Timestamps

 

(1:04) What are carbohydrates? What nutrients do they provide? 

(4:57) Understanding insulin resistance, blood sugar, and cortisol 

(16:34) Why LOW blood sugar deserves a place in the conversation as well; Why going super low carb for weight loss may not be the answer 

(25:46) The relationship between insulin and hormones (cortisol, thyroid, sex hormones); Why balancing blood sugar is step 1 for PMS, PMDD, fertility, PCOS, and endometriosis 

(29:45) Optimal targets for blood sugar levels - the difference between functional vs. conventional ranges & why?

(33:57) Strategies for making insulin more sensitive and finding your carb “sweet spot”

(37:58) Importance of nutrient timing: Eating based on circadian rhythm; Intermittent fasting - pros and cons for blood sugar management 

(42:33) Vitamins, minerals, and herbs that can support insulin sensitivity and blood sugar management 

(49:00) Simple lifestyle strategies for balancing blood sugar

 

Transcript

 

I know I don't have to tell you this but this post is only for educational purposes. It is not nutrition or personalized medical advice. We want you to get the most from the episode but to keep that in mind as well and we really hope you enjoy it

 

Understanding Carbs and Blood Sugar with Jillian Greaves RD

 

Michelle Shapiro

You know, generally when people invite their friends over, it's to have a lovely meal, maybe some charcuterie, I invite my friends over and put them to work. And that's what I'll be doing. Today. I am here with one of my closest friends, one of my arty besties Gillian greaves, and we're not gonna be having too much fun today, we're really going to be getting to work on carbs and giving you guys the information you need. Hi, Julie. Hello.

Jillian Greaves 

And what are you talking about? This is fun, right? This is kind of our idea of fun. Exactly.

Michelle Shapiro

It's what we would be doing if we were socially hanging out anyway. But I really want today's episode to be a really good deep dive, which is what Julie and I both love doing on carbohydrates, where we go wrong and limiting carbs. What's a sweet spot for people to get to? How do we know if we're consuming the right amount and what is going on in our body and blood sugar when we eat carbs. So our goal is to get through this really big and heavy and important topic and give you as much information as possible. So Julian, for that. I am super grateful. And so excited to have you here today.

Jillian Greaves 

Thank you for having me.

 

What are carbohydrates? What foods have carbs?

 

Michelle Shapiro

Yes, we are going to rock on all things carbs. So on a very basic level, Jill, can you just tell us like what are carbohydrates? What do they do for our bodies? Why do we need them in the first place?

Jillian Greaves 

Great question. So much confusion here. So carbohydrates are essentially sugar molecules saccharides. And we have simple carbs, we have complex carbs. And ultimately, at the end of the day, all carbs are broken down into sugars. And this is really going to be the primary preferred fuel source for the body. So carbs, fuel, you know, our brains, our muscles, our organs. And when carbs are available, the body is always going to default to using this easily, you know, kind of Accessible Energy.

Michelle Shapiro

And when you say preferred fuel source, it means we could have other fuel sources but our body again, like you said, if carbs are in the room, they're like, you know, the queen of the room. Everyone wants to use carbs instead.

Jillian Greaves 

Absolutely. So they're, they're preferential we can utilize other other things for energy. But the body does prefer to use carbs, it's easy for the body to use carbs and, you know, store carbs for energy and kind of tap into that when it's it's needed. So, carbs aren't all bad, in terms of what some of us might think.

Michelle Shapiro

And when we say carbs, just for the super elemental people listening who just want basic basic information, what kind of foods are we talking about? We talk carbs.

Jillian Greaves 

Great question. So carbohydrates are mostly mostly gonna come from from plant foods and some other types of foods. But really carbs. When we hear that term, we often think about bread, pasta, rice, which these are sources of carbs, but also things like fruit lagoon, so like chickpeas, beans, lentils, you know, dairy has carbs as well. So carbs are in a lot of different types of foods that we eat.

Michelle Shapiro

Absolutely. And again, when we take carbs to mean this larger group of demonic or bad for us foods or whatever it is, we actually could be eliminating some vital nutrients that are carried within carbs to what kind of micronutrients vitamins and minerals do we find specifically in carbs foods?

Jillian Greaves 

Great question. And, you know, I 100% agree, where if we're like arbitrarily going low carb eliminating carbs, we could end up with this nutrient depleted diet, and outside of vitamins and minerals, which we can touch on in a second. The first thing I think about when I think about these, like really restrictive low carb diets is inadequate fiber intake. So you know, fiber is the non digestible part of plant foods. So it's going to be found in like the starchy vegetables, potatoes, you know, squashes and then you're, you know, beans, lagoons, fruit, you know, your chemo whole grains. So fiber is really important for actually regulating blood sugar for feeding healthy, you know, gut bacteria, for all sorts of things. So if we are not kind of eating enough carbohydrates and getting good diversity there, then we may be missing out on fiber from a micronutrient perspective, really, because carbs are found in so many foods. There's really a spectrum here when it comes to like the vitamins and minerals but something I think about is like the deep nutrition starches like the you know, squashes and potatoes and things that are rich in you know, potassium and you know, other other key minerals. So, you know, really there's a wide variety of vitamins and minerals found in carbs. When we are eating the whole food, minimally processed sources, we do have other sources of carbs that are processed in a way that we lose the majority of the vitamins and minerals and fiber and processing.

Michelle Shapiro

Yeah, so again, that's one way we'll know if a car Abre hydrate has some Advil advantage to us from a health perspective as if it has natural dietary fiber as a part of it. And I think of blood sugar, and we'll get into that bigger conversation of blood sugar, I think of the visual of with not wanting our blood sugar to shoot up and drop down, the way we know if something if that's going to happen is the ease at which we can get sugar from these carbohydrate foods. So I'll give an example of if we're drinking something like juice, it's already broken down, it's like an IV to your veins, right, your body can get the sugar from that really, really quickly. If you had something like an apple instead of apple juice for your body to get to the sugary part, which we know is the inside underneath the skin, it has to break down the skin, it takes time for it to do that. And if we put some peanut butter on that Apple, it would take even longer. So the more that blood sugar shoots up in our body, the quicker it comes down. And this dysregulation of blood sugar can lead to a lot of health issues. So I've just jumped into kind of how our blood sugar can vary. Can we walk it back to what blood sugar is first, Jillian, and how do we get sugar from the foods that we eat?

