Dr. Joe Tatta: Welcome back to the Healing Pain Summit. I’m your host, Dr. Joe Tatta. Today we are talking about blood sugar with Dr. Ritamarie Loscalzo. She is an internationally recognized expert in the science of, we just signed a chronology. Her approach combines the ancient healing wisdom of fresh whole foods with the functional medicine approach. She’s the founder of the Institute of nutritional endocrinology where she trains doctors, nurses, nutritionists, health coaches and other practitioners. Her mission is to transform our healthcare system so that each and every person has access to chew health, healthcare and fix our broken disease management system. Dr. Rita Marie, welcome back to the Healing Pain Summit 2.0 it’s great to have you back for a second year in a row.
Dr. Loscalzo: It’s really great to be here. Joe, I love talking with you and I think you did such a nice job of getting this message out to people last year and I’m excited to have more for people. They need it.
Dr. Joe Tatta: Thanks so much. So we’re going to talk about blood sugar today and blood sugar is blood sugar regulation is a result of our endocrine system and you are the nutritional endocrinology expert. So I think the place to really start is just what is the link or what is the general link between dysregulated blood sugar and pain?
Dr. Loscalzo: Yeah, so the common, the thing that binds them together is inflammation. So dysregulated blood sugar can lead to a condition called insulin resistance, which is, you know, a diagnosable form of imbalanced blood sugar after it’s been around for awhile and it’s associated with inflammation. So we actually have some inflammation that gets built up and it actually, it affects, uh, the insulin receptors but also can affect the whole body and the regulation of, of the fatty acids and the nutrients and all the things that are related to blood sugar.
Dr. Joe Tatta: You mentioned the diagnosis of incident resistance. When I think of the diagnosis of blood sugar right away, I think most of them gonna think, Oh, that’s diabetes. Maybe they might think that’s pre diabetes. Can you talk to us about the spectrum of insulin resistance, diabetes? Where where does that all, Oh
Dr. Loscalzo: yes, no, absolutely. That’s perfectly cause that’s the thing I like to talk to about people is do you want to deal with a problem after it’s a pathology and it’s already made physiologic changes in your body that can be damaging because people get diabetes, they get diagnosed with diabetes and shortly thereafter they have peripheral neuropathies or retinopathies or all these complications and they think, Oh it happened because I became diabetes sob diabetic on this date and then the problem started happening after that when in reality, those problems have been brewing for decades before leading up to the final diagnosis of diabetes and in fact there’s so many warning signs early on that you’re heading down that path. So diabetes is medically determined or assessed when the blood sugar, the fasting blood sugar goes above one 20 on three consecutive draws and prediabetes is considered when it goes above a hundred so between a hundred and 119 you’re considered pre-diabetic.
Dr. Loscalzo: It’s also other names for that are insulin resistance and a form of insulin resistance that’s also associated with cardiovascular risk, which is high blood pressure and high cholesterol, triglycerides and all that is called metabolic syndrome, but in reality there’s another stage or that that most people don’t catch. They’re not told that they have a blood sugar problem until they hit that hundred and they’re like, Oh, you suddenly have a problem. The ideal range of fasting blood sugar is probably between 75 and 85 some people do really well below 75 like if they’re on more of a ketogenic type diet, they do really well below 75 and everybody’s a little different in how they handle that. I do great. My favorite blood sugars between 65 and 70 love it when it’s there. I just feel best other people go, I feel like I’m crashing, so it’s all a matter of, there’s a lot of things that plan, but between that 85 and a hundred there’s a lot of stuff happening right around 90 diagnosable.
Dr. Loscalzo: There’s plenty of studies that show that you start to increase your risk of cardiovascular disease. You start to increase your risk of inflammatory conditions, which ties us back into pain, right? So you really want to keep it between that 75 and 85 and there’s a number of different things that we can do to assess, but we get there. The last thing I want to say is that fasting blood sugar is the worst test for whether you have a problem because that is like, it maintains, it maintains it’s going to hold it, the body’s going to hold it there, hold it there, hold it there until it becomes a problem. So there’s other things that you can do to measure, like what is your blood sugar do after you eat a meal, right? What’s the curve of how that happens? What’s your something called hemoglobin A1C. That’s like a little early warning clue them. We’re heading in the wrong direction, but most medical doctors aren’t trained in how to detect what I like to call pre insulin resistance. So we have prediabetes, which is insulin resistance. Pre insulin resistance is where I like to catch people and don’t let them go down that damaging path towards diabetes.
