The Neurobiology of Insulin Resistance: Impact on Mood & Cognition

I'd like to welcome everybody to today's presentation on whole person counseling, stress, vagal tone and metabolic health. I'm your host, Dr. Donnelly Snipes. We all have clients who are stuck, they're fatigued, irritable, having chronic pain. And our talk therapy tools are helping, but just not quite enough. It may not be a lack of motivation, it may not be that the tools are inadequate to address certain things, but it could be that they have a disregulated nervous system. As I talk about a lot because of things going on, quote, under the hood, when the stress response stays on, it triggers a cascade and which can lead to insulin resistance that makes emotional regulation and cognitive functioning extremely difficult. We've talked in the past about how when we're in fight orf flight, when our stress response is activated, our body is shunting blood glucose to that ability to fight or flee. So it reduces the amount of blood glucose going to the prefrontal cortex. All of our organizing, thinking, rationalizing, that kind of goes into the crapper while we prioritize getting safe. So it's harder for people to think clearly when they are stuck in fight orf flight. Unfortunately, when people start to develop insulin resistance, they actually create a situation where their body is constantly feeling like it's in a vulnerable state because it's not getting enough glucose into the muscles and into the cells. Today we're going to look at the impact of cumulative stress, will explore the bidirectional relationship of insulin resistance and mood and cognitive issues. We'll ident identify symptoms of metabolic issues and mental health, explain blood sugar regulation mechanisms, differentiate between types of diabetes, and then finally explore interventions. So some of the main points, because today obviously we're talking about medical stuff or physiological stuff, which is not necessarily in everybody's wheelhouse. But what I want you to think about as we're going through today's presentation is that cumulative stress across all pieces of life that's physical, interpersonal, emotional, cognitive, environmental and spiritual, can contribute to the development or worsening of insulin resistance and diabetes. When people are experiencing cumulative stress, that stress response stays on. The body keeps dumping blood sugar. The liver and pancreas keep trying to help manage what's going on and it feels like it's not working well. Insulin resistance and unstable blood sugar further trigger the stress response. Insulin resistance and unstable blood sugar cause many symptoms of mental health issues, including fatigue, irritability, emotional disregulation, anhedonia, low motivation, increased aches and pains, sleep changes, brain fog, cognitive slowing, racing heart shakiness, and cravings for both high sugar, high fat foods and for some people for substances. And we're going to talk about how that happens in a couple of slides. Helping people understand the connection between stress, chronic stress, their blood sugar regulation and their symptoms often demystifies some of the neurophysiology and empowers them to make positive behavioral changes. I've said so many times that any positive change in any of the pieces of life that helps reduce stress is likely going to have positive effects on all the other pieces of life. So if somebody feels stuck with where they're at with handling the cognitive stuff right now, okie dokie, let's pivot and let's look at some other interventions that might be useful. Tools that help reduce stress in any of the pieces of life will help stabilize blood sugar and improve many symptoms. So what we're really doing, the crux of it is we're helping people rebalance their autonomic nervous system so their parasympathetic, their rest, digest and repair can turn off the stress response, the fight orf flight, their sympathetic nervous system. That's what we're doing. It's, there's no magic to it. Why are we talking about this though? Well, because as you already saw, a little bit insulin resistance and that is what is going on even before somebody becomes pre diabetic or diabetic. But insulin resistance can contribute to the development or worsening of a whole host of symptoms that are also symptoms of anxiety, depression, PTSD, etc. So we want to understand what, what's going on. We also recognize that people who are coming to us have often been experiencing trauma, depression, anxiety, anger, stress for a long period of time. So the proportion of people that present in a clinic setting, mental health, present from mental health services, the proportion of those people with insulin resistance and diabetes is actually higher than in the general population. However, in the general population, type 1 or what they call juvenile onset diabetes affects about 0.6% of the population or 2 million people. Now they are seeing a significant increase in the diagnosis of type 2 diabetes in children. So that's something else we're not really going to hit on a lot today. But it's something to think about. What, why is it that children are now developing? I think the number I saw was 10 to 15% of new cases of diabetes in children are actually being diagnosed as type 2. Why? What happened? Type 2 diabetes is the one that we typically think of when we think of adult onset diabetes. 14.7% of US adults are now living with diabetes. 23% of adults with diabetes do not know they have it. So 23% of that 14 don't even know they have it. So you very well may be working with somebody who is diabetic, pre diabetic or insulin resistant and have no clue that that could be contributing to their symptoms. Okay, I guess I did put it down here. Type 2 diabetes accounts for 10 to 15% of all new diabetes diagnosis diagnoses in the youth population. Type 3 diabetes. Now we're going to talk about what these are in a minute, but just let's get through the stats. 