Hashimoto's Nutrition Rx®️

How to Reverse Insulin Resistance with Andy De Santis, Registered Dietitian

Nataliia Sanzo, Licensed Registered Dietitian Episode 59

In this conversation, Nataliia Sanzo and Andy DeSantis discuss the critical relationship between insulin resistance, gut health, and Hashimoto's disease. They explore how insulin resistance can exacerbate thyroid issues, the importance of diet and lifestyle factors in managing insulin sensitivity, and the role of gut health in overall metabolic function. The discussion includes practical dietary recommendations, debunking common myths about insulin resistance, and emphasizing the importance of fiber and legumes in the diet. The conversation concludes with actionable steps listeners can take to improve their health.

Contact Andy @andytherd on Instagram

Contact Nataliia Sanzo at All Purpose Nutrition
Office Phone: (615) 866-5384
Location: 7105 S Springs Dr., Suite 208, Franklin, TN 37067
Website: www.allpurposenutrition.com
Instagram: @all.purpose.nutrition



Formerly known as Thyroid Hair Loss Connection Podcast.


Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Hey everyone, welcome to Hashimoto's Nutrition Rx show. Today I have a special guest who is passionate about nutrition as he is about making people laugh. Andy DeSantis is a registered dietitian and 11 time published author. He has helped people reach their health goals with his clear, no-nonsense approach and his big dose of humor With his extensive education, including master's degree in public health nutrition from. With his clear, no-nonsense approach and his big dose of humor With his extensive education, including master's degree in public health nutrition from University of Toronto. Andy has been all over. He has worked with top health organizations and even made appearance in media, but today he's here to help you figure out how to improve insulin sensitivity and decrease inflammation, all while improving gut health. So buckle up and get ready for a dose of nutrition wisdom. Welcome, andy.

Andy De Santis RD, MPH:

Thank you so much for having me. I'm very excited to be here and definitely very excited to talk about this subject area, which is definitely important to me and my practice and my scientific interest, honestly, more than anything else, and I know it interests you too, so it's going to be a good time.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Yes, absolutely. I'm excited to have you on the podcast today because you have such a wealth of knowledge when it comes to insulin resistance and I know this topic is incredibly important for my Hashimoto's community. And, andy, before we start, or before you start, sharing your knowledge, let me cover a few reasons why insulin resistance is something that we need to pay attention to when managing Hashimoto's, because insulin resistance it can worsen thyroid symptoms. It can contribute to weight gain, fatigue and difficulty losing weight, and understanding how to manage insulin resistance can help ease these challenges. Then, insulin resistance impacts metabolism, and Hashimoto's already slows down metabolism due to low thyroid hormones, and insulin resistance can make all of this even worse, and insulin resistance can make all of this even worse.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Of course, insulin resistance increases inflammation well, chronic inflammation right which can exacerbate other health issues and worsen thyroid functions. And finally, we'll be talking about gut health, because we know that gut health is incredibly important in managing Hashimoto's. Gut health is incredibly important in managing Hashimoto's, and what's fascinating is that gut health is also a key factor in insulin sensitivity. Andy is here to help us understand how improving gut health can actually help insulin resistance and, in turn, thyroid health. So, andy, what exactly is insulin resistance?

Andy De Santis RD, MPH:

Great intro and great contextualizing as it relates to Hashimoto's.

Andy De Santis RD, MPH:

That was interesting for me and we'll definitely talk about some of those things. You know look, insulin resistance, insulin sensitivity ultimately what it refers to is how well the cells of your body respond to the hormone insulin In the simplest way possible, just like the name sounds like, and that has consequences for fat metabolism, carbohydrate metabolism, many other things we'll talk about today, and it's obviously it's very complicated, right, and there's different levels to it. There's a level that you and I will discuss it about. There's a level that people out there will bring into life with, and there's people who maybe have a PhD in the subject area and then they know terms that we don't. But ultimately, you know insulin and your cells interact, and how well they communicate with each other is essentially. You know what insulin resistance and insulin sensitivity boil down to, and if they communicate well, you get better health outcomes, and if they don't communicate well, for various reasons, you get worse health outcomes. But I think honestly, in terms of a working definition, I think it's a perfectly fine way to look at it.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Absolutely, and I love the simple ways explaining what is such a complex topic, because if you can't explain it simply, then you don't understand it. What people don't realize is that different tissues have different insulin sensitivities, like your pancreas, liver, blood vessels and your muscles are all involved in insulin resistance. It's like we said pancreas, it produces insulin, so that's like a first organ to pay attention to. Then, of course, liver is storing your insulin is signaling your liver to store excess glucose or release it, and of course, our muscles, muscles, store excess energy. That's why you know and we're probably going to touch on that how we say oh, go for a walk after your meal, because your muscles are the major organ and tissues that use that insulin.

Andy De Santis RD, MPH:

Yeah. So then there's multiple studies that show that going from no physical activity to even a modest amount, five 30-minute brisk walks a week, that can significantly enhance insulin sensitivity. Of course, resistance training. Lots of evidence, long-term studies, you know, if there's a little bit of resistance training involved better beta cell function, you know, which is in the pancreas much lower risk of type 2 diabetes. That's obviously just one aspect, right, but activity plays a big, you know we can spoiler alert. You know physical activity plays a big role?

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Absolutely so. If physical activity plays a big role, how does the insulin sensitivity start?

Andy De Santis RD, MPH:

Well, yeah, fair enough. I mean, realistically speaking, there's multiple factors at play and these are not going to be necessarily unusual. Obviously, physical activity sedentary versus moderately active versus very active that plays a role. Okay, sleep quality Good evidence shows that. If you, you know, you take individuals and I've seen, I've seen a study where you take someone who sleeps seven to eight hours a night, you take it down to six hours for six weeks that worsens insulin resistance by about 20%. Okay, and it's a bit abstract to say it in those terms, but you know, just for the sake of it, that's not a good thing, right? So even moderate term sleep reduction can increase insulin resistance.