Jillian Greaves 

Yes, absolutely. And I think this is an important thing for really everyone to understand. So when we eat those carbohydrate rich foods that we just touched on, these are broken down into glucose or sugar, we'll kind of use those those words interchangeably when we're talking about blood sugar, or blood glucose. So carbs are broken down into glucose or sugar. And basically, this is what causes blood sugar to rise. So blood sugar goes up after eating a meal containing carbs. When the body senses this rise or increase in blood sugar, it starts to pump out a hormone called insulin. And it's insulins job to then take that glucose, that sugar and bring it into your cells where it is going to be converted into energy or ATP by the mitochondria in the cell, or it's going to be stored for later use. So insulin plays a really important role in kind of, you know, balancing or regulating blood sugar levels in terms of preventing it from getting too high, too low. But basically, we eat food, blood sugar goes up, the body produces insulin, and then the insulin brings the sugar the glucose into our cells. And that's where we get energy. That's where we store energy for later use.

 

Understanding insulin resistance and blood sugar

 

Michelle Shapiro

I love the visual of insulin being like kind of the bouncer to the club cell. And blood sugar will kind of knock on the door. And if your insulin isn't paying attention, or maybe it's not working efficiently or properly or it's not registering, like Julian said, noticing that you have too high of blood sugar, what's going to happen is your blood sugar will stay high, because it's not going into the cell, it's kind of just hanging out there. And then you're not going to get the the energy usage that you need for when it enters the cell. And what ultimately ends up happening. And something that we know as insulin resistance is that that insulin won't be paying attention. And eventually, a bunch of other insulin friends come and say, Dude, you got to open the door to the club, and then the blood sugar rushes into the cell. And that then two things happen as a result, you end up getting low blood sugar because it's already in your cell. And then you end up having more deposition of fat created from all the immediate release of sugar into the cell. So we are definitely going to talk about insulin resistance, but understanding that it's important, of course, to see how many carbohydrates you're having and how much is in your blood. But it seems more important in from a functional nutrition perspective, to understand how smart that insulin is acting and how effective that insulin is.

Jillian Greaves 

100% agree what's happening after you know, we, we eat the carbohydrate foods? And yes, you know, we're gonna want to talk about, you know, the types and kind of how to use carbs in a way that is really supportive for the body in terms of, you know, how much and what types. But what happens after we eat the carbs is really the important piece like, what is the body doing with that, you know, how sensitive are the cells to insulin? How well can we use that glucose and create energy from it?

Michelle Shapiro

Yes, and I think from a societal standpoint, we are pretty obsessed with like, let's let's view our bodies as a car, right? And we think about glucose being the fuel that we put in the fuel tank. Conventionally, people would say, hey, put less fuel in the fuel tank, if you don't want it, you know, if or put the right amount of fuel in the fuel tank so that it doesn't spill over, or you have enough for the car to run. What we want to know is how's the car running? And that's really what is important about insulin from functional nutrition. So our goal is not to limit carbs so that you don't have to use your insulin. Our goal is how do we make your insulin act more efficiently and better? And that's really again, the functional perspective is looking at the root cause of it and looking at insulin sensitivity and just terminology wise insulin sensitivity, you want more of it and insulin resistance you want less of it resistance, meaning the insulin is not responding. insulin sensitivity, meaning it's super responsive. It's an HSP insulin. Yeah, absolutely.

Jillian Greaves 

So that's kind of the, the lens that we look at things through and if someone's having issues with blood sugar, could we need to sort of modify what's going on with the fuel coming into the tank? Yes, but it doesn't end there. It's much, much deeper than that in terms of understanding what's going on with the individual and the different factors that might be impacting, you know, the insulin sensitivity, like Michelle mentioned,

 

Symptoms of high and low blood sugar

 

Michelle Shapiro

and even taking it back to just the blood sugar component of this puzzle. So let's call the breakdown of carbs into sugar that goes into your blood as step one, tell me what are the issues people might have with either high or low blood sugar? What happens? What health issues or symptoms might come up for people as a result of erratic or too high or too low blood sugar? Great question. And

Jillian Greaves 

I think there's sort of two parts to this. And that if we experienced kind of, you know, a one off high blood sugar or one off low blood sugar, we'll experience immediate symptoms. But if that's happening on a persistent basis, it can can can contribute to some bigger health issues down the line. So some of the things I think about, in an immediate sense, if we're getting big spikes in blood sugar, and you know, blood sugar and insulin are remaining elevated. I don't know about you, Michelle. Well, the first thing I think about is like fatigue, particularly after meals. So we eat all this food, we have, you know all this blood sugar and insulin floating around in the bloodstream. And it's not getting into the cell, right? So we're not converting, you know, into that ATP and getting energy for the body. So often there's fatigue after meals, there's, you know, strong sugar or carbohydrate cravings. If we're in a low blood sugar place, or we're experiencing big blood sugar crashes, I would say some of the biggest things I see are your inability, anxiety. So a lot of mood related nervous system related symptoms, in a very immediate sense.

Michelle Shapiro

Yeah. And we'll talk about what the long term effects are, I just wanted to comment on the short term to the reason why you might feel that way with high blood sugar. And that lethargy and not feeling good is because you might actually be having symptoms of not having easy to use carbohydrates for yourself and for energy, right, you're tired because all of your sugar is stuck in your blood, and you're not able to use it for energy. So that's why you're actually feeling exhausted, because you're not getting the energy from that. So often, one of the diagnostic parameters for or signs or symptoms that people notice in diabetes is actually weight loss in the beginning, when that people's blood sugar starts to skyrocket, because you're not actually putting that sugar anywhere, it's just hanging out in your blood, which will cause and we can talk about long term issues, if you do have too much hanging in your blood. From a low blood sugar perspective, we get that hanger kind of sensation, because your body's preservation system gets kicked on and thinks, Oh, we're gonna starve and die if I don't get some sugar immediately. So the symptoms of low blood sugar are, you know, there's a cascade after you feel those symptoms of what's going on from a biological and hormonal perspective to as your body tries to desperately get you sugar from somewhere else in the body. Can we talk about that before we talk about the long term effects of higher low blood sugar? What happens when we have low blood

