Why Your Client’s Metabolic Health is the Key to Her Longevity in Menopause and Beyond with Dr. Ritamarie Loscalzo

Dr. Jessica Drummond 00:00:03 Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here as we dive into today’s episode. As always, innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Hi there. It’s Doctor Jessica Drummond here from the Integrative Women’s Health Institute. Today we have an inspiring treat. Today I’m joined with my dear friend and colleague, Dr. Ritamarie Loscalzo. Doctor Ritamarie is a doctor of chiropractic. She also holds certifications in acupuncture, nutrition, herbal medicine and heart math. And through her Institute of Nutritional Endocrinology. She has been working in the field of metabolic health for decades now.

Dr. Jessica Drummond 00:01:35 We’ve known each other for, gosh, at least ten, 15 years, and she’s been doing this for much of her life. And what’s so inspiring about Doctor Ritamarie is that she really helps people take data and utilize it in an actionable way to optimize their metabolic health, metabolic health Concerns cardiovascular disease, stroke, Alzheimer’s are the true life risk, the risk of women. Our number one risks of death all have to do with metabolic health cancer, Alzheimer’s, dementia, heart disease, stroke. So for each and every woman, especially in the perimenopausal transition where we lose that buffer of estrogen for metabolic health, focusing on metabolic health is top priority. And we’re going to get into some of the controversies. We’re going to talk about the carnivore diet. We’re going to talk about Redeemers approach to longevity. You are not going to want to miss this one. So dive right in and we’re going to chat on the other side about a couple of little nuggets that I want you to add to your practice starting tomorrow morning.

Dr. Jessica Drummond 00:02:59 Hi there, doctor Ritamarie. I’m so thrilled to have you on the Integrative Women’s Health podcast. How are you today?

Dr. Ritamarie Loscalzo 00:03:07 I am great and I’m excited to be here. I love talking to women about their health. It’s actually one of my favorite things to do.

Dr. Jessica Drummond 00:03:15 So you’ve been an expert in metabolic health for decades now. And I want to talk a little bit about how you transitioned into this field, how you’ve kind of grown your career in the last couple of decades. What are some of the key pieces of this conversation that you think are the most important things that women in the late 2020s need to be thinking about?

Dr. Ritamarie Loscalzo 00:03:42 Oh, that metabolic health is the cornerstone, the backbone, if you will, because it’s negative of every disease known to mankind. It is the most common cause of heart disease, heart attacks, sudden heart attack, strokes, digestive imbalances. And it becomes much more critical as women age because there’s some specific metabolic changes that happen as we go through that pause, that menopause.

Dr. Ritamarie Loscalzo 00:04:10 And you need to know that everything you do in your day to day life matters for your metabolic health.

Dr. Jessica Drummond 00:04:17 Yeah. And I think when we think about as health and wellness professionals focusing on helping women optimize their metabolic health, it’s one of the key cornerstones, as you mentioned, I would say metabolic health and inflammation, which are tied together, of course. Yes. As clinicians and coaches, we really want to be thinking about asking each and every one of our clients key questions about their metabolic health and what they’re doing to support their metabolic health. So when you think about a woman in her late 30s to early 50s, in that perimenopause to menopause transition. What are some of the big red flags we want to be sure not to miss, as we’re doing our screening of women in this age, when it comes to metabolic health.

Dr. Ritamarie Loscalzo 00:05:03 I always say to people when I’ve had friends who were talking about, well, I don’t have insulin resistance. And I look at them and I say, yes, you do.

Dr. Ritamarie Loscalzo 00:05:11 And they go, what do you mean, yes, I do. You don’t know me. You haven’t seen my labs. I said, I don’t need to see your labs. I’m looking at your body proportions, waist hip ratio, waist height ratio. When somebody has a protruding belly, even when the rest of them is slender, that’s a clear sign that there’s most likely metabolic imbalance, insulin resistance, blood sugar imbalance, cortisol dysregulation, and all of those things are tied together. So that’s one of the key things. But the other thing is fatigue and brain fog, which are very common in everybody pretty much, and especially as women start to go through menopause pre menopause and perimenopause. We think it’s normal to be exhausted all the time. We think it’s normal that 4:00 we have that slump. Now, they don’t realize is that’s a sign of metabolic imbalance and some of the other things, which are blood tests that most doctors don’t do, are not as obvious. And as a clinician, you should be looking at not just fasting glucose, which is like the last thing to change.

Dr. Ritamarie Loscalzo 00:06:15 You really should be looking at fasting insulin, a onesie and all the inflammatory markers. Those are critical things to be looking at.

Dr. Jessica Drummond 00:06:23 So for women testing their own waist to hip ratio we’re looking for less than 0.8. We want the waist to be a bit slimmer than the hips. And in terms of, you know, compared to the height, same kind of thing. So in perimenopause, one of the biggest complaints that many of us will hear in our practices is that weight gain, weight loss, resistance, that and elevated fasting glucose, even elevated hemoglobin, a onesie or sort of trailing indicators that we’ve already got a situation where metabolic health is out of balance. And this is so common even for the women in my practice who are lifting weights, who are eating a mediterranean style diet, who are doing kind of all of the exercise and nutrition things that often are touted. And we can get into a little more detail about that. But what are some of the things that are more commonly missed that contribute to dysregulation of metabolic health?

Dr. Ritamarie Loscalzo 00:07:26 You mean in terms of habits that may be missed? Yeah.

Dr. Jessica Drummond 00:07:29 Yeah.

