“Blood Sugar Talk” with Dr. Brian Mowll and Daphne Olivier, RD, LDN

March 11, 2016. Topic: How to Burn Belly Fat

Dr. Mowll: All right. Happy Friday, everybody. This is Dr. Brian Mowll, The Diabetes Coach. It’s great to be on the line with you today. And I have with me, dietitian Daphne Olivier, The Unconventional Dietitian.

So, Daphne, welcome again to our Q&A tele-class today.

Daphne: Thank you. Thanks for having me.

Dr. Mowll: Absolutely. So this is blood sugar talk. And we’re excited to have some guests on the line with us today. I’m going to do a topic for today, which is how to burn belly fat. And then we’re going to jump into your questions.

If you have a question and you’d like to ask today, you have two options. If you’re on the phone, calling in, you can press *2. And that will raise your hand or let me know that you have a question. And I will unmute you. You can ask your question.

The second option is if you're watching via the web or even if you are on the phone and you have your computer up as well, you can enter your question on the left-hand side. There's a question box there. And you can type your question in. Or if you have a comment or suggestion or anything, just go and put that in there. And we’ll go through that with you today. We do have a lot of pre-submitted questions that we’ll go through as well.

So let’s jump in and talk about how to burn belly fat. This is a common question that I get from people, where we realize that carrying around extra fat around the mid-section is a risk factor for diabetes. It’s a risk factor for heart disease and other problems.

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There's been some studies that have looked at liver fat and fat around the pancreas as possibly the main driver for type 2 diabetes. And we know that visceral fat, which is the fat packed in around the organs, is what some call angry fat. That’s an inflammatory, dangerous fat that triggers metabolic disease.

When we analyze body composition, there's a number of ways to do that. We can do that through anthropometrics, which is things like body fat testing, bio-impedance testing. There’s the scales that you can step on or hold or more sophisticated devices. There is the, I remember being back in athletic training, as co-exercise physiology school And we would do the skin calipers and that’s still done today. The best way is to do a BOD POD where you do underwater weighing to test body fat. And that’s one way to do it.

What they’ve shown to be really just as helpful is to do waist-to-hip ratio. So you actually measure around your waist, around your hips. And you compare the two. And you really want your hips to be larger than your waist. And in men you certainly want better than a 1:1 ratio. So you want your hips to be a little wider than your waist. And in women you want even better than a 1:1 ratio, 0.8 or more.

So, it’s important to have wider hips and more narrow waist. For people that have what we call the apple shape, which is the big stomach compared to the hips, that is a known risk factor for metabolic disease, heart disease, and diabetes.

We can also again, look at body fat percentage. But it’s really the visceral fat that is the most dangerous. So that’s why looking at that hip-to-waist ratio is really important. And of course BMI is a factor also. You want your BMI under 24½. And that’s helpful but it’s not perfect. So, for people, especially males who have more lean body mass, the BMI doesn’t quite work all that well. So we have to look at a number of these different factors.

If you know you have some extra belly fat…And that could be by the way, either sub-cutaneous fat, which is the fat that sort of hangs off your belly, sort of blubbery, sort of flabby fat. Or, it could be the visceral fat where you see the stomach sort of distended, the stomach is kind of hard but underneath that muscle, you have a lot of that fat packed in that’s pushing the stomach out. That actually is more dangerous. Either way though, we want to learn how to burn that fat.

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So, we’re going to talk about some things today, some strategies to burn that belly fat. Now, many of you have heard and there's a lot of truth to this, that you can’t target one specific area of the body to burn fat. So when you burn fat, you're going to burn it all over. And that is mostly true. However, there are some specific factors that do enter into this discussion. We look at burning belly fat. And there are people who tend to gain more weight around the belly.

And there are reasons why you would tend to gain more weight around the belly. One of those is this hormone cortisol. So, cortisol, we think of as stress hormone. It’s not a bad hormone, we need it. But elevated cortisol can cause us to store more fat around the mid-section. What happens is, when you have elevated cortisol, it activates fats storage. And it actually activates the dumping of sugar from the liver. So you get excess sugar in the blood. And you get increased fat storage. And the fat cells in your viscera have more cortisol receptors than do subcutaneous fat cells. So you do tend to store more fat around the mid-section when your cortisol is elevated.

So, the first thing we want to look at is, finding ways to reduce or normalize our cortisol levels. And that’s mainly by helping to reduce stress. So stress will cause you to gain more belly fat. And if you can find ways to diffuse your stress, that’s a great way to reduce the storage of belly fat. And then you can find other ways to burn it.

Another strategy that’s helpful is make sure you get plenty of rest. Sleep dysfunction has certainly been associated with an increase in body fat and especially around the midsection, for many of the same reasons. And when you're not sleeping well, I just did an interview for our Diabetes Summit, with the paleo mom, Sarah Ballantyne. And we talked all about sleep and particularly how this affects blood sugar, and our hormone balance, and can lead to an accumulation of belly fat. So, we want to make sure we’re sleeping, and she says minimum of 8 hours a night. And we have to get to bed earlier.

