In this episode, Dr. Eric Osansky talks with certified nutritionist and menopause specialist Leah Vachani about blood sugar imbalances, insulin resistance, and how these issues often show up long before a diagnosis of prediabetes or type 2 diabetes. Leah shares how her work with women in perimenopause and menopause led her to see blood sugar as a major missing piece in hormone health, energy, sleep, and weight regulation.
Together, they explore why stress, poor sleep, processed foods, and hormone shifts can all contribute to unstable blood sugar. Leah also explains how continuous glucose monitors can help people see their individual patterns more clearly, from food triggers to stress spikes, while also discussing the limits of CGMs, fasting insulin, A1C, protein intake, apple cider vinegar, intermittent fasting, and exercise.
This conversation gives listeners a practical, realistic look at how to support better metabolic health without chasing perfection. If you want a clearer, more balanced understanding of blood sugar imbalances and insulin resistance, you’ll get a lot out of this episode.
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Dr. Eric Osansky:
I am going to read Leah Vachani’s impressive bio here. Sometimes, I do it in the conversation, but I’m going to do it here instead: As a passionate advocate for holistic health and wellness, Leah helps women over 40 transform their lives through sustainable nutrition and lifestyle changes. As a certified nutritionist and menopause specialist, her expertise combines practical health coaching with science-backed strategies that deliver real results.
She specializes in hormone balancing, energy optimization, and sleep improvement, helping women get off their mood rollercoaster, sustain energy throughout the day, and fall asleep faster while staying asleep at night, through her website, LeahVachani.com; her podcast, Women Aging Powerfully, which I was a guest on; and as host of the Women Aging Powerfully Summit, where I have guested in the past.
She also shares evidence-based health strategies, nutritional guidance, and wellness tips. She offers personalized coaching through her group and 1:1 programs. Her mission is to empower you to take control of your health journey one small but powerful change at a time. Whether you’re struggling with low energy, poor sleep, or mood swings, or simply want to optimize your wellbeing, Leah provides the tools, support, and accountability you need to feel like yourself again.
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I am super excited to chat with today’s guest, Leah Vachani. We are going to be talking about blood sugar imbalances. It’s going to be a great conversation.
I want to start out, Leah, by- First of all, how are you doing today, Leah?
LeahVachani:
Good. I’m happy to be here. Thanks for having me on.
Dr. Eric:
It’s great to have you here. You do a lot with hormones and menopause and blood sugar. A lot of people have blood sugar imbalances. Is that the reason you decided to focus on helping people with blood sugar imbalances, because it’s so prevalent?
Leah:
That’s a really good question. When I went into nutrition, working with clients, I had zero desire to talk about blood sugar. As I progressed in my practice and my age, I hit perimenopause, and everything I thought I knew kind of went out the window. Everything that was working for me in the past in my 20s and 30s didn’t work anymore.
As I dove into perimenopause, menopause, hormone issues, and my problems, because when you solve your problems, you tend to solve your clients’ problems, I realized that we say it’s a hormone issue for perimenopause and menopause, which it is 100%. But what I didn’t realize is a big part of that puzzle is blood sugar and insulin. Insulin is acting like a hormone in the body.
When I started to dive into that, I realized that it was such a big player in how we feel as women going in our 40s, 50s, 60s, and beyond, and how everything is changing. That is intricately involved in that.
At that point, I was like, I can’t ignore this. I need to do a deep dive into blood sugar, insulin, how that plays a role. That’s how I got here, working with clients.
Dr. Eric:
Thanks for that brief background. Why do so many people have blood sugar imbalances, insulin resistance, type two diabetes?
Leah:
It’s growing. The prevalence of type two or prediabetes is growing exponentially, which is concerning. I think it’s a very complex issue, butit can come down to some of the same factors.
In general, we just aren’t eating a great diet anymore. A lot of people are eating more packaged foods, more processed foods. Part of that is a time issue. We lead very stressful, busy lives. We don’t take the time to cook anymore.
Stress and sleep are a huge part of what my clients are dealing with, what many women are dealing with. Not addressing stress and sleep are huge components of blood sugar issues.
Of course, we talked about hormone shifts. That is out of our control in a way as we go through this shift. That plays a huge role in insulin resistance, which I’m sure we’ll talk about, and blood sugar imbalances.
Dr. Eric:
A lot of people don’t think about stress and sleep when it comes to blood sugar. Definitely could have dramatic impact. The importance of sleep, getting that 7-8 hours of sleep.
