BONUS: The Impact Of Intermittent Fasting On Metabolic Health In Women with Temple Stewart

Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. This is Bonus Monday, your most downloaded favorite podcast. I love that this community runs the gamut from medical professionals, research scientists, science writers, personal trainers, and more. These are your favorite, most loved podcasts in the last five years. I could not be more proud of the diversification of guests that appeal to all of you. Thanks for tuning in. Today, I had the honor of connecting with Temple Stewart. She is a registered dietitian specializing in low-carb dieting for women's weight loss. I've had the opportunity to speak on several stages with her in the last year. She's absolutely delightful. We dove deep into her background and her history of PCOS and Hashimoto's that she was able to reverse with adopting a low carbohydrate ketogenic diet. We discussed food psychology, woke nutrition, whether or not if it fits your macros is a good philosophy. The issues surrounding traditional allopathic models of nutrition, challenges related to nutrition research, weight loss resistance, plateau busters, and five different ways to measure success other than the scale. I hope you will enjoy this conversation as much as I did recording it. Welcome, Temple. I've been so excited to connect with you. Yeah, I'm so honored to be here. Thank you. I've listened to your podcast, so it really is a delight to be able to be on it. Yeah. We actually met in Las Vegas last year at the Keto event and then our paths crossed again in Austin and then again in New York City. I feel really fortunate to have interacted with you in three different locations at three different events. I'd love for you to share with listeners a bit about your background. For everyone that's listening, you are a registered dietitian, but you're also in naturopathic schools. You've now relocated to another part of the country. I love your story. You really have a pain to purpose story, how you yourself healed your body with nutrition along that journey with a couple different little bumps along the way, things that got you focused on looking at nutrition as medicine. Yeah, it's been quite the journey, but I feel really honored to have walked it because I think it really helps me when I'm having clients with real life problems. I can say I've been there. I understand what that feels like. It all really started probably my second year as a student dietitian. I was following all the guidelines and to become a registered dietitian we're obviously taught the conventional dietary approach, lots of whole grains, limited red meats, the typical stuff that we all know. I was following that and I was just getting sicker and sicker and bigger and bigger and I was having more and more hormonal issues. I was just so baffled because I'm doing what I'm being taught, yet I'm having all these issues and I really can't solve it. That's when I started jumping around, diet, trains, try veganism a little bit, tried all these things and ultimately led to a PCOS diagnosis when I got down to the root of it and I was told nothing about my diet. I was literally handed my formin spheromolactone and birth control and told to move along and to let me know, let this OBGYN know when I was ready to get pregnant and he would send me to a fertility clinic. I was 21 at the time, maybe 22 at the time and I'm thinking I've been healthy my whole life. I'm a division one soccer player. All these things, this can't be happening to me and I'm not going to take this as an answer. That's really ultimately when I started to do the deep dive into what can I do to heal my body naturally. I started reading books while we get sick by Dr. Pikman, the obesity code by Dr. Fung and it completely transformed my life and it also transformed the way I was acting as a dietitian because I wasn't seeing results with my veterans either and my patients either. It was a huge journey but ultimately I'm thankful for the PCOS diagnosis because I don't think I would have ever found low carb keto without it. It's really interesting. We've had Dr. Felice Gersh most recently here talking about PCOS and her book PCOS SOS is I think truly the best book written talking about PCOS and really looking at is stemming from inflammation and oxidative stress and insulin resistance. This is the piece that I think so many clinicians are missing with these young women. I myself didn't realize I had PCOS until I tried to get pregnant and I remember my GYN who was on top of things. Clearly we were charting and she could see that I had this luteal phase defects and not enough progesterone and she said, I bet you have PCOS. The kind of conventional way of dealing with PCOS prior to conception is contraception, oral contraceptives, the pill and then still not fixing the root cause and then you go on to take or at least I did I took clomid and did IUI to get pregnant and still didn't realize that insulin resistance, even though I was thin, they missed these diagnoses and women and it really sets them up for a constellation of long-term problems and it's my understanding that you also were diagnosed with Hashimoto's and how many young women and middle-aged women for that matter have Hashimoto's and you were able to successfully reverse that, put it into remission with diet alone which I think is incredibly encouraging. Yeah, I was. They were kind of back to back and I forget that one because I reversed that one kind of first so but yeah it was PCOS and then some of the symptoms I was still struggling with with the fatigue, my hair was bald, just you know all the typical thyroid stuff and again kind of the same thing of like you're going to just need to go on armor, love of hypoxine and there's no dietary patterns that can fix this and at that point I had already basically reversed PCOS and so I was kind of like you know what I've done this once I'm going to do it again and started doing the research with that too and you know within a few months my antibodies were down below nine which is where they should have been and I was feeling fantastic and better than I had felt in years and I just that's when I really got not frustrated but I was just like how many other women are out there who spend years and years and years and years suffering not living their best life because they don't know that they can take control of this and really fix it on their own and I'm not saying conventional medicine isn't helpful or medication isn't but it absolutely isn't it has a place but ultimately nutrition, lifestyle, some of these things are more powerful in a lot of ways. Absolutely and what do you find in your given patients right now what do you find in terms of inflammatory foods foods that will provoke inflammation with their thyroid gland I have a couple that I usually recommend women stay away from in particular but I'm curious to know if they're the same that you see. Yeah definitely gluten would be like top number one and some of the cross-reacted for gluten and so a lot of women just have no idea that that can be so damaging for any autoimmune really and so that's usually the first thing I'll say look if you're going keto anyway it's pretty easy to get rid of this one or low carb and so that's one of the first ones sometimes I see my women have some issues with dairy as well and of course your typical seed oils and the more and more that keto has gotten popular we know that these seed oils are in all these keto products so a lot of times it's just adjusting diet in terms of okay yeah you're following keto but you're still eating a lot of these inflammatory seed oils through these keto fake foods and so that's a really helpful one for them to switch off as well but I would say gluten dairy and then the seed oils tend to be like my top three and then really with Hashimoto's as you know it's very helpful to get rid of a lot of the toxins stop drinking tap water we could probably go on and on about some of the more quote unquote crunchy things to do to help that but I just see a huge