Andy De Santis RD, MPH:

What I'll say as well is let's talk about sleep for a second, because there's one quick action point I can give on that and in terms of the evidence I've seen, right, and then we've all been in this scenario let's just say that you know we're not going to get the eight hours of sleep we might want on a given night. Sometimes what we do and I'm guilty of this, you know I'm not going to get eight, I'm going to be tired anyway. I might as well sleep five, I might as well sleep five and a half, it doesn't really matter, but what I've seen evidence-wise is even 45 minutes of additional sleep, if it gets you over the six or seven hour threshold, will actually help with insulin resistance. So I think that's an actual message for people is that even as low as 45 minutes of extra sleep can make a difference. And I know that not everybody can get that perfect seven, eight hours due to life commitments, family work or otherwise. So I think that's important.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

So you're saying hit that snooze button for extra 30 to 45 minutes.

Andy De Santis RD, MPH:

If you can do that or get to sleep 30 to 45 minutes earlier, then yeah, absolutely, I think that will serve you very well. And then, of course, you have the dietary aspect right, I mean, and the most likely path forward for someone to end up with insulin resistance is probably a combination of the physical activity hasn't quite been there and on nutrition side it hasn't quite been there either. Maybe protein's inadequate, Maybe like the average glycemic index of the diet is quite high. There aren't like mitigating components that help reduce insulin resistance, like anthocyanins, which are, you know, we'll talk about some of the fancy compounds that help, but it's really a combination. I would look to personally sleep, physical activity and then diet right as three big pillars, and that's not going to be earth shattering. That obviously influences the majority of human health. But those are good areas to look at and obviously areas that we can act on.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Absolutely. We're going to try to simplify all of these areas, even though this is a complex topic, but we're going to boil it down to actionable steps our listeners can take today, actually starting next meal or even before meal. Right, because there are some strategies. Now let's talk about some of the myths that our listeners maybe heard or read about how insulin resistance starts. One of those is that insulin resistance is caused by obesity, like if you're overweight, chances are you have insulin resistance. Do you have any insight on that?

Andy De Santis RD, MPH:

Yeah, so this is a very interesting area, because what so? There's a few things that are very important to say. First of all, let's just say body weight, why someone is on, you know, in BMI for its limitations. Let's say someone's on the higher end. What is certainly true is that person can reduce insulin resistance without significant weight loss. I think that's the most important message right Now.

Andy De Santis RD, MPH:

I specialize in fatty liver, and fatty liver and insulin resistance are tightly related, and there are multiple studies and, anecdotally, I've helped many people right to reduce insulin resistance, to reduce liver fat levels without revolutionizing their body weight. And why that message is important is because and I'm sure you know there are many people out there they're putting their best foot forward, they're making real changes, but perhaps due to the nature of calorie balance, energy expenditure, they're not quite able to see a downward trend in body weight. So it's very, very important that we don't overvalue that as a metric. In my opinion, if someone wants to pursue body weight loss, body fat loss, that's their right to do so. But I don't want to confuse the two things. I'll make a quick comment about something you said at the beginning of the video regarding insulin resistance and successful weight loss and so on.

Andy De Santis RD, MPH:

I recently encountered a long-term study and what they found in this particular study and I look at so many papers that the name eludes me, but people will be able to find this with a quick search they looked at body fat loss over an extended period and what they found is the individuals who lost the most body fat and lost the most visceral fat, the fat stored in and around the organs, which is the one that you really want to get rid of the people with the best insulin sensitivity were most successful.

Andy De Santis RD, MPH:

Right, which is pretty much a code for saying you know, if you kind of do the lifestyle stuff and you eat well, if you're trying to manage your calories and you also eat well, you're going to get an extra benefit for that reason, you know. So it's not just about macros and calories, as much as that is relevant. So I think that's an important message for people to hear and I think that essentially answers your question. You can certainly have someone at a low body weight who's insulin resistant, and you can certainly have someone at a high body weight with great metrics in that area, but then, above and beyond that, it's the associated behaviors that matter most and, of course, genetics can play a role as well.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

And you know I don't like giving personal example but at normal weight I, a few years ago, I developed insulin resistance. My fasting insulin was high, my fasting glucose was high, my hemoglobin A1c was at like 5.6, which is still at normal range. But for me I was like I'm eating well, I'm exercising. What is happening, and that's what forced me to look into hormonal balance Hashimoto's with thyroid and that's why I wanted to bring this topic up. Like you, don't have to be overweight to have insulin resistance.

Andy De Santis RD, MPH:

So stress could play a big role as well.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Absolutely. I was, you know, finishing school. Just you know, you went through the same steps to get your registered dietitian license. It was very stressful, so who knows why it happened, but I implemented all the strategies that we'll be talking about today to reverse my insulin resistance. But the point is, yeah, you can be normal weight and thinking that you're eating everything right and you're doing everything right and still have this problem.

Andy De Santis RD, MPH:

Yes, absolutely.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

You mentioned about carbohydrate intake, but it's actually a myth right that insulin resistance is always caused by high carbohydrate intake. That's not true, or not always true.

Andy De Santis RD, MPH:

For sure. I mean, there are a few realities. You know. Nutrition, I referred to it. It's like nutrition is a game of averages, so the average of your behaviors around food is going to dictate a lot about your health.

Andy De Santis RD, MPH:

So as much as we could say objectively that white bread or maybe white rice or like a bakery item is, that's not a superfood to reduce insulin resistance. It certainly has a high glycemic index. It's not optimal. But if you let's just say for the sake of argument, someone's eating 200 calories of white rice a day, but then the rest of their diet is characterized by check, check, check and we'll talk about what those are right Protein, phytonutririents, monounsaturated fats, you know that individual is going to be pretty well protected against insulin resistance. So it's always with the totality of factors.

Andy De Santis RD, MPH:

Of course people like to simplify things and particularly on the negative side, this one thing causes this problem. It's it's rarely the other way around where it's like this one food fixes this problem because there's a fear and avoidance. People resonate with that unfortunately more. But you're absolutely right. I mean, eliminating carbohydrates is not necessarily the path forward to resolving insulin resistance. Certainly you have to be understanding that there are different types of carbohydrates and be selective and find the right balance with other foods, that there are different types of carbohydrates and be selective and find the right balance with other foods. But the idea that you cannot eat carbohydrates at all to reverse insulin resistance although some people will put that forward because it might sound sexy it's definitely not required.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

And I think it's actually hurt somebody journey of reversing insulin resistance because people say, oh, if insulin resistance is caused by high blood sugar, let me cut out all carbohydrates, go on keto diet and I'll be fine.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

But what I see in my practice and one of my clients it was such a specific example which I love to bring up during conversations like this is that she had insulin resistance. Dr Google told her that she needs to go on the keto diet. She did. She stuck to it for like six months, got her hemoglobin A1c rechecked and her fasting insulin and actually her numbers got worse because she replaced good carbohydrates, because she replaced good carbohydrates oatmeal and whole grain bread and fruits and vegetables and beans with keto foods, low-carbohydrate foods that tend to have high saturated fat content, a lot of trans fats and omega-6 fatty acids. So all of those actually those three things actually make insulin resistance worse than carbohydrates. So I mean this was an extreme example and she didn't change anything else. So I don't think a lot of people don't I mean people don't realize when they do the switch.