Leah:
I can expand on those if you want. We could do 10 episodes just on stress and sleep. That’s how complex it is.
Dr. Eric:
Yeah. When it comes to sleep, what is your approach? Is it the typical 7-8 hours, or does it depend on the person? Do you find some people can get away with six hours and still have healthy blood sugar levels and mitochondria?
Leah:
Everyone is biologically unique. What works for one woman, maybe that six hours of quality sleep is fine for her. Another woman might need eight hours of quality sleep. The key is quality. It’s not your time in bed. I actually use devices in my practice to help women. The first question is, how are you feeling? Are you waking up feeling rested and restored?
Beyond that, we use things like continuous glucose monitors (CGM). If a client has an Oura ring, I love using data to steer where we’re going with this because as you said, sleep is a huge issue for so many women, especially in that perimenopause/menopause phase of their life.
For me personally, I actually don’t address sleep first. I find if I tell a woman, “You just need to work on your sleep,” there are so many factors happening during the day that are affecting her sleep. We first start with trying to manage her blood sugar levels and stabilizing that. That ironically helps a lot of her sleep issues. That’s where we start.
Dr. Eric:
Great point. If someone has blood sugar issues, that could affect sleep. Stress also can affect sleep. If you say, “Work on going to bed an hour earlier,” which is not a bad idea.If someone is going to bed at 11pm, midnight, not a bad idea to go to bed a little bit earlier.
If they are having issues falling asleep and/or staying asleep in the first place, you want to address that rather than just telling them to go to bed earlier and just laying in bed and not falling asleep, or having those issues waking up in the middle of the night and not falling back asleep.
You’re right. It is important to address blood sugar imbalances.
How do stress and adrenals play into that? Do you instruct the person to block out time for stress management?
Leah:
Funny enough, if I can get a client to wear a CGM, then I don’t really need to harp on them about addressing stress because they actually see what stress is doing to their body.
I’ll use an example. I had a client who had rising blood sugar issues, but it wasn’t showing up on labs, which is very common. You’ll go to get your fasting glucose, and the doctor will say, “Everything’s normal.”
What was happening behind the scenes is her blood sugar was doing this rollercoaster ride, lots of highs. Her insulin in her body, she was doing overtime, pumping that insulin out to get that blood sugar down. She had all the classic signs of insulin resistance, which we can dive into later.
Once I got her to wear a CGM, she actually saw that while diet was playing a role in her blood sugar issues, what she didn’t realize was those moments of stress, the email from her boss, the fight with her spouse, the kids. I love my kids, but it’s a lot of extra things that we are dealing with that we might not be realizing are elevating our stress levels. She would see that on the CGM. Her blood sugars were just spiking on these moments of stress, and it was happening way more frequently than she realized.
When I connected that, and she realized that “When I’m stressed, my blood sugars are rising,” she then had the motivation to address that. For everyone, it is different. She was able to connect that and then address those moments.
What was the question again? I think I got off on a sidetrack here.
Dr. Eric:
I was asking, do you have people block out time for stress management while also doing things to balance blood sugar since there is that link between stress and blood sugar?
Leah:
With everyone, it’s different. Some people are so stressed out that they just need to address a few things at a time. We’ll pick and choose what are the easy obstacles first? I have a bunch of tricks up my sleeve about how I can help people with sleep and stress. They are so intertwined that it’s hard to pull it apart.
Things like magnesium for example. I’ll have a lot of my clients start magnesium. That takes the edge off their stress levels. It helps them relax, especially if they have muscular tension. It helps them sleep better.
We’ll do things like a five-minute breathing exercise. It’s amazing what you can do with your body and the way that it relieves stress if you just do five minutes of breathing. We’ll do small techniques like that.
If I say, “You need to address stress,” most people are lost. They have no idea how to do that. We take baby steps and use the toolkit of things I can throw at them.
Dr. Eric:
That’s great. When it comes to stress management, I recommend starting slow. Start with a few minutes per day. In my opinion, it’s about getting into that routine of stress management. Block out time for stress management, especially if you have to do 15-20 minutes per day, which for some people, they are doing a lot more than that. For others, they can’t even imagine 5-10 minutes per day, let alone 15-20 minutes a day.
What exactly do I do? There are different types of stress management techniques. I think we’re on the same page.
I want to talk more about the CGMs. Getting back to insulin resistance. It’s so common that we assume that most people listening to this know what insulin resistance is. Let’s backtrack a little bit. If you could briefly explain what insulin resistance is and how you differentiate insulin resistance from type two diabetes, for example.
