Episode 035: Insulin Resistance, Unlocked- Stop the Spiral Before It Starts

Understanding and Combating Insulin Resistance: Practical Tips and Lifestyle Interventions

In this episode of The Lifestyle MD podcast, Dr. Angela delves into the often misunderstood topic of insulin resistance, explaining what it is, how it develops, and its potential consequences, including type 2 diabetes, polycystic ovarian syndrome, and cardiovascular disease. She discusses the basic physiology of insulin, the role of the liver and muscles in glucose processing, and the importance of early detection through lab markers and lifestyle factors. Dr. Angela also provides actionable advice on how to prevent and reverse insulin resistance through exercise, improved nutrition, adequate sleep, stress management, and building a supportive community. The episode emphasizes the importance of small, sustainable changes and offers guidance on setting measurable goals to track progress. Finally, Dr. Angela highlights the role of medication alongside lifestyle interventions for individuals who may not fully reverse insulin resistance through lifestyle changes alone.

00:00 Introduction to Insulin Resistance
01:26 Understanding Insulin Resistance
02:32 The Role of Muscles and Liver
06:22 Factors Contributing to Insulin Resistance
12:47 Preventing and Reversing Insulin Resistance
15:14 The Importance of Exercise
17:31 Nutrition and Diet Tips
20:03 The Role of Sleep and Stress
21:57 Tracking Progress and Setting Goals
25:01 Final Thoughts and Encouragement

Transcript

  Dr. Angela, welcome to another episode of The Lifestyle md. I'm so excited to have you with me today, it's something that has been on the top of the conversation list for almost every patient visit.

It seems for the last several months, if not years, and I'm doing more testing and diagnostics in the office to pick up on this thing. So most people don't know that they have insulin resistance, until their labs come back. What is that thing? It's insulin resistance.

Most people don't even know that they have insulin resistance until their labs come back. Abnormal or worse, they've already been diagnosed with type two diabetes, but long before that, your body is quietly fighting to prevent you from entering into that state of insulin resistance, and then ultimately, diabetes.

Today, my goal is to pull back the curtain to help you understand what insulin resistance really is, how you can catch it early or just. Prevent it altogether. Thanks for tuning in, so keep listening to hear some simple lifestyle changes that you can make to turn around or prevent it altogether.
 

So on today's episode, we're going to define what insulin resistance is. I'm going to. Talk to you about how it develops from a deep dive level, but trying to keep it pretty understandable. And then how you can prevent it and or reverse it.

So if you're joining me today, imagine that your insulin are keys, and that these keys, their job is to unlock the cells in your body to allow glucose, or in other words, sugar to enter in over time. Imagine that those keys stop unlocking the doors. They stop working. Well, this is what insulin resistance is, why this is important is that insulin is the key to fueling your muscles, Insulin resistance is the precursor to diabetes, but not everyone with insulin resistance presents ultimately diabetes. It also looks like. Polycystic ovarian syndrome, metabolic disease, cardiovascular disease, peripheral artery disease, strokes.

Insulin resistances associated with higher rates of obesity related cancer, central obesity, you name it.

Insulin is a hormone that is produced by your pancreas, that helps glucose enter cells, specifically three types of cells, your muscle, the fat, and then your liver.

And it is used for fuel or storage. 70% of the glucose that your body either takes in or breaks down food to make glucose is taken up by your muscles. But when those muscles get. Overwhelmed or inundated with too much glucose, they shut down the shop. They close the door, they say no more. So then that glucose gets shunted over to the liver where it is processed and stored. The liver's got a really big job

The storage process is de novo lipogenesis. So that's fat. You're making fat, various forms of fat. Fat comes in many forms in the body. Over time, you're going to begin making too much fat.

All right, so let's get into the basic physiology insulin is a hormone that is produced by your pancreas and its job is to help glucose enter into cells, specifically muscle fat and liver. That is where you are either using it for energy or you're storing it in insulin resistance.

Those target tissues are less responsive to the insulin. So in other words, pancreas kicks out insulin. Insulin goes to the muscle, knocks on the muscle door, muscle says Uhuh, you can't come in here. So then the body keeps kicking out more and more insulin and the pancreas keeps producing more and more insulin to try to override that resistance.

Eventually your body can't keep up, and that leads to. Hyperglycemia or high blood sugar, and then that gets too high, that leads to pre-diabetes and that gets too high. That leads to type two diabetes. And so that's the natural progression that many people are familiar with. We don't generally pick it up until people are already in that hyperglycemic or pre-diabetic range.