Dr. Ritamarie Loscalzo 00:07:30 Stress and sleep are two biggies. And timing, like most people, are not timing their meals, timing their exercise with relationship to their meals, timing their bedtimes with relationship to meals. All of those things and their exercise is critical. But when are they exercising? I was just looking at a study just the other day that was saying that, contrary to popular belief, that when you exercise in the afternoon, you burn more fat than when you exercise in the morning. And so many of you, I get up and, you know, exercise right away, but actually showed that you burn more fat. And it has to do with the fact that insulin is usually more elevated in the morning than it might be later in the afternoon. Just depends on what they’re eating and all that. So that’s something that’s really missed is the timing. But stress like look around, right. This world is one stress situation after another. And women and men, everybody kids are stressed 24 over seven which causes an elevation in cortisol.

Dr. Ritamarie Loscalzo 00:08:34 Cortisol elevation causes us to be prepared to run away from whatever or fight. And that causes us to release stored glucose into the bloodstream, which elevates the glucose. Even though you’re not eating, even when you’re not eating, and then you’re not doing anything to get rid of it. So when you’re elevating your glucose because there’s a tiger chasing you, then you’re going to be using that glucose, obviously to get away from the tiger. But when you’re sitting at your desk and reading the stock market report and getting mad at your boss or whatever other stressors happen, then you’re releasing the same amount of glucose as if the tiger was chasing you and you’re not doing anything to get rid of it. And that elevated cortisol, elevated insulin, are major contributing factors to it. And then sleep. People are laying awake, stressing out and not sleeping, and even one night of bad sleep can cause insulin resistance in a healthy person, let alone in somebody who’s already got a lot of bad habits.

Dr. Jessica Drummond 00:09:41 I think this is an interesting conversation because there’s so much we can do on an individual level in terms of shifting or schedules shifting, kind of how we wake up in the morning from jumping up, grabbing our phone, grabbing a 64 ounce jug of coffee and like, you know, having a donut and running to work in traffic to moving more slowly, being outside hydrating like eating at certain meal times, I think we have a lot of control over certain habits.

Dr. Jessica Drummond 00:10:12 And I think the reality is that the environment we live in, even in the last 15 years, as things like cell phones and working remotely and all of the equipment we’re both surrounded by now, and the blue light and 24 hour access to news and things like algorithmic exposure to news, which is driven by, you know, fear mongering, fear. Yeah, chaos. Chaos and fear. I think it’s helpful that those of us who are health professionals take that into account. Is there anything beyond the individual that you think we can do to help with these dramatic shifts in environment?

Dr. Ritamarie Loscalzo 00:10:58 So in terms of helping our clients to better cope with it, I like teaching mindfulness practices that they can incorporate throughout their day. I like teaching people that before you jump out of bed, before you reach for your cell phone, take 30s to a minute to find some things to appreciate in your life. To look back over yesterday and find that one good thing that may have happened in the midst of chaos, that you can shift your body into appreciation.

Dr. Ritamarie Loscalzo 00:11:27 A few deep breaths and just meditation would be great. But if you’re talking somebody who’s already in a rush, it’s hard to do that. But even meditation for 30s to a minute to just shift you from sympathetic to parasympathetic, and it’s always being aware of what can I do to shift into parasympathetic. And as health professionals, we know how to do that. And then finding something that’s going to work for that individual, you know, despite their busy life, they’re crying babies and barking dogs and, you know, whatever else they have going on. So I think we just need to teach people to stop and to incorporate that throughout their day. And that will go a long way to then, okay, what are the next habits and the next habits? I was speaking to a client this morning and saying, you know, I can give you 20 things to do right now to help you where you’re at. You’re going to get overwhelmed by that, and it’s going to make things worse. So I’m going to give you one, maybe two, maybe three to start.

Dr. Ritamarie Loscalzo 00:12:28 And then that’s it for now. We’re going to get those mastered. They become your regular routine. And then we add some more.

Dr. Jessica Drummond 00:12:35 I think what we would both agree on is that individually we have a lot more power than we sometimes think about navigating the stressors. So it’s a bit of a double edged sword, right? There are certain things that no matter what position we’re in, it’s really hard to turn back the time of accelerating stressful environments. But we do have, on an individual level, many, many options that don’t have to be so difficult to implement. So when we think about stress and we think about sleep as options for optimizing metabolic health, we can talk in a minute about diet and movement. There’s obviously a huge push now in the conversation around perimenopause and menopause to support women with estrogen who are in perimenopause, and to support women with GLP one agonists, which are similar to the tools such as Ozempic and other brand names to help give them the peptides that their bodies are not creating enough of, or at least being agonist to those receptors.

Dr. Jessica Drummond 00:13:48 So even at a low dose, what are your thoughts on those tools in this population? Do you think there are more of a last resort? Start with them to give people a boost. Long term. Good tool. Like what are your thoughts about it?

Dr. Ritamarie Loscalzo 00:14:00 Well, in my personal opinion, I haven’t done major research. I’ve done a little bit of research. I think they’re good last resorts or they’re good to use in very low doses in combination with shifting dietary and to much of people, they’re just relying on, oh, I’m taking this ozempic thing and, you know, for $1,000 a month and, you know, if I have to be on it for the rest of my life, so be it. But I probably won’t. If you are teaching the dietary and lifestyle and stress management and sleep and teaching them, and it’s using that GLP one agonist as a crutch, basically to overcome the insatiable appetite that they have. But a lot of the insatiable appetite is coming from insulin imbalance, and a lot of the insulin imbalance is coming from eating at the wrong time of day, eating the wrong kinds of foods, and not getting enough sleep because even one night of bad sleep in an otherwise healthy person can cause insulin resistance.