Leah:
Most people do have insulin resistance who are listening, and many of us don’t even realize it as we are going through our day.
If you were to think of a lock and a key, and every cell has this doorway that is going to allow glucose into the cell to use for energy, there is a receptor, which is like the lock on a door. The insulin is the key that goes in and opens that lock and allows the glucose to come in. In a perfect world, that sounds great.
Except insulin resistance is when that insulin isn’t functioning as well. Your cell receptor isn’t listening as well. If you were sitting in a room, let’s say, and someone was playing some music, and they slowly turned up the volume more and more and more but slow enough where you didn’t realize all of a sudden you are sitting in this room with music blasting at you. It is so loud that you barely even hear the music anymore.
That’s what insulin resistance is. Your cells are bombarded so much that they stop listening and realizing that the insulin is there to help. It’s a rudimentary analogy.
What the signs are that a lot of people don’t see is their blood glucose is rising over time. What you might see on a lab is your fasting glucose will start to rise over the years. You also might see your A1C start to rise, which is the snapshot of the last three months of what your blood glucose has been doing.
Some people will start getting skin tags or some dark skin in certain areas, like their elbows, neck line. Some crepey skin.
Another sign is weight gain that is coming on in the midsection especially. You’re doing the same things. You’re eating the same. You haven’t changed a lot, but you start to gain that visceral fat and the weight around the waist.
Another sign would be energy levels. Not having the energy levels you used to have, which I know could be due to a lot of things, but that’s one of the things.
Sleep issues. Waking up at night to pee more is a common issue. I could go on and on. Those are some of the common ones.
Dr. Eric:
When it comes to lab markers, you mentioned hemoglobin A1C. It’s an average of the blood glucose over a number of months, approximately three months. You mentioned earlier fasting glucose. We’ll talk more about CGMs. Do you like to see fasting insulin as well?
Leah:
I do. Doctors won’t usually run that test, so I will ask all my clients to get it. It’s a question of whether the doctor will actually run it or not.
Dr. Eric:
Agreed. A lot of them don’t.
Leah:
It’s a huge piece of the puzzle. If I could wave a magic wand and have every doctor test fasting glucose and fasting insulin at the same time, it would make my job a lot easier.
Dr. Eric:
Agreed. What do you like to see the numbers at? You could mention fasting glucose. What do you like to see fasting insulin at as well as hemoglobin A1C? What are your optimal levels?
Leah:
Fasting glucose, most people have seen that number. They know if they’re under 100, it’s usually considered normal. The prediabetes range would be 100-125mg/dl. If you’ve had a number over 125, it’s probably leading to adiagnosis of diabetes, especially if you have more than one of those numbers.
Hemoglobin A1C is the measurement of the last three months on average of what your blood glucose levels are doing. The normal range is considered less than 5.7%. I like to see it a little bit lower than that. I like more of an optimal range. Prediabetes would be 5.7-6.4%. if you have a number of 6.5% or higher, you’re probably in that range of getting diagnosed with type two diabetes.
Fasting insulin, if you’re getting it, can be confusing because what your doctor will consider normal is a very wide range. I think it’s 2.6-24.9 or something like that. It’s a wide range. The optimal range for me personally is 2-5 although if you’re in the 5-10 range, I consider that pretty good. If you’re over 10, let’s address some blood sugar issues.
I don’t know if that outlines some optimalversus normal ranges. That’s where I’m at with my clients.
Dr. Eric:
Makes sense. Ideally, between 2.5-5 for fasting insulin, but if it’s less than 10, you’re not too concerned.
Leah:
Yeah. I work a lot with optimal ranges versus “normal” ranges. That’s another topic of discussion, right?
Dr. Eric:
Yeah. Getting to that, have you seen cases where either insulin looks good, but hemoglobin A1C is maybe within the range but kind of on the upper end, 5.5, 5.6? Or vice versa?
I guess what I’m asking is have you seen scenarios where they don’t agree with one another, the labs? Maybe it’s the opposite, where hemoglobin A1C looks good, and insulin is high? I guess I’ll see more frequently where hemoglobin A1C is on the higher side, 5.5, 5.6, yet their fasting insulin lookspretty good. It’s definitely below 10, even around the 5 mark. Their fasting insulin looks good, and maybe their glucose also looks good, but the hemoglobin A1C is on the higher end. What do you do in that situation?
Leah:
That’s a really good point. Generally, a prediabetes or diabetes type two situation is happening for sometimes a decade or two behind the scenes before you’re actually getting that diagnosis. The journey there is happening for 10-20 years sometimes.
