola was there, Kellogg’s was there, Abbott Nutrition was there, all of these different companies that I know were just trash food, like not helping anyone’s health, were huge expos at this certain conference and I was appalled. I was thinking, I’m at the leading dietetics conference in the country and Coca Cola shows up. I couldn’t make sense of it. At the time I was still dabbling in this and I wasn’t a mature dietitian. That’s when I knew. I knew that there was something more to this, to follow the money there’s got to be something going on. And I think you’re 100% right. I think there’s a lot of responsibility on the higher ups that they’re just not being accountable for.
Cynthia Thurlow: Yeah, it’s unfortunate and certainly probably not in my lifetime is this all going to be solved. But my hope and intention is that we are creating greater awareness, the consumers will start demanding more for their health, not just in the food supply overall, but demanding more in terms of health care. I think many of these things are confounded by poor quality nutrition research. I know I was listening to you on another podcast and you were talking about some of the issues with nutrition research overall. So, maybe that’s a good place to kind of pivot a bit because I would be remiss if we didn’t address this. I mean, almost every day, I’m sure you are getting DMs about it. I’m getting DMs about epidemiologic research or research that’s really not great quality and people trying to draw conclusions from that.
Temple Stewart: Well, yeah, and I saw you post on your Instagram about that newest intermittent fasting article that came out that was just a hot mess. You’re right, it’s very challenging to do nutrition research. One, because people just don’t remember, a lot of nutrition research is done off of food journals or how many times a week did you eat red meat and you fill in a little bubble. Well, nobody remembers barely what they ate for breakfast, much less what they’ve eaten seven days ago. And so that’s one of the issues. A lot of times nutrients aren’t pulled apart separately and studied. They’re studied in combinations. And so, red meat gets demonized, but nobody asked what they had with the red meat. They had fries and a beer.
It’s these types of implications that cause a lot of problems because there’s no real way to can keep it super controlled, especially because people, one, probably aren’t willing to even do it because it’s not going to be pleasant for them and people aren’t willing to give up their habits. A lot of nutrition research on that just erroneous on the way that they gather their data. The other thing is, a lot of it is sponsored just kind of going back to what we just talked about, it’s sponsored by these big corporations, Coca Cola, Kellogg, and you can make a study bias very easily. You can pay enough money to make them come out with the outcome that you would want. So, that you see that quite a bit too. And so, I do encourage my clients. Look, they send me research all the time. I easily scroll down and see, “Oh, well, this is funded by these big brands.” Of course, it’s going to come out with whole grains are the best thing you can do for your body. Those are kind of my two biggest challenges to nutrition research.
There’s virtually no money spent on it. If you look at what spends on pharmaceuticals, it is not even close. Nutrition research, there’s barely a drop in the bucket money wise and there’s really no motivation for them to spend money, I don’t want to say they don’t want, but sick people aren’t profitable– I’m sorry, sick people are profitable. To heal them with nutrition isn’t very motivating. So, I think that’s some of the problems with nutrition research and yeah, it’s messy when you get to start studying food and people’s habits.
Cynthia Thurlow: Well, and I think it’s hard because most adults, at least it’s been my experience years ago when I worked at a research hospital, people get uncomfortable sharing what they’re eating. So, they share with you what they think you want them to be eating, as opposed to the fact that they’re really eating foods that are not ideal for them. There’s some degree of lack of transparency. The other thing is people don’t want to live in a controlled environment for the duration of a research study because they want to go back to their homes.
They’re unlike lab animals that are in cages and in a controlled environment, humans don’t want to have that source of conflict or containment or just feeling like they don’t have the ability to live their lives as they choose to. I think that’s probably a greater issue, is people perceive it to be really inconveniencing and therefore it’s more challenging to do the research on top of everything else you just mentioned.
Temple Stewart: Yeah, absolutely it is. I personally wouldn’t even want to live in a controlled environment. So, I get it.