1/2 to 1% of people in the general population have type 3 diabetes. But 25% to 40, 50% of those with chronic pancreatitis have type 3 diabetes. When we talk about insulin resistance now, that's what people generally develop before they develop pre diabetes and then diabetes. It's a progressive illness. Approximately 38% of all adults, or almost 100 million people, have pre diabetes. Forty to 50% of U.S. adults have some degree of insulin resistance. And again, that's in the typical population. That is not in the population of people who are already struggling with chronic stress, chronic pain, chronic illness. Now let's switch over to addiction, because addiction is a huge stressor. Addiction to any of the substances has been shown to significantly negatively impact pancreatic functioning. Alcohol addiction prevalence, about 11% of people. Cannabis addiction, 7.3. Opioid addiction, 3.4% of U.S. adults may have it. Cocaine addiction, point 5%, amphetamines and methamphetamines, 0.7%. So we're getting these numbers, obviously from the National Institute of Drug Abuse and the cdc. I personally think that the numbers are relatively low compared to what is actually happen happening in the population. But that is my perception, that is my feeling, not necessarily a fact. I'm curious, those of you who work with substance use populations, do you think these numbers are low? I also put compulsive gambling and gaming disorder here. Do those directly attack the pancreas? No, no, they don't, because they're not a toxin, so to speak. But compulsive gambling and gaming disorder, sex addiction, your behavioral addictions increase dopamine. When we flood the system with dopamine, that's a stressor. You're going to get a rush of blood sugar when you're detoxing from or recovering from the compulsive gambling. Gaming disorder when you can't get access to it and you want to use, you want to play and you can't that's a stressor. So people with behavioral addictions also have chronic stress related directly to their addiction. Now, a lot of people don't really understand insulin resistance and diabetes and all those things. I mean, we hear the terms, but let's talk a minute about what insulin resistance actually is. So think of every cell in your body as a tiny little house that needs fuel. In this case, it's glucose to function. To get inside the house, the glucose has to get in the door. The body produces a hormone called insulin, which knocks on the door. So glucose can be let in. They walk up, or it walks up and knocks on the door. I don't think it actually walks. But I digress. When you're stressed, the body dumps a lot of glucose and insulin. So the blood sugar's flowing and the pancreas is secreting insulin and saying, hey, let's get this sugar through the door. Let's give this body plenty of energy to fight or flee occasionally. It's not bad. It's kind of like, I don't know how many of you have subscribe and save, but on the day that my subscribe and save orders are supposed to be here, they never arrive all in one truck. So it's just constant knocking at the door, dogs going nuts, etc, but once a month is not the worst thing. But if it happens every day, eventually I just stop listening. I'd stop paying attention. If the door is knocked on too often, the cells are bombarded too often by insulin. If the door is knocked on too often, the people inside the house ignore the knock and the door's not opened. So the glucose just sits outside going, well, I'd like to help you, like to fuel the process, but I can't get in. To compensate, the body sends more insulin to knock louder. So now you've got insulin knocking on the door, knocking on the windows, trying to get the glucose in. Finally, glucose gets in. But the people in the house are getting tired of opening the door. So this is where we see insulin resistance starting to develop. The level at which the body quits listening. It just says, nope, we're not going to respond to insulin anymore today. Eventually, insulin can't knock loud enough and the glucose is left sitting in the bloodstream instead of getting inside to provide energy. So you see a lot of people with insulin resistance have really high blood sugar levels because that sugar can't get into the cells. In type 2 diabetes, this is adult onset diabetes. The residents have become so exhausted by the constant knocking that they've essentially put on noise canceling headphones, they're just like, no, not opening the door so the glucose can't get in at the same time. The pancreas has worked so hard for so long producing insulin. To knock on those doors and it's too worn out to make more. It's just like, you know what, it ain't going to work. I don't have the energy to make any more insulin. So it's a double whammy. Not only can the glucose not get into the cells when the insulin knocks, but the insulin levels start to become depleted because the pancreas just can't keep up. Because the doors stay shut, the glucose piles up in the bloodstream, causing damage to your system. High blood sugar is what is implicated in a lot of peripheral neuropathy, including hearing loss. You've got nerves in your ears that help you hear and high blood sugar contributes to damage to those. Type 1 diabetes is an autoimmune condition. It's typically called juvenile onset diabetes. And in this case, the body destroys the beta cells in the pancreas. These are the cells that produce insulin. So the pancreas just can't produce insulin. It's like the factory was demolished. We know that stress is