To your point, what I will see sometimes is a “normal” fasting glucose and a pretty good hemoglobin A1C number, like an okay, normal, slightly elevated maybe, but their fasting insulin is much higher.
What is often happening is their body is pumping out so much more insulin. It’s working so much harder because behind the scenes, their glucose levels are rising, but their body is still capable of punching so much insulin out to keep those glucose numbers down. That’s not a good state to be in.
That’s why the fasting insulin number is so important. You can usually catch these metabolic issues earlier if you’re doing all three of those tests versus just the glucose and the hemoglobin A1C. Is that what you’re seeing sometimes?
Dr. Eric:
Yeah. Also, I can’t say I have everybody use CGMs. I don’t know if you do, but that of course will give some additional information as well. The blood sugar markers are kind of a snapshot. The hemoglobin A1C is looking at an average, but it is still a single test. No single test is perfect. If you suspect they have blood sugar imbalances, or if you suspect there is conflicting information, doing the CGM can provide some additional information that could be helpful.
Leah:
It’s fascinating to see people wear a CGM because they have their flaws, too. There are pros and cons. One of the flaws, I’ll put it out there because I think people should know this. There is a margin of error. It’s up to 12% or something, which can show you a number that-
Let’s say the CGM that you’re wearing on your arm has a fasting blood glucose number of 105, which is getting into that prediabetic range. In actuality, the margin of error is such that your actual number, if you went into a lab that morning at that specific time, would show you at 95. People really don’t understand that there is a margin of error.
What I like CGMs for is it can show you- For example, if your choice of breakfast is steel cut oats with some berries and maybe some sprinkling of nuts on it. You think that’s a really healthybreakfast, right? That’s what we’ve been taught. It is decent for some people. For other people, it can completely throw their blood sugar on this rollercoaster ride all morning or all day.
What the CGM will show you is what foods are working for you in your system and what foods are spiking your blood glucose, what are not spiking it. It’s like wearing a little coach on your arm, telling you what foods are good for your body and what foods are maybe not so great.
Dr. Eric:
Great point. You’re right. Some people will do fine with a banana, but other people, it will really spike up their blood sugar. That could be with so many other foods as well.
You mentioned a margin of error. I used a CGM on myself for two different cycles. I don’t know if it was the instructions, but I got the higher reading. My blood sugar usually isn’t whatever it was, around 102 or something. I learned in some cases, you have to calibrate it, so that could also help, too. A little bit of a pain, I guess you could just assume there’s that margin of error. That’s probably the easier way.
With me, I got the glucometer, where you prick your finger, and that was lower. That was the normal amount. Then you enter it into, it’s been a while since I did this, the app, three consecutive days. Then it calibrates it, and that number will actually come down based on that. At least the one that I used.
If you know there’s that margin of error, and especially if you’ve done a fasting glucose recently, and you know your number was 95. The CGM said 105. You know it was artificially spiked up. There is that option.
Leah:
Well, there’s only the option for certain CGMs.
Dr. Eric:
Yeah, I was going to say that, depending on the CGM.
Leah:
Yeah, we teach that in my course because the world opened up to people that don’t necessarily have diabetes or even prediabetes last fall, I think it was. No, maybe it’s over a year now. It’s been a little over a year that they opened up the over-the-counter options. You can get the Stolo or the Lingo.
Before that, you could only do prescription. Those prescription CGMs, you can actually calibrate like you were saying. But the over-the-counter ones, unfortunately, I don’t know why they made this decision, but you can’t calibrate it officially in the app.
What you can do, and what I teach my clients to do, is get a very inexpensive glucometer and know in your head, “I did the finger prick, and it said it was 90. My CGM said it was 100. It’s about 10% off.”
What I really love is it shows you trends. That’s really what we’re getting down to. We’re not trying to change one number; we’re trying to change our lifestyle over weeks and months. Those small choices you make for breakfast or dinner or even shutting down the kitchen three hours before you go to bed, that can completely change your glucose patterns overnight.
I mentioned the stress connection. It’s really fascinating. These little changes can make a big change in your blood glucose.
Dr. Eric:
I agree. How long do you usually have your clients wear them? Is it usually two weeks? Do you have them go longer? It might also depend on the situation.
Leah:
For my group programs, we do four weeks. The first two weeks, we just collect data. How is that oatmeal affecting you? How is that glass of wine affecting you? People need to see how what they have been doing in the past has been creating this internal story of why their A1C is a certain way, why their blood glucose is a certain way. They need to see it first.