So we want to follow the circadian rhythms of the sun rising and setting. And she taught me that the body is really meant to go to sleep about 2 hours after the sun sets, which sounds crazy during the winter. But I think we can all probably go to bed a bit earlier and maybe wakeup a bit earlier and still get the same amount done, and be a lot more productive with a sharper mind, if we get a little bit more sleep. And it helps us not only control our appetite and what we’re eating, but it helps us to burn fat.

So just a quick break. If you have a question today, and you're on the phone line, press *2 and that will raise your hand. And then when we get to the

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questions, I’ll go ahead and dive in and unmute your lines, you can ask some of those questions. If you are following along on the web, then go ahead and put your question right in there in the question box.

The next thing I want to talk about is, a couple more hormones and that’s leptin and insulin. So, Daphne, would you mind talking just a little bit about leptin? Maybe what it is, where it comes from, what it does, and how it might be related to excess storage of body fat?

Daphne: Sure. Leptin is a hormone that is secreted actually by the fat cells in your body. And the way that it’s supposed to work is that, well it secretes the hormone and it crosses that blood-brain barrier and tells the brain to burn energy and get rid of some of the fat that you have. I find it very interesting the way that all of these hormones work in concert with each other, because leptin works also with the thyroid hormones. And so, it will work with the thyroid so the thyroid can increase the metabolism to burn some of the energy in your body.

And the biggest challenge, I think, is what would cause some of the abdominal fat, is whenever we become leptin resistant. And leptin resistance is whenever the receptors on the cells are not actually being able to utilize the leptin. So we have a lot of leptin that’s floating around, the hormone’s floating around the body but the cells can’t recognize it and the cells aren’t using it, the fat cells are not utilizing and getting rid of the energy that they would have.

Dr. Mowll: Yeah. So, we end up eating more because we’re not turning off that hunger. So if you guys ever feel like you just eat, and eat, and eat, and eat, and you never kind of feel full, that’s a sign of leptin resistance because leptin’s supposed to turn off those hunger signals in your brain. And if they're not getting turned off, one of the reasons, there’s other possibilities like food addiction and other hormonal imbalances and things, but one of the common issues there is leptin resistance. So leptin’s just not working for you.

And then also sort of a sister hormone is insulin. Insulin, which all of you hopefully are well aware of, is important for blood sugar health. And insulin resistance which leads to high insulin levels, will not allow us to burn fat. So, insulin is basically like the gatekeeper to the fat cells. And there's actually a hormone called insulin sensitive lipoprotein lipase, which burns fat, breaks down stored fat into free fatty acids to be burned.

And when insulin is present in certain amounts, that hormone shuts off. So we need to allow insulin levels to fall for us to be able to burn fat for fuel. And

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when insulin levels are high, we store more fat. And again, we tend to store more of that fat around the viscera, around the organs. So it becomes a vicious cycle.

And so, the last piece I want to talk about today is lean mass, lean muscle mass. And the more lean muscle mass you can build, the more energy you will burn. So, many of you have probably heard that muscle is more metabolically active than fat, and that is true. Muscle burns calories, burns energy, in the form of glucose and free fatty acids, at a much, much higher rate than does fat tissue. So, the more lean mass we can have, the more fat we’re going to burn and the more fuel we’re going to burn. And also the easier it’s going to be to regulate you're blood sugar and the more insulin sensitive you’ll be. It just really helps this whole hormonal cascade work better.

So, resistance training is a really important step to take. A lot of people are doing cardio, and that’s great. We have something that I recommend, called the sweet life fitness pyramid. And base of that is fat burning cardio exercise, and I think we need to do that: walking, and swimming, and biking, and so forth.

But the next level is resistance training. And that’s also very, very important. It’s important especially as we age, to start to build lean mass. This is one of the reasons why drugs like statin medications can be so dangerous, because statins have a known side effect of sarcopenia. They actually cause us to lose lean muscle mass. And that is not a good thing when you’ve got blood sugar problems already.

So, we want to maintain our lean muscle mass by doing some resistance training. And I just like body weight exercises. I think doing things like squats and lunges, maybe some sit-ups and push-ups, assisted if you need be, those are great. You don’t have to go hit the gym and get on the weight machines.

Daphne: Yeah, I agree. And typically, if you're not having to go somewhere to exercise, you might be a lot more willing to stick with it. You don’t have that barrier, having to physically go somewhere.

Dr. Mowll: What are some of the things you like to do, Daphne, with exercise?