Jillian Greaves 

sugar? Yeah, and one thing I want to mention to which you kind of indirectly pointed out, Michelle, is that you can experience both and most people do, right? They they coexist together in terms of these big swings with blood sugar, high blood sugar, low blood sugar, I think high blood sugar gets a lot more attention. But from a low blood sugar perspective, what's happening is because glucose is that, you know, primary preferential source of energy for the body. When blood sugar dips too low, this sort of sends off the alarms in the body, the body is like, oh, my gosh, you know, energy is scarce, you know, how am I going to keep all these systems, you know, functioning and operating. So blood sugar dips low, and that causes the body to mobilize or produce cortisol. If you're not familiar with cortisol, it's one of our primary stress hormones, and you know, produce from the adrenal glands. And cortisol is a glucocorticoid. And you know, one of its primary jobs is to make sure that blood sugar is balanced and stable. So when blood sugar dips too low, we start pumping out cortisol. And cortisol is going to tap into glucose stores, you know, in the liver and your muscles and dump sugar or glucose into the bloodstream to try to normalize things. And at that same time, especially if this is happening on a chronic basis, cortisol will basically tell your cells to be more resistant to insulin because it doesn't want you to get to that low place again, where it doesn't have enough energy to function optimally. So you know, in a really simple way to think about it, blood sugar goes down and crashes, cortisol stress hormones go up.

Michelle Shapiro

So what I noticed is when people start to have insulin resistance, or they're having they're in a state of, you know, high blood sugar on a more regular basis. I've seen at least in my own clients, I know studies are really differ on this, but if they engage in something like intermittent fasting and they don't eat carbs for a long period of time, I'll actually see their blood sugar start to rise in the morning and this is explained as we know as like the domino effect and diabet EdEx but even in pre diabetics, or people who are insulin resistance, it's so weird because you would think eating no carbs should never cause a glucose rise. So if you're a person listening to this, who's saying, oh, you know, I didn't realize intermittent fasting could actually cause my blood sugar to go up, even if I'm not consuming carbs, because remember, we have those fuel stores that our body can tap into and break down. And then you get to spill into your blood sugar of higher blood sugar. So there's really, you really don't want blood sugar to be too high or too low. Because there's, there's a risk of either,

Jillian Greaves 

absolutely, it's kind of this this Goldilocks situation. And I think, because high blood sugar is not good on a persistent basis, and it gets a lot of attention. And there are a lot of people struggling with that. The low blood sugar dynamic, and the impact that it has on the body kind of gets overlooked. And I agree with you, Michelle, I see that a lot in practice where women especially are overly restricting carbs, they're going really, you know, long periods of time without eating. And we're actually seeing like pre diabetic blood sugar parameters for these individuals. And, you know, when I'm doing cortisol testing with people, and they're doing, you know, this prolonged fasting, and they're having caffeine in the morning, we're seeing massive, massive spikes with cortisol at times where we don't want to be seeing that. So the low blood sugar dynamic is, you know, just as bad and in my mind as kind of the high blood sugar dynamic. And it sort of speaks to the idea that we need to work to achieve true blood sugar balance, true blood sugar regulation, and not you know, any of these extremes.

Michelle Shapiro

Do you think the reason that we're so obsessed with high blood sugar is because it's tied into like the societal view of us always being like overindulgent or something? Why do you think high blood sugar has been so much more publicized than low blood sugar? This is more of a theoretical question.

 

The role of blood sugar in health

 

Jillian Greaves 

Yeah, I feel like there's so many things that have contributed to this. But, you know, I think a lot of awareness has, you know, been happening, which I, you know, there's some good parts to it around, you know, how our food system has shifted, and just the never ending access to these, like highly processed foods, and particularly carbohydrate foods that do blast the blood sugar, kind of like the juice example that you gave Michelle. So I think our food system has changed, and people are sort of catching on that man, these ultra processed foods are, you know, having an impact on blood sugar, but again, it's sort of a one sided conversation. And then, of course, people kind of like, pick up the kind of high high blood sugar piece of things. And now there's like fear mongering, right around carbs, and it's not a true conversation around okay, how do we balance blood sugar? How do we, you know, make choices that feel really good for you? You know, it's, it's now a diet thing. It's a fear mongering thing, and everyone's, you know, carb phobic.

Michelle Shapiro

Right? There's this initial societal understanding that high blood sugar could cause us health, ails, which we will talk about, and then the response is, okay, you shouldn't eat any carbs. And then the response to that is, well, don't tell me what to do. I can eat all these carbs and have food freedom and all this. So I think that we're all missing the mark a little bit, which is that yes, there are some carbs that are preferable and easier to break down and more efficiently us in our body. And there are some that can, you know, cause a cascade of issues for us. And it's okay that some are better than others. It doesn't make us bad for choosing ones over others, you can eat all the cake you want in the world, it doesn't make you bad in any way. But biologically, there are differences between consuming highly processed carbs and natural carbs, let's call them

Jillian Greaves 

exactly and yeah, it doesn't doesn't mean you're a bad person, a good person for any of these these choices, I think it's just information that's important for people to have to be able to make decisions that feel good for them. And, you know, I think with the just, you know, all the fear mongering and misinformation and all of that out there, it's just really challenging for people to tease through all of this.

Michelle Shapiro

I agree. And I think if we can, at each point in our conversation, do a takeaway, because we're gonna keep hitting people with the with the facts and the processes. Eating whole carbs can absolutely be a part of a balanced diet, and oftentimes is necessary for a balanced diet. And again, we're talking about all those carbohydrate foods that Julian mentioned before, and people not fearing fruit, or, or grains, or potatoes or things like that feels really, really important. And to just let people know that not only should you be eating these things to liberate food restrictions, but additionally, because biologically, it's oftentimes advantageous to incorporate these foods and even people who are hardcore ketogenic for a long time, still have carb refeeding days because our brains really do love glucose. So it's never advised to go on a ketogenic diet forever. And I think the model of carbs in our society now is eat as little as possible. And that's really not balanced at all. And I could not love these carbohydrate foods more like potatoes, rice, I mean that they're like Staples. And I know both of our diets because we've shared many meals together, I know that we've addressed also the low blood sugar thing. But one takeaway I want to also hammer in is, if you are experiencing chronic low blood sugar, that could be leading to some sort of weight plateaus, health plateaus and things like that, because that state of preservation for your body can actually cause you to create more stress hormones and stress hormones in abundance, create more fat deposition. So if people are trying to go really low carb to lose weight, just as a fact that also could could really inhibit them from those goals as well.