Cynthia Thurlow: No, absolutely not. One of the biggest issues that I see and obviously the bulk of my patients and people that I work with are in perimenopause, the 10 to 15 years preceding menopause through menopause. And so, weight loss resistance is a huge issue, as I know you know. How do we address weight loss, like, as kind of a broad concept? How do we make it sustainable because this is such a big focus. People truly believe they should be the same weight they were at 18 even though their body is not functioning the way it did at 18, they’re not as active, they’ve got all these other pressures and stressors and hormonal fluctuations. So, when women come to you in particular with weight loss resistance and a desire to lose weight. What’s a good starting point for you?
Temple Stewart: Well, the first starting point with me is making sure that they’re working with a provider that can help them sort their hormonal issues if they are there. I hate to see women in perimenopause and menopause suffer through it. I haven’t reached that stage in my life but I know enough to not let people suffer if their hormones are really wacky. And so, I love having people I can refer out to of like look at bioidenticals, look at these things that could be helpful, you don’t have to suffer and there’re supplements and all that as well. But I think number one is setting realistic goals. Like you just said, the whole I want to look like I did when I was a senior in high school.
I think being open and upfront as a practitioner and talking about, well, you do realize that that would take extremely high amounts of restriction and extremely high amounts of time in the gym and all of these things and really laying it out there in a truthful manner of like, let’s set some goals that would make you happy where you would feel good and that’s healthy. But also understand if you really truly want to get down to that weight, it’s going to be challenging, it may not be healthy, it may not be super realistic. And so, I like to be honest about weight loss goals. In general, because of diet culture, people have very, very odd weight loss. I shouldn’t say odd, but unrealistic weight loss goals. They expect to lose 10, 15 pounds in a week. They think they’re going to lose 100 pounds in two months.
It’s like, “No, no, no.” Just because you saw that on the cover of a magazine doesn’t mean it’s healthy and/or realistic at all. For me, first step with those types of clients is understanding and explaining to them that they’re in a challenging second puberty of their life and things are really a little bit challenging hormonally. Number two, is just helping them set realistic goals that they are comfortable with, feel good about and that we can actually maintain and achieve.
Cynthia Thurlow: I think that’s really important and it’s interesting. I used to and I still say one to two pounds a week is really the max. I mean that is sustainable. If you lose 5 to 10 pounds in a week, that’s not sustainable. Interestingly enough, when I was going through the book launch, there was a major publication that will remain unnamed and because I didn’t have specs of lose 20 pounds in two weeks or lose 50 pounds in a month, they were not interested in featuring the book, talking to me, etc. They only wanted these big double digit numbers and it had to be in a short span of time. I kept saying to my PR person, “That’s not realistic, that’s not sustainable, that would be a problem. It would be unethical for me to say that this program is going to do that because that’s not sustainable weight loss in any way.”
One of the things I find with a lot of women in general is we know the RDAs are woefully inadequate, so recommended daily allowances on macros, protein, fat and carbs are woefully inadequate and largely skewed to, this is my opinion, too many carbs, too little protein and the wrong types of fats. I would imagine that’s been your experience as well, that when you’re looking at a diet recall or looking at a food diary, you’re scratching your head and you’re like too many carbs, too many carbs, not enough protein, too many seed oils, all these things that are contributing to this weight loss resistance piece.
Temple Stewart: Oh, 100%. I even tell my clients, don’t look at the percentages, that’s all based off a 2000-calorie diet. Don’t look at it because you’re at a different spot. That’s very confusing for people when they see that percentage and they’re doing that math in their head and they’re thinking, “So, yeah, it is. The RDAs are a mess and old, old, old and needs to be revamped.” Yeah, I just tell my clients just ignore it all together.
Cynthia Thurlow: Do you have a particular food tracker that you like to use?
Temple Stewart: So, Cronometer is probably my number one. If some of my clients do find it a little confusing in terms of some of the numbers because it does give you extremely high amounts of information, I’ll go to something like, Lose It! or Carb Manager, or MyFitnessPal. I find the best ones is just let them try it out and figure out which one they find most user friendly. I love Cronometer when I’m using it with clients just because it’s a wealth of information in terms of a lot of that stuff.