Daphne: I do also some body weight exercises. I do push-ups. One of my goals for the year, and I accomplished it last year. I’ve kind of fallen off the wagon but to be able to do pull-ups. That’s one of my goals, to do still pull-ups. But I’ll do arm-dips, and some yoga poses, and sun salutations that use more of

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the upper body. So those are the things that I really enjoy. And also very calming, well not all of them, but the yoga poses are very relaxing too.

Dr. Mowll: Yeah it is. The point is, it doesn’t have to be super-complicated. If you have stairs in your house, you can walk up 2 stairs, walk down 2 stairs.

Daphne: The calf- raises.

Dr. Mowll: Calf raises, yeah, that’s a good one. You can sort of sit on the bottom stair, put your arms behind on the stair above and do some sort of like reverse push-ups. Basically they are like dips for the backs of your arms. Just simple things like that. If you need to use a chair or a countertop or even the wall to do push-ups, that’s fine. The more you elevate the upper part of your body, the easier the push-up would be. So if you do them against a wall for example, and then gradually maybe the kitchen counter where you're using that to put your hands on and do push-ups that way. There’s really no excuses. You guys can do this stuff. It’s just a matter of setting your intention to do it.

Daphne: I agree.

Dr. Mowll: All right. So, let’s jump into some questions. Again, if you're on the phone today and you want to be brave and ask a question live, just press *2, to raise your hand. And we’ll get your question. But in the meantime, we’ve got some questions that were submitted ahead of time. So this one’s from Eric. Eric says, is there a place for intermittent fasting with type 2 diabetes management. So he’s asking is intermittent fasting an effective strategy to use for management of type 2 diabetes. Daphne, what do you think about that?

Daphne: I think yes, there definitely is a place. And I think in men, the research shows that in men, it tends to have a better outcome than in women. So, I think you kind of have to play with it and see how your lifestyle fits into it. So, I would start with probably at least the 12 hours fasting. And that’s almost fairly easy where you start with 12 hours so that you have supper say at 7 o’clock at night and then the key at this point would be to make sure that you don’t have any kind of snack or anything before bed. And then wake up in the morning and wait till about that 7 o’clock in the morning and have breakfast. So, I’ll start with that. But then you can also expand that timeframe. You can do a 14 hours or even 16 hours of fasting.

But honestly, I think the thing that’s going to dictate how your body responds to it, is how your blood sugars react. So, in the mornings, if you're waking up, and your blood sugars are higher, after you’ve been fasting for a while, then

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it’s probably not going to work out for you. But I do think there is a place for it. There good room for experimentation on the intermittent fasting. What do you think?

Dr. Mowll: Yeah. I think fasting can be a wonderful strategy. I will say that it’s important that you kind of reset your metabolism first. And if you do intermittent fasting, that you really do intermittent fasting and you don’t just skip breakfast. Because that’s what I see a lot of people do. They say, oh, it’s just skipping breakfast. Okay, I can do that. But really, intermittent fasting is, it’s an eating window. So you're eating between say 12 and 6 or 12 and 7, and that’s it. And typically you're going to do 2 meals in there.

The benefit is that it helps to reset insulin and leptin. So, we talked about those hormones earlier. And think about it this way, every time you put food in your mouth, it’s going to cause a hormonal cascade. So you're going to release certain gut hormones. You're going to release insulin. And then your fat cells should release leptin at some point to tell you to stop eating. Then after a few hours ghrelin starts to come up, which should make you hungry again.

But that whole hormonal cascade is usually dysfunctional in people with diabetes or who are overweight. And what happens is, instead of a normal hormonal cascade happening, you get usually a surge in insulin which kind of throws the whole thing off. And if you do that every say 2 to 3 hours, your insulin levels are never really dropping. So, your cells just continue to become desensitized to insulin and you never burn any fat.

So what you wanted, if you want to burn fat and lose fat, then you’ve got to have these periods of time between feedings, if you will, or eating occasions, where your hormone levels can actually reset. So, the fed state lasts for about 4 hours or so.

And you want to get to a point where you are out of the fed state. So you need longer than 4 hours for that to happen. Typically it’s not going to happen during the day much. So if you can take that overnight fast, from say, 6 or 7 or even 8 o’clock at night, and go all the way until maybe 11-12 o’clock the next day, that’s where you're going to get a lot of the benefit from intermittent fasting.

So, what happens, one of the things that research has shown, and the confusion comes in, people say, wait a minute, I thought skipping breakfast was a bad idea. And there was some research that indicated that what they

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found is that people who skipped breakfast oftentimes will eat more at night. So, it sort of shifts the circadian rhythm back. And if you eat your first meal at 11 and you eat your second meal at 4, and you eat your third meal at 9 or 10 o’clock at night, then that’s generally not a good thing. You're not going to lose weight that way, for most people. But if you can truly do intermittent fasting, then there are some good benefits to that.