Dr. Ritamarie Loscalzo 00:15:02 So we need to be looking at those things. And most doctors aren’t measuring insulin. And people will come in and I’ll say, we’re going to measure your insulin. And I look at their insulin and it’s like 22. And they say, but my doctor said that was normal. Or they’ll say it’s 15. And they go, look, it’s within the normal range. It’s not. And it should be between 2 and 5. As soon as it’s above that five, you’re going to have insatiable appetite. You’re going to be storing weight around your middle. Your blood sugar is going to be all over the place, so your appetite is going to be crazy, and you’re going to get that slump in the middle of the afternoon. So we have to address the imbalance in insulin, which has to come from diet, lifestyle, stress, sleep and the timing of everything. So if we’re going to use it as a crutch, on top of that, there are natural foods, natural ingredients, herbs and things, and even a new sugar called allulose that has been shown to actually stimulate GLP one.

Dr. Ritamarie Loscalzo 00:16:07 So if someone is taking ozempic or something like that as a crutch, great. Let’s give them the foods and the lifestyle that is going to help support them. And I did a podcast on that recently with an expert. You probably know her Marcel pic and she’s been researching this like crazy. And in that podcast she gave us a whole big, long, long list of foods that have been shown to stimulate GLP one, including probiotics, including having specific gut bugs that are going to produce and help with the production of GLP one.

Dr. Jessica Drummond 00:16:42 So let’s say someone either uses this as a crutch or decides to put it off for now. And their early 40s, they’re gaining weight around the middle. They’re having that afternoon fatigue. They’re having trouble sleeping through the night. Are there any particular characteristics that’s going to help you guide their nutritional protocol? Is it relatively similar across women? What are the things you’re thinking about when you’re helping them determine which foods to eat and when there’s similarities?

Dr. Ritamarie Loscalzo 00:17:15 But everybody’s individual. So one of the first things I do is have them either get a CGM, a continuous glucose meter, or start testing their glucose to see what their patterns are of elevated glucose, where their spikes are happening, what foods might be causing it, what particular stressors I call the elevation in glucose that happens with stress.

Dr. Ritamarie Loscalzo 00:17:37 The candy bar eating effect of cortisol. Basically, you get you get the elevation the same way as if you just ate a mars bar.

Dr. Jessica Drummond 00:17:45 You know, without the candy.

Dr. Ritamarie Loscalzo 00:17:47 Without the pleasure. Like, all right, screw it. I’m not going to get mad at my boss. I’m just going to eat a candy bar instead. Right. And I’m not promoting the use of candy bars. I’m just saying that it’s so profound. And if we’re not addressing that with all of our patients, let’s just say everybody. If we’re not addressing their stress levels and we’re not looking at their cortisol levels and we’re not looking at their insulin levels, and we’re not looking at their postprandial glucose monitoring, you know, watching the curve, we’re not going to be able to guide them. Right. Because I’ve seen it where people will eat blueberries and their blood sugar goes to 170 and somebody else eats three bananas and their glucose barely budges like it’s very different. And the diet that I might propose to you is going to be different than the diet I would propose for myself or somebody else.

Dr. Jessica Drummond 00:18:33 I love that, and so it’s primarily individualized based on their reactivity to relatively high sugar, high glucose foods, which like you said, for some people it’s pretty minimal, well controlled, and for other people, even eating fruit can have a big effect.

Dr. Ritamarie Loscalzo 00:18:50 Oh yeah. And grains. So the biggie grains even more so than fruit. You know, some people can eat pineapple with no problem as soon as they have a bite of brown rice, boom, it shoots up.

Dr. Jessica Drummond 00:19:00 And so how long are you tracking continuous glucose? Ideally two, four weeks, something like that.

Dr. Ritamarie Loscalzo 00:19:07 Yeah. So what I do initially is I say do not change anything. Just put this on and let’s see what happens. Because I used to give them all these things to do and they were testing. Oh I don’t think this is a problem for me. Well because you already you already.

Dr. Jessica Drummond 00:19:20 Know the changes.

Dr. Ritamarie Loscalzo 00:19:21 You already made the changes. So now it’s like eat everything that you normally eat. Even if over the last couple of weeks you’ve started to shift a little bit, or you’ve been experimenting with avoiding grains or grapes or whatever.

Dr. Ritamarie Loscalzo 00:19:33 I say go back and eat those foods, whatever you know, you’ve typically used to over the last month or two of eating, eat those high glycemic foods. Let’s see what happens, because then it imprints on their brain that, oh, I had no idea that rice did that to me. Then they don’t want to touch the rice anymore because they don’t want that effect and they equate it to their belly getting bigger.

Dr. Jessica Drummond 00:19:55 Now, do you see sometimes that sometimes rice will increase, give a spike, and other times if someone is eating it, say when they’re not under stress or they’re eating it earlier in the day and then they go for a little walk or something like that, that there are other ways to modulate.

Dr. Ritamarie Loscalzo 00:20:12 Yes. And a lot of times we do find that out. Once we discover these foods, I tell them to experiment. So let’s experiment with it and see if you eat more rice and then go for a walk. Is it do the same thing. But if it’s a high spike like 180, 160 even.