 

The problems with low blood sugar and intermittent fasting

 

Jillian Greaves 

100%. And I see that very often in practice, and, you know, with women I work with, and this sort of also speaks to the just, I think, general way that we approach like health and nutrition and lifestyle, it's like we're focused on the more the better, right? Like, the lower the carb, the better, the harder I work out, the better the more I do this, the better and more is usually not better. It's, you know, it's often not better. And a low carb diet or a lower carb approach could be warranted in certain circumstances, but it needs to be executed thoughtfully, so your body's needs are met well, and sometimes these are more short term therapeutic interventions, and we don't want to just like deprive the body endlessly, and put it in that chronic stress response, our modern world is full of stressors as it is, and stressors like a low carb diet, or, you know, a caloric deficit, or, you know, fasting, these things are only healthy and beneficial. And adaptive when the body is is in a place of homeostasis, and you're kind of kicking it out temporarily, and then bringing it back in most of us are not in homeostasis, and we're totally stressed out. And, you know, depriving the body of calories or carbs is just like throwing gasoline on the fire.

Michelle Shapiro

Exactly. And especially the fires already burning the fires of inflammation and deprivation already burning, you really can do more damage than good. So this idea that you should not always go lower and lower in carbs. The other thing is there are psychological consequences of not eating carbs and having low blood sugar. I mean, when I think of anxiety, and I know we covered this in a past episode, blood sugar management is essential for anxiety because you can feel an experience anxiety at high blood sugar and low blood sugar for sure. And I think that for people who are like said, outputting, cortisol already diminishing the carbs they eat, it might work in a lab for specific people. But for people in our modern world, it's really hard to keep up with the stress demands without those carbs. So it's completely essential. One thing I want to go back to is, what is the risk of having constantly elevated blood sugar? Why are we so afraid to develop blood sugar issues? What What's the deal with that?

Jillian Greaves 

Yeah, so when it comes to elevated blood sugar, and elevated and you know, insulin, kind of, you know, speaking to both of those things, if we are chronically repeatedly, you know, pumping out a lot of insulin and there's a lot of blood sugar circulating, this puts the body in an inflammatory state, so too much insulin, too much blood sugar chronically it is it is pro inflammatory. And we have, you know, a lot of data to support that. And not to like over oversimplify, you know, something complex, but chronic inflammation is pretty much at the root of every chronic disease in our world. So if we are driving inflammation, it's going to impact absolutely every health condition, every system and organ in the body. So that's what I think about, you know, as, as the biggest thing, or the biggest problem when it comes to, you know, chronically high blood sugar, it's that, you know, pro inflammatory cycle where contributing to,

Michelle Shapiro

and there's actual, like damage that can happen to like your vessels from blood sugar being high, as we know, like in diabetic neuropathy, and these other conditions. So blood sugar being elevated could could cause an inflammatory response that could then cascade into any number of diseases. So just having that blood sugar behind chronically is an issue for people. And I know, this is something I want to mention too, which is that a lot of people who have restricted carbs in the past, do end up binging on the higher carb items, again, because we end up craving sugar, and it feels like, you know, something comes over us and we need to eat those foods too. So I think that from this conversation, I want everyone to understand we're not fearing high blood sugar or fearing low blood sugar. We're going to give solutions that can help to alter either, so it's not about restricting entire food groups. It's not about cutting things out. It's

Jillian Greaves 

about applying this information in a usable way. Because I know there's certain people who do have such strict carb fears and I want to let you know, hey, and to piggyback off of that, I will Say most women I work with in practice, I am increasing their carbohydrate intake, and it has a profound impact on how they feel in an immediate sense with mood, energy, digestion, sleep, cognition, so many things in an immediate sense. So definitely not trying to cause fear around the high blood sugar at all. And blood sugar is supposed to rise after we eat. That's a very normal, healthy process. So you know, we don't want you know, we're not trying to achieve flatlined blood sugar that you know, that doesn't doesn't make sense. That's not a thing. So we do want rises in, you know, declines with blood sugar, but we want it to happen. We want slow rolling hills with the blood sugar after we eat. We don't want the big, you know, peaks and valleys.

Michelle Shapiro

Exactly right. And I think that understanding what the impacts of high blood sugar are on our vessels and our body. And I think understanding the impacts of low blood sugar are really, really important. Let's talk about insulin but hormone who's going to influence how much you know sugar we have in our blood, tell us a little bit more about our friend insulin, the hormone, whatever you'd like to say,

Jillian Greaves 

yeah, so you know, insulin, I touched on this a little bit, but to review, So insulin is a really important hormone and specifically talking about it, you know, in relation to blood sugar, it plays a really big role in you know, kind of preventing blood sugar from getting too high, you know, or too low. So, the pancreas pumps out insulin in response to blood sugar, and you know, that rise in blood sugar after eating. So, you know, insulin plays a really important role there.

 

The relationship between insulin and hormones

 

Michelle Shapiro

Yeah, and insulin has relationships with some other hormones, can you tell us about the relationships and the friendships that insulin has,

Jillian Greaves 

so blood sugar and the thyroid have a huge bit, you know, very, very interconnected relationship. And like, without going down a total rabbit hole here, blood sugar issues can cause thyroid issues, and thyroid issues can cause blood sugar issues. And if the thyroids not functioning properly, that this can actually contribute to that desensitization of the cells to insulin. So insulin and the nervous system, insulin and the thyroid, insulin, and basically every system in the body, so that, you know, this sort of even speaks to just like a true functional nutrition functional medicine approach, and that everything is interconnected at the end of the day, but the thyroid and insulin and blood sugar are, are very interconnected. And that's one that is definitely not talked about enough.