That has been what most of traditional medicine is focused on. Your doctor, if they're not already doing that, to try to be a little bit more proactive. The signs of metabolic disease, insulin resistance can be picked up on even without having lab values. But there's lots of objective testing that you can do that can, confirm that suspicion.

So I would encourage you to do that and we'll talk more about that.

Your muscles are responsible for taking up 70% of the glucose that's circulating. So if you have really active muscles or you have lots of muscle, you're gonna be doing a lot better job handling that glucose. But if you're frail and inactive, your muscles aren't going to be taken up very much of that glucose and they're gonna get overwhelmed much easier.

Which means more of that glucose is gonna then get shunted over to the liver where it is then pushed into storage. The job of the liver is primarily to store in the form of fat.

If the liver gets overwhelmed because there's too much, too much glucose and therefore too much fat accumulation or fat production, that's going to become toxic to the liver and tox to the body. You're gonna start seeing a rise in triglycerides, and then you're also going to see suppression of the liver's ability.

To suppress or stop the production of more sugar, which is odd, right? So you have too much sugar, sugar circulating, so the liver makes more sugar. It doesn't make sense, right? But that's what happens. Additionally, that inflammation is gonna then start, affecting other processes.

It's gonna make the muscle even more resistant to insulin is going to suppress the body's ability to break down fat into energy because it's already sensing that you have an, abundance of glucose circulating. So therefore there is no need to break down your fat and make more glucose.

So it inhibits what we call lipolysis. Okay. So. It's a complicated process and you might think, oh my gosh, there's so many steps there. How can I possibly reverse this if I've already gotten there? First of all, it takes a while to get to this point and it's gonna take some time to reverse it. insulin resistance is a byproduct of multiple things happening, colliding all at once. There are, genetic factors. There are lifestyle factors, so poor sleep, chronic stress, consumption of processed foods, inadequate physical activity.

These are all factors. And there also could be medication. Some medications are prone to induce insulin resistance, so some blood pressure medications. Taking steroid medications and then if you have certain genetic conditions that are predisposed to people having insulin resistance.

People will exhibit signs of insulin resistance long before their lab values overtly, show it. We have the ability to measure visceral body fat in our office using an InBody scanner, and it's amazing. We are able to connect these lab results to your visceral body fat.

And the reason this is helpful is people can have elevated amounts of visceral body fat and still have a relatively normal waist circumference. Visceral body fat is something that we usually have to measure indirectly

so this is one of many factors that we can address in order to measure whether or not, someone has insulin resistance.

When I think about insulin resistance and I'm talking to my patients, I, really struggled with trying to help them comprehend how they got to this point in the first place. And I also don't want. People to think that it's a lost cause and that they're broken and that, you know, it's not reversible.

First of all, we know that resistance is reversible, especially if caught early. Now, there are instances where won't be possible, but the objective of this is to help you identify it early enough to where you can prevent it becoming irreversible. So taken as a whole insulin resistance, is a combination of factors present all at once. You can have a high fasting insulin level. You may have high triglycerides, low HDL, high visceral body fat, a large waist circumference that is adjusted for your gender and your ethnicity. You can have, signs of acanthosis which is darkening of the skin in certain areas like the back of the neck, under the armpits.

These are all signs and objective measures that can. Be used to determine that someone has insulin resistance. There are medical conditions that are associated with insulin resistance that you may have already heard of.

Polycystic ovarian syndrome. Prediabetes is a more advanced form of insulin resistance, fatty liver disease or non-alcoholic fatty liver disease. Metabolic syndrome, which is very similar to PCOS. It's a collection of signs and symptoms that point to a syndrome or condition. If you have Macrovascular disease, so that's peripheral art, disease, stroke, have had a stroke or coronary artery disease. These are manifestations or associated with insulin resistance and microvascular disease. Things like retinopathy, neuropathy, and nephropathy. So you do not have to have full blown diabetes in order to develop these symptoms. So how can we test for it? I mentioned some of the values already. We can look for surrogate markers. So high triglyceride levels. So if your triglyceride levels, fasting triglycerides are greater than one 50, then that can be a strong indicator. If you have a low HDL, that's a strong indicator.

Not everyone has the ability to measure visceral body fat, but you can use waist circumference as a proxy. There's a lot of definitions currently in different cutoffs for waist circumference. There's the classic US NIH threshold for abdominal obesity associated with metabolic syndrome or the metabolic syndrome criteria.

