What Is Insulin Resistance? Signs, Symptoms, and How to Reverse It

Hello everybody. Thank you for joining us today. Thank you for joining the Med Matrix Method podcast. Um, I'm Dr. Sasha Rose and I will soon be joined by Brian Leggott. He is one of the owners here at Med Matrix. Um, we are super excited to have him host the show today. Um, he's going to be on in a minute. Um, but if you are new to this podcast, I'll tell you a little bit about what we do. Uh, one to two times per week we talk about all things functional medicine and how to take a more personalized preventive approach to your health. So, we talk about all sorts of things. Um, today I am super excited to talk about insulin resistance and to talk about the fact that it is it is more than just diabetes. So, um, we're going to kind of dive into that. Um, we're going to let a couple people more people kind of stream in here. Um, but I will mention a few housekeeping details and just kind of introduce myself a little bit as well. So, um, everything that we talk about today is um, really for educational purposes only. Um, we are not giving medical advice. Um, the other um, thing that I will do as we wait for Brian. Um, my name is Dr. Sasha Rose. I am a naturopathic doctor. I'm a licensed acupuncturist and I am one of the lead providers here at Med Matrix. Um, I've been practicing functional medicine for over 20 years, going on 21 years. And um, a lot of what I have done over those 20 years is metabolic health. Um, insulin resistance is obviously included in that. So, um yeah, we're going to again kind of give people a few more minutes to stream in. Um and then and then we will start. So, um just to give a little bit of um again, if you are new to the podcast, um what we usually do is we will we focus on one topic. Today, again, it's insulin resistance. And um then we will answer questions. So, we really encourage you to put questions in the chat. Um and again, we can't um we're not providing medical advice, but um you know, a lot of questions we really can answer and we really do appreciate your engagement and just simply letting us know that you're here. So, um I think what I'm going to do, um I think we're having a little bit of technical difficulties um getting Brian uh logged on. So, I am going to kind of jump in and just start on the topic that we are talking about. And there he is. Hey, Brian. Oh, hey, Dr. Rose. Um I'm not sure we have audio on you. Okay. Um so, what I'm going to do while we are letting Brian get hooked up cuz I'm I can't hear you. I don't know that our audience can hear you that great either. So, I'm just going to start um I'm going to start kind of talking about insulin resistance um because I think that term is thrown around a lot, but many people don't actually kind of understand what it is. So, I'm just going to start kind of with the basics. Um that is that um insulin resistance is when cells are less responsive to insulin. So, the pancreas, which is one of the what we call visceral organs, um the pancreas um is the organ responsible for producing insulin. When um insulin is elevated, and it could those insulin levels can be elevated for a long time before your blood sugar actually becomes high or abnormal. So, what can happen is that um a lot of things can kind of contribute to insulin resistance, and that once when there's this higher level of insulin in the body, and that can be going on um for a while, it's going to be affecting everything from your energy level to your weight, even to your hormonal balance, to inflammation, um cardiovascular health. So, this is kind of why we're tackling this topic today. We're tackling it because it again it goes beyond diabetes, it goes beyond blood sugar, it's overall metabolism, it's overall inflammation. Um so, that's kind of just an introduction um to why I guess why insulin resistance is important, and now that I think Brian's audio is on, can we hear you? Can you hear me okay now? I think so. Can you have Leah check that everything is good? Good? Okay. Yeah, I think good. Okay, great. Um so, let's swap a little bit here, Brian. How about I kind of introduced you, but you what can you introduce yourself and your role at MedMatrix? So, I don't know if you said this, but I'm the guy that signs the bottoms of your emails with all the webinar updates and whatnot. So, I figured it'd be a good time to put a name I mean a face with the name. Great. All the emails you're getting, that is me. You're welcome. [laughter] And we're super happy to have you. Um Yeah, and just to follow up on what I said earlier, that again this is educational purposes only. It is not meant to replace medical advice. Um but if you are interested in us giving you medical advice, you are more than welcome to book a discovery call on our website. Um anything that you feel that you want to mention before I kind of had as you came in, Brian, I was just kind of giving an introduction of why insulin resistance is more than just diabetes, but is there anything else that you want to add before we kind of dive a little bit deeper? Um No. I think um sorry. Uh I think good place to start, I think you already did this, is um It doesn't sound like we covered this. Like, what even is insulin resistance? Yeah. Yeah, so I started to talk about how um the pancreas is the organ that produces insulin, and after time the cells throughout the body, we