Michelle Shapiro

And elevated insulin can actually stop the conversion of thyroid hormone to its active form. So it can literally make it impossible for your metabolism to regulate itself too. So it's not only that the blood sugar immediately is causing an issue, it's insulin, the actual hormone being released in excess can also cause other hormonal issues, like we heard with cortisol and with our thyroid tip. So getting that sweet spot balance is really, really important.

Jillian Greaves 

And it has a big impact on sex hormones, as well, in terms of, you know, sex, sex hormone metabolism. So just another specific example. We see a lot of issues with androgen hormones, a category of hormones that we all have, but we consider them more male hormones. So if we have too much insulin, it can impact how we're metabolizing testosterone in particular, and that can create issues with things like acne and hair loss and all sorts of things.

Michelle Shapiro

And certainly, in the work that you do Jillian, blood sugar becomes extremely important because you work with women with PCOS. And that exact relationship between insulin and testosterone like you just said, it could be a huge driver of symptoms for people is that something that you really work on with your clients? She was blood sugar, yeah, absolutely.

Jillian Greaves 

And particularly, you know, with with PCOS clients, this is huge, because insulin resistance is very, very common 70 plus percent of women are suspected to have some some degree of insulin resistance with with PCOS. So, in that sense, if we are having issues with insulin and high insulin, it contributes to the issues with the androgen metabolism, like I mentioned, it also interferes with ovulation, it actually stimulates the theca cells on the ovaries to produce more testosterone and then we're we're metabolizing testosterone into a even more potent form of an androgen that can contribute to some not so pleasant symptoms. So yeah, so a really big deal with PCOS but I'll say across the board you know, just in terms of specializing in women's health and working with endometriosis clients PMS PMDD, fertility, blood sugar balance is step number one and you know, we can't balance or regulate our hormones If blood sugar is out of whack, you know, because it really does impact everything.

Michelle Shapiro

It's one of the biggest as Jillian I would say foundations of functional nutrition is blood sugar support. Absolutely. Speaking of functional nutrition and and blood sugar and insulin, what do you feel like is the appropriate ranges that you want people to be seeing when they're looking at their fasting blood sugar and hemoglobin Awan seeds do the functional ranges compared differently than the conventional ranges

Jillian Greaves 

they do. And I think that's a big problem. And before I even tell you a little bit about some of the differences there, something I want to highlight that I just think is so profound is that the CDC estimates that one in three US adults are pre diabetic, and 80% are unaware. And I kind of giggled when I said the CDC because sometimes these these big organizations are a little behind on certain things, in my opinion, or they are under estimating things. So the the one in three, being pre diabetic is probably an underestimate, in my opinion. And this kind of takes me into talking about the blood sugar parameters and why that might be important. So conventional reference ranges for blood sugar labs are really wide. And newer research has identified kind of tighter ranges for you know, fasting blood sugar, fasting insulin, and your hemoglobin a one see that Michelle mentioned, which is a kind of a measure of your average blood blood glucose over the last three months. So newer research has identified kind of tighter, more narrow ranges for what is considered optimal. And, you know, even though we have this information, the reference ranges conventionally are are very, very large. So a lot of times, you know, people are having labs done, and their blood sugar labs may be in a pre diabetic range, but they are not getting flagged, and there are no interventions at that early stage where we have so much opportunity to reverse those dynamics, you know, through food through lifestyle. So that's, that's a really big problem. And I actually see that often, in my PCOS clients, when, you know, I might be working with a new client, and they told me that, you know, their doctor tested their blood sugar and said they didn't have any issues with insulin resistance. And then, you know, we review their labs and see that their fasting insulin is 20 something and newer research has identified that we really want to see that below five, ideally, I always say below seven is usually where I want to get people, but below five is considered optimal. So I think that's that's another big problem that we aren't identifying things early. And people are getting to the point where there's a bigger issue, often requiring medication.

Michelle Shapiro

And there's no issue with someone taking medication, if that's what they feel is right for their bodies with their doctor also feels right for their bodies. But there is a very critical timeframe when you're in a pre diabetic state that by the time you're seeing insulin resistance and seeing pre diabetes, you could have had some sort of blood sugar dysregulation for 10 years before it could have been 20 years before. But once you get into that pre diabetic state, I have seen it happen where things can kind of the boulder can roll down the hill pretty quickly. So you have more opportunity early on, for sure. I think prevention and treatment early on is is essential. So knowing your numbers is really important. You gave us a beautiful parameter for fasting insulin, which is less than maybe seven or really optimally less than five. What do you use for fasting blood sugar fasting glucose? Yeah,

Jillian Greaves 

so for fasting glucose, I typically use the range of 70 to like 86, that would be my ideal for fasting. And there, there are some slight differences based on research and different things that people use some people say 70 to 9070 to 86. In terms of the A one C, I like to see clients a one C at 5.4, or, you know, below, like 4.6 5.4, typically for optimal health.

Michelle Shapiro

Yeah. And it's funny because I actually have like a chronically low blood sugar issue, or did formerly so my goal was to get my hemoglobin a one C up which doctors were like, Why? Because my hemoglobin a one C was like a 4.2, which translates to an average glucose of like 70, which means that you could go as low as 40, or as high as 100, basically, on average. So again, I was hugely symptomatic with that blood sugar level, and you would never hear a doctor telling anyone to raise their hemoglobin anyone say, and I was fighting to get my blood sugar up. So there's definitely again, there's a sweet spot for all this. I would say like, again, for hemoglobin, anyone see the parameters using like conventional medicine will be less than 5.6? I'd love to see it less than 5.4. Like you said, Julian and I really wouldn't like to see it much lower than 4.8. Yeah, I think like somewhere between 4.8 and 5.4. And same for blood glucose. The conventional ranges are about 70 to 100. Or some offices use 110. I'd like it less than at least nine. Yeah, I would definitely agree or like you said at six that that makes total sense. And these are just free to interpret your own labs. And if you're noticing, hey, this is creeping up or this is changing, it can be a time to look

Jillian Greaves 

a little deeper. Yeah, and something to point out too is that usually li your glucose is getting tested, you do want to make sure that that's fasted for an accurate reading. But often you have to ask or request, you know, in a one C, and sometimes you have to fight a little bit for a fasting insulin I've found, but you can have, you know, a normal fasting glucose, a normal a one c in terms of these optimal ranges that Michelle and I are talking about. And if we can get a fasting insulin, sometimes that can pick up on those earlier stages of insulin resistance. So, you know, again, to Michelle's point, there is no no shame in you know, medication at any point in any journey, if that is the right choice for you. You know, my big issue is, and I, you know, I think you would agree, Michelle, like our big issue is that people aren't given all the information, they're not given all of the options to be able to choose and support themselves at the early stage and to maybe be able to negate the need for medication. And I just think everyone deserves that that option.

