How to Reverse Insulin Resistance After 40

Nikkiey: Real quick, the only ask I could ever have of you guys is to help spread the word so we can help more women lose body fat, build muscle, reach their goals, and feel insanely confident. And the only way we can do that is if you rate, review, and share this podcast. So the single thing I ask you to do is leave a review. It will take you 10 seconds, and it will mean the absolute world to me and may change the world of someone else.

Morgan: That is why my heart is in preventative medicine, so that I can help people in midlife, maybe their 60s, early 70s, get their health back so that they can be there for their family, because, heck, kids need their parents. Grandkids need their grandparents. And I think that society is just a better place with people of good health. We save so much money, so much energy, so much time, and have a greater quality of life if we can get and stay healthy now versus waiting until you're 70 or 80 hoping that your doctor can fix it.

Nikkiey: What is going on, everybody? Welcome back to The WarriorBabe Show. Today, we are so honored to have and host Dr. Morgan Nolte, a board-certified clinical specialist in geriatric physical therapy and the founder of Zivli. Dr. Nolte's pioneering work, you guys, focuses on reversing insulin resistance, sustainable weight loss and disease prevention. So I'm super excited for her to be here today, because I know there are so many of you who listen to this podcast who have or are dealing with these types of diseases, and we're here to pick her brain. So stay tuned, and let's dive into some amazing insights with Morgan. Welcome to the show.

Morgan: Thanks, Nikkiey. I'm excited to be here.

Nikkiey: Awesome. So first and foremost, what is insulin resistance? Let's just dive right into that.

Morgan: Okay, so insulin resistance is essentially a condition that can happen throughout the body when your cells become resistant to the hormone insulin. Insulin is a hormone made in your pancreas that has a lot of different roles in the body, but the primary role that I focus on is its ability to regulate blood sugars. So for example, after you eat a high-carbohydrate meal, your blood glucose will spike up, especially if it's not during exercise or right after exercise. And that's going to require insulin to come up to push the glucose back into the cells to maintain a normal, low blood sugar level.

What happens over time, if you repeatedly eat a diet high in refined carbohydrates, and I know your crowd is a bit different because they may be eating those but also exercising to match that, but I'm talking about people who are over-consuming carbohydrates compared to their exercise level, or perhaps they're chronically stressed or sleep-deprived. There are a lot of things that can contribute to insulin resistance, but a diet high in processed foods and refined carbohydrates is usually part of the equation for most people.

Over the years, their glucose has spiked and their insulin has spiked, and their cells just start to tune out insulin and become less sensitive to its blood sugar lowering effects. And what you'll see then is a rise in blood sugar levels. But the thing that I think is so important for people to realize is that you can see elevated fasting insulin levels 10 to 20 years before you would see the downstream effect of a rise in blood sugar or hemoglobin A1C, which is a three-month estimate of your blood sugar. So many doctors aren't checking fasting insulin levels, and they are waiting until somebody is diabetic to do something about it. But there are 10 to 20 years of intervention that we can use to prevent diabetes in the first place, and that's what I'm so passionate about.

Nikkiey: Thank you so much for that explanation. And thank you also for the differentiator there between the majority of people who are going through this and the people listening to this podcast, for whom carbohydrates are a great fuel source for exercising. So with insulin resistance, how does that affect weight loss and overall health?

Morgan: Yeah, so it's interesting. Let's start with overall health first of all. High levels of insulin are very inflammatory, and inflammation in general can raise insulin levels. So inflammation and high levels of insulin really fuel each other. Our program, our approach, is to keep both levels low: keep inflammation low and keep insulin low. And that's really how we prevent disease.

If you're looking at root causes of disease, you're going to find insulin resistance in so many. I like to think of a picture of a tree with a root system and a lot of different branches. Insulin resistance is at that root system. Whether or not it manifests into type 2 diabetes, cardiovascular disease such as a heart attack or stroke, Alzheimer's dementia, vascular dementia, osteoarthritis, sarcopenia or muscle wasting, there are so many things that can be traced back to insulin resistance. But your lifestyle and your genetics will determine how that manifests for you personally.

And obesity is also something. Insulin is not just your blood sugar regulating or stabilizing hormone. It's also your fat creation and storage hormone. So another really important job of insulin, it's almost like the master regulator of how your nutrients are assimilated in the body. If you're eating a lot of protein, for example, that will stimulate a moderate insulin response. And what that does is your insulin will essentially tell the cells what to do with that protein: okay, go build bone, go build muscle mass, go build more skin or hair. So insulin also tells your body what to do with the nutrients that you eat.