Cynthia Thurlow: That’s actually my favorite because it gives macros and micros. If you’re a data nerd like I am, and I would imagine you are as well, I like more data rather than less. But I have clients say it’s overwhelming to have so much information and so really kind of figuring out for them what works best. Now, I know in your background you worked at the VA, which I had the honor of working with VA patients when I was in Baltimore as well. You started to notice that when you restricted their carbohydrate intake, you were getting results that medications alone were not getting. Let’s talk a little bit about carbohydrate restriction or reduction and what that does for us metabolically.
Temple Stewart: Yeah, I was going through that whole journey with my PCOS when I started implementing the low carb, lower carb, ketogenic, strategic carb, whatever you want to call it, dietary lifestyle with my veterans. We know the veteran population has some of the worst metabolic health in the country and due to a lot of factors, but I was so disheartened as a dietitian because I was giving them the regular guidelines that I had learned, and just nothing was happening. Oftentimes, their A1c would go up when they would eat more whole grains. Imagine that. So, I started using strategic carbohydrate restriction. I can remember I specifically floated as a dietitian in the diabetes clinic often, and there was a dietitian that worked there, and she would always tell me, “Temple, diabetes isn’t reversible. You need to stop telling clients that. You need to stop telling clients that. They’re never going to reverse their diabetes.”
And to me, the definition of reversing is just putting it going back in a disease where you’re getting off medications, your lab values are looking better, and I’m thinking, no, it absolutely is reversible, and it’s really not even– it’s hard to reverse, but a lot of times, people can get off completely off everything. And so, I started implementing it and I was shocked. And the doctors, that the endocrinologists and everyone that was working with some of the same clients, who’s that dietitian, all my clients are getting off their insulin. And I was getting more and more referrals, so many that I couldn’t handle because all of these clients were telling their friends, “Go see the dietitian in the diabetes clinic. Go see her here, because they’re getting off all this insulin and all this medication that was just making them a hot mess and oftentimes more metabolically unhealthy.” So, I found that that was really fun.
I use Virta Health a lot too. Vitra Health really gave me a good understanding of keto, because they did a pilot study in the hospital that I worked at the time. It was just amazing to be able to see a 70-year-old veteran improve his metabolic health tremendously after having diabetes for 40 years. And so, there’s hope, and I think a lot of them are missing that. No one had ever told them, “Hey, you can get off metformin.” I don’t know why you think you have to be on that forever. That was some of the best moments of my career just because I love seeing how happy and how healthy these veterans could get after losing a lot of hope.
Cynthia Thurlow: Yeah, that’s incredible. For anyone that’s listening, type 2 diabetes is lifestyle mediated, meaning it’s the choices we make in our lifestyle that contribute to insulin resistance and ultimately diabetes. I would imagine that was just incredibly rewarding. So, out of curiosity, what was your threshold for carbohydrate intake while they were in the hospital when you were monitoring them?
Temple Stewart: Well, I had to be very careful with this, because not everyone was on the same page. And I’m a lowly dietitian. Like, “You need to reduce the carbohydrate.” But one thing that I found was very challenging– So, my threshold, ultimately, I would start lower, like we would do 75 -ish, and then we would go down based on that. The hospital that I was at treated was sliding scale, so it allowed for me to have some of that power. But I’ll tell you and you probably already know this, one of the problems with dietitians or working as a dietitian in the hospital, is the cafeteria the controls food. I’m over here writing do not put one slice of white bread on the thing. Stop giving low fat 1% milk and the carb-controlled plates.
Half my battle was getting into the kitchen before the patient would get the food and getting the carbs off of it because it was loaded with carbohydrates, even on a carb-controlled diet. And so that’s another problem. They were given way, way, way too high, 35 grams per meal usually are higher than that, 45, up to 65. And so, half my battle was just trying to make it to the kitchen before my veterans got the food. But, yeah, I would say I started around 55, 60, and then would just lower it until we could get the medications down or until they felt comfortable.