Dr. Joe Tatta: But that’s a great introduction. I think a great timeline that you just articulated for everyone. Now you didn’t mention A1C, which I think some people are really familiar with. It obviously played. Do you have diabetes? They’re familiar with it.
Dr. Loscalzo: Yeah. You hear it all the time on television. This will lower your anyone’s see number. This can help you rate once you number, what is a one C and how does it relate to blood sugar? Okay, so hemoglobin a one C is basically, it’s telling you how much of your hemoglobin, how much of your red blood cells are coated with sugar. So it’s called glycosolated. So it’s glycosylated hemoglobin. And you know how if, I don’t know if as a kid you did this, but we’d make molasses and we’d um, melt some molasses or other things and then turn it into hard candy. Right? So you’d melt it down and then you’d let it come to room temperature and you’d pull it. But when you pulled, you’d have these little spiky things, right? If you dropped some on the counter and it dried, it’d be all spiky.
Dr. Loscalzo: That’s what happens in our blood vessels. This sugar that’s in our blood all the time starts to coat our red blood cells and there’s a normal amount about, you know, between 4.5 and 5% of our red blood cells. It’s okay to be there. It just isn’t natural. Just the implication of having sugar in the blood. But once it gets above that, it gets a really good marker of our average blood glucose levels. So it’s used in diabetes to maintain or to see how well maintained that person is. So for example, they’ll say, Oh, you’re a well-maintained diabetic. If you keep your hemoglobin a one C like below 7.5 well when you add, when you look at what that means, it means that, Oh yeah, that’s great. You keep your average blood glucose somewhere around one 40 and I’m like, wait a minute, you should never go to one 40 let alone be the average.
Dr. Loscalzo: That means you’re still an uncontrolled diabetic, in my opinion, and you’re creating havoc in your body. So I like to measure that hemoglobin A1C and people who are not already diabetic. The standard medical convention is to measure it in people who are already diabetic, to see how well they’re controlling it. And let me tell you, people come in when they’re diagnosed with diabetes, sometimes it’s up to 11 do you think it got there overnight? No. It’s something that is, that could have been detected long, long, long, long before it got there. And you watch that pattern and you’d do something dietarily lifestyle supplements, et cetera. So how do you teach people to, I guess measure their own glucose? Because it’s very important to, obviously if you’re pre diabetic or if you have diabetes, keep to keep on top of that. Do you teach them? Yeah.
Dr. Loscalzo: So if someone is diabetic that’s naturally assumed, well you hear your meter, you have to do it. If somebody’s prediabetic there, most of the time they’re given it because they want to make sure that they maintain. But it’s very easy to do. And I recommend that anybody who has a family history of diabetes, anybody that has a as extra weight around the middle, even though they’re good shaped elsewhere, right? They have some brain fog, they’re tired, they have chronic pain that they can’t explain. It’s not explained by you had an injury or a surgery or whatever. It’s just, I don’t know why you have this chronic pain. So anybody who has these chronic symptoms that just don’t seem to get better with conventional or even alternative approaches. So I have people measure their glucose and it’s very easy. You get this little $15 meter and you poke the finger and yet feels like a little mosquito bite.
Dr. Loscalzo: You get used to it. Diabetics get used to it. If you don’t do it now before that, you’re going to end up doing a lot worse. You’re going to have to take a lot of medication and you’re going to be poking your finger all the time and you may have to even shoot up insulin. So you know, and the, and the risk of losing your eyesight, your, your nose, your toes, your camp, you know, all that stuff. So it’s worth it. And most people are like, Ooh, I don’t want to do it. I create videos to show them how to do it. I, I do it myself and I show them and I show them how to test. Very easy. Take a little prick. You put it on this little strip that goes into a meter. The meters are 15 bucks. You can buy them on amazon.com it’s really easy to get.
