Balancing Omega Fats For Heart & Brain Health

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Thank you, and thank you for the great introduction. I love it.

Joel Kahn, MD, FACC

There is an incredible website, drritamarie.com, that I am very familiar with. You want to be very familiar with them. I know she put a lot of effort into it. We’re so glad that you can share it with us. Let’s talk. I’m going to kick it off with a tough question and one that you’ve talked about before. We are hearing a lot at this summit about heart disease, halting it, preventing it, and even reversing it. A lot of it’s through nutrition. Our emphasis is whole food and plant-based nutrition. But you’ve spoken before about when a plant-based diet can be harmful. Nobody else is talking about that. Why don’t you share that with us?

Ritamarie Loscalzo, MS, DC, CCN, DACBN

A lot of people think that just because they’re eating a vegan diet or a plant-based diet, they’re on a healthy diet. What I find is that there’s a lot of misinformation there. There are certain things, like, Triscuits are probably vegan right there, probably, but it’s Whole Foods. The real big emphasis is on whole foods, but even among whole foods. When we add in all the crap, when we take out the fake meats and the fake food, that’s bad. The sugar is. We talk in detail about why too much sugar is bad. A lot of people who eat plant-based foods make a lot of flour products, like pasta and bread. A lot of them are conscious of the quality of those grains. All that stuff can contribute to insulin resistance, which is one of the leading causes of heart disease and sudden death from heart disease when we have constriction and restriction of the arteries. that’s it. But the other piece is when someone doesn’t eat right for their blood sugar balance. It may be that they’re just eating too much pineapple and not balancing out with more greens, or whatever it might be that’s causing blood sugar spikes. They’re not measuring it. They’re not looking at their labs. They’re not wearing a CGM or using a device to break their fears. They don’t know, and they’re running around with big spikes in their glucose and insulin. Those are some of the ways that a plant-based diet can be dangerous.

Joel Kahn, MD, FACC

To you, it is certainly not suggesting we give up the salmon and go over to the carnivore summit. One is the high-fat, high-animal food ketogenic summit. That’s how you’re suggesting it takes a little bit of discipline, education, and doing it right.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Do it right. keto, too, and you can do a Keto-type diet on plant-based foods, like if you’re very sensitive to glucose and glucose spikes, having a little bit more on plant-based whole foods, that’s not oils and all that garbage. But if you’re doing that, you might have a better response than somebody who maybe doesn’t have the genetics towards insulin resistance, the family history of insulin resistance, or their glucagon in glucose and insulin. It’s just a matter of optimizing the diet to meet your particular needs.

Joel Kahn, MD, FACC

You’ve emphasized the potential dangers of refined grains and white flowers; maybe some of the white pasta emphasizes the added sugars. We’ve got to start reading labels. We’ve got to do our work.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

It’s amazing how many products are plant-based, vegan, healthy blah. You read them, and they have sugar in them, and maybe it’s disguised; maybe it’s maple syrup; maybe it’s some agave nectar; maybe it’s coconut syrup, whatever it might be. Those are sugars. Sugar of any other name with any other name is still sugar. If it doesn’t have all the fiber and nutrients that a whole food would have, it has the potential to cause glucose spikes.

Joel Kahn, MD, FACC

You’re certainly one of these doctors who teaches mind-body importance and that food is medicine. But you’re pretty high-tech in your practice, like I am, and you do a lot of blood work. How could somebody listening say, I wonder if my diet is promoting insulin resistance because I don’t want to promote heart disease? What can they do in the lab work that might appeal to them if they’re developing full-blown insulin resistance?

