Dr. Jay Wrigley engagement report

Best tweets

• Oct 7, 202628x their median

  Type 2 diabetes starts in your fat cells, but your blood glucose doesn't get meaningfully worse until the problem reaches your muscle. As fat cells grow too large, they become insulin resistant and pro-inflammatory, both of which promote insulin resistance throughout the body. For a while, the pancreas keeps up by making more insulin, and glucose looks normal. The trouble becomes more pronounced when the insulin resistance reaches your muscle. Muscle is where most of your blood glucose goes when insulin rises, so once muscle stops responding, glucose starts climbing. Protect your muscle as if your blood glucose depends on it! Ideally, lift two or three times a week (the signal) and prioritize protein and fat (the fuel).

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• Oct 5, 20269.3x their median

  It's funny when certain accounts always reply with negativity to your posts, and you see them elsewhere, and everything they say is negative. So I guess, don't take it personally.

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• Oct 9, 20268.7x their median

  One of the greatest nutritional mistakes of the last 60 years? Convincing people to fear the cholesterol in eggs and the saturated fat in red meat while steering them toward carbohydrate-heavy, highly processed foods. We demonized some of the most nutrient-dense foods on the planet while filling grocery stores with refined starches, sugars, and products marketed as “heart healthy.” Six decades later, we’re still paying the price. It wasn’t the eggs and steak we should have been so afraid of.

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• Oct 7, 20263.8x their median

  A woman in her early 40s does not automatically need estrogen because she’s entering perimenopause. Without clear evidence that estrogen is deficient or ovarian function is failing, simply adding estrogen may miss what’s actually changing first. For many women, progesterone is declining while estrogen production is still quite adequate—and sometimes highly erratic. That changes the conversation completely. Hormone therapy should address the hormonal pattern that actually exists, not simply the woman’s age. In early perimenopause, natural micronized progesterone may deserve much more attention than it gets.

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• Oct 8, 20262.7x their median

  Every time I mention the FACT that my insulin and glucose get higher with a high fat diet it causes a storm... Here's how this works for those who can't wrap their head around this. First I have tell you that it doesn't matter whether the glucose comes from carbs, or gluconeogenesis. And genetics can and do make a difference to how much glucose is produced by the liver. Okay, let's go: Can a very high-fat diet increase insulin and glucose—even when carbs are low? Yes, it can. And there is a well-established physiological mechanism behind it. When fatty-acid availability is high, the body increases fat oxidation. Fat and glucose compete as fuels, and increased fatty-acid oxidation can reduce insulin-stimulated glucose uptake and glucose oxidation. This is part of what's known as the glucose–fatty acid cycle (Randle cycle). The result can be reduced insulin sensitivity. When insulin sensitivity falls, the pancreas may need to produce more insulin to keep blood glucose under control. If compensation isn't enough, glucose can rise as well. So: Low carb ≠ automatically low insulin. And: High fat ≠ metabolically neutral simply because it doesn't directly raise glucose like carbohydrate does. This doesn't mean dietary fat always causes insulin resistance. The response depends on the type and amount of fat, energy balance, metabolic state, tissue involved and individual physiology. But the idea that "carbs are the only thing that can cause high insulin" is simply not supported by the physiology. There's research going back decades showing that elevated fatty acids can interfere with insulin-stimulated glucose disposal and insulin signalling. The science: Randle et al. — The glucose fatty-acid cycle (1963) PubMed Free fatty acids and insulin resistance PubMed The Randle Cycle Revisited PubMed I'm particularly interested in this because my own glucose and insulin markers were better on a higher-carb, very-low-fat diet than when I pushed dietary fat much higher. That's why I think we need to stop treating "low carb" and "metabolically healthy" as automatically synonymous. Your individual response matters.

