Insulin Resistance Changes Everything

I am so excited for this conversation we're having today. It is on all things insulin, insulin resistance, how it impacts diabetes, high cholesterol, how there's, you know, a bidirectional relationship between thyroid and insulin. And honestly, I view insulin as one of the biggest health markers to predict your long term health outcomes. So we are bringing in Dr. Alessia Ronell, a double certified endocrinologist who focuses on metabolic health, insulin resistance and preventative focus hormone care. She blends traditional endocrinology with a holistic, lifestyle centered approach to help patients truly restore their metabolic function, which you all already know I am incredibly passionate about. So I'm so excited for this conversation. Let's dig in.

Foreign.

So I am so excited to have Dr. Ronald on the podcast today. I have stalked her on social media for months and months and begged her to come and she is here to share her brilliance, knowledge with all things insulin resistance, metabolism. Just we're going to go deep today. So thank you so much for being here.

Thank you so much for having me. I'm so excited about this.

I love it. So let's start with the basics because I get this question a lot. What is insulin resistance? If that's the topic we're going to dissect today, let's lay out some foundational information that we can build off of and maybe also talk about, hey, how does insulin resistance, long term, big picture. We'll dig into the nitty gritty later. What do people need to be concerned about for their long term health? Like why is this important?

Yes, so that's a great question. Because insulin resistance is so important to metabolic health, overall health, inflammation, longevity, all of it. So the body generally makes a hormone called insulin whenever you eat something that has sugar in it or you have any kind of carbs. Basically the role of insulin is to take glucose from the bloodstream, bring it into your cells so that that glucose can be used as energy. But what happens when you have insulin resistance is whereas a normal body would need a certain amount of insulin to do that job, if you're insulin resistant, you need a really high signal to do the same job to bring that glucose into cells. And when insulin levels are high, it creates a lot of inflammation in the body. Now, while initially high insulin levels can be achieved, your body can push that insulin level up high enough to do the job of pulling glucose into cells. At some point your body starts to get tired. It is tired of creating that huge surge in insulin and it starts to be unable to achieve what it's intended to do, which is bring that glucose in. So then you start to get high sugars in your blood or high blood sugars, because you can't pull that excess sugar into your cells. And that's when people start to insulin resistance to pre diabetes and then all the way to full blown diabetes. So making sure that you are not in a state of pushing that insulin level up very high is very important to your health. If you are starting to develop insulin resistance, you can reverse that early on. You can start to improve these signals and bring that level lower so that you're not constantly pushing your body into that state. However, if you just let it go, if you just continue to leave that level high, you will ultimately develop pre diabetes and then type 2 diabetes.

Yeah, it's almost like, I think about the increase in insulin is like you're working and you just get more work piled onto you. And for a while you can kind of keep up, but more work more. Eventually it's impossible, it's impossible to keep up. And then that drips into a secondary condition. Right. What would people maybe notice if they were potentially developing insulin resistance? What should they be cued in on to watch out for? And when does that most commonly happen?

So some of the things that as providers, we might notice in a patient, there are a few signs that you can actually find on the body itself. So when people are developing insulin resistance, they will oftentimes develop these marks on the back of their neck. It's a dark line. It almost looks like dirt. And people will come in and say, I've been trying to get rid of this. It doesn't really come off. It's not dirt. It's actually a rash and it's called acanthosis nigricans. And that is a hallmark sign of insulin resistance. On blood work, we can do blood tests to see what the blood sugar is like, what the insulin levels are like, the ratio of the insulin levels to the blood sugar. That can help us as clinicians determine if somebody has insulin resistance. But what the patients often will notice. This is the real hallmark. When I have a patient come in and say these words, I can tell them without a doubt they have insulin resistance. And the main thing is they come in and say, I can gain £5 in a day, I can gain £10 in a weekend. I have been doing really well during the week, eating really healthy, doing my exercises, but if I have a cheat meal or a cheat day, I will gain five pounds like that. And it's not in their head. They truly are so carb sensitive that their weight can fluctuate five to ten pounds within a few days. I've seen it in my office. Patients talk about it all the time. And that is really a hallmark sign that patients may think is normal. Like, oh, this is just my body. This is just my metabolism. I gain weight really easily. But that is usually a hallmark of insulin resistance. And let me explain why. So when you are insulin resistant and you are eating that food that might have some sugar or some carbs in it, and your insulin level doesn't go here where normal is, it goes all the way up really high to try to pull that glucose in. Insulin is also a hormone of fat storage. So when your insulin levels jump up, your body is in a state of storing fat all day. So I often tell my patients, you know, if you start your day with a really high carb breakfast, like a bagel or pancakes, and that insulin level goes up, it's up the whole day. So even if you have a salad for lunch or some fish for dinner, your body is still in the state of storing fat. So that one meal created such a huge signal that it's going to tell your body, okay, even that salad, I'm going to store it as fat. Even that lean fish, I'm going to store it as fat. And that's why people who are insulin resistant can gain weight so rapidly. Yeah.