There are different cutoffs for different, racial and ethnic groups as well. But broadly speaking, for the US according to the NIH, the male cutoff is 40 inches for the waist circumference and the female cutoff is 35 inches, and that's measured, all the way around your belly, right at the level with the belly button.

Instant resistance is strongly associated with obesity, but being obese or overweight or having a lot of body fat. Isn't all there is to it. In fact, when we think about risk factors that are going to lead someone to becoming insulin resistant, there are two in the top. They kind of like compete neck and neck.

The first one I like to talk about is. Physical activity or lack thereof. If you are very inactive, the more sedentary you are, the less active you are. Guess what? Your muscles are not taking up blood sugar. Your muscles are, are not adding insulin receptors to take up more blood sugar. You don't have a need to burn and utilize sugar. So more of that glucose that you're consuming is going into storage. And if you're consuming more glucose or more food, or in other words you have a higher caloric intake than your body needs to meet your physiologic demands, then you're going to be putting more of that into storage, IE fat.

And that leads to the next. Main factor associated with insulin resistance, and that's belly fat. So these two things go hand in hand. All of these things are intricately tied together, so I really struggle to pick one or the other. I will say, you know, telling someone that their belly fat is a problem isn't really helpful.

What can they do about it is probably more helpful. So that's why I really like to focus on the physical activity because physical activity, you can immediately start getting the direct benefits of improving your insulin resistance in the first 12 to 24 hours after exercise, you are going to be more sensitive in that moment, you're muscles are going to take up more glucose. Independent of insulin. Long-term, the more you exercise and with more regularity, your muscles will become more sensitive to insulin. And so you're going to be reversing that insulin resistance.

So let's go back earlier into this conversation. I describe the process of becoming insulin resistance. It starts with the muscles first being overexposed or being inundated with way too much glucose. Then that pushes it to the liver. Then the liver gets inundated with too much glucose, and then that pushes more sugar into the storage form, which then puts it into the body, and you have visceral body fat, you have triglyceride production, and you have decreased breakdown of fat.

And then you have this circle, this reoccurring circle. And there's basically, if you imagine a diagram where you have this loop that's speeding on itself, you need to interrupt this cycle. And I think the easiest way to interrupt that cycle is with physical activity.

And the second easiest way is caloric reduction. And not just any caloric reduction, but reduction of high carbohydrate and highly processed foods. So if we wanna talk about the top things that someone can do in order to prevent or to reverse insulin resistance. It's going to be exercise or move. So movement and exercise B is going to be your nutrition.

You wanna make sure that you have a good diet, high quality whole food diet,

 So that brings us to the next point I wanna talk about how do we prevent and reverse insulin resistance with lifestyle? It's possible to do with lifestyle. There are medications that we often prescribe, but medication is not the preferred first step.

Medication is a bandaid. You are not correcting the underlying problem. We want to restore your cells, sensitivity to insulin. So how do we do that? Well, for one, we wanna exercise for two. We wanna improve the quality of our nutrition. Three. We wanna make sure that we're getting adequate sleep because, poor circadian rhythm and inadequate sleep, inadequate rest is going to lead to high levels of cortisol, which is also further gonna decrease insulin sensitivity.

The last one I'm gonna kind of put together, and that's like. Stress reduction, having community, like building a support system around you. If you have a healthy community of support, like friends, church group, social circles like your family, your neighborhood.

Having these positive relationships is gonna make it easier for you to, feel good about taking care of yourself. It's gonna give you motivation to find reasons to take care of yourself. 'cause maybe you have a purpose or you have other people rely on you or you're contributing to a community effort or contributing to something bigger than yourself.

I think of it as kind of like the all encompassing, like if we have like this, this, this sphere around these big three areas of food, nutrition, exercise, and sleep. But then around that is this whole behavioral component that involves having, managing your stress through,

healthy relationships, having good coping strategies, having behaviors that are supportive of your wellbeing. So all these things kind of like intertwine together. It can be very overwhelming if you're someone who's struggling with this.

You're not going to fix it all at one time. It took a while to get here and it's going to take some time to undo all of the habits that you have that may be contributing to you not doing well in one or more, or all of these domains. So let's start with one at a time.

Regular exercise. So both aerobic and resistance training. All the different authorities, across the board have recommended, 150 minutes of moderate intensity exercise. You can do less time if you're doing high intensity. And what is moderate intensity exercise? Something that's you can have a conversation but still need to take some breaths. It doesn't have to be any particular exercise. It can be vigorous walking, jogging, swimming, biking. It can be, doing resistance training with very little rest.