And when you're eating a diet that is high in refined and processed carbohydrates and sugar, and this is the last time I'm going to use that caveat on carbs, if you're not balancing that out with some high-intensity exercise. So just know there's always that caveat. I understand your audience is very much into muscle building, which can require intense exercise, which is better performed with some carbohydrates. However, when you spike your insulin, that puts you in a fat storage mode. High levels of insulin will drive fat storage. Low levels of insulin will facilitate fat burning.

That's not to say that calories don't matter. Low-insulin calories are still calories. If your goal is to lose body fat, you will have to be in an energy deficit. But from my experience in coaching and personal experience, that's going to be easier to do on a lower-insulin diet. Low insulin doesn't necessarily mean low carb if you're doing a ton of exercise and stuff like that, but usually it does.

So insulin resistance does contribute to obesity, but it's not always accompanied by obesity. There are some really interesting statistics out there on TOFI: thin on the outside, fat on the inside. And I think this is another benefit of insulin testing, because if your physician is just looking at your waist circumference or your body weight, you may be in the normal range. You may look thin on the outside but actually have fat around your organs on the inside. When we test for insulin, we can catch that more effectively than if we're just looking at body weight or waist circumference.

The same goes for metabolically healthy obesity. If we're looking at symptoms of metabolic syndrome, for example low HDL cholesterol, high blood pressure, high blood sugar, high triglycerides, high waist circumference, when you only look at those factors, I think the statistic was that 50% of people with obesity are considered metabolically healthy. In order to have metabolic syndrome, you have to have, I believe, three or more of those criteria. When you check fasting insulin, that number reduces to about 7%. So only 7% or so of people with obesity have healthy insulin levels.

So we're giving people a false sense of confidence in their health if we are not checking insulin, which again has been shown to predict type 2 diabetes 10 to 20 years before glucose and A1C. I like to say glucose and A1C are the last dominoes to fall here. We have got to be more informed about our insulin.

I think one barrier to this is physician education, physician knowledge. It takes a long time for evidence to make it into mainstream practice. I hear people all the time saying, I asked my doctor for an insulin test and they looked at me like I had two heads. Or they said, well, we only do that for people with type 2 diabetes, I'm not ordering one. But you don't have to have your doctor order you one. You can order one from testing.com. We sell them on our website as an at-home test. So if your doctor's not on board, there are a couple of other great options to check your insulin.

Nikkiey: Awesome. I was actually going to lead into my next question there. Individuals are listening to this and maybe want to go and do this. How does someone determine if they are insulin resistant? Do they have the test, or fasting?

Morgan: Yeah. So there are a few different ways. The gold standard in research is going to be a HOMA-IR score. If you Google HOMA-IR calculator, H-O-M-A dash I-R, that's going to come up. In order to calculate that, you're going to need your fasting glucose and your fasting insulin. I say Google it because it depends on whether you're in the EU or the US which equation it is, so it's just easier to type the numbers into a calculator. That's going to be the gold standard that you'll see in most research.

I think there are some simpler things you can do. Just look at your fasting insulin level. Ideally, that's going to be less than six. And if you don't have access to a fasting insulin, there are even more markers of insulin resistance. I've already covered some. If you have a large waist circumference, if you have elevated fasting blood sugar, that's the telltale sign. High blood pressure, high blood sugar, even if it's mildly high, that's a telltale sign that you have some degree of insulin resistance. High triglycerides, low HDL.

Some more symptomatic things would be frequent carb and sugar cravings, which are often a sign of insulin resistance. Because when your cells are insulin resistant, they have a harder time letting nutrients into the cell. It's kind of like a type 1 diabetic situation, where they don't really make any insulin. Their blood sugar is chronically high and it can't get into the cell. There's no key to unlock the cell to let the glucose in. So there's plenty of available energy, but their cells are actually starving. A type 1 diabetic, before they start taking insulin, is starving. They're ravenous. They're so thirsty all the time, and they can't gain any weight. Why? Because they don't have any insulin. If you don't have any insulin, you can't gain weight. So I think it's really important to recognize that insulin is a vital hormone in our body. We need some of it. We just don't want too much of it.

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Okay. We're like 11 minutes into this podcast right now, and you've just been dropping so many knowledge bombs. Of all the guests I've had on The WarriorBabe Show, we've been able to get through an entire episode with tons and tons of knowledge bombs, and I'm like, we're only 11 minutes in. We've got at least 40 more to go. This is going to be a very, very valuable podcast for many of the people listening. So I just want to thank you before we even continue, because just in those three questions, you're sharing in a way that's very understandable, not too scientific, where you kind of bring it down. You're amazing.

Morgan: Thank you.

Nikkiey: So you mentioned doctors a couple of minutes ago. And I totally agree with this, coming from the medical space, that they try to treat symptoms rather than root causes. And it takes a lot of time for studies like the ones you just shared to show evidence and show value, and to show that maybe some people need to start questioning how things are being done in the healthcare space. So why do you personally think it's important to shift from just treating symptoms to preventing health issues?