Dr. Ritamarie Loscalzo 00:20:29 I mean, if it’s a little spike like it goes into the one 20s or 30s, and that’s more likely to say thing, say that to test it out. But if it’s spiking really high, the dangers of the high elevations in glucose like that are just not worth it. So after we figure out the foods we do, a 30 day metabolic reset and the 30 day metabolic reset has them take out all the different foods that caused him to have any kind of a bug, any kind of a spike. And I call a spike in a normal person who’s not already diagnosed with diabetes, anything more than 25 to 30 points after they eat the meal. We also teach them stress techniques, timing techniques. We teach them all that stuff to do in the 30 days, and then at the end of the 30 days, then they’re allowed to go back and test again. So an answer to your question about how long two weeks is a good amount to do the initial testing. Some people will just continue to do it after that because they want to see how they’re doing, and they usually end up cheating and throwing something back in in the meantime.

Dr. Ritamarie Loscalzo 00:21:31 And so I want them to see what that does. So I have them continue it through the whole thing. So two months is usually a really good amount of time to get through the testing at the beginning, the 30 day reset and then the testing at the end.

Dr. Jessica Drummond 00:21:45 And so once they’ve done the reset, it’s not to say they should go right back to what they were doing. That’s sort of the beginning of a longer term shift essentially forever.

Dr. Ritamarie Loscalzo 00:21:58 Absolutely. And if they come out with like 25 foods that cause their sugar to go up, testing those 25 foods is going to take a while, because I recommend kind of like when you do a food allergy elimination and then provocation, you test very slowly and have a very specific like what’s to start with, you know, so if if blueberries raised your sugar beforehand, blueberries are known to be a low glycemic food, but not for everybody. Then you start back with blueberries. If they hate blueberries and they don’t really care, I tell them to find something that they really are missing a lot and test that again.

Dr. Jessica Drummond 00:22:33 And that’s when you could test it also a little bit in context around stress and movement and timing and all of that.

Dr. Ritamarie Loscalzo 00:22:40 Exactly. And I find that people say, well, I this caused my sugar to go up before the reset, but now I’m taking it right. And then I’m meditating, or I’m doing hard math, or I’m going for a walk or time of day can make a difference as well.

Dr. Jessica Drummond 00:22:54 So what are some of your strategies for helping people get that better, deeper, more restorative recovery kind of sleep when they come to you in perimenopause with that really common? Well, I can fall asleep, but I’m waking up between 2 and 4 a.m..

Dr. Ritamarie Loscalzo 00:23:11 That’s a tough one, and I just wanted to just step back because I forgot to say, in testing the foods, it’s also what foods you can eat with it. So I found for myself pineapple shot my sugar way, way up. If I eat a big salad and I have a bite of pineapple between bites, or I’m drinking my big old 32 ounce green smoothie that doesn’t have fruit in it, and I can eat the fruit with it.

Dr. Ritamarie Loscalzo 00:23:34 I do well, other people find if they have it with almond butter, then it’s going to do better. So it’s all very different.

Dr. Jessica Drummond 00:23:41 So layering something like a relatively high glycemic food with either a beneficial fat or a high fiber fiber.

Dr. Ritamarie Loscalzo 00:23:51 Yeah, greens tends to be the best because it’s so loaded with nutrients and minerals, especially magnesium, that the body actually needs to carry the glucose through the insulin receptors.

Dr. Jessica Drummond 00:24:03 Okay. Great. Yeah. So sleep strategies. Yeah.

Dr. Ritamarie Loscalzo 00:24:07 Sleep is one of the most challenging things, especially in the perimenopausal. So it’s going to depend on the person. So I ask lots of questions. We also do a lot of testing. But if they’re waking up because of a spike in cortisol now why could that be. Well, maybe they have an old trauma. Maybe when they were a kid, their dad came home drunk in the middle of the night and started screaming. And they’re fearful, and it’s imprinted in their nervous system to be very afraid in the middle of the night.

Dr. Ritamarie Loscalzo 00:24:34 It could be that they had a high glycemic food at dinner, and it causes spike and then a drop, and then in the middle of the night, their glucose drops and cortisol is released to try to bring the glucose back up. So it could be that it could be just the stressful situation. So there’s several herbs. So I ask lots of questions to determine the herbs of the supplements that that person might need if they’re falling asleep. No problem. And then waking up. Sometimes I’ll recommend things like passionflower or magnolia or phosphate tidal serine at bedtime to keep them from going into that elevation of cortisol for whatever reason, in the middle of the night. But it’s really a matter of asking a lot of questions, getting a sense I have paper and pen kind of questionnaires they can do to determine which of their neurotransmitters might be out of balance. Oftentimes it’s serotonin or Gaba, and if they tend to be too low, then we either give them precursors like five HTP or taurine or some or things like that.

Dr. Ritamarie Loscalzo 00:25:40 And we want to determine is it melatonin. That’s everybody’s go to let’s just take melatonin right. And if you take melatonin but you don’t need it. And I’ve seen that a lot happen on like a Dutch test where their melatonin is through the roof. And I asked them about melatonin. They go oh yeah I forgot about that. Yeah I take whatever amount at bedtime. And that’s why their melatonin is too high. So we have to determine what it is. You can’t just throw a whole bunch of supplements and herbs at them. You have to determine what the cause of it is. Now it’s menopause, right? Or it’s perimenopause. But that doesn’t mean that it’s related to, say, progesterone because progesterone could be low. It could be that they’ve had an imbalance all along and perimenopause just aggravated it. So it’s really not a matter of saying, oh, you’re in perimenopause. Let’s just try progesterone. It could be something totally different. It could be a combination of things. Right. So they try one thing and they find that didn’t help.

Dr. Ritamarie Loscalzo 00:26:40 Therefore they throw that away and they try something else sequentially. And sometimes it’s a combination of things that they need to be doing together.