Then the next two weeks, it’s like beinga data scientist and experimenting. You experiment on yourself. “What if I change my oatmeal in the morningto eggs and avocado? How does that change my blood sugar levels? What if I don’t eat three hours before bedtime? How does that change my blood sugar? What if I add more protein to my daily diet? Instead of getting 55g a day, what if I up it to 75g a day?” All of these things, we experiment with.
Most of my clients love this experiment so much. They end up graduating from the program and getting another CGM and doing their own experiments ongoing, which is cool. I love that. I love that they have that empowerment of knowledge and what they can do with it.
Dr. Eric:
Awesome. I was going to ask you about the diet. Part of the diet depends on the CGM. I also assume that you have certain guidelines. You’re not going to say eat anything. Go eat refined foods and pizza. If your CGM looks fine, which it probably won’t, but if for any reason it does, it’s fine to eat those foods.
I assume you recommend whole, healthy foods. I don’t know if you’re more plant-based or carnivore. Can you talk a little bit about the diet that you recommend to your clients overall? Based on the CGM readings, make whatever modifications they need to make.
Leah:
I have yet to see someone go ahead and eat all processed foods and not have their CGM show them that is not going to be healthy for them. But you never know, it might happen.
I believe that there is not one diet that is perfect for everyone. I think everyone is biologically unique. I use some therapeutic diets with clients. I will use therapeutic ketogenic diets or more of a carnivore for a period of time. It depends on the client and what their needs are.
In general, I think I could probably say a blanket statement of most of us are eating too many carbs. We could lower that number. Most of us could eat more whole foods. Most women, especially in their 40s, 50s, and beyond, could eat more protein. Those are blanket statements, but I find 99% of people fit that mold.
Dr. Eric:
I’ll ask you the protein question. Everyone has their own opinion. How much protein do you typically recommend?
Leah:
I find if I tell my clients- Again, I work with women in perimenopause, menopause, and beyond, 40s, 50s, and beyond. If I tell them their goal is 100g per day, that’s actually difficult for a lot of women, just getting to 100g.
Would I like to see that number higher for some people? Absolutely, especially for my clients on GLP-1s, I want that number of protein to be much higher. If anyone is dealing with for sure muscle loss, as we age, that’s a big factor. A lot of women are dealing with that. They’ll have more protein. Even getting them to 100g, which is about 33g per meal if they’re eating three meals a day, that is a feat in itself. We start there.
Then we assess. How are you feeling? Most of them feel amazing after getting 100g. They actually want to increase their protein. Then we increase from there.
There is a formula that you could use if you wanted. There is a lot of opinions out there. What I find works for most people is if you take your ideal body weight and multiply it by .7, that’s the minimum grams you should be trying to get.
Dr. Eric:
Ideal body weight-
Leah:
Ideal body weight in pounds. Multiply it by .7. That gets you your goal in grams for protein.
Dr. Eric:
Okay. Your ideal body weight x.7 would be the grams in protein you should be eating, correct?
Leah:
Minimum, yeah. I think it works out. A 150-pound person is going for 105 grams per day, minimum.
Dr. Eric:
Okay. How about supplements? Do you recommend any supplements to support blood sugar? There are things like berberine, alphalipoic acid, others.
Leah:
With my clients, we keep it really simple. I find if I throw a bunch of supplements at people, they miss the main part of this whole journey, which is food. For me, the biggest piece of the puzzle is what you’re actually eating in terms of food. I will give them things.
I mentioned magnesium, which isn’t necessarily specific for blood sugar, but I find it helps amazingly with stress and sleep, which then helps with blood sugar.
One of my most favorite tools is apple cider vinegar. We’ll do a tablespoon or two of that in a small amount of water before meals. That actually is incredible. It does incredible work with lowering their blood sugar.
Cinnamon as well.
Some people use berberine, but again, it’s usually that extra layer where women just can’t think about adding another pill to their already large, long list of supplements they’re doing. We keep it very simple. Cinnamon and apple cider vinegar are the go-tos.
Dr. Eric:
Makes sense. You mentioned GLP-1s. If your clients are on GLP-1s, they might need more protein. What percentage of your clients are on GLP-1s? What are your thoughts on that? I assume they’re on it prior to seeing you. They’re already taking it before seeing you.