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Great question. It’s stuff that you probably didn’t learn in medical school because they didn’t focus on it. They said, fasting glucose goes above this point; you’re diabetic. If it’s not your fight, what about insulin? We got it tested. Insulin. A lot of times, people wait decades before they see their insulin levels, their glucose spikes, or their glucose fasting. They’re running around with high levels of insulin, and that keeps their blood glucose down. But it also has all the inherent dangers of high insulin. One of the dangers that bothers me the most is that it stiffens the arterial walls. It makes them less elastic. If you do have one of those plaques building up and it breaks off and the artery can’t expand, the same thing can happen with running for a bus or one of these other things that are going to need it: increased blood flow, and you don’t have elasticity in the arterial walls. You can get into lots of trouble. Insulin is one of my favorites. The other one is hemoglobin A1C, which, mostly B’s insulin and hemoglobin A1C, are tested in people who are already diabetic. But you can find out 30 years before, 20 years before, 40 years before, or many decades before, as you’re developing this process, and you don’t want to find out when you just suddenly dropped out of a heart attack.

Joel Kahn, MD, FACC

That is not a good time to find out. We will agree with that. There is no sort of related topic. I don’t think anybody else is going to speak about this among those that we’re interviewing. When I get the pleasure of seeing you at a conference, you almost always have a continuous glucose monitor on the back of your arm. I did ask before we turned this on. You have it off. I know I caught you off guard, but you said you were going to put it back on because they do need to be replaced every 10 to 14 days. Some people wear them for just a couple of weeks or a month. Some people wear them pretty regularly. What have you learned about your own food choices? Metabolism? You have a very large following. What do you hear from those that you’re educating? How much does it help to wear a FreeStyle Libre or something?

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Or Dexcom or whatever? I find it very helpful because it allows people to see what their food is, what their activity is, and what their stress levels are doing to their bodies. So I wear it most of the time, mainly because that’s what I teach and all that, but because if I don’t, then I might be a little bit more lax about some of the things that I eat. Not that I eat any garbage food. I don’t think I’m strict, but what I found in doing this is that things like pineapple, papaya, and mango, some of my favorite foods in the whole bloody world, raise my blood glucose a lot. If I eat them by themselves, and if I eat them in combination with a giant green smoothie or with a big green salad or something, that’s going to add the fiber and the nutrients, minerals, etc., it slows that down. The first time I discovered this, I had not eaten for hours. They said, Well, I’m going to test this thing; I’m going to make a video, and holy cow, I tested just my blood sugar before I even had the meter. I’m like, “Oh my God, I eat pineapple. My blood sugar shot up to 165.” For those of you who don’t know, that’s the diabetic range. I was shocked, and I was confused. I’m on a Whole Foods plant-based diet, and I’ve been on a Whole Foods plant-based diet for, at that point, 15, 20 years. What the heck is going on with me? That helps. But with the meter, we don’t have to poke our fingers all the time because what I find in working with my people is that when we can figure out their peak after a meal, the glucose will go up. The insulin comes up, brings it down, and then comes down. Depending on the degree of insulin regulation, sensitivity, and dysregulation, we can find that it goes up stays up, and then comes down. But by morning, it’s perfectly normal. Nobody catches it. But what happens every time we’ve got these high levels of glucose in the system? 

We get damaged. We get peripheral nerve damage; we get retinal damage; we get damage to the kidneys; and we get damage to the blood vessel linings. That part is particularly important to me because both my parents died suddenly with no warning of heart disease. Heart attacks like mom’s 56-year-old was 62. They just died suddenly. We didn’t know they had this problem. I don’t want that to happen to me. I don’t want stiffened arteries. I don’t want anything that’s going to put me at that kind of risk. I don’t want my blood sugars to go up and stay high. Even if it’s fasting, it’s still normal. Mine was fasting glucose. My fasting glucose was probably 85, but my peaks were way up. So when I started wearing the continuous, I could find out what was causing it. I found out that stress increased my cortisol levels. I was mad about something my glucose would go up accordingly. It helps people understand how your diet choices your lifestyle choices, your stress levels, your exercise even is affecting your glucose, and how you can optimize it.  This is about cardiac function, and that optimizes heart function as well.

Joel Kahn, MD, FACC

In that wonderful personal testimony to what you learned. In your group, do people get a continuous glucose monitor on a prescription from a medical practitioner? Do they go to the company levels in Nutrisense and pay the bigger dollars to also get somebody to get some feedback? How do they get it? What’s practical?