Dr. Jessica Drummond 00:26:47 Yeah, absolutely. So that’s exactly what we would do as well. So it’s like is it hormones. Is it brain neurotransmitter. Is it cortisol blood sugar stability in the middle of the night? Or is there some other reason someone’s nervous system absolutely could be waking them up just out of trauma or habit, you know, and sometimes it’s funny things like dogs or, you know, and and I.

Dr. Ritamarie Loscalzo 00:27:15 Think actually.

Dr. Jessica Drummond 00:27:16 You know, important to ask these questions because you could have I’ve had clients had someone actually once who was taking like 300mg of progesterone. It was not moving the needle at all. And I later found out it was, well, it was because her two big dogs who would like, jump in and out of the bed in the middle of the night, like sometimes it’s actually situational. So we have to ask the question.

Dr. Ritamarie Loscalzo 00:27:37 Or a partner that snores and oh, I forgot, I have a new partner in this partner snoring.

Dr. Ritamarie Loscalzo 00:27:42 Oh, that happened just right around the time my perimenopause started. How? And the other thing is like they may not be as sensitive to the dog jumping in and they get really deep sleep normally, but now they’re going through this shift and now they’re more sensitive to every little thing. They’re in a much lighter sleep. I will oftentimes recommend an aura ring or Fitbit or something like that that they can wear. So we can see what the pattern of deep and REM and light sleep is to see if there’s something we can help them shift there.

Dr. Jessica Drummond 00:28:13 Absolutely. So once people shift their sleep and their stress, what are the impacts that you see when you start measuring the continuous glucose monitor and sort of the follow up? Do we see smoothed like what are you actually looking for as a clinician?

Dr. Ritamarie Loscalzo 00:28:34 I’m looking for normal glucose patterns after a meal. Right. Unfortunately, we can’t test insulin at home. Right. There is a test that you can do and you have to send it in and you don’t get the immediate feedback.

Dr. Ritamarie Loscalzo 00:28:47 And it’s super expensive. It’s much better to just go to the lab. And there are ways that I help people with the insulin, but given that they can see the glucose on the meter, then what I see shift is, oh, they’re getting a good night’s sleep now, they’re waking. Glucose is better and their shifts after a meal it starts to normalize. We should get a spike and then a down. But the spike, in my experience, shouldn’t be much above 110, right? If we look at really healthy populations, 110 is about as high as they get. And so if it’s going much higher than that and the spikes are erratic, it should be oh pre meal up down again. And at two hours past the meal it should be back to premium level. And in Western medicine they’re teaching. Oh it should be no more than one 42 hours after a meal. And I’m like 142 I should never be 140, but two hours after a meal it should be back to baseline. And so those are the kinds of things we’re looking for and we’re looking for smooth up smoothed down instead of up.

Dr. Ritamarie Loscalzo 00:29:52 Oh up again. You know, in an erratic looking curve. That’s a sign that it’s dysregulated.

Dr. Jessica Drummond 00:29:58 And so our baseline you’re like okay here 110 the max back down. You’re talking about around 8580 something like that.

Dr. Ritamarie Loscalzo 00:30:09 I like it in the 80s you know, low to mid 80s is about right. As soon as it goes above 90. As a fasting glucose, there are studies that show four times the risk of cardiac situations four times just by 91 versus 88. So you know, we really want it to be ideally in the 80s. And then we want it to not go above 110. So 80 to 110 is about a 30 point difference, right. If they are already diabetic or have been diagnosed as pre-diabetic and they’re fasting is 110, then of course, well, they have to fast continuously to keep it at 110, right? Which might be a healthy thing for them to do temporarily, but most people are not going to comply with that. So then it shouldn’t go above 140, right? If it’s fasting as 110 and then back down.

Dr. Ritamarie Loscalzo 00:31:00 So that’s what I teach. You know, when I’m teaching people to go through this metabolic reset is before they even go into it. We want to see what their peak is and we calculate what their peak is. And then we look at that, we look at their fasting. And I basically teach them how to calculate what their peak should be during the reset. But as they go through the reset, it’s going to come down. So I have had people where their fasting glucose was 180 to 200 and had them within 2 to 3 weeks go down into 98 as a fasting. It happens very quickly. If they actually follow all the the rules, and there’s not some kind of hidden dysfunction somewhere that we’re not aware of.

Dr. Jessica Drummond 00:31:45 And then what about lows? What are you looking for there?

Dr. Ritamarie Loscalzo 00:31:49 Well, it doesn’t much matter there. I’m just going to be controversial there.

Dr. Jessica Drummond 00:31:54 Okay. Sure. Yeah. What’s your thoughts on that?

Dr. Ritamarie Loscalzo 00:31:57 People say oh, it’s dangerous if it goes into the 60s. Not necessarily.

Dr. Ritamarie Loscalzo 00:32:02 It depends on the person. Right. If they’re going into the 60s and they’re like jittery. And, you know, they’re in that state of I have to eat. That’s different. But I’ve been in the 60s, I’ve gotten my blood glucose down to the 30s when I was fasting, you know, doing like a five day water fast. And on by day four, my fasting while my all day glucose tends to go down into the 40s and it’s even gone as low as 35. How did I feel? I felt perfectly fine. Right? But then it goes back up and I find that for me, a fasting level in the 70s is like where I feel the best, I feel the most clear. I don’t have hunger, I just feel really good. But other people, it’s different. So we help them to calculate what that is based on how they feel and what their numbers look like, and what their agency is and what their fasting insulin is as well.