improvement with just gluten alone half the time yeah and it's interesting how gluten is snuck into our diet so innoculously and that's why I think it's important to read those food labels ask questions because we probably even if we are excluding gluten from our diet we get passive exposure in restaurants of reading at friends houses and so I've gotten to the point now where I just tell people I have if I go to a restaurant I just say I have an allergy and then they take it a little more seriously yeah 100 I do the exact same thing and a lot of it really is the passing on the plates the passing on the grill everything you can be exposed in especially when you're not in control of the cooking etc. Absolutely and so let's pivot a little bit and talk about food psychology because I know in your work and certainly in my work that the psychology around food is incredibly impactful and so when we're looking at our relationships with food and how we perceive food to be some people look at food as fuel some people look at food as comfort when you're working with your your probably I'm sure that we probably share very similar populations that we work with but some of the food rules that people grow up with or dietary you know constraints or their food relationships how does that play into your work oh I mean it's a huge portion I feel like it's very difficult diet may be the single handling most difficult thing to change and a lot of people because it truly is it's ingrained into the the culture the way that they were raised people have happy memories and sad memories and it all can come back to food and food behaviors and so yes it's absolutely something we can address and it's one of those things that there isn't like a blanket way to address everyone all the same right we always have to look at the individual what have they gone through what were they raised like what culture were they in had they experienced childhood trauma around food did something happen to them that causes them to use it for comfort so it really is it's like a it's like a very investigative process of figuring out each individual's kind of main driver of what their food behaviors and I really encourage my clients to either get help with this there's some great like food therapists and people that really like specialize in this that can really dig deep but also just telling my clients look look back on your life where did this problem arise what happened to you did you experience any trauma what where do you think this started to become an issue and then treated at its root cause right because there's tons of strategies of like hack this and a tip for this and that's all great but until you really address some of the root issues whether that's low self-esteem low confidence all of it you know it's important to fix that first especially if you want long-term results now I think it's really important for people to just be honest with themselves and fully transparent I find when I'm really digging in deep with clients and patients when they start sharing about how they were rewarded with food growing up or you know maybe they didn't have the support system they needed from their parents or their loved ones and so food was something they could do in secrecy and private that made them feel good you know they I've had women describe you know carbohydrate dense foods as feeling like they've had a hug yeah and so you know that serotonin boost at least temporarily it's a really understanding that you know working with practitioners that are going to take the time to get a good history that are really going to talk to you about your relationship with food I think is a really important first step yeah absolutely and it oftentimes is really eye-opening for clients too because they've struggled with this problem but haven't really thought about why and so yeah I think that that's the first step in creating a long-term success in a client if you're in perimenopause or menopause and are feeling more fatigued dizzy lightheaded struggling with headaches or noticing your workouts feel harder than they used to electrolytes may be part of the missing piece as estrogen declines we lose some of the fluid regulating and vascular protective effects that hormones once provided that means blood pressure regulation can shift cortisol can run higher and many women become more sensitive to dehydration especially if you're strength training walking more intermittent fasting or reducing processed foods that's why I love element it is my favorite electrolyte formulation and I've exclusively used their products for the past six years element contains a science-backed ratio of sodium potassium and magnesium without sugar artificial ingredients or unnecessary fillers it supports hydration at a cellular level helps reduce muscle cramps improves energy as well as recovery and can even support better stress resilience this is particularly helpful in midlife when we're prioritizing metabolic health and muscle preservation I personally use element throughout the day and it's become a staple in my routine as well as my household if you'd like to try it go to drink element dot com slash synthia to receive a free sample pack with any purchase stay hydrated stay strong especially in midlife if your women in midlife or beyond you're probably noticed those changes in energy strength and recovery just don't feel like they used to and what's frustrating is that for many women this happens even when you're eating well lifting weights prioritizing protein and doing all the right things you're not lazy you're not unmotivated and you're not doing anything wrong a big part of what's changing actually starts inside your cells as we age or mitochondria the energy producing structures inside our cells become less efficient and when mitochondrial function declines it can show up as lower energy slower recovery reduced muscle strength and feeling less resilient overall this is a normal part of aging physiology and it's one of the reasons midlife can feel so different and that's why I've added might appear gummies from timeline nutrition into my daily routine might appear as the only clinically proven form of urolithin a a compound shown in human clinical trials to support mitochondrial renewal in simple terms it helps your cells do a better job of making energy and when your cells have more energy your body is able to support strength endurance and recovery as you age what I appreciate most about might appear is that it's foundational not flashy this isn't a stimulant or a quick fix it's a daily habit that supports how your body actually works at the cellular level and the gummies make it easy they're just two sugar-free gummies per day they're vegan and cleanly formulated they're independently tested and certified for quality and if supporting your energy muscle health and overall resilience as you move through perimenopause and menopause is important to you might appear is worth considering you want to go to timeline nutrition dot com slash synthia and use code synthia-thorlo for 20 off your order again that's timeline dot com synthia and use code synthia-thorlo for 20 off your might appear gummies what are your thoughts on woke nutrition things like if it fits your macros yeah you know as a dietitian I feel like I get trolled a lot on this about an instagram and tiktok and stuff because I don't believe in it I think it can be really damaging I think things like if it fits your macros for especially a diseased individual that may be struggling with Hashimoto's or diabetes or anything I think it can be a total disaster and same thing with like the movement that's going around that like you can be healthy in every size yeah you can there's a chance that you are healthy but to say that to everyone there's going to be a significantly more majority that's not healthy at every size and so yeah this woke there's several different kind of dietary methods in this woke nutrition platform right now that I think are really creating a disaster and a lot of the times I'll get clients that have tried them and have