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Expense? I would ideally get them to go to their medical practitioner and get it because it’s much less expensive. But a lot of medical practitioners won’t do it unless they’re already diabetic. Which to me is like, Why do you wait till somebody is sick before you do preventative work? But the ones that won’t—we use health levels here—are another one. You mentioned Nutrisense. There’s a number of them where they will cover the prescription for you. You pay a lot more.

Joel Kahn, MD, FACC

A lot more. Where I practice, if a doctor writes a prescription, the one I’m familiar with is the Abbott Freestyle Libre. Yep. It’s about $37 for a two-week setup. then you just have to download the app, and you don’t get a dietician in bells and whistles, but you get all the data.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Everything you need.

Joel Kahn, MD, FACC

Every time you want to see the numbers, they’re there on your phone.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

No, that’s a great price, because here in Texas, I’ve had prescriptions filled for $78 per year, or $68 per day. That’s a great price.

Joel Kahn, MD, FACC

Those other companies can easily be close to $200 a month. It’s still worth asking your practitioner for.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

There’s nothing off, no skin off your back. No, but you’re not asking to get insurance reimbursement. You’re just writing a prescription. It’s not going to be a problem for a doctor to write the prescription.

Joel Kahn, MD, FACC

I know that, in any kind of nutritional summit, even a plant-based summit, there’s going to be a little variety in the level of fat in the diet. My co-host is Dr. Joel Fuhrman, who teaches nuts and seeds, not oils. That’s pretty similar to your teachings. He’s a fan of avocados, and then we’ve interviewed the great Dr. Dean Ornish, who, at least in his research studies, experimented with diets that were much lower in flat fat, although he has eased his recommendation about nuts and seeds to include them in the last five or six years. But we didn’t talk a lot with a lot of the experts about alcohol, and we’ve mentioned added sugar. Why don’t you riff a little bit about what you see with alcohol and optimal health, added sugars and optimal health, and cardiovascular health?

Ritamarie Loscalzo, MS, DC, CCN, DACBN

First, I’ll talk about sugar, and then I’ll relate alcohol to sugar. Sugar is sugar. It’s like anything that’s pulled out of a plant to be a plant. Mostly, it’s a plant, but it doesn’t have the fiber or the nutrients. It’s something that we eat recreationally. We eat because it tastes good, not because it’s good for us. What happens is that without that, the sugar will just cause your blood sugar to skyrocket, and then the insulin levels will skyrocket. Then we have to pull them all together and get our cells back to normal. I find anything with the rose at the end: sucrose, dextrose, etc.—anything that’s refined. And coconut nectar—all of these things are sugar, and everybody’s got a different tolerance level—is what I found in researching this and working with people with meters and CGM for the past 12 years. I find that some people tolerate a little bit more than others. Some people, one person, put like a half teaspoon of coconut syrup in her tea, her herbal green tea, and it shot her blood sugar up almost 100 points. Other people can do that, and that is not a problem. Some people say, Well, it only goes up and it comes back down, but how often are you doing that? How often are you getting your sugar up to the point where it causes glycosylation of tissue, where it causes sugar coating of things, stiffening of the arteries, and it causes problems in the retina, etc.? I don’t want that to happen every minute of the day. That’s what I teach people. Some people have different levels of tolerance, and sometimes it could be a teeny tiny bit and it’s not a big deal. But some people are more sensitive than others, and some of that plays into genetics. A big part of it plays into genetics; it plays into early history. If, like me, you grew up eating M&M’s, Oreos, and Kool-Aid and you have a genetic tendency to insulin resistance and diabetes, then you’re going to be in more trouble, so that’s sugar. 