Anything that's gonna elevate your heart rate to somewhere between 50 and 70% of your maximum heart rate, and you can calculate that, just Google it for your age. Sustain it for a period of time, that would be considered moderate intensity. But you also need to incorporate resistance training or strength training.

That's a relatively more recent addition. I'm so glad to hear that because actually remember being mocked about this. I went to a conference, I'm not gonna say where. I was in residency and I was doing bodybuilding training at the time. I was also doing some cardio stuff, but I was working on building my muscularity and I asked the question about what about strength?

And they were really dismissing the value of incorporating strength into it. They were really heavily focused on just the cardio part of it. I was really surprised by that. So I'm happy to see that there has been a shift to recognizing the importance of building strength and building muscle because, hello?

The more muscle that you have, you have better longevity. And no surprise here because your muscle is an important factor in managing your glucose. So you need to be doing this ideally on a consistent basis, not all at one time, and it's gonna be difficult to do all at one time anyway.

So two to three times a week high achievers out there, wanna do it five days a week. But pick something that you can do and that you enjoy and do it on a regular basis. Okay? It is better to do it over time. And it's a good idea to combine both your resistance and your aerobic activity on the same day if you can.

If you have a Monday, Wednesday, Friday routine, maybe Monday and Friday, you have aerobic and strength. I get that. I will tell you, if you go back and listen to my last podcast episode with Marcie . We talked about a program called Faster Way.

There's lots of programs out there. If you are overwhelmed and don't know where to start with this, you should definitely get help it needs to be nuanced and personal to you, but if this is something you're struggling with, I would say low hanging fruit, increase your physical activity.

The next part is nutrition. The American College of Lifestyle Medicine has also updated their, language here. So originally it was all, plant-based diet, and then it became like plant predominant. I've often referred to plant predominant, and now that's the overarching theme, is that a diet that is rich in, predominantly things like legumes, fruits, vegetables, nuts, seeds.

These are all wonderful, wonderful things, and for a lot of reasons. One, they're anti-inflammatory. Two, they have lots of fiber, and these foods have low glycemic indexes. In other words, when they're broken down, they don't make a lot of glucose. So you really need to make sure that your diet is rich in these things.

Another thing, I tell people is make sure that your food is as close to the way God originally created it. Marcie, who was on our last podcast, she likes to say, if it grows from the ground or it has a mother, then it's good for you. So there should be very few steps from where it came from to the time it gets to your mouth.

So the more processing that it has to go through, the more things that are added to it or taken away. The less healthy or less good it is for you. So keep that in mind if you're wondering, is this something that I should be having? Read the label. If there are things on that label that you don't understand, it's probably not the best choice.

So choose things with fewer ingredients on the label. If you can't get away from things that are boxed or packaged then just try to choose simpler things. Take it one step at a time. We know that there are some diets that have been shown to have more improvements.

I'm not going to get into the nuance of different dietary strategies, but I will promote the Mediterranean diet because it has an abundance of evidence across so many health issues, whether it's cancer prevention, cardiovascular prevention, insulin, resistance improvement, just across the board, the Mediterranean diet, it checks all the boxes. It is a great approach if you're just looking for a place to start. Caloric restriction in this area of diet and nutrition is tricky. I would say before you think about reducing calories, focus on eliminating things from your diet that are not beneficial to you. Remove empty calories, focus on high quality foods, high nutritious foods. Start there. You're going to naturally reduce your unnecessary caloric intake. Without measuring anything. So focusing first on the quality of the food, and then we can start thinking about the distribution of your nutrients, how much fat, protein, and carbohydrates.

But again, to keep it simple, first, let's start with improving the quality. Then you can get more nuanced. Again, I'm gonna refer back to the FasterWay If you do a program like that, or lots of, again, there's other programs out there, but if you do that, you can get help with that as well.

Sleep. I talk about sleep a lot. I think I have at least one whole episode about sleep, so I'm not gonna spend too much time on this. But I will remind you that poor sleep quality or sleep restriction, You know, if you're only getting four or five hours of sleep and your sleep is inefficient or ineffective, so that time that you're sleeping, you're not getting enough deep sleep, or you're waking up a lot throughout the night, it's very interrupted.

Then you're going to impair your insulin sensitivity. just understand it that way. Less sleep, less good quality sleep, less insulin sensitivity, or in other words, more resistance. When you are overtired and your body's overtired, you have more appetite. Your metabolism naturally shifts from one of metabolizing to fat storage.