Andy De Santis RD, MPH:

Yes, and the issue there is that there's many different ways to do a ketogenic diet, right? So, just like there's many different ways to do a vegan diet, you know, somebody could eat kale and avocado and salmon all day, or they could eat, you know, sausages dipped in cheese whiz, and that's keto both.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Or steak with butter over it, oh boy.

Andy De Santis RD, MPH:

Yeah, I know that's a very common, I know it's increasingly popular trend, I mean, know, I know that's a very calm, I know it's increasingly popular trend, I mean and look in a strong, balanced diet.

Andy De Santis RD, MPH:

Many people could have steak quite regularly, to no detriment. But I think what scientists believe is that excessive amount of saturated fat it can interfere with how the mitochondria function, and so the mitochondria are part of cells that work with fat metabolism and other aspects of metabolism. They're definitely tied in with insulin, and so that's one of the reasons why scientists believe too much saturated fat is not the best, and obviously there's a lot of complicated aspects there. But carbohydrates speaking of carbohydrates, one of the families of foods that are carbohydrate-rich foods like legumes, lentils, chickpeas, kidney beans, black beans those are great example of foods that can reduce insulin resistance, for example, and equally, on the keto diet, somebody can eat a lot of monounsaturated fat from nuts that can reduce insulin. So there's something for everyone out there. But there's ways to do things well and ways to do things less well, no matter what rules you're putting on yourself.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

I agree less well, no matter what rules you're putting on yourself, I agree. I think if somebody sets their mind on a certain diet either keto or vegan diet, or eating only fruits I think there is a way to do that specific diet in a healthy way, to make sure that you get all the nutrition. But, as you know as a registered dietitian, you know it requires a lot of planning, especially on our parts, because that's our job. We can simplify that process for people. But yes, I'm with you, you can do keto diet a healthier way?

Andy De Santis RD, MPH:

Sure, yeah, I'm just, like you know, sometimes just a closed loop. Sometimes people are their minds already set and it's like at that point it's not to say don't do this, it's like here's the best way for you to do it and for many of these quote-unquote diets there are better ways. I mean, when you get down to carnivore level, I mean there's only one way I'm supposed to do it. So it's kind of. I'm kind of it's whatever right, there's no room to intervene. But yeah, so just to say I'm not necessarily advocating for one way or the, but even a vegan diet and with people with good intentions, you can do that very wrong, unfortunately, nutritionally speaking.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Yes. So we're talking about oh, eat this, it causes insulin sensitivity, or don't eat this, it will improve insulin sensitivity. So what is the connection between gut health, insulin sensitivity and let's throw in inflammation in there?

Andy De Santis RD, MPH:

Yeah, fair enough. So it's a big question. So there's a few different ways we could look at it. So one example is when you have, like you know, your gut microbiome, when it's in a good place, which is to say, let's say, it is characterized by a diverse amount of what we might call like health promoting bacteria. So, as in you know, scientists deem that people with higher levels of these bacteria generally have better health, and it's a complicated subject area. So I try and I don't want to oversimplify, but let's just say someone's gut microbiome is in a good place.

Andy De Santis RD, MPH:

A healthy gut microbiome generally produces compounds called short-chain fatty acids. Okay, what scientists and also, but in order to do that, they have to be given certain types of foods to be fed, like what we call prebiotic fiber. So that's where legumes, lentils, chickpeas, kidney beans, black beans come in. So one of the many reasons why foods like that lower insulin resistance is they stimulate your gut bacteria to produce these short-chain fatty acids, one of which is called butyrate or butyrate, depending on how you want to pronounce it and what scientists believe is actually. These short chain fatty acids actually interact with the beta cells in the pancreas. So that's one of a number of things they might do in the body, right, they also have anti-inflammatory effects.

Andy De Santis RD, MPH:

Now, inflammation is a massive subject, but I'll try and give an example. Very often people use the idea that insulin is a key that opens the cells to let sugar go in. Okay, that's like on a basic level. And there's a lot of other stuff that goes on there, right. Like, for example and I'll give this example because we're talking about it Like, if you know, magnesium, of which lentils and chickpeas legumes are high in magnesium, is anti-inflammatory, right, but it also helps. It also creates more glucose receptors on the cells and helps all the reactions that take place. So when people's magnesium intake goes up, insulin resistance goes down, because once insulin connects to the cell to open it up, a bunch of other stuff has to happen and magnesium plays a role in all of that. So, anyway, just to say that. So imagine the keys in the door, so inflammation, so I said at the beginning, insulin resistance is your insulin. Your cells don't communicate as well as they should. So imagine you're putting a key in the door like a dragon is like breathing fire on you and you can't get the key in because you're going to burn your hand. That's kind of like what it is.