Alcohol. Alcohol gets converted to sugar pretty quickly or is utilized as sugar very quickly. Alcohol is addictive. Alcohol damages the liver, and the liver is a source of gluconeogenesis. We store sugar there, and this is a source of detoxification, so many things. We don’t want to damage our livers, and it affects brain cells. To me, people like those in the health industry, and you’ve been around some of these folks as well, are like, it’s organic alcohol so let’s just drink it. I just think it’s damaging. that it’s effective. So much a day is good for the heart, and this much is not good for the heart. Where do you draw the line for each individual? I don’t know. I’d rather if you’re going to get the polyphenols and all that, eat grapes or something; eat the foods that contain them. I’m so anti-alcohol that at my wedding, which was 38 years ago, we didn’t do a toast with wine. We had a rabbi, and he led the singing. This is the most unusual wedding I’ve ever performed, he said. Then we fed each other grapes. Like the fruit of the vine. This is the fruit of the vine because I don’t want to poison my body with it. Plus, the tendency to drink is so great that people don’t realize it when they cross the line. As I go out in the world, and they recently came back from a retreat, and I’m like, This is sad how much alcohol people drink. They have no idea how it’s affecting their hearts, how it’s affecting their livers, or how it’s affecting their brains. used to it recreationally. I don’t know about you, but the things I want to do recreationally are outdoor activities, hiking, and biking, and funding is not poisoning my body. I know I’m an extremist, but this is what I found with over 30 years of experience and practice that works well.

Joel Kahn, MD, FACC

I know what a lot of people are thinking right now. How is she married? 38 years. She looks about 40 years old. Keep them on their toes with that comment. Well, I want to keep it short, sweet, and powerful because I do want people to wander over to drritamarie.com, and maybe they’ll become students of the Institute for Nutritional Endocrinology. You have great programs for insulin resistance, digestive mastery, and certification programs. You’re a powerhouse. I know that from now on, I’ll be able to participate in the programs with you, and I thank you for those invites, so don’t go anywhere. Dr. Ritamarie, we’re going to say goodbye to our wonderful general seminar audience, hang around for a couple more minutes for our premium package listeners, and just drill down on a couple more topics you touched on because they’ve been helpful. Thank you so much.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Thank you.

Joel Kahn, MD, FACC

We’re back with Dr. Ritamarie. We’re excited because we know we have so much information that you’re going to use, and we thank you for your premium listeners. We’re just going to go a little deeper. You’ve talked a lot about the ratio and how we’ve talked about it on the summit of omega three to omega six and how to measure it, not optimize it. What’s the importance of that? We can’t talk for hours about Omega 3, but this specific ratio. Help us with that.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Omega six and three. A six is more anti-inflammatory, and this is generalized. This is taking complicated science down. But six tends to be more inflammatory, and three tends to be anti-inflammatory. Six tend to be more spasmodic-causing, and three tend to be more relaxing. We know the importance of omega-3 fatty acids in heart disease. We know its importance in a lot of things, inflammatory, and autoimmune. But what a lot of people don’t realize is that you do need to make sure that you keep a good ratio. I found and mentioned why, when plant-based diets can be dangerous, a lot of people think I’m not going to drink milk anymore; I’m just going to drink almond milk. Well, almond milk has an extremely high ratio of six to three omega-3. You can inadvertently put yourself in an inflammatory state when you think you’re in a protective state. Not that I’m saying almond milk is worse than dairy milk, and I’m not a fan of dairy milk, but what we think is, that it’s a plant. Let’s just see almond butter, and let’s just eat; let’s just drink almond milk and other things like that. We need to keep it in balance. The studies vary, but I like to see no more than four times the amount of omega-6 than three. None of the studies show higher levels. When we look at the US, the people that are in the US—the people with the most inflammation, the people with MS, and the people with autoimmune diseases—have very high ratios of omega-6 to three. So I’m a fan of keeping that in balance so that we have more of a tendency toward antispasmodics, anticoagulants, and all that.

Joel Kahn, MD, FACC

What are some of your favorite sources you teach for Omega 3 to get that portion of the ratio up?