Cynthia Thurlow: That’s amazing. Thank you for your revolutionary work because how many people, clinicians kind of go through the emotions every day they’re at work, they’re just not really thinking. And sometimes I would cringe. Here I am seeing cardiac patients, and I’m looking at their heart healthy diet. I’m like, “Dang, there’s a lot of carbohydrate on there.” For anyone that’s listening, the average American consumes 200 to 300 grams of carbs a day. That’s average. And it’s important to understand. I listened to Dr. Gabrielle Lyon’s lecture at KetoCon, I’m sure you did as well and she was talking about, for her threshold is 30 grams of carbs in a meal period, total.
So, really understanding that if we’re giving our patients 60, 90, 100 grams of carbs and they’re in a bed, more than likely, maybe they’re getting up with assistance, or maybe they’re sitting in a chair all day long. They’re not in a position where they’re using up that carbohydrate load. So, you’re wondering why, “Oh, we’ll just cover it with insulin.” The sliding scale, for anyone that’s not familiar with that, you get a range and amount of insulin that you provide, depending on what their blood sugar is. For a lot of diabetics, they just say, “Oh, we’ll just cover it with more insulin. Well, we don’t want that. We actually want the exogenous insulin needs to go down and to be in a position where this can be controlled with lifestyle and diet.
It’s interesting, when I was in the hospital three years ago, out of the 13 days, I wasn’t allowed to eat until, I think, day 11 or maybe 12, then I had to beg the cafeteria to send me– I think I asked for bone broth or chicken broth. I got that. I remember they were very kind to me. I said, “Can you just give me just cut up chicken. I just want some meat. I don’t want anything else.” They kept saying, “You sure you don’t want some starch?” I’m like, “nope,” but they accommodated me, but probably only because my surgeon fought so hard for me to be able to eat the things that she knew that were going to nourish my body. But the average person in a hospital is getting such an enormous sugar and carbohydrate load. There’s very little nutritious food in most conventional hospitals right now.
Temple Stewart: Yeah, absolutely. I mean, juice, we would give juice, chocolate milk Ensure which is one of the worst things you could ever drink. It’s cornstarch, palm oil and water, essentially. We’re giving that as a nutritional shake, it’s bad. A lot of times too not just on the hospital itself, but you’re working with these cardiac and diabetic patients, and then they’re uber eating pizzas and McDonald’s, and so you’re battling that as well. So, yeah, hospital food leaves a lot to be desired, for sure.
Cynthia Thurlow: No, absolutely and it’s interesting. I want to make sure I share my banana story. So, I had a patient diabetic, cardiovascular disease. I think he was a vasculopath. He had diffuse vascular disease, very nice man, was clueless about carbohydrate counting. I referred him to the diabetes educator, came back to me, he was delighted, he said it was fantastic. I met with her. I said, “Tell me what you guys talked about.” He said, “She’s okay with me eating.” He said, “a banana.” I said, “Okay, well, how often are you eating a banana?” He’s like, “Oh, about six times a day.” And I said, “What?” I said every banana is 30 to 40 grams of carbohydrate and you’re already not able to handle sugar properly in your body.
And so, I remember it was this teachable moment trying to explain to him, like, “If you desire to have a piece of fruit, have a little bit of blueberry or a little bit of raspberry.” By that I mean a quarter cup and not every day. It facilitated a very interesting conversation with the dietitian to kind of let her know, like, “You might have said, eat a banana. But I think heard, “As often as I want” and trying to explain to him, if you’ve already got diabetes, fructose, yes, little bit of fiber with that fruit, etc., but it is not benefiting your blood sugars in any way, shape, or form.”
Temple Stewart: No, absolutely. That comes down to understanding your patients, understanding where they are knowledge wise, meeting them where they are and helping them through that, because, yeah, that could have turned into a disaster really quick and not telling what else he could have been confused about. Good for you for catching that one.