Morgan: I've seen it. I've seen it. You know, Nikkiey, I was a geriatric physical therapist, and the reason I stopped doing that was my heart broke. I saw so many people who had devastatingly low qualities of life. There was one lady who was morbidly obese. I went to the home that was on the home care record and knocked on the door for her home care evaluation. The neighbors were like, oh, she had to move months ago. I'm like, oh, great. You know how that goes. Someone in admin didn't do their job. What's this lady's address?

I had to track her down. She was living in a mobile home, in a bed in her living room, and it was terrible. She hadn't been out of bed in 10 months. She had to move because the medical bills drained her bank account. She never did get out of bed while I was working with her. And when the squad had to carry her on a stretcher into her new home, they had to turn her sideways because she didn't fit through the door, and she fell out at the door. That is one story that will stay with me forever.

Another one is this sweet, sweet man who I worked with for nine months in rehab. We got so close. He had had a fall in his apartment. He lived alone, and he had rhabdomyolysis, which for those who aren't in the medical field means severe muscle wasting. He had very uncontrolled type 2 diabetes. He was not overweight. He was actually probably somewhat underweight, one of those TOFI people, thin on the outside, fat on the inside. He had developed a huge ulcer on his ankle because he wasn't strong enough to get up from the floor, and a huge ulcer on his bottom from being bed bound.

In nine months, we got him from being bed bound and using a Hoyer lift, which means a mechanical lift, to get in and out of bed, because he was on the ground for three days until a neighbor found him, to walking independently with a walker, even though he couldn't feel his legs from the knees down because of diabetic peripheral neuropathy. And then I found out later that Medicare came back and took back payments for months six through nine of his stay in a skilled nursing facility.

And I thought, what the heck? How many thousands of dollars were spent during these nine months on resources for a preventable condition? And then I was like, what caused them to take their money back? It turns out somebody in billing miscoded and put muscle weakness as the primary diagnosis instead of rhabdomyolysis. Because of a coding error, this lovely business, and I really liked that company a lot, lost thousands and thousands of dollars. And all the work I did for three months rehabbing this person was not reimbursed. It was story after heartbreaking story like that that made me want to do something about it, and made me want to help people prevent diabetes.

And then I saw it hit home. My dad is a type 2 diabetic, and he was way too young. But I saw the signs. Candy bar every day after work, a ton of sugar, obesity. His doctors didn't do anything about it besides prescribe him medications. And I thought, man, if only he had known better. He was really starting to experience some symptoms of brain fog. I was really worried about his cognitive health. His mobility was really declining. I didn't want him watching my children alone. I didn't want him carrying my babies around the house. He got a double hip replacement, which helped, but he also got his blood sugars under control. And I trust him with my children now. His quality of life has greatly improved. His energy levels have improved.

And I have seen firsthand how many people slip through the cracks in traditional healthcare. Just this week, Nikkiey, I was doing a lab review for one of our Zivli members in office hours. I was looking at her glucose levels, which were 99, so very, very borderline prediabetic. And the normal range was listed as 64 to 126. There wasn't even a middle zone of prediabetes. And I'm like, what is happening here? Her doctor probably wouldn't say anything about her blood sugar until she was diabetic, and then it would be, oh, here's some metformin.

So many doctors are like that. They're ignoring prediabetes. I had a client who had prediabetes for over a decade. When she finally started to look at her own lab work and interpret it for herself, instead of believing the little excellent that the doctor wrote at the top of the lab work every year, she said, I have been prediabetic for 10 years. Oh my gosh. And my doctor didn't even tell me. This happens all the time. That's why I'm so passionate about disease prevention, Nikkiey, because I've seen firsthand how it affects my patients.

But here's the other thing I like to say. Eight out of nine of our grandparents were present at our wedding. Eight out of nine. And I'm like, man, we have great grandparents. They influenced my life so much. They taught me values of hard work and loyalty and faithfulness and faith and love. And I saw them age well. I saw them enjoy a healthy, happy retirement. So I saw my 80-year-old grandparents acting like 60-year-olds, and then I saw my 60-year-old patients acting like 80-year-olds. And I'm like, what's the difference here?

That's why I went into geriatrics, to really pay it forward to my grandparents. And I realized that we were doing way too little, way too late in healthcare, especially for geriatrics. That is why my heart is in preventative medicine, so that I can help people in midlife, maybe their 60s, early 70s, get their health back so that they can be there for their family. Because heck, kids need their parents. Grandkids need their grandparents. And I think that society is just a better place with people of good health. We save so much money, so much energy, so much time, and have a greater quality of life if we can get and stay healthy now versus waiting until you're 70 or 80, hoping that your doctor can fix it. Because it's never too late, but the earlier you start improving your health, the longer you will have to reap those benefits, and you won't have decades of unhealthy habits to undo. So that opened up a can of worms, that one right there. That's why I'm so passionate.