Andy De Santis RD, MPH:

Inflammation worsens insulin resistance because it makes it even harder for insulin and your cells to communicate, but it's a two-way street because insulin resistance also worsens inflammation. It's a vicious cycle and I'm going to give one example of how this happens as it relates to the liver, because that's my area of expertise. So when you have insulin resistance, generally it can lead to in someone with fatty liver, it can lead to fat being stored in the liver cells and they're not supposed to be there. Okay. As a response to that, you know, inflammation occurs. It's an inflammatory response to fat being stored right, because it's fat being stored in the cells is toxic, essentially, right, right, so in that case insulin resistance leads to inflammation, right, and that's just one micro example. Now to your point earlier. These interactions occur all over the body, so they look different in different areas, but that's just one tangible example of how it occurs in the liver.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

I think the main point was that our gut microbiome. It influenced not only our immune system I feel like everybody knows that but also metabolism. And when we talk about storing glucose, that's your metabolism, that's how well your cells are opening, and the fact that our cells, or our gut microbiome, produces this byproduct, butyrate, short chain fatty acid. A lot of people miss that connection. They're like, oh, let me take these supplements. But they don't realize that to produce that butyrate, you have to feed the good bacteria.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

And what do they eat? They eat complex carbohydrates, fibers, all kinds of fibers, right, I think we know there's like 300 types of fiber and every plant kingdom has its own fiber, but we just call them all one name fiber. But the reason we, as registered dietitian, always say, oh, eat the rainbow, it's not because it's cute, it's because we're encouraging people to include as many colorful fruits and vegetables as possible, because they all provide different kinds of foods for trillions of microbes out there. The only thing I wanted to mention as far as like gut and insulin-resistant connection, is that gut microbiome also regulates hormones, right, especially like GLP-1, which helps control insulin production. And we know that GLP-1 is responsible for regulating blood sugar and, in turn, regulating appetite, and this GLP-1 is now a very hot topic with weight loss medication, but in our world we're looking at it as a satiety hormone and something that helps us store the glucose away.

Andy De Santis RD, MPH:

Yeah, and I saw some recent evidence I was sharing on my page that monounsaturated fat, which is a fancy way to refer to the fat that's in nuts and avocado and olives and olive oil. Monounsaturated fat actually stimulates GLP-1 production, and monounsaturated fat also helps insulin sensitivity, and you can be sure that those phenomenon are connected and even to your point about eating colorful vegetables. Absolutely, but even a banana which is I guess it's yellow or it's whitish, whatever Even banana has at least two different types of fiber inulin and resistant starch that are helpful for like a microbiome. Right, bring up bananas because they don't necessarily get much attention, and that's not their fault, because other fruits just have so much good stuff, more so than that bananas are not good, but uh yeah, so just just just share that I think bananas got a bad rap in the last two years because they're not ketogenic and it's all sugar and sugar it feeds everything, feeds inflammation and cancer and all that stuff.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

That's all the you know, um, maybe not misconceptions, but exaggerated terms, because banana is great, potassium is great for regulating, you know, hundreds of functions in the body, including our muscles contraction. You know people don't realize that and muscles what? They're very metabolically active when it comes to glucose stores and stuff.

Andy De Santis RD, MPH:

So eat bananas and I'll just tell you one funny thing. I mean and you know that, you know that I was doing a presentation earlier and someone asked me you know, okay, they say an apple a day keeps a doctor away. Is that true? Is there something else? And in parallel they're asking me about bananas. Well, I said, well, you could probably make the case. You know, one of the most common reasons for doctors to visit in North America is high blood pressure. So bananas have magnesium and potassium, and relatively obviously more potassium than magnesium, but they have both in a meaningful amount, and those two nutrients play a big role in blood sugar regulation. So you could argue, you could probably make an argument that a banana is more likely to keep the doctor away than an apple because it's higher in potassium and magnesium. Like I mean again, if you care to make that argument. I mean, obviously it's all good either way, but that's just, you could make that argument if you wanted to.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Absolutely, and the fact that most people in America I don't know about Canada don't get enough potassium, shockingly, and they are cutting out all the fruits and vegetables because a lot of people are going on keto diet. So I think we're making this matter worse.

Andy De Santis RD, MPH:

It's tough. It's tough. It's tough to account for People don't consume enough potassium, not enough magnesium, not enough vitamin D, not enough vitamin A and yes, I mean a lot of those are in fruits and vegetables and other things. But it's tough because you have this data which shows certain things, and then everyone's on a different spectrum in terms of exactly what they're doing. That's the joy of customized work, of course, that we get to do with clients. But yeah, it's not easy. It's not easy to resolve all this.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Absolutely so. Fixing your gut can help improve blood sugar and reduce inflammation right.

Andy De Santis RD, MPH:

Yeah, I mean a basic example of this. And look, let's talk about probiotic supplementation for a moment. Let's just use this as an example. Okay, now again for fatty liver, which I spend a lot of time on. People with a fatty liver take a probiotic supplement. Now, almost everyone who has a fatty liver has imbalances in their gut bacteria and they also have insulin resistance. So that's why I'm using it as an example here. So probiotics can reduce insulin resistance and inflammatory markers in people who have a fatty liver, which is very interesting.

Andy De Santis RD, MPH:

I'm not going to say it completely takes it down to where it needs to be. It's only one small piece of the puzzle, but the reason for that is because of its positive influence on the gut microbiome, right, and that's a simple example and there's a lot of layers there, but that's just a great example. And I've even seen evidence like probiotics and people with type 2 can lower A1c by maybe 0.1, okay, which is not huge, but it's not nothing and, again, not definitive, but there are definitely trials that have demonstrated that. So that kind of ties it all in very nicely. And there's many more examples beyond that. I mean legumes are the best one. I mean legumes are the best one because they influence the gut bacteria. Because of the prebiotic fiber they lower insulin resistance and blood sugar. They lower cholesterol, even with small amounts, so I'm a big fan of them for that purpose.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

You're talking about probiotics, kind of reminded me. Another connection between gut and insulin sensitivity is, you know, this big term, increased intestinal permeability, or aka leaky gut, that's been thrown around on social media. There are some truths to that, especially, like for my community, for people with Hashimoto's. Like 90% of this population has increased gut permeability, measured by zonulin, which is a marker of how tight your junctions are. So when the zonulin levels are high or a person has increased intestinal permeability, the food particles can eventually make it out in the system, triggering white blood cells, triggering your immune system, to go into this override and that's what's causing this full body systemic inflammation, right. So it's not directly causing insulin sensitivity that we know of, right, but this we're talking about inflammation and how a poor gut health, you know, talking about probiotics, adding probiotics, how it all tightly connected. So, yeah, I deal with this all the time and I'm a huge proponent of probiotics.