 

Nutrition and lifestyle strategies for balancing blood sugar

 

Michelle Shapiro

And certainly, you know, I think when we think of government guidelines, or these big organization guidelines for food, our assumption is that they are correct, and that people aren't doing them enough. That's actually not the case. People follow the guidelines pretty well. And especially they've done numerous studies that show the the actual diabetic diet by the American Diabetes Association, was less effective at supporting insulin resistance. And this is no shock to Julian or i, then a Mediterranean or, you know, in one case, a paleo diet, but But generally, the recommendations from these organizations are not super supportive for people, and we're following them. So what upsets me the most is when people are doing everything they think is right, and are told is right, and they're getting worse results. So I would like to give some tangible support for people on how to make their insulin more sensitive, how do they find their carbs sweet spot? And I know Julian's full of knowledge on this. So can we veer into that Convo?

Jillian Greaves 

Yeah. So for I like to kind of break break this up into nutrition strategies. And then, you know, not nutrition strategy strategies, or lifestyle strategies for improving insulin sensitivity, and, you know, balancing blood sugar. So, you know, first and foremost on a basic level with nutrition, thinking about eating consistent meal. So you know, eating every three, four hours throughout the day, to support stable blood sugar, if the pattern of eating is really erratic, this is going to, you know, contribute to wonky blood sugar, both going long periods of time without eating. And you know, if you're like a grazer, and you're just kind of like picking grazing all day. So trying to create some structure there to support your body,

Michelle Shapiro

I'm going to throw us both a curveball, because some studies do show that intermittent fasting does lower blood sugar in a favorable way for people who are experiencing high blood sugar. But from what we've anecdotally seen, too, and seen in some other research, that's not always the case. Why is that the case that intermittent fasting is sometimes good for people. And sometimes it's not good for people when it comes to their blood sugar.

Jillian Greaves 

Yeah, so a lot of different factors at play here. But the way that I would boil it down is, it's like the idea of hormesis, right, where certain stressors can be healthy and adaptive for the body in the right context, context is king. So if someone is, you know, intermittent fasting, and they, you know, their body is already in a very stressed out dysregulated state. So we're not sleeping, we have a lot of emotional stress in our life, we're under eating calorically we're not getting, you know, enough carbs, and protein, and then all of a sudden, now we're prolonging our fasts, that's not going to be healthy or beneficial. So to boil it down, think about the context. So there are some circumstances where fasting or you know, prolonged windows of not eating could be beneficial. To break it down a little bit more men seem to benefit from or respond, I guess, a little bit better, to some of these stressors and things like intermittent fasting women, particularly women of reproductive age, our bodies respond differently. So our hormones and our hormone cycles are different. And therefore, we are more sensitive to these stressors. Across the board, though men, women, if someone is considering, you know, intermittent fasting time restricted eating, I really like to emphasize first and foremost, you know, diet quality, like are we like getting in enough of the nutrients that the body needs? Are we getting seven to nine hours of sleep a night? Are we doing what we can to support the nervous system? So arbitrarily, just like, you know, starting to prolong the fat or of yourself? Yeah, it's not it's not going to get to do anything good. But there is certainly data. And there are circumstances where, you know, prolonged fasting could be helpful. In practice. I have yet to work with a woman and I have worked with hundreds of women possibly, you know, over 1000 At this point, hundreds of women I've yet to see a woman successfully. To, you know, achieve health goals and achieve optimal health, when they are going long periods of time without eating

Michelle Shapiro

with lots of intermittent fasting or lots of carb restriction, I have to say the same. And I would say, if there was a person, an avatar of a person who does better, it would be like a man who has more muscle mass and not a lot of stress in their life. And I think that's really the people who are generally pushing fasting and intermittent fasting, which is the funniest thing is that our bodies operate differently. But women, you know, I guess, have this more like protective mechanism, which is just like, hey, just in case we need to, like make a human life or something where their cortisol is a little more trigger happy. And that does cause that downstream effect, too. So for sure, I guess the first step for insulin resistance would just be balancing blood sugar eating regularly, as simple as

Jillian Greaves 

that, yeah, and you know, to take it one step further, and this is going to look a little bit different for everyone. So I want to make that clear, in terms of what your schedule looks like, there are no rules here, you know, these are tools and guidelines. And the goal would be to kind of adjust based off what works for you. But generally, aligning your pattern of eating or your timing of eating with your circadian rhythm, you know, has been found to produce a lot of benefits with various metabolic markers, you know, blood sugar being a big one. And what that means is, you know, having something to eat within the first hour or two of waking and then eating those consistent meals about every three, four hours throughout the day after that, and then, you know, naturally having an overnight fast that, you know, might be, you know, the the time might vary, but you know, maybe there's a 12 hour overnight fast or something like that, because you have dinner at seven o'clock, and then you have breakfast at 7am. I think what people are also doing with this whole intermittent fasting craze is they're interpreting intermittent fasting and time restricted eating as skipping breakfast, and like going as long as you can without eating, and then you know, being hangry, and you know, eating all of their food and getting in all their nutrition at night, that actually kind of goes against how the body typically likes to, to operate. So aligning the pattern of eating with the circadian rhythm can be helpful. So if you're someone that doesn't eat until noon, and you had dinner at seven or eight o'clock the day before, that's a really, really long, fast. And to Michelle's point, particularly for women and how sensitive women's bodies are, we can actually see that really, really disrupting, you know, what's going on with cortisol and kind of kind of jacking up that stress hormone.