And I think my listeners are probably like, oh, my God, that's me. And you know, part of that is also secondarily because hypothyroidism creates insulin resistance so early on. I mean, often the insulin resistance, the blood sugar issues will be caught even before the thyroid issues. Like, it's one of the first manifestations of hypothyroidism. For anyone listening, that's like, oh my God, that's me. Those two things so very much go hand in hand. I'm curious too, if you also think that this weight fluctuation that's such a significant thing, because sometimes these people can also lose that weight pretty quickly. It's like water weight. It's inflammatory. Do you think that's because the insulin is circulating and is inherently inflammatory, inflammatory itself, so it's sending off this inflammatory cascade throughout our whole system.

Absolutely. Insulin is such a pro inflammatory hormone. So if it is high and it's chronically high, a lot of people will have chronic inflammation. And that makes you kind of hold on to water weight. That makes other organs in your body not function as well. So you mentioned thyroid disease. Absolutely. The inflammation from insulin resistance can affect thyroid hormones. It can affect how well you might absorb medication, it can affect how well you might convert medication into active hormones. So that insulin level being high is not just doing things to your blood sugar and your weight. It's. It's hitting every organ. We know a lot about this in women who have PCOS or polycystic ovarian syndrome, that insulin resistance can cause issues with ovulation, with ovarian function, with egg quality. And we know when we improve insulin resistance, we actually see improvement in egg quality, ovulation, all of it. And it's not because we're targeting estrogen or we're targeting the ovaries. Just by targeting insulin resistance, we see an improvement with fertility. So insulin is a hormone that we normally think of just relating to blood sugar, but really it relates to every organ in the body.

Right. And I think I want to put in a pin in what you said about thyroid. It's so interesting because hypothyroidism causes insulin resistance. Insulin resistance impacts your thyroid in so many ways. I think it's inflammatory because. So it could influence Hashimoto's, but it definitely influences the activation or the conversion of your T4 to T3, not dumping into reverse T3. So it is like this bi directional thing. And both sides honestly need to be addressed for people to get to their optimal health. Don't you agree?

Absolutely. Because if you look at it from the opposite way, like how you're coming from where thyroid issues can affect insulin resistance, if you have somebody where their thyroid function is not optimized, that is going to affect their metabolism, for instance. And if the metabolism is already not functioning well, that's going to play into how much worse this insulin resistance gets and how much more weight people are gaining and just energy levels, how you're processing things, it all relates. And if you look at it from the other, the other end, this insulin resistance that maybe started first is now impacting how well you can metabolize those thyroid hormones and that's affecting your metabolism. So if you don't look at the entire body, all of these organs together, these endocrine organs, you're going to be missing a big piece of the puzzle.

Right. And that can make the difference between people continuing to suffer perpetually or thriving, you know?

Absolutely.

So tell me a little bit about who. I know there are labs that we can objectively look at to work up for insulin resistance or, you know, metabolic dysfunction. Tell me who should get these? Like, is it a certain population of. I mean, I think thyroid people certainly Should. But at what age should people start checking these labs? And then what are your favorite labs that you feel are most important to look at in this case?