have insulin receptors throughout the body, and over time when the pancreas is compensating for high blood sugar, it's compensating for with for inflammation, all these metabolic things are going on, and the pancreas just keeps putting out more insulin, the cells over time become less receptive, less sensitive, less responsive to the insulin. So, one analogy is that you know, the role of insulin is to shuttle glucose into the cells. It's a little bit like a lock and a key. So, it's a little bit like we need that insulin, which is the key to open the a oh, know, open the door so the glucose can kind of pour into the cell. Every cell in the body runs on glucose. That's fuel for the cells. That's fuel or food for each cell. So, when that goes on and on and on and there's so much insulin and there's so much kind of like pound like over and over that key is going into that lock, it gets a little worn out. Like the lock gets a little bit, you know, a little rusty, a little bit it's not working so well anymore. And so, that's kind of one way to think of um that increased insulin production kind of over time creating metabolic stress throughout the body. I think one important key is that we have these set we have these um basically insulin receptors. We have these locks on like every cell in the body. Every cell needs glucose, so every cell has to be responsive to insulin. Got it. So, with all that said, I mean, for the average person listening, that sounds, I mean, I can gather that that's pretty important. And why should anybody actually care about insulin resistance specifically? Yeah, so what right why we hear this term insulin resistance, why does it matter? Um and as I said at the beginning, it is more than diabetes. You know, a lot of people do not have diabetes, but insulin resistance still may apply to them. Um so again, as insulin is helping move glucose from the bloodstream into cells, in that way, it's playing such a crucial role in metabolism, fat storage, hormone regulation, cellular communication. We basically need insulin for just normal body function. And so, when there's issues, like when that lock key relationship is not optimal, that's when problems start to arise. Got it. So, with that said, what are some of the problems and or health issues that people may might not realize are connected with insulin resistance specifically? Yeah, it's a really good question because again, um, I think we've all heard the term insulin resistance. What what other what are some of you know, I've used kind of broad terms in terms of like metabolism, but to get a little bit more specific, um, other than diabetes, type 2 diabetes, we are looking at um, what used to be called PCOS or polycystic ovarian syndrome. It has recently been renamed, which I think is a great thing. It is now PMOS, which is poly endocrine metabolic ovarian syndrome. So, PMOS, um, fertility. So, oftentimes a woman will deal with like some infertility if there's an insulin resistance, and that as well is often linked with PMOS. Sometimes fatty liver disease, um, and fatty liver disease is not it's usually non-alcoholic, so usually there's not necessarily alcohol as the culprit, but um, insulin resistance and fatty liver disease often go hand in hand. Cardiovascular disease, sometimes more This is not like a condition or a disease, but symptoms such as brain fog, cognitive decline, chronic inflammation, um, difficulty losing weight. A lot of our patients are are struggling with this. A lot of times there is an insulin resistance component to that. Um, and then overall metabolic syndrome, another super common group of signs and symptoms. So, that will include high cholesterol, high blood sugar, fatty liver disease, um, sometimes high blood pressure, oftentimes, um, you know, a person being overweight or obese. So, uh, the ins- you know, kind of having that lack of sensitivity on the cellular level to insulin is going to impact all of that. And it's kind of like, I guess I think of it this way, like insulin resistance is a part of all of those things. I don't think of it as that insulin resistance causes all of the things I just listed, but that all of those conditions are very complex and insulin resistance is often a pretty crucial component of them. Got it. And you listed almost every single uh, like comorbidity that humans currently struggle with. So, I mean, it sounds fairly important just based on the litany of things that it's tied to. Am I hearing that correctly? You're hearing that correctly, yes. Okay, got it. And it's not just, I mean, we've been over this and over this, but it's not just the end result is diabetes. No, it's off- it's Right, it's it's sometimes, um, diabetes like type 2 diabetes, um, is often kind of the end result, but these it's been developing over years or decades, right? So, people people insulin is not, um, we have it on our initial comprehensive panel of blood work, but it's not Insulin is not tested with your annual blood work. It's just not commonly done. So, there's no way to really know, um, if you are insulin resistant. Uh, so, but it's most likely it kind of, you know, happens over years and decades, and your blood sugar might be normal that whole time, but there's all these other underlying issues kind of starting to progress. Again, the inflammation, the um some of those other kind of comorbidities, uh difficulty losing weight, uh