going to worsen autoimmune issues. Type 3C diabetes, who knew it existed? Well, you're learning something today. Maybe it's caused by physical damage or loss of the pancreas rather than autoimmune attack on the beta cells or simple receptor unresponsiveness. Common causes of type 3 diabetes are alcoholism and drug abuse. When people are ingesting these substances, it's toxic and it also causes chronic stress, genetic mutations. Okay, you can't get around that. I had a colleague in graduate school who had chronic pancreatitis. She didn't drink, she lived a very healthy lifestyle, she didn't use drugs. But she struggled with really horrible pancreatitis flare ups and you know, she would be in bed for a couple of days at a time. She likely had one of those genetic mutations. I didn't ask her why it was flaring, but I'm going to extrapolate. High triglycerides are also implicated in causing pancreatitis. And then further, as when the pancreas is inflamed, it can't produce insulin as effectively. What causes high triglycerides? Insulin resistance. So as people become more resistant to insulin, it the body can't handle the lipids, the triglycerides as effectively, so they start to build up. This can be damaging to the pancreas as well as the liver medications. And this is an important one because a lot of our clients are on medications, antipsychotics, beta blockers. These are typically blood pressure medications. Corticosteroids, like prednisone. A lot of people may do short courses of corticosteroids, but some people are on them chronically. And estrogen, if they're on hormone replacement therapy or if they're on hormonal birth control, these medications may increase triglycerides, which may start causing chronic pancreatitis, which then causes the person to have more difficulty handling blood sugar. Hypothyroid liver dysfunction, and again, chronic stress. Chronic stress is going to increase. Every time you get stressed, your body dumps blood sugar. Every time that blood sugar goes up in the body, insulin is recruited to get it into the cells. If that system is not working, then blood sugar is going to go up. If somebody's under chronic stress, they're going to become likely insulin resistant, which is going to start spiking their triglycerides, which may lead to chronic pancreatitis. So it's not a. We have to dig down and ask what is causing this? And not just take the superficial answer at face value. Autoimmune pancreatitis is also a cause of chronic pancreatitis. It's his whole own issue type. Type 1 diabetes is an autoimmune disorder that specifically attacks the beta cells in the pancreas. Autoimmune pancreatitis attacks the whole thing. So people with autoimmune pancreatitis are going to. When they have flares of their autoimmune disorder, that pancreas is going to flare right up. And this is another one that's really important, I think chronic hypercalcemia. And that means having too much calcium in your blood. Where does that come from? Well, generally, if you're just eating a normal diet, you're not going to have chronic hypercalcemia unless you have a problem in your parathyroid gland. Some people have a condition called hyperparathyroid, and when they have their blood test done at the doctor, their calcium levels are off the charts. They start looking for it. This is, in general, usually an easy fix medically, but we also have people who take a lot of supplements, and a lot of supplements also tend to include calcium. So you may be taking antacids, you may be taking a multivitamin, you may be taking something else that has calcium in it. And then, because this is the thing now, it seems Everybody's telling you to take magnesium to sleep. Well, a lot of the preparations that have magnesium in them that are supposed to help you sleep also have calcium. So you're getting like a quadruple dose of calcium, and the body just doesn't know what to do with that. So calcium levels go up, it starts aggravating the parathyroid gland and can contribute to the development of chronic pancreatitis. Over time, that chronic pancreatitis, that chronic inflammation starts causing damage to the pancreas, so it becomes less able to handle blood sugar, which is where you get type 3 diabetes. Now, the one thing I didn't put on here for type 3 diabetes is those who have their pancreas removed for some reason. And that also qualifies as type 3 diabetes because it had some sort of physical damage or, or it was taken out and it occasionally happens. So let's look at the symptoms that are caused by insulin resistance. But remember, most of our symptoms are bidirectional. So circadian rhythm disruption. Circadian rhythms help set, tell our body when to process sugar. Generally, first thing in the morning, our body is better able to handle sugar. It's more sensitive to insulin than later in the evening. If our circadian rhythms get out of whack, then the body doesn't plan for how to handle blood sugar as well. But they found that the stress of being insulin resistant can also disrupt circadian rhythms. The stress of being insulin resistant and circadian rhythm disruption can also disrupt sleep. They found that people who had there was a correlation between regulation of blood sugar or glycemic regulation and sleep quality. And people who had the. The worse the glycemic control was, the worse the sleep disruption was and the more likely the person was to start showing signs of sleep apnea. I thought that was kind of interesting. Blood sugar instability can be caused by insulin resistance. Well, you. Your body is resistant to insulin, so you've got high levels of blood sugar in your system. Eventually enough insulin may come in that suddenly everything goes into the cells the body has a hard time