So I think the appropriate age to start testing patients really depends on how they feel as well as their family history. So if you have a very strong family history of thyroid disease or a very strong family history of insulin resistance, type 2 diabetes, PCOS, I think people should really be checked, probably starting in their teens even, because we do see some of these issues start to come out around big hormonal changes, first one being puberty, the second being pregnancy in women, and the third being menopause. And those are huge areas in life where there are so many hormonal changes. That's when things can start to maybe go a little haywire or at least get uncovered, and we can finally detect them on blood work. So I think if there's a strong family history around the teenage years is very appropriate. Otherwise, I would say when people start to develop symptoms. So again, this major weight shift, maybe shifts in their energy levels, shifts in mental fog, concentration, all of that, those symptoms that are a little bit vague, that could point to a lot of different problems in the body, that's when we should start looking for this. If you are just a healthy adult, you feel well, you have no significant family history, I think it makes sense to even start checking in in your 20s, at least by your 30s, because a lot of these things can be very slow to start, and catching them early is so incredibly important to reversing. In terms of blood work, my favorite test, and one of the tests that I think tells us the most about someone, is an insulin level. An insulin level does need to be checked. Fasting, meaning you can't have anything to eat or drink after midnight except for water. Some people will advise patients that drinking black coffee is fine. I am a big proponent that that's not okay, because the caffeine in even black coffee can affect other hormones. Caffeine can cause a spike in cortisol. A spike in cortisol can cause a spike in blood sugar, and a spike in blood sugar will cause a spike in insulin. So even though it's not directly related to insulin, it can affect it. So you have to be fasting just water in the morning. An insulin level is a really helpful tool. If it is high, it signifies insulin resistance. If it is normal, you still might have insulin resistance. You need to look at that insulin level with regards to the blood sugar. If blood sugar is normal and insulin is normal range, like middle normal, range, that still signifies early insulin resistance. Because if you're totally normal and you're very insulin sensitive, when you have a normal blood sugar, your insulin levels should be low, like 3, 4. So if you get a normal insulin level, it says something like 20. While that might fall in the lab, normal range, it certainly is not a normal number with a normal blood sugar. So looking at insulin, looking at blood sugar, and other really important numbers, in my opinion, are liver function tests. So that would be something called your AST and your alt. These are numbers that tell us how well your liver is functioning. And insulin resistance can cause liver problems, specifically something called fatty liver. So if we start to see abnormalities in liver tests, that can key us in even sooner that there might be a problem with insulin or even thyroid. Of course, we would always check thyroid function tests as well as thyroid antibodies to see if anybody has a, an autoimmune component to their thyroid function. A lot of times we will check something called the hemoglobin A1c, because that can tell us if somebody has already developed prediabetes or diabetes. And I always like to also check vitamin D levels. Now, I might be a little bit out there with checking vitamin D on all my patients, but vitamin D is a vitamin, but it's also a really important hormone in the body. Vitamin D will affect thyroid levels, vitamin D will affect parathyroid levels. Vitamin D will affect calcium levels, bone metabolism, energy, muscle, everything. So I always also check a vitamin D level on pretty much all of my patients. And I would say these are the most important tests that I look at when I'm at least initially evaluating someone. And then other tests really depend on other symptoms they might be having or family history.

I love that. And, yeah, it's so interesting, the more we learn about vitamin D, the more we know that it's, like, related to everything. And obviously, it's kind of a pervasive issue that we're all walking around kind of vitamin D deficient. And I love that you said, hey, look, normal is not optimal. And what I want to kind of open up our dialogue to, it's really interesting. You know, medicine deals with very concrete, finite ranges, and we don't often intervene very much until we're in those, quote, abnormal ranges, which are usually quite far from optimal. For example, hemoglobin A1C. You know, hemoglobin A1C is our average blood sugar for 90 days. And sometimes clinicians will tell you, hey, it's good, it's good, it's good, it's good. It's good. Oh, you're diabetic. You know, and what I love about this approach is long before you're diabetic, pre diabetic, you'll see these movements in insulin, you'll see. See these movements in blood sugar, and we can pick up on them five, 10 years ahead of that pre diabetes manifesting. Right, Exactly.

So if you are just waiting for that hemoglobin A1C to hit an abnormal value, you've almost missed the boat. I mean, you really need to look at this much earlier. And the markers that will change first will be insulin and then glucose.