blah blah blah. Everything I just said is takes this is not happen overnight. And then in the end, somebody gets, you know, kind of handed this diagnosis of type 2 diabetes. And oh oh and oh yeah, you're insulin resistant as well. Mhm. So, I mean, for some of those things, it's it's really tough to know like what's happening as it's happening to you until almost it gets to be like, you know, critical event or something. Yeah. So, like what are some, if any, early warning signs that a person might be experiencing as like it that letting them know they might may may not be insulin resistant? I think you're absolutely right. I think one of the most difficult things about insulin resistance is that someone is most likely going to be kind of asymptomatic. So, maybe they're feeling a little their cravings have gone up. Maybe they're feeling um an increase in hunger. You know, there's that energy crash or that fatigue, um kind of we call it postprandial or after meals, maybe especially in the afternoon. Um a lot of these things that I'm listing are not unique to insulin resistance, um difficulty concentrating. Again, midsection weight gain, mood changes. I mean, this sounds like a lot of things we talk about on this podcast. Um we've talked about inflammaging. We've talked We talk about hormone imbalances a lot. Um a lot, you know, we talk about the importance of sleep. So, all of these things can all contribute to weight gain, cognitive issues, and mood changes, and insulin resistance I would add to that list of it can uh cause / contribute to these kind of vague often somewhat debilitating symptoms that somebody might be going through, but because they can be relatively subtle, um it's easy for either the individual themselves and especially um a physician who has a 5-minute visit to dismiss to dismiss them. Got it. So, I mean insulin resistance is rarely the thing that's caught right off the bat is what I'm hearing. Correct. And then it's always a bunch of other things and then the hypothesis you're working backwards from is like, "Oh, this person might be insulin resistant because of X, Y, and Z." Is that That is That is correct. I mean, sometimes again, um there's like into more intense sugar cravings. We talked about the difficulty with weight. Sometimes you might see like some skin tags or some darkening of the skin around the neck or the underarms. I wouldn't say that that's, you know, we use this term kind of pathognomonic, like if you have that, you automatically have insulin resistance. Likewise, you don't um have to Yeah, it's it's it's it's it's a possibility, but it's not like, you know, an absolute. Um so, I think some of these kind of symptoms that are common and difficult to pinpoint will maybe more often than not include at least the beginnings of insulin resistance. So, the energy fluctuations and um kind of overall metabolic issues going on. Um but unfortunately, insulin resistance is not usually included when we're kind of assessing all of that. Got it. And so, I guess given everything you said, when if at all, do symptoms typically typically become serious enough to where people are actually seeking help. It's usually not until something else develops. Is that basically the gist of it or Yeah, I would say it's usually that people are really frustrated with their weight is probably the the first thing. Possibly the fatigue gets to the point where they're finally seeking help. And then eventually we do start to see lab values change. So if we are going to test the insulin you start to see that that insulin is creeping creeping up you know kind of to the higher end. If somebody is getting their hemoglobin A1C tested that's an average blood sugar over the last three months and so that's going to be again you're going to kind of get into that pre-diabetic range for a while eventually into the diabetic range. So but it's not like oh I you know what I've been eating poorly for three months and that's kind of you know that's it's this is again been going on for years if not decades. All these more subtle metabolic changes. Got it. And you mentioned um you actually mentioned weight loss a few times. And I know that is something that not just our patients but like I mean everybody. I mean all you have to do is go to the grocery store and you know you'll kind of see where everyone's at. So why is in why does insulin resistance make it so difficult um for weight loss? Yeah, um I mean back in medical school when I we were they were first describing insulin you know it's basically a fat building hormone. It's a storage hormone. So it basically if If have an elevated level of insulin, that is promoting fat storage. It's not really going to promote fat loss. Um it limits fat burning. And you know, part of when just I think our how we're wired just to in terms of how to to survive, when the body has these higher levels of insulin, it's almost like we are in the body's prepping for like a famine, so holding on to fat, right? And and then cravings can increase and hunger can increase because we're wired to basically, in case the food supply is not here tomorrow, hold on to what you have. Um it's based on our biology, it's not based on our current reality. Um and so that kind of the longer that that goes on, there's less what we call metabolic flexibility. And it just kind of the body gets stuck the insulin level kind of gets stuck