Home
FAQ
Membership
Login
Register
Contact us
Image gallery for:
Eggs and the er
Eggs and the ER
The time when eggs sent me to the emergency room with A Gutsy Girl agutsygirl.com
Advertisement
Silk Oat Extra Creamy Oat Milk - 32 fl oz
Products
Turkish Eggs with garlic yogurt (Çilbir) | Recipes | Moorlands Eater
egg
inspiration
Jokes🤣
Advertisement
Scrunchy Face Tea Towel - Wrong Day
Products
Motivational
Doctor Shares the Number One Factor that Predicts How Long You’ll Live with Tyna Moore, ND | Metabolic health is key to true longevity. Without actively focusing on metabolic health, the risk of chronic disease increases. Whether cardiovascular... | By Dhru Purohit | Doctor Tina, welcome back to the podcast. You know, we had an incredible first episode together and I if I could recap a little bit, you brought something powerful to our audience. You brought the idea that as much as so many of us, even in the wellness community, even listeners of this podcast, even my own biases that were there, so many of us had heard that we need to discount these GLP one agonists like Ozempic and Wegovi They're a cheat. They're a shortcut. They have side effects. They're going to be the downfall of society. You brought truth to the conversation and said, there's another perspective that you're not hearing and not only that, not only are they safer than they're being talked about. Not only they are they a powerful tool for many clinicians like yourself who use them in targeted ways for individuals. They could actually be the unlock to some major challenges that we're facing in society. Just remind us of some of those challenges that you talked about in the first episode. Yeah, so there is good data showing that there's efficacy and a lot of help for neurodegenerative issues, for cardiovascular issues for pancreatic and kidney issues as well as potentially musculoskeletal complaints like arthritis and even sarcopenia, muscle wasting plus they are incredibly helpful in healing to the whole metabolic health pathways for individuals. So, most Americans are sitting in insulin resistance and active insulin resistance and they don't know it and these peptides are a significant help in that pathways so and they're not a band aid. They quite literally are regenerative healing and anti-inflammatory. So, I think that there's something here that I'm so glad we gotta talk about it last time because it's being looked over and passed over and everybody's going to this far polarized extreme of you know, oh we're we're just going to use it for extreme weight loss and it's only reserved for those people and for type two diabetics and anyone who's using it otherwise is getting, you know, trying to get a get out of jail free card and they're cheating and I just don't think that's at all fair or nuanced or truthful. Well, you're back on the podcast today with an important message, another powerful truth that you want to share with our audience and that is it doesn't matter what drug you use, what intervention if you are not metabolicly healthy, you are never going to be stepping into true longevity, true health, true health span, true lifespan. So, first and foremost, everything comes back to metabolic health and largely that is lifestyle interventions that get us there. Is that true? Yes, 100%. So, let's expand on that a little bit further. What is metabolic health and how does somebody listening today know if they have it or if they don't have good quality metabolic health? Well, metabolic health in just this most simplistic definition of metabolism is that when you take in calories in whatever form in carbohydrates, fats, or proteins that your body will hopefully metabolize them into cellular energy in its most basic form and convert them into the building blocks that we need inside our body. So, some of it gets converted to energy, some of it gets reformatted into new proteins which is what all of our organ systems are made up of and the and some of it, you know, the fat goes down the right pathways and we have my nation around our nerves. We have you know the building blocks of our brain and cholesterol and our steroid hormones. So the ideas that that system would work efficiently. But we need a couple players in place working well like insulin. Insulin sensitivity, insulin signaling. We need those metabolic pathways to be optimize and unfortunately in US adults we're looking at you know 2018 data showed that 9394% of US adults have busted metabolic health. So we're looking at a whole group of individuals enlarge are metabolicly unhealthy and so what that means is that they are sequestering their calories into their fat cells. They are having hyperglycemia or high blood sugars which is causing a lot of issues. Basically, high blood sugar will cause caramelizing like your cellular layers literally caramelized in the face of extreme sugars and insulin is being cranked out of the pancreas and in an attempt to regulate all this and insulin is progress Which is awesome when you're trying to build muscle and it's not so awesome when you've got cancer happening. So it's an anabolic steroid but it's not always working in our favor when we are bathing in it when we're swimming in it. So humans right now and we've exported this across the world. So humans are swimming in excess blood sugar and excess insulin and it's causing them to be sick, fat, and die early from a whole variety of different disease processes. What are some of those disease processes that are connect to poor metabolic health. Just name a few. Cardiovascular cardiovascular diseases number one. If you look at the stats over the past few years of the top three causes of death it was cardiovascular disease by far. Three times as many people were dying of cardiovascular diseases was dying of COVID and right in the middle is cancer. So cancer and cardiovascular disease are right on that pathway of busted metabolic health. Those are those are probably the top two obviously and I firmly believe that all three of those Conditions or poor outcomes are being driven by poor metabolic health. I think the pandemic was being driven by poor metabolic health. It's we have the data to show that. And the pathway that happens is you start with metabolic dysfunction. You don't realize it because your doctor's not looking for it. You might get some fatty liver. You might get some fatty pancreas. Both of those lead to really poor outcomes. Fatty liver is a big deal. It's been normalized. It leads to cirrhosis but more importantly it leads to liver cancer. We're looking at an epidemic of liver transplant need in the next several years that people are not giving any you know weight to or merit to but it's a real issue. Down that pathway if the cardiovascular disease doesn't take you out in the process you will magically fall upon that type 2 diabetes and they will say oh you have hit the magic number on your labs you're a type 2 diabetic now the damage has been happening for 15, 20 years and some of that damage is of the microvascula so you're looking at retinal damage, kidney damage, brain damage, and as that pathway goes down, those folks are looking at a life of dialysis because their kidneys fail. If they make it that far, the cardiovascular disease doesn't kick in first. Does this sound like America, right? Like this is the pathway. In there, you're getting your statin drug and your lipid drugs and all your other lifestyle drugs that you stay on forever that noone says boo about. They're totally normalized but god forbid we try an intervention with the GLP one and then further along that pathway is dementia. So, you don't know your name and someone's wiping your butt and you live in some kind of extended care home, right? Like That's where we're headed and we can actually, the data has shown links to autism on this end and links to dementia on this end. So, type 3 diabetes is dementia, right? That's, I'm sorry, Alzheimer's disease. So, it's this trajectory that I have been watching happen over the course of my clinical career with horror because I've watched it get worse and worse and worse and worse and back when I started my practice, I took heat from my colleagues because they were like, of Doctor Tina thinks everybody has metabolic dysfunction and here we are and everybody quite has metabolic dysfunction and I was trying to sound the alarm decades ago and I was telling people to lift weights and eat meat and go out in the sun decades ago and everybody was sort of like oh that's not sexy. We're going to blow that off. You know the health gurus online were telling people to go vegan and do yoga and I was over here like no deadlift. You need to add more deadlifts. And here we are. We you know the pandemic I think really highlighted what a metabolic disaster we are in. And Nobody, even during it, that information was being censored and I was being censored and people trying to get that info out were being censored because we were sitting in such a pickle. There wasn't a whole lot we could do, right? Like, if everybody has some level of metabolic dysfunction for the most part, including children are right on that trajectory then, we're sitting in a pretty precarious spot. To connect our first conversation in this conversation together, I feel like a big part of your message is that if we're talking about these tools like GLP one, the vast majority of people who are out there talking about them even with the benefits they're completely ignoring metabolic health so some people although they talk about the benefits of just generally going from obese to not obese they're not in the weeds of metabolic health so theoretically you could have people who are getting skinnier because they're on these drugs but they're not actually that much healthier yes if you weigh less You are less likely to get cancer. If you're not obese, you're less likely to get so many different diseases out there including cardiovascular disease but if you're ignoring metabolic health and you're using ozempicuncovered or something else, that doesn't mean that you are going to avoid a whole list of chronic diseases because your metabolic health is not optimize. Is that accurate? Yes. So, there's two ways that I look at this. These peptides are not just a band aid they actually induce healing so while an individuals on them at whatever dose I think most folks are being dosed too high we talked about that last time but on whatever dose they are getting the benefit of the metabolic healing process that's happening so they're getting better insulin sensitivity they're getting better insulin signaling they're you know they're getting a whole host of benefits out of this and then they are abruptly cut off usually because people say oh well your insurance coverage is up or however that works for most individuals in the medical care system they get cut off If they have not been taking all the steps to optimize their metabolic health along the way, all of those benefits are not going to completely go away right away, I don't think because there has been some healing done. Peptides innately heal you. That's what peptides do. All these different peptides that we use are regenerative and healing to some degree but you cut them off and they're going to be in a world of hurt because they haven't done anything if if they haven't done anything to change their lifestyle including protecting their muscles, strength training, The opportunity, there's this window of neuroplasticity that happens when you're on them as well because of these neuro regenerative effects and so they can literally rewire their brain into new habits and there's this wonderful opportunity to completely overhaul their life while they're on them but I don't think most folks are being cancelled that way and so and they're being put on these crazy high doses that are crushing their appetite so they're just wasting away in the process and you come out the other side of that a metabolic disaster. Now, you're thin but you're going to rebound and gain all the weight if you didn't do all of these things in the interim to drastically change your lifestyle and then the other way I look at it is the way that I'm dosing it is I'm keeping people on it potentially for a long period of time because we use peptides and hormones for longevity and so that means we cycle them and rotate them but all of my patients are already doing most all of the things but here's the here's the big clincher. Some folks need help getting started and they just They just cannot get started for whatever reason. Maybe they're in too much pain. Maybe they're just reaching up to touch bottom. Whatever it may be. They are in such a pickle that getting started in getting moving is so difficult that we use the GLP one to give them that leg up to get started. It's not just the weight loss kickoff. It's the anti-inflammatory benefit. It's the mood boost. It decreases anxiety. It gives people the onus of control back and so I'm seeing with some folks who just we we didn't withhold the peptide and