Nikkiey: Amen. I also just learned, and I don't know if we talked about this on your podcast, that we have very, very similar starts. I started in geriatrics. I was in long-term healthcare.

Morgan: We didn't talk about that.

Nikkiey: Yeah. Right out of the gate, while I was going through college, I was a CNA. I took care of the geriatric residents in the nursing home, in the skilled unit. The ones with dementia, the ones that were a little combative, and the ones that were also very, very sweet. I had full-on chills when you were sharing those stories, because I can totally resonate with that. I got so close to some of these residents that their families trusted me to take them out for lunch on one of my shifts. So that's so cool. I didn't know that was your extensive background as well. That's amazing.

Morgan: Yeah, very much. And I worked with a lot of people with dementia, Nikkiey, and insulin resistance is directly tied to Alzheimer's disease. I just interviewed Dr. Georgia Ede, E-D-E, and she wrote the book Change Your Diet, Change Your Mind. It's very scientific, but she does such a beautiful job of explaining that when your blood sugar goes up, your brain sugar goes up, and that is very inflammatory. It's a cause of oxidative stress, and you can get insulin resistance in the brain. Alzheimer's disease has been coined type 3 diabetes.

You know how heartbreaking that condition is, for people to have their loved ones come in and they don't know their daughter's name. There was one time when I was a physical therapy student, maybe a resident, in a long-term care home, probably similar to where you worked. One of the residents was saying, where's my husband? Where's my husband? Where's my husband? And I went to the CNA, or the nurse, and asked, where's her husband? And she said, oh honey, he died a really long time ago. And I'm like, oh my gosh, do I have to go break it to this woman? But you don't. You just enter into their world: I don't know, he's not here right now.

My passion really started from a diabetes prevention standpoint, but once you dig down the insulin resistance rabbit hole, you realize that when you live a low-insulin, low-inflammation lifestyle, you kill the most birds with one stone. You reduce your risk for dementia, heart disease, obesity, osteoporosis, osteoarthritis, diabetes, the gamut. So that is my passion. I'm a very efficient person, and I'm like, if I can focus on one thing, what should I be focusing on for my long-term health and to help other people get healthy and prevent these heartbreaking things that I saw?

Nikkiey: Yeah. I love that so much. What you were saying earlier, and even right there, about going in and seeing it when it's almost too late, and healthcare trying to fix something when it's too late. That's how I felt working in long-term healthcare, looking at these older women and men and thinking, wow, these people probably never exercised a day in their life, and some other things I was very intrigued by when seeing their bodies. And then I worked in the ER for four years, and I was like, man, there are a lot of preventable situations that could be helped by eating right and by exercise that are just not being taught. Seeing that is what made me transition into wanting to be in the fitness space and wanting to help and serve more women, and men too, but predominantly women.

Anyway, our stories are very similar. We're passionate in that sense because we've experienced it, and you've experienced it with the clients you worked with there, and then with your dad, which is incredible to hear that outcome. And you touched a little on how understanding the underlying risk factors can lead to better health outcomes. Can you touch on that again? When you address these risk factors with insulin resistance, how can that lead to better health?

Hey, just want to drop a huge appreciation to you guys listening to the show. It means a lot. I hope you're enjoying it, and there's so much more to come. If you are enjoying it, hit the subscribe button. I'd appreciate that tons, and it would also help this podcast reach others who need to hear these messages too. Thanks so much, guys. Let's get back to the show.

Morgan: Yeah. Well, first off, I just wanted to highlight one of the reasons I went into this, which was the kids of the patients I was treating. I saw family members following in their footsteps, and I thought, who is helping you? You don't need a physical therapist right now, but you are not well. So people in the gray zone are who I'm really passionate about.

As for other risk factors for insulin resistance that are completely controllable, I always like to start with sleep and stress management. When you're not sleeping seven to eight hours a night, maybe up to nine, but not past nine and not less than seven, that does a couple of things. Number one, it increases stress in your body. It increases a stress hormone called cortisol, and cortisol will naturally cause your blood sugar to go up. And if you're not moving your body to use that blood sugar in your muscles, well, guess what? Your insulin is going to go up. So over time, poor sleep is definitely an underlying contributing factor to insulin resistance.

The other thing is that when we are sleep deprived, we are way more likely to overeat, and far more likely to crave carbohydrate foods. That's because cortisol increases a substance in your body called NPY, which preferentially makes you want to eat carbohydrates. So it is not just you after a poor night of sleep, or when you're super stressed out at work and going to the candy jar. That is your hormones. And there are things we can do to change your environment. So sleep is really crucial for good hormone health. As you know, that's when we really build our muscle. So it's important for so many things.