Daphne: Right. And along with what you said, kind of goes the idea of, I guess it’s kind of an older idea now, but people still really use it a lot, the idea of 3 meals and 3 snacks throughout the day, where having those snacks between meals is really never allowing our insulin levels to come all the way down. And to lower your insulin levels so that you can get out of that fed state. So the 3 meals and 3 snacks a day is really not working in your best interest, to balance your metabolic hormones. And I see that happen a lot with people who are just kind of the constant grazing all day long, becomes problematic.

Dr. Mowll: Yeah, for sure. Okay, so we have a question here. It says, does a low-carb, high-fat diet, even with good fats, raise fasting blood glucose, fasting insulin, and hemoglobin A1C? And I would say, generally no. that’s kind of the recommended diet.

My friend Mark Hyman just wrote a book all about this called, Eat Fat, Get Thin. And it’s talking about lowering carbohydrates, still eating healthy carbs but lowering many of the carbohydrates that we eat today and increasing healthy fats. Jonny Bowden and Steven Masley, who are both going to be on our Diabetes Summit in April, as well as Dr. Hyman, wrote a book called Smart Fat.

And so, Dr. Masley characterizes smart fat as fats that don’t trigger inflammation and that actually contribute to our health. Things like mono-unsaturated fats like avocado and avocado oils, olive and olive oils, the fats in certain nuts and seeds, like macadamia nuts for example. And then there are some fats that are neutral, what he classifies as neutral, which are things like coconut oil and MCT oils, the medium-chain saturated fats.

And then the longer-chain saturated fats that come mostly from animal products are sort of somewhere in the middle as well. As long as you are burning fat effectively, then they are fine. If you're not burning fat effectively, then they can be problematic especially if they are more inflammatory.

And then there is the toxic fats which are the processed fats, the partially hydrogenated oils, heated omega-6 fats, particularly like soy bean oil, corn oil,

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sunflower oil, and so forth, especially when they are heated. I think that was it. So, you can check out his book, Smart Fat. It’s a really good book.

But to the point of the question, will the good fats, will the smart fats actually raise blood sugar, insulin, and hemoglobin A1C? And the answer there is no. In fact fat is really the only macronutrient that has a very minimal if any effect on insulin levels. And therefore certainly shouldn’t raise insulin and shouldn't raise blood sugar or A1C either. Now, the controversy here comes in with free fatty acids in the blood.

So, there have been some studies that have shown that elevated free fatty acids in the blood are associated with insulin resistance and diabetes. That is true. But you’ve got to ask why do you have high free fatty acids in the blood? And according to Dr. Masley, I actually asked him this and he linked it all back to the carbohydrates in the diet, especially processed carbohydrates, and fructose actually in the diet.

So these two things have a negative impact on the liver, which causes the liver to actually produce more free fatty acids which spill over into the blood stream. And it’s those free fatty acids that clog up the liver, and the muscles, and actually lead to insulin resistance and diabetes.

So, if you look at this question in the right context, does a low-carbohydrate, high-fat diet raise fasting blood sugar, fasting insulin, hemoglobin A1C? The answer would be no, as long as you have a good healthy diet around that. And you’ve worked to make sure your metabolism is burning fat effectively. Anything you want to add to that, Daphne?

Daphne: No, I agree with everything you said. I think the quality, whenever we just throw out a term like fat and the macronutrients, we really have to look at the quality of the food and where that fat is coming from. Just like you said, the mono-unsaturated fats across the board have always been very healthy fats. So, focusing on the healthier fat and the quality of fat that you get is going to make a big difference in how, if you become insulin resistant, how it’s going to affect your diabetes, for sure.

Dr. Mowll: Yeah, for sure. Okay. So, guys, don’t be shy. We’ve got a number of people on the line here with us today. If you’ve got a question, press *2, and we would love to say hi to you. And answer your questions today. Until that happens, I’m going to keep going off of our pre-submitted questions. We have one that says, I have neuropathy in my feet and hands. What can I do? So this is a big question.

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But neuropathy, I’ll say, can be caused by a variety of factors. And if it’s in the

feet and hand, it’s what we would call peripheral neuropathy. And not all peripheral neuropathy is due to diabetes. However, diabetes is certainly a significant cause of peripheral neuropathy. They are other causes like compression. Carpal tunnel syndrome for example is peripheral neuropathy. And it’s caused by the compression of the medial nerve in the wrist. So, there, that’s not due to diabetes.

There's other forms of neuropathy that can be caused by compression of the spinal level, for example. And then there is toxins that can cause neuropathy. A great example of this is chemotherapy induced neuropathy, one of the main contributors to peripheral neuropathy is cancer treatment. So, for example, Cancer Treatment Centers of America has an entire treatment protocol devoted to dealing with peripheral neuropathy from chemotherapy treatment. So there are other toxins and chemicals that can induce neuropathy.

