Note: this transcript is not 100% accurate.
00:01
But as you get older and your metabolism slows down, you are supposed to be taking in less food. If you’re constantly eating throughout the day, your body is not getting a time to rest. It’s not getting a time to start breaking down fat, to let your liver rest. So it is very well established that men have faster metabolism than women. It also has to do with muscle mass and height because generally men have more muscle and men are taller.
00:31
that we give birth to the kids and we also have these weight issues that we go through perimenopause. What do they go through? Can we talk about them for a second?
00:43
This is Dr. Meenal and welcome to Uncover Your Eyes, where we break down the most pressing health topics shaping lives today. Metabolism just isn’t about burning calories, but it’s the engine that powers and fuels your entire body from energy production and digestion to hormone balance and mental clarity. But with so much misinformation out there, it’s
01:13
easy to feel lost. But I’ve got you covered today with Dr. Alessia Roehnelt, who is an endocrinologist and a metabolism expert. She has a holistic approach and also focuses on longevity. Welcome, Alessia. Thank you so much for being on today. Thank you so much for having me. So, you know, I know we talk about metabolism in a very layman’s terms, like I tell everybody I must have slow metaz.
01:41
metabolism because I keep gaining weight. So what is metabolism and like, how do we fire it up? I want to say. Yeah. So basically the metabolism is how quickly you are utilizing energy and how much energy you need. So everybody has a different resting metabolic rate, meaning how much energy or calories or food intake do they need to do the basic functions of life? Like breathing, cell turnover, things like that.
02:11
And everybody is different. So this can vary based on age. This can vary based on gender, weight, height, muscle mass, a lot of different things. So everybody basically has their own set metabolism, just genetically, physically what they were kind of made to be. And then there are the components of, is something making this worse? Is there an external factor outside of your genetics that you could potentially
02:39
change in order to improve your metabolism? How do we improve our metabolism? Good question. So there are a few different ways. One is definitely muscle mass. So muscle is critical for metabolism. The more muscle you have, the faster your metabolism will go. And the less muscle you have, the slower your metabolism will be. And this really comes into effect as people start aging. Okay. We know that
03:09
especially in women in that perimenopausal to menopausal range, we see a dramatic decrease in their muscle mass. Even if they are doing the same activities that they’ve always been doing, they’re losing muscle at a very accelerated rate at that time of life. And then in the general population, we generally do lose a little bit of muscle every year after about that range of age 40 or so. So if you are not doing something to proactively
03:39
improve your muscle mass or build muscle mass, you’ll technically continue to lose it and your metabolism will continue to get slower. So one thing that I tell my patients who are interested in improving their metabolism naturally is to exercise. mean, muscle is so key for this. It really is a way to make sure that your metabolism is maximized without having to add anything special or take anything away dietary wise and things like that.
04:08
other components that fall into this. It could include things like intermittent fasting. The idea behind intermittent fasting is that you want the body to be able to transition between breaking down carbs that you’re eating in a meal versus breaking down stored fat. If you are, and I say you, meaning the average person, if the average person is eating
04:34
three times a day, possibly more, you’re pretty much constantly in a state of burning those carbs that you’re eating or the food that you’re eating. You’re never really getting to a state of starting to burn your fat stores. So the idea behind intermittent fasting is that you go a certain amount of hours without eating. And at a certain point, for most people that starts to happen around eight hours, 12 hours, even 16 hours, their body starts to break down the fat that they’ve been storing.
05:03
The ability to go between a state of breaking down carbs that you ate and breaking down fat that you stored is a very important mechanism for your body. This is referred to as metabolic flexibility, the ability to go between burning what you ate and burning what you stored. And the more that your body can do that, the healthier your metabolism will be. Wow, that’s loaded. So my question for you is, so
05:32
It is important for us to have those breaks in between meals or, you know, if it’s not intermittent fasting, to have periods of non-eating to give the body an opportunity to burn fat. Yes. I guess that’s the idea behind grazing. A lot of people, or, you know, we let our children obviously graze a lot more, have a lot more snacks, so possibly reducing those snacks, correct?