Right. And what's interesting too, is a lot of people don't get their insulin checked. Like, they'll get their hemoglobin A1C checked, and they'll be like, well, it's increasing, but we'll keep an eye on it. And they're just sort of waiting all the while. Insulin could be skyrocketing or already has been, obviously. Right. And I mean, so much of the time, I'm sure your patients say the same thing. They're like, well, I just don't want to get diabetes. Like, I so afraid of diabetes. And I'm like, that's not going to come overnight. We're going to know about that so long before that occurs, and we'll be able to intervene. It's not going to happen that one day you show up here after six months and all of a sudden you're diabetic when we're keeping such a close eye on your insulin, et cetera. I know I have, like, our optimal ranges for Things like Hemoglobin A1C insulin at Modern thyroid clinic, but I would love to hear yours of, like, where should people in an ideal scenario be? I heard you say insulin 3 or 4, but give me your whole spiel on kind of optimal ranges for those so people can better understand where they're where they should be.

Sure. And I will say as a caveat to this again, other hormones in the body can affect your numbers. So if somebody's listening out there and they say, oh my gosh, I had a blood sugar, that was that number one time. And it doesn't necessarily mean there's a problem. For instance, if you have your blood work checked when you're in the emergency room because you're sick, your blood sugar is going to be high. That's actually an appropriate response for your body under times of stress. So when I'm referencing these labs, we're talking about normal situations. You're not Sick, you're not overly stressed. You had your fasting blood work done. You're not on certain medications that can raise blood sugar, like steroids. So, again, we're talking about really ideal environments for checking these numbers. In my opinion, a normal blood sugar is somewhere between 65 to 90. Now, the lab will say a normal blood sugar goes up to 100, and then if you're 100 or over, you have prediabetes. But as you said, it's not that all of a sudden you're normal, and then there's a light switch that goes off, and all of a sudden you have prediabetes. So it starts at these, like, high end of normal numbers. So if you are consistently seeing fasting blood sugars of 92, 94, 98, that would tell me that you are starting to develop an issue with blood sugar. You are on track to develop prediabetes. So whenever I see a patient come in and they've had fasting glucose levels in the 90s, and they've been told that they're normal, I will absolutely challenge that and say, trust me, this is not normal. We have to look into this. As I said, the insulin levels, if generally the normal range for an insulin level is on labs somewhere between 2 and 25. If I see an insulin level with a normal blood sugar over 10, over 15, I'm gonna say, there's a little bit of a problem here. Why is your body trying so hard and pushing that insulin signal to the upper end of normal? In terms of hemoglobin A1C, the lab will say anything under 5.7 is normal. Now, normal does not go all the way down to zero. So it's not like you should be trying to achieve an A1C of zero. But most people, if you have normal blood sugars, will have an A1C somewhere between 4.8 to 5.4, maybe 5.5. But if you have an A1C of 5.6, you're a decimal point away from prediabetes. This is not heading in the right direction. So I look at an A1C 5.6, and I start to get concerned. Even though the lab normal range will say that it's fine. So those are markers that I look at when I'm determining if we need to do more testing, if we need to be more proactive. These are, again, numbers where the lab will say it's normal. Many physicians will say it's normal. But I look at it and think, okay, this is a red flag. Something's going on here.

Early intervention. Quite random. Totally random question for you, but I swear, when I went to PA school, a hemoglobin A1C above 6.0 was diabetes, and now it's above 6.4, I believe. Is that accurate? Did they really expand it that much farther into the diabetic range?

So for many years it's been the cutoff of above 6.4 for diabetes. But it's interesting you bring this up because they do often change the normal range on the lab based on the population in the area. So a good example of this are the liver function tests. Normal range for liver function tests used to be somewhere between nine and 20. Nowadays, if you look at a lab, normal range. At most of the big labs, it goes all the way up to 34, sometimes 45. I've seen at some of these smaller labs. So it's not that we're finding out that it's okay to have liver tests that high. It's that we're realizing, oh, everybody in the area is starting to develop these liver issues. Let's just change the range so people don't feel abnormal. So, absolutely, you can't just take what the lab says as high, normal, or low. You really need a clinician to interpret what's happening with your blood work.

No, I totally, totally agree. And it's. We're adapting our normal ranges based on a sick population. And I say that for thyroid, too, because the same happens with thyroid. Every lab's definition of normal is different, even between same lab, different location. That we don't want to base optimal on a population of sick people going to the lab to figure out what's wrong with them. We want things to be optimal, of course. Tell me a little bit. So let's say someone gets their labs drawn, they see, okay, I'm a little insulin resistant, my blood sugar is creeping up. What are some of the most effective initial things that they can work on? Shifts that they can make in their life to start moving towards the right direction.