gained you know 30 40 50 pounds their a1cs have gone up three points and it's just like whoa we need to be able to be honest enough with people that yes it might be uncomfortable but I think we can do it in a loving way where we we tell them the truth in efforts to help them not to hurt their feelings or be disrespectful to me not being open and honest with someone is the least loving thing you can do right especially about their risk their health risk and all of that and so as a dietitian I feel a little bit like I'm the black sheep of the family when it comes to this because I don't buy into it I don't promote it and that's where a lot of nutrition and dietetics has moved is don't ever make anyone uncomfortable it's okay to have everything in moderation sugar isn't you know going to cause that much problems and it's just not true and ultimately I think it harms people in the long run now I think it's such a good point and it's interesting there's one individual who I will not call out on Instagram who every Saturday buys a big thing of donuts and this individual says you know this is my higher carb day and I'm going to eat all these donuts and that's fine because this individual is metabolically flexible but the people that are watching these stories and watching this you know if it fits your macros I think it's destructive and it's not to suggest that you don't have a higher carbohydrate day if you're carbohydrate cycling but you're going to get more from a whole foods source carbohydrate than you are from this highly processed hyper palatable seed laden you know sugar bomb and the other piece that I think is important and I say this often is if you can't moderate then you eliminate and you know there are people like I can eat a piece of dark chocolate I cannot just eat a cookie or a piece of cake like my brain when it gets that flour even if it's a gluten free flour product my brain goes more I want more I want more and so it's much easier for me just to not have those things in my home of course around the holidays I will have a piece of pie I will have a piece of cake I will get rid of them afterwards but I think it's important for people to understand that that whole concept of if it fits your macros I think is particularly destructive you know being healthy at every size I agree with you being respectful and direct and honest and forthright with our patients and clients is so critically important and then really understanding that you know finding an alternative like I had Mark Cucasala on this past week and he's so funny he was saying get 90% dark chocolate and I can guarantee you it's so rich you can't eat more than like one square and so really understanding like the less sugar that's in something the less addictive the less dopamine energetic the less dopamine pleasure seeking behavior will come out of that and I think that's important to make that distinction 100% agree and I love that you mentioned like the moderator versus abstainer aspect because it is true a lot of people don't know what they are they don't know if they're a moderator abstainer but they you know they're really abstainers but they keep falling into that binge cycle and it's like well this is why is because you don't do well with these foods as an abstainer so I think that's a huge concept that's good for people to understand as well yeah absolutely and so you and I are the byproduct of the traditional allopathic medical model and we both openly talk about the fact there's a lot of good things that our traditional model does we are superlative with emergencies we are superlative with surgeries we don't do such a good job with prevention and chronic disease management and so what do you think are some of the big issues with the traditional allopathic nutrition model and for everyone that's listening understanding that registered dietitians really are at the crux of being the like nutrition pros like within that model I know when I was rounding on patients and I'd call for a nutrition consult with the rds in the hospital some of whom were aligned with us and then many of whom were not and we can talk about my registered dietitian that suggested my patients eat six bananas a day and I was like no no no well I think yeah this is a huge topic I think one of the biggest issues is just time itself the way that conventional medicine has moved is we can't really expect a lot of these doctors and nurse practitioners and all these people to be able to do preventative care like you said they just don't have time the sheer amount of patients that they're being forced to see for payouts and all of that is just I mean they can barely fit into words right and so to expect them to do preventative care and treat the problem at hand I think is a lot of pressure and I do believe that there are great doctors and nurse practitioners and dietitians out there they just simply don't have enough time and or the patient themselves are just not interested in it like you know they're in the hospital for some reason they may or may not have taken care of their health and they may or may not be interested in preventative care so I think there's a huge time money issue there as well and I completely agree conventional medicine has saved my daughter's life it's fantastic for emergency medicine but I think we need to open our eyes and be a little bit more open-minded about preventative care and understanding that there's a lot of tools at hand there's people like you and I there's so many great professionals and I think conventional medicine needs kind of a come to Jesus meeting a like let's use these people we don't need to feel the pressure of preventative medicine let's send them out let's start reimbursing these professionals that care about preventative care you know I think it starts much deeper than probably what I'm scratching the surface and then ultimately too I think there's a lot of responsibility that comes down to the patient themselves I don't think that it's a medical professional's job to create motivation and to change people's lives that don't necessarily want it so I think it starts ultimately with the patient themselves of where's your motivation and give them the proper education and then ultimately they're the ones who are going to put the practice into the lifestyle so yeah I could go on about conventional medicine probably more than you'd like but you know I think ultimately the more that we prop up preventative medicine and help people understand that you don't have to live this way diabetes is reversible PCOS is reversible and then getting those patients to the providers that can help them is a huge piece yeah it's interesting you know working in cardiology for 16 years we had patients who were on 50 plus medications between cardiology and all the other specialties that they saw and to me it was always disheartening when I had to add more anti-hypertensives for blood pressure had to you know increase someone's insulin in the hospital had to you know add more medications for their dyslipidemia or their lipid disorders and I used to always try to get the conversation back to we really could work on lifestyle and more often than my patients would say Cynthia I'm not going to stop smoking I'm not going to exercise I'm not going to change my diet so just give me the prescription and I would always kind of be like okay that this is the patient's choice I'm trying to educate them but I agree with you wholeheartedly that it really has to stem from the patient intrinsically wanting to make changes so that we can help facilitate that process and as I was preparing for this podcast today I wanted to just share with listeners some statistics that I was looking at we are the 35th healthiest country in the world we are ranked 46th in the world for life expectancy and the net impact of special interests and lobbyists on the USDA and health and human services is undeniable and Robert Lustig had a really interesting quote if anyone knows Robert we've I've actually had a podcast with him he's this prolific pediatric endocrinologist who uh has kind of