The other thing is stress management. I had a very long coaching call today with somebody on mindset, and the action items we came up with were creating boundaries around her work, because she's working 60 hours a week, and creating more joyful activities in her life. I had her reflect on the prompt: when I think about planning my meals, I feel... And she wrote a whole paragraph about how the external was affecting the internal. One thing she said was, I feel like my spontaneity is taken away when I plan my meals, and then my fun is taken away, and I need more fun. And I said, wow, that's a great line. You need more fun. How are we going to create boundaries around your work time to create more intentional rest and more fun, so that food is not your only source of rest, fun and spontaneity?

So getting into the underlying factors that are leading people to be stressed out is very important, and then helping them create better thought habits and activity management habits. I like to say you can't manage your time. We all have 24 hours in a day. But we can manage our activities.

So stress and sleep are important, and physical activity, as you know, is so important. The more physically active you are, the more likely you are to prevent insulin resistance, because your muscles act as a sponge to soak up that glucose after a meal, and that reduces the insulin response to whatever you're eating. I like to say a balance of activities is best. The cornerstone has got to be strength training for long-term health. At least twice a week of moderate- to high-intensity strength training for all major muscle groups is my baseline recommendation. Then different forms of cardio are important, and flexibility too, which I think is often overlooked. So just a nice comprehensive activity program.

There are some other factors too, especially menopause, which I think is important to address for insulin resistance. Many women go through perimenopause and say, oh my gosh, I gained 30 pounds overnight, I'm not changing how I'm eating, I'm not changing how I'm exercising, and now I have all this belly fat. What's happening to my body?

I like to explain to them that when you go through menopause, your ovaries stop producing estrogen. And estrogen is not just a reproductive hormone. It's a hormone that's important for your nails and your skin and your hair and your muscle and your bone, and your mood and mental health. We need estrogen. Your body is very intelligent, and it has backup mechanisms to produce estrogen: your adrenal glands and your adipose, or fat, tissue. As we transition through menopause, your fat tissue starts picking up some of the slack your ovaries used to handle for producing estrogen, and your adrenal glands do the same.

But if you are chronically stressed out and your adrenal glands are pumping out a bunch of cortisol, because they also produce the stress hormone cortisol, there's not going to be enough bandwidth in the adrenals to produce more estrogen. So your body relies even more on your fat tissue to produce that estrogen. That's one reason stress management is so critical, especially in midlife, to really calm the adrenals and calm the stress response so they can produce some more estrogen, and so your body feels it's a safe environment to release some more of that fat tissue. So that's kind of what happens hormonally.

Your estrogen levels are going to drop anyway, but estrogen is an insulin-sensitizing hormone, meaning when we have higher levels of estrogen, we have lower levels of insulin and lower levels of cortisol. A cycling woman will experience that. When estrogen is highest, around day 14, when we're ovulating, I believe, we're going to feel naturally slimmer. Then as our estrogen levels fall, about the week before our period, insulin levels will naturally rise and we're going to feel more bloating. It happens in pregnancy too. If you look at a woman who's pregnant, insulin will skyrocket. You can look up type 1 diabetic insulin needs during pregnancy, and you'll see that direct correlation between insulin and weight gain.

So that is so pivotal to understand for women going through menopause. It is hormones, but it's not necessarily estrogen. It's insulin that's really driving the weight gain, the prediabetes, the high blood pressure that you're seeing in midlife. And a couple of things we can do: recognize that what worked in your 30s and 40s is not going to work anymore. We need to pivot our strategy to one that focuses on keeping cortisol and insulin and inflammation low, and one that supports healthy muscle mass. Really, a more comprehensive approach.

I don't prescribe any medications, but I think looking into hormone replacement therapy is a wise decision on a person-to-person basis, because there's kind of a golden window around menopause where taking some hormone replacement therapy can help preserve your muscle mass, your cardiovascular health and your mental health for a bit longer as you age. So those would be the other things.

Nikkiey: Yeah, I love that you touched on menopause there. Let's dive into it. With HRT, what you just mentioned, it used to get a really bad rap, and now it's kind of being resurfaced as something that is very beneficial for women around the years of menopause, like you just said. It's too late, though, if you're like 65, right, to do HRT?

Morgan: Yeah, that's my understanding. Dr. Jaime Seeman, who also goes by Dr. Fit and Fabulous, has come on my show to talk about HRT before. I believe it was her, though it could have been a different guest, who said it's about a 10-year window after you go through menopause, which means you haven't had a period for a full year. That's kind of the golden window when we want to optimize hormone replacement therapy. And the benefits really reduce after the 10 years after menopause. There aren't as great benefits from taking it.