Cynthia Thurlow: No, I just remember saying, “How many bananas are you eating a day?” And he’s like, “six”. I was like, “Okay, we got a problem here.” [crosstalk] I know you’re a proponent of keto and low-carb diets. I’m curious, do you use therapeutic carnivore? Do you find that that can be helpful? I know that for me, I was full carnivore for nine months after being hospitalized because my body tolerated zero fiber. And I come to find that sometimes doing of a carnivore reset, even if it’s temporary, can be very very helpful. I’m curious if you’re using that therapeutically with your patients too.
Temple Stewart: Yes, I do. I think it can be really, really helpful. I think it comes down to understanding the patient what’s going on with them. But yes, I’ve used carnivore more times than I can count. For me, it’s not something that I think I would do till the end of my days. But I think if you’re eating mostly animal based products, even if you are, “keto,” I think that that’s the best way to go, that’s the most stable my blood sugars have been, mood, sleep, the whole nine yards is when I’m full carnivore. And so, yeah, I think it can be very, very helpful, especially when people are maybe making the switch to getting into ketosis, but don’t necessarily grasp full keto yet.
I think it’s a pretty easy way to just say, “Hey, look, just make most of your meals meat and you’ll get into ketosis.” So, yeah, I think carnivore is super healthy and I think there’s some very interesting stuff in regards to plants and antinutrients. I think we’re kind of just scratching the surface with a lot of that, just given that there’s very limited research. I do think, though there’s no doubt it’s helpful anecdotally in just seeing everything in my own life as well. So, yeah, I’m a fan of carnivore, for sure.
Cynthia Thurlow: Yeah, and it’s interesting. I have even within girlfriends of mine just suggesting maybe doing carnivore for a week, they’re bloating, their digestive issues go away so effortlessly and easily. For me, I have been humbled at how plant antinutrients whether it’s oxalates or saponins and all these different plant-based compounds, that if your gut health is pristine, you probably can tolerate eating them without issue. But I know for myself, I can tell when I’ve had too much oxalates. I don’t eat almonds anymore, but if I were to go to an event and maybe someone I was sampling something that had almond flour in it’s a very delicate balance. My gut will definitely let me know if I’ve consumed too much.
People that are pushing kale and spinach and celery juice, they’re not intrinsically bad foods. I’m not to demonize any of these things, but if you consume them and you get GI upset and bloating and don’t feel good, it could be that your body just doesn’t tolerate these things or more often than not, I see a lot of women heading into perimenopause and menopause. We’re just coming out of this two-and-a-half-year pandemic plus and everyone has had unprecedented amounts of stress and certainly middle-aged women. I’m not picking on anyone. I’m just speaking the facts. We know that the bulk of our immune system is in our gut.
We know that if we go through traumas and certainly there’s been a lot of traumatic things that have happened over the last several years, it impacts the integrity of the lining of the small intestine, and if that’s breached, makes you susceptible to leaking food particles into your bloodstream, which can drive inflammation and food sensitivities can also make you very susceptible to autoimmune disorders. And I’m speaking from personal experience.
So, when we’re looking at these anti-nutrients and looking at how well our body is assimilating certain types of foods, I think keeping a food diary or just being food aware, being able to make connections. I have to be careful with cruciferous vegetables. I love them to a point that’s probably a little bizarre. I love brussels sprouts, I love cauliflower, I love cabbage. But again, it’s that tipping point. My body will just remind me gently, “Okay, you’re at the tipping point. If you continue to eat as much of this as you are, you’re going to have some digestive issues for the next week.”
Temple Stewart: Mm-hmm. Yeah. When my daughter was born, she’s now two, but she was born, she had a chylothorax, and it was just this traumatizing event. She was in the NICU for a month and I was a hot mess as a new mom and the baby, everything. It was just a mess. I promptly got diagnosed with ulcerative colitis after that because it was so traumatic, I was eating hospital food, all of these other things. And you’re absolutely 100% right. I love that you brought up the stress and traumatic events, because oftentimes people separate that from food. It’s like our health. They don’t understand. And I knew exactly what happened. Yeah, my daughter was just in the NICU for a month, nearly lost her life. My stomach is a mess. I’m a mess. That was one of the uses of carnivore. I went carnivore for a while and it has helped tremendously.