So three big things patients can start doing right away on their own without even the guidance of someone, necessarily. Number one is adequate sleep. We really underestimate how important sleep is here. But if you are not sleeping well or getting enough sleep, you are going to have higher cortisol levels. Cortisol is your stress hormone. And higher cortisol levels are going to raise that blood sugar even more, raise that insulin level even more, and cause more weight gain around the belly area. And that's not the good type of weight to gain. So really setting a good bedtime for yourself, an appropriate wake up time and prioritizing sleep is very helpful for blood sugar. Number two is exercise. So muscle really helps you process excess sugar and it also improves your insulin sensitivity. So while walking and things like that can improve blood sugar in the moment, really focusing on an exercise routine that's building up strength and muscle will help you long term in terms of reversing your insulin resistance. So building up muscle is number two, and then number three is a low carb diet. There's no way around it. You can't eat an excessive amount of carbs. If you have insulin resistance, it is going to ruin all of your progress. And unfortunately, this is one thing I'll tell my patients just to make sure they understand the expectations here. You can't have cheat days, cheat meals, and still expect to see the same progress that another person might have when they're watching what they're eating and trying to lose weight. Because again, if you're insulin resistant, all of that progress can go away in a day or a couple days if you're eating too many carbs. Carbs raise that blood sugar, carbs raise that insulin. So focusing on reducing sugars, reducing starches that don't have that much nutritional value, for instance, bread, rice, pasta, these aren't nutrient dense foods and all they're going to do is raise your blood sugar. So reducing starches from your diet and making sure that when you do have carbs, you are pairing them with a fat or a protein, because fat and protein help to slow the release of glucose, which helps to slow the release of insulin and leads to less of an insulin spike. So really focusing on the quality of your food, making sure you are eating nutrient dense foods, protein, fiber in vegetables and things like that, but trying to get rid of those starches that aren't really giving you any nutrition, I love that.

And that's what I talk so much about too. I call it my food flow formula where I have people look, eat, you know, protein and, you know, fiber rich, low glycemic index foods first before you eat carbohydrates. And it's, you know, you can hack into that so much just by doing it. But no, I totally agree. It's so strange too to think of the paradigm shift from when we were young, which, like 80% of our diet was supposed to be carbs. Right.

Like, right, the food pyramid.

Right, the food pyramid. Wow. Were we wrong? We were really off base there for sure.

Absolutely.

Tell me your idea. So I talk a lot to Thyroid people about the concept of intermittent fasting because so many of them do have insulin issues. I talk about it in a way that's very balanced. Like look no more than four to five days a week. You need to listen to your body, switch your food eating windows depending on if you're hungry, if you need fuel, workouts, et cetera. But I'm curious on your take on intermittent fasting as a tool to also help reverse insulin resistance.

Intermittent fasting can be so helpful for some people, not everybody, but a lot of people will benefit exponentially from intermittent fasting. The idea behind intermittent fasting is that our bodies were not designed to constantly be eating. When you're constantly eating, you're having breakfast, you're having a snack, you're having lunch, you're having a snack, and you're constantly putting food in your body. Your body is working really hard to metabolize what you just ate and digest what you just ate and burn off what you just ate. But it's never burning off the fat that you've stored. The body stores fat. If you eat something and you're not utilizing that energy, you will store that energy as fat. And if you don't give your body an opportunity to break down that fat store, then you are constantly going to be gaining weight. So the idea is that you, when you are intermittent fasting, you're giving your body that time to rest, you're giving your time for your insulin levels to come down, you're giving time for your liver to start breaking down some of the toxins. Your body, you're giving your body time to digest and reset and break down some of the stores of fat. While for most people this can be very helpful in their weight loss journey, as well as improving their insulin resistance, there is a small subset of people with already pre existing blood sugar issues like pre diabetes or diabetes where intermittent fasting is not optimal. There is a concept called the dawn phenomenon. And what happens there is that if you do go a prolonged period of time without eating, your body actually might start to make sugar. Your liver makes sugar. It's called gluconeogenesis. And for some people who are really sensitive to this dawn phenomenon, a prolonged fast can actually start to raise their blood sugars. This is not that common, but I do see it in my practice. The kind of patient this would apply to is somebody where anytime they get a morning blood test done, their blood sugar comes back high, but their hemoglobin A1c is normal, which means on average their blood sugar is normal or they might check their blood sugars later in the day, and they never see an abnormal number unless it's right in the morning. Those are the people where intermittent fasting might not be productive enough for them or might actually work against them. But as long as you are not one of those people, which is the majority of people, intermittent fasting can be a really good way to break down unnecessary fat stores to allow your body to detox some of these toxins and allow your insulin levels to come down and fight that insulin resistance. Right.