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• Oct 8, 20262.5x their median

  Menopausal brain fog is much more interesting physiologically than simply saying, “Your estrogen is low.” In many women, brain fog is the downstream effect of several overlapping metabolic, neurological, hormonal, and sleep-related changes. Here are six mechanisms worth looking at. 1. Impaired brain glucose metabolism Estrogen influences how the brain transports and utilizes glucose. During the menopause transition, changes in estrogen signaling can alter cerebral energy metabolism. The result can be reduced cognitive efficiency, particularly when a woman is already dealing with insulin resistance or metabolic dysfunction. What she notices: Difficulty concentrating, slower thinking, and trouble retrieving words. 2. Sleep fragmentation and loss of deep sleep A woman doesn't have to experience obvious insomnia to have poor-quality sleep. Nighttime hot flashes, increased sympathetic activity, and obstructive sleep apnea can disrupt restorative sleep. Even if she gets seven or eight hours, she may not be getting sufficient uninterrupted sleep to support memory consolidation and attention. What she notices: Waking up mentally exhausted despite spending enough time in bed. 3. Thyroid dysfunction Thyroid hormones influence cerebral energy metabolism, neurotransmitter function, and cognitive processing speed. Hypothyroidism can contribute to slowed thinking, poor concentration, and memory complaints. Thyroid disease also becomes more common with age. What she notices: Brain fog accompanied by fatigue, cold intolerance, constipation, or declining physical stamina. Importantly, these symptoms warrant thyroid evaluation rather than assuming a woman needs more thyroid hormone. 4. Chronic stress and HPA-axis dysregulation Persistent psychological or physiological stress can impair attention and working memory. Elevated or dysregulated cortisol signaling may affect hippocampal and prefrontal cortical function, particularly when accompanied by inadequate sleep. What she notices: She can remember things when relaxed but struggles to think clearly when overwhelmed. 5. Neuroinflammation and metabolic inflammation Obesity, insulin resistance, sleep disorders, and chronic inflammatory conditions can contribute to systemic inflammation. Inflammatory signaling may influence brain function, although directly attributing an individual woman's brain fog to neuroinflammation is difficult without stronger evidence. What she notices: Cognitive fatigue alongside other metabolic or inflammatory symptoms. 6. Nutrient deficiencies and impaired oxygen delivery Vitamin B12 deficiency, iron deficiency, and anemia can cause cognitive complaints that resemble menopausal brain fog. These issues are particularly important because they are potentially correctable and can coexist with menopause. What she notices: Poor focus, mental fatigue, forgetfulness, sometimes accompanied by weakness or reduced exercise tolerance.

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• Oct 10, 20262.2x their median

  During perimenopause, progesterone often begins declining long before estrogen does. That changes the hormonal balance. Your body may become more prone to water retention, disrupted sleep, and changes in how it stores fat. Suddenly, the diet and exercise routine that worked for years doesn’t seem to work anymore. You’re not imagining it. Your hormonal landscape is changing. And your approach needs to change with it.

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• Oct 8, 20262.1x their median

  One of the biggest mistakes I’ve watched people make in 30 years of clinical practice is trying to negotiate with a food their body has repeatedly told them is a problem. It might cause digestive distress, poor sleep, inflammation, cravings, or simply leave them feeling terrible. But they convince themselves: “I can have just a little.” “I’ll only eat it occasionally.” “I can manage this.” Here’s what I’ve learned. For some people, certain foods aren’t manageable through moderation. Once you start eating them, the cravings, symptoms, or cycle of overeating can become very difficult to stop. And every time you make an exception, you start the cycle all over again. Sometimes the answer isn’t better self-control. It’s complete elimination. Not because that food is bad for everyone. But because you’ve learned what it does to YOU. And there’s tremendous freedom in no longer negotiating with something that consistently makes you feel worse.

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• Oct 5, 20262.0x their median

  Eating while lying in bed at night is a sure way to disrupt sleep, increase Insulin so you store those calories overnight and disrupt your Cortisol and circadian rhythm cycle. Stop doing that

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• Oct 11, 20261.9x their median

  One of the cruelest ironies of getting older: At 25, you could eat pizza, drink wine, skip the gym, and stay thin. At 50, you’re eating salads, counting calories, walking every day, and somehow your waistline keeps expanding. And everyone seems convinced the answer is to follow their particular way of eating—even more strictly. But here’s what they’re missing: Your hormonal environment has changed. Your muscle mass may be declining. Your insulin sensitivity, sleep, and stress response may not be what they once were. You’re trying to solve a different metabolic problem with the same old advice. After 40, your body didn’t break. The rules changed.

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