Andy De Santis RD, MPH:

Yeah, and even to expand that point yeah, zonia, I've seen that as a relevant biomarker. There's also something called calprotectin, which measures inflammation in the digestive tract, and, interestingly enough so there's a family of compounds called polyphenols and, um, I I talk about them a lot and some examples of foods that are high in polyphenols artichoke, blueberries, flaxseed, dark chocolate. Those are a few and there's many more, but those are a few, and you know I saw I wrote an article recently based on some, some recently published evidence that actually found, like you know, higher poly, higher polyphenol intake, lower zonulin, lower calprotectin, so less permeability, less gut inflammation with higher polyphenol intake. Now, polyphenols, for those who don't know, one of the effects that are most famous for is for influencing the gut bacteria. So they're like a prebiotic but they're not a fiber. They're like a phytochemical, so they're not a vitamin, not a mineral, not a fiber but a beneficial Antioxidant.

Andy De Santis RD, MPH:

Exactly Sure, and a beneficial antioxidant. So that's a great example. And polyphenols are pretty you know. Scientists are pretty confident that they positively influence the gut bacteria, which is, they increase the levels of the ones that we believe are good for us.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

We started talking about these nutrients, like omega-3s, the polyphenols. They improve gut health and, in turn, improve insulin resistance. Are there any specific food?

Andy De Santis RD, MPH:

groups that people need to concentrate on. The two that I would say and partially because people don't always think about them would be legumes and I brought them up a few times because there's numerous studies as low as quarter cup of lentils a day can reduce insulin resistance. That's how effective they are. And a quarter cup of lentils canned lentils is not likely to cause anyone GI distress. It's a small amount. So if anyone's concerned about that, that would be where I would start. And canned lentils have the lowest FODMAP total and so on, so they're quite IBS functional. So legumes would be one. The next would be nuts. You know I brought up the point about insulin sensitivity and weight loss. Equally I you know there's a study published this year that showed that nut intake actually can improve brain insulin sensitivity, which is very fascinating, and so and actually I should correct myself earlier I said insulin sensitivity helps. Helps with visceral fat loss. It was specifically brain insulin sensitivity that they looked at in that study. Okay, so nuts are.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Yeah, that's our fatigue and our mental sharpness. If your brain uptake glucose better, that means that you function better. It's not just a fancy word that we're using because for some people they're like okay, so what does that mean? If my brain is using glucose, I can do. You know brain doesn't have to use glucose on keto diet. It use ketones. If you want to be well rounded, healthy person, you know you want to concentrate on the good type of sugar and fiber and healthy fats.

Andy De Santis RD, MPH:

Yes, absolutely. And then, even beyond that, the parts of the brain that are most responsible for food intake and appetite. From what I've seen, they also have the most insulin receptors. So that's also interesting, which means that if your brain is not responding well to insulin, you're going to feel that very heavily in terms of your appetite regulation, your cravings. That's an oversimplification, yes, but this is what I'm seeing in the scientific literature, right? So very interesting stuff.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Absolutely. I would add another group, just maybe berries, because first, they are my favorite and they're full of antioxidants and those polyphenols, and they not only improve insulin sensitivity.

Andy De Santis RD, MPH:

They also fight inflammation. Yeah, it's a one-two punch Berries 100%, because then you have blueberries with anthocyanins, and anthocyanins are one of the most potently anti-inflammatory compounds Lots of evidence. They help with insulin resistance. Raspberries have something called the allergic acid, which is good for the mitochondria, and then again we talked about the mitochondria and the role that plays right, so you can find something unique about every berry, and I would say yes for someone who likes them, whether fresh or frozen. However, they can access them economically, geographically. I mean, if you can eat berries most days, you'll be better off for it, there's no question.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Yes, and of course, we cannot miss an opportunity to talk about the leafy greens. Like kale, you have a beautiful picture behind you, I believe that's kale.

Andy De Santis RD, MPH:

It is kale. Yes, you're absolutely right.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

We know the darker the leafy greens are, the more vitamins and minerals they have, higher in fiber.

Andy De Santis RD, MPH:

And, yeah, leafy greens are also high in. You know talk about polyphenols and polyphenols is actually a massive group of compounds, absolutely massive, and one of the many subgroups of polyphenols are called flavonoids, flavonoids. Again like a lot of evidence. Flavonoid intake goes up. Diabetes risk goes down, fatty liver risk goes down. Brain health goes up. Leafy greens, kale, spinach, swiss chard have lots of flavonoids, also good for cognitive health because they extend brain cell life, they reduce inflammation of brain cells and so on. So, yeah, I did create some content on my page not long ago which showed that people who had the highest leafy green intake their brains aged at a much slower rate.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Oh, wow.

Andy De Santis RD, MPH:

You know, yeah, so all very interesting stuff. The downside is, when you look at all these studies, we always can't remember the exact journal and the year it was published. Of course, but this is out there and worthy to look at. I'll be happy to actually send it to you later too.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

And interesting? Yes, absolutely, and if you do, I can share it in the show notes below so people can read up on it and you know a lot of people, I think well, especially in my community, with Hashimoto's autoimmune disease a lot of as delicious and is as nutritious. Well, depending how you cook it, of course, and if you're using the juice that it's cooked in and all that stuff.

Andy De Santis RD, MPH:

And with leafy greens. The bioavailability of nutrients is usually higher after cooking, Not to say they're still good for you if they're raw, but usually there's going to be higher content of certain compounds when they're cooked. So that's bonus points too.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

And I think the only thing we didn't talk about is like fatty fish. Well, we've touched on omega, but that's our salmon mackerel sardines that I love personally.

Andy De Santis RD, MPH:

As do I Basically.

Andy De Santis RD, MPH:

I think it's important for people to know that there's two types of omega-3s, as do I, as do I Basically.

Andy De Santis RD, MPH:

I think it's important for people to know that there's two types of omega-3s. There's one type that's found in plant-based foods, like flax seeds and hemp seeds and walnuts, and soy-based foods, and that's good for you. But it's different than the other type, which is found in only fatty fish salmon, sardines, trout, herring, mackerel and really, if you don't eat fatty fish, you don't get exposed to those types of omega-3s EPA and DHA which are politely anti-inflammatory, which are associated with healthier gut, microbiome, lower triglycerides, better insulin sensitivity. So for me in my community fatty liver if someone's not eating fatty fish at a certain threshold it's pretty much for me they have to seriously consider an omega-3 supplement because you're going to be at a loss of that important nutrient. So, as a random fact, people with a fatty liver they tend to have lower levels of omega-3s in their liver cell membranes and that affects fat metabolism. So very cool stuff. And again, the reason I keep using fatty liver examples is insulin resistance is present in almost 100% of fatty liver cases, so it's such a good proxy for the conversation.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Oh no, you're definitely in the right place because with Hashimoto's autoimmune disease this full body systemic inflammation, slow metabolism most people with Hashimoto's are unfortunately, overweight. So I see a lot of fatty liver disease on different stages in my clients. So that's why I was like you're a perfect person to talk about it, because it's all interconnected and just insulin resistance. In general, it doesn't matter if you have Hashimoto's or don't. If you have fatty liver disease or don't, insulin resistance it can affect anybody. It does not discriminate, so anyone can benefit from listening or watching this episode.