It allows us to do, like, the deep work. We're not just treading water, keeping up with all the demands that our body, that we create on our body just by eating food all the time. Right. Like, we can't go deeper and clean up all of this other mess and deal with all of this other inflammation if we're just barely scraping by. So, yeah, I couldn't agree more. Talk with me a little bit like, so at what point do you shift from, hey, let's focus on lifestyle, what people can do at home without, you know, any medication, et cetera. When do you switch from that to, hey, maybe we need to consider something like Metformin. Maybe we need to consider something like a glp. How do you navigate that?

So I always recommend people start with the lifestyle modifications, and if they initially start to feel like they're failing, their weight is still going up. Maybe they're not even sure if what they're doing is working. A lot of times we'll at least try a continuous glucose monitor. Those are the devices that you wear on the back of your arm, and they are telling you what your blood sugar is 24 7. So those can be really helpful for people who don't know where the disconnect is. They don't know why the changes they're trying to make aren't working. For instance, I have a patient who anytime she goes to her son's tennis match, her blood sugar spikes up crazy high versus it's never high any other time of the day. So. So wearing a continuous glucose monitor can see what your individual body is doing in times of stress, in terms of what you're eating, in terms of how you're exercising. So for people that are really trying to do this without medication, a continuous glucose monitor can be that extra tool to help them figure out where to go. But if all of these things are failing, the lifestyle modifications are failing, the continuous glucose monitor is not doing enough for the person. And we're looking to medications, it will usually just be a conversation between myself and my patient to say, okay, you know, we were hoping for more progress. I know you were hoping for more progress. If you are feeling like you're not achieving that and you're not hitting your goals, we can talk about medications. I usually offer it to patients when they feel like they're not hitting their goals. Maybe nothing has changed on the scale, maybe nothing's changed on the blood work. But if they feel defeated and that they need more help, that's when we'll absolutely talk about medications. Or if I'm seeing that the scale is going in the wrong direction, that their body composition is changing not for the better, that their blood work is starting to become more abnormal, that's when I will really suggest using medications. And as you stated, there are really two great categories of medications right now to help people with insulin resistance. One is metformin. And the reason why metformin is so fantastic is, number one, it's been around for decades. We know a lot about Metformin. It's also very inexpensive. You can get metformin for free from certain pharmacies. So for people where cost is an issue, metformin can be really helpful. Metformin helps make the body more sensitive to insulin. It doesn't make you create more insulin. It doesn't cause low blood sugars. It's a very safe medication to use. And for some people, it can actually help with a little bit of weight loss. Not a ton, not what we see from some of the GLP1s, but a few pounds here and there. And for some people, that's all they need. And so metformin can be a great medication to start early on to prolong the development of prediabetes or diabetes. For people who are not interested in metformin, not tolerating metformin, looking to lose more weight, that's where the GLP1s really come into play. These medications can be so helpful for the right person, especially in people who are already showing signs of any type of organ damage from insulin resistance. Whether it's cardiovascular disease, whether it's fatty liver, whether it's already starting to have high blood sugars, These medications are incredibly helpful. These medications are injections. And I'm sure, as your listeners know, they work from many different mechanisms. They don't just help suppress appetite. They help slow the amount of time it takes your stomach to empty so that you feel fuller, longer, you digest food a little bit better, a little bit slower. You don't have these big blood sugar spikes. They reduce the amount of sugar your liver is making in the background. We talked before about gluconeogenesis, where the liver is making sugar. These medications calm that down. And as these are out longer and longer, we're finding all of these other benefits. They have anti inflammatory benefits. So a lot of my patients who are trying to lose weight or help their insulin resistance, but they also have Hashimoto's, they come in and say, oh my God, my joint pain is gone, my eczema is better. All of these inflammatory autoimmune conditions are now starting to get better. There was even a recent study that came out showing that in teens who were obese treated with GLP1s, their asthma was getting better. Asthma is an autoimmune condition. So the longer these are out, we're finding that they are working by so many mechanisms to improve inflammation. And again, that's the key word here. When you're talking about insulin resistance, when you're talking about weight gain, when you're talking about thyroid disease, autoimmune disease, it's all linked to inflammation. So if we can help inflammation with a medication like a GLP1, most patients are incredibly happy.