Nikkiey: Yeah, man, our bodies are incredible.

Morgan: I know.

Nikkiey: Even with menopause and being insulin resistant, there are ways to fix it outside of just turning to any type of medication. Which leads to a question I want to ask you. Working with individuals like you do in Zivli, what are some of the dietary changes that are effective in helping your clients combat insulin resistance?

Morgan: We have a little bit of a different approach. We call it the Zivli habit hierarchy. We start with mindset and sleep, because that's the foundation. If you're not sleeping well, if you don't have a strong mindset and system of accountability for yourself, you're probably not going to follow through on anything else.

Then we talk about water intake: at least half your body weight in ounces of water a day. That's very important, especially during fat loss. Fat actually holds on to water. So if you're dehydrated, your body's not going to want to release that fat, because that's your water reserve as well as your energy reserve. So be well hydrated. Electrolytes, I think, are important to supplement during fat loss, especially if you're using fasting.

We focus on protein next. If you're sleeping well, if you're hydrating, if you're eating your protein, your carbohydrate cravings are naturally going to be lower. A lot of people we work with have very intense sweets and carbohydrate cravings. They feel like they're addicted to sugar, so they just start cutting their carbs and sugar. And I'm like, well, you don't have the foundation in place to really help reduce your cravings in the first place.

For protein, I recommend about one gram per pound of ideal body weight. That may not be what some people feel is realistic. If someone is 250 pounds and thinks a realistic goal is to get down to 170, that may even be above their ideal body weight. Their ideal body weight may be closer to 140, so it would be 140 grams of protein. A great starting goal is at least 30 grams of high-quality protein per meal to support muscle health. So that's usually where we start from a nutrition standpoint: water and protein.

We also really recommend healthy fats. We're not afraid of fat. Fat is the macronutrient that keeps the insulin response the lowest compared to protein or to starches or sugars. So fat is good. We recommend biasing your fat intake toward monounsaturated fats especially, so avocados, olives and their oils, and unprocessed polyunsaturated fats like nuts and seeds. You want to avoid processed seed oils like canola oil, corn oil, soybean oil, et cetera. Those are very inflammatory. Even though they won't raise your insulin level and you won't see a blood sugar response, they're inflammatory for your cells, and ultimately they will drive insulin resistance.

We're not afraid of saturated fats. I think it depends on the source, and it depends on the person and their specific genetic risk factors for cardiovascular disease, whether we're recommending eat as much as you want or bias your fat intake toward the ones I just mentioned. We really recommend reducing processed fats as much as possible, and they're kind of everywhere, especially salad dressings. Many people think they're eating healthy because they're eating this huge salad with a little bit of protein, and then they put a dressing on top that's loaded with added sugar and refined oils. That's just not the way we want to go.

Lastly, I think it's important to mention gut health. I see a lot of people who are pretty dogmatic about keto or carnivore, and they're forgetting about fiber and gut health in general. There's a bunch of bacteria in your gut, long story short, and those bacteria eat fiber. So even though we can't digest the fiber, our bacteria can, and we get some benefits. We recommend 20 to 30 grams of fiber a day as well.

For carbohydrates, it's really person-specific. The more insulin resistant you are, the fewer carbohydrates you're probably going to be able to tolerate. I think a really nice starting place is around 30 grams of net carbs per meal or less, which is still a pretty good amount of carbohydrates. Definitely lower than your typical processed American diet, but very doable. And then, depending on your levels of activity, we can strategically time some carbohydrates before or after a workout to improve performance but also reduce the insulin response to those carbohydrates.

I think it's really interesting to note that I say the 30 minutes after a workout is like the golden window for eating carbohydrates without secreting insulin. You're still going to see a blood sugar spike, but there's a receptor called a GLUT4 transporter. It's on the cell membrane of muscle, and it's like a tube slide that glucose slides down from the bloodstream into the cell. The GLUT4 transporter gets to the cell membrane via exercise or insulin, and they stay on the muscle cell membrane for about 30 minutes after exercise. So your glucose can just slide right down without the added insulin after exercise.

So just to sum that up again: we want to focus on water. You want to get one gram of protein per pound of ideal body weight, spread out ideally throughout the day in doses of at least 30 grams. Then we want 20 to 30 grams of fiber, and then fill in the rest of your calories with healthy fats and then carbohydrates, depending on your level of insulin resistance and activity, as tolerated.