Dr. Loscalzo: And they, they test their sugar. Well they don’t just test their fasting cause what did I say about fasting? Right? It’s the last thing to go. We want to do something that in medical terms is called postprandial sugar. And so what that means is after eating, but it’s not two hours after eating, like the conventional wisdom tells our diabetics that says, okay, measure your fasting and measure it two hours after eating. As long as it’s below one 40 at two hours after eating, you’re in good shape. You know, it’s so much damage going on for these four people. So what I like to do is have them test it. And really the way it works is physiologically, and they’ve tested thousands and thousands and thousands of people and grafted out is right around 45 minutes. You get to the peak amount of sugar. So you eat this meal and the sugar starts to climb and climb and climb.
Dr. Loscalzo: It gets to a top, the insulin’s kicking in, the insulin kicks in and brings all that sugar into the cell. So you can make energy and you feel great and then it comes back down. And it should be this way. This is what before meals and after meals should be identical. Right. So that’s what I teach them to do. And when they first test, I have them test frequently so we don’t miss the peak cause some people have the peak at half hour summit at an hour. So we do it more frequently. So I have them do it like every 15 minutes, 20 minutes, whatever. Once we figure out their peak, then they just go and tested at wherever their peeps supposed to be and I instruct them to keep it below 110 instead of keeping it at 140 over at the other end. Why did I choose 110 well, there’s tons of studies that show that once the sugar goes above one 20 you start to get the damage to the peripheral nerves.
Dr. Loscalzo: That’s part of peripheral neuropathy, which is one of the common and devastating side effects. The other thing is that there’s lots of studies that show even between 120 and 140 there’s some retinal damage, which is the diabetic retinopathies and the blindness that can actually result, but also I have them. Um, there are studies that show that definitely over one 40 so when they’re telling people that have it at one 40 at two hours after the meal from who knows where it was, right? It’s not like 300 or 200 who, and there’s lots of damage happening to those things. There are thing is there’s some studies that show at a hundred we even start to get damage to the beta cells, which are the cells in the pancreas that produce the insulin. So I’m like, do I want all this happening? So ideally you keep it below a hundred but you know, you know that’s hard.
Dr. Loscalzo: That’s really hard. But 110 gives you some leeway. So if occasionally it’s up at one 15 one 17 you’re still not going into that really red zone. Like I like to call it and you’re keeping it nice and steady. And most people when they start doing this, when they’re working with me, like they’re peaking all over the place, but we put them on specific dietary protocols and supplementation, herbs, fatty acids, lifestyle things, and they’re able to bring it down. And the side effect of all this is their chronic pain and inflammation goes away. For some of them, their auto immune diseases go away. I’ve had people who had autoimmune diseases for 50 years, they just went away when they got their blood sugar under control. So it’s just a phenomenal process.
Dr. Joe Tatta: Yeah, I mean I think it’s so important. You give you a really great framework for obviously how to measure your blood glucose and then you’re talking about tie me with meals. So you know, I think the next question that people are going to be wondering is, well, what kind of meal should I eat that you recommend a certain diet. Is there a certain nutritional strategy recommend for how long? So what’s your typical with the pre diabetes?
Dr. Loscalzo: The, the, the beauty of testing is that you get to choose the diet. Your body tells you the right foods to eat. So I could say, well Joe, I need you to avoid, you know, I’ll sugar of course everybody has to avoid all the sugars in the process. White flour, cause that turns into sugar really quickly. So that’s the basis of it. No sugar. Uh, but some people do okay with whole grains, like non gluten grains, like quinoa or lentils and they, they’re just fine and their blood sugar doesn’t go up. Other people should sit up. I had people where they eat keenwah and their sugar goes up to one 60. So we do these tests over time of all the foods you typically eat, we don’t have you do a weird diet and we don’t have your drinks, sugar syrup, like some of the tests that you pay three or $400 for in the office.