managing. Once you become insulin resistant, it's kind of a crapshoot whether the door is going to get opened or not and how much glucose is going to get let into the ship, into the cells, chronic pain and neuropathic pain. And I'm kind of going to jump down and touch on neurotransmitter imbalance as well. When we're stressed, our neurotransmitters change. Serotonin and dopamine particularly are influenced. And when Serotonin levels drop, our pain threshold also drops, we actually feel more pain. Likewise, people who have chronically high blood sugar because they're insulin resistant typically have more pain, neuropathic pain, that pain in their feet, in their nerve endings, in their hands and it again hearing loss that's caused by hypoglyce, hyperglycemia or too much blood sugar. Now when you've got chronic pain that's freaking stressful. So that bi directional loop, all of these things not only can be caused by insulin resistance but they're all, all these symptoms are stressful and will further worsen insulin resistance hormone imbalance. Our gonadal hormones when we're stressed are in a very different balance than they are when we are not stressed. So we start seeing changes in estrogen and testosterone levels, dhea, etc thyroid hormones when people are stressed. And we talked about this a few weeks ago, when people are chronically stressed, eventually the body has a built in braking system that says you know what, there's no point in continuing to use energy on this. We're burning through too much energy. So it's puts the brakes on the thyroid system. That's called reverse T3. Reverse T3 goes up under chronic stress and that can lead people to having feelings of hypothyroid. If someone is insulin resistant that's chronic stress which will eventually potentially trigger an increase in RT3. The nice thing is a lot of these things are reversible when the stressor is removed and the autonomic nervous system is rebalanced which is why we're going to talk about vagal tone later then you have less chronic stress and a lot of thing, a lot of these things improve, they may not get completely better. If the person's all the way over in pre diabetes or diabetes may not be able to get back to know perfectly healthy but we can certainly help them mitigate what's going on and slow the progression. Overtraining is another issue that causes insulin resistance because it's very stressful on the body now. Yeah, medication side effects, we already talked about some medications earlier but it's important for us to recognize that insulin resistance so once we've gotten to that point that insulin can't get the sugar effectively into the blood cells. Insulin resistance is a pro inflammatory state. So when your body can't handle that glucose, when your blood sugar starts to go up, you start seeing systemic inflammation throughout the whole body including the brain. So we start seeing neuroinflammation too. So insulin resistance is a pro inflammatory state. That interacts with cellular signaling pathways which can influence how drugs are metabolized or how tissues respond to them. So when people start becoming insulin resistant, pre diabetic or diabetic, they may respond to medications differently than people who are insulin sensitive, if you will. And that's really important to recognize. That's not something that we as non prescribers are going to get down into the weeds with, but we need to hear and recognize and validate when somebody's saying, well, my doctor prescribed this and ever since I started taking it, I feel like crap. Well, you need to go back to your doctor and talk about that. You need to advocate for yourself, especially if they already know that they are pre diabetic or diabetic. That's, you know, one of those things that the doctor may not have factored in. I hate to say it, but it's true. Unless they're going to an endocrinologist, a lot of doctors don't, didn't get much training in nutrition, didn't get a whole lot of training in insulin resistance per se. So they don't think about it much until it's flagrant diabetes. Many drugs also increase insulin resistance. A lot of our patients are on these drugs. Obviously we're not going to tell them to stop taking them. That's unethical. But we do want to be aware that if our clients are on one or more of these drugs that their likelihood of being insulin resistant and the likelihood of some of their symptoms being caused by insulin resistance increases dramatically. So statins, those are your cholesterol medications, your beta blockers, blood pressure atypical antipsychotics, oral contraceptives, decongestants, some antidepressants and immunosuppressants, those are very, all very common medications anymore. Immunosuppressants have gotten a lot more popular or prevalent as the number of people in our society have developed autoimmune disorders. So people who are on immunosuppressant medication for things like psoriasis may have more difficulty regulating their blood sugar. Now, hopefully their doctors monitoring this other things caused by insulin resistance, fatigue. Well, if the sugar can't get into the house to power it, then the house is not, the house is going to be tired. So that makes sense. But then when we're fatigued, what do we do? We drink coffee, we stimulate that system, we trigger the stress response. She says as she drinks coffee. Anyway, the fatigue is both caused by insulin resistance and can cause insulin resistance when we are sleep deprived, when we are physically tired, our Body perceives that as a vulnerability and will dump more blood glucose and will increase the stress hormones to kind of help us stay awake and alert so we don't get attacked by that hungry lion. That's the primitive part of our brain that