How much do you really know about insulin resistance? It’s a topic that comes up a lot on this podcast, and yet, it’s still not a condition that’s widely understood or even really talked about at large. So what’s actually going on? How do you know whether you are, in fact, insulin resistant? What are the risks if you are?
And what can you do about it? That’s exactly what we’re talking about in today’s super in depth episode as we sit down with Dr. Morgan Nolte. And it’s definitely an episode that every woman who cares about their health needs to listen to maybe more than once.
Today we’re going to be chatting with Dr. Morgan Nolte.
She is a board certified clinical specialist in geriatric physical therapy, who, after recognizing a lack of preventative care for conditions that are largely preventable, has Founded Zivli, an online course and coaching program that helps adults reverse insulin resistance for long term weight loss and disease prevention.
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And today she’s sharing exactly what each and every one of us needs to understand about insulin resistance, what it means, what it looks like and how to reverse it. It’s such an important topic. So without further ado, I am so excited to be able to introduce you to today’s interview guest, Dr. Morgan Nolte.
Morgan, thank you so much for being here today. I’m so excited to talk to you. I’m excited to be here. Thanks for having me, Ruth. You’re welcome. So let’s just start with a little background. Tell us a little bit about yourself, who you are, what you do.
Dr. Morgan Nolte: Yeah. So by trade, I’m a geriatric physical therapist and I have a lot of work experience in post acute rehab and home care.
So I saw a lot of end stage disease, a lot of end stage diabetes, like amputations. Severe neuropathy that led to a lot of falls some blindness issues, a lot of heart disease, like heart attacks and strokes. A lot of dementia, all the dimensions, Alzheimer’s vascular Louie body dementia, and a lot of obesity, just poor body mass composition, excess body fat, low muscle mass.
And you’re not in that field too long. I don’t think before you. You get a little bit heartbroken by all the stories that you see. So I think a lot of people are used to seeing aging on a small scale, maybe in their parents or their grandparents. But when you work in geriatrics, hundreds and hundreds of people.
And it’s heartbreaking because When you don’t have your physical health, you don’t have a great quality of life. And often your children become your caretakers, a lot of your money, time and energy goes to being sick, going to doctor’s offices, going to the hospital again, another surgery, another pill, and it’s just sad, so honestly, I felt like in PT, while it’s a very valuable profession, it wasn’t.
It wasn’t like what I felt very called to do, which was to help prevent the diseases that I was treating in the first place, because a lot of that diabetes, heart disease, dementia, all really boils down to your lifestyle choices. And I thought who’s helping people like in the gray zone of healthcare, like my patients, children who are following in their footsteps, who’s helping them get healthy because if they don’t make the changes in their forties, fifties, sixties, they’re going to end up right here.
And I’ll be treating him in 20 years. And it’s a deja vu or like groundhog’s day where we’re doing the same thing over and over. After I had my son, I decided, if I’m going to work, I’m going to do something that I’m very passionate about. I’m not just going to go to work for a paycheck.
I’m not just going to go to work to like. Do a job, I felt this calling to help people prevent disease. And so that’s why I started my company and that’s what I do today. And we focus on insulin resistance because just doing independent research, like hundreds of history and physical reviews, right?
No one ever just had diabetes. Like no one ever just had heart disease and no one ever just had dementia or obesity. It always comes with multiple conditions, multiple comorbidities. And I thought that’s because there’s an underlying cause to all of them, but no one taught me that. Like I had to do my own research, just like you did.
I was looking into you and your story on your weight loss journey. And it’s once you really understand the truth of what causes these diseases, it’s just mind blowing. Like how do, how does that, like, how is this not being taught in school? How does everybody not know that? I ask myself that every day.
Why? I don’t understand. So I, that was really inspiring to me that the root cause of all of these conditions was insulin resistance and inflammation. And if I did one thing for the rest of my life with my career, it’s going to be helped to help people really live a low insulin, low inflammation lifestyle.
And that’s what I get to today. I love that. Yeah. First of all, what a hard job to be dealing with that day in and day out like that. I can’t imagine that honestly just this limited exposure I’ve had to, with my mother in law being sick and then obviously passing away. And then now my own mom and her issues and health issues, like It’s so hard to watch that on a small scale to, to actually be in that every single day.