And then the last cause that I’ll mention is micronutrient related neuropathy. For example, depletion of vitamin B12 and vitamin B9 can cause peripheral neuropathy. And interestingly there is a drug that many of you may be taking, called metformin, which depletes vitamin B12. So you can be taking metformin to control blood sugar, to prevent diabetes complications, and that in turn can actually deplete vitamin B12 and lead to peripheral neuropathy. And this is not uncommon. So that’s something to consider.

And one other thing, certain other medications like statin drugs can deplete nutrients like co-enzyme Q10, which then in turn can contribute to neuropathy and muscle wasting and other things. So, sometimes we have to look beyond diabetes. But since, we’re kind of talking about diabetes today, I’ll focus the rest of the answer on elevated blood sugar. And certainly high blood sugar can be toxic to nerves, just that they can be toxic to every other cell in the body.

So, if you have peripheral neuropathy in your feet and/or hands, the first things is to address the root cause. So figure out where it’s coming from. Is it a compression neuropathy? Is it due to toxemia? Is it due to a medication that you're taking? Do you have depletions in certain vitamins and minerals? Or it is due to elevated blood sugar?

Figure that out first. And then, fix it. If you have chronically high blood sugar, then you have to bring it down. That’s why stage 1 of care for us is always fix your blood sugar. If your blood sugar is 180 and you want to get off

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medications, that’s great that you want to get off medications, but we’re not going to help you get off medications and keep a high blood sugar. That’s not going to really do you any good. So, first step is get your blood sugar normalized and then, from there, we can start to address a more natural way to keep your blood sugar healthy.

So, if you have neuropathy, find and address the root cause first. Now, stopping the damage doesn’t mean that the neuropathy is going to go away overnight. You also have to do everything you can to encourage healing. So, that means encourage good circulation through exercise and things like contrasting baths can be helpful. Just be careful with hot water with neuropathy.

And if you're exercising, be careful with blisters. Make sure your shoes fit well, keep dry socks, that type of thing. But, exercise is really important. Contrasting baths can be really important. There’s devices like infrared light therapy which can improve circulation. Vibration plates, which can improve circulation. We recommend something called a chi machine, which is, you lie on you back, put your feet in this thing and it wiggles your body and it improves circulation. There's all sorts of things like that, that can improve blood flow to those remote areas of your body like your feet and toes. But that’s important.

And then lastly you want to feed those nerves with the right nutrients, particularly thing like vitamin B12, and B6, and B9, and B1. We recommend a form of B1 called benfotiamine, which is a fat soluble form of B1 that helps cross into the nerve cells and helps the nerve cells heal. And then protect those nerves with antioxidants like alpha-lipoic acid, and selenium, and vitamin E, and bioflavonoids, and other antioxidants that come from really colorful fruits and vegetables. So that would be my prescription to improve peripheral neuropathy.

Here's a question that we get often, and Daphne, I’ll give this one to you. It says, what’s the difference between probiotic bacteria… actually don’t quite understand this question. It’s basically a question about the gut and using probiotics and how much do I need, what’s sort of a good amount to take? Do you have any suggestions for using probiotics to improve gut health?

Daphne: Yeah. That’s a very big topic. For probiotics, you have to look at what's already in the gut. So, right now your gut has like 10 trillion microbes in the gut. So, what you want to do with the probiotic or the purpose of a probiotic is to add beneficial bacteria into the GI tract. So allow the microbes

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to play well together. So I kind of often refer to the gut as being like a kids playground, where there are lots of kids playing around or lots of microbes in there. And for the most part everything can flow along just well, but whenever we get an in-surge of the bullies or the bacteria that aren’t as beneficial, when they start to proliferate and start to grow, then it can cause harm to, and not allow the beneficial bacteria to do their job as efficiently.

So, when you're taking probiotics, the purpose is to add those beneficial bacteria into the GI tract so that they can all play well together. And so, whatever you're starting, it is important to start taking probiotics slowly. Because as those beneficial bacteria start to grow, whenever we introduce them into the gut, and it could start to kill off some of the harmful bacteria which, they are always there, we just need to keep them at bay. But once it starts to kill off these harmful bacteria, they release endotoxins. And they can really start to make you feel pretty lousy. They can have an effect on how you feel physically.

So we want to allow the beneficial bacteria to grow slowly, so that it will slowly kill off some of the bad bacteria. So, a couple of things to know about probiotics if you want to take them in supplement form, I would start slowly with probably about 10 to 25 billion colony forming units, because that’s how probiotics are listed, in the supplement form, it’s CFUs. So, what's important is, to look at how much bacteria is there, certainly that’s important.

But also depending on if there are certain things that you're trying to work with, you may need to look at certain species of bacteria. But just generally speaking, I would start with between 10 and 25 billion and then you can gradually increase. I think another good way to look at some of the beneficial bacteria is to try and get them through food forms. So, through some of the foods that we consume, we can get beneficial bacteria that are, I think a little bit more widely varied, more different types of bacteria that can work together with the gut.