and it's that's just it's not like um that's the new normal, I guess is a way to say it. Metabolically, I see a lot of people who are just kind of in this stagnant place and they are maybe doing the things. They are doing the exercise or at least to some extent, they're trying to eat well and yet it's just like really hard to move because metabolism has been at this level and it the old unfortunately, the older you get, the easier it is for metabolism to kind of get stuck. And so they might be restricting calories and it seems like it and nothing's happening. I heard. And then so I'm just curious, how cuz you mentioned you know, if there's too much insulin in a person's bloodstream, it makes fat metabolism nearly impossible. So, I mean, how does body composition affect this? Is it Does it just become this reinforcing kind of feedback loop where, you know, there's more insulin in my blood, which means it's more you know, it's more difficult for me to metabolize my fat. I'm holding on to my fat. Right. And then my body composition starts changing because I've got all this muscle mass that's not getting the appropriate glucose it needs and then it just becomes this that basically a downward spiral that just keeps self-reinforcing. Is that Could you just Just so I understand, is that effectively what happens or how does body composition fit into this if at all? Yeah, a good question. Um how do you know, what's the relationship or how does body composition relate or impact to impact um insulin levels or insulin resistance? I I do I think it's really kind of like you said, maybe a vicious cycle, maybe if kind of a feedback loop where higher the insulin, the more um kind of fat storage. The higher the fat storage, the higher the inflammation, the higher the insulin levels. And what we're going for with most people is, as you mentioned, increasing lean muscle mass, decreasing percent body fat. And um so the There's and we'll get into this in a little bit, but that's kind of the goal, right? The goal is to maybe shift this body is shift where the what the body composition has been and to start to to now trigger this process where we're burning fat, we're maintaining or even better building skeletal muscle mass, lean mass, um and then kind of sending the message pretty loudly to the body that it doesn't need to keep producing The pancreas, you know, doesn't need to keep producing insulin. We kind of all these things that we can do to re regain that re that sensitivity in terms of the insulin receptors. Uh so, it's not this I wouldn't think I don't think of it as a linear thing, but I think that yes, there's a there is a imbalance uh so a less-than-optimal body composition that's contributing. And so, when we do different things to shift that, hopefully everything will line up. Got it. And so, another question um that I was curious about is why why does the fat kind of concentrate around the midsection specifically? Like, why not Is there something about this that makes it predominantly visceral fat? Why is it not kind of spread out across the body, etc.? Right. Yeah. Um insulin resistance is strongly linked with associated with visceral fat accumulation. So, visceral fat, it's not necessarily what you see on the outside. It's that visceral means internal. So, the visceral organs um when there's fat kind of around and in between those visceral organs, that's visceral fat. Um and then sometimes we will also see it on the outside. Oftentimes we see it kind of, you know, in that midsection. So, with insulin resistance being associated with that accumulation of visceral fat, um we have that excess abdominal fat. It's metabolically active, and it's again vicious cycle. It's kind of contributing to inflammation. Other components that will contribute to that specifically that midsection weight gain is dysregulated cortisol and chronic stress. So, um basically kind of coming back to that, you know, how we are wired as humans to survive, and when we are chronically stressed, part of, you know, part of that is survival, and part of that, um, stress response is, I might not have a my next meal, or there might be a famine around the corner, and so I am going to hold on to the fat that I have, um, so that I have something to burn in case I don't have any food. You know, that kind of reptilian brain doesn't know the difference between the daily stress of can't pay the bills and got to take care of my aging mother from [snorts] and that jerk at work. I don't know the difference between that and that I might be starving tomorrow. And so, there's that accumulation of fat in the midsection. Um, and then we do, you know, part of like the the way that we [sighs] look at, um, health is that we have an in-body scan in the office, as you know, and that is, um, monitoring waist circumference, and that is one tool that we have to kind of look at metabolic health. So, I'm, you know, when I'm working with somebody, at least every 3 months, I have this tool where I can see what's happening with their waist circumference. So, in addition to how they're feeling, in addition to their blood work, in addition to their actual weight, um, I have this other metric of waist circumference, and and my goal is for that to slowly go down, and that's going to tell me that a lot of things are most likely improving, maybe including insulin resistance, including these other