say work harder and then a Give it to you. It was let's start you on this and let's see how you do and within a few months suddenly they're like I want to move more. I want to start cooking at home. I have the energy. I feel better. And so there's two avenues you can take here. You can just use them as a crutch monotherapy substitute for everything and hope for the best and I think you'll come out the other end spit out and in worse off shape. Or you can use them as a tool to piggyback as along with a multiple tools to piggyback Onto a really healthy lifestyle and use it to ingrain in those better habits, those lifestyle habits that are, those are non-negotiable for metabolic health, like you can't cheat that. We're going to get into how you know if you're metabolicly healthy or not, what test you run on patients, what test you recommend people get, but before we do that, just expand on my last question, I think some of the fair criticism that came in early on, was, when you're looking at a lot of these celebrities who say that there might be just eating a little bit of salad here and there, or less processed food, they're not eating protein, they're not lifting weights, they're not doing this stuff. So, even though they're skinnier which they may get some benefits, they're actually might be more frail. Oh. As an individual and that's always what gets attention initially. We can't let that dominate the conversation but would you say that that was an that was a fair critique of how it was being used early on. There's people were obsessed about just looking thin but that you could be thin and weak and potentially not that much Better off metabolic even though there are some therapeutic benefits that were there. Is that fair to say? Well, yeah. As a lifelong anorexic, I mean, I've dealt with anorexia most of my life and the only way I got out of it was through strength training. So, actively engaging in strength training over 10 years ago is what helped you finally get over it and being skinny is addictive. So, it's really easy and you know, in Hollywood and in any industry where you've got doctors catering to these clients, you're going to see abuse of all kinds of medications. We seen multiple celebrities die from accidental overdoses, you know, that their doctors provided them. So, yes, that is a very slippery slope. Those women are looking at hip fractures down the line. That that's no way to go. I found myself in my 30s able to fit into the same pair of jeans I wore in high school but my labs look atrocious and I was skinny fat. My metabolic health was a you know, complete disaster. I mean, it was a complete disaster. My labs looked like I either had cancer or I was headed right into type two diabetes and it's because I was all fat and bone. I had no muscle on me. So and I was in naturopathic medical school. Like I was in the middle of learning about all of this in chiropractic college and I was sitting over here in chronic pain, skin and bones feeling like if I fell over I was going to shatter and that's how most of them look to me. You know you get bumped by something wrong and they're going to break. And that's just absolutely no way to live your life. That's not there's no sustainability in that. There's no longevity. And if we've seen anything if I I look back at like the Stevie Nicks and the just some of the just that whole era of rock stars and actresses and I'm not particularly trying to throw anyone under the bus because they all look lovely but we've seen like Linda Ron's dad as an example. You look back at videos of how thin they were that was I'm going to guess the cocaine days you know in music. Cocaine diet. And these were very very very thin thin women. And the bulk of them by the you know either they're still alive or they've since passed. They all ended up quite overweight. Because they completely blew out their metabolic health, right? They were just going for skinny. It was like be skinny. However, whatever my, you know, we could get over the counter crack basically in the grocery store when I was growing up. There was diet pills. My mom was on, everybody was on them. So, I grew up in Southern California. I know how this works. So, I've watched this happen and then I found myself in my late 30s and I thought, I better get my together because I A, I need to train for menopause and not end up a complete hot mess when the hormones start dipping and I know exercise is protective for that and B, I need muscle mass because I don't want to Break a hip when I turn 60 or seventy because breaking a hip is the kiss of death. I mean that's it. Like you end up with pneumonia and you end up dying for the most part or your risk of death is significantly increased for the next 10 years. So we in medical school we learn like kiss of death. You break your hip it's over. Or your life is just completely changed drastically. So that's what being really skinny. That's where you're going. You're either going to end up rebounding into obesity and frailty at the same time or you're just going to end up skinny skinny and in I've seen these patients in clinic they're in so much pain and they're so frail and they're so susceptible to fracture so. Yeah that's not what we want for people. We want strength. No. You want longevity. We want true health. And today we're going to talk about how to get it. Yeah. You mentioned in naturopathic college you ran your labs. They were a mess. You were metabolic unhealthy. You were skinny fat. Walk us through some of what you did on yourself. What labs in particular you were getting done and also with your latest knowledge and information. The things that you recommend to your patients. Like how do you objectively see that you poor metabolic health. Let's walk through the most important to, you know, secondary, most important items, you know, one, two, three, and four labs, Dexa scans, whatever it is that you look at to help people figure out if they're metabolic healthy or if they're not. Alright, so the most simplistic way to do it is when they would walk in my door of my clinic, I take their blood pressure, right? My assistant takes their blood pressure and I have a look at their waist circumference. So, if their waist circumference is elevated and a easy rule of thumb is to take your height in centimeters or inches and cut that in half and your waist circumference should be below that. That's the red flag. That number is the red flag number. We don't want it to be there or creeping up just above it. We want below that and if their blood pressure was elevated in conjunction with an elevated waist circumference, I would put my money that their labs are going to come back, messed up like. Got it. So, somebody is, you know, and and it's an inches for the waist circumference. Doesn't matter. Centimeters, anything. Just measure your self it take a string and get up against the wall and take you know mark your head and take a string and then fold that in half. Right so if you measure your height in centimeters then do it in centimeters if you get in fee and inches and make sure the same. Yeah. And then then check your waist and you should be well below that. Okay great. So that's the easy and most straightforward one. You know just because you brought up blood pressure. A lot of people hear numbers when they go to the doctor. Yeah. Give us a sense. What is healthy? What is unhealthy and is there optimal for blood pressure? Blood pressure has changed over the years because if you think about it, when you get older, your tissues get floppier, right? And so, a amount of pressure to get through a, you know, strong hose with good musculoskeletal is going to be lower than trying to get through a floppy hose. So, our blood pressure is naturally going to elevate as a response to aging. Especially if we're not exercising. Yeah, the more flaccid our tissues get if you will. So, it's not necessarily the worst thing. It used to be that blood pressure and cholesterol were measured according to age bracket and so you were almost allowed to have a higher blood pressure as you got older because it was a natural response but now, it's 120 over 70. That's about that's about where people like to see it. What I don't like seeing is the bottom number, the diastolic going up. That is more concerning to me than the top number and people will just start creeping up, creeping up creeping up, creeping up and it's a slow insidious creep. I really do try to keep blood pressure under control. I am I'm pretty avid about that because that slow creep is telling me especially if they've got metabolic dysfunction and insulin resistance that their micro vasculature is having to take a heavier load, heavier load, heavier load and that's going to be impacting their brain and cognition over time. So, I'm not thrilled about that. So, I do keep sharp tabs on that. We don't, you know, one20 over 70 is a good round number. I actually have a free guide on my website that has like the the international criteria for metabolic dysfunction so you can people can go download that and check all this. Do you know the URL off hand? We can mention it. We can put in the show notes too. Yeah it's just a Doctor Tina. com. Okay got it. Yeah. And it's right there. Just assess your metabolic health. And so or it says free guide I think. The other the next question I ask them is are you strength training? Before we move on? Yeah. Can I ask you a quick question about blood pressure so on the topic? Dear friend of mine reaches out and says hey my mom had some abnormal symptoms, they thought it was bell's palsy, it turned out it was a mild stroke, and one of the things that her doctors talked to her about, is she's gotta get her blood pressure under control, and the first thing, I've seen this from so many different friends that reach out, they said, they're telling my mom, my dad, or even me in some cases, because you have a lot of young people, you know, that are dealing with a lot of these issues, and poor blood pressure, they said, You gotta limit the salt in your diet. Yeah. Right? That's the almost the first recommendation and many times the only recommendation. Yeah. That these individuals get and I'm sure a lot of people in the podcast have heard that. Now, we've had many people on the podcast talk about how if you look at the consumption of sodium even if the answer was as simplistic as just limiting salt the vast majority of salt intake sodium intake let me be more clear sodium intake is not from the little bit of sea salt that you add to your salmon that you cook at home or your broccoli or whatever it's coming from packaged foods right it's coming from potato chips it's coming from pasta sauce it's coming from I learned from a friend Max it's coming from bread rolls yeah and ultra process foods, it's the package foods that you buy that have the highest levels of sodium before they even come to your house and you adding anything. Yeah. But the thing that I have with that, first of all, I want you to talk about salt, no salt but the second thing is that people obsess over the tiniest little bits of salt and I think that that's going to make a difference in their blood pressure. What do you want to say about that? That's such a joyless way to live. Couldn't I would seriously, I would, I couldn't imagine living without salt. That would this like salt and coffee are my two. I mean, I travel with salt everywhere. Multiple vials of it. Um it's not the salt. It's the insulin. So when your insulin's elevated you will have a response of having your blood pressure go up and holding on to that salt. So it's just it's part of the biochemical pathway that happens but it's the insulin resistance. It's not the salt. But if you have insulin resistance which most people do and you start packing in the salt and you're like oh well Doctor Tina said it's okay to eat salt because I tell all my patients to increase their salt intake to be honest with you. But we're also actively working on getting their insulin resistance in check. If you don't do that part and you just increase the salt because we're talking about it, you're going to end up with your blood pressure going up and your cardiologist is going to freak out. So, it's the insulin resistance. So, that goes back to the waist circumference. Whenever somebody says, I can't eat salt. My doctor told me, I look down at their waist. I'm not judging them. I'm just like, where's their waist circumference at? Normally, they've usually got a little bit of a waist circumference going, right? And that's a natural unfortunate side effect of our estrogen dumping out as we age for women especially. So, men are built in this android shape of having you pack on your fat and your tummy first and you guys have skinny little butts and legs and women have nice full hips and butts hopefully when they're young and healthy and tiny little waist and the second our estrogen drops we shift into the same shape that you guys do and we start getting bellies and that insulin resistance actually