But, yeah, it’s funny, people don’t tend to be mindful about their body until something happens where they’re forced to be mindful. So, if I could say one thing, start listening to things like you’re saying, Cynthia, the bloating, the gas, that stuff isn’t normal. That’s your body trying to tell you something’s wrong or you’re eating too much of this. So, yeah, I couldn’t agree more. I think the almond flour and the coconut flour is one of the issues as well, because a lot of keto foods are going that way. Oh, you can still have your donuts, you can still have your cake, and it’s like, yeah, to some degree you can, but you have to be careful because it will backfire after a while.
Cynthia Thurlow: Yeah, it’s interesting because after going to a lot of keto and low-carb events this year and last year, I’ve been able to look at packages and look at ingredients and politely decline samples of packages or foods that aren’t aligned. Sucralose, as an example, is in a lot of keto, low-carb foods and that is definitely something I try to avoid as much as possible. Thankfully, I’m also dairy sensitive, so I was able to politely decline said product that was offered to me. In your experience, do you find that sometimes people transition from a standard American diet over to keto, paleo, low carb? I mean, gosh, there’s even vegan junk food, but people kind of trade one for the other assuming one is superior to the other but in essence, it’s still the same junk food.
Temple Stewart: Oh, all the time. All the time. Marketing has gotten so good about being making people buy their products with these labeled fat-free, this free, gluten-free. It’s like yes. And so, that is a conversation that I always have with any of the clients that are in my program, is we’re eating real food. We’re eating whole foods. We’re eating foods that you can read the ingredient list and pick out every single thing and you know exactly what it is. Yes, and I think ultimately that doesn’t address a lot of the root causes of their actual eating behaviors, is when you see that.
When you see people go from soda to diet soda and it’s like, “Okay, yes, that’s a step in the right direction,” but ultimately, we’re going to get used to the diet soda and sucralose and things like that. My encouragement to my clients is we don’t want to trade one for the other. We’re making a whole lifestyle change. Ultimately, those things and those types of foods are going to cause problems, too. I think being upfront and honest about that and helping them make the switch and helping them find alternatives that aren’t going to cause problems is a lot of what I do, probably 80%, honestly.
Cynthia Thurlow: I bet it’s interesting. When I was at an event with Vinnie Tortorich in August, and one of the most common questions by the audience that was asked was, “What do you think of monk fruit? What do you think of stevia? What do you think of erythritol? What do you think of this?” He said, “I’m going to just stop everyone and just say it’s still sugar. It may not be conventional sugar, but it is still sugar. If you have a sugar addiction, it’s not helping you, it’s hurting you.” And so that really stuck with me. Actually, my husband was in the audience, so it stuck with him too.
Just understanding how complex that relationship is, because sugar or sugar alcohols or sugar substitutes are proliferative. They’re in all of our condiments, they’re in a lot of our foods. Things that you wouldn’t necessarily think about. Like, my husband was teasing me in a loving way, making fun of me because I wanted to buy this Primal Kitchen ketchup. I was trying to explain to myself, well, there’s no sugar in that. But the Heinz “organic,” but yes, I know it’s in a squeezy bottle, but we want to limit the exposure to plastics as much as we can, does have sugar in it. He was like, “I don’t know what the difference is.” I said, “We want less sugar in our lives, not more.” So, if you do nothing else, just read food labels and just be aware of where the sugar is sneaking into your lifestyle.
Temple Stewart: Yeah, 100%. The more you read labels, the more shocked and appalled my clients. I didn’t know this had this in it. I didn’t know ketchup, our barbecue sauce or honey mustard, I had no idea all these things. You’re like, yeah, now imagine just eating a regular standard American diet, how quickly that adds up. It’s rapid. Some people don’t even make it till [09:00] AM before having 60, 70 grams of sugar. And so, yeah, absolutely.