comorbidities, because of that association. Got it. So, you mentioned and you've been mentioning stress quite a bit here. And when I think of stress off I mean often times I think it as like a a lifestyle factor. Um for lack of a better term. So, I mean other any other lifestyle factors that are common contributors to insulin resistance? And if so, like what what should we be on the lookout for? Yeah, I I would I would say that there's a number of lifestyle factors that are going to contribute to insulin resistance. Um I think we all probably can guess that what you eat is going to play a role. So, ultra-processed foods um are you know, going to definitely contribute. Um but there's other ones that people don't always associate with insulin insulin resistance. Um but those include poor sleep quality, and that's both like duration and quality. Um chronic stress as mentioned. Um just overall being sedentary. Um pretty easy to do in this day and age um with desk jobs, with driving a lot, etc. Um blood sugar instability. And um I I would say all of these things um so kind of linked with the sleep is also what we call circadian rhythm disruption. So, that does have to do with cortisol. You know, one extreme would be somebody who works nights, right? Like that circadian rhythm is definitely disrupted. Somebody who's been working nights, um they've been a nurse in the hospital for a decade, for two decades. That's going to increase that person's risk of insulin resistance. Um but again, this is cumulative. These are These are like These are things that are happening for years and decades and then it takes a toll on overall metabolic health. So, I mean basically your body just gets used to living this way and forming certain adaptations and then before you know it your body's not processing insulin properly and you've got an accumulation of it in your bloodstream. Yeah. Got it. So, I mean with that said, I I know we'll get into this in a moment and with that said can modifying lifestyle drastically help and or start to reduce some of the symptoms the ex- you know, these other things associated with insulin resistance? Yes. I would say whether we want to say aggressively or drastically modifying lifestyle behaviors can is probably the most important thing you can do to reverse insulin resistance. Got it. Because everything you said you know, circadian rhythm disruption chronic or even momentary stress I mean all those things will effectively give you insulin resistance for x amount of time. Correct? To some degree? Like if you don't you know, cuz they haven't they looked into that like they you know, you they disrupt someone's sleep cycle long enough like they become insulin resistant for a short period of time, you get them re-regulated and then it goes away. Yes. Yeah, correct. Um so I mean effectively what can be done here is some lifestyle modifications to some degree for the the people listening. Yes, absolutely. Lifestyle modifications is probably the biggest biggest and best tool. Yeah. So, with that said, where uh oftentimes if lifestyle modifications are the biggest bang for our buck, um sometimes when we go to our regular doctors, those concerns can either be dismissed and or we can leave feeling that way. Cuz I know not all doctors do that and regardless, sometimes you can still feel that way. So, if someone does bring concerns to a regular doctor, a conventional doctor, let's say, um or provider about insulin resistance, what's that typically look like? Yeah, so someone is concerned about insulin resistance, they come to their primary care provider. Um usually, hopefully, there will be a review of symptoms and medical history, why this person is concerned. Some standard labs that would be run would include um a fasting uh blood sugar, fasting serum glucose, the hemoglobin A1C test, which I mentioned earlier, which is your It's a better test than a fasting glucose. It's a 3-month average of your what your blood sugar has been. Um they would basically be doing an assessment for diabetes or prediabetes. Um maybe, you know, um again, time dependent, they would maybe recommend some lifestyle changes. They may sometimes they're referred to a dietitian. Sometimes they're told, "Well, eat better and move more," which is not bad advice. Um it's just sometimes a little bit the the person doesn't know what to do with that, um but it's good advice and maybe, depending on the blood work, they might be prescribed certain medications. But that would mostly be around the blood sugar, not for kind of like insulin resistance in general. Oh, got it. Got it. Got it. Okay. So, I mean, you kind of touched on the treatment options commonly used for this with conventional medicine and short of pre-diabetic type medications, I'm not hearing a lot of help. Is that correct? In terms of Like how it's normally done? Yeah. So, basically, if depending on the blood work, depending on the person's weight, um body composition, there may be some diet recommendations, some ex maybe exercise guidance or usually it's more just like go exercise. Um some weight management strategies. Um you know, again, hopefully they would be they would given be given um like a continuous glucose monitor, um which is you know, you can for 10 days 10 Yeah, 10 days you can basically in real time have your you know, see what your blood sugar is doing, how it responds to certain foods. Um if the