starts to chew up our muscle tissue in our appendages so we start to waste in our arms and legs so we get these skinny little arms and legs in this big big midsections and you know everyone starts turning into a potato shape. No disrespect but that's right. My whole family is shaped like a bunch of potatoes as they age and they all have high blood pressure. And you would have been to if you didn't change what you did. You changed the trajectory. I trained for this. About all the stuff. I started early. I was like and I'm not having this. So an important point about blood pressure just to kind of summarize and you correct me if I got anything wrong. Core in your clinical experience and your understanding of the literature, insulin resistance is the big driver because if you have insulin resistance, you have poor vascular health and if you have poor vascular health, your heart has to work harder just to get the blood to the regions of the body that needs to get to. So, your blood pressure is going to be off. It's not going to look good. Salt can contribute. We did learn from Doctor Richard Johnson who's been on this podcast that we don't want people, you know, having a lot of sodium Without water, we want to dilute it especially if they're dealing with kidney disease, high blood pressure, high uric acid, you know, these are all things that we want to take into account because extreme concentrations of sodium for most of the population who are metabolicly unhealthy, have insulin resistance, it's going to be negatively impacting them but if you just try to focus on the salt itself and not understand that the vast majority of the sodium, it's coming from packaged foods and if you don't get to the root issue which is what today's conversation is about, metabolic health, you're going to be running in circles. You can go on an extremely restrict Active diet for a temporary period of time and through sheer willpower and cutting off all salt you could lower your blood pressure or you could get to the root of insulin resistance and actually have some joy in life and be healthier overall. Yeah. Is that accurate? Yes and the the kidney issues you just mentioned and the hyaluric acid are also due to insulin resistance and metabolic dysfunction. So that's that goes back to that constantly. So when as folks age they will start to see cysts on their kidneys and they're benign cyst and sometimes they'll get biopsy and they'll be like hm we're not sure if these are benign or not we should do surgery and you'll start to see elevations in uric acid and that's usually in a more obese population generally speaking and they always to my experience always have metabolic dysfunction yeah so it's not cut the protein to lower the uric acid cut the salt to improve the kidneys it's get to the root cause which is build some muscle and get your together so we were going down the line of things that you look at and things that our audience can look you haven't gotten your blood pressure done, go get it done. If you haven't looked at your waist circumference, you don't need to go to a doctor's office. You don't need to pay for an expensive Dexa scan, right? If you can get that, you can just do it at home by following the instructions you have. What's next from there? You're kind of about to get into it and I cut you off to add some questions about blood pressure. Yeah, so if those are the first two markers and then I ask them on their intake, how often do you strength train and if they're not actively strength training, then, I can almost guarantee 100 percent that they have metabolic Because they're not building muscle and your muscle is what's protecting you against metabolic disease. Your muscle is what's driving good metabolic health. Your muscle is what's driving good glucose uptake and what's mitigating that insulin resistance. So without it you're a sitting duck. So your friend's mom probably doesn't lift her weights and she probably has a little bit of a waste circumference that's starting to expand or has expanded maybe for some time and she's aging so her vessels are getting floppier and here she is Which is like so many people as we age in this country and this world. Yeah. Now if you have it depends on the culture I think that if you look at folks of Asian descent whether they're Eastern Indian or they're coming you know right out of like China all of these countries we actually have to be more diligent about that waste circumference because that is that group cohort of people tend to really have a big impact with just the slightest expansion of the waste. So So Caucasian folk can actually pack on more visceral fat in the midsection and not have such deliterious results on their vasculature. So that's a whole thing too. I I'd love to ask you a question of that. Obviously I'm Indian and I see so many people that are in my demographic parents, aunts, uncles, cousins, even young health quote unquote healthy people. And they're skinny fat and they have poor metabolic labs. I actually had great metabolic labs and I was still skinny fat. Cuz I was under not eating enough protein and not taking resistance training seriously enough and once I got serious about all that I was able to dial that body composition in but even somebody like myself who traditionally has been skinny growing up and has been thin primarily because I was grown up vegetarian and I was eating an ultra processed vegetarian diet you know vegetarian to me growing up meant anything that's not meat so Twinkies Sprite Coca-Cola vegetarian I was. I get it. Right? Yeah. So you get it. Yep. I did that. I call that a mac and cheeseitarian. Yeah. Exactly. So some people said oh maybe there's something genetic. Maybe there's this. I don't think it's genetic at all. I think those populations even in India the populations in the groups that consume meat. Which is still the most bioavailable protein that's out there. Not that you can't do this on a vegetarian diet. You just gotta be a lot more diligent or vegan diet. They eat so little protein that's there. So you Have a whole population that even if they weigh the same these populations tend to be less muscle mass compared to their counterparts so somebody who's Caucasian somebody who's white they can get away with it because they have more muscle mass as a whole right and they are more likely to be able to deal with that glucose and the other stuff circulating inside the body but the Indian populations the Asian populations they just have less muscle mass is that your understanding or do you think there's truly some sort of genetic component to it I think it might be both if it's the genetic What is the genetic like what is the aspect of that? I wonder how much of it is aromatase enzyme. So aromatase is an enzyme that lives in our fat and it converts testosterone into estrogen. And so I'll see more gynecomastia in that population which is like breast enlargement in males and I'll see more propensity towards subcutaneous adipose tissue and so I've I've seen this in patients that were Iranian descent, middle eastern. So there's something there. I don't know if it's just dietary or like generation. It might be epigenetics too. You know like gender of of being under muscle but I it's the advent of the definitely there's a contribution to the modern diet because if you look traditionally back you know Indians were very fit you know if you look back at old well everybody was in the whole world everybody was really well musculoskeletal I see pictures I saw a picture the other day of some young surfers in Southern California back in the 40s and 50s and they were like just a bunch of really fit young men you know and I remember growing up down here in Southern California and all my guy friends were super well musculoskeletal and they were surfing and they were playing soccer and we were always outside but yeah so modern society is probably contributing hugely but I I wonder too like are genes getting turned on? Is there an epigenetic component? Can I add one more thought to that? Yeah. So, couple things. You're right. When you look at a lot of these old photos of like I'm from this region of India called Gujarat. I wasn't born there. I was born in Nairobi, Kenya but if you look at a lot of like old photos where people in this region were largely farmers, right? And but they weren't eating meat then. They were just they were fit. Yeah. They were fit. So it's not that they were consuming more protein. They weren't doing resistance training. They were just more active. In fact they were probably having a lot of carbs back then too. It's just they were much more active and obviously the prevailance of ultra processed food wasn't there. When you look at a lot of the cultures you just mentioned. You know my wife is Persian. When you look at the United States even North America. And you say highest income earning ethnic you know by ethnic minority. The top of the list is Indian. And Persian right? Indian, Iranian, Asian, a lot of these families that were able to come over you know felt like America's the opportunity the land of the free hardworking making sacrifices often living in like one home like four different families saving up money and then buying a business or really emphasizing education getting you know their kids becoming doctors I think 10% of all doctors in the United States even though 1. 5% of the population is Indian 10% of the doctors are Indian a huge amount of the CEOs obviously these are people from these countries that could flee and have the education to be able to come over here but those are the same professions lead to a lot of sedentary living, right? Being a doctor, being a business owner, running a motel. So, I didn't see anybody growing up, like really working out besides like my dad who would play cricket, like it was almost look down upon, if people in our community, it's like you're working out, like why aren't you studying? Aren't you getting ready for med school? So, you know, who knows what the exact answer is, but I think that what you believe in, regardless of what your culture is, if you focus on resistance training, if you focus on getting metabolicly healthy, if you dial in your if you dial in your body composition, right? You can change all this stuff around. So, nothing puts a limit on you getting fit. Do you, would you say that you believe that? I do and I think that we can all do our best. I get a lot of messages from women. I have a I have a really cool following. I have women in their 70s and 80s and on that message me and they're really trying. They've just found me and they're like, you know, my generation didn't lift weights. We wouldn't be caught dead in a gym. We don't know how. You know, they grew up on, I mean, some of these one-woman is describing how the gym when she last time she went and had the belt thing that you know that shake that shake you up that you see in that archival footage of what it look like to be in the gym back in the 60s or the 50s and they always ask me is it too late and I'm like no it's never too late you can always have muscle protein synthesis activated you just have to put in the work and it's going to be harder and you know I'm not going to have the muscle I do not have the muscle mass that I had 10 years ago and I have to work harder just to even maintain what I have so it it does change and I do think based on ethnicity I I something I wanted to say about what we were just talking about. I have said this forever. I think the closer you are to more pure bred roots you might have a harder time with the white man's food. You know what I'm saying? Like I think that the Native American population. Yes. Yes. I think that that is going to have a a it's going to be a player there. Whereas because I had a friend who was Indian in naturopathic school and he was having this whole epiphany during school because he went into it fit. School does a number on you. It was mostly female students at this school so he's getting a lot of estrogen and I remember him being like god I'm I'm getting a little thick here and then a few years out of school he was very fit again and he's he was like I learned in school that I had to eat closer to my ethnicity I had quite literally had to eat even I've had some instructors say even eating foods that are more native like fruits and vegetables that are more native to the country that you came from and less eating of the vegetables and fruits that maybe you would find over in Western Europe I just some interesting thoughts, you know, and microbiome I'm sure is playing a role into it and how people's microbiomes are probably more in alignment with the soils that they grew up with like my husband's a farmer that's lived on the same land. His biome's amazing and it's in that soil like he is of that land quite literally. When I met him on our first date, I was like, I want to lick him. Because biome was so healthy and vital like people glow vitality you know and so I think there's something to that and then us