I think it's also important to note that when I make those recommendations, people ask, what if my cholesterol goes up if I'm eating a bunch of meat and a bunch of fat? There's so much really good information out there right now showing that your total cholesterol and your LDL cholesterol have no indication whatsoever of your risk of cardiovascular disease. We must go deeper. There are so many great resources out there that explain this further. One of my favorites is an interview with Dr. Robert Lustig and Casey Means from Levels Health, where Dr. Lustig explains how to properly interpret your cholesterol panel. If people want to check out that resource, I think it's a really good one. But long story short, it's very commonly misconstrued that total cholesterol and LDL are any indicator whatsoever of your risk for cardiovascular disease.

And here's the problem. Doctors will see high LDL or high total cholesterol and say, oh, your cholesterol is high, you need to take a statin. And they don't look any deeper into LDL particle number or LDL particle size, which are the two factors that are more important for cardiovascular risk, and statins directly increase insulin resistance.

So that's another factor. We talked about stress, sleep, movement and diet, but there are actually a lot of medications that contribute to elevated levels of insulin resistance. Some blood pressure medications like beta blockers, statins, and a lot of antipsychotic medications, or antidepressant or anxiety medications, can also contribute to insulin resistance. So when we get to the root cause, which is diet and lifestyle, you're going to reduce your need for these medications in the first place, which are sometimes the ones confounding the problem.

Nikkiey: Amen. Thank you again. That was a lot. I want to unpack that a little bit.

Morgan: I know that was a lot.

Nikkiey: It's all good. It was great stuff. And I love that we align, and we talked about this on your podcast, on protein. It's great that you share the same value in getting one gram of protein per pound of body weight and dosing it out in 30 grams throughout the day. I love the foundation of mindset, sleep and hydration. That's golden right there, because like you said earlier in the podcast, managing your stress can totally help with insulin resistance.

At the end, you mentioned something about fiber and carbs, and I want to circle back to that first, because somebody was on the podcast recently and we talked about fiber and carbs, but I couldn't pull this out the way I wanted to. Would you say fiber and carbs are the same? What do you think?

Morgan: No.

Nikkiey: I agree.

Morgan: Okay. No. So why? Technically, I like to explain that there are three types of carbohydrates. This is a little bit misleading, but I think it's easiest to understand. Starches, sugars and fibers are the three big categories of carbohydrates. The caveat is that starch is just a type of sugar. If we're breaking sugars down, and I think this is really helpful, there are three main simple sugars: glucose, fructose and galactose.

Those simple sugars combine to make different kinds of sugars. The lactose found in dairy products, for example, is galactose bonded with glucose. Table sugar, the white stuff people might put on their cereal or in their tea, is one molecule of glucose bonded with one molecule of fructose. Whereas starchy foods like bread, rice, pasta, et cetera, are many molecules of glucose bonded together. That's why you might hear that starch is just sugar. Starch is just many molecules of one type of sugar, glucose, bonded together.

Fiber is none of those. Fiber is a completely different plant compound that acts totally differently in the body, and there are different types of fibers with various benefits. In general, that's why I can't ever tell someone not to eat fiber, because I know what it does for the gut. I know how beneficial it is to the gut microbiome. I'm reading a book right now called Super Gut by Dr. William Davis, and his episode airs on my podcast next week at the time of this recording. I learned so much from him.

If you're a nerd like I am and you're going down the rabbit holes, you will find there is no required carbohydrate. There are essential proteins, like essential amino acids. There are essential fatty acids. But thus far, no essential carbohydrates have been declared. So some people say, oh, your body can make all the glucose it needs, keto, and so on. And yes, that's totally true. If we're only focused on energy needs for the brain and whatever, your body can make glucose from fat and protein. But we're forgetting about gut health.

So I do not agree, and I don't know if that's what that person said, but fiber is in its own category. When you eat fiber with your food, that's going to cause a slower and lower blood sugar and insulin response. It's going to feed your microbiome. It's going to help you feel full. It adds volume to the food, so it triggers satiety mechanisms from gastric stretching. Whereas sugar has a completely different hormonal effect in the body, a different physiological effect, and a different effect on your gut health. So I don't think we can say that fiber and sugars, to simplify it, are the same.

Nikkiey: Beautiful. Thank you so much for sharing that and elaborating on it, because I agree with you a thousand percent. It felt like carbs were getting a bad hit and that fiber was being treated as more important than carbs. And to your point about carbs and the molecules involved, they're straight glucose, which is why I love talking about why carbs are good for building muscle and for performing exercise, because that glucose helps you get through a workout with sustained energy. But twofold, on strength training: I want you to elaborate on why strength training and muscle are good when you're dealing with patients who are insulin resistant.

Morgan: Yeah. So, muscle. Maybe you know this stat too. I thought it was something like 80% of the glucose that we eat is deposited in muscle. Have you heard that one?

Nikkiey: No, I haven't, but I firmly agree with that.