person is Usually, I would say diabetic, not even pre-diabetic, they may be given something like Metformin. Um and so, I do think that diabetes blood sugar, that is a place where conventional medicine is trying is attempting to prevent, right? They're trying to prevent full-on diabetes. Um I just think as we have talked about a lot on this podcast is just the constraints of the typical primary care visit. Not the fault of the provider, fault of the system. They This is a perfect example of time. You really need time. You need time to figure out what is getting in the in the in the way for this particular person. What what is this person doing currently and what do they need to do? And it's not a one-size-fits-all and if you have a 7-minute visit, you just can't know you can't figure that out about a patient and you don't have time to give them personalized treatments because you just don't. Um and as also as we have also talked about, you know, in that system, they are very constrained by insurance and um so it's I I do think that, you know, 99 percent of providers have their patients' best interest in mind and they do want to prevent all these um comorbidities. Um it's just they don't really have the the time or the tools to do that. So, I mean, with that said, how how does functional medicine approach insulin resistance differently? Well, as I think we've kind of been at least alluding to, functional medicine is approaching insulin resistance not just from a blood sugar perspective. It includes blood sugar, but it's also looking at why what what's been happening for the last however many years to get to this point. So, looking at how it like I use the term stress resilience a lot. How is this We all have stressors, but how is this individual actually handling stress? Um what's their internal response to it? What is their level of physical movement? Um getting into the nitty-gritty in terms of nutrition. Um and then we can't forget the really important things like opti- like where are they in this stage of life? What's their hormonal status? How is that playing a role? Um inflammation is again, I think a huge piece of insulin resistance, and looking at what may be contributing to inflammation in this person. Um how can we modify that? How can we lower that? And it really wouldn't be functional medicine if we didn't um do an assessment of what their digestive health looks like, their gut health. So, it's very mhm it's a lot more complex than um what's your what does your fasting blood sugar look like? Um it's really kind of looking at this person as an individual, and because we do that, we can create therefore create individualized treatment plan. So, not a one-size-fits-all, and hopefully catching them early enough where it's like the beginning of this process. Um but even if it is more towards the end, we, you know, with time, we can kind of we can reverse a lot of things. Got it. And then I guess you kind of touched on this a moment ago. Like, what I know no two people are the same, so how come two people can with insulin resistance require completely different treatment plans? So, two people who show up, their blood work maybe looks somewhat similar, that it's pretty clear um that they have insulin resistance, but they walk out of MedMatrix, they walk out of their visit with one of the providers here with two different treatment plans. Um and that's not a mistake. Um basically, part of personalized medicine, part of the personalized medicine that we practice, is understanding that we all have different genetic makeups, we all have had our past histories are different, and our current like our past lifestyle, like what we've how we've lived in the past is different, how we're living now is different. We've all had different environmental exposures. That's going to affect things. Um and we're obviously all diff- somewhat different hormonally, right? I mean, there's there's not just like male and female, but there's what stage of life were you in? And are you a female who was on a birth control pill for 20 years? Um you know, how many children have you had? Are you a man who's had low testosterone for 20 years and didn't know it? So, that is all going to play a role in how we assess the situation and what we recommend in terms of treat- treatment. Um I mean, we do comprehensive gut panels all the time. I can't tell you the variations we see on the test results of those those comprehensive um gut tests. Uh very different. And then stress. So, not just the what stressors have been handed to this person, but how again, internally, what's their stress resilience? How do How have they handled these stressors? How has that really impacted their nervous system, their cortisol all uh regulation. And so, by kind of recognizing what we call bio-individuality, we are therefore able again, to tailor the treatment to that person. Personally, it's the most fascinating part of what I do. It's just so great that it's not the same every time. It's never the same every time. Um it's creative and it's really, you know, the the old way of saying it is like meet the person where they're at and um kind of figuring that out with somebody and letting them see that this is not the same thing I give every person. It's very much about like where they are in their health and what they're able and willing to do. Um usually leads to a much more successful