Dr. Jessica Drummond 00:32:53 Right. So reactive hypoglycemia we’re worried about when people are more symptomatic, when either they’re waking up or they’re jittery, versus if they’re fasting, but they’re at least somewhat keto adapted.

Dr. Jessica Drummond 00:33:05 And so they’re able to.

Dr. Ritamarie Loscalzo 00:33:07 Exactly.

Dr. Jessica Drummond 00:33:08 Fuel off.

Dr. Ritamarie Loscalzo 00:33:09 Their fueling their fat. Exactly, exactly. And one of the things I look for is the reactive hypoglycemia is usually preceded by a spike. So it’s not like somebody 8085. They go up to 105 and then they come down. But then all of a sudden instead of going down in the 80s, they’re coming down in the 60s. Then something triggered them. And oftentimes it’s they did get a spike, but it didn’t register because the body produced a ton of insulin. This is why I wish we could test continuous monitoring of insulin, because then we’d see exactly what’s going on in the cases of reactive hypoglycemia.

Dr. Jessica Drummond 00:33:48 Right. Because then it’s not necessarily just the glucose. It could be that the body’s responding. So it’s aggressively responding aggressively.

Dr. Ritamarie Loscalzo 00:33:56 And hyperinsulinemia precedes hypoglycemia as a condition. But nobody’s testing for it, and it could be preceded. In decades, it could be 20 years of that. Oh, I gotta eat, I gotta eat feeling. But nobody ever tested their insulin, so we don’t know that it was really hyperinsulinemia.

Dr. Jessica Drummond 00:34:17 And so interesting. So when someone in that perimenopausal age range changes to be much more metabolically stable, so they’re shifting their morning routine, they’re implementing a nutrition protocol that’s not spiking their glucose significantly. Their insulin response is more normal. They’re exercising after meals or in the afternoon they’re more consistently exercising. They’re getting better sleep. What is the risk reduction that we’re talking about in terms of the major killers of women, things like cardiovascular disease and stroke?

Dr. Ritamarie Loscalzo 00:34:53 Yeah, I don’t know that I’ve seen any particular studies that look at that per se. But what I do know is what happens with Hyperinsulinemia. And I know that excess insulin is a leading cause of heart disease. I mean, that’s documented. Well documented. So the risk goes down dramatically. And assuming when we’re looking at the glucose, you know, and monitoring it that way, that we’re also looking at inflammatory markers. Because if they’re continuing to eat foods that are inflammatory, like, say, oils like processed oils, hydrogenated oils, oxidized oils, those are not going to result in a glucose spike that you’d see.

Dr. Ritamarie Loscalzo 00:35:32 But what it’s doing is just wearing down at every cell in the body through the inflammation. And we’re not going to necessarily see that. So assuming that they’re following an eating plan that that you or I might recommend that’s really anti-inflammatory and produces a more alkaline state in the body than an acidic state. We’re going to see a dramatic reduction of risk.

Dr. Jessica Drummond 00:35:55 Yeah that’s amazing. So when you think about looking at metabolic health in perimenopause. What’s going on there that’s shifting people’s metabolic health is the fact that I think sometimes in perimenopause, it’s like when we lose that support of estrogen, it becomes more erratic and then it just declines, which an estrogen does help with insulin sensitivity. We do have to actually work significantly harder to maintain what we were doing before. So are there any foods that are part of the real benefit? For most people, obviously we would test it individually, but by and large there are certain foods that are probably of benefit.

Dr. Ritamarie Loscalzo 00:36:43 Absolutely. I have like a 6 or 8 page document that I put together.

Dr. Ritamarie Loscalzo 00:36:47 It’s like a pretty picture of each food and describes exactly how it does that. So green leafy vegetables. Sprouts. Sea vegetables. Avocado. Chocolate. Carob. hawthorn berry. I’m trying to remember all of them. Like omega three rich foods and some herbs like dandelion, which can be considered a green as well. But dandelion is very helpful. The cactus nopal cactus can be super helpful, so there’s a whole list of them. Like I said, I have an eight page document. I’d be happy to share that with you. You got you can share it with your followers.

Dr. Jessica Drummond 00:37:24 Yeah, that would be great, because I think sometimes when women are already in this stress state and then it’s like, okay, we have to restrict this. We’ve got to get an earlier bedtime. You have to change everything about your life. It can feel like it’s overwhelming. It’s a lot.

Dr. Ritamarie Loscalzo 00:37:39 Yeah, yeah, it’s a lot. That’s why I’m so happy. Chocolate’s on that list. And avocado. So there’s nothing better than a chocolate avocado mousse.

Dr. Ritamarie Loscalzo 00:37:48 And then if you want to sweeten it, that allulose to help stimulate GLP one and Allulose has been shown to reduce blood sugar and reduce insulin and increase ketones. So there you go. You’re stressed out. Have chocolate avocado mousse with some allulose in it.

Dr. Jessica Drummond 00:38:05 Good. I think that’s very important because I do think we have to make sure women really understand that this phase is not about restriction, restriction, restriction. It’s about understanding physiologically what we’re trying to do to prevent the most common causes of death in women.

Dr. Ritamarie Loscalzo 00:38:26 Absolutely.

Dr. Jessica Drummond 00:38:26 But that you and I and other nutritionists out there and health coaches, we don’t like hate fun.

Dr. Ritamarie Loscalzo 00:38:33 No, no, no, you love fun, right? I love fun in the food. Have fun with your food. I’m very much into treat foods. And I have a I 250 page recipe guide menu plan for my Sweet Spot program, which takes people through the 30 day metabolic reset. We have pizza in there, we have lasagna in there. We have all kinds of cool deserts because it’s not about deprivation.