moved away from being in a teaching environment but wrote an amazing book called Metabolical he said tasking the government agencies tasking the government agencies that manage America's food production with crafting nutrition policy is akin to a fox in charge of the hen house and so really understanding that in many ways this is a top-down issue it is not just a clinician issue patient provider issue it really stems from a government regulation issue government policy which in many ways reinforces some of the nutritional guidelines and recommendations that you and I are not aligned with in many ways you know they're very deficient in protein they're very oversaturating carbohydrates they incorporate a lot of these but seed oils which are bastardized the wrong types of fats and so on a lot of levels when I look at information like that I find it so disheartening because even good people are trying to work within a system that is really designed to make it harder for us to practice in a way that encourages our patients to really lean into lifestyle as medicine as opposed to you know the sick care model that we're really stuck in I could not agree more I think absolutely it starts from the top down and and you know as a student dietitian and I don't say the group but my first like large dietetics conference that I ever went to I was my first year as a dietitian and I walked in and the coca-cola was there Kellogg's was there Abbott nutrition was there all of these different companies that I know were just trash food like not helping anyone's health were huge expos at this certain you know conference and I was appalled I was thinking I'm at the leading dietetics conference in the country and coca-cola shows up I couldn't make sense of it and at the time I you know I was still dabbling in this and I wasn't a mature dietitian and I was like this just that's when I knew I knew that there was something more to this to follow the money there's got to be something going on and you know I think you're a hundred percent right I think there's a lot of responsibility on the higher ups that they're just not being accountable for yeah it's unfortunate and certainly probably not in my lifetime is this all going to be solved but my hope and intention is that we are creating greater awareness that consumers will start demanding more for their health not just you know in their food supply in the food supply overall but demanding more in terms of health care yeah and so I think many of these things are confounded by poor quality nutrition research and I know I was listening to you on another podcast and you were talking about some of the issues with nutrition research overall so maybe that's a good place to kind of pivot a bit because I would be remiss if we didn't address this I mean almost every day I'm sure you are getting DMs about it I'm getting DMs about you know epidemiologic research or research that's really not great quality and people trying to draw conclusions from that well yeah and I saw you post on your Instagram about that newest intermittent fasting article that came out that was just a hot mess but you're right it's very challenging to do nutrition research one because people just don't remember a lot of nutrition research is done off of food journals or how you know how many times a week did you eat red meat and you fill in a little bubble well nobody remembers barely what they ate for breakfast much less what they've eaten seven days ago and so that's one of the issues a lot of times nutrients aren't pulled apart separately and studied they're studied in combinations and so red meat gets demonized but nobody asked what they had with the red meat you know they had fries and a beer and so it's these types of implications that cause a lot of problems because there's no real way to can keep it super controlled especially because people one probably aren't willing to even do it because it's not going to be pleasant for them and people aren't willing to give up their habits so a lot of nutrition research on that just erroneous on the way that they gather their data the other thing is a lot of it's sponsored just kind of going back to what we just talked about it's sponsored by these big corporations Coca-Cola Kellogg's and you can make a study bias very easily you can pay enough money to make them come out with the outcome that you would want and so that you see that quite a bit too and so I do encourage my clients look they send me research all the time then I easily scroll down and see oh well this is funded by you know these big brands of course it's going to come out with whole grains are the best thing you can do for your body so those are kind of my two biggest challenges to nutrition research and there's virtually no money spent on it if you look at what's spent on pharmaceuticals it is not even close nutrition research there's barely a drop in the bucket money-wise and there's really no motivation for for them to spend money right because they don't want I don't want to say they don't want but sick people aren't profitable they I'm sorry sick people are profitable and so to heal them with nutrition isn't very motivating and so I think that's some of the problems with nutrition research and yeah it's messy when you get to start studying food and people's habits. Well and I think it's hard because most adults at least it's been my experience years ago when I worked at a research hospital people get uncomfortable sharing what they're eating so they share with you what they think you want them to be eating as opposed to the fact that they're really eating foods that are not ideal for them so there's some degree of lack of transparency and the other thing is people don't want to live in a controlled environment for the duration of a research study because they want to go back to their homes that you know they're unlike you know lab animals that are in cages and in a controlled environment humans don't want to have that source of you know conflict or containment or just feeling like they don't have the ability to live their lives as they choose to and I think that's probably a greater issue is people perceive it to be really inconvenient thing and therefore it's more challenging to do the research on top of everything else you just mentioned. Yeah absolutely it is it's yeah I personally wouldn't even want to live in a controlled environment so I get it. No absolutely not so one of the biggest issues that I see and obviously the bulk of my patients and people that I work with are in perimenopause the 10 to 15 years preceding menopause through menopause and so weight loss resistance is a huge issue as I know you know how do we address weight loss like as kind of a broad concept how do we make it sustainable because this is such a big focus people truly believe they should be the same weight they were at 18 even though they don't their body is not functioning the way it did at 18 they're not as active you know they've got all these other pressures and stressors and hormonal fluctuations so when women come to you in particular with weight loss resistance and a desire to lose weight what's a good starting point for you? Well the first starting point with me is making sure that they're working with a provider that can help them sort their hormonal issues if they're there I hate to see women in perimenopause and menopause suffer through it I haven't reached that stage in my life but I know enough to not let people suffer if their hormones are really wacky and so I love having people I can refer out to of like you know look at bioidenticals look at these things that could be helpful you don't have to suffer and you know there's supplements and all that as well but I think number one is setting realistic goals like you just said the whole I want to look like I did when I was a senior in high school I think being open and upfront as a practitioner and talking about well you do realize that that would take extremely high amounts of restriction and extremely high amounts of time in the gym and all of these things and really