05:58
Yeah, I mean, for children it is a little bit different because they’re growing. mean, their bones are growing, their bodies are growing. They do need different amounts of nutrition than adults. But for adults, if you’re constantly eating throughout the day, your body is not getting a time to rest. It’s not getting a time to start breaking down fat, to let your liver rest. So we’re starting to see really high rates of things like fatty liver, which is when the body is basically depositing fat on the liver.
06:26
Part of that is thought to be due to eating late at night and then going to bed, having a lot of carbs and processed foods. It’s just like we’re overloading our bodies in these extra calories and products and never giving it a time to rest. Are there, you touched on processed foods, obviously they’re not great for us. Are there foods that you feel help to…
06:48
boost metabolism? Like we always see these gimmicks, know, metabolism booster. get these ads on Instagram. Are there really foods that boost our metabolism? I would say not exactly. I think anything that’s, that’s being marketed as like a metabolism booster. mean, unless it’s like a stimulant, it’s really, it’s not going to be doing very much. You, you want to eat foods that jive well with your body and everybody really is different. So for instance,
07:19
If I have a patient who has insulin resistance or pre-diabetes or diabetes, I know that carbohydrates are going to be the worst thing for their metabolism. When they eat carbohydrates, their insulin levels will spike. And insulin is a hormone that tells the body to store fat. You cannot break down fat if insulin is high. So for my patients with blood sugar issues or insulin resistance,
07:45
Carbohydrates are the absolute enemy of a healthy metabolism. So for those patients, I would likely suggest things like more healthy fiber, like vegetables, lean proteins, nuts, things like that. But it would be definitely steering away from carbohydrates. But again, for someone without insulin resistance, it might be more of a total calories during the day, not necessarily what types of foods, but a balance of all of them, just in appropriate amounts.
08:14
you know, in terms of calories, like when I think as a lay person about metabolism and, know, just talking about it with friends, we’re like, oh, you know, we’ve gotten older, we’re past 40 now, slower metabolism. We think about eating fewer calories. So how does this correlate? Like, should it be that we should be gearing towards eating less calories or like, what’s that kind of not quick fix, but that way to help us get back to our metabolism? Yes, that’s an excellent point. So
08:43
You know, we live many years eating a certain way. You know, once we get into adulthood, we’re eating around the same amount of food every day. We’re looking at meals, we’re looking at a plate, we’re saying, okay, I have a plate full of food, so I’m supposed to finish this plate full of food. order, you know, you go to a restaurant, you order the appetizer, because everybody else is, you order the entree, because everyone, you get the dessert. So there’s also this social aspect of it that we’re kind of trained to eat a certain way and eat a certain amount.
09:12
But as you get older and your metabolism slows down, you are supposed to be taking in less food. So if you continue to eat the same way that you grew up with, that you ate for the last 30 years, you are gonna start to definitely put on weight. It’s difficult to tell someone to eat less because it’s not an easy thing to do. They feel hungry, they…
09:36
are trying to make these changes, it doesn’t seem right. They’re also maybe they’re at a dinner table with people of all age groups. And so, you you’re looking at someone eating a whole plate of food. Why can’t I eat that? But the metabolism does slow as we get older, as we age, you need less and less food. And we need to listen to that kind of cue. If you’re not as hungry, don’t eat what everyone else is eating. And okay, now I’m in my 40s or I’m in my 50s. Maybe I really need to start.
10:04
intermittent fasting and that’ll cut out breakfast. You know, something where you are proactively saying, I’m going to try to eat a little bit less. How do we measure, like you touched on the basal metabolic rate and all of that. So how are we getting tested for this and who needs to go, you know, and talk about this with their family doctors? So the, the basal metabolic rate is basically a calculation. is factored in age, weight, height, gender, things like that.