Dr. Ritamarie Loscalzo 00:38:59 It’s about learning how to make your favorite comfort foods in ways that’s also metabolically stable.

Dr. Jessica Drummond 00:39:05 Yeah, yeah. So obviously your perspective is very highly informed by a more plant heavy, phytochemical heavy colors of the rainbow. What are your thoughts on the more carnivore ketogenic perspective?

Dr. Ritamarie Loscalzo 00:39:25 yes. My diet is plant based keto or I call it keto ish. Right. Because it’s not butter and bacon. And I was just watching a video earlier today about eating a pound of steak and a stick of butter every day, and that’s all she eats. And I’m like, there’s got to be some problems with that long term, because where are you getting the fiber and where are you getting the phytochemicals? Proponents of carnivore will say you don’t need those things. And I see there’s lots of research that says otherwise. so. A pure carnivore diet. I don’t believe in a diet that’s heavy and oils, which is what a lot of people do on keto tallow and butter and coconut oil and all kinds of stuff. And I’m not a fan of oils either, because they’re heavily processed, and especially if you’re trying to lose weight.

Dr. Ritamarie Loscalzo 00:40:13 It’s just a lot of calories without a lot of nutrition to go along with it. So I’m a big fan of keto type diets, and I propose that. And I’m fine with people including some animal products, some fish or organic lean meats and stuff. But I’m not a fan of dairy I think hurts most people. Gluten is a killer for most people, especially people who are having symptoms and then processed meats and meats that are loaded with chemicals. So you have to differentiate between the quality of what you’re eating and that I don’t know that there’s long term studies on carnivore. Straight carnivore. I do see that people have temporary benefit from that because it’s the ultimate elimination diet.

Dr. Jessica Drummond 00:41:01 Sure.

Dr. Ritamarie Loscalzo 00:41:01 Yeah, right. You’re eating butter and meat, so you’re not getting the benefits of the phytochemicals. And there’s a lot of people debating that. But I think there’s a lot of research on that. So when I take people through a metabolic reset, the menu plans are all saying this, this, this and this and optional four ounces of fish or four ounces of pastured meat or whatever.

Dr. Ritamarie Loscalzo 00:41:23 We do take everybody off of dairy and gluten, because those tend to be inflammatory and they’re very high on the allergy lists. In fact, I take people off all the top allergens gluten, dairy, corn, soy, eggs and peanuts just because they are very problematic for a lot of people. And they’re not necessarily overtly problematic, where they say, oh, every time I eat it, I get a rash or my nose runs or whatever. A lot of those just causes of inflammation, and we’re trying to reduce the inflammation so we can restore the sensitivity of the insulin receptors.

Dr. Jessica Drummond 00:41:56 Yeah, I tend to agree. I think there’s the place for like a pure carnivore diet or even sort of a what’s known as like an animal based diet, which is basically meat, some fish, a little bit of berries, things like that to me without butter, because that starts to get complicated in terms of the allergens. But I think the short term place for that is very similar to the short term place for fasting in terms of reset of the immune system, because like you said, these are kind of the ultimate and elimination diet for people who struggle with histamine issues, mast cell activation, post-viral illnesses, things like that.

Dr. Jessica Drummond 00:42:39 But you’re absolutely right. The data is just so strong about fiber for things like cancer, phytochemicals, vitamins, Minerals. Yeah. And I think the other thing, too, goes back to that social conversation. We want women in this stage to feel like they can cook, they can socialize, they can eat, you know, without really just limiting their diets to 1 or 2 foods.

Dr. Ritamarie Loscalzo 00:43:09 Right. My diet, the diet that most people go on for metabolic reset is a huge amount of food, a huge different variety. It’s got to be, from a social perspective, challenging. If all you’re eating is me and all you’re eating is organic meat, you know, you’re getting all kinds of other processed things. That virtually eliminates almost every restaurant on the planet.

Dr. Jessica Drummond 00:43:32 Yeah, I totally agree. I think social health is part of what I was alluding to in the very beginning of this conversation. When we’re talking about like, what can we do as health and wellness professionals to start changing the tide on this chronically stressful lifestyle.

Dr. Jessica Drummond 00:43:49 You know, we have one of the major trends that’s forecasted to be coming up in 2025 and beyond is around more outside social interaction. And when we think about blood sugar and metabolic health, there’s nothing better than taking a hike with people like that.

Dr. Ritamarie Loscalzo 00:44:13 Laughing yeah, right. All of those things that are are health supportive that are not centered around food.

Dr. Jessica Drummond 00:44:21 Right, absolutely.

Dr. Ritamarie Loscalzo 00:44:23 And there’s so many.

Dr. Jessica Drummond 00:44:24 You know, and if you layer food on that, having a picnic outside or whatever, but doing it in a way that can be beautiful and connecting, you know, I think that’s one of the advantages of the way you do that. It’s very personalized, but it’s also very flexible.

Dr. Ritamarie Loscalzo 00:44:39 Yeah. Yeah.

Dr. Jessica Drummond 00:44:40 So anything else you want to leave our listeners with? As we wrap up this conversation.

Dr. Ritamarie Loscalzo 00:44:47 I would say that when you’re working with people, you’re really understanding that this is a challenging time for them. If you’re already past that time, then having personally gone through it might help you and in really understanding with people.