Ruth: I can’t even imagine how that must change your perspective. It was hard. Yeah. It was emotionally hard. Yeah. Like really and especially when you start to see this is absolutely preventable. Like these people are, and maybe not at that point, maybe you get to a point where it’s you’re, it’s too late, but.
Dr. Nolte: Oh, yeah. And but then at the same time to the question, why? Why are people not talking about this? Because you’re not the only health practitioner who’s dealing with an elderly population or people who are dealing with these health issues because it’s so prevalent and it’s so everywhere. So doctors everywhere are dealing with this.
But why are not more people talking about this? That’s such a good question and you’re right. I did feel like a lot of the services I was providing was too little too late and I almost felt like my hands were tied and my mouth was muzzled and I’m like, they need more than just exercise and they needed a lot earlier.
And so why are more people not talking about it? I think. If I had to give you a really point blank answer, I think it’s because we live on autopilot and we are just going through the motions of our day. We’re just doing it, going to work, doing our job, trying to meet productivity standards, trying to get those billable hours, trying to like just get through the day.
Like I think so many people are just in survival mode and on autopilot that they don’t take the time to really sit down and reflect is what I’m doing working? Is what I’m doing effective. And I think you can tell that because most healthcare practitioners aren’t healthy. Unfortunately, nurses, I think are so often under stressful demands.
12 hour shifts, night shifts, like they have some of the hardest jobs and I think that’s the main reason is because we don’t create the space to think and reflect. And honestly, it took me on maternity leave to really think through things as much as I wanted to, because it was the first time I was just like sitting breastfeeding my child.
Not working. And I think that when we’re on this like hamster wheel of productivity, we just don’t have the time to think. And I think the other thing too, is there’s a lot of external factors at play. Like our medical system is not designed to keep us healthy. It’s designed to treat us for sick insurance.
There’s a lot of profit and big food and big pharma and big medicine for us to be sick. So there’s not a lot of incentives to prevent disease on a societal level, unfortunately. And I think that’s where, Podcasts like this hopefully provide a great value to people because we’re providing them education that their physician either doesn’t know or doesn’t have the time to tell them in, the seven to 10 minutes they get with them once a year.
Ruth: Yeah. Yeah. Oh, it’s just, it’s a systemic problem clearly. And you’re absolutely right. Like I, and I don’t think like I tend to go Straight to the conspiracy theory. It’s a big pharma, big food is conspiring against us, which I do actually think is true to an extent. But what you’re saying is there’s a lot of good people who are trying to do good work, but there you’re constrained by the system that you’re in and you just, you’re just, it’s just, it’s an industry.
So you’re churning through it and just trying to help people right where you are, but you don’t actually have the time to think about it. It’s not, there’s not necessarily something sinister going on. They’re just stuck in a system that sucks. Yeah. We could talk about that for probably an hour but we won’t.
Let’s talk about insulin resistance. And so what I think like specifically insulin resistance. And some of the signs and symptoms that people need to understand are actually signs of insulin resistance. Because even though like we do talk about insulin resistance on this podcast, I think it doesn’t as a whole get talked about it that much.
And a lot of the symptoms I think are things people are like, Oh, that’s just getting older. That’s normal. Like whatever. So what do you need to be watching out for?
Dr. Nolte: Yeah I think it’s important to understand every cell on your body has. insulin receptors. And so insulin resistance affects every cell of your body.
And that’s why there can be a lot of different systemic symptoms. And most physicians don’t talk about insulin resistance. We can talk about the importance of insulin testing. And so if you’re talking to your doctor about I’m having this sign and this sign in the sun, they’re so used to treating the symptoms, the sequela of insulin resistance, that no one’s even talking about this root cause.
And so some common signs and symptoms that you want to look out for are high blood sugar levels. So if your blood sugars are in the pre diabetic range or the diabetic range, so if your fasting blood sugar is over 100 or your hemoglobin A1C is like 5. 7 or higher. You’re definitely experiencing some insulin resistance.