Andy De Santis RD, MPH:

Yeah, the reality is. Again, if you want to talk about fatty liver, the reason why ultimately and to your point, which I appreciate that you made, is I do enjoy looking into all different areas. I really do like that and the reason I landed on focusing on fatty liver is because it really does bring to life. You have insulin resistance plays a role, inflammation plays a role, high triglycerides plays a role All of these different things which are related but unique microbiome imbalance plays a role are all brought together in this one place in fatty liver. So for me, I can give my philosophy on nutrition under the pretense of fixing this condition, but really I'm representing what I believe is the optimal way for longevity and eating. So that is literally a big part of the reason why I chose to specialize in this area, if that makes sense.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Absolutely, because, as you know, I have a specialty in just Hashimoto's autoimmune disease. But it all comes down to four or five pillars of health and it doesn't matter what disease you have, it doesn't matter if it's autoimmune or not. It all comes down to eating a balanced diet fruits, vegetables, nuts, seeds, fatty fish, colorful diet to not just improve insulin resistance but also improve your mental health, mental clarity, regulate hormones. So it's kind of an umbrella. Even though we specialize in different things, I think we're obviously talking about the same thing.

Andy De Santis RD, MPH:

It's true, and it is true that what I said for fat liver, it pretty much extends to every condition. That's the nature of how the body works. You don't really, you don't fix one thing without having an effect on something else. It's almost inevitable, right? Just depending on what it is. Some things can affect things more than others. Um, and also I should just say as well the the fatty.

Andy De Santis RD, MPH:

So fatty, so high triglycerides is a common problem. So high triglycerides, insulin resistance, resistance are definitely connected because insulin. People think of insulin as it's related to carbohydrate metabolism, which is to regulate your blood sugar levels. But insulin plays a massive role in fat metabolism, which is to say it regulates your blood fat levels. And, for the sake of this discussion, we can think of triglycerides in the blood as basically the same as blood sugar, except it's fat. And very often high triglycerides are a common feature of fatty liver because there's insulin resistance. So your body doesn't work with fats the way it should, but there's too much fat in the blood, right? Just like how having type 2 diabetes can increase your risk of damage to your eyes and feet because there's too much sugar floating around in the blood and there's too much fat floating around in the blood, there's a higher chance it's going to get stored in your liver. That's a great way to connect the two things together.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

What I know about the triglycerides and fats in general is that of course, they're inside your cell and when you have all the sugar in your blood flowing, trying to be compartmentalized, your cells are sitting there with so much energy from fat, just stuffed with energy, and saying no, no, no, go away sugar, we don't need you because we have, we already have so much energy and as more blood sugar flowing there, your pancreas makes more insulin and it just snowballs, right, that's going back to. It's not just carbohydrates that cause insulin resistance.

Andy De Santis RD, MPH:

Primarily, it's actually fats, triglycerides, trans fats, saturated fats it's actually fats, triglycerides, trans fats, saturated fats and, to be perfectly honest, like I, look into a lot of this stuff and the level of complexity of what actually goes on is extraordinarily high. We're talking about it in a way that's factually true, you and I, but you can get two people who have a PhD in the subject and they're going to say terms and it is like the complexity is so, so high. So why am I saying that to anyone? Listening Is, I guess, anyone out there who especially tries to oversimplify things and not have a bit of an expanded conversation? That's a red flag.

Andy De Santis RD, MPH:

It's not always this does this for this one reason. It's like people try to pin fructose on fatty liver, for example. That's another. That's one you know and I'm sure you know for hypothyroidism, for hypochromatosis. It's very similar. And I don't know what those examples are because I don't spend as much time in that area, but I'm sure they exist and if you want to share them, I'll be happy to listen to them as well. But yeah, just to keep in mind what I thought of when you said it.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

It's like in my world it's gluten. Gluten is evil, gluten is killing us all. Gluten is this and that, but then you're looking. We just came back from Italy. We were there for nine days. We go there pretty often and I actually this is first time that I looked at the prevalence of Hashimoto's hypothyroidism in Italy. Because what do they eat there? Mostly pasta, pizzas, bread, drinking a lot of alcohol, wines specifically, but their prevalence of Hashimoto's hypothyroidism is much, much lower here in US. It's like oh, this is gluten. Stop eating dairy, stop eating gluten and you're not going to have Hashimoto's autoimmune disease, which is absolutely not true. I don't know where people get all of this. Maybe there's this much truth, but then the whole podcast name Humanity Against Gluten goes on.

Andy De Santis RD, MPH:

Yeah, if you're talking one or two slices of whole grain bread, if you think that removing that is going to be what fixes it, that changes your life. It's unlikely. If you have celiac disease, of course it will, but beyond that, you know that changes your life. It's unlikely. If you have celiac disease, of course it will, but beyond that, you know you want an avocado toast in the morning. Taking that away is not your path to salvation with nutrition. Right, and I'm not the first person to say that, but it's true.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

It is true we're talking about this big umbrella of pillars and steps that we can take. What are some of the dietary patterns Can you name like best top three or top five whatever it's arbitrary number diets that can improve insulin resistance, inflammation, gut health? What I would say.

Andy De Santis RD, MPH:

I would say that there's one that just stands above the rest by far for various reasons, and I would say it's what I call like a curated Mediterranean diet. So what that means to me is not a Mediterranean diet by the book, like you literally follow the guidelines presented. Mediterranean diet, for the most part, is telling people to eat more legumes, eat more nuts and eat more fatty fish, and these are things we've already talked about today. That's really what it's telling the average person. And then, on the flip side of that, that might entail eating a little bit less of other stuff so that you have room for these things, right? So I don't see the Mediterranean diet as saying not to eat red meat. I see it as saying eat more fish.