Morgan: I think it's something around there. So muscle acts as the reservoir for the glucose you eat after a meal. The more muscle you have, it's almost like the bigger your garage, the more cars you can park in your garage before you have spillover onto the driveway. The more muscle mass we have, the more glucose can be stored in the muscle in the form of muscle glycogen before it's shuffled off to the driveway, in other words adipose stores or fat tissue. That's the primary reason muscle is so important when we're talking about insulin resistance. We want to reduce how much glucose spills over into the fat tissue. And ideally, we can pair our eating with some form of movement to reduce the insulin response after a meal.

Nikkiey: Beautiful. Love that. That's why I love carbs so much. I can eat as much as I want because I have more muscle, essentially, you know?

Morgan: It's true. It's totally true. And I think that's another reason people's carbohydrate tolerance tends to decrease with age, and why they say, I can't eat what I used to. Well, your muscle mass isn't what it used to be either. So if we focus on muscle mass, we can definitely eat more. And I do believe we are in a movement that is maybe prioritizing strength training more. But I know when I was growing up, it was all about calories in, calories out. Cardio is king. You can see how many calories you're burning on the treadmill or the elliptical. You can't see the calories when you're lifting the weight. I know the temptation is to get that instant gratification of a calorie burn. But recognize that you're still burning calories. I don't remember exactly what the study said, but it's 24 hours after a strength training session. Do you know that one?

Nikkiey: For sure, 110%. It's that EPOC. It's what Orangetheory got really big on with their marketing.

Morgan: But it's with strength training in general. The effects of cardio last a little bit after the workout, but not nearly as long as after strength training. So we can't just focus on the immediate gratification of seeing the calorie burn. We also have to emphasize protein and diet, because in order to build muscle, we must have great strength training programming and we must have good protein. Both are important.

Nikkiey: Love this. You're speaking my language.

Morgan: I know.

Nikkiey: It's music to my ears. A second ago, when you were talking about it, I knew all of this valuable information is going to resonate with the audience. Specifically, there are people in our community who say a lot of the time that they're insulin resistant. Yes, we understand. And they don't want to do strength training. It's a very small number of people, but it's nice to have me, who preaches a lot of these things, and then somebody else come on the podcast and preach it in the same way.

Morgan: The same thing happens with my members. They say, oh, you had so-and-so on, and they said it like this, and that made way more sense to me than how you say it. And I'm like, I don't care how it gets in your head. I just want it to get in your head, whether it's from me or someone else.

Nikkiey: So yeah, this has been great. I learned so much from you today, Morgan. Thank you for sharing. Your insights are invaluable, and so are the lives you're helping. You can feel your passion as you share what you love so much. So talk a little about Zivli and where people can find you. I'll have everything in the description below, but tell us where people can find you and a little about your program.

Morgan: Yeah. We open enrollment for our program a couple of times a year, and the next one is in September. It's a 12-week online course. I developed a curriculum that teaches people in depth all the things we covered today. We cover macronutrients in depth, micronutrients, different forms of exercise, stress, sleep, mindset and habit change, and we develop systems to help them implement these lifestyle changes.

It's lifetime access, so when people join, they're a member for life with ongoing support. We're just starting accountability pods, which we're really excited about, because we know that behavior change takes time and it takes a consistent, focused effort. So we wanted to develop a program that people can join and get that ongoing support and the information they need. Everything I wanted to tell my patients and their children in geriatric PT is in this course, so they can empower themselves with the knowledge required to reverse insulin resistance.

Because sometimes there's some unlearning to do, as we've alluded to today, on cardio and dietary fats. Many people are under-eating protein and overlooking sugars, and so many things. The mindset stuff is my personal favorite and passion, because you can have all the strategy in the world, but if you don't have the right mindset, it's going to fall on deaf ears. You're not going to follow through. You're not going to be consistent, and you're going to keep beating yourself up. So we really like to pair the strategy with the mindset.

If people want to learn more about insulin resistance right away, we have a starter course they can take. They can go to zivli.com, that's Z-I-V-L-I dot com, and learn more about macros and insulin resistance that way. I have a YouTube channel and a podcast. You were gracious enough to come on mine. It's the Reshape Your Health podcast. And I'm also on Instagram at Dr. Morgan Nolte.

Nikkiey: Amazing. Well, Morgan, thank you so much for being here and sharing your insights with the audience. Guys, go check her out. And again, thank you for being here.

Morgan: Thank you, Nikkiey. I appreciate it.

Nikkiey: Hey guys, real quick. If you're interested in taking your body to the next level, losing body fat, building more muscle and feeling more confident, do it alongside one of our 30-plus professional coaches. Work one-on-one with her to eliminate all of the guesswork you may have. All you need to do is the work she tells you to do to get to those goals of yours. To learn more, click the link below this podcast and apply to our VIP program right now.