Learning to read labels will save you money, it’ll save your health, it’s crucial. And learning all the what is it– There’s like 260 different names for sugar. It’s like this is my job as a dietitian to know this, but someone on the street, they’re not going to know what dextrose or maltodextrin and all these other names are. So, yeah, it’s good marketing on food corporation side, but it is the responsibility of the consumer to become educated and figure out, what am I eating, what is this ingredient, what are all these different names.
Cynthia Thurlow: Absolutely. It really makes a big difference. When we’re talking about plateau busting and strategies like your more advanced strategies that you use it with your patients, what are some of your favorite ways to break through plateaus because the questions that came in from most of my followers were about plateau busters and what’s your philosophy about the scale. And so, we’ll get to that too.
Temple Stewart: Yeah, yeah. So, first and foremost, I love fasting. I love different types of fasting. I love some extended fasting, short term– I think fasting is one of the best ways to reset, get things going and break through a plateau. Secondly is resistance training. People don’t understand that your metabolism isn’t broken. You just need more lean muscle mass. And then ultimately hormones too. I think every female should, especially in kind of the demographic of the perimenopause, menopause, don’t take those lightly, have them checked.
I’ll have clients all the time that haven’t had their hormones checked in 15 years and they’re full on menopause and it’s like, “Go get that stuff looked at.” So, I use fasting a lot. I use resistance training a lot. Sometimes I’ll do carb cycling if I think the client is appropriate and their insulin levels are low and I have that fasted insulin number and I know they’re not inflamed, etc. Those are kind of my favorite ways. I’d be interested to hear your method.
Cynthia Thurlow: Yeah, those are all ones that I definitely embrace. Ironically enough, I didn’t sleep great last night, but I made sure I got to the gym anyway to lift legs because I’d been in New York all weekend and I was like, I need to lift weights to help with insulin sensitivity. I would definitely add especially because women in middle age are less stress resilient. Managing stress proactively, like, this isn’t five minutes of meditation once a week. It’s really finding a practice that resonates with you. I do a lot of walking in nature. I have a PEMF mat in my house. I’m not suggesting everyone needs that, but it’s probably one of my favorite things in the world, high quality sleep because sleep in and of itself can be very important for balancing blood sugar, leptin, and ghrelin, so appetite and satiety hormones.
I think about just something really simple like walking after a meal. I really encourage people get out after lunch, walk for 10 or 15 minutes. You don’t need anything special, just set the time aside. Same thing with dinner. Maybe it’s getting dark out at [05:00] in the evening and it feels really late at [07:00] or [08:00] at night. But walk down your street. I actually have a dog leash that has reflective tape on it so people can see us, so that I don’t have to worry about getting run over. I think I also think about being very mindful about macros. This is a time I’ll really encourage people to track. How much protein are you getting, because if you get enough protein, you’re not going to be hungry after you eat a meal.
I was in New York City this past weekend and I went to a restaurant where all of the meat, unbeknownst to us, was soaked in heavy cream. And so, they got very creative and they ended up bringing me a massive burger to eat. After eating said massive burger, I was like, “Oh my God, I’m so full, I’m so uncomfortable.” My husband’s like, “Well, at least I know you’re not going to have any interest in having any type of dessert.” And I was like, “Absolutely not.” So, really getting that protein bolus in with your meals and just being aware of the interrelationship with alcohol, I think that this is a very personal decision.
I myself, during the pandemic, just decided to stop drinking. I’ve never had a problem with alcohol, but it was the only thing that gave me hot flashes and my sleep is far too important. That’s been my assessment of that. But how many people are in this toxic mommy drinking culture where women are drinking a lot of alcohol during the week, they’re drinking a lot on the weekends.