Dr. Loscalzo: Now we, what’s your highest carbohydrate rich meal? You know, some of us don’t eat carbohydrates, meals anymore. Um, but some, some people still do and they, and they’re whole grain and they’re healthy. Cause a lot of people come to me, they’ve been on a health path for a long time. They’re eating healthfully but it’s not right for them and for where their sugar balance is. So I like the diet to be free of processed foods. No sugars, no white flowers, no white rice and all that. I like it to be gluten free because gluten creates an inflammatory response in the body of most people. I would say maybe a third to a half of the population at large, but 99% of the people with any kind of illness or chronic pain probably have a gluten intolerance. And that’s what I’ve seen in my practice. I don’t know what you see in yours, but that’s what I see.
Dr. Loscalzo: So we get them off gluten, we get them off of the sugars and the flowers. That’s the starting point. We get them off all those processed fats, you know, the hydrogenated oil, the Crisco, but also some of the regular polyunsaturated fats that are touted as the good fats, which are then he did, which causes oxidation. They’re exposed to light, they’re spun there to extract and they’re damaged, they’re oxidized and they’re going around your body just looking to make trouble is we get them off all of those. Um, so the basics, we eat whole foods organic as much as possible. If you’re going to, I call it plant powered diet, like I do plants exclusively, but a lot of people don’t. But if you’re going to be doing like a paleo diet, right? For example, you want to do paleo, the way the real paleos did it, which was every now and then they caught something.
Dr. Loscalzo: They ate it for awhile and then they went back to roots and you know, roots and fruits and whatever else was around. So I like to see that. I’ll say, you know, make your PA your, your plant powered plate would be like 75% non starchy, high fiber, antioxidant rich vegetables and that other 25% you choose if you’re vegan, if you’re paleo, whatever. Some people are very, very thin, need to have like more of a carbohydrate in there like Keene wa or something to give them a little bit more caloric density. So that’s, that’s my basics. It’s real food.
Dr. Joe Tatta: Great. So those are some great nutrition recommendations. I know RC nutrition has a big impact on your endocrine system. Um, let’s talk about stress because stress can dysregulate your cortisol as well as your blood sugars. Talk to us about the connection between those two.
Dr. Loscalzo: Absolutely. That’s a big one. That’s a huge one. So when my program, when I’m working with people, I don’t tell them, this is not just about diet. There’s five aspects that we have to balance. Stress, the nutrition, fitness, keeping moving. Uh, sleep is huge. And then timing, like how are you timing this throughout the day? How frequently are you eating, what’s the spacing and all that. So going back to stress, stress, when you’re under stress, your body produces a hormone called cortisol from your adrenal glands and it’s a great hormone and it does great things. If you have a tiger on your tail, right? If you’ve got a tiger or a lion chasing you, you want your blood pressure to go up, your heart rate to go up, your respiration to go up and your blood sugar to go up. So you have the energy to fuel your muscles to get the heck outta there.
Dr. Loscalzo: But when we’re not in a physical danger type of stress, cortisol is actually damaging because it makes your blood sugar go up, it makes your blood pressure go up. So all the reasons, that was great. When we’re running away from a tire, it’s not so great when we’re sitting at our desk and we’re just getting sicker and sicker. So it raises the level of sugar. But then like with the tiger situation, you then burn that sugar cause you’re running, right? But when you’re not in that situation, the sugar just sits in your blood and eventually, you know, the insulin comes in and stores it a stat, it triggers the storage of that has fat. So I was like to tell people typically cortisol favors breaking down protein into sugar. So it’s basically you want to turn your thigh muscles into belly fat, get stressed. Yeah.
Dr. Joe Tatta: So let’s talk about blood sugar and its effect on the brain because a lot of people are talking about brain health and the stomach cause um, brain health and pain is so intimately linked. What are the longterm effects of having dysregulated blood sugar on the brain?
Dr. Loscalzo: Well, longterm and maybe shorter term, but longterm. For example, they’re talking about Alzheimer’s. They’re actually calling it Alzheimer’s type three diabetes or insulin resistance of the brain. When I went to school, we learned that the tissues in the body needed insulin to bring the sugar in. But the brain, because it was so important, was immune from that. And he could just yank the sugar out of the blood and pull it in. But our recent studies are showing that’s not true. Our balanced center, our hippocampus, the hypothalamus, all those places that regulate control of the brain. They are not necessarily going to pull the sugar right from this, from the blood stream. They need to be escorted. The sugar needs to be escorted by insulin just like everybody else. So what happens is we end up with insulin resistance, which we didn’t really talk about, but when people have floods and floods of sugar in their bottle OD either because they’re stressed or they’re eating a lot of sugary foods, eventually the cells become like, okay enough that’s enough, no more.