So, typically through a lot of fermented foods, are going to be excellent ways to introduce the beneficial bacteria into the GI tract. And again, I would say start really slow. So, a little bit of sauerkraut, maybe mixed in with a salad or with some other vegetables, can be a slow introduction. And I usually say, start with about a teaspoon, and then you can work up. Because that’s really not an excellent way to be able to determine from your sauerkraut that you may purchase in a grocery store, how much bacteria is in there. But we know that if it’s a good quality sauerkraut, that it’s going to have some good bacteria. And then you can gradually work your way up. Maybe sauerkraut’s not the

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thing that you enjoy, maybe you could try something like kimchi, or maybe some kefir, or maybe a little bit of yoghurt. That seems to be the one that’s the most familiar, that people are able and willing to incorporate that a little bit on a regular basis, as long as it has live cultures in it. So, starting slow and then gradually increasing is the best way to handle the probiotics.

Dr. Mowll: Yeah, excellent. And if you guys are going to follow on with the Diabetes Summit in April, which starts on April 18th, then check out the talk I did with Donna Gates. She’s just phenomenal, really an icon. One thing I learned is Donna is responsible for actually bringing stevia to the United States. She’s the one who actually found it and brought it to the US. But her main thing is fermented, cultured foods. And she gives some great tips on how to ferment your vegetables and gives her go-to recipe for fermented veggies, which is great. So, definitely recommend listening into that.

Daphne: Yeah, Donna’s great.

Dr. Mowll: Yeah, she’s awesome. So, I have a couple of people who have raised their hands. So I’m going to go first to area code 773 from Chicago area. So, you're unmuted, you're on the line with us. Please just state your name and you can ask your question.

Mark: Hi, this is Mark.

Dr. Mowll: Hey, Mark. What’s your question for us today?

Mark: Well, going back to the belly fat thing. When I was diagnosed, I was fit, and trim, and had no belly fat, never really did have. But once I had to go on insulin, shortly thereafter, that became a problem immediately. And so far, I haven’t been able to do anything with it. And that’s been like my biggest struggle right now. I guess it’s an automatic effect of taking insulin in some ways if you're not careful.

Dr. Mowll: Well, here's the thing. That is true to a certain extent. Now, what we found is that, it’s not insulin in and of itself that causes the storage of extra fat. It’s too much insulin. So, for example, people who have type 1 diabetes, who are not insulin resistant, and eat low-carbohydrate diets, and use just enough insulin to keep their blood sugar normalized, they actually don’t gain weight, even though they are taking insulin. But if you have type 2 diabetes and you are already insulin resistant, chances are that you're already overproducing insulin. So your pancreas is releasing a certain amount of insulin. The problem is, because you are so desensitized to it, that that’s not enough to control your blood sugar. So now you're injecting extra insulin on

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top of that. So your blood insulin levels become very high and that’s why you end up storing a lot of fat. So just kind of a little bit of a clarification there.

You are right that it’s common for people to gain weight on insulin. But mainly that’s due to extra insulin. And this is true even in type 1’s who for example, don’t control the carbohydrates in their diet. So you’ll see people who are on an insulin pump, who are eating pasta for lunch and have a pie for dessert, and that’s maybe a bit extreme, but just to illustrate the point, and then they just pump more insulin in. And those are the people who gain weight and they actually become insulin resistant type 1 diabetics.

But I’ve worked with people with type 1 diabetes who only use maybe 5 or 10 units of insulin at night and some of them with a bolus, maybe 2 to 5 units per meal. They're not using much at all because they don’t need much because they're eating a very low-carbohydrate diet. And they are not insulin resistant. And they don’t gain weight. In fact they stay very lean.

So, basically the answer is somewhere in there. The answer is, how do you become more insulin sensitive so that you can reduce your insulin use or maybe even get off of insulin altogether. And of course that’s the trick. It will take more than 10 minutes here to answer that on how to reverse insulin resistance. But ultimately, just to see it clearly, that’s going to be the answer for you, is getting your blood insulin levels down.

I will say that there's a test you can do, called c-peptide, which will tell you how much insulin your pancreas is producing. And you can do that fasting. You can also do that after a challenge, like you can do it after eating, and go and have a c-peptide draw done. What you see is c-peptide levels. But basically it will tell you if you are overproducing insulin, likely you are. And then adding insulin to it, just makes it nearly impossible to burn fat and yes you're going to go into fat storage mode. Insulin also drives cortisol which will cause you to store more belly fat. So it becomes again this vicious cycle. Daphne?

Daphne: I agree. I also just want to add that we tend to only think about insulin and carbohydrates as working together, but we oftentimes discredit the fact that you had alluded to earlier, that sleep and the quality of sleep that you get every night, plays a huge role in the insulin resistance part of it. So when looking at diabetes, sometimes I think people kind of tend to get the tunnel vision of, it’s just the diet and exercise. But the sleep and stress also are two very important roles in being able to manage the blood sugar, but also

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being able to decrease insulin resistance. Because even just one night of poor sleep can lead to insulin resistance for several days.