It's kind of crazy. Sleep does a lot.

Stress and kind of like this whole community, you know, more like a holistic view on a person's wellbeing is not only overlooked, but it is hard for people to comprehend. I cannot stress how important it is to think about reducing, you know, the impact of whatever stress is in your life.

one of the most common things I tell people to do. Okay. Don't take my advice here again, if you're not working with me. I'll often tell people that maybe they need to either quit their jobs, change their job, or put up more boundaries with their jobs, something like that.

and I've had a couple of people who have, left their jobs and, no surprise there, myself included. Better quality of life and. The impact of stress. I mean, sometimes stress is like the factor that you haven't changed, that you're missing. I actually have a podcast episode that I'll be recording with one of my new patients who did just that, and she did it on her own.

She did it before she and I met, and I can't wait for you to hear a story. she will bring this part to life, the impact of stress and recovery and how that affects your hormone modulation and just all of that and how that all has a big impact on your overall wellbeing and your ability to process nutrients effectively.

So how do you know if you're on the right track? it's not good enough to say, these are the things I need to do. Well, you need to first of all, decide what you're going to do, set some goals around it, and then make it measurable. So track things like your waist circum ference, track your body composition if it's available.

It's not enough to know what you have to do. You actually need to put a plan to it, okay? So you have to decide what you're gonna focus on and then decide how you're going to track it. Some things are much easier than others. if you're gonna improve your sleep, then maybe you're gonna use a sleep tracker to measure your progress for sleep.

You're gonna take steps towards improving your sleep. Maybe you're gonna set a bedtime, you're gonna create a new routine, and you're going to check off on the calendar whether or not you met those targets. You're gonna set up a regular wake schedule. If sleep is your target, then make it sleep.

If you're going to focus on food, maybe you're gonna focus on getting more vegetables in on a daily basis or more fruits, maybe work on, increase in your legume consumption, measure your fiber and assess whether or not you've been tracking and meeting those goals. You know, I would say aim for 25 to 35 grams of fiber per day.

Pick something specific in one or two of these domains and measure it and track it over a period of time. Then assess your progress. What you're trying to achieve is reduction in your risk factors for insulin resistance or improvement in insulin resistance. I usually don't recheck, lab markers for three to six months, depending on, how aggressive my patient is.

You can measure your body weight and if you have access to body composition, you can measure that at your office or your gym or wherever you might have access to that. And then working with your primary care doctor, you can get follow-up lab markers for fasting insulin. You can get a Homa IR , lipid panel to recheck your cholesterol. Check your fasting insulin, things like that. If you pair that with visceral fat, you can also really get a good measure of whether or not you're starting to, tap into that visceral fat part of it. So use small, sustainable habit changes versus an all or nothing or, sweeping strategy.

That social component, that community part is really important. That's why I kind of emphasize as kind of like the all around overarching aspect of all this. This is easier when you do it with other people. It's easier when you have community. It's easier when you feel supported and nurtured and you're not doing it alone against, I'm gonna go back to the faster way.

FasterWay is a community of coaches and other participants. Who are all engaging and activity together. So again, find a community that you can be a part of that will help support you and you will have some accountability. In our household, my husband and I, we've been in each other's accountability, actually more him for me than me.

For him, I actually kind of maybe him his accountability for sleep and he's my accountability for staying on top of my exercise and my nutrition. Hopefully you're fortunate enough to have someone in your life, and if you're not find someone, it doesn't have to be a family member. It doesn't have to be a spouse. If you don't have that, then I would encourage you to find someone so that you don't feel like you're alone.

I was gonna tell you a story, but I'm gonna save that for, the upcoming podcast. You'll have to tune back in to hear about that. It's gonna be wonderful. I can't wait to talk with her. She's such an amazing young woman and she's figured out something early in life that most people take decades to figure out if they ever figure it out.

There are some things I do wanna leave you with some cautions. Not everyone can fully reverse their insulin resistance or their prediabetes and whatnot with lifestyle alone, it's doable for many people, but not everyone. So genetic factors play a big role. Some people just can be prone to it more than others, and if it's been going on for a very long time. So longstanding chronic damage may make some of those changes irreversible. So I encourage you to, get on this early. And you know, if you're in your twenties or thirties, take action to create habits now that you can sustain over the next 10 to 20, 30 years so that it's less difficult.