10:34
and you come up with a formula or an answer. Honestly, I don’t think that number is that helpful because that is the rate at which if you were doing nothing all day, what would you need to live? That’s not the reality. Most people are running after their kids. They are running to catch a bus. They’re trying to work out. knowing that basal metabolic rate to me does not is not very helpful. It really is trying to figure out, I burning enough? Am I active enough to
11:03
kind of be allowed to eat this much food? Can I defend eating all of these calories based on how I’m exercising and working out? Again, muscle is gonna help with the speed of the metabolism. So for people who are doing more strength training, muscle building, weight training, they’re probably gonna have more wiggle room in terms of what they can eat than someone who is just doing cardio. The interesting thing or the good thing I should say is that…
11:30
When you do cardio, generally makes you very hungry. You burn a lot of calories quickly, but that’ll drive a hunger response and kind of make you eat a lot, potentially even overeat. When you’re doing strength training, you’re not burning calories as quickly. So most people do not feel as hungry after they do some kind of strength training exercise. It also, you know, working it into realistic life, it’s a little easier to do strength training rather than cardio. You don’t have to…
11:56
be on an elliptical for 45 minutes or go for a five mile run, you could do 10 minutes of some weights and that could be enough to really get your metabolism going. So it actually is an easier way to get your daily exercise in and it generally won’t make people much hungrier like doing cardiovascular exercise would. Signs like, you know, I’m assuming weight gain, things like, you know, cravings, hormonal imbalances, like
12:24
What are other signs that would help us know that, we got to look at all these calories and our exercise routine to help with our metabolism? Are there other signs as well? Yes. So, you know, we can look at just the patient’s physical exam as well as blood work. So on exam, you know, basic, are they gaining weight? What is their BMI? How high is it? I don’t love BMI. It’s not a perfect marker of health.
12:50
but it gives us a general sense of if we think this person is overweight, obese, morbidly obese, all of that. Blood work is also very helpful because when we start to see metabolic abnormalities on blood work, it really means that this is truly becoming a problem. This excessive weight, it’s not just cosmetic anymore. This is actually affecting organs. So things that I look for, fasting blood sugar and insulin levels, if I see that maybe the blood sugar is normal,
13:19
but the insulin level is very high, that suggests insulin resistance. The body is trying really hard to keep that glucose in a normal range. So that would be the first sign that somebody is developing insulin resistance and we have a problem. I look at cholesterol, especially triglycerides. I’m sure a lot of cardiologists would argue with me on this one, but my biggest thing when I look at a triglyceride, when I look at a lipid panel, my biggest concern is the patient’s triglycerides.
13:47
Triglycerides tell me so much about how someone’s eating. Usually we’ll see high triglycerides when patients are overeating carbohydrates or processed foods. That doesn’t go for everybody. There are some genetic issues where people can have high triglycerides just genetically, but most often it is because they are eating too many carbs or processed foods for their body. So I look at triglycerides. I look at liver function.
14:15
As soon as we start to see liver tests going up, I get very concerned. That usually is a sign of fatty liver, which is when we’re literally depositing excess fat on the liver. Who knows where else this is happening? You know, could this be happening to the heart, to the brain? Where else are we depositing this fat? But it is certainly a sign that there is excess fat and it is now causing problems with the internal organs. So I’ll certainly look into the liver tests as well.
14:42
If a patient has any of these abnormalities going on, know, the first thing we do is try to talk about how they’re eating and how much they’re moving, because those are the things that really long-term will make the biggest difference and optimize that patient’s health long-term. However, if things are really going in the wrong direction and despite diet and exercise or attempts at diet and exercise, patients are still headed in the wrong direction. That’s when we start to talk about medications to try to reverse some of this.
15:12
Women tend to have like a lower metabolism or a harder time metabolizing foods and things after 40. Why women versus men? Great question. So that is one of the factors that goes into kind of our basal metabolic rate is gender. So it is very well established that men have a faster metabolism than women. It also has to do with muscle mass and height because generally men have more muscle and men are taller.
15:42
So all of these factor into the metabolism and therefore men have a faster metabolism on average compared to women. Also women will go through all of those hormonal changes of perimenopause and menopause, which again will be another hit to our metabolisms. We lose a lot of muscle, so now the metabolism is going slower. We’re losing estrogen and the more hormones you lose, again, the more it affects that metabolism.