Dr. Loscalzo: And they no longer pick up the signal from insulin and the sugar stays in the bloodstream because high levels of insulin have another whole set of problems that they can do. They can stiff in the tissue and they can inflame the tissue. Plus, you know, the high levels of insulin caused those receptors to become inflamed, so they can’t actually accept the insulin. So we develop insulin resistance and we used to think that you couldn’t develop insulin resistance in the brain and now we’re saying, yes we can. In it, it shows its ugly head is something that most people want to really avoid, which is Alzheimer’s, dementia, memory loss,
Dr. Joe Tatta: and just kind of taking that one level deeper on a cellular level. Can you talk to us about mitochondrial function? You know, what are the mitochondria and how does our OD, is blood sugar affect?
Dr. Loscalzo: Yeah, so you may have mitochondria in every single cell in the body, and it basically is the mechanism that takes the sugar and combines it with oxygen and a bunch of other nutrients, puts it through something called the Krebs cycle and out the other end comes ATP, which is the energy currency of our body. And the mitochondria needs to be healthy and happy and just doing their thing in order for us to feel energetic, but they get damaged by a lot of things. They get damaged oxidative Lea. So by just our metabolic processes produce oxidative byproducts. And if we don’t have enough of those, remember I talked about those? Those was brightly colored, high fiber, nutrient dense veggies, which have a lot of antioxidants in them. Then the mitochondria can’t protect itself. And even the mitochondria itself produces oxidative byproducts. So if we’re low in these antioxidants, the mitochondria are actually self-destructing. So we need the mitochondria to give us energy. And that’s why a lot of people who are insulin resistant, they’re not getting the sugar into the cells the way they need to so the mitochondria can’t function properly. And then there’s all this oxidative waste product that gets produced.
Dr. Joe Tatta: So other than the, you know, you gave us a great five-step framework rather than nutrition. Are there any natural supplements people can use to help lower regulate the blood sugar?
Dr. Loscalzo: Absolutely. And in fact, I’m a big food first kind of gal, but um, in this particular case, a lot of times I get them on the supplements first because the cravings for those sugary foods are so powerful and so strong because of the dysregulation of the mechanism. So chromium is a biggie. Chromium is like, it’s like that shuttle for the, for the insulin. So when there’s not enough in a chromium, then we can’t shuttle the insulin into the cells with the sugar. So I get them on chromium. Most of our soils are depleted. Most people just are deficient in chromium. So put them on chromium. Magnesium is another one. Again, unless you’re eating that big plate full of greens all the time and a lot of high magnesium foods, you’re not going to be getting it. And even if you are, it depends on where they’re grown and you know how well they’re grown, whether the magnesium contents up.
Dr. Loscalzo: So chromium, magnesium and then our Omega three fats in particular, DHA, very, very important. And the DHA EPA is also very helpful for chronic inflammation that leads to pain and a lot of people have that, the pain because they’re out of balance there and the cells are damaged. So I get them on those three. I call my, my craving crusher supplements cause they go on the craving crusher supplements for about two weeks before I very, um, let’s say aggressively ask them to change their diet. They know what dietary changes are coming, but I tell them to be kind to themselves and give them the three weeks on. Those are two weeks on the supplements. But so to let the craving levels go down. People swear, I mean by the end of a week and a half, they’re usually like, yeah, they don’t, I don’t crave that anymore. It’s really cool. So it’s easy then to follow the dietary guidelines
Dr. Joe Tatta: and if people are following them, how fast can I see those changes start to occur? No, no. So they’re measuring their blood sugar. How fast should they see that starts to change.