says, hey, when you're asleep you're not, or when you're fatigued you're not as aware. So I need to help you stay more alert, more hyper vigilant. Golly, thanks shakiness. I think most of us have experienced this when our blood sugar has dropped and people with difficulty controlling their blood sugar, sometimes their blood sugar just drops like a rock and you get shaky. It feels like a panic attack. I don't want to invalidate people's experiences of panic attacks by any means, but I do want to explore whether a drop in blood sugar or a significant rise in blood sugar maybe accompanying or worsening their experience of their panic attacks, confusion and brain fog. We already talked about this. When people are insulin resistant, this glucose can't get into the cells. Well our prefrontal cortex where we do our higher order thinking and reasoning that is made up of cells. And if it can't get the blood glucose into the cells to power our thinking, it's going to be hard to think likewise. I don't know about you, but when I've had periods like a couple weeks ago when I was just completely foggy, it was frustrating as all get out because I literally would be in the middle of a sentence and forget what I was saying and I would get irritable. That's a spike of that blood sugar. And as we're working with clients, we can help them become more aware, more mindful of when they're starting to get frustrated and then make a decision at that point do is this worth spiking my blood sugar? Is this worth worsening this condition, attention deficit, that's regulated in part in that prefrontal cortex. When we have ineffective blood sugar regulation, high blood sugar and low sugar in the cells to do their job, we can't pay attention. High blood sugar is considered by the body a stressor. So we are going to be in fight or flight. We're going to be focused on know, trying to survive, not doing math problems or whatever we're supposed to be doing. Eating changes. When people are insulin resistant, they often their cells are still starving. There's plenty of glucose in the bloodstream, but it ain't getting in there. So their cells are starving and the brain says hey, we need more fuel. So people tend to still have cravings for, for high fuel foods. So you may see eating changes and cravings, food cravings in people with insulin resistance. Likewise, eating changes, especially if people are eating a lot or eating highly processed foods that spike the blood sugar, those can contribute to insulin resistance. So again, it's a bi directional thing. Cells aren't getting the sugar they need. The brain says, give me some fue. What do we reach for? Something that's high sugar generally, or high fat and highly processed. That spikes blood sugar, which is not what we want, and can worsen the insulin resistance indirectly. Insulin resistance can cause hyper vigilance, especially in people with a trauma history, because it keeps us in a stress activated state or a sympathetic dominant state. And when we're in that state, we don't feel safe. When we don't feel safe, we tend to be more hypervigilant. Emotional dysregulation tends to be more prominent in people with insulin resistance. Why is this? Well, because the blood sugar isn't getting into the prefrontal cortex, which is where we override our amygdala. So they can be feeling flat or okay or blah or whatever. They're generally not feeling great, they're there and then they go from flat to furious like that. Because the prefrontal cortex isn't contributing any information. We're just running off of the amygdala's belief that there may be a threat. So the stress response is triggered like nobody's business. And insulin resistance can cause depression and apathy. There are significant correlations between dopamine levels and our ability to effectively manage blood glucose. So as people become more insulin resistant, their dopaminergic system starts to go more offline. Insulin and dopamine systems work together to orchestrate motivation and reward. So if your insulin system is offline, then your dopamine system can't do it by itself. So we start having less motivation, we start feeling more apathetic. Reductions in circulating glucose can activate reward related brain areas. So as I said, when the glucose levels are are low, when the cells aren't getting glucose, the brain will kick in and say, hey, we need reward, we need energy. In people with addictions, when in people with active addictions, this can also trigger the reward pathway for the substance, whatever that substance is, improving brain glucose metabolism. And I thought this was a fabulous study. If you work in addiction treatment, I would encourage you to click on this link in the PDF and actually read the study. But improving brain glucose metabolism, stress hormone regulation and monoamine transmission, including dopamine, can reduce cognitive Deficits, impulsivity and potentially cravings and relapse risk in substance use disorders. Well, if we help the body better handle its energy reserves, if the body is not constantly dumping stress hormones or just bathing in stress hormones, then our monoamines, our neurotransmitters are going to be better balanced and we're going to have less distress. So yeah, I mean, I think this is definitely something that we can look at in relapse prevention to help people recognize that it's not just stinking thinking that's going to bite you in the butt. We need to pay attention to all these other stressors that may be making it harder for your body to handle blood sugar and fuel itself in a healthy and effective way. So let's talk about interventions. Circadian rhythm stabilization, the mnemonic is least. Circadian rhythms are typically set by our light levels. Bright in the