Leah:
It varies quite a bit. I tend to be the last resort. They will try it before they go on GLP-1s. A large percentage of my client base is like, “Okay, let’s try this CGM. Let’s try managing blood sugar and get this stubborn weight off.” It’s usually a weight thing. That’s why people are coming. It helps a lot more than just weight, I’ll say, but that’s usually why people come in the door.
A lot of my clients actually, after they have done this process of discovering how a CGM is outlining what foods are good and bad, how their diet needs to change, they end up not doing the GLP-1.
I’m not against it. I’m actually in this neutral boat right now with GLP-1s. I have my reservations. I also have seen it have amazing outcomes for people. Let’s talk about it on an individual basis.
If youare going to go on it, here’s what you need to do. The protein is a big one obviously. Weight lifting. Retaining that muscle is a huge component of it.
But you asked what percentage of clients are on it. I would say not that many. 10-15% possibly. I’m usually the last resort. Let’s try this first before I go on GLP-1s.
Dr. Eric:
I was just curious. It makes sense. Try to do everything you can from a diet perspective. Not to say there is not a time and place for the GLP-1s. With this, we’re also on the same page. If they decide to take it, that’s fine. If you could avoid taking it, that’s great.
A couple of things before we start wrapping it up. Intermittent fasting. I wanted to get your thoughts on that. You also mentioned that protein can be challenging. If eating three times a day, it could be 33g per meal. Depending on how long you’re fasting, that can sometimes even be more challenging. Is intermittent fasting something you recommend? 16-8 fasts for example? Or is that not usually something that you-
In my case, I’m not against intermittent fasting, but it’s not something I tell my patients, “Let’s go ahead and do 16-8 fasting.” Some people I work with, I wouldn’t want them to do 16-8 fasting. If someone has hyperthyroidism, and they’re losing a lot of weight, or other reasons why I may be cautious in some cases. I’d love to get your perspective on it.
Leah:
I love that you brought this up. I’m going to be honest. I made the mistake when I first started working with clients of recommending it to almost everyone. What I learned as I went is that it’s an incredible tool. I love intermittent fasting. It’s an amazing tool, when used at the right time for the right person.
The mistake that I made, including on myself, was when you throw someone into intermittent fasting, and they’re not physically ready for it, it can have counter effects. It can backfire. They won’t feel good doing it. They won’t get the outcomes they’re looking for, and they will probably hate you as a nutritionist. They’ll be out the door.
If you are someone who is considering intermittent fasting, you need to ask yourself first, “Am I metabolically flexible?” What I mean by that is: Is my body only capable of burning glucose, mostly from carbs, or can I flex and burn ketones as well? Can I utilize ketones in the body? If they cannot, if they’re not there yet, then it’s not a great option for fasting yet.
But you can change the metabolic flexibility of your body. You can teach it to be more flexible and burn ketones. When you do that, fasting can be an amazing tool for these people.
I don’t know if that made sense. Yes, I do use fasting. 18-6, fasting for 18 hours, keeping that window of eating to six hours is the first step. No, it’s not. Getting people to fast overnight, 12-14 hours, that is the first step. I’m shocked athow many people don’t do that. That should be a baseline for everyone. We were meant to fast overnight. That’s what break-fast is: you’re breaking the fast.
If you are considering going into some 18-6 or other intermittent fasting diets, you need to look at your schedule and figure out when you close down that kitchen and when your first bite is in the morning. If that is not a minimum of 12-14 hours, start there. Then go to 18-6.
See how your body feels. You might have to take a step back. You might have to increase protein and healthy fats. Building that foundation of hormones in the body, getting that body to be metabolically flexible.
I do have clients who go into OMAD, one meala day, or TMAD, two meals a day. I do find that the trickiest part for that is they love how they feel so much that they want to keep fasting. Then you have to pull them back and say, “We need to make sure you’re getting enough protein.”
Having one meal a day for once a week is perfectly fine. You could make up your protein needs on the other six days. When people start doing it seven days a week, we need to look carefully. Are you actually getting the nutrients you need?
I wouldn’t just jump into it without someone overseeing your diet, is what I’m trying to say.
Dr. Eric:
I agree. That is a concern. Getting one meal a day, you’re probably not getting enough protein. You might not even be getting enough nutrients. If you are doing that continuously. Short-term is a different story.
The final question I want to ask you is exercise. You did mention resistance exercise, which is pretty common for building muscle mass. A lot of practitioners recommend that these days. Do you recommend any cardio? What typically do you recommend from an exercise standpoint?
Leah:
Good question. I’m not an exercise physiologist or trainer, so I’ll put that out there. What I have seen with my clients is many of these women are coming in stressed out and exhausted. I am not telling that woman to go lift heavy things in the gym every other day.