laying it out there in a truthful manner of like let's set some goals where that would make you happy where you would feel good and that's healthy but also understand if you really truly want to get down to that weight it's going to be challenging and may not be healthy it may not be super realistic and so I like to be honest about weight loss goals and in general because of diet culture people have very very odd weight loss I shouldn't say odd but unrealistic weight loss goals they expect to lose you know 10 15 pounds in a week they think they're going to lose 100 pounds in two months and it's like no no no no just because you saw that on the cover of a magazine doesn't mean it's healthy and or realistic at all and so I for me first step with those types of clients is understanding and explaining to them that they're in a challenging second puberty of their life and things are really a little bit challenging more morally and then number two is just helping them set realistic goals that they are comfortable with feel good about and that we can actually maintain and achieve I think that's really important and it's interesting I used to and I still say one to two pounds a week is really the max I mean that is sustainable if you lose five to ten pounds in a week that's not sustainable and interestingly enough when I was going through the book launch there was a major publication that will remain unnamed and because I didn't have like specs of lose 20 pounds in two weeks or lose 50 pounds in a month they were not interested in featuring the book talking to me etc they only wanted these big double digit numbers and it had to be in a short span of time and I kept saying to my PR person like that's not realistic that's not sustainable like that would be a problem like I would be unethical for me to say that this program is going to do that because that's not sustainable weight loss in any way and one of the things I find with a lot of women in general is we know the RDAs are woefully inadequate so recommended daily allowances on macros so protein fat and carbs are woefully inadequate and largely skewed to this is my opinion too many carbs too little protein and the wrong types of fats has that been I would imagine that's been your experience as well that you kind of when you're looking at a diet recall or looking at a food diary you're scratching your head and you're like too many carbs too many carbs not enough protein too many seed oils all these things that are contributing to this weight loss resistance piece oh 100% I even tell my clients don't look at the percentages like that's all based off of 2000 calorie diet don't look at it because you're at a different spot and that's very confusing for people when they see that percentage and they're doing that math in their head and they're thinking you know so yeah it is the RDAs are RMS and old old old and need to be revamped and so yeah I just tell my clients just ignore it all together do you have a particular food tracker that you like to use so chronometers probably my like number one if some of my clients do find it a little confusing in terms of some of the numbers and what it because it does give you extremely high amounts of information I'll go to something like lose it or carb manager my fitness pal any I find the best ones is just let them try it out and figure out which one they find most user friendly I love chronometer when I'm using it with clients just because it is it's a wealth of information in terms of a lot of that stuff that's actually my favorite because it gives macros and micros and if you're a data nerd like I am and I would imagine you are as well I like more data rather than less but I have clients that it's overwhelming to have so much information and so really kind of figuring out for them what works best now I know in your background you worked at the VA which I had the honor of working with the a patients when I was in Baltimore as well and you started to notice that when you restricted their carbohydrate intake you were getting results that medications alone were not getting so let's talk a little bit about carbohydrate restriction or reduction and what that does for us metabolically yeah I was you know I was kind of going through that whole journey with my PCOS when I started implementing the low carb lower carb ketogenic strategic carb whatever you want to call it dietary lifestyle with my veterans and we know the veteran population has some of the worst metabolic health on in the country and due to a lot of factors but I was so disheartened as a dietitian because I was giving them the regular guidelines that I had learned and just nothing was happening oftentimes or a1c would go up when they would eat more whole grains imagine that right and so I started using strategic carbohydrate restriction and I can remember I specifically floated as a dietitian in the diabetes clinic often often and there was a dietitian that worked there and she would always tell me temple diabetes isn't reversible you need to stop telling clients that you need to stop telling clients that they're never going to reverse their diabetes and to me the definition of reversing is just putting it you know going back in the disease where you're getting off medications your lab values are looking better and I'm thinking no it absolutely is reversible and it's really not even it's hard to reverse but a lot of times people can get off completely off everything and so I started implementing it and I was shocked and the doctors that the endocrinologist and everyone that was working with some of the same clients you know who's that dietitian who's these all my clients are getting off their insulin and I was getting more and more referrals so many that I couldn't handle because all of these clients were telling their friends go see the dietitian in the diabetes clinic go see her here because they're getting off all this insulin and all this medication that was just making them a hot mess and oftentimes more metabolically unhealthy and so I found that that was really fun I used verte health a lot too verte health really promoted or really gave me a good understanding of keto because they did a pilot study in the hospital that I worked at at the time and so it was just amazing to be able to see you know a 70 year old veteran improve his metabolic health tremendously after having diabetes for 40 years and so there's hope and I think a lot of them are missing that and no one had ever told them hey you can get off met for me I don't know why you think you have to be on that forever you know and that was some of the best moments of my career just because I love seeing how happy and how healthy these veterans could get after losing a lot of hope yeah that's incredible and for anyone that's listening type 2 diabetes is lifestyle mediated meaning it's the choices we make and our lifestyle that contribute to insulin resistance and ultimately diabetes and I would imagine that was just incredibly rewarding so out of curiosity what was your threshold for carbohydrate intake while they were in the hospital when you were monitoring them well I had to be very careful with this because not everyone was on the same page and I'm here I'm a lowly dietitian like you need to reduce the carbohydrate but one thing that I found was very challenging so my threshold ultimately I would start lower like we would do 75-ish and then we would go down based on that the hospital that I was at treated with sliding scale so it allowed for me to have some of that power but I'll tell you and you probably already know this one of the problems with dietitian are working as a dietitian in the hospital is the cafeteria controls the food and so I'm over here writing do not put one slice of white bread on the thing stop giving low fat 1% milk you know and the carb controlled plates half my battle was getting to the kitchen before the patient would get the food and getting the carbs off of it because it was loaded with carbohydrates even on a car controlled diet and so that's another problem you know they were given