And if you're one of those people who can't fully reverse it, you can at least improve your symptoms and maybe rely on less medication. Medications are sometimes necessary for folks. Things like metformin, GLP one agonists are wonderful for that. SGLT twos, if you're tolerant of it. There are some caveats to each one of these medications, so make sure you discuss it with your primary care doctor as to whether or not it's necessary as an adjunct or if, you're a good candidate for any of them.

So if nothing else, I wanna remind you again, please coordinate with a medical provider before adjusting any medications or embarking on anything intense, or at least working with a health coach because it is difficult to do this on your own, especially when you don't have the experience, and background you wanna make sure that you're doing the right things. There some risk of relapse. Everyone is going to relapse at some point. The question is, how quickly do you bounce back?

You want to, first of all be attentive, have something that you're using to keep track of, to keep yourself accountable. whether that's monthly weigh-ins or monthly circum conference checks, or, regular visits with your primary care physician.

Getting on a composition scale on a semi-regular basis, whatever that is, you need something that's going to be an objective check-in or objective measure to make sure that you're not falling off track. I don't weigh myself on a daily basis. I will periodically weigh myself, I don't even have a timeframe on. I mean, again, a lot of things that I do are just out of routine and habit. But I will have a check-in with myself. periodically, at least maybe once every few months, where if I'm feeling like I'm not my best, I'll check in to see where I'm at.

I don't wait for the scale to get out of control. before I actually start taking action, so if I feel like things aren't going the right way, I will verify, yep, looks like I'm up a few pounds. Let me assess what I've been doing and haven't been doing. So don't be afraid of measurements. It is important that you have an objective measure that's going to keep you honest. if you need to do it every month, if you need to do it every week, whatever you need for whatever period of time, it gets easier over time, and you may not need to do it quite as often.

Okay? It might even be just that your favorite pair of pants that suddenly start feeling tight. Usually lately for me, it's how my clothes feel. Then that's when I'm gonna jump on the scale and I'm gonna start making some adjustments and reflecting on how I've, what I've been doing or haven't been doing.

All right, final words here. So, insulin resistance is not inevitable. You do have agency, through movement, diet, sleep, trying to manage your stress through behavior modification, putting up boundaries, whatever that is that you need to do in your life. These are things that you can do to prevent or reverse insulin resistance.

I challenge you to pick at least one small habit to add in this week. So if you're not doing any exercise at all, one thing that you can maybe do is add a 15 minute walk after dinner. Another possibility, maybe add a vegetable to every meal. If you're not getting enough sleep, go to bed 10, 15 minutes earlier. Heck, if you really wanna push it 30 minutes, I usually like to do it in 15 minute increments and then stick with whatever that thing is.

I would love to hear from you. If any of you have had any victories, you've been able to successfully implement strategies, even if you've done it before this podcast, I would love to hear from you, what you've done and how you've been successful.

You can email us at info@angelalifestylemd.com and let us know, what's worked for you and what hasn't worked for you. And then we can share those tips with our listeners on our next podcast episode. So in our next episode, we're going to hear from a patient who has done this, who has successfully changed things in her life and for her the big shift didn't happen until she addressed the stress factor. She was already doing really well with exercise and she was eating pretty well. But the scale wasn't budging. She was still feeling crummy. Things just weren't quite adding up.

And it was the stress. And in this case, it was her job. And this is a very common thing I hear from people. Common thing. Doc, I am doing all the right things and I can't seem to lose the midsection, whatever that may be. Well, have you, have you looked at your stress? Have you looked at your relationships?

Have you looked at your sleep? Have you looked at your time on social media? Whatever that may be. What are you doing in those other areas of life that maybe have a negative impact on you that you just don't realize? And then I wanna remind you, don't wait until your labs are bad to do something about it.

Most of us don't act until we see that the number is off. Right. So that's what happens in my office all the time. People will say, this is off. I need help with this. or maybe they don't know something is off and I show them and it's like, that's a wake up call. and that's fine.

But it would be so good if more people would Just act before that becomes a problem. Okay? So my encouragement to you is don't wait for things to get bad, for you to make a lifestyle change. If you found this episode helpful, please write a review. Share this with a friend or someone you know who may benefit from this episode.

And we are so grateful that you taken time to listen today. Please join us next time. Bye.

This has been another episode of The Lifestyle MD. Special thank you to Lou Musa for the show Theme Music created with free photography and makeup by Janae for the cover photo. And if you enjoyed this podcast and you haven't already, please subscribe today and share. You may also follow me on Instagram at Angela Lifestyle md. I am Dr. Angela. Thank you for joining me today.