16:10
As we start to go through menopause, we see things developing in women such as high cholesterol, high blood pressure, insulin resistance or pre-diabetes that they did not have before. They start to develop cardiovascular issues. So we know that the drop in estrogen is very closely linked with metabolic health. So unfortunately, women are certainly at a disadvantage when it comes to that in that age group of 40s to 50s. And are we gaining weight?
16:38
at a more rapid rate than men generally after 40? Certainly. So that time period, 40s to 50s, when the estrogen starts to fall, when we go through perimenopause and menopause, that is when women will see the biggest shift in their metabolism. It is a big, steep drop. It does kind of level off and it doesn’t seem scared. It’s all bad news. It does level off though it still remains slower as we age.
17:07
But for men, they generally have a slower reduction in their metabolism. It’s not a fast drop off. We don’t see men coming into the office at age 42 saying, I don’t know what’s going on, I’m gaining weight. But gosh, my whole schedule is full of women who are undergoing this issue where their metabolism is changing so much faster than they can even get a handle on. So certainly women will lose faster than men.
17:31
Great. So we give birth to the kids. I’m a feminist. I’m like, we give birth to the kids and we also have these weight issues. Then we go through perimenopause. What did they go through? Can we talk about them for a second? know what? can go through. I just want to know. They do not go through that much. They don’t have this drop off in testosterone. It’s more of a slow change over time. They, they really, I’m with you. They really get by without too many metabolic issues like we struggle with.
18:00
I also know- nice to your wives. Exactly. A lot of women will also ask if starting hormone replacement therapy will improve this metabolic change and help them lose weight. There are some studies to maybe suggest that it could improve the metabolism at least better than what you were kind of dealing with when you didn’t have hormones in your system.
18:27
but not everybody responds that way. I have definitely seen women gain more weight if they start estrogen. It’s almost similar to like if you were to start estrogen in the form of a birth control as a younger woman, you know, every now and then we see people do gain a little bit of weight. I generally caution my patients that I don’t recommend starting hormone replacement with the goal of losing weight because it won’t necessarily happen that way. However,
18:52
Could it improve metabolic function like improving insulin resistance, improving cholesterol, reducing the risk of heart disease? Definitely there’s a lot of good data out there, but it is not like a quick fix weight loss situation. Are there supplements? I mean, I know it’s not one size fits all, but are there generic supplements that you have recommended to some of your patients? Yeah. So if anyone is really starting to show signs of insulin resistance and they’re not interested in medications,
19:22
know, prescription medications. Sometimes I will advise them to try inositil or myoinositil. That is a supplement that I think of it as almost a mini metformin. It’s like a supplement version of metformin, not as strong as metformin, but a little bit. It does help with insulin resistance. So in patients who are not looking to be on a prescription, that is something I might have them consider. I’ve had other patients have success with, as it sounds, cinnamon.
19:50
can help improve blood sugar. Apple cider vinegar can help improve blood sugar. And in someone with blood sugar issues, improving blood sugar generally corresponds to an improved metabolism and improvement in weight. So those are some supplements I might recommend to my patients. What about, have you heard of berberin? I know a lot of my patients are on that. Would that be a supplement of choice as well? Certainly I’ve had some patients really swear by berberin, as well as chromium actually.
20:20
It’s just, is so hard to study these supplements. They don’t have a lot of great studies on them. But I’ve had patients try it and they do have a lot of success with it in terms of improving blood sugar. So normally if they ask me about it, I say, it’s fine, safe enough. You can give it a try and we kind of monitor their blood work. When you look at processed foods and insulin resistance and all of this, the number one thing I’m sure you recommend to your patients is diet, lifestyle.
20:47
And with diet comes a lot of these processed foods that we’re shopping for. So like, is there a way that you would tell your patients to look for like processed foods? Like look at the ingredients. You know, I’ve heard some doctors say something like, you know, if there’s more than three ingredients or something, you know, it’s processed or not good for you. Like, what is that rule of thumb as an endocrinologist? Sure. So I’m very much a fan of more of an ancestral way of eating. So whole foods.