I totally agree. I don't know if you're seeing this in your practice and I didn't expect it years ago when we really started going deep with GLPs, but undeniable. I'm seeing reductions in Hashimoto's antibodies in big, big ways. It's just so cool, so fascinating. I think I'm so grateful that the conversation is evolving around these medications because for so long, and I think still to a degree, there's so much fear around them, but not enough people are talking about how they're absolutely changing the trajectory of long term health outcomes in so many ways that are honestly independent of weight loss in so many cases. And, and people need to know all those benefits. So I love, love, love that you're talking about them. And I want to touch on something that you mentioned in the beginning of this question, which really sounded a lot to me, like, hey, you use these medications when people are putting in effort, they're doing the things they've tried, the lifestyle work, and it's not working. And what I really want people to understand is for a very long time, medicine thought calories in versus calories out equals fat loss, fat gain, et cetera. But I love to hammer in anytime I have the opportunity and would love your take on this, that that's not true. Like we are not all metabolically created equal with this 2000 calorie paradigm. And there are a lot of people who are so metabolically disadvantaged that they in fact can do a lot of the work and not see the outcomes that other people that don't have that metabolic disadvantage can see.

Absolutely. What's interesting is when these medications first came out and we were first starting to really use them in practice, one of the comments that I continued to hear time and time again is the comment about the food noise going away. And my patients would say, my entire life I didn't know what normal was. I didn't know you weren't supposed to have this constant food noise of as you're finishing one meal, already thinking about what you're going to eat for your next meal or your next snack. And I tell them, yeah, that is not normal, that is not supposed to happen. That's not how our bodies are designed. Having that constant food noise is a problem. And you can just see that there are some people that from a young age were unfortunately set up like that to have that food noise. We don't know the exact cause yet, but hopefully once we do, we can truly reverse it from the start. But at this time, at least we have tools to help those people who have been, as you said, metabolically disrupted for so many years. Because these are excellent tools to help people in addition to a healthy diet, in addition to exercise. You know, I really want to emphasize these medicines won't just fix it and forget it and you can just take an injection and do nothing else. You really, you have to work at it still. But at least they are leveling the playing field. So when people are putting in that work, they're seeing results instead of constantly being frustrated and feeling like they're failing when their bodies were maybe not set up to succeed.

I love that you just reaffirmed that. And the reality is this, like, look, we're all human. If we're doing all this work and doing all these things and it's not making an outcome, it's not shifting what's happening, we're not going to keep doing it. Most people are going to give up, they're going to throw in the towel. And so, you know, there's just no way. So allowing these meds to make that work take effect and change lives is so incredibly powerful. Well, thank you so much for this conversation and your work in this. I mean, I really view insulin sensitivity as one of the biggest predictors of someone's long term health outcomes. So I can't, you know, overstate the importance of this. And this conversation is there anything else that you would like listeners to know? Anything that maybe I didn't bring up and I'd love for you to share with people where they can find out more about you, your work, your practice, how they can keep up with you, all the things.

Sure. Thank you. So I would say the one thing I want people to know is that if you feel something isn't right, there's a puzzle piece that isn't fitting, something isn't making sense. You're maybe eating the same as somebody else in your family or exercising the same, and you don't see results, but they do. If you just feel like something is not right, talk to your doctor about it, or at least find a provider that will listen and that will evaluate the situation. Because many times, if you feel like there's a disconnect between what you're eating, how you're exercising, how you're feeling, if there's something not right, you have good intuition, there's probably something wrong with your body. Go with your gut, advocate for yourself, and find someone that will listen and look into it. If people do want to find me, I'm on Instagram. You can follow me at endohealthdoc. I also have my own practice in New Jersey, as well as telehealth in New York and Florida. And you can find my practice information on my Instagram profile as well.

I love it. Well, thank you so much. I'm so happy we were able to have this conversation. Thank you for generously giving your time to share all of your knowledge with everyone, and I just so appreciate it.

Yeah, thank you. This was great.