outcome. Okay. So, I guess with that said, you touched on a bunch of different things, but when someone comes to Men Matrix concerned about insulin resistance, where does the process begin for them? What are you looking for in like in practice, what does this look like for you? Yeah, so before they're even sitting in front of me, they I have information. They've had kind of their initial discovery call. I have a lot of information in terms of why they're reaching out, like what's going on with their health, what they're feeling, maybe what test results they've had with other providers. I have all of that information. I also have the information from that inbody scan that I mentioned earlier, which gives us not only weight, but skeletal muscle mass, water weight, BMI, visceral fat. I have all those metrics. I have the very comprehensive lab panel that every patient gets, and I have all those results. So, before they're even sitting in front of me, I have a lot of information. Um and I have time to review that. And then when they're sitting with me, then I can get into kind of, well, what are you really eating? And what, you know, all the all the questions that are going to kind of fill in the gaps. And um at that initial meeting, we're really kind of getting on the same page in terms of what their goals are. Um we do a very So, we do a really thorough evaluation of nutrition, sleep, stress, physical activity. And again, starting to get a sense of what have the environmental factors been for this particular individual. Um that plus again, the lab results, all these other kind of metrics, the data, I can kind of piece that together for that um customized treatment plan. And so, once you've identified what's contributing to someone's insulin resistance or anything else for that matter, what might a treatment plan look like? Well, it's going to be multifactorial. So, we're going to most likely have a pretty personalized nutrition strategy. Um sometimes I am starting that outline or I'm giving them maybe what they need. Some people have they've done the work at other times in their life. They tell me that oh, I know that I did better when I ate this way. It's just been 5 years since I've done it. So, they kind of know that. I can direct them back to that. It's familiar to them. That's great. Other times it's kind of brand This is brand new information for somebody. Um and so, I will often refer to one of our health coaches for that kind of more nitty-gritty guidance, right? Kind of getting in the weeds and to have somebody to be kind of accountable to maybe a little bit more often than when I'm going to see them. Um so, this at least the start, I'll say, of a personalized nutrition strategy. Same thing with the movement and exercise. Some people are like, oh yeah, I know what I need to do. I'm just not doing it. Other people say, I've never stepped foot in a gym or I really don't know if They just don't know what to do, right? They're They're It's basically like getting somebody off the couch and where to start. And again, that health coach or a personal trainer is a great place to start with that. But at least we start with something that's going to sort of make sense to the person and is realistic. Definitely talking about sleep, optimizing sleep, definitely talking about stress management techniques. And that is very personalized. Like, what what what might work for me to reduce my stress is not going to work for you. Like, I might find yoga to be like so great for me. You might say, I can't stand it. I really need to go just unplug my phone for 48 hours and sit by the lake. Great. Um So, again, very customized, um but definitely starting to regulate cortisol, starting to kind of bring somebody out of that fight or flight mode. Um usually we're doing some targeted supplements, so some high-quality nutraceuticals that are often based on what their lab results look like in combination with again, like this overall metabolic picture. Um And then maybe, you know, when appropriate, there will be some medications if that seems like it's going to be a good tool, some peptides, for example, that might be the right tool for fat metabolism, for metabolic support, for kind of giving them the energy to do the lifestyle pieces. And I'll say the same thing with like hormone replacement therapy. Sometimes that's the piece or a really important piece to get that metabolism going, to get them the energy and the motivation they need to actually get off the couch. So, putting that all together and then not just leave not just sending them on their way, but kind of whether it's me, whether it's me and the health coach, whether it's me and all the other fabulous staff members here, really being here to support them and so they don't feel like they're just out there kind of trying to figure it out on their own cuz that, you know, usually doesn't work quite as well as when you have some consistent support. Yes, I mean, definitely. And so for everybody listening at home that, you know, thinks, "Hey, this might be me. I might be experiencing this or I have a bunch of those things that you mentioned earlier, like fatty liver disease and all these other things. Um What are three steps you would want them to take or some things they could do, you know, today that might help them? So, the first one I think would be to take kind of a real honest look at quality of