If you have high blood pressure, that’s often the first kind of clinical symptom of insulin resistance. So anything over 120 over 80, that would be a concern to me. Higher triglycerides, excess belly fat. A lot of carbon sugar cravings, sometimes numbness and tingling in the feet or the hands can be an early sign skin tags especially around the neck, that can be a sign of insulin resistance.
A skin condition called acanthosis nigricans, which is like where you have like thick, darker velvety skin, especially in your skin folds your groin or your armpits. That can be a sign, but also there’s just musculoskeletal things too. So like even the cells in the joints. So those can be insulin resistant to like osteoarthritis is now more and more considered a metabolic condition, not just wear and tear because the cells inside the joint The synovial sites that are supposed to produce like the fluid to keep the joints running smoothly, those when they’re insulin resistant, start to produce inflammatory materials instead of that grease.
And then the chondrocytes on the outside of the joints that are supposed to make that nice smooth surface on the top of the joint. Those become inflamed and they stop producing that that material. So every single thing that could be going wrong with you with aging could probably be traced back to insulin resistance.
A couple other things that are really important would be like erectile dysfunction in men. And PCOS or polycystic ovarian syndrome in women, both of those can be definite indicators of insulin resistance, but you don’t know unless you really check your insulin. And so that’s, I always like to tell on every podcast I’m on, if you learn nothing else, please get a fasting insulin test.
It’s very affordable. It’s very fast, and it can give you a 10 to 20 year heads up. On your risk for developing diabetes, then if you were only checking your glucose or only checking your A1C because glucose and A1C are like downstream effects, right? But insulin is going to be rising and rising and rising in the background to keep your blood sugars in a healthy range.
And then, overnight, all of a sudden we met from like a 5. 5 A1C to 5. 8. Now you’re in trouble. It was not overnight. It took decades and you missed it because you weren’t checking insulin. Interesting. So let’s talk a little bit about the difference between insulin resistance, pre diabetes and type 2 diabetes.
Ruth: What’s the marker for each of those things? So because insulin resistance is like a newer molecule compared to glucose, there are not certain cutoff points for Diagnostic criteria for your fasting insulin level and pre-diabetes and type two diabetes. So those two conditions are diagnosed based on your blood sugar levels.
So pre-diabetes is your blood sugar. Fasting is 100 to 1 25. Go look at your paperwork because I see over and over completely ignoring blood sugars in the pre-diabetic range. And they’re just like waiting for it to get bad enough to prescribe a medication. So look at your own blood work. 100 to 125, that’s a yellow flag.
And then 126 or higher is that diabetic range for blood sugars. And then for hemoglobin A1c, you can just look up different standards, but around 6 is going to be that cut off for we got a problem here. And then over 6. 5 is that diabetic range. That’s going to be important to recognize that insulin is not a clinical indicator for prediabetes.
Or type two diabetes, but insulin resistance is the cause of both of them. So I always describe it like a train moving, like from New York to LA and the track that the train is going on is insulin resistance. And then, once you get to Omaha, which is where I live outside of Omaha.
That’s pre-diabetes. And then if you get all the way to LA now you’re at type two diabetes. Same thing, you’re on the same track. It’s just a different degree of severity.
Ruth: Interesting. So what is what’s New York? What’s a healthy level?
Dr. Nolte: Yeah. So ideally two to six for a fasting insulin level.
You can get a finger prick test. We sell at home finger prick insulin tests. You can ask your doctor to order one, like with your next annual lab report. If you want to do like a walk in, go to quest or lab core, just Google Ulta lab tests insulin. And it’ll pop up. You can order your own for 30 bucks.
Ruth: So there’s a lot of different ways to test it, but you want to see that between two to six. Okay, so if you have normal blood, CLO, GGL, blood glucose, can’t see it. And A1C levels, does that mean that you don’t have insulin resistance? If what? What is the best way to, to know this?
Dr. Nolte: Yeah, so this is so important. Your blood glucose and A1C can be in completely normal levels and you can still have insulin resistance. And I hear this a lot especially if you have other symptoms like excess weight or high blood pressure. Man, you got to be checking that insulin and you have to understand you have insulin resistance.