Andy De Santis RD, MPH:

So the reason why I say curate is because there are things like yogurt right Now for people who like yogurt. I'm a big fan of it, because a lot of evidence that shows that yogurt actually reduces risk of fatty liver, because yogurt influences the gut microbiome and I didn't mention this. But the gut and the liver are connected. So whatever your gut creates flows to your liver through the portal vein. So when your gut microbiome is healthy, good stuff flows. When it's not bad stuff flows. It's also the reason why antibiotic use is associated with increased risk for some people with fatty liver.

Andy De Santis RD, MPH:

So the Mediterranean diet curated, which means we take the things that's telling you to eat more that you're probably not eating enough of, and then we also just like, but we're also a little bit more relaxed about the other stuff.

Andy De Santis RD, MPH:

So if you want to eat red meat a little bit more than the Mediterranean diet says, I don't care.

Andy De Santis RD, MPH:

The Mediterranean diet is not big on dairy and I'm big on yogurt, because yogurt, independent of anything else, we can also put nuts and berries in yogurt, so it's the ultimate facilitator. So for me it is an individually curated Mediterranean diet and then also focusing within fruits and vegetables, on their choices, focusing on the ones that are the most unique, highest polyphenol content, highest flavonoid content. So that for me is like where I put my energy and then, yeah, I mean, then you can like okay, you just dash diet and like the American healthy eating index and these other things, and there are more or less just iterations of each other that are not that different in my opinion. So I would put the Mediterranean diet, but you take away the word Mediterranean and you have whatever cuisine you want, it's about the foods themselves. The name is meaningless. It just tells you the foods that you're not eating, that you need to eat more. That's really all the Mediterranean diet is, and in my opinion it does it best.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

I agree with you, I think Mediterranean diet every year it is named one of the best diet for overall health. In US I think everybody's like against dairy, but dairy is not inherently inflammatory. Actually, the latest study that we have that came out a couple of years ago. It's like it's a meta-analysis of 52 controlled trials show that people who eat dairy actually have lower inflammation, better gut health, better gut microbiome because they did test that and just overall healthy diet. Because, like you said, dairy is so versatile Because you can add stuff to it and you can eat it fresh or fermented or added to recipes and stuff. So I'm all up for dairy as well.

Andy De Santis RD, MPH:

Yeah, and let me be clear nobody has to eat dairy if they don't like it. You can live a great life and not eat it, but if you like it, you know it can play a role and it's specifically dairy that has an influence. Like you know, fermented products, yogurt, kefir, things like this, like it's very clear that these foods positively influence the gut microbiome, right, and equally the microbiome influences liver health, inflammation, insulin resistance. So that's where it comes from, you know. You know milk might not have anthocyanins or yogurt might have anthocyanins, but doesn't mean doesn't contribute in other ways. Um, but that's the joy, like that's the curated nature of it. Everyone has foods they are and aren't willing to eat. So it's like how can we get the most of compounds that are not found elsewhere with what you like? And then maybe we can supplement the rest. Like fish is the most obvious example. You don't eat fish, you're not going to optimize your omega-3 intake. You probably have to supplement, and then you can obviously then parse it down from there based on the other food groups.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Definitely, definitely. Supplements have and play such a huge role in people's life if they have gaps in their nutrition. I think supplements are great and they're important and you can take it. Most supplements are unnecessary, but when it comes to like iron for women, you know, vitamin D most people are deficient in vitamin D, omega-3, magnesium those are very helpful.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

But since we're talking about this best diet, what I'm started thinking about, the diet, what I kind of follow personally and what I see, my clients and my whole Hashimoto's population is like a low-carbohydrate, high-fiber diet, and low-carbohydrate is far from keto, because on a low-carbohydrate diet we're eating like 100 to 120 grams of carbs, which is a pretty substantial amount, and all of those carbs come from fruits, vegetables and, of course, legumes. Keep weight down, insulin sensitivity in check and still feel satiated, while still following a high fiber diet to make sure that your gut health is where it needs to be. I don't know if you agree, but I think the most satiating nutrient is fiber. I don't care, like for me, I don't care how much protein I eat. If my meal does not have fiber like 10 to 15 to 20 grams of fiber I will be hungry an hour later. But that may be just my personal mechanism.

Andy De Santis RD, MPH:

Yeah, no, fiber is incredibly important and reality is is that most people I tell this to my clients all the time I'm not, I don't say it with great joy, but most people. We have this, we have these challenges, we have a challenge. We, you know, don't need that much energy. It's hard to expend energy unless you're like a high-level athlete who's just not working and training all the time. It's very easy to eat a lot, so, inevitably.

Andy De Santis RD, MPH:

And then you have to reconcile that you need to hit a protein target right, because protein is indispensable. You have to. You don't have unlimited caloric intake to work with. And then you also have to respect the fact there's a lot of different foods with a lot of unique value, like nuts and other things. So something for the average person who doesn't have 5,000 calories to work with yeah, it's reasonable.

Andy De Santis RD, MPH:

You probably have to moderate a little bit your carbohydrates and like it's not to say that that's like an explicitly low-carbohydrate diet or not. I think 100, 120 grams is totally reasonable. Low carbohydrate diet or not, I think 100 120 grams is totally reasonable. It's just a reflection of the reality, of of what science tells us and how to leverage the highest quality diet. So that makes sense that that for most people that's what it looks like and, of course, if you have someone who's very active and you, you know they can have more carbohydrates and so on, of course but yeah, but most of us, I think, are sitting like this in front of the computer or the phone or whatever all day long.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

So I feel like the easiest way to manage is like stay within your carbohydrate window but also pay attention not just to your macros. I say stop counting everything and count your fiber and see how your life will change. You will automatically. You know, if you're concentrating on getting 40 to 50 grams of fiber per day, there's going to be no time or room to eat all the bad stuff or room to eat all the bad stuff. So it's like you know you count or track one macro or one nutrient fiber and everything else kind of going to fall into place. Just another approach.