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Well, there are flax seeds, chia seeds, hemp seeds, walnuts, and parsley, which most people don’t eat, but it’s a wild green edible, and it’s very high in EPA, algae, very high in the DHS, a little bit of EPA. Those are things that people could start to include regularly. Then we also, thought, this is the part people forget about people who are anti-plant omega-3s will say, people can’t convert. You can’t convert those short chains in those foods you just mentioned into the long chains. You need fish. I don’t believe that because the reason people can’t convert is that delta-60 saturates are converted by enzymes. guess what? It’s heavily nutrient-oriented. If somebody is eating a processed food diet and they’re missing their B vitamins, vitamin C, copper, boron, etc., no, they’re not going to convert. But if you’re eating a very nutrient-dense, whole-food plant-based diet with easy conversion, and I’ve seen it, I’ve seen people who have been plant-based for a long time. We do a test; we do an Omega 3 index, and it looks pretty good, but not for everybody there. Maybe there’s a particular genetic snip called a FADS2. If you have that, it might be slower, and you have to be more conscious of whether you may need to supplement to make that happen. But it’s very doable. But it’s part of the bias against eating a plant-based diet. No, you have to have fish to do it. I don’t believe that now.

Joel Kahn, MD, FACC

If you can’t achieve an adequate omega index with the foods alone, why use algae-based omega-3 vegan supplements?

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Absolutely. 

Joel Kahn, MD, FACC

I agree with you. That’s the way I practice. Dr. Joel Fuhrman would be smiling since he’s been teaching that for more than a decade, probably closer to two decades, and the importance of brain health, optimal cholesterol particles, and all the rest.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Absolutely. 

Joel Kahn, MD, FACC

Let’s wrap this up by just going back to a topic you talk about and teach about so much: insulin resistance. We talked in the first part about the foods and continuous glucose monitors. But I just want to get back to the connection to heart disease. Why should people ask their primary care doctor for fasting insulin, hemoglobin A1C—maybe even a two-hour glucose tolerance test? All of it is still not a worthless endeavor. What’s the connection?

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Or postprandial. You don’t have to drink the glucose syrup, necessarily. You can just go out to your car and eat the highest-carbohydrate meal that you normally would eat. It could be a high or a plant-based nice thing, but you’re eating bread, sugar, or whatever you might use. But I don’t know. It doesn’t have to be the two-hour glucose tolerance where you drink the glucose syrup; you can just do it yourself. I like to go out to the car 45 minutes to an hour later and then go back to the lab and have it tested. You see your postprandial, and I have seen some ridiculous elevations in the insulin level after eating. What was the question? How is it related to heart disease? High levels of insulin are damaging, the labs are crazy, and the ranges, like in functional medicine, look like two to five is a good fasting insulin. Anywhere between two and five is ideal. The range in the lab can go up to 19. If you’re fasting, your insulin is 19. It means you’re constantly in an anabolic state, you’re constantly storing fat, and you’re constantly in a state where high levels of insulin are damaging your system. It stiffens those artery walls, and that’s not a good thing.

Joel Kahn, MD, FACC

I do not want to harden and stiffen arteries; that is, they’re supposed to be soft and flexible and allow blood pressure and blood flow to happen nearly effortlessly. All that with our genetics, our dietary indiscretions, our lack of sleep, our lack of fitness, and all the other things.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

Sleep is worth mentioning. How insulin resistance is going to be at an all-time high after a bad night of sleep. One bad night of sleep for an otherwise healthy person can cause insulin resistance the next day. Sleep is critical.

Joel Kahn, MD, FACC

Well, we appreciate your time. Busy woman that you are. Say hello to your wonderful husband, Scott, and give me one more shout-out where people can find you and learn more about all the years of education you’ve been doing.

Ritamarie Loscalzo, MS, DC, CCN, DACBN

drritamarie.com is my main website. You can link from there to our practitioner website, where we have all kinds of great training for health practitioners, doctors, nurses, and health coaches, wherever you are, who want to go deeper into the science behind how to use nutrition and lifestyle to get results with people and help them get to the true root cause. That would be inemethod.com.

Joel Kahn, MD, FACC

A lot of great social media posts, so be sure to follow Dr. Ritamarie is here all the time on Instagram and doing great stuff. Thank you so much again. We will continue to work with each other because it’s so much fun.