morning dark at bedtime, when we eat, and there's a German word for it, but basically when we eat helps anchor our circadian rhythms. Eating at the same time every day. Now I eat my first meal at 7am, I eat lunch ish at 10:30 and then I eat my dinner at between 2 and 3pm every day. Now that's not when most of y' all eat, but that's okay because my body has adapted to that and it knows it said it. Circadian clock to respect that activities, your routine, your body respects routine. And after a trauma, one of the first things that we encourage people to do is get back to their routine as quickly as possible. Why? Not just because we need them to feel a sense of personal power, but also because your circadian rhythms impact every cell in your body. And if people's circadian rhythms get off, then they're going to feel more vulnerable, more stressed, etc so having that sleep routine, having those activities relatively stable. But the sleep routine is super important. Where you're doing something generally similar every night, telling your body hey, it's time to start winding down. Stress. Well that's pretty self explanatory. We want to help people reduce their stress prior to bed. So the last hour and a half, two hours in the night, trying to encourage them to avoid things that are going to stress them out. Whether it's stressful TV shows or paying bills or whatever it is trying to create that last two hours as a down regulation time and then temperature. We sleep best when it's cold, cool, and we tend to be more alert when it's warm. Paying attention to sleep hygiene, doing things to improve the person's ability to not only get to sleep, but to stay asleep and have quality sleep. I have multiple videos on sleep hygiene, so I'm not going to belabor that one. Improve vagal tone to reduce stress and inflammation. This is one of the things that most people aren't aware of, and it's one, one of the things that we can really teach. Vagal tone. Your vagus nerve is basically the gateway to your parasympathetic or your rest, digest and repair nervous system. When people engage their vagus nerve, and this is oversimplified, but when people engage their vagus nerve, it tells the body, hey, we can relax. So what does the vagus nerve help us do? It slows heart rate. It slows breathing. It helps trigger the release of the relaxation chemicals and rebalance us away from those stress neurochemicals, improving vagal tone. I encourage people periodically throughout the day, they can get one of the little pulse ox monitors, slip it on their finger. You know, it's easy to keep in your briefcase or your purse or whatever, and just a couple of times a day, take a little mini relaxation break, slow their breathing while they watch that number because they want to bring their heart rate down to baseline. That's one way to start improving vagal tone. You're basically exercising that parasympathetic nervous system, doing the same thing. When they experience some sort of stress, they can go on a walk around the block or a walk around the office and then sit down and try to bring their heart rate back down. Waiting until they are emotionally or cognitively stressed. Probably not the best idea, because then it's harder to engage. Sorry, y'. All. Prebiotics and probiotics. Fiber, fiber rich foods and fermented foods feed the gut microbiome and actually do help stabilize insulin levels. When people eat a meal that has fiber in slows or buffers the insulin spike afterwards. So including fiber in meals can be extremely helpful at reducing the impact of carbohydrates on the person's insulin or blood sugar levels. Eating antioxidants, very helpful. And again, something else that I regularly recommend. Having three colors on your plate at every meal. Red, orange, green, and blue colors have all been shown to reduce inflammation and oxidative stress. So it reduces internal stress, which reduces overall stress, which helps get us out of a sympathetic dominant state or a stressed state and into a relaxation state. Now, eating an apple is not going to make you feel all chill, don't get me wrong. But providing the body with these antioxidants that can help clear out some of the oxidative stress and help reduce inflammation is over time a very beneficial step. Plus most of these things have a lot of fiber in them. Neat is non exercise activity thermogenesis. People who, like my mother in law, she doesn't exercise per se, but she is constantly puttering around the house, she's constantly cleaning, she's constantly doing things and that is considered non exercise activity because you're not engaged in some sort of formal exercise. However, whenever we use our big muscles, it helps get the blood sugar out of the bloodstream and into the cells engaging in light exercise. And I know for many people exercise is a bad word, which is why I put out, put neat out here you don't have to get into training zone. There's a lot of benefits to doing it. But let's just talk about insulin resistance right now. Let's move, let's do something to move. But doing some light movement, even if it's doing dishes and putting them away after dinner, actually helps buffer the insulin spike after meals. So it's beneficial. And intermittent fasting, this is one of those things that's newer I think to industrialized societies because a lot of people eat, snack, graze throughout the day and our body's really not meant to handle that. Cuz every time you eat your blood sugar goes up, your insulin goes up and so you're constantly knocking on those doors. The body's not really meant to handle that 16, 18, 20 hours a day. And I know when I was in college I would be having a snack at 10 o' clock at night. You know, I get it. However, they found that if you can