21:16
things that are natural to the earth, things that you can recognize. You can look at a strawberry and you know what it is, but if you had a granola bar outside of a wrapper, you might look at it for a while and be like, I wonder, is that meat? What is that? So if you can’t recognize a product, that’s a good rule of thumb that it probably is processed and not good for you. I generally tell my patients at the grocery store to shop the perimeter. All of the natural foods that will spoil,
21:44
are normally located in the perimeter. So all of your fruits and vegetables, all of your dairy, your meats, your fish, things like that are in the perimeter versus all of those foods that have a long shelf life are located in the center. That’s so interesting. Never thought about that. Now you got me thinking. Yes. They’re all in the middle. also tell people who are really responsive to visuals, I tell them to imagine that food sitting in your cabinet.
22:13
for three years and not changing. For instance, Halloween candy that was never thrown away or something. It’s sitting on a shelf, not changing. What is that doing in your arteries? What is that doing when you put it in your body? And normally that’s enough for a patient to recognize, wait, maybe I should not eat things that have such a long shelf life. Food is meant to spoil. So if you’re eating foods that could sit in a cabinet for a year and not change, it’s probably very processed. Again, I agree with less ingredients is better.
22:42
you always have to turn that bag or box or can around and look at every single ingredient. It’s not good enough to look at the front because the front is all marketing. They will put every label on there to make it appeal to those looking to eat healthier. They will put gluten-free, dairy-free, all of these things that people assume, well, if it’s on there, it must be healthy because they’re really advertising that. It’s all about what’s in it.
23:08
The first few ingredients on a label are going to be those in the highest amount by weight. Meaning if you look at something and the first ingredient is sugar, it means that product is mostly sugar. Same thing with flour, things like that. So you want to see what’s in it, what order are those ingredients in, and always pay attention to even the ones that say less than 2 % XYZ because a lot of times you will find there are
23:36
many added chemicals to these products. And even a little bit of these chemicals may not be good for you. I would argue that probably none of them are good for you. But in general, if I’m just to be general, I would say most of them are not going to be good for you. That’s where you’re going to find things like artificial sweeteners. That’s where you’re going to find a lot of preservatives. That’s where you might see something like natural flavor. Natural flavor is just a catchall term. It could contain up to 100 different ingredients that the companies don’t need to disclose.
24:06
So I always tell people really look at every ingredient. If you can’t recognize it, if you don’t know what it looks like, where it came from, put it back on the shelf. I’ll tell you my struggle. When I look at the ingredients, yeah, I don’t know what half of them are, but they could be good. I mean, I just don’t know what half of them are. You know, there’s all these eights, these oxes, these, you know, I don’t know what they are, but I mean, I don’t know. Maybe that’s what is used to, like, to, I mean, again, to preserve it, but
24:34
maybe that’s okay. Are there like staple ones that you were like, like for your family and you’re like, you look at the back of a box and you’re like, Oh, it has that in it. I’m not giving it to my kids. Are there a staple ones that you’re like, no, no, definitely artificial sweeteners. think artificial sweeteners are probably one of the worst things that you could put in your body. And this, this does go against many other endocrinologists to be honest. artificial sweeteners, you know, would be things like aspartame sucralose.
25:04
They Splenda, Truvia, things like that. They’re what’s in diet sodas, sugar-free candies, things like that. So while yes, they’re better for blood sugar control, overall, they can cause a lot of problems to the body. So there are a lot of studies showing they disrupt the gut microbiome. There are studies showing that they may increase insulin levels. So even though the blood sugar is stable, they still make the insulin go up. And when the insulin’s up,
25:32
you can get insulin resistance faster. It again makes you store fat instead of breaking it down. So it changes hormones in your body more so than just, you know, blood sugar up or blood sugar down. They certainly alter many, many hormone pathways in the endocrine system, as well as in the gut.