Dr. Mowll: That’s right. I mentioned the interview I did with Sarah earlier, and she said that there's one study that showed that 1 night of, I think it was less than 5 hours of sleep, or less than adequate sleep, created more insulin resistance, this was done in dogs, but created more insulin resistance than 6 months of a high calorie, what they considered poor quality diet. So, pretty amazing, the power of sleep, yeah.

We have another call. This one is from area code 559, California. So, if you're there with me, just state your name and ask your question please.

Annmarie: Hi, I’m Annmarie and I have 3 questions. My first is, you guys were talking about how sleep affects insulin and leptin. What do you do for that? What do you take to be able to get a good night’s sleep?

Dr. Mowll: Daphne, you want to jump in on that one?

Daphne: Yeah. The first that I would say is to start to prepare yourself for sleep. So, shortly after the sun goes down, which, our time is going to be changing here this weekend. But after the sun goes down, start preparing to go to sleep so that your body can get into the rhythm of knowing that sleep is coming up.

And as far as what you take, there's various types of teas that you can drink. Like a chamomile tea is good to help the body kind of relax so you start preparing for sleep, turning lights off, making the house dim, getting rid of electronic devices, and then maybe doing something relaxing. So, for some people that could be like meditation or prayer. At that point maybe, like I mentioned earlier, doing some yoga poses or something. But allowing your body to get prepared for sleep is very important.

And then, going into some of the sleep hygiene. Of making sure that your bedroom is very dark. That you are not using anything that’s going to mess with the melatonin in your head. And the way your body produces melatonin, which would be some of the bright screens like phones, and iPads, and that sorts of things, that can affect sleep.

As far as what to take, magnesium may also be something that can help your body to relax. And you have to be careful with magnesium because it can affect the GI tract. So starting just with a low milligram of magnesium.

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Magnesium baths could also be helpful. So those are just some of the things that I recommend. Dr. Mowll, what have you got?

Dr. Mowll: Yeah. There's a lot there. And I think those are just some great tips to start with. There's also things, just try to sort of get into the rhythm of sort of primal living. So, when the sun’s going down, you kind of get yourself prepared to wind down at night. One thing that I get into this trap of trying to do stuff at night. So, especially if I didn’t have a productive day, then like I want to get my kids to sleep and then I think like it’s time to work again. And that’s really not a good habit for me. And it’s really not a good strategy for most people.

You really need to train yourself, train your circadian rhythms to be able to shut off before you hit that witching hour, that second wind where your cortisol actually starts to rise again, which for most people is somewhere between 9:30 and 11. They’ll get sort of this second wind and then you’ll be able to stay up until 11:30-12 o’clock or whatever. And if you add some stimulus like TV, or your computer, or engaging mystery novel, or something like that, then you end up not going to bed until midnight or after midnight. And that’s just not good for anybody.

So, kind of forcing yourself to get to sleep earlier, trying to get to sleep before that cortisol level starts to rise again. And as Daphne said, turn of stimulating technology. Anything that has a blue light to it, or like a white light to it, disrupts melatonin production. So you want to stay in the red or yellow light range, as much as you possibly can.

Some people who have major sleep circadian rhythm problems, will actually wear tinted glass or put amber filters on their computer screens or whatever, or on their TV screens to make sure that they are staying in that. But, using like yellow bulbs, rather than those blue bulbs in your lights in your bedroom is important. So, there's a lot there, and we will probably do a topic on that in the near future. But, let’s move on since we’re running short on time. What are your other 2 questions?

Annmarie: The other one is hunger. If I’m struggling with that, is an appetite suppressant the way to go? What I do right now is, I eat every 4 to 6 hours apart. And I'm still in the 21-day program. And for the last week I have found myself extremely hungry. So I was looking at PGX, is what I was looking at.

Dr. Mowll: Right. So, PGX is a fiber and not really an appetite suppressant, but a fiber with mulberry leaf extract, which is shown to reduce blood sugar. It

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was designed by a friend of mine, Michael Murray, who was on our summit last year. And it’s glucomannan fiber, which is one of the 3 types of fiber that I recommend. It is good for blood sugar. And it is good to help with satiety.

The 2 most important things for satiety are protein and fiber. So, you want to make sure that you are eating a good quality protein at each meal. And then the fiber can be helpful. So fiber can come from foods like fibrous vegetables, and nuts, and seeds. And if you can tolerate beans and legumes then one of the good things about those is that they are high in fiber.

You can also supplement fiber in the form of inulin or psyllium fiber which I find is a little harsh for most people. But it can work or glucomannan fiber which is which you mentioned, PGX. And what those do is basically just blow up or swell up in your digestive tract, absorb a lot of water and other things.