you know way way way too high 35 grams per meal usually are higher than that 45 up to 65 and so half my battle is just trying to make it to the kitchen before my veterans got the food and so but yeah I would say I started around you know 55 60 and then we'd just lower it until we could get the medications down or until they felt comfortable that's amazing and thank you for your you know revolutionary work because how many people clinicians kind of go through the motions every day they're at work they're just not really thinking and sometimes I would cringe here I am seeing cardiac patients and I'm looking at their heart healthy diet I'm like dang there's a lot of carbohydrate on there and for anyone that's listening the average American consumes 200 to 300 grams of carbs a day that's average and it's important to understand you know I listened to dr. Gabrielle Lyons lecture at keto con I'm sure you did as well and she was talking about for her threshold is 30 grams of carbs in a meal period total and so really understanding that if we're giving our patients 60 90 100 grams of carbs and they're in a bed more than likely maybe they're getting up with assistance or maybe they're sitting in a chair all day long they're not in a position where they're using up that carbohydrate load so you know you wondering why oh we'll just cover it with insulin you know the sliding scale for anyone that's not familiar with that it's you know you get a range an amount of insulin that you provide depending on what their blood sugar is and you know for a lot of diabetics they just say oh we'll just cover it with more insulin well we don't want that we actually want the insulin needs exogenous insulin needs to go down and to be in a position where this can be controlled with lifestyle and diet you know it's interesting when I was in the hospital three years ago out of the 13 days I wasn't allowed to eat until I think day 11 or maybe 12 and I had to beg the cafeteria to send me I think I asked for bone broth or chicken broth I got that and then I remember they were very kind to me I said can you just give me just cut up chicken I just want some meat I don't want anything else they kept saying you sure you don't want some starch I'm like noob but they accommodated me but probably only because my surgeon fought so hard for me to be able to eat the things that she knew that we're going to nourish my body but the average person in a hospital is getting such an enormous sugar and carbohydrate load it's anything there's very little nutritious food in most conventional hospitals right now yeah absolutely I mean juice we would give juice chocolate milk and sure which is like one of the worst things you could ever drink I mean it's cornstarch palm oil and water essentially and we're giving that as a nutritional shape which was I just you know it's it's bad and then a lot of times too not just on the hospital itself but you're working with these cardiac and diabetic patients and then they're uber-eating you know pizzas and mcdonalds and so you're battling that as well so yeah it is hospital food leaves a lot to be desired for sure no absolutely and it's interesting I want to make sure I share my banana story so I had a patient diabetic cardiovascular disease I think he was a vascular path he had diffuse vascular disease very nice man was clueless about carbohydrate counting and so I referred him to the diabetes educator came back to me he was delighted he said it was fantastic I met with her said tell me what you guys talked about he said she's okay with me eating he said a banana and I said okay well how often are you eating a banana he's like oh about six times a day and I said what so I said every banana is 30 to 40 grams of carbohydrate and you're already not able to handle sugar properly in your body and so I remember it was this teachable moment trying to explain to him like if you desire to have a piece of fruit have a little bit of blueberry or a little bit of raspberry and by that I mean like a quarter cup and not every day and it you know facilitated a very interesting conversation with the dietitian to kind of let her know like you might have said eat a banana but I think he heard as often as I want and trying to explain to him if you've already got diabetes fructose yes a little bit of fiber with that fruit etc but it is not benefiting your blood sugars in any way shape or form no no absolutely and that comes down to understanding your patients understanding where they are knowledge wise meeting them where they are and helping them through that because yeah that could have turned into a disaster really quick you know and no telling what else he could have been confused about so good for you for catching that one no I just remember saying how many bananas are you eating a day and he's like six 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synthia20 at checkout my family and I are actually taking astra zanthan to see if we can drop our LP little a stay tuned I know you have a your proponent of keto and low carb diets I'm curious do you use therapeutic carnivore do you find that that can be helpful I know that for me I was full carnivore for nine months after being hospitalized because my body tolerated zero fiber and I come to find that sometimes doing a little bit of a carnivore reset even if it's temporary can be very very helpful I'm curious if you're using that therapeutically with your patients too yes I do I think it can be really really helpful I think it comes down to understanding the patient what's going on with them but yes I've used carnivore more times than I can count for me it's not something that I don't I think I would do like till the end of my days but I think if you're eating mostly animal based products even if you are quote unquote keto I think that that's the best way to go that's the most stable my blood sugars have been mood sleep the whole nine yards is when I'm full carnivore and so yeah I think it can be very very helpful especially when people are maybe making this switch to getting into ketosis but don't necessarily grasp full keto yet I think it's a pretty easy way to just say hey look just make most of your meals meet and you'll get into ketosis and so yeah I think carnivore is super healthy and I think there's some very interesting stuff in regards to plants and anti-nutrients and I think we're kind of just scratching the surface with a lot of that just given that there's very limited research and I do think though it's there's no doubt it's helpful anecdotally and just seeing everything in my own life as well so yeah I'm a fan of carnivore for sure. Yeah and it's interesting I have you know even within girlfriends of mine just suggesting maybe doing carnivore for a week they're bloating their digestive issues go away so effortlessly and easily you know for me I have been humbled at how plant anti-nutrients so whether it's oxalates or saponins and you know all these different plant-based compounds that if your gut health is pristine you probably can tolerate eating them without issue but I know for myself I can tell when I've had too much oxalates like I don't eat almonds anymore but if I were to go to an event and maybe someone I was sampling something that almond flour in it it's a very delicate balance like my gut will definitely let me know if I've consumed too much but you know people that are pushing kale and spinach and celery juice they're not intrinsically bad foods I'm not to demonize any of these things but if you consume them and you get a GI upset and bloating and don't feel good it could be that your body just doesn't tolerate these things or you know more often than not I see a lot of women heading into perimenopause and menopause you know we're just coming out of this you know two and a half year pandemic plus and everyone is at unprecedented amounts of stress and certainly middle-aged women I'm not picking on anyone I'm just speaking the facts we know that the bulk of our immune systems in our gut we know that if we you know if we go through traumas and certainly there's