25:54
I feel very strongly that I, you know, I tell my patients, say, oh, but I have diabetes. Shouldn’t I be drinking diet soda? And I’ll say, you know, with all the chemicals in there, I’d rather you have a little bit of regular soda if you’re going to have it rather than a can of diet soda. Cause I feel very strongly that these are really harmful to the endocrine system and gut microbiome. So that is one of those ingredients that no matter what, it’s not coming into my house. I’m not going to let my kids have it. They sneak it sometimes when they have gum.
26:22
Um, but I really try to get them not to eat it. I’m to have to go throw out that old Halloween candy very soon. There’s always something I do after a podcast where I feel like it’s directed towards me. being that mom that brought kept that Halloween candy here. Um, are there foods, like a few foods that you gear towards, but also foods that you don’t bring home? Like for example,
26:49
you will not allow a granola bar into your house. Like that kind of thing. Are there staple foods that, know, breakfast cereals, something that you would not allow in the house? I would say nothing is completely off limits in terms of categories of food because a little something every now and then is okay. You know, the idea of everything in moderation. I mean, I don’t think we should be totally restricting and saying, no, I can never ever, ever eat cereal.
27:17
But if I buy a cereal for my family, I’m probably gonna buy one that’s organic so that it’s not sprayed with glyphosate, which is the same thing in the weed killer, the herbicide. I’m gonna buy something that doesn’t have as many ingredients. I’m gonna definitely look for something without artificial sweeteners. So sure, maybe it has sugar in it, it probably will, but that’s okay sometimes. We don’t need to be so restrictive like that. It’s more about quality products.
27:44
I also love to stock my house with fruit because my kids, if there is not fruit ready in the fridge to grab, they will only eat things out of the pantry. And again, everything in the pantry, it’s shelf stable, it’s probably a little bit processed. So what I like to do is I always have fresh washed fruit in a…
28:09
Bowl without a top, know, literally here take this and my rule is before you take something from the pantry You have to take something from the fridge So I really try to gear my family towards always pick something nutritious first And then you know if you’re still hungry if you still want a little something fine have a little something But always pick the healthier option first when you’re going to eat Let’s be honest. Like I mean as busy moms like, know, we’re working we’re you know, how do you do it? Like I mean
28:38
You know, I’ll be honest, like sometimes I’m picking up the kids right after work and I’m just like, okay, just take some cookies from wherever, you know, package and that’s what I’m going to give them as soon as they come home. How do you do it? I know there’s people who do meal prep and all of that, but it is hard. Um, is very hard. do very tired. Like, yes. So what, do you do? I just want to know. think, you know, I don’t have a perfect system and there’s certainly times when I’m saying here, take this.
29:05
granola bar because we got to go we got to get out of the house. don’t have time to cut you up strawberries right now. But the idea is that that is not that common. The common is okay, we’re going in the car for a trip. I’m to give you guys each a little container of berries. And I’ll bring one more snack from the cabinet. Every morning I wake up pretty early just to food prep for the kids as well as myself for work. So I’m always kind of making their lunches, having something available in the fridge for when we get
29:34
home because I know that’s when everybody’s the most tired. I’m the most tired. They’re the most tired. I want to have it easy. So I have that ready. And on weekends, a lot of the time, especially on my Sundays, I’m baking. My kitchen is a disaster on Sundays. have, I have muffins I made. have cookies I made. have items that I know they want to eat and I’d rather them eat my homemade muffin than a muffin in a package. So I try to give those things to my kids, but just made in a healthy way where I know exactly what I’m
30:04
putting in. So maybe sometimes I won’t use sugar, I’ll use organic maple syrup, know, things like that to just make them a little bit healthier because they’re kids, they’re going to eat things. But I try to have things in the freezer that we can easily grab throughout the week. I can put in their lunchbox just so that it’s ready. But my weekends are mostly food prep. It’s not easy.