Michelle Shapiro

This just again, speaks to how bio individual nutritionists and how, at the same time, it's just so simple, like, Yes, eat during the hours of being awake and don't eat during the hours of sleeping, like it always comes back to like literal nature and like our clocks of Earth. I mean, it comes back to the most basic version of things, eat foods that you could get yourself by hunting or gathering like the most, the most simple truths that we just know. But we need to hear time and time again. So incredibly helpful. Balancing your carbs with your circadian rhythm tell us in specifically, insulin resistance. So we've targeted let's say, carb quality by saying eat the most natural form of carbs as possible with the highest fiber content. And those would be again, in their most, whatever natural form we'll call it, meaning closer to where, where in the earth they were grown. We have balancing your blood sugar by eating regularly and eating according to your circadian rhythm. So let's say those are our carb recommendations in ways of nutrient timing tell us insulin resistance specific recommendations to to target the system instead of just carb about

Jillian Greaves 

so couple things here. We don't want to just look at carbs in isolation, we do want to think about what we are eating alongside carbs. I think this is the the other place that some sometimes people are overlooking. So what else is at these meals, so we know that other macronutrients, particularly protein, and also fats, really helps to slow down the digestion of carbs. So we don't get those big rapid spikes, and crashes in you know, blood sugar and insulin. So when we are having balanced meals with carbs, adequate protein fat, we're getting in, you know, non starchy veggies with lots of lots of fiber, we're going to elongate that blood sugar curve and the body isn't going to need to pump out large amounts of insulin in or in a rapid way. So that core meal composition is really important and, you know, kind of a foundational piece of things I would say to take it even a step further. There are other things that we can think about from an insulin sensitivity perspective. So our body does need certain vitamins, certain minerals to highlight a few here magnesium, which is Michelle, I know know how much you love loves magnesium. She's in a long term relationship with magnesium. Literally, my real husband but you know there's there's certain minerals like magnesium, zinc, chromium, potassium thing things that are needed to support you know, insulin signaling insulin sensitivity. So a lot of that boils down to, to when we're choosing foods that we're eating, really kind of aiming to incorporate a wide variety of nutrient dense foods. So those foods that are bringing in the vitamins and minerals, and you know, maybe, you know, utilizing supplements, if that's appropriate for you. So minerals, really important, also antioxidants. But again, bright, colorful fruits and veggies, these plant foods that are so wonderful, can be really helpful for supporting insulin sensitivity as well. Those are some of the big things that come to mind. For me from a food perspective initially,

Michelle Shapiro

I love that. And it's really, really helpful. Again, I have this visual of insulin being like the bouncer to club cell, right. And we think about the things that make insulin work less effectively. And that will take him away from his job of letting the blood sugar into the cell. Things like inflammation can really make your insulin receptors less sensitive, aka, it's almost like he's looking around, and he doesn't even see the blood sugar there, and doesn't realize that there's too much sugar in the blood. So our goal is to make him more like we're saying sensitive, which makes him pick up on the fact that there's sugar there in the first place. So when Julian is saying these things like things that can improve insulin sensitivity, I think of it if he's a bouncer of the club, like someone handing him 20 bucks, you know, let me in, like giving things that are anti inflammatory or supportive can make insulin more effective. So this is something that I want to also reiterate, which is that insulin becomes more resistant when there's more inflammation present. So it can make those sensors less able to pick up on things. So anything that's anti inflammatory can also help with insulin sensitivity, which is amazing. Do you use any? Now this is not medical advice, do you but do you use any specific in addition to these incredible minerals and nutrients, do use herbs in your practice to support insulin sensitivity to

 

Herbs and supplements that can optimize blood sugar

 

Jillian Greaves 

I do absolutely, and definitely, you know, on a case by case basis, we'll you know, personalize those things. So always want to check with your provider. But magnesium is definitely a big one and just minerals in general. So most people are going to benefit from some mineral support, you know, due to stress, depleting minerals, poor soil quality. So bringing in some supplemental supplemental minerals can be helpful for a variety of reasons. But promoting insulin sensitivity is a big one. In practice, and definitely a lot with my PCOS clients. Since there's a lot of data there on some of those things, I use different tools from a supplement perspective, things like a noxa talls, Manassa. talls, are kind of like a cousin of the B vitamin found in a variety of foods, but very important for insulin sensitivity and signaling. I use things like Berberine, chromium, Alpha Lipoic Acid, even things like probiotics, and you know, essential fatty acids will like your like really good quality fish oil, or cod liver oil, these things have been found to, you know, help promote insulin sensitivity as well. And when I mentioned probiotics to without like, again, going down like a rabbit hole here, which we could totally do, the bacteria in our gut actually play a role in you know, regulating, you know, immune function and inflammation. So if there's some issues going on in the gut, that could be a driver of insulin resistance. So the probiotics can be helpful. Cinnamon is another one which you can incorporate, of course, through food. But I was actually reading an interesting study recently in PCOS that found that encapsulated cinnamon was as effective at promoting insulin sensitivity as a medication called Metformin, Metformin. I love that study too. And I have to say, I found one of my clients we were using cinnamon on recently like, and he wasn't comfortable using other interventions yet, which is, it was very early in our work. And just cinnamon alone lowered his fasting sugars from like, 179 to 120. But then, like two weeks, it was really well, and again, this is case by case you will not get these results. This is not medical advice by any means. But it's it's really powerful, how any one of these interventions can support. And then, you know,

Michelle Shapiro

I think, again, the way that we in Western society view health is like, Oh, I'll take all these things and lower blood sugar and then my blood sugar good. It has to be much more about balance, it has to be much more about incorporating strategies to target the sensitivity of your insulin than just to bring down your blood sugar. So it's all about how do you make your body a less inflamed place? How do you make your body a place that feels safer, and then blood sugar can act in a much more efficient way. So that was incredibly helpful. Again, I Julie and I told you this wasn't going to be fun. We were going to really you know get to work on this podcast. Is there anything else you feel is really important when we're talking about blood sugar insulin that we want to include