And I had Dr. Lara Briden on this summer and she was talking about how it impairs blood sugar regulation, impairs estrogen detoxification, it impairs sleep quality, it impacts your risk for breast cancer. So, really examining your relationship with alcohol and there’s no judgment. It’s really just thinking, like, if I’m drinking two to three glasses of wine four or five nights a week that can add up and understanding that our body processes alcohol first in the body as opposed to the rest of the food that we’ve consumed. I find that those are usually the low-lying fruit piece that I’ll kind of pull from.
Temple Stewart: Yeah, no, I completely agree. I feel a lot of those people put aside because they’re so focused on, well, what am I eating, what am I eating. And they forget, like, no, you actually still need to sleep and you need to reduce your stress. I just shared something on my Instagram about the toxic wine culture among moms, and it is, it’s so true. That’s one of those things where we need to keep talking about it, because that’s one of those things that we may participate in, sometimes and I love that you’ve given up alcohol. I don’t drink either and I feel great with it sleep and stress wise. But, yeah, those are all spot on, and ultimately, those are the foundations. Sometimes they get lost in the sauce because people are so focused on all these newer strategies and these more sexy strategies, and it’s like, no, but remember, sleep is huge. And so, I think that’s good.
Cynthia Thurlow: Yeah, absolutely. Getting back to basics and last but not least, what is your philosophy about scale?
Temple Stewart: Oh, man. Yeah, the scale, it’s one of those things that you love, but you also hate because it can absolutely help people stay motivated. That is one of the things that people cling to when it comes to motivation. It’s one of the things that, yes, it can be helpful, but when you have a complicated case or you have someone that’s maybe losing more visceral fat and putting on muscle and the scale is kind of staying the same, people will get so discouraged by the scale. I spend a lot of time counseling clients, like, “Look, you need to have more than one measurement of success.” Sometimes the measurement of success doesn’t even need to be a number. It needs to be how my clothes are fitting. Do you feel good sitting down? Are your joints achy? I like to have my clients start off in the very beginning when they work with me, is come up with five different ways you want to measure success that isn’t necessarily hyper focused on the scale.
I’m not saying throw it out, but I am saying that you can’t use that as your only level of I’m doing a good job and success to fail rate. And so, again, I love tape measurements. I love lab values. I love the way people feel. Do they have a libido? Do they have energy? Does their skin look good? Do they feel confident in their mood? I think all of those are great measurements to use when you’re working with the client, and great measurements to understand, is my nutrition plan working? Which is why I love keto and carnivore so much, because it improves all of those things and people typically start feeling great.
But, yeah, the scale is one of those where I think it can be useful in some situations, I think it can be very damaging in others. You have to be really careful with the individual. How often are they weighing? Are they weighing daily? Do they understand that women’s hormones can cause weight fluctuations daily? Those are the types of things I like to make sure people know, especially if I suspect or get some inclination that they hold onto the scale like gold.
Cynthia Thurlow: Yeah, I think the reframe is really important and I think those different ways to measure success is really invaluable. I agree with you wholeheartedly getting a sense for whether or not someone has a healthy relationship with the scale versus an unhealthy relationship with the scale. I’ve gotten DMs from women saying, “My weight fluctuates by 3 to 5 pounds every couple of days.” I’m like, “That is completely normal. It is completely normal depending where you are on your menstrual cycle, or how many carbohydrates you’ve consumed, or how much alcohol you’ve consumed, it can absolutely impact that.”
Well, I could obviously talk to you for hours. It’s been a wonderful conversation. Please let my listeners know how to connect with you. You absolutely want to follow Temple on Instagram. She’s one of my favorite people to follow because her reels are always outstanding. I’m just now getting on TikTok, so I’ll have to follow you there as well.
Temple Stewart: Yeah, same with TikTok. But your reels are fantastic too. But you guys can find me, I’m @the.ketogenic.nutritionist on all the platforms. I’m on TikTok. Instagram is my biggest one. I just got on Twitter recently. That’s a fun place too. My podcast is in the beginning stages, but I’m on Spotify and Apple Podcasts as well there, so I love a follow. I’m really, truly honored that you asked me to be on your podcast and this is fun.
Cynthia Thurlow: Of course, I loved our conversation.
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