30:25
I hate making food. I’m just being honest out there and I’m not a baker. So I mean, that’s our, that’s our struggle. So really this podcast is all about me. My struggles in life. But what are like, what are some crazy, you know, myths that you want to debunk that your patients come in and swear by about metabolism and you’re like, this is crazy. Yes. Juicing. I’m very much against juicing. I think, you know,
30:55
The idea is people are just drinking juice of some sort, you know, usually like watered down or homemade or something, but they are kind of putting themselves into a fasting state, but not quite. Right. So they are still adding calories. They’re adding simple sugars in a sense, because if you’re having a juice that’s really like, there’s no fiber in it. You are just having the sweetness hit those taste buds right away.
31:25
And as soon as the enzymes in the saliva start to break down carbs, glucose goes up, insulin goes up. So they’re still getting the negative metabolic effects of eating carbs, but then they’re also depriving themselves of nutritious foods. They’re getting very little protein. They’re getting, again, very little fiber. They’re getting essentially no healthy fat. And they…
31:52
generally are just dehydrating themselves over those few days that they’re doing their juicing. A lot of my patients will do it, let’s say for three days. And maybe they lose a couple pounds because they’re losing water weight. They’re not building up muscle. They’re not burning fat. They’re basically dehydrating themselves and they will regain that weight very quickly. So I am not a fan of juicing. I think it’s a very poor choice in terms of helping your metabolism or losing weight.
32:19
I am a big fan of intermittent fasting. do think that long-term that can help people. It’s something that does not need to be done every day. There are people who will do it for maybe one day a week, maybe an extended fast four times a year, just to kind of reset and let the body break down the stuff it doesn’t need instead of constantly giving it too much. Okay. I’m going to flip that a little bit and just ask you.
32:47
I know a lot of, you know, doctors talk a lot about not intermittent fasting if you’re insulin resistant. Thoughts on that? Again, people are different. I will say there is a small subset of patients with blood sugar issues where the longer they fast, the higher their blood sugar goes. And only by breaking that fast and eating something does their blood sugar start to come back down.
33:15
but that is by far not the most common. Pretty uncommon. We can see it on blood work. If you were that type of patient, your doctor could clearly identify it because what would happen is your hemoglobin A1C, which is the average of your blood sugar over the last three months, would probably be normal or maybe just a little bit in the pre-diabetes range. But every time fasting blood work is checked, they have a very high fasting blood sugar. So you know, because the A1C is an average,
33:45
They’re going high in the morning, but they’re going back to normal very quickly after they their day. So for those patients, I would agree, it’s not going to be helpful enough in terms of metabolism, blood sugar, and things like that. But for the vast majority of people, especially those without blood sugar issues, it actually can be very helpful. Our bodies were not designed to sit down and eat three meals a day. Many years ago, we roamed this earth.
34:14
where we would eat maybe, maybe once a day, maybe once a week, know, whenever you found food. It wasn’t something where you had scheduled meals every few hours. And it just seems like over time, our bodies are not able to accommodate that anymore. Wow. That’s so interesting. I’m glad you mentioned that because I am one of those patients, the odd one always, where, you know, my A1C was normal, but every time I would test my sugars in the morning, and I hadn’t eaten since like
34:43
know, 6 p.m. the night before, it was super high and I could not figure it out. But after I ate a meal, an hour or two later, my sugar was less and I would be like, I don’t even understand this. you know, I actually dropped intermittent fasting for that reason. So, you know, thank you for mentioning that, but I just couldn’t figure it out. It was like a puzzle to me.
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But over time, you know, I had talked to another doctor and they were saying, maybe you need to drop it. So that’s important. And the reason for that, for why that happens to some people is when your body is fasting and you’re not bringing in calories and carbs and glucose, at some point your liver will start to make sugar. It’s called gluconeogenesis. The liver generates sugar. And for whatever reason, in some people, especially with mild blood sugar issues, that
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response can just be very exaggerated. Where the liver is just making too much sugar, it’s not needed. The body can’t handle it. It’s like a glucose load at three o’clock in the morning. There’s no reason for it. So that’s the reason that it happens is because that gluconeogenesis component really turns on. Generally for my patients who have this, I will recommend trying to eat a very low carb snack just before they go to bed, like a couple almonds, a little piece of cheese, something like that.