Dr. Ritamarie Loscalzo 00:45:02 But teaching them that having a healthy body is the best gift they can give themselves and the best gift they can give their loved ones, and that they don’t have to take it all at the same time. Unless of course, they are suffering from cancer or just had a heart attack, or, you know, something where it’s imminent that they don’t take their time because they may not have a lot of time. So it’s really working with people where they’re at and giving them small changes, so they get small wins at the beginning. And then I would say that what I find is testing with a glucose meter or testing their fingers, or just getting a panel of different kinds of tests, is one of the most motivating things you can do for people because when they see it, it’s not just you saying it, they see it and they go, oh my God, I better change this.

Dr. Jessica Drummond 00:45:52 Yes, thank you for that. And having personally gone through menopause yourself and, you know, kind of leading the way there, I think.

Dr. Jessica Drummond 00:46:01 What do you see as the future of health and wellness for women in their 60s? 70s 80s. Because now that women are healthier through their perimenopause to menopause, you know, with my own students, I keep periodically bringing up the fact that every single one of the Golden Girls was in their 40s. And that was not that long ago, right? That show was like, I don’t know, 30 years ago. Many of my friends are in their 60s, even 70s and thriving. What’s your perspective on that? Kind of you know, I think no one has talked about the age range of 60 70s and 80s nearly enough.

Dr. Ritamarie Loscalzo 00:46:37 Yeah, well, I would say that life begins after 50. I personally did not have a problem in menopause, and I attributed it to the fact that I was metabolically healthy and that I had been taking care of my health for decades before that, and not that I did in my first 25 years of life.

Dr. Jessica Drummond 00:46:58 But for sure after that.

Dr. Ritamarie Loscalzo 00:47:00 And so I think I was able to circumvent a lot of the symptoms of menopause that most people I know went through.

Dr. Ritamarie Loscalzo 00:47:08 I’m 68 now, so that means I’m close to 70. About a year and a half I’ll be 70 and I’m as active as I ever was. I’m lifting weights, I’m hiking, I’m walking, I’m running, swimming, and I’m running a busy business. And so it can be you too. And it’s never too late. I work with people in their 70s and 80s all the time, and when they say to me, my goal is to be, you know, in my 90s and hundreds and be active and fit and not sick. And you don’t have to be the average person in their 60s is on a long list of medication. I think it’s five medications on average. I’m not on any. So somebody’s taking some of mine, right? My husband’s in his 70s and he’s not on any right. And that’s the way we intended to continue to be. Right. And it can be, no matter what your age is, when you make shifts, if you take care of this vehicle, it’s going to take care of you the same way as your car.

Dr. Ritamarie Loscalzo 00:48:09 Right. We don’t ignore the health of our car, and we change the oil and we put the right kind of gas in it. We just have to do the same for our bodies. And when you do, I always say nothing tastes as good as healthy feels. There’s no way. I used to love M&Ms and chocolate chip cookies, and I don’t eat M&Ms, and I made chocolate chip cookies. But I can make healthy chocolate chip cookies. Yeah, but I can’t make healthy M&Ms. I haven’t figured that one out yet, but I can make healthy Mars bars. I figured that.

Dr. Jessica Drummond 00:48:37 One, you know?

Dr. Ritamarie Loscalzo 00:48:38 Okay, there you go. And so. And almond Joy. Enjoy. But the point is, the temporary pleasure of the food pales in comparison to this feeling good all the time.

Dr. Jessica Drummond 00:48:49 Yeah, absolutely. Well, that is extremely inspiring, and I’m so grateful to you for not just putting together such a really focused program that looks at everything so holistically, but also for really being a personal inspiration.

Dr. Jessica Drummond 00:49:05 I do think you stepping into living this lifestyle and being a model for people is really inspiring. So thank you.

Dr. Ritamarie Loscalzo 00:49:13 Thank you.

Dr. Jessica Drummond 00:49:13 Appreciate it. Thanks so much for being here everyone. And you’ll see in the show notes, we’ll give you the checklist of beautiful foods to enjoy that Doctor Rita Maria is going to share with us. And we’ll see you soon. Thank you so much. That was a wonderful conversation. I always love talking to Doctor Ritamarie because we’ve been friends for a really long time and she is just inspiring. She really walks the talk. She’s active, she travels. She just got back from her son’s wedding a couple of months ago. She was talking about a trip she’s taking next month, and she’s 68 years old and life has barely beginning for her. And I really feel like the women in our field that are not just talking about these things were trying to live this perfectionist wellness lifestyle, but who are collecting the data, who are making holistic changes not just about a restrictive diet, but about movement, about timing, about pleasure, about connection.

Dr. Jessica Drummond 00:50:23 You know, when she says, life begins at 50 and you’re working with women in their 30s, 40s, and 50s who feel like life is ending. Getting some inspiration from the way Doctor Ritamarie works and lives, I think helps women open their vision, open their possibilities of what life is available to them, not just in their perimenopause and menopause transition, but for decades, decades beyond. And I think this is one of the conversations that Doctor Marie is leading the way. And this is your opportunity. So this is what I want you to take back to your practice starting today. Starting tomorrow, help your clients really see that there are more and more role models of women living pleasurable, joyful, healthy, moving, active lifestyles into their late 60s. 70s 80s 90. She has clients who are starting at 80. I think that’s just so inspiring. And when you start to frame it in that way for your clients, they can think with an even bigger vision and they’re not so overwhelmed by having to live in this perfectionistic way.

Dr. Jessica Drummond 00:51:43 It’s not sustainable. And if we’re helping women live healthfully for decades, we want them to enjoy it as well. I’ll see you next week. Thanks so much for being here with us on the Integrative Women’s Health podcast. Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients. Let’s innovate and integrate in the world of women’s health.