The downside with taking some of these fiber supplements is that they can also absorb minerals and other nutrients. And so you’ve got to be a little bit careful with that. And sometimes it can interfere with your ability, so I wouldn’t take it with other supplements for example or you're going to lose a lot of what you just took. And you’ve got to be careful with adding a lot of fiber in your food supply because you can lose that. But that’s in fact how fiber reduces cholesterol is that it will soak up a lot of the free cholesterol that would normally recirculate out of your gut.

So fiber is good but there's probably some other things you can do to decrease hunger and appetite, hormonally and otherwise. So, Daphne, any suggestions for decreasing sort of that hunger that people feel where they just don’t quite feel full or content after they eat?

Daphne: Sure. I agree like you said, the fiber, it’s an important part. But also good, healthy fats can play a role with that too, just because the fats breakdown much slower than carbohydrates do. So, making sure that you're not feeling fat, then it helps you maybe lose weight or something. You want to make sure that there is good quality fat in your meals, especially if you're eating about 4 to 6 meals every day, that you have a good quality fat in there to help keep you feeling satiated.

Dr. Mowll: Yeah. And sometimes it’s just retraining yourself. Like, this is hard advice but eating can sometimes be habitual also. And if you're used to eating a certain amount at a certain time, there's a strong addiction component there. And just like somebody who’s trying to give up smoking, or other

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addictions, sometimes you have to sort of hang in there and override that, which is not easy to do.

And you can use some of these things like we just talked about, increasing your fiber, increasing your healthy fats, making sure you’re getting good quality, clean proteins with each meal. Eating more frequently in the beginning if you need to, to break through some of that food addiction. But at some point you’ll be able to override that if you hang in there. But just if you keep it in mind that, I wonder if I’m really hungry or do I just want to eat because there is a difference. And if you just want to eat, and you're not really hungry per se, then that could be more emotional or related to a food addiction.

Daphne: I agree. And then also, and this goes with the sleep also, that training takes a long time. It’s not something that you try once or twice, and you say, it works, or it didn’t work, or whatever. Training yourself to sleep or training yourself to kind of hang in there and really start to pay attention to that hunger scale, so on a scale of 1-10, how hungry am I right now?

Or, like Dr. Mowll said, is it just that it’s like, I feel like it’s probably time to eat. It takes a long while to train your body to really focus on and find out what the issue is. Is it more of an addiction type where you were kind of eating by the clock, or is it true hunger that your body is feeling hungry and telling you that you need to eat something.

So, be patient with yourself, is something that I think that we tend to forget about a lot. That any type of training, like weight training, or any kind of training that you ever do, takes some time. And I feel like oftentimes we start something for a little while and then we think, oh well, after 3 or 4 days, it’s just didn’t work for me. And it’s just because we haven’t quite given it enough time to allow it to work.

Dr. Mowll: Yeah, for sure. Okay, and I think we have just about 2 or 3 minutes left. So if you wanted to get that third question in, we’ll see if we can answer that quickly.

Annmarie: It was just going to be about the fermented food. If you're not supposed to have cabbage or beets, does the fermentation change it enough to be able to have it or no?

Daphne: So, I guess it would depend on why you're not supposed to have it. But also I would say that, there are lots and lots of different types of fermented foods. That you can ferment things like salsa can be fermented.

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You can ferment different teas, could be kombucha. You can ferment milk, which would make kefir.

So you're not limited to just things like cabbage and beets. There's a whole plethora. You can ferment carrots. You can ferment pickles, lots of things that can be fermented. I don’t know what’s the reason for not being able to have the cabbage or beets is necessarily, but that wouldn't be a reason to limit fermented foods because there’s a whole plethora of different types of ways you can get fermented foods.

Dr. Mowll: Yeah, I agree. So if, for example you are avoiding beets because of the sugar content, then the fermentation is going to consume a lot of that sugar. The bacteria will eat a lot of that sugar. So it makes beets a lot more tolerable. And carrots, as well.

If you're talking about avoiding cabbage because of its goitrogenic effect on thyroid, that’s something that you have to look at in the big scheme of things, that’s sort of the minimal effect from cabbage. I’m just throwing that out there as one possibility. But if it’s a food that you have a food sensitivity to, fermentation probably won’t affect that, because the proteins are what you're reacting to and the proteins really aren’t altered that much through fermentation as far as I know. So yeah, I agree with Daphne.

All right guys. Well, we’re right about at an hour so I want to thank all of you for joining us on the line. And I hope you enjoyed this episode of Blood Sugar Talk with the diabetes coach, Dr. Brian Mowll, and the unconventional dietitian, dietitian Daphne Olivier. We’ve enjoyed spending time with you. And we’ll be doing this every 2 weeks. So look for an email for our next Q&A call. Everybody have a great weekend and God bless.

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