white folk I'm a I'm a mutt right I'm a super mutt but I that being a mutt just like with our dogs it makes you more resilient to a lot of things in a lot of ways and we have a little bit more wiggle room not always but and it might make us more prone to some diseases but I look at all my dogs for the most part are mutts and they live a whole lot longer than the pure breds I've had so alright I don't know does that make sense like we don't know yeah there's just some things to consider yeah so you know we were going down this list of things and the last thing that you mentioned is you say you Ask your patients, do you strength train and if you're not regularly strength training, you know that they have some level of insulin and I've shared my personal account is that when I got serious about strength training and Doctor Gabriel Lyon was a big part of that and I connect connected with this group here in Los Angeles called Ultimate Performance that is very on you about coaching and very on top of it. They make you track all your calories primarily because people generally have never audit their calories and that's the first time and even somebody like me who's been in the wellness space for 20 years I didn't fully get that when I'm cooking and I do the long pour of olive oil versus the short pour of olive oil and I believe olive oil is healthy. I didn't see until I did that in real time that wow, doing that every day when I'm cooking from home, breakfast, lunch, and dinner, that's like an extra 500 calories and doing that every week, it's no wonder in a month, my body composition would be especially if I'm undereating on protein would not be optimal, right? So, these are good calories but they still because I wasn't having awareness, I didn't understand the connection, right? That's there of like overdoing it on things. So, I was strictly tracking for a period of time to take a look at my intake. The other reason why is that for somebody like me who's underrate on protein and my sisters have seen this too, you vastly think that you're eating more protein than you are and if everybody's telling you to get a gram of protein for your ideal target lean muscle mass that you're trying to have, I was eating. I thought I was eating at least like 120 grams. I really should be eating like a hundred and 1sixty, 170 grams. I was eating often many days like 80 grams. Yeah, I know. It's hard. You have no idea until you weigh your food a little bit and make some connection between what's there. Doesn't mean that it's a long-term solution for people but just getting some sort of auditing. Anyways, where I was getting to is that by strength training regularly, three to four days a week and in the beginning, it was just three days a week and it's an hour at the gym with a trainer and tracking my macros so I get some sense of making sure that I'm eating enough which is was my problem and that I'm getting enough protein I saw first hand how quickly things shifted right now I'm not in the demographic of a woman who's going through perimenopause or menopause and I understand that there are unique things that are going on in that situation but what I saw is that even though my carbohydrate intake went up because I was adding about a pound of muscle a month my insulin was actually improving. Yeah. Even though it was in a good range. It was getting an even better range because I was simply growing muscle and not living as much of a sedentary life getting in 10, 000 steps a day. So, these are things that you ask your patient because you know if they're not active, if they're not strength training, they're most likely not going to have metabolic health. You know, the reason that I like everything you've said so far, everything you've mentioned, you don't need to go get any additional labs. Nope. We're going to get to lab work in a second but these are all things you can take an audit in at home. Yeah. Anything you want to add to that? Sleep if people aren't sleeping regularly and well and going to bed like a grown up and getting up with the sun. They're probably dealing with metabolic dysfunction to some degree too because just you know one night of sleep being off will give you transient insulin resistance and metabolic dysfunction but several nights in a row, several weeks in a row will really throw you over the edge and so a lot of folks are not sleeping. I know sleep can be elusive for some and there are reasons and we work with that but some folks are just not honoring their sleep. They're just not going to bed like a grown up. They're just staring their phones all night and then they don't go to bed and then they you know stay up on whatever and I'm guilty too. My husband **** at me so he's like why are you on your phone this late? I'm like I can't sleep. Just I know. I know what I'm doing. It's not helping. But that piece is huge. Huge huge. So if someone says my sleep is atrocious I'm not ever I you know I've never been in the gym or I'm not working out at all or maybe they're using little tiny baby weights and they're trying but they're still not lifting heavy enough. They're definitely not eating enough protein macro that's kind of a given like I'll just ask them. And you're right. People underestimate what they're eating. They overestimate what they're eating. It depends on what they're doing. But if their waist circumference is elevated I can visually see that it doesn't that's not you don't even have to measure yourself. You could probably guess. You know if if you're a woman of you've lost your waist if you've lost your curves. If you've lost your waist there's probably a problem happening. That's an easy one. And then if they are having some elevation of blood pressure. Even if it's mild but it's creeping up. They're On the path. So let's talk about labs. Okay. What labs can be helpful to definitively help people know where they stand on the spectrum of metabolic health? The big one that they'll get ran on their general yearly exam is a fasting glucose because that's part of a comprehensive metabolic panel. All that looks at is a snapshot in time during the moment when they had their blood drawn. Where was their fasting glucose? And when that number gets to 120 you have magically arrived at type 2 diabetes and they say you know you have type 2 diabetes and I'm over here saying We could have done something 15 years ago if you ran some other labs or you just paid attention but we've normalized it in our society. So that's the big one that most people are only looking at. That's the only one they're getting. The problem with that is if you have aberent cortisol surges in the morning because you're stressed out or you have a very stressful life that's going to surge your glucose as well so you can have aberently high fasting glucose in the morning and it's just because your cortisol's off the charts. And so an example is you know, I now I use a CGM or a continuous glucose monitor but I used to prick my finger. My mentor 30 years ago was having everybody by the little home glucose monitors and pricking their finger at various times during the day but especially in the morning and I remember when I was in bankruptcy, single mom trying to build my practice stressed out of my mind and I remember my morning glucose running at about 100 for months. I also wasn't sleeping at all because I was in such shambles financially that I couldn't sleep. I was terrified. And I had a little girl and I was trying to keep my dogs and my family together and it was 100 consistently and I knew that was my cortisol but had nothing to do with my true you know glucose signaling but that cortisol that high cortisol will drive you into insulin resistance as well that's another factor to consider so a morning cortisol is really helpful to look at in conjunction with a morning AM fasting glucose what's your preferred way to look at that is that like a Dutch test no just blood test Yeah, just ask your doctor for an AM cortisol and a fasting glucose because the glucose is going to be on there anyway because they're looking at a comprehensive metabolic panel. Um a hemoglobin A1C is a three-month marker of how sugared up your red blood cells are. So, it's a nice marker to have and oh let's go back to the glucose. I want that at or below ninety. 90 is the number. Now, if you're at ninety, something is starting to go a little haywire but if you have that AM cortisol, you can gauge it and what I want that as that that depends. I'm not going to you straight numbers on that but if it's high and it's on the high end of normal, you're probably driving up your AM glucose with that cortisol. You're probably stressed the F out and you need to reevaluate your life and you're probably not sleeping well. One morning, the low anecdote is my my fasting insulin is usually around like three and a half, four, somewhere right around there. I think that's considered like good optimal good as anything anything below five, right? Insulin, yeah. But I'm bringing it up because one morning, I was dealing with all this stuff. I was running around and I went in for like my normal quarterly blood work and my fasting glucose that morning showed up as like one ten. Even though my insulin which you're going to talk about in a second was in a good position. So that's also just a heads up to people that you know it's good to have multiple markers or a continuous you know glucose monitor because you don't want to be making you know these big recommendations or people get freaked out and it's that's just one little snapshot. I know I'm going to be more the exception to the rule in that instance but for a lot of people that are listening to this podcast who are already thinking themselves as pretty healthy dowing things in. I've even seen that with AoneC as you've mentioned. Some people have blood cells that stick around a little bit longer. Red blood cells. And so my A1C always looks a little bit more elevated. Even though my fasting insulin is in a good position. And I have learned through Chris Cresser friend of mine that some individuals their blood the red blood cells stick around a little bit longer. So it can look like they have elevated AoneC. Have you ever seen that before? Mine runs a little bit high. But it's usually in with how stressed out I am too. So I feel like there's a cortisol player piece in there. I'm not sure exactly but. Got it. The more stressed out I am the higher my AoneC goes. So the A1C is a more so if we're looking at fasting glucose that's like okay Susan that's where you were that morning. And let's admit not having any food, not having any coffee and trying to drive across town to get your blood drawn by 10 AM is kind of stressful. Yeah. You know that's for me that's not like the ideal way I start my day. Totally. So there's that. So that glucose is the snapshot in time is what I patients, your AoneC is the long-term marker. So, folks do have, a lot of times folks will have a great normal blood glucose. Uh fasting glucose but their AoneC is high and I'm like, you've been cheating. Uh you know, something is a right or something's off. It's because that's the three-month marker. It's a little bit more sensitive look into how they've been behaving the past three months and again, it can be off for various reasons but I like that at or below five point five. I think 5 pointfive is where I draw the line. Another marker I like to look at is fasting insulin and not a lot of doctors will run that. In fact, a lot of doctors will give you a lot of grief if you ask for it. They're like, you're not diabetic. I'm like, yeah, but most people are on the way. So, maybe we should all check that. So, fasting insulin, I like between two and five. Below two or close to two is actually a sign of pretty severe burnout and it's not great. I used to run at one to two when I was really really burned out and I I've been there. It sucks. You're not even making any insulin. Were you also on like an extreme low-carb diet? Yeah. Yeah. It's I'm just that's a little bit not. I mean some people say oh that's fine. I'm like I don't know. Most people feel like when they're down there. Like in general. Like I felt like all the time. And then you know above five we don't want that. So we want a fasting insulin. I have seen insulin though. Insulin's really sensitive to where your other hormones are at and it's insensitive to your estrogen. It's sensitive to your cortisol. So not to say that's an excuse to ride with a elevated insulin but we gotta look further beyond that. We don't just stop there. If you're if that's if those three things are off yes lifestyle interventions 100% but also I think a prudent doctor should look a little further and consider how old is this person is it is it a woman who's walking into menopause like what are the other factors what are some other markers I like I love running a high sensitivity C reactive protein that just gives us it's a non-specific marker for inflammation it doesn't tell us where the inflammation is it just tells us if