been a lot of traumatic things that have happened over the last several years it impacts the integrity of the lining of the small intestine and if that's breached makes you susceptible to leaking food particles into your bloodstream which can drive inflammation and food sensitivities can also make you very susceptible to autoimmune disorders and I'm speaking from personal experience so when we're looking at these anti-neutrants and looking at you know how well our body is assimilating certain types of foods I find keeping a food diary or just being food aware you know being able to make connections I have to be careful with cruciferous vegetables I love them like to a point that's probably a little bizarre like I love Brussels sprouts I love cauliflower I love cabbage but again it's that tipping point let my body will just like remind me gently okay you're at the tipping point if you continue to eat as much of this as you are you're going to have some digestive issues for the next week yeah I had when my daughter was born my she's now two but she was born she had a chylothorax and it was just this trauma the traumatizing event she was in the nikkju for a month and I was a hot mess as a new mom and you know the baby but everything it was just a mess and I promptly got diagnosed with ulcerative colitis after that because it was so traumatic I was eating hospital food all of these other things and you're absolutely 100 right is and I love that you brought up the stress and traumatic events because oftentimes people separate that from food it's like our health they don't they don't understand and I knew exactly what happened I mean I was yeah my daughter was just in the nikkju for a month nearly lost her life my stomach is a mess I'm a mess and so that was one of the uses of carnivore I went carnivore for a while and it's helped tremendously but yeah it's funny people don't tend to be mindful about their body until something happens where they're forced to be mindful so if I could say one thing it's start listening to things like like you're saying Cynthia's the bloating the gas that stuff isn't normal that's your body trying to tell you something's wrong or you're eating too much of this so yeah I couldn't agree more and I think the almond flour the coconut flour is one of the issues as well because a lot of keto foods are going that way you know oh you can still have your donuts you can still have your cake and it's like yeah to some degree you can you can but you have to be careful because it will backfire after a while yeah and it's interesting because after going to a lot of keto and low carb events this year and last year I've been able to you know look at packages and look at ingredients and you know politely decline samples of packages or foods that aren't aligned you know sucralose as an example isn't a lot of keto low carb foods and that is definitely something I try to avoid as much as possible thankfully I'm also dairy sensitive so I was able to politely decline said product that was offered to me but in your experience do you find that sometimes people transition from a standard American diet over to keto paleo low carb I mean gosh there's even vegan junk food but people kind of trade one for the other assuming one is superior to the other but in essence it's still the same junk food oh all the time all the time and marketing has gotten so good about being making people buy their product with these labels that free this free gluten free this is all it's like yes and so that is a conversation that I always have with any of the clients that are in my program is like we're eating real food we're eating whole foods we're eating foods that you know you can read the ingredient list and pick out every single thing and you know exactly what it is and yes and I think ultimately that doesn't address a lot of the root causes right of their actual eating behaviors is when you see that when you see people go from soda to diet soda and it's like okay yes that's a step in the right direction but ultimately we're going to get you the diet soda and and sucralose and things like that so my encouragement to my clients is is we don't want to trade one for the other we're making a whole lifestyle change and ultimately those things and those types of foods are going to cause problems too and so I think being upfront and honest about that and helping them make the switch and helping them find alternatives that aren't going to cause problems is a lot of what I do probably 80 honestly I bet it's interesting when I was at an event with Vinny Torterich in August and one of the most common questions by the audience that was asked was what do you think a monk fruit what do you think a stevia what do you think of a thyrotol what do you think of this and he said I'm going to just stop everyone and just say it's still sugar like it may not be conventional sugar but it is still sugar and if you have a sugar addiction it's not helping you it's hurting you and so that really stuck with me and actually my my husband was in the audience so it stuck with him too just understanding how complex that relationship is because sugar or sugar alcohols or sugar substitutes are proliferative they're in all of our condiments they're in a lot of our food things that you wouldn't necessarily think about like my husband was making fun of me teasing me in a loving way making fun of me because I wanted to buy this primal kitchen ketchup and I was trying to explain to myself well there's no sugar in that but the Heinz quote-unquote organic but yes I know it's in a squeezy bottle but we want to limit the exposure to plastics as much as we can does have sugar in it and he was like I don't know what the difference is and I said we want less sugar in our lives not more so if you do nothing else just read food labels and just be aware of where the sugar is sneaking into your lifestyle yeah 100% and it's the more you read labels the the more shocked and appalled my clients I didn't know this had this in it I didn't know ketchup our barbecue sauce or honey mustard I had no idea all these things and you're like yeah now imagine just eating a regular standard American diet how quickly that adds up it's rapid it's rapid you know some people don't even make it till 9 a.m. before having 60 70 grams of sugar and so yeah absolutely that's learning to read labels will save you money it'll save your health it'll it's very it's crucial and learning all the then what is it there's like 260 different names for sugar and it's like you know this is my job as a dietitian to know this but someone on the street they're never gonna know that you know what dextrose or maltodextrin and all these other names are and so it's yeah it's good marketing on food corporation sides but it is the responsibility of the consumer to become educated and figure out like what am I eating what is this ingredient what are all these different names absolutely it really makes a big difference and when we're talking about plateau busting and strategies like your more advanced strategies that use it with your your patients what are some of your favorite ways to break through plateaus because the questions that came in from most of my followers were about plateau busters and what's your philosophy about the scale and so we'll get to that too yeah yeah so first and foremost I love fasting I love different types of fasting I love some extended fasting short term I think fasting is one of the best ways to reset get things going and break through a plateau secondly is resistance training people don't understand that your metabolism is in broken you just need more lean muscle mass and then ultimately hormones too I think every female should especially in kind of the demographic of the perimenopause menopause don't take those lightly have them checked I'll have clients all the time that haven't had their hormones checked in 15 years and they're full on menopause and it's like go get that stuff looked at so I use fasting a lot I use resistance training a lot sometimes I'll do carb cycling if I think the client