give your body a 12 hour respite from having to deal with insulin and blood glucose, that it actually is very beneficial for moderating or improving the body's ability to handle handle blood glucose and it actually improves insulin sensitivity. Not everybody can do intermittent fasting if you're, you know, obviously always check with your doctor before you change anything about what you're eating or how often you're eating. But it is interesting to note that intermittent fasting can be beneficial. So eating your last meal at 6pm and then not eating breakfast till 6am has a whole host of benefits for improving your insulin sensitivity as well as your circadian rhythms and other things encourage people to reduce interpersonal stress. We're trying to reduce all kinds of stress because stress increases blood sugar, increases insulin, increases the knocking. So we're going to address attachment and abandonment issues. We want to improve boundary awareness and maintenance and that's boundaries in all parts of life, physical boundaries, self explanatory, interpersonal boundaries. How much you share in relationships, how quickly you develop trust in relationships. Everybody has their own boundaries there, emotional and cognitive boundaries. My thoughts and my feelings are mine and nobody has a right to tell me how to think or how to feel. They can share with me how they think and how they feel, but they don't have the right to tell me how to think and feel. And then environmental boundaries, that's our stuff. Feeling safe that people aren't going to come into our office, come into our room, come into our home and start ravaging through our stuff. Everybody has a right to boundaries. And when we don't have the sense that we have safe boundaries, if we don't feel like we can protect our boundaries, then we feel unsafe. And what is the definition of trauma? Feeling unsafe and powerless. We want to make sure that people understand that they have multiple types of boundaries and help them develop skills to maintain those boundaries, which often go down to the next one. Involve assertive communication, telling people, hey, you know, I don't mind loaning you my sweater, but I would appreciate it if you would ask me and not just go into my closet and get it. Or you know, you get the point. But helping people learn how to effectively and assertively communicate and reduce mind reading. And normally I put this under cognitive distortions, but it's so important in interpersonal relationships because I'm seeing it, interestingly enough, increasingly I'm seeing this where people engaged with others and I assume if I'm mind reading, I'm assuming I know what you're thinking. So then I'm going to respond to what I think you're thinking. Well, that creates all kinds of problems and usually a lot of misunderstandings. But the other one that's becoming more and more prominent is expecting mind reading. Well, I shouldn't have to tell you because you should know no. Or getting my feelings upset, hurt, getting upset, getting angry because somebody didn't do something that for me that I wanted them to. Well, did I tell them if I didn't, if I expected them to read my mind and know what I wanted? I'm setting myself up for distress. So we do want to really emphasize that with a lot of our clients that, that it's unfair to expect people to read our minds. Even if you've been together. My husband and I have been together for 30 years, literally. And I don't expect him to read my mind. I have to ask for what I need and it's not that he's insensitive, it's just, you know, humanity. We want to help people reduce intrapersonal stress. That's that self esteem, feelings of self worth, feeling of being safe in our own skin. Using Fit cat the facts in this context at this time to examine and restructure if needed, our core beliefs and our messages from our inner critic. A lot of people we work with have a really nasty inner critic. So when that inner critic starts screaming at the top of his lungs, okay, let's hear what you have to say. And then I am going to evaluate the accuracy of that statement based on fitkat. Is my inner critic actually on point or is it echoing something that I heard from somebody a long time ago? And we want to enhance self efficacy, helping people focus on what they can do when. What can you do to improve the moment right now? What is one thing you can do starting today to improve things? It's not going to turn the world around, but is those small steps are very additive. And helping people recognize that and chart it. So over the course of time they start seeing that, yeah, you know, six months ago I was way back here. You know, each day may not feel like a huge step forward, but then when they look back over a month or three months or six months, they're like, wow, how much progress I've made. Help them improve life satisfaction with hardiness and your rich and meaningful life. They actually found that people who had higher life satisfaction had better insulin sensitivity. Help them use the concept of hardiness that was proposed by Kabasa way back in the 70s. Commitment to the things that are important in their rich and meaningful life. Encouraging them to notice both what is going wrong, which we tend to do pretty easily, but also notice what is going right. And that's the part we typically forget. We focus on all the things that are going to heck in a hand basket and we don't notice all the wonderful things that may be happening. Control making a conscious choice to use our energy to address the things we can that are important in our rich and meaningful life and accept those things we cannot control in our rich and meaningful life. Because you know, there are a lot of things that are important and, and I've talked about, you know, our dog Brewster before he is an elderly dog, he has bladder cancer and yeah, that sucks. And I could stew and be miserable about that fact or I can use my energy to address what I can and that's making sure that he has the highest quality of life he can. And I can enjoy the time with him that I've got left, however long that is, so I can make. I'm controlling how I'm using my energy and challenge. Reframing problems as obstacles or challenges instead of seeing it as a barrier that I can't get past. Obstacles you can get over, around, under, through, somehow you can get around them. That's why we have obstacle courses or view them as challenges. It's like, okay, well how can I best deal with this? Encourage people to practice 20 minute positive focus. 