they're inflamed and I think that's nice to have I like to run a said rate as well because it gives us a little bit different look at inflammation and so I between those I'll see high said rates and low C reactive proteins or vice versa you know I want to know are they inflamed that's at the end of the day are we dealing with an inflamed body are we now in bonus territory or C reactive protein is like you're even recommending for our audience that's listening. Everyone should run a C reactive protein. Sed rates are cheap. SED rates are really cheap too. Uh so I think that both. Okay. I run both. Yeah. Because You can miss inflammation by one being low for whatever reason and the other one's super high and you're like okay we out of rate stand for. Um it's it's a sedimentation rate sedimentation. Yeah. It's so it's a marker of your red blood cells. Got it. Uh actually if I've ever gotten that done or not gotten it done. Maybe it's in some of the blood work that I've done but ESR. Yeah. ESR is another erythro sedimentation rate. It's cheap. I think it's like a it's a very inexpensive add on. The other thing I'd is get your labs ran through find it my I always use lab co-ops in my practice so patients could get labs. If they try to run it through their insurance it was going to be thousands and if I ran them it was like 200 bucks. Yeah. So there's so many great options now to get your blood done. There's kits you can order. There's so many things you can do at home. Blood spot test. Like just take control of that and manage that because sending that stuff off through your insurance is potentially going to land you with a massive bill that is so much bigger than what it would have cost you to just pay out of cash. And I also have never ever trusted using my insurance for anything and so I do everything I can out of pocket even when I was broken in bankruptcy. I was paying for things out of pocket because I just don't trust the system entirely. Yeah. They don't my insurance doesn't need to see my lab work. You know, my lab works fine but that's between me and the lab. Um that's just me putting on my tinfoil hat but I've been that way decades before twenty twenty happened. Um I think vitamin D is really important. Vitamin D can tell us a lot. It's really hard to get someone's vitamin D up if they have a lot of adipose tissue on them and if they're inflamed so if they're rocking a lot of D won't come up and it's the 25 OH vitamin D. It just won't come up but they might have a high one twenty-five. So these are extra add-ons but vitamin D can be quite inexpensive and right now I have no idea why but there the powers that be in the medical establishment are saying we don't need to run vitamin Ds on people anymore. It's like they cannot make up their mind but we know that people had significantly poor outcomes with COVID when their vitamin D was low. So really get your vitamin D ran. Pay out of pocket for that. I think it's what like fifty bucks. It's worth it. So, that's an important one just to have around because there's just so much correlation to things that we don't want happening with low vitamin D. We want to know where that's at especially if you have, if you're a person of color and you have darker skin and you have darker melanocytes, you're going to not probably be making as much vitamin D in that 20 minutes outside that I would be. Yeah and we're no we're not getting as much sun and that's typically how we've always gotten vitamin D. So, people are not making up for that with some supplementation. They're going to run into problems. We're you like to see? You see a lot of different ranges especially in the wellness, integrative, functional space. Some people like it higher. Some people say the body naturally down regulates to around fifty. What's your what's your goal of where you want your patients to be? 50 to 80. 50 to 80. Especially walking into winter. Yeah. Try it out. So every single late summer, early fall. My entire family starts on vitamin C, zinc, and D. I've been doing that for decades. It was really ironic because in twenty 20 I was not allowed to talk about that without fear being D platformed and I was like but we've been doing this forever. Like I'm not talking about any particular virus. Like this is just how we don't get upper respiratory disease. So vitamin C, zinc, and D. Yeah. 50 to 80 I think is a good nice number. And I think most people taking around 5000 IUs a day. Depends on how much sun you get. I actually find that as my health improves my D goes up. So again because I think it's related to inflammation. So I haven't really dosed vitamin D much at all in the past couple of I probably last two winters I've been a little lazy about it but my D still remains in a how much do time do you spend in the sun everyday how I get out in the sun every single day yeah so morning sun midday sun and late afternoon sun all three different types of sun because I'm getting different rays and having a different impact but I live in Oregon so it's like only three months out of the year that I get to do that and then I try to travel as much as I can in the winter I actually try to bank my D so I try to get as tan as humanly possible by the end of summer although that is causing me some skin damage and I feeling it at age fifty. I'm starting to see the signs. I'm like, I think I need some lasers. I need somebody to resurface this but it I'm I I always say I'd rather die tan than die of all of the vitamin D deficiency-related cancers so. Yeah, that's great. So, you were continuing down a list of things that people can get done or if they've already gotten these done, they can do a little bit of an inventory and and generally speaking, I find that individuals have a feeling that you know what? I don't feel my best. My body composition isn't dialed in and I want to feel better and sure if that ends up having me look better too amazing and they need a little bit of that reminder to go back and say okay I know I'm not the healthiest but everybody's not really that healthy but when they hear about these laps and they start to add these things together and they hear that they're not you know having at least some aspect of resistance training you know you can always even start small and work your way up at any level you can do resistance training you can even do it with bands you could be we interviewed oldest female ninja warrior. Oh awesome. She was on this podcast. Amazing. You would love her. Um I think everybody calls her her friends call her Ginny and she got diagnosed with osteopena by her doctor. Yeah. And she came back and she was saying she was feeling very sorry for herself. This was at the age of like 58 and her daughter had been getting really into CrossFit and she was like mom you can reverse this. You can get stronger and she's like no I'm too old she said no you're not and we go deep into her story we'll link to it in the show notes but she got serious and said I want to start strength training and in the beginning it was like she couldn't even do one pull up right and that's a lot of people so they get intimidated and she said look work with the trainer there's plenty of things you can do strengthen your back that'll help you do pull ups in the first place yes to start off with resistance bands if the weight seem too heavy and little by little she stuck with it and by the that she turned like 7072, she was competing in her first official competition as the oldest American ninja warrior that's amazing I think I seen her on Instagram yeah been on all these viral meals you can do it at any age I mean you can do it at any age yeah she added a ton of muscle mass and she feels amazing and then she went back in to check because I think Osteopen is on the way to osteoporosis and they said you must have gotten misdiagnosed because no evidence here that you have osteopenia anymore and obviously she knew that her lifestyle was making a difference in her body and her bones and everything were getting stronger. So, wherever you're at at any age, maybe you find a trainer, maybe you start the YMCA, you can get started. So, these are all the things that people can do at home, right? Yeah and there's a few more labs. Let me just quickly mention. Well, let me say this first. Osteopenia and osteoporosis are just metabolic dysfunction in your bones but it's literally diabetes to the bones and osteoarthritis is diabetes to the joints. So people don't realize that. That's all part of this. So if you're suddenly plagued with a bunch of you know degenerative joint disease in your middle age ironically as your waste circumference is expanding that is the insulin actually impacting your joints and leptin and the whole signaling cascade getting screwed up. This is one of the reasons I love GLP 1 so much. So that's a whole other thing. Uh when you go in for your yearly physical you're going to get a comprehensive metabolic panel so they're going to be looking at your liver enzymes. If those are elevated it means you've got to start a fatty liver and what often happens it's completely been normalized and doctor will say, you've got a little fatty liver but that's okay. It's not okay. There's no version of fatty liver that's okay at all. So, if you see elevated liver enzymes, you're having some activity in your liver. It doesn't mean your liver is diseased. It means your liver cells are active and they are secreting this enzyme to let you know your liver is being a little, it's got a little stress on it. It's probably fatty infiltrate. That comes along with metabolic dysfunction and then the other thing is your lip is, your cholesterol, your LDL, your HDL, your triglycerides. If your cholesterol and your triglycerides equal each other, you are in trouble. So, let's say your cholesterol is creeping up at two twenty and your trigs are at one twenty, you are in trouble and essentially your liver is pickling. It's not a good sign, your lipids are off. Now, lipids can get off because of thyroid dysfunction and because of hormonal dysfunction but most notably, it's due to metabolic dysfunction. So, I remember I had a a fellow student in chiropractic college. I was like the token naturopathic doctor in the chiropractic college so like all the dudes would come up and be like, hey, Tina. Can you explain this to me and I I labs really like a ninja as myself so I was like yeah this guy shows up and he's super fit he's Korean and he's super fit very well muscled probably the best adjuster in our school like fast and really into martial arts and like just so he would take a shirt off and you were like damn that guy's in good shape his triggs were off the chart his cholesterol was creeping up and like off the chart you know like what would that look like it was in the two hundreds I mean it was not good for him I was look I mean I remember looking at his labs and him being like what is going on here he also had elevated LDL and low HDL, right? That's not good. We don't want high DLL. I I'm not worried about these lipids causing heart disease the way that we have been traditionally taught but we still can look at them in correlation to one another and see trends. So, we don't want high LDL and low HDL and I said, what are you doing? Are you like secretly an alcoholic? And I don't know it and he said, no, I don't drink hardly at all and I said, well, what are you doing? He was getting a soda every day. He was going to Carls Junior and Getting his lunch at Carl's Junior which I was like what are you doing? So back to what we were talking about. Sometimes you can really mask the metabolic dysfunction. That's what I was saying. This is why waste your compass is really so important in anybody of of Asian descent because we do not want that you guys can have atrocious labs and still have really great body composition. So there's a there's trouble brewing. It was soda. He was drinking soda and so then he switched to diet because he thought he wasn't clear enough. I was like don't drink the freaking soda but he switches to diet. They still look bad but they actually look a little bit better and not that I'm a fan of diet by any means but yeah so Carl's Junior and soda every day but he was eating well for breakfast and dinner seemingly. So anyway that's just a great example. So you don't want your LDL above a hundred and you don't want your HDL below forty-five. We want these in a good ratios to one another. My LDL has always naturally been a little bit high. Even with low triglycerides and high HDL. Yeah. And I've done a lot of work up and I've had my cardiologist on the podcast Doctor Mike Twyman. Uh Michael Twyman and one of the things that he talked about with me is I don't have familial hyper cholesterolemia but I am a hyper reabsorber of cholesterol. Yeah. So that is leads to high LDL and also my ApoB traditionally has been high. Is he worried? Uh he looks at it as these things are shots on goal and if your goalkeeper is really strong and if you're which is your endothelium if your endothelium is really