I’ve heard twice now of people who had a normal hemoglobin A1C level and weight to lose. And they really wanted to get on Ozempic and their doctor is just wait a little bit longer and your a one C will go up and then I can prescribe you Ozempic. And I’m like, this is not how we should be dealing with it.
Ruth: No, that, oh, that makes me sick. I’ve heard that twice just this summer. Yeah, that, that makes my heart hurt. Honestly. But that’s where a lot of people are at, like they’re desperate for a solution. And I think that it’s important to understand insulin resistance is a lifestyle disease. This is not genetic.
Dr. Nolte: This is what you eat. How often you eat, how you exercise. This is, our sleep, our stress management, all of these things go into our degree of insulin resistance. So that’s good news because if our lifestyle caused the insulin resistance, we can make lifestyle changes to reverse the insulin resistance.
Ruth: Yes. Yes. And why, like why is that so hard for people to understand? And why do we not talk about that more? I don’t know. I think it just goes back to the status quo. I like to call it our rhythm of life. Like we get in this certain rhythm, but just like you, like when you’re trying all these, all the diets to lose weight, like dieting was your rhythm of life.
And a lot of people have this external messaging from so many different places. Just watch the news. In the States, politics is big right now with this upcoming election. And it cracks me up. So many of these commercials are just prescription medications. Like, every other one.
Dr. Nolte: I can’t even believe it. Cause I don’t, you’re right. I don’t really normally watch that much TV, but because of debates and all the stuff that’s been going on, I have watched more and I’m like, every commercial is for medicine. Every single one. I’m like, maybe they could be more affordable if you spent a little bit less on advertising.
But I think the same thing about a lot of companies like Hy Vee hiring like a Patrick Mahomes. And I’m like, maybe Hy Vee could lower the prices if they weren’t paying Patrick Mahomes so much. And same for State Farm. I’m so like. I’m being cynical. Cynical. I know. Anyways, I think that Yeah it’s very important that I always think we need to be prevent preventing before we’re prescribing.
And so if a physician is noticing like elevated levels of triglycerides or sugar or blood pressure, anything, we need to be having upfront conversations early hey, You need to fix this. Otherwise, this is what’s coming and we’re not doing that well enough in health care. And I think it’s honestly because of how the system is set up and insurance only pays for a certain amount of time.
And so they’re incentivized to see as many people as possible during a day, which obviously reduces the visit. Time and what they can provide and it’s a lot easier for physicians to take the time to adjust a medication or prescribe a medication then explain carbohydrates to somebody and my brother is a physician.
He’s a plastic surgeon. I asked him once, I was like, why don’t physicians talk more about this stuff with their patients? And he was like, honestly, I think most of them think it would be a waste of time. I think most physicians are so jaded that they don’t believe their patients would follow through.
Therefore, it would be a waste of time in the first place to give these recommendations, which is really sad. Really? And I don’t think all physicians are like that. I’m not saying that at all, but I just think they’re just like I was in geriatric PT, their hands are tied too. But I think also, physicians don’t even have the right information that they’re giving out.
Ruth: A lot of the advice that they’re still giving people is, cut back on red meat and eat less fat. All these, all this so called conventional wisdom, health advice, eat less, exercise more. That’s not actually helpful. Especially for this specific problem. So can you talk a little bit more about that?
If this is a lifestyle issue primarily it’s not genetic, it’s lifestyle, then what is the lifestyle fix?
Dr. Nolte: Yeah. So we have to think about that root cause. Okay. So if high levels of insulin and high levels of inflammation are the problem, we need to view all of our choices through the lens of how will this affect my insulin and how will this affect my inflammation.
And when we view nutrition through those choices, we see very clearly that this plant based craze is not appropriate for somebody with insulin resistance. It’s too hard to properly structure a plant based diet for most people to get adequate amounts of protein and healthy fat and reduce the starches and the sugars because most plants are mostly starch and sugar.