is appropriate and their insulin levels are low and I have that fasted insulin number and I know they're not inflamed etc so those are kind of my favorite ways I'd be interested to hear your methods yeah I mean it's definitely I mean those are all ones that I definitely embrace and ironically enough I didn't sleep great last night but I made sure I got to the gym anyway to lift legs because I'd been in New York all weekend and I was like I need to lift weights to help with insulin sensitivity I would definitely add you know especially because women in middle age are less stress resilient managing stress proactively like this isn't five minutes of meditation once a week it's really finding a practice that resonates with you I do a lot of walking in nature I have a PEMF mat in my house I'm not suggesting everyone needs that but it's probably one of my favorite things in the world high quality sleep because sleep in and of itself can be very important for balancing blood sugar leptin and ghrelin so appetite and satiety hormones you know I think about just something really simple like walking after a meal like I really encourage people get out after lunch walk for 10 or 15 minutes you don't need anything special just set the time aside same thing with dinner maybe it's getting dark out at five o'clock in the evening and it feels really late at seven or eight o'clock at night but walk down your street you know I actually have a dog leash that has reflective tape on it so people can see us so that I don't have to worry about getting run over yeah but I think I also think about you know being very mindful about macros like this is a time I'll really encourage people to track you know how much protein are you getting because if you get enough protein you're not going to be hungry after you eat a meal you know I was in New York City this past weekend and I went to a restaurant where all of the meat unbeknownst us was soaked in heavy cream and so they got very creative and they ended bringing me a massive burger to eat and after eating said massive burger I was like oh my god I'm so full I'm so uncomfortable and my husband's like well at least I know you're not going to have any interest in having any type of dessert and I was like absolutely not so really getting that protein bolus in with your meals and just being aware of you know the interrelationship with alcohol I think that you know this is a very personal decision I myself during the pandemic just decided to stop drinking I've never had a problem with alcohol but it was the only thing that gave me hot flashes and my sleep is far too important that's kind of what that's been my uh assessment of that but how many people are in this like toxic mommy drinking culture where women are drinking a lot of alcohol during the week they're drinking a lot on the weekends and you know I had Dr. Lara Brighton on this summer and she was talking about how it impairs blood sugar regulation, impairs estrogen detoxification, it impairs you know sleep quality, it impacts your risk for breast cancer so really examining your relationship with alcohol and there's no judgment it's just you know really just thinking like if I'm drinking two to three glasses of wine four or five nights a week that can add up and understanding that our body processes alcohol first in the body as opposed to the rest of the food that we've consumed so I find that those are usually the low-lying fruit piece that I'll kind of pull from. Yeah I know I completely agree and I feel like a lot of those people put aside because they're so focused on well what am I eating what am I eating and they forget like no you actually still need to sleep and you need to reduce your stress and you need I just shared something on my Instagram about the toxic wine culture among moms and it is it's so true like that's one of those things where we need to keep talking about it because that's one of those things that we may participate in sometimes and I love that you've given up alcohol yeah I I don't drink either and I feel great with it sleep and stress wise but yeah those are all spot on and ultimately those are like the foundations right and sometimes they get lost in the sauce because people are so focused on you know all these newer strategies and these more sexy strategies and it's like no but remember you know sleep is huge and so I think that's good yeah absolutely getting back to basics and last but not least what is your philosophy about the scale oh man yeah the scale it's one of those things that you like love but you also hate because it can give you so it can absolutely help people stay motivated like that is one of the things that people cling to when it comes to motivation and it's one of those things that yes it can be helpful but when you have a complicated case or you have someone that's maybe losing more visceral fat and putting on muscle and the scales kind of staying the same it's it can people get so discouraged by the scale and it's like so I do I spend a lot of time counseling clients like look you need to have more than one measurement of success and sometimes the measurement of success doesn't even need to be a number it needs to be you know how my clothes are fitting do you feel good sitting down do you you know are your joints achy and so I like to have my clients start off in the very beginning when they work with me it's come up with like five different ways you want to measure success that isn't necessarily hyper focused on the scale I'm not saying throw it out but I am saying that you can't use that as your only level of I'm doing a good job and success to fail rate and so again I love tape measurements I love lab values I love the way people feel I love do they have a libido do they have energy do they you know do the skin look good do they feel confident in their mood and so I think all of those are great measurements to use when you're working with the client and great measurements to understand is my nutrition plan working which is why I love keto and carnivore so much because it improves all of those things and people typically start feeling great but yeah the scale is one of those where I think it can be useful in some situations I think it can be very damaging and others and so you have to be really careful with the individual how often are they weighing are they weighing daily do they understand that women's hormones can cause weight fluctuations daily and so those are the types of things I like to make sure people know especially if I suspect or get some inclination that they hold on to the scale like gold yeah I think the reframe is really important and I think those different ways to measure success is really invaluable and I agree with you wholeheartedly getting a sense for whether or not someone has a healthy relationship with the scale versus an unhealthy relationship with the scale I've gotten dm's from women saying my weight fluctuates by three to five pounds every couple days I'm like that is completely normal it is completely normal and depending where you are in your menstrual cycle or how many carbohydrates you've consumed or how much alcohol you've consumed it can absolutely impact that well I could obviously talk to you for hours it's been a wonderful conversation please let my listeners know how to connect with you you absolutely want to follow temple on instagram it's one of my favorite people to follow because her reels are always outstanding and I'm just now getting on tiktok so I'll have to follow you there as well yeah same with tiktok but your reels are fantastic too but you guys can find me I'm at the.ketogenic.news.com on all the platforms I want tiktok instagram is my biggest one I just got on twitter recently that's a fun place too and my podcast is very it's in the beginning stages but I'm on Spotify and Apple podcasts as well there so I love a follow and I'm really truly honored that you asked me to be on your podcast and this is fun of course I loved our conversation if you love this podcast episode please leave a rating and review subscribe and tell a friend