For that woman, that is starting with walking, or any movement that feels good where they are focusing on their diet first and dialing that in. As they start to feel better, they’re sleeping better, their stress level is going down, they’re feeling more energetic, then we’ll talk about, “Can you lift heavy weights?”
Maybe that’s body weight first. There’s no shame in that.I have a lot of women who are just doing body weight exercises, and they’re feeling great. They’re retaining their muscle, and they love it. Other women are moving on past that and lifting heavier things. That’s great. You and I both know that as we age, we lose muscle faster.
You have to just take a step back and think, “What does my body need right now?” We live in this culture, “You must lift heavy things. You must go to the gym 3-4 days a week.” Maybe not right now. Maybe start with treating your body a little bit kinder. Start with diet. Are you hydrated? How is your stress level? If you’re not sleeping well, why would you go to the gym four days a week and tear down your muscles? When will they repair?
It’s a very specific individual choice for each woman. Each woman needs to take a look inside and see where they’re at right now. If you don’t have your diet, sleep, and stress dialed in, I don’t think you should go do resistance training four days a week.
Dr. Eric:
Okay. Thanks. You’re right. Ifsomeone doesn’t have their diet dialed in, if they’re still eating refined foods, fast food, not to say they won’t get any benefit from resistance exercise, but I would agree. You want to start withdiet and lifestyle. Exercise is part of lifestyle, but the diet and even stress management- All of these things are important.
It’s great that you take that step-by-step approach. This is the order that you should do it in, not just telling them, “Go to the gym. Go do some resistance exercise. Go block out 30 minutes a day for stress management.”
Leah:
I read this study. I can’t remember what the name of it was. They looked at the health of people who did a 30-minute block of exercise versus 2-3-minute blocks 10 times spread throughout the day. The people who had the better metabolic shift intheir body were the people who had the small increments spread throughout the day, versus the people who did the 30-minute increment one time per day.
It goes to show that sometimes, what we think is the best for us might not be. If you are sitting all day at an office or desk, getting up once an hour for two minutes is going to be better than if you struggle to fit that 30-minute training session in, and you sit the rest of the day. I thought that was fascinating. Any movement is better than nothing.
Dr. Eric:
Agreed. Thanks for this conversation. Obviously, we could easily talk for another hour. This is a conversation that it’s hard to fit in everything in a short period of time. Overall, I think you shared a lot of great information.
For those who are interested in learning more about you, including the program you mentioned, where can people find out more about you, Leah? How can they join the program?
Leah:
Thanks! The easiest way is to go to my website, LeahVachani.com. From there, I havelinks to everything, to Instagram, YouTube, the course signup. It is a group program that we do periodically throughout the year. It’s not a DIY. It’s pretty cool. There is community that we build. You get Zoom coaching calls. That’s nice to feel part of something. They can join there.Get on my mailing list. That is the best way. You will get discounts, too.
Dr. Eric:
Awesome. This was great. Appreciate having this conversation.
Leah:
It was my honor. Thanks for inviting me.
***
Dr. Eric:
That was a great conversation with Leah. Spoke about blood sugar and sleep. She mentioned how she focuses on blood sugar first if someone is having sleep issues, simply because this could impact sleep. It makes sense that if you are having sleep issues, what is the cause of the sleep issues, and focusing on diet and lifestyle. Directly helping with blood sugar can greatly help someone get better sleep.
Blood sugar and stress. She discussed how stress can affect the CGM readings. A lot of people don’t think about the impact of stress on blood sugar. Obviously, we realize the impact of diet on blood sugar. If we are eating a lot of carbohydrates and refined sugars, stress can have an impact. Diet and stress management can help with blood sugar, which in turn can help with getting a better night sleep.
She recommends magnesium to help with sleep. It could also help to some extent with blood sugar. I didn’t ask her what type of magnesium. I like magnesium glycinate. Magnesium malate if someone has constipation. Maybe magnesium citrate.
Magnesium in some cases can help with sleep. It’s usually low-risk. Usually, it won’t cause side effects other than- Everybody is different. I can’t say 100% it can’t cause side effects. Anything can. But minimal risk.
If someone has enough magnesium in their system, and they take more, it could cause loose stools, sometimes diarrhea. If that happens, you know that you don’t need to take magnesium.If you take a few capsules, and you get loose stools, then you might want to back down to one capsule per day.