strong because you have good production of nitric oxide you don't have all this vascular inflammation through insulin resistance and you are getting good quality sunlight he's a big believer in photobiomodulation and you're not super stressed and you're not consuming alcohol all the time these are all the things that keep an endothelium strong yeah I was going to say I think they're protective they're alcohol protective and he said because I look at the data, I know there's a lot that we don't know. So, it's very clear that high apobe is athrogenic, is that the word? Arthrogenic, yeah. It it it does it is causative with vascular disease and when these lipids are able to get into the endothelium and then you get these little pimples, that is the formation of these plaques that are there. So, he said in your you just have to weigh the pros and cons and the risk that are there so after looking at all the different solutions I said oh wow I wouldn't actually I got these genetic test done that showed me what you know interventions would I respond to what would do well and because I'm a hyper reabsorber one of the recommendations was look you can go on a Zetamide that seems to be one of the best tolerated and it's just blocking some of the reabsorption of these lipids and it doesn't seem like there's a ton of side effects and again you gotta make the decision because you're the patient but here's the pros and cons they are shots on goal and your endothelium is in Incredibly strong. Yeah. I also got a CCTA scan to look at the actual plaque in my arteries much deeper than a CT scan and I had virtually no plaque at all whatsoever. Like he said it was the it was the best scan that I had seen of any male above the age of 40 years old. So that gives me peace of mind and I know that heart disease is a big component for South Asians and skinny fat individuals where most of them are dealing with insulin resistance. So I've chosen to take the xenomide and let's see. I may decide differently but I'll tell you it definitely lowered my Able B where I previously was at like one sixty. I've gotten down to you know like ninety around ninetyish eighty around there. So again all pros and cons that you're just trying to weigh off in your journey of of of you know trying to decide how to make yourself healthy. Yeah I I think of it similarly like if something's a little off I'm not terribly worried. I look at trends. I'm more interested in the trend and I'm more interested in what the other labs are saying in conjunction and then I'm more interested in how that individuals living Life. So I this reminds me of something I saw. It was actually during you know the past few years and it was a doctor I follow who's really into metabolic health on Twitter and he was actively seeing patients during the pandemic and he basically threw up some lab values and it had like a hemoglobin A one C, a C reactive protein, and you know a couple other markers and he said you know you guys consider this normal and this having a really hard time in hospital with COVID. We are not the same. It was something like that and basically what he was saying was like in conjunction all of these together being a little bit off, little bit off, little bit off, little bit off. That is your typical middle-aged male in America with a little bit of belly fat, just a little bit of a dad bod, like just a little bit off is enough to put you into this really pro-inflammatory state, which would make you susceptible to all kinds of things, including what we've just been dealing with. So, that was his point was like, you guys look at this and brush it off and say, oh this is just normal because it has been normalized, right? But that doesn't mean this is ideal or optimal and he's like, we are not the same because all of that looks like a hot mess and. So true. Yeah and I remember like turning to my husband and I was like, your lips look a little bit like this. Maybe you should listen to me. You know like that middle age you know got it's it's easy to neglect it but and it's hard to see it especially as a man because you can really sort of pack it on throughout that torso especially guys that are taller you don't see it as much you wear it well right but it's I'm telling you that waist circumference is the truth teller well you were talking about HDL triglycerides LDL and where you look at it that is there anything else you want to say on the lab conversation? No because all that's really inexpensive and really easy to get a hold of. Yeah. Like you're talking about more advanced lipid panels and some other fancy stuff but just for your average American you're going to get a comprehensive metabolic panel which is going to have your lipid I'm sorry your liver enzymes and you're going to have your cholesterol and lipids done that's just part of annual physical exam so you can easily just ask hey can we add on the D can we add on the C reactive protein can we add you know you you don't necessarily need the said rate but it's nice to have in conjunction and so you don't miss the inflammation and you can add on the serum fasting insulin that's a pretty complete package it's not a terribly huge expense it's something that people can do because I think People get intimidated and this I see this all the time in my community. They're looking at the biohackers and the influencers online and it's hardcore. You know, there's a lot of guys that are young and a lot of women that are young that are kind of sitting in your age group that are starting to dabble with this and taking their health really seriously but a lot of this feels really hardcore to a lot of people and I'm over here dealing with patients who just more in reality like these folks just want to live well and they're not necessarily concerned about having like a perfect body composition. They just want to be happy and healthy. Yeah. And so like take what you have already that your insurance is covering on your annual and like let's just add a few factors and learn how to use it. Yeah. You know instead of getting so fancy. Yeah because we can get fancy and that just gets really I've I've actually had lab companies come to me and offer me free kits and I've done it and then I look at the results and I won't agree to work with them as a brand sponsor because I'm like this is going to scare the **** out of people. It's just too much. Like sometimes that's the goal of these companies. Yeah because they gotta keep in the cell on the tail end. Yeah or you know I'm going to have them on because I actually want to have a genuine conversation. They're not a sponsor or anything else like that. I think it's interesting but some of these epigenetic sort of age test that are there. From looking from the outside my big concern is that a lot of the people that seem to be doing really well on that you know it seems that supplements can influence it really heavily. So if a supplement can not that lifestyle doesn't matter and of course a lot of these people are doing that but if a supplement can influence it that heavily how valuable is it on it on its own? It's just questions that I have. I'm not sure. I don't have the answer. I think there could be utility for them but is that where most people need to start? You know, is do most people need to start at that and I want to have all the options on the table but I want to make sure that we never forget about the majors that people need to focus on because most people don't even have those dialed in and getting that dialed in alone as somebody who's very involved in his parents' health and is trying to support them and I have the support of my sisters who are actually probably leading a lot of the efforts of my brother-in-law, Doctor Neil Patel, just even getting your parents to do some strength training, right? To go to the sauna a couple times a week, to clean up the diet a little bit, like that sometimes can feel like a full-time thing. If you're, for them and for you to support them because you're trying to change habits when you've had years or decades of doing things a particular way. Just buy the sauna and put it in their basement. That's what I do. I was like, Here's the sauna. Go in it every day. So now, we've covered the basics. Okay. People know how to know if you're metabolic healthy or not and let's say whether they needed that confirmation from the labs or they did that waist circumference and they're like, oh. Mm hmm. Okay. I am in the eighty-five, 90 percent of people that are metabolicly unhealthy. You've already talked about some of those things that are there. Resistance training, right? Non negotiable. Non negotiable. Is there any tip or resources that are things that you tell your patients that are important about them getting started on that because it can feel again very intimidating for people in their fifties, sixties, 70s who have never done this before and 80s and beyond, what tips, resources, guidance do you have for those individuals that are like, okay, I get it. Doctor Tina, I want to get more serious about resistance training. What do you tell them to help them on that journey? Ideally, find someone who you pay money to who can get you started because it is a skill. String Training is a skill and there's a lot of opportunity to hurt yourself and folks are often coming in with orthopedic issues already and those are the people I took care of in my practice, right? I took care of people who had orthopedic issues and if you bung yourself up and you get yourself hurt, you're going to stop and then you're going to be maybe even worse off than when you started because now you're really going to be not wanting to go back to the gym. The gym is an intimidating place for a lot of people. So, I think hiring somebody, I would specifically ask, are you training middle age and older folks because that's a whole art form in and of itself. Anybody can train a 25 year old but it takes some skill to train someone who's 45 or older. So, finding somebody and you often can just, you gotta interview these coaches. You often can find people who've had backgrounds like I think my first coach, the reason I hired him was because he had a very strong cardiovascular background. He was actually training people post op in a cardiovascular clinic and I was like, I want you like you you get this, right? We have to work to tolerance and we have to build upon a And that might take a lot of time. So finding somebody who is skilled to work with. You don't necessarily have to do one on one because I know that's cost prohibitive for a lot of people but you can work in small groups that really brings the price down. So find a group of folks you know maybe five to eight people in a small class. Maybe even 10 people, but where you still have some individual eyes on you but you're in a place where you can afford it and that then you've got community and accountability which I think is also really healthy. I mean that's a huge part of the gym right? It's just like seeing people and having friends and being part of something where you're all bettering yourself. That's a big deal. It's a really big deal as people age. I think that if that is out of your cars because you live somewhere more rural. I hear from people all the time. I live out in the middle of nowhere so that may not be as easy to find. There is a ton of online stuff that you can do although you don't have eyeballs on you. So, I just don't want people getting hurt. I want them starting somewhere that's easier to do when you're younger, harder to do when you're older, getting started on your own. So, finding some kind of community that can help support you. CrossFit, I think is great if you have a good CrossFit coach, not a fan of like berries boot camp, orange theory, all of that. I think those just exhaust people and burn their adrenals out. I think it's way too much. That's not strength training. I'm talking about slow and heavy and finding somebody that can work with you on that. If you have to start at home with bands or small weights, that's fine. Body weights, actually it's very difficult to hold your own body weight up for a lot of people. It's easier to start with weights sometimes. So, kind of depends on where you're at but if you have orthopedic faults, probably better money spent than hiring a functional medicine doctor. Yeah. Strongly believe that patients would come into my clinic. They'd want the full laboratory workup. They'd want the full regenerative injection therapy workup and treatment and I'm like, why don't you spend all of these thousands of dollars on a strength and conditioning coach and come back to me in three to six months and tell me you don't feel better and in many case and I'd send them all to the same gym because I knew these folks could train older folks or folks that had orthopedic compromise and I would see them in the gym later and I'd be like, hey, how's the shoulder? They're like, it's great. Don't need you anymore. I'm like, okay, good. I did my job. I could've made a lot more