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And for some people, you know, hitting the body with a little bit of caloric intake at that hour will be enough to kind of reset and not make that gluconeogenesis occur. Doesn’t work for everyone, but it’s a little trick you could try. Thank you. Are there any breakthroughs like happening, you know, that you feel are, you know, important or you’re excited about in terms of metabolic health?
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There are a few breakthroughs in the last few years that I think are really changing the landscape of how people can monitor their health and how people can improve their health. So in terms of devices, a few things on the market are really helpful for some people. So one is a continuous glucose monitor. So those are those little circles people are wearing on the back of their arms or on another area of their body, which are basically transmitting their blood sugar numbers to an app on their phone.
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so that they can see what these foods are doing to their body in that moment. This is really changing how people understand their bodies and how they can make decisions with this real-time data that can improve their A1C tremendously. you know, generally people are waiting months in between doctor’s appointments just to check that A1C, just to see, okay, on average, how am I doing?
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But that does not give the patient information about, what about when I eat an apple? An apple is carbs, but you told me it was healthy carbs. Can I eat it? What does it do to my blood sugar? And everyone’s different. So now people are able to eat an apple and see, okay, my blood sugar is fine with an apple. Or, wow, I didn’t eat the skin on the apple. I took that fiber off and now my blood sugar went up when I ate that apple. They can see patterns such as, okay, when I take a walk after a meal, my blood sugar drops really quickly.
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If I sit on the couch, it just stays high for many hours. So now people are able to make behavioral changes based on that immediate feedback. And that is huge because we’re seeing that just wearing this device alone can improve the A1C by over a whole percentage point. So no medicines involved, just data for the patient to understand. And it has really changed how people monitor their health.
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So that’s one thing that’s really in the last few years really become very popular and for good reason. It can really help people understand what’s good for their body and what’s not. Another device that I think is helpful is this at home breath device. The company is called Lumen. It is something where you breathe into it and it’s measuring CO2 in your breath. And it actually can tell you whether you’re in a state of burning fat or burning carbs.
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So for people who are intermittent fasting and they’re kind of wondering, all right, well, how long do I have to do it for? Do I do it for 12? Do I do it for 16? know, what happens after I do a workout? I wonder what’s going on with my body. This at home test can be very helpful again for information in that moment. You know, hey, I stayed up late last night and I ate pizza at midnight. What do I look like this morning? And they can see, oh wow, that actually had an impact bigger than I thought.
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So those are monitoring devices that I think are very helpful, but the category of medications that have really been groundbreaking are these GLP-1 medications such as Ozempic, Monjaro, Zephan, Wegovi, all the names. They can be so incredibly helpful for patients struggling with metabolic issues. They can reverse fatty liver. They can reduce the risk of heart disease. They can reduce the risk of stroke. They can protect the kidneys. They can…
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help shed some of this visceral fat that’s coating the organs. So for patients who have been struggling, whether they’ve failed the dietary or lifestyle modifications, or for whatever reason, they’re just not able to do that, these medications have truly been life-saving for many people. Wow. Thank you so much. That was super helpful. And I’m sure a lot of people are going to make a lot of changes, including myself, after this podcast. Please tell everybody where they can find you. And definitely,
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your social media channel because I follow you and I’ve learned so many things from your videos. So please tell us where we can find you. Oh, thank you. Well, so my main platform is Instagram and I’m @EndoHealthDoc I also see patients in New Jersey and virtually from Florida. So you can find me in my practice. are you just Google my name. I’ll come up. So but thank you so much for having me. This was really wonderful. Thank you so much for your time today.
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Thank you listeners and viewers for tuning in. If you want to catch more episodes of Uncover Your Eyes, make sure to follow or subscribe on your favorite podcast platform and on YouTube. To learn more about me, follow me on Instagram @Dr.MeenalAgarwal Until next time, keep those eyes uncovered!
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See comfortably, near and far.
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with total multifocal contact lenses. Feels like nothing.