20 minutes a day. I generally suggest during a meal because, you know, who doesn't want to feel happy during their meal? But focusing on the things that are going right that day, the other 23 hours and 40 minutes. If they want to focus on how the world is falling apart, that's their choice. But 20 minutes of positive focus actually can help balance out. Encourage them to engage in behavioral activation, that is doing things that bring them a sense of contentment, joy, gratitude, connection, some sort of a positive feeling. Now, if they're clinically depressed, don't expect them to feel happy, but encourage them to do things that are important in their rich and meaningful life. They that bring them some sort of satisfaction, you know, doing something. And it may only be 5 minutes, 10 minutes, it may be texting a friend because they don't have the energy to get out of bed. Okay, you know, let's look at what you can do to literally activate those positive neurons. Enhance emotional intelligence with idea, another mnemonic, teach our clients to identify what they're feeling. They start feeling it and it's like, okay, what am I feeling? Last night I woke up in the middle of the night with something just short of a panic attack. I don't know why, but I woke up and I noticed I was breathing really quickly and my heart was, you know, beating really fast. And I was like, okay, this is weird. I identified the feeling. I down regulated. You know, I looked around, I'm like, I'm safe. Okay. So I slowed my breathing and got to a place where I was more regulated. Explore the cause of the feeling and the associated facts and solutions. I sat there for about five minutes. You know, it's one o' clock in the morning. I'm not going to spend too much time on this thinking about what in the world is causing this. And I came up with some ideas. But ultimately I realized that, you know what, there's nothing I can do about this right now. My best course of action is to use my energy, if you will, to go back to sleep. And that's What I did. And so identifying, down, regulating, exploring the cause of the feeling, the associated facts and solutions act and assess address cognitive distortions with feel. Yeah, there's lots of mnemonics today. Explore these distortions with the facts in the current context. Exceptions to what's going on at alternate explanations. Besides it being me or the worst possible thing and the likelihood that something bad's going to happen. When we're emotionally reasoning, we're often not focused on facts. So focus on the facts of what's going on. The availability heuristic is focusing on what is most prominent in our mind, even if it's not the most frequent. Like, I just finished flying on an airplane. You know, some people are terrified of flying because it seems like planes crash a lot. They really don't. So the availability heuristic says flying's dangerous. Facts say, no, not so much. The likelihood of a plane having a problem is pretty minimal. Personalization. It's all about me. It's all my fault. I did this. Okay, what are some alternate explanations based on the facts in this situation? You see where I'm going with this? Looking at catastrophizing. Well, the worst thing, the sky's going to fall. That's catastrophizing. Well, what is the likelihood that that's actually going to happen? Minimizing the positive. A lot of our people are really good at minimizing the positive because they're kind of waiting for the other shoe to drop or they feel bad about themselves, so they, you know, minimize the good things and the successes they've had. So let's look at the facts in this context at this time and take credit where credit is due. Mind reading. We already talked about all or nothing thinking if this always happens or never happens. Well, let's look for exceptions. When is it that this person has paid attention to your feelings? Instead of saying, you never pay attention to my feelings. Well, maybe they have sometimes. Let's look for exceptions. And overgeneralization is putting somebody or something into a bucket with every other thing that you think is like them. Like saying all dogs are aggressive and dangerous. That's overgeneralization. We want to help reduce environmental stress, increased stress hormone levels, reduce sensory gating, our ability to filter out stimuli, so everything seems to be more bombarding. And it heightens our sensitivity to sensory input. So not only are we getting more sensory input, but it feels louder. Encourage people to pay attention to their environment, the sights, things that may trigger them in their environment, good and bad. You know, add the good things things that trigger empowerment and safety. Lighting, glare, darkness during the day, whatever that adds stress. Smells, noise, temperature and toxins. All of these can significantly increase stress in our bodies, which will increase blood glucose, which will increase insulin resistance over time.