money just shooting them up but that's not the right thing to do. No, great advice. You're really helping people understand prioritization. Yeah. And that if they're focus on their body's innate ability to take care of itself. That's naturopathic medicine. Get involved with all these things or you need less of the tools. Yes. I want people to have less. I don't want people taking 18 supplements and doing all. I mean the biohacking community is cool that it got people interested but like it really became a lot of overkill to me. I just feel like simplicity is so much easier to manage long term for people. You know I'm trying to build a foundation so that you're a tough old broad and you don't break your hip. Yeah. There's biohacking as a And just like there are sports where people get into all the statistics in this team versus another and they get so emotional about stuff and it's also it's a sport. Right? Yeah. In the same way we gotta look at the biohacking stuff that's out there and say okay this is sport. I get that these people like to compete at this sport that doesn't mean I need to pretend that I'm Tom Brady and start living or spending or try to live my life like Hita because I think that that's what I need to do if I'm interested in football when generally you can have a lot more fun and save money if you just do things in a more simple way. So you can see a lot of the biohacking that's out there. It's a sport. People have a lot of different incentives to promote different things and instead you could just focus on the basics that are there. You're going to get a tremendous bang for the buck if you just focus on the basics. Yeah and you get really good at them and you repeat them which is not sexy and it's boring. People want sexy. People want to nerd out on stuff. I feel like too Guys like gadgets so biohacking is really fun because it's like all these gadgets but you just need some things that are basic and you need to do them consistently and there's also this neurosis that happens this like orthopedic and this neurosis that can occur with all of this journey for people and they get way overwhelmed and they get totally freaked out and they start hyper focusing on like different lab markers and different this and that and I'm like dude the cortisol is killing you. You're killing yourself with the neurosis. So ask my husband how often we run blood work. It's not it's not often. We should do it every year. We do it probably every two to three years like I really do not want to worry about a lot of this stuff anymore. I've been in that world of like being hyper neurotic about my health and it did not serve me well. So, I'm taking more of the approach of chilling out. I'm also not someone who's a big proponent of colonoscopies and mammograms. So, that's me and my risk tolerance. I want to make that very clear. I just have a different risk tolerance and I have a different strategy about what I will do if something bad creeps up. Like, I'm not of the ilk of like run every single lab and do every single thing. I think that's heroic metabolic and I think that's also done a lot of damage to our society so I am much more of a I will you know do we want to run these lab markers and I ask patients this do you really want me to run all of this to see what we find is it going to change the treatment any like we have to really talk about that are we here are your treatment options based on what might show up are we going to how are you going to handle this and that is a big question noone asks yeah and they get all these labs ran and then they're like well what am I going to do and now a whole new neurosis starts and you get more pokes and prods and you know poking the bear. Biopsying tiny little tumors that maybe are benign or not. I'm not saying don't do it and again that's up to folks' wrist tolerance but you open the capsule on a cancer. You now have invited a potential spread of that cancer. So we're poking the bear a lot in different ways in medicine and I'm just I feel like the biohacking community is really perpetuating that and I'm like I'll just be over here running some basic labs every once in a while and I'm going to just do everything else to take really good care of myself. Well, I appreciate you sharing your perspective because that's what this podcast is here for. They want to hear of how do you look at your worldview, what options do you present with your patients that are out there and I want people to have access to all the information and then they can decide how to make that prioritization themselves and then you'll help hear themes from different episodes and one of the big themes that a lot of individuals, many of your friends, contemporaries who've been in this podcast too, have been talking about and you're talking about it here is whatever you do because we don't want to yuck Somebody's yum. If you're not focusing on the basics and the majors. Yes. None of the other matters. Yes. Amen. And the same thing goes with even our last conversation which is the topic of Ozempic and GLP ones. Yes, even at low doses that can be helpful but if you don't plan on improving your metabolic health, you have to ask yourself, what are the long-term pros and cons of these things? The best of both worlds is that you've shared that these things for people who want to get better can kid kickstart in many instances and make it easier to double down on the metabolic health and obviously that's the best of both worlds if somebody chooses to go down that journey right so I want to bring it back to here because there's a few of the things on metabolic health that you touched on that are just part of those basics what do you want to say about the dietary side of stuff so resistance training and first understanding your labs and where there are if a those are a big part of it what do you want to say about the dietary piece keep it simple That's another thing I really try to keep simple and I focus on honestly just a chunk of protein. Animal protein is preferred. A chunk of protein at three meals a day or two big bigger meals a day. So a good gauge is the size of your hand. Eat a piece of meat the size of your hand. If it's not as long as your hand then it should be thicker. That should get you started. That's a really great gauge to get started. And you can use different fitness apps if you want to. You can keep track of your macro but once you start knowing what how much how much protein is in something, you can just start to eyeball it, right? It's not too difficult to do. So, I aim for like 30 grams per meal at least. We could go heavier if we're really actively trying to build muscle and or maybe we are a bit older and we are dealing with some sarcopenia. We want to go higher. If you're a man, you want to go higher but undereating is a real issue but trying to hit your macros, your protein macros when your gut and digestion is compromised which is a lot of people that's a really daunting difficult test too. Nobody considers that but that is a very hard thing to do. It's really easy to say oh pound you know gram per pound of body weight but in somebody who has gastrointestinal issues. That's just like I can't do it doc. It's too much. I feel terrible you know. So really just trying to meet the patient where they're at because everybody's an individual and I'm looking for needle movers. So a good one is pain. I had a really awesome old timey doc tell me years ago. All of your female patients are under eating their protein. If you can just get them to eat more protein their pain will go down. Any kind of pain that with? Any, yeah, it's a good gauge, right? Women in general are under eating protein especially older women and then we have to consider dentistian as as folks are aging. Their teeth are starting to actually, they're starting to have tooth problems. A lot of that is osteoporosis especially in women. Their jaw bones are dissolving and so their teeth are rattling around so they're starting to have dentitian issues. They want to blame it on the you know, I had dental work done 20 years ago in Mexico. It's that. I'm like, no, honey. It's your osteoporosis and your teeth are falling out of your head and so they're eating less and less. We also have to look at societal factors, cultural beliefs you know like getting somebody who's been a vegetarian who's Indian who's been vegetarian for generations and you're trying to tell your grandma like I need you to eat meat grandma she's going to be like I mean we have to be have to be respectful of that and and try to work with it tell my grandma that I started eating meat she probably was just like she would have been you know if you care about your your grandparents health it's like I want her to live as long as possible I don't want her to die early because her grandson is now eating meat we have to look at money too I mean I've had patients say I've got five kids at home and a husband and or I've got three boys that are football players and a husband I can't even afford that much. Like we just have to look at issues. But if you're cooking meat at home yes I know meat is more expensive than certain things but actually when you look at people's budgets nothing is more expensive than packaged food. Of course. Of course. Yeah. And like you know convenience stuff that like trying to feed. If you're going to cook it. Two or three boys. Sure. You know and a husband. And it's just it's just a lot. And then there's even the concept of women I've had so many female patients who have to cook their own food because their husbands refuse eat that way and their kids refuse to eat that way and they for whatever reason don't have the strength or don't have the position of power in the household to say look this is the way we're eating because I'm the cook so she's making her own food over here I mean there's all kinds of factors to consider but ideally yes we're getting adequate protein and that would be roughly for women I would say your average woman 120 grams is a great goal not everyone's going to hit it but that's a great goal for women 150 or more for men animal protein is preferred and then and the other part I want to mention When women lose their partners, they stop cooking and they often will have a quick deterioration in their health because they stop eating and they start eating canned foods and packaged foods because they're not, they don't have anyone to cook for anymore. Wow. And so this is actually really common and I took care of a lot of little old ladies that I inherited from my mentor and they their health was deteriorating and their protein was so abysmally low because they were alone and they were sad and they were lonely. Snacking is a lot easier than cooking up a meal when you don't have your husband or. What's the answer if somebody that situation or somebody they love is in that situation. Protein powder. Or even is it a bigger answer? Like you know I know like I know this is like such a complex issue but is it the answer is it community? Yeah it is like if we can find it but unfortunately like community in many cases is church and church loves to feed you a bunch of sweets and snacks and baked goods. It's you know it's it's hard. It's like trying to get our church to shift serving cookies. What I actually tell them is like if you love snacky if snacky foods are easier for anyone who snacky foods are easier I'm a snacky food girl. I grew up like Latch Key Kid eaten whatever. I was like ultra carb addicted. Ultra addicted to ultra refined carbs. And so for me beef jerky, meat sticks, you know, hard boiled eggs, string cheese, whatever kind of like quick proteins we can do might be a better solution and then like focus on one good meal. I don't know. That's what I tell my patients. Yeah. It's just and chewing. You know chewing on beef jerky and chewing on stuff that's hard to chew on is really really great for that bone structure and for your facial structure. So we don't want to we don't want to stop doing that. Um ground beef, you know, however we can get it in but when you're looking at, I've even seen this with women when their kids move out. You know, they all go to college and they're like, it's just me and my husband and they're so sad like their whole purpose has just moved out and that's all they've ever done is really like rearing their children is their life's work and so, we just have to take these things into consideration because in the online health space and the podcast and the influencers, we're all just like baking these blanket claims and then I'm hearing from these women in real stories and they're like this is hard. So from there I do I'm not afraid of carbs especially if you're strength training. Eat the freaking carbs. Just don't eat a ton of them. If you get your protein in first you won't eat as many carbs. If you go for the carbs first you'll eat them all up. You'll gobble them all up. So eat your protein first then go after your carbs. Fruits and vegetables. Big fan of fruits. Not a huge fan of a