Dr. Loscalzo: I’ve had people who are diabetic, they’re, they’re on Metformin or other kinds of medications and within a week, not always, but within a week I’ve seen it dramatically drop. Like if they’re on Metformin and their blood sugars are fasting at two 20 I’ve seen them drop to one 20 inside of a week. That’s dramatic. Other people, I’ve seen it go a little bit more slowly, but it is pretty dramatic. And the, the, the external symptoms are dramatic. I remember one person who joined my class, I had a 30 day program and she, we had an event at our house. We have these monthly health events at our house and she came to one and then my class started the next day. She came to the next one and I like dropped him. I’m like, what the heck did you do? She had this hourglass figure and this is not a young woman.
Dr. Loscalzo: She was, you know, 60 something and I’m like, Holy cow, what did you do? She goes, I’m just doing your program. I’m just doing what you told me to do. So it was dramatic. Right. And it’s dramatic when they don’t just do the food piece. So some people will do the food piece 100% with, Oh, I’m doing all this and it’s not happening. Like, Oh, maybe we need to deal with the stress a little bit better. Right? Or they’re not moving or they’re timing their meals inappropriately or they’re not sleeping. Right. So sleep is really critical as well.
Dr. Joe Tatta: So what do you say to people when they say, well, my diabetes or my blood sugar problems, it’s genetic because my mom had it, my dad had it, my grandmother had it. Where did, where did genes fit into this equation?
Dr. Loscalzo: Most things in our body are 90 to 95% epigenetically modifiable without, you know, five to 10% are are there in the gene. So yeah, I have genetic tendency to be diabetic and I’m going to go there, right? I maintain my best in blood sugar at 75 I’ve tested and there’s certain foods that shoot my blood sugar up to 165 what do I do? I just stay away from them and I look at modifying my my lifestyle factors. So yes, there is a tendency and it means that you’re not going to get away with like being George Burns, right? Smoke and drink and eating crap and limited to a hundred and not having diabetes. Okay. If you’ve got the tendency and you do that stuff, you’re going to be 50 and you’re going to have diabetes or 40 or 30 so if the genes determine sometimes how strict you need to be in keeping it under control, but there are definitely genetic markers there. I think there’s about 50 of them that have been identified that would make a person predisposed. So yes, genetic plays a part, but that I think, um, you know, I love the genetics movement. I do a lot of study and I work with it with my patients, but I think that a lot of people use it as an out an excuse. Oh, well I have the genes for that. So it doesn’t matter what I do, I’m out as well, just, you know, do whatever I want.
Dr. Joe Tatta: Yeah. So, and then you know, with that, then you could basically say that if we get people on the right track, they can slowly start to move away from their medications as well.
Dr. Loscalzo: Yeah. And I’ve seen it not so solid. You know, I’ve seen people drop the medication completely and now they’re like, Oh, I can’t get my blood sugar. I’m still at a one 20. I’m like, Hey, you started out at three 30 on medication. Let’s celebrate where we are now, where we ideally want to go. Right. And I’ve seen it over and over. I’ve seen people get off their medication and maintain their blood sugar is perfectly normal. I’ve seen it happen very rapidly. I’ve seen it take several months and again it’s a lot, you know, each person’s individual, but the results can be dramatic if you’re strict about it.
Dr. Joe Tatta: So it’s been a great interview. I want to go have dinner now and check my blood sugar right after it to see what my levels are. They usually 85 or below so I’m usually good. But um, tell us where we can find out more about you.
Dr. Loscalzo: Absolutely. My main website is dr Rita marie.com if you’re a health practitioner and you want to study this, actually have an insulin resistance practitioner training and I have a blood sugar balancing program for the general public. So insulin resistance, practitioner.com is where that you can find out about how to do that for, for um, practitioners. And I have a main website for practitioners called nutritional endocrinology.com. So those are it. And then I have a really cool set of little videos at a place called bye bye before like bye bye before and before stands for belly fat, brain fog, burnout in blood sugar imbalance. It’s a shortcut for it, so it’s by, by before, and that has some free stuff that you can download and learn more because it’s just so much we can do in a short interview.
Dr. Joe Tatta: Great. So I want to thank Dr Ritamarie for being here. Make sure you check on all four websites. They are going to be in her bio attached to the summit home page. Make sure you check out her free gift. I want to thank her for being here. Make sure you click the byte to share the video or the interview on Facebook as well as Twitter so everyone can hear Ritamarie’s message and we’ll see you on the next interview on the Healing Pain Summit.