So it becomes very obvious that a diet that prioritizes protein for muscle mass because muscle is really good for insulin sensitivity. And we want to have muscle just so that we can function and metabolize our food and all these great things. So high protein. High healthy fat, high fiber diet, low starch and sugar.
That doesn’t mean you have to do carnivore. That doesn’t mean you have to do keto. That doesn’t mean you have to give up your favorite foods. It means figure out a sustainable approach to nutrition. Because I eat so much. So much good food and I eat so deliciously and I’m so satisfied because I’m prioritizing the right things in my diet.
The second thing is the amount of food does matter too. Especially from a weight loss standpoint it’s certainly not all about calories in calories out. Like I’m the last person that would ever say that. But from personal experience, low insulin calories are still calories. So you can still overdo it on the nuts and the peanut butter and the cheese.
And that could be causing like a weight loss stall, for example. But the other thing too, is how often are we eating during the day? How often are we spiking our insulin or our inflammatory levels? And when we’re thinking about inflammation, let’s break down the fats a little bit because I was evaluating someone who had a heart attack once.
And I was like, huh, I wonder what their discharge paperwork says. And the registered nutrition wrote on there, choose unsaturated fatty acids, like canola oil over butter. And I’m like, This is terrible. Your audience knows, canola oil, those are inflammatory. They’re not going to spike your blood sugar.
They’re not going to spike your insulin in the short term, but they contribute to inflammation, which will raise your insulin resistance in the longterm. So keeping those refined oils to a very minimum in your diet. Keeping added sugars to a minimum in your diet, no pop, that kind of stuff. It’s all important.
Yeah. The other things too okay, let’s think about stress. Like man, in our culture, we are we tend to overschedule ourselves. We tend to underschedule joyful activities and leisure activities and chronic stress. A lack of boundaries around work, a lack of emotional boundaries around your relationships, all of these things, like living beyond your means and creating financial stress for yourself.
That’s going to raise your cortisol. And when your cortisol, your stress hormone goes up, your blood sugar is going to go up. And what happens when your blood sugar goes up is your insulin is going to go up too. So we want to control that stress. We want to be sleeping well because chronic sleep deprivation is a stress on your body, which I think like looking back on postpartum, I’ve had two kids, I always hit a plateau.
Until I started sleeping better. And I just accepted that I am not willing to compromise my milk supply by reducing my intake anymore. I can’t like, I’m just hungry. And I’m just going to live with the fact that my stress is up and my sleep is off. And I call it a circumstantial plateau at that point, because it’s those kids are going to sleep through the night at some point, then you can keep going.
So if there are new moms out there listening and you’re like, This is not coming off. Give yourself some grace, give yourself some patience, understand that your sleep and your stress is totally off right now. Those hormones will normalize as the baby sleeps again. And then exercise, right? So we want to be moving our bodies, prioritizing strength training in our regular weekly activities, and then activity after a meal, especially a high carb meal can be great to allow the muscles to use up that energy.
That blood glucose and reduce the insulin response from the meal. So going for a walk or should it be more strenuous than that? No, I like just going for a walk like you’re late to work. If you can make it like, like a brisk walk is great. But any, seriously, any movement after a meal is better than just plopping on the couch and turning on the latest series that you’re watching.
Ruth: Do that later in the night, but go for it. Yeah. So let’s talk a little bit about insulin resistance as it relates to Alzheimer’s because that there’s a lot of emerging stuff there, with it, with like calling it type three diabetes, that’s even can you speak to that? What’s happening?
Dr. Nolte: Yeah. So if people haven’t heard, Alzheimer’s disease is being coined type three diabetes because they’re realizing that this is not caused by plaques and tangles in the brain. Like we, we really historically have thought this is those plaques and tangles are side effects. They’re symptoms.
They’re natural consequences of the underlying root causes, which are inflammation in the brain, oxidative stress in the brain and insulin resistance in the brain. And so again, it really comes back to this low insulin, low inflammation approach. Like your brain’s connected to your body guys. And so whatever is good for your blood sugar is good for your brain sugar.
And if we want to really do all that we can to prevent dementia, which is. Unfortunately, increasing in prevalence in our nation. I think we’re going to have a really big issue with long term care, dementia care, just having been in that profession for a long time. I know that companies were really ramping up, building a lot of assisted living, a lot of long term care facilities because the projections of dementia are going up up.
