Hills I’ll Die On as an Integrative Dietitian

Nutrition is the loudest, most contradictory industry on the internet. Cut carbs. Eat more carbs. Fast. Don’t fast. Drink celery juice. No, don’t. Cleanse. No, that’s a scam. The signal-to-noise ratio is brutal — and most of the people shouting the loudest don’t have clinical training.

I’m a registered dietitian (RDN) and an integrative and functional nutrition certified practitioner (IFNCP). I work at the intersection of evidence-based and functional medicine, which means I read the studies AND I look at the patient in front of me. After years of doing this work, I’ve made peace with something: I’m going to disagree with a lot of people. Loudly. And that’s the job.

Here are five hills I’ll die on — even when they cost me followers.

Hill 1: Fasting insulin should be standard on every PCP panel.

Hemoglobin A1c — the standard “are you diabetic yet?” test — lags two to three years behind insulin resistance. By the time your A1c moves, the metabolic dysfunction has been progressing for a long time. Fasting insulin, paired with fasting glucose (HOMA-IR), catches it earlier. Sometimes years earlier.

This isn’t a niche functional medicine opinion. The clinical literature is consistent: fasting insulin is one of the most underused markers in primary care. Most insurance covers it. Most patients have never had it run.

If you’ve been told your labs are “fine” but you’re gaining weight despite eating well, having mid-afternoon energy crashes, or struggling with PCOS/PMOS-style symptoms — and your fasting insulin has never been checked — your workup is incomplete.

You don’t need to switch doctors to ask for it. You can request it at your next physical. The phrase is: “Can you add fasting insulin to my standard panel?” Most PCPs will run it without pushback. If yours won’t, that tells you something too.

This is the hill: “your labs are fine” doesn’t mean you are. It means the labs they ran were fine. There’s a difference.

Hill 2: Cortisol isn’t the villain. Chronic dysregulation is.

The internet has decided cortisol is the new sugar. Cortisol face. Cortisol belly. Cortisol everything. The framing is wrong, and it’s making women anxious about a hormone they need.

Cortisol is essential. It pulls you out of bed in the morning. It runs your inflammatory response. It mobilizes energy when you need it. The problem isn’t cortisol — it’s the pattern of cortisol over a 24-hour day. A healthy cortisol curve peaks within an hour of waking and declines through the evening. A dysregulated one stays flat, spikes at the wrong times, or crashes when it should be steady.

You can’t fix this with another adaptogen. You fix it by measuring the curve first — usually with a four-point salivary or DUTCH test — and then matching the intervention to what’s actually broken.

So no, “lowering your cortisol” is not the goal. Restoring its rhythm is. And until you know what your curve looks like, you don’t know which intervention you actually need.

This is the hill: stop fearing your stress hormone. Start measuring its rhythm.

Hill 3: Anti-inflammatory eating shouldn’t require a $200 grocery bill.

Most “anti-inflammatory” content online is class-locked. Organic everything. Wild-caught only. Pasture-raised. Grass-fed. Cold-pressed. The list reads like a luxury shopping cart, and it gatekeeps women out of better health.

Here’s what the research actually shows: the largest inflammatory drivers in the standard American diet are ultra-processed foods, refined seed oils consumed at high volume, and insufficient fiber and omega-3 intake. You can address all three without ever stepping into a Whole Foods. Frozen wild salmon at Aldi. Canned sardines. Frozen berries. Lentils. Cabbage. Olive oil.

The reason the expensive version dominates online is simple: it photographs better. The cheap version is the version that works for most people, most of the time.

If your protocol can only be afforded by people in the top 10% of household income, your protocol isn’t a health intervention. It’s a luxury product.

This is the hill: simple before complex. Start with what’s in the budget, and add as you can.

Hill 4: Counting macros without minding micros is incomplete medicine.

You can hit your protein target every day for a year and still be magnesium deficient, iron deficient, B12 deficient, and short on omega-3s. Macros tell you how much energy you ate. Micros tell you whether the cellular machinery can use it.

USDA data is blunt here: most adults in the US fall short of recommended intake for magnesium, vitamin D, vitamin K, choline, and omega-3 fatty acids — and that’s just the standard intake recommendations, not the optimal ranges. The deficiencies don’t always show up as a clinical disease. They show up as fatigue, brain fog, slow wound healing, mood changes, and a general sense of “off.”

This is why I don’t write protocols that start with macros. I start with micronutrient density — what’s missing, what’s deficient, what needs to come in. Then we layer macro structure on top.

This is the hill: protein-counting culture is incomplete. The micronutrients are where the function lives.

Hill 5: GLP-1s are a tool, not a moral failing — but they’re also not the first answer.

I’m going to make exactly nobody happy with this one.

GLP-1 medications (Ozempic, Wegovy, Mounjaro) are powerful tools with real clinical use cases. They are also being prescribed to women whose actual issue is insulin resistance, undiagnosed thyroid dysfunction, poor sleep, chronic underfeeding, or a metabolism that’s been wrecked by a decade of restriction. Putting a GLP-1 on top of an untreated upstream issue is going to work in the short term. Five years from now, when the prescription stops, the upstream issue is still there.

This isn’t anti-GLP-1. There are patients I’d refer to a GLP-1 prescriber tomorrow. It’s anti-”GLP-1 first, ask questions never.” Run the labs. Address the upstream drivers. If the answer after that is still GLP-1, that’s a clinical decision made on a real foundation — not a panic prescription.

The opposite take — that GLP-1s are cheating, weak, or shameful — is just as wrong. Diabetes medications have always been part of medicine. This one happens to come with weight loss as a side effect, and the moralizing around that says more about culture than about clinical care.

This is the hill: anti-extremes, in both directions.

That’s five.

These aren’t opinions I picked off the internet. They’re shaped by clinical training, functional medicine certification, and years of watching women get told “your labs are fine” when they knew they weren’t. If any of these resonated, we should probably talk.

Balance Blue Collective offers two ways to work with me:

Elite — full functional medicine workup, including functional testing, biweekly 1:1 sessions, and a personalized protocol. This is the program for the woman who’s done the surface-level stuff and needs root-cause work. (Indiana residents only.)

Blueprint — nutrition counseling with a functional medicine lens, group education, personalized meal planning, async messaging, and a monthly 1:1. The program for women who want clinical guidance without the full functional workup yet. (Indiana residents only.)

Book a free Discovery Call to figure out which one fits.

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