Jillian Greaves 

a couple just lifestyle strategies to really quickly touch on because I think, you know, food is so important and fundamental and impactful when it comes to blood sugar and insulin resistance. But the lifestyle pieces are just as important and often neglected. You could be you know, eating in a way A that is very blood sugar supportive for you. But if there's a lot of lifestyle, things going on that are disturbing blood sugar, we could have some issues there. So the big things that come to mind for me are sleep, even one night of poor sleep has been found to impact fasting blood sugar, insulin, insulin levels. So if we're not getting enough sleep, or good quality sleep that can, you know, be a big one, stress, of course, emotional stress, we talked a little bit about the physical stressors in terms of, you know, going to low carb or intermittent fasting but, you know, emotional stressors as well can disturb blood sugar and create more insulin resistance. Also exercise and this is another Goldilocks situation where both too much and too little exercise that has been found to, you know, be not so great for blood sugar and insulin sensitivity. So working on a, you know, establishing just a well rounded, supportive movement routine. Also one that is flexible, if, you know, we need to kind of peel it back because there's, you know, different stressors going on in life. And I just have to highlight that my absolute favorite form of exercise for promoting blood sugar balance is walking. It's unbelievable what it does for insulin, it's really unbelievable. Studies are just unbelievable, and there was a recent study that that came out, I'm sure you saw this, I just think it's so profound that two to five minutes of walking after eating a meal, or even just breaking up sedentary time. So like, you know, if we're sitting in a chair all day, maybe we're standing up and we're, you know, taking some calls, um, this can actually really help with that post meal blood sugar response in terms of preventing some of those bigger spikes. So if you're someone that eats lunch during the work day, and you're like, oh, my gosh, I'm like, so tired afterwards, you know, we can totally take a look at meal composition and see if there are supportive tweaks that we can make, that maybe you pop out for five minute walk, or 10 minute walk, you know, if you will, you know, if you only have a few minutes, you only need a few minutes. And you know, that might help promote that insulin sensitivity and that energy creation utilization. So then we feel better and blood sugar is more balanced. And I really would

Michelle Shapiro

argue based on your beautiful description of lifestyle strategies, that going hardcore keto, and then like really doing a tremendous amount of cardio and lifting a tremendous amount of weights that your body is not prepared for, could absolutely be as damaging to your blood sugar as eating hyper processed foods all the time, there's, there's, I can make an argument for that. And I know you can, too. And I'm gonna give you all something that I promised I wouldn't do. But if you made it this long of the episode, you deserve it. But what is considered a very low carbohydrate diet is less than 20 grams of carbs a day, which is a ketogenic diet, what is considered a low carbohydrate diet is anything less than 130 grams of carbs per day. I hate using numbers when it's not personalized. But just to give context, again, people who are like I'm going to have as low as possible, if you were eating less, between 20 and 30 grams and doing something that I would call like, lazy keto, or something where you're kind of going as low as possible, your body doesn't have enough fuel to signal that it has enough carbs there, it doesn't have enough carbs for fuel, and it also doesn't have too little carbs to signal to use fat for fuel. So you end up just not having adequate fuel sources at all. So the worst place to kind of be in in my head is between that 20 and 130, which is funny because oftentimes we think like, again, lower is better first. So if you're gonna do keto, you have to stay below that, because then your body will just continue using carbs because it loves carbs, remember, so if you're between 20 and 130, that's a spot you actually probably don't want to be in because your body doesn't know what the heck to use, and it doesn't have enough to use of either.

Jillian Greaves 

Yeah, and oftentimes, in those cases, too, when people are in that range, kind of, you know, trying to really hammer in the low carb, you know, we see them doing the hit training and the cardio and then you know, getting mad or angry at their body when they're not, you know, building muscle and seeing, you know, the aesthetic changes they want when it's like, you know, that is on the very low down on the totem pole of priorities for your body in terms of like, you know, building lean muscle or hair and you know, skin and nails and all of these things. If resources are scarce, the body has has much more important priorities. And you know, for women of reproductive age 150 and above is my my guideline there in terms of if we're dipping below that, you know, we are putting the body in that place of scarcity, which is not good.

Michelle Shapiro

And we have to just know where your body's at, again, if you're like a super muscular person who's extremely healthy and fit and has no stress in your life, and you feel that you feel great when you do intermittent fasting and you're checking your blood sugar and you're checking your inflammatory status and all these things. We don't care you whatever you want. That sounds great. But for most people, this idea of lowering carbs, lowering carbs, puts them into a real disadvantage with blood sugar management. And again, then you have that psychological component which is that we restrict carbs that are awesome for us. And we end up eating carbs that aren't as awesome for us as a result. So we stop eating potatoes. So we have to eat cake because our body is going to get those carbs somehow to get that blood sugar up. Jillian, thank you so much for coming on this episode and just being an amazing teacher. Please tell people how they can work with you and find you. I mean, people I need to explain something also. And I should have said this beginning of episode. Julian is my favorite person to go to with any health question or concern you are my number one go to because you're literally the smartest dietician I know and one of the smartest practitioners I've ever met in my life. So I could not recommend please go to Julian's page, it would be silly for you not to Julian, how can people find you work with you tell me oh my gosh, you're

Jillian Greaves 

making me blush over here. And it was so much fun to be on here. I could literally talk about this with you for days on end. But you know, in terms of where people can find me, I have a website Julian grieves.com. And you can also find me over on Instagram at Julian grieves rd where you'll you will hear me talking about all things blood sugar, and you know, building on this conversation, and I actually do have a re blood sugar guide that you can access on my website that kind of breaks some of this down and outlines blood sugar parameters is a resource for anyone that would find that helpful.

Michelle Shapiro

Yay. Okay, please go get that resource. Julian, thank you so much. Thank you. Thank you so much for tuning in to the quiet the diet podcast. If you found any of this information relevant. Are you related to it? Please feel free to share the podcast it would mean the world to us. Also remember to subscribe so you don't miss any episodes. And you can follow us on Instagram at quiet the diet pod. We'll put the link in the show notes after each episode. Thank you again for listening and I can't wait to see you in the next episode.

Transcribed by https://otter.ai