Andy De Santis RD, MPH:

Yeah, no, no. And I was having a conversation with another dietician and then he was actually telling me that he actually often has people track fiber too, and that makes perfect sense. And he was actually telling me that he actually often has people track fiber too, and that makes perfect sense. And you know, I've seen a study where they compare the satiety value of meat versus beans and then beans were actually more satiating. So for those who don't know, yeah, for those who don't know, beans are pretty much the only food that has fiber and protein in the same place, and fiber and protein are the really heavily satiating dietary components. So a couple lentils has like 15 grams of fiber and 15 grams of protein, which is pretty cool. But it's not to say but again, people misunderstand. It's not to say it's beans or beef. You can have both in the same meal, you should have both in the same meal.

Andy De Santis RD, MPH:

Yes, you should. Yes, even better, yes, absolutely, and that would be the ultimately satiating meal, truly abundant like legumes, a protein source and vegetables. That's a very high level meal.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Well, Andy, we covered a lot of ground. What would be one takeaway for somebody who's finishing either watching or listening to this show? What can they do today to improve their insulin sensitivity?

Andy De Santis RD, MPH:

I would, let's say. First of all, I would say something I haven't said yet, which is to eat slowly, chew thoroughly, eat mindfully Okay, Like good evidence there, quick eaters, more insulin resistance and various other things come along with eating quickly. So definitely don't eat a meal in five minutes. That should take 15. Okay.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

I tell my clients to set a timer on the phone, like literally set a timer and just sit there and eat it.

Andy De Santis RD, MPH:

That's actually a good idea. To be honest, I might steal that. So, yeah, that's great, that's a great idea, and the next thing I would say is to combine stuff together. You know what I mean. Like, the more things you combine together first of all, the more likely you're going to be able to do like we've put all these great foods out there, and the negative side of that is like it's a lot of pressure for someone. Now how am I going to get these all in? So when you sit down to a meal or a snack, the more foods you can combine together the better. So if it's a snack instead of a fruit, can it be a fruit with nuts? Snacks are a good opportunity to combine things. Can it be yogurt, fruit and nuts, fruit and nuts? These components that help and, honestly, the highest return on investment advice I would give is go buy a bunch of canned lentils and pan fry them, season them up, pan fry them, put them in your fridge, or they can be cooked from fresh too, but that's a big step of effort.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

That might be overwhelming. Even I don't do that and I love to cook and I cook everything from scratch, but I'm like, don't ask me to cook lentils for, soak them overnight and then cook them for 45 minutes. I don't have that. Well, I have the time, everybody has the time, but I don't have patience.

Andy De Santis RD, MPH:

I refuse to do that I respect anyone who does, by all means, but get a bunch of cans of lentils. Hey, maybe you love white rice. Okay, a lot of studies. So I'm going to share this one study that I talked about recently because it kind of puts it all together. Okay, so in this study I think it was on the Nutrients Journal, I think it was in 2017.

Andy De Santis RD, MPH:

I have to remember this one, but they gave people either a three quarter cup of white rice or half a cup of white rice and half a cup of chickpeas or black beans. Now, lentils are basically the same thing, like literally exactly the same. It wouldn't matter. And what they found is that, even though the chickpeas and black beans was more total food as a cup of food versus a quarter cup, so more food and led to a smaller response and blood sugar levels. So that's like you know, that's how powerful legumes are. Right, you're talking more food, less blood sugar response, and you can mix it with white rice to dull the blood sugar effect of white rice, because a lot of people like white rice. So it's like you have to remove white rice to reduce insulin resistance. Right, that's a great example of that, you know.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

And the reason why lentils had less response in glucose right is because they have fiber.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

An incredible amount Because it slows down the absorption of sugar into your blood. So it's like you don't have that spike which I hate to use this word but it's the increase in blood sugar. It slows it down. And even if somebody likes white rice and eats it every day, what I encourage my clients to do and I do it myself is I make like a version of a fried rice, like Asian, you know, with vegetables, but I don't obviously fry it in butter and all that stuff. But I buy this frozen mixed vegetable medley, something from the frozen section, cook it up and I add it to rice so it looks like fried rice, but it's just rice with fiber added to it. So this way I still enjoy that food without worrying about my insulin resistance.

Andy De Santis RD, MPH:

Yeah, no, frozen vegetables are great, it's pathophys. Resistance and efficiency is important because nutrition is a medium to long-term game. If you cannot, you know I mean, I'm not the first to say it but if you cannot retain what you're doing to get to a certain point, you're not going to stay at that point. So I think it's helpful to you know look, step outside your comfort zone, set high standards for yourself, that's fine, but don't let those high standards be like the enemy of doing something halfway there, because doing any like if you do nothing else if someone listens to this, there's nothing else different besides having a couple lentils a day. There's literal human trials that show that amount is enough to reduce insulin resistance in the liver cells. You know that's meaningful as far as I'm concerned.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

I'm going to start doing that. I actually have. I have so many beans just different kinds of beans and I'm sure there are lentils, so I'm going to cook that for dinner tonight. Amazing, I took some notes in here, so I'm taking your advice to heart and I hope our listeners and if somebody's watching on YouTube take that too. So, andy, we covered a lot of information and I just want to take a moment to thank you for joining us today and sharing your incredible knowledge about insulin resistance and its connection to everything gut, liver and thyroid health way and I know listeners are going to walk away with some valuable insights, especially when it comes to improving insulin and supporting just overall health. And for everyone who's listening, I hope you're feeling empowered and ready to take actions on what we've discussed today. And, andy, if people want to learn more about you or want to reach out, where's the best place to find you?

Andy De Santis RD, MPH:

Yeah, I would say probably Instagram. Andy the RD, I've been sharing a lot. You know, I've been sharing a lot of my graphics on LinkedIn lately and people, people love it on there. I have to say, linkedin has been a fun little treat. Probably Instagram is the easiest one. So Andy the RDcom or Andy so andyvrdcom, or andyvrd, on Instagram or TikTok Been loving TikTok lately too, to be honest. So, yeah, one of those three and thank you so much for having me. It was a really amazing chat and I also learned some things too, and I might be using that timer with my clients sometime soon.

Nataliia Sanzo RD, LDN, Hashimto's Dietitian:

Yes, of course, of course, and I will leave all of your information in the show notes so people can easily find you. And again, thank you for being here. You've made this conversation both enlightening and fun and I know our listeners are going to benefit so much from the information you shared. Now, if you guys are listening to this podcast or watching it on YouTube, please subscribe to my channel to be notified when this episode and other episodes like this go live. Until next time, stay nourished.

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