And as of now, there’s not going to be enough places to care for all of these people with dementia. Which is interesting. So doing all that we can from a nutrition and lifestyle standpoint to prevent dementia, like think about how that’s going to help your family, help your kids, like from not needing to care for you so much.
And think about the impact you can have on your grandchildren by, More meaningful conversations with them. So all of that’s really important. And insulin resistance in the brain is certainly one of those root causes of dementia.Wow. So does it mean, when you think about that, it’s very scary. Does it, does that mean that dementia and Alzheimer’s could potentially be semi reversible by making lifestyle changes or is it once you get to that point, it’s too late.
So it needs to be prevented. That’s a great question. The research does show that the disease can be slowed. I would say Symptoms can be paused in some early cases symptoms have been shown to be reversed especially with a ketogenic diet because insulin resistance in the brain is Doesn’t allow glucose to be used for energy as well.
So when you’re in ketosis, the ketones, which are a by product of fat metabolism can be used for energy without the need for insulin. So that’s cool. So there is some really interesting research there. If people are interested in learning more about like insulin resistance in the brain, specifically the book, Change Your Diet, Change Your Mind by Dr. Georgia Ede is always who I recommend them to. It’s so well written. It’s very in depth, but she is a nutritional psychiatrist and she deals a lot with people with early onset Dementia, some cognitive impairment, anxiety, depression, ADHD, autism, bipolar, schizophrenia, a lot of these brain diseases.
Can be helped with a ketogenic diet. So I’m not like necessarily a keto person, like I mentioned, but for the right person, it could be life changing.
Ruth: That’s amazing. And we will include the link to that book in the show notes as well. So what do you wish, what do you wish more people understood?
Like it, if you were to wrap this all up at in a bow, if you could just like. have a platform, right? Obviously you have this platform. It’s a small platform, but we’re going to call it like, if you could just sit people down until the one thing this is what you need to know and shake them and get them to listen to you.
What would it be?
Dr. Nolte: I think that it really does come down to, you have to live a low insulin, low inflammation lifestyle, and Lifestyle is the key word. There is no quick fix. You cannot circumvent your way around through medications, supplements, injections, the necessary lifestyle changes required to lose the weight and to keep the weight off and to improve your health.
So really remember losing weight is not the goal. You can do that in a hundred different ways, and that doesn’t matter. Like losing weight and keeping it off is the goal and improving your health is the goal. And that requires this low insulin inflammation lifestyle.
Ruth: Yes. I love it. I love it. That’s how I would tie it up with a bow.
So good. That is, that’s tied up in a bow. Can’t say it any better than that. Morgan, this is so helpful. Could you just tell us how, a little bit more about how we can find you? What what is it that you’re helping people with? How do we find you online? How do we get more Morgan?
Dr. Nolte: Of course, yeah. So we have a Zivli Diabetes Prevention and Reversal Program. And we are doing enrollment for that again this September. And if they’re interested in that or learning about whatever else we offer like insulin testing, we have a starter course for people, a recipe bank. They can go to Zivli.com.
We have a great YouTube channel. I highly suggest people check out our YouTube channel. And there’s an insulin resistant resistance for beginners playlist. And that’s always where I point people to first. Instagram is @DrMorganNolte.
And then our Podcast is Reshape Your Health.
Ruth: Awesome. Awesome. And we will include all the links to all of those things in our show notes as well. Morgan, thank you so much for joining me today. This was incredible and such great information. Definitely. If you want to know more about.
Insulin resistance, check out all the resources that she just mentioned and just thanks for being here today.
Dr. Nolte: Thank you, Ruth. It was a pleasure.
Ruth: Thanks. All right, guys. That about does it for this episode. Remember that you can find all the links we talked about in the show notes along with a link to Dr.
Morgan’s upcoming challenge. And if you know someone else who might be interested, please be sure to send it their way. Then be sure to subscribe to the podcast to be notified of future episodes. And I will see you back here for another new episode very soon.