We spoke about optimalranges for blood sugar markers. I have had a number of other natural health care practitioners on the podcast, a few who spoke about blood sugar. It seems like 5 or less is ideal for insulin. I agree. That would be ideal. If someone is a little bit higher, like 6, 7, 8, I usually don’t get too concerned.
Leah agreed. She didn’t know that’s what I think about insulin. Less than 5 is great. She said as long as it doesn’t exceed 10. If it’s 9 or 10, I’m not crazy about that, but it depends. If someone is an 8, and everything else looks good, and the hemoglobin A1C looks okay, maybe it’s all right.
Speaking of hemoglobin A1C, 5.7 typically is when someone is in that prediabetic range. She likes to see it below that. She didn’t give a number. I have had other experts say even with hemoglobin A1C, they want to see it at 5 or less. If I see it at 5.2, 5.3, I don’t get too concerned. You might want to keep an eye on that. Maybe incorporate a CGM.
I was giving her examples where you might have one marker looking good and the other marker not looking as good. Which one do you trust? Maybe just retest them. If you see that pattern, where insulin looks good and hemoglobin A1C doesn’t look good or vice versa, maybe you get a CGM.
Speaking of CGMs, the margin of error we discussed. It’s important because when I was using a CGM- I don’t use one regularly. I tried one for two weeks. I forget if the company sent me two or if I ordered two. I got two CGMs. I used one of them for two weeks. Then I took a break. At a later date, I used the other one. You integrate it with an app.
At first, I was seeing the numbers were in triple digits. That’s not what my blood sugar usually is. Then I learned about calibration and got a glucometer. I pricked my finger for three days in a row. As she mentioned, the over-the-counter ones, which were not the ones I used, I didn’t know that you can’t calibrate them. You can still do the glucometer; you just can’t calibrate it.
You could prick your finger, and if you see 2-3 days in a row your morning fasting glucose is, let’s say, 95, and the CGM says 105, you know there is a 10-point difference.
Apple cider vinegar. She recommends one or two tablespoons of raw apple cider vinegar for blood sugar. She also recommends cinnamon. You could easily integrate them. Get some organic apple cider vinegar and maybe some cinnamon. Everybody is different, but there are some studies showing that apple cider vinegar and definitely cinnamon to some extent could help with blood sugar.
I can’t say I recommend for everybody to take supplements, but I do like berberine, alpha lipoic acid. To me, those aren’t long-term solutions. Sometimes, they could speed up the process. If someone takes them temporarily for a few months, obviously, and incorporate diet, stress management. She tries to minimize supplements, which is fine. I don’t overload people with blood sugar supplements. It’s something that is in my toolkit.
Intermittent fasting. This is where we differ a little bit. Well, with supplements, but I don’t give a ton for blood sugar. For intermittent fasting, she starts with having people do an overnight fasting, 12-14 hours. That part, I agree with.
Then it sounds like she recommends an 18-6 fast to some of her clients. It sounds like if they tolerate a 14-hour overnight fast, then she will jump into an 18-6 fast. Maybe it’s not across the board, and it was my mistake for not asking her. We both had a time crunch when we met.
Sometimes, when I do an interview, the person has a little bit more time if we go over the hour. Even if the interview is not exactly an hour, it’s not like we meet and press record right away. Usually, we talk for a few minutes. If someone has to go at the top of the hour, then I make sure that we’re done a few minutes before. She had something going on. I knew she had something going on, so I scheduled something as well. We had less than an hour for this conversation. Still covered a lot, but I didn’t have time to ask her a few questions, and that was one.
I am not a huge fan of regular 18-hour fasts. I have spoken about this on the podcast. Even for some people, 16 hours is too much. The concern with 18 hours, and we spoke about this a little bit, but getting enough protein. If someone is eating one meal per day, it’s hard to get enough protein. If someone is eating two meals a day, and they only have a six-hour eating window, every two hours, they could get some protein in. I still find it’s really narrow. I am not saying every now and then, but on a daily basis, that’s extreme.
I don’t know how long she recommends it. Maybe she only recommends it for a few weeks, which for some people, might still be a long time. If it’s a few weeks or throughout her program, which I think is four weeks, then that’s not too bad. I think really long-term, you want to be careful about doing too long of a fast. An 18-6 fast continuously is not a good fit for everyone.
Everybody is different. Some people will do fine with longer fasts. Like I said, the concern is not getting enough protein or nutrients in general.
That is it. Really enjoyed talking with Leah. Hope you enjoyed the conversation on blood sugar imbalances and CGMs.
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