sleep. And that again, I said earlier I said it's not just like how long you're sleeping, but what's the how long, but what's the quality of your sleep? And so, sleep hygiene, if the listeners don't know, is really like having a consistent schedule of going to bed pretty close like around the same time every day and waking up the same time every day. Um looking at the environment of your of your bedroom, like the temperature, the light, the noise, all of that is really important. And how, you know, when would not eating right before bed, you know, not having alcohol right before bed. You know, for some people it's like hydrating earlier in the day, not right before bed, so you don't wake up frequently to go to the bathroom. Um how much are you on your phone or screen right before bed? That's all kind of under that sleep hygiene category. Um and so, really realizing that sleep is pretty crucial. And that's tied in to um I would say cortisol regulation and stress resilience. The the higher the higher quality your of your sleep, the better the stress resilience. Um and then the other one that I like to ask people, they'll often say, "Well, I don't really eat sweets." And then I ask them um do you stop at Dunkin' Donuts? Do you stop at Aroma Joe's? Do you stop at um Starbucks frequently? And what are you what are you getting? Because those coffee beverages are really sugar beverages. And some people are more aware of that than other, but like they may not be eating whoopie pies every day, but they're getting their Frappuccino everyday. Mhm. So, to just kind of looking at those what I call like hidden sources of sugar, um or maybe you put in a you know, two full heaping tablespoons of sugar in your own coffee every morning. Looking at sugar and energy drinks. So, those kind of things that might be contributing when you and you don't even realize it. Um and then I would say really important is somebody can kind of start looking at things that may be contributing to inflammation for them. So, yes food, so looking at kind of what we call pro-inflammatory food consumption, fast food being at the top of the list. Um and then, you know, high gluten, high refined carbs, um you know, kind of bad bad fats, super high salt. All of those are kind of what we call pro-inflammatory. Um Most home-cooked meals are going to be less inflammatory than what you get out out at a restaurant or takeout place. Um So, that's one example of just kind of taking an honest look at what you're consuming. And then one nutraceutical supplement that's beneficial for pretty much all of us is an omega-3 fatty acid. And that's there's just so much research behind omega-3 fatty acids uh lowering inflammation systemically, and that would include these factors that are contributing or playing a role in insulin resistance. So, I'm usually aiming to get most people close to 2,000 mg of um omega-3 fatty acids per day. You do want a decent quality on fatty on um fish oil or fatty acids. A lot of minerals or vitamins, the kind of the the brand isn't as important, but you do want to kind of spend a little bit more money to get a high-quality omega-3 fatty acid. Got it. Um I All good things, all great suggestions. Sleep one is something that most people could probably do without much money or time investment really. Uh so very very good uh suggestions and thank you so much. Mhm. Um Anything else? Oh, wait a minute. We got a question. I think this is a glucose I think this person's asking about a glucose tolerance test. Okay. I I believe that's what the question is. So, um good question in terms of like assessing insulin resistance, you know, I think what you're asking is, you know, would we would we run or would we recommend um a glucose tolerance test? Definitely when assessing um for diabetes, absolutely. Um you know, if we think that it's kind of progressed to that level, um a glucose tolerance test definitely makes sense. You basically get like your blood sugar tested, you eat a very high glycemic meal. So, orange juice, pancakes with syrup, come back 2 hours later and have that repeated and it's a way to kind of test how well your insulin is working, how well the insulin is actually shuttling all that glucose into the cells. Um so, I think yes, if if things have progressed to that point, but I guess I would say say that comes back negative, that doesn't necessarily mean that there's no insulin resistance or that there's no metabolic dysfunction. It just means that it's not to the level of pre-diabetic or diabetic. Yeah. So, I think that's that's what we got. [clears throat] Got it. Okay. So, if you're interested in becoming a patient, um we'd love to just have you click the link. I'm sure you can do that down below. Um if this was at all valuable a valuable for you, please drop a like in and or share it with a person that you think might benefit. Thank you so much Dr. Oz for doing this. Um it's not a small ask to take an hour out of your day. Um you did see patients all day. I think it's worth [laughter] mentioning. Um and you'll be doing that again on Friday or Thursday Wednesday or Thursday or Friday. It's Thursday. So, thank you so much for ending your day with this. I know a lot of people get a lot of value, so thank you. That's great. Thank you. I really appreciate it. It was really fun uh working with you on this. Thank you. I'm looking forward to more of these. Likewise.