lot of vegetables. I feel like they can I feel like they can really aggravate people with gut issues. So I know controversial but I love the vegetables that are actually fruits. So, zucchini, squashes, things like that. Those are actually fruits because they. Avocado. Yeah, they have seeds. So, eating plenty of that. If leafy greens because a lot of people are eating, they think eating big salads with some chicken on it's you know, that's what they're supposed to do but then, their guts are a mess and they're having chronic diarrhea. So, we have to be cognizant of that. A lot of people have gastrointestinal issues. So, maybe play with your intake of your vegetables, leafy, roughage, Cooked, uncooked. I really think cooked vegetables are the way to go and for most people for absorption, not raw. So, salads. I'm not a fan of salads. I used to do great on like raw salads like fifty different things in it and just naturally, I noticed that as I aged, that same salad that I used to love and when I eat it younger because at one point in time I was doing like the raw food diet. I wasn't even cooking them. Oh my gosh. Uh when that was a whole trend that was. But you had great digestive juices then. You and that same salad now it's like I I feel bloated I don't feel as good so I cook my vegetables and I feel a lot better I make a stir fry you know chicken sausage this that whatever and I make a little breakfast stir fry and I feel a lot better and I can still get my vegetables in but even me you know not that like I'm about to turn 42 that's not that old it in and and 50 is not old 60 is not old if we like take care of our body our body is so resilient but Even for me to see like wow my I'm not digesting as well as I did before. That's interesting to notice. So everything atrophies including your gut lining. So your gut lining is atrophying and with it comes all of the secretions that are supposed to be happening. So as that gut lining atrophies due to age. This is one of the other reasons I love GLP ones is because I I really do I think that in as folks age their L cells the the parts of their gut that contain the L cells that are supposed to be secreting the GLP one are probably going through an atrophy and they may not have such a vigorous GLP one production and it's really easy to say oh just eat less and move more and take these herbs in your L cells will produce you know these probiotics and we'll crank it up and we'll we'll promote GLP one production and I'm like yeah if their L cells are not totally petered out and considering a lot of folks have gastrointestinal inflammation IBS and bloating and distension and a lot of people I mean my daughter's twenty-four and her whole all of them have gut issues. It's crazy. Yeah. So, these are just considerations like having actual patients in front of me. It's a whole different story than when I see the influencer crowd and their health advice. I'm like, that's hardcore man. This doesn't fit everybody. Yeah and I think the solution to that is more diverse voices that represent different population sets. Yeah, right? Yeah. Like you coming in from the location that you're in being The individual you are with the background, the patients that you took care of, including these little ladies, you can come in and bring a different level of context that somebody may not have because they don't have that lived experience. So, the more that we could feature people that have different backgrounds that are taking care of different people, the more that we're going to get real health advice, right? That actually can meet people where they are. And I will say, I generally took care of very active healthy people. It was an aging cohort because I was doing regenerative injection therapy. So, these are people who had bunged up joints but for the most part, I only accepted people who were quite fit. So, very good body composition generally speaking. I was not taking care of sick sick people. My practice has always been I'm pretty picky there's an application process like I really take I my whole angle was that I keep active people active. So yes I inherited a whole group of people from my mentor and I inherited these little ladies but those little ladies were very active. I was not taking care of sick people. Got it. You know these were not complicated complex cases. So even in that group where what I'm telling you is happening. So. Yeah. You know, just for the audience listening for anyone who's maybe been, you know, there's so much great free information out there online and I appreciate all of the contributors to it but there's also like reality of physiology and we have to honor that too because I I see 6-5-year-old women trying to follow the advice of a 25-year-old strength and conditioning coach online and I'm like, may have a mismatch. Little bit. So, how we got on that topic is we were talking about dietary things. Yeah. Right? You had a few rules that you wanted to share. Especially if you're strength training. Don't worry about the carbs. Don't over do it. Don't overdo the added sugar etcetera but don't be full of carbs. In fact, it going low carb, super low carb for long periods of time can be not great for women and I've heard multiple people on this podcast talk about the damage that a lot of women in particular. That'll destroy your gut lining. Right, that'll destroy your gut lining, maybe other components are there, probably not great for men too, anybody, you know, long term, super low carb, and I totally respect the fact that there are people in this whole ketogenic metabolic brain health that truly feel that that's what gave their life back. Yes. Or they're suffering from such bad autoimmune conditions that the only thing that worked for them even as a medical doctor was going on a carnivore diet, right? I can respect both aspects of of those things. Uh so, don't fear carbs. Make sure you adequately get your protein. You gave some different rule of thumbs for that. You know, keeping it simple. Get your vegetables cook your vegetables, lean towards the ones that maybe are going to cause less digestive issues. Any other principles on diet that you want to put in before we move on? Cook at home and don't eat **** out of packages if you can help it. Love it. If you're going to eat a packaged food, consider, you know, there's different companies that make really nice meat sticks or even some of the more clean bars but you really gotta be picky about those if you need like a portable food but cook at home. 99% of the time, cook at home. That's great. So, we talk about exercise. We talked about diet. You've mentioned a little bit about sleep as well earlier too. We talked about the importance of community a little bit briefly. Anything additional that you want to say about that, friendship, community, finding your tribe, and the importance that that plays into modulating stress, connecting to your life's purpose, you know, anything you want to say about that? Well, you are who you spend time with. You quite literally our microbiomes are contagious. So, we are who we spend time around. So, pick your friends carefully and find your tribe That doesn't mean I'm I'm really a hermit at heart. I'll stay home all day with my dogs and not see humans for weeks and be just fine but I need to be around other humans. I'm happier that way. My heart rate I actually track my heart rate variability goes up when I'm around other humans. So I have to be really cognizant of that as somebody who's pretty introverted. So finding people but make sure the people that you choose to spend the most time with if if you really want to optimize your health you have to consider their health and I don't mean to be judgmental but that is a real thing. We really do Share our chronic degenerative illnesses with one another through our microbiome. It's not just habits and you know lifestyle. So that has to be a consideration in there and I see that a lot with folks who are maybe having lots of struggles in their health getting dialed in and then you know their partners incredibly unhealthy. That can play a role. So it is important. Uh but you you gotta pick your people. Yeah. That's a hard one to hear I know but. Health is contagious and lack of health is contagious too. So those are big problems on both ends. Um in other big components that are there, sleep, sauna, I'll throw sauna in. Yeah, just getting hot. You know, getting hot. If you can't afford sauna, I don't care what kind of sauna it is, just get hot. Yeah. That might be through exercise that might be through a hot bath but really stoking those heat shock proteins can be incredibly vitalistic and helpful. So, cooking yourself a little bit is is my jam. Yeah, so the temperature variation, some positive stress that we're bringing to the body to get some resilience. Yes and I am not keen on protocols. Just get hot. Get as hot you can to tolerance. Water is a beautiful, beautiful tool and treatment and naturopathic medicine. We call it hydrotherapy. It is too tolerance. It is to stoke vitality and that is a different temperature for everyone. So, you can listen to all the gurus and you can put yourself at potential risk if you have cardiovascular disease or you can just take it to tolerance and you can build yourself up and it's really a vitality surgical. All of these things are. All of these things are vitality stokers. What I love about everything you shared is these are all simple and straightforward things that people are already working They just might need to give a little bit more attention to them and generally speaking, if you find somebody coming in and they think like, look, I'm living pretty healthy but my midsection is getting wider. I'm looking more like a potato as I get older. Potato. Right? My labs don't look great, you know, and I'm aging and I feel like I'm aging in the wrong direction but I want to get metabolicly healthy. They hear about these main components. Yeah. They take it seriously and it's not full-time job but they take it seriously. They're working on it every week. They might be including in a different habit. Maybe they're focusing a little bit on their diet than strength training than their sleep or in whatever order that you come up with them. How long have you generally seen that it takes somebody who comes in, who's motivated, like a lot of our listeners are, who's not metabolicly healthy. I'm not talking about severe obesity. I'm talking about they just don't feel good. They're outside of the optimal zone how long have you generally seen in your clinical experience it takes them if they focus on these few areas to feel like they are now metabolicly healthy? They will start to feel better immediately. And within a week to two weeks they'll start to notice their inflammation going down and their clothes are fitting differently because they're losing some of that inflammatory bloat. Labs will not change for 90 days. But that doesn't mean that the goodness is not happening during those 90 days. So it really is like within 30 days they come in and they say I feel awesome. I want to rerun my labs and I say no no because they're going to look the same. Don't waste your money. In 90 days I'll see changes on labs. I'll see those markers I mentioned really start to improve. So I have heard from so many people like what's the point if it takes 90 days. That is not correct. That's not the correct thinking. We are on a path. We are on a journey and journey is a yeah there's no destination. It's just a journey. Health is a journey. Right? So you will notice within a week or two improvements. And then we retest to see but we're really looking to see if that waist circumference is coming down and it should start and if it's stuck and they're doing all the things this is where I pulled in GLP ones. This is where I got interested. So you mentioned giving them to folks you know who really might need them and I'm over here also saying we have folks doing everything right and they're in my age cohort. They're sitting in middle age especially women. Women listening to me your estrogen going if you are not exercising going into menopause you are screwed if you don't get on the ball. Like period. But as your estrogen drops even if you are well musculoskeletal and doing all the things you will start moving towards metabolic metabolic dysfunction period that is the that is the side effect of estrogen dropping. So, I'm a big fan of bioidentical hormone replacement in this age cohort but even with that and doing all the right things, this is where I will pull GLP ones in. Yeah. So, you know, we have about 10 minutes more here on the podcast. I'm going to run through a few questions that we got that are from the first episode that are related to this. The one that I want to rebring back up and have you answer again is again, everybody asks, where do I find a doctor and it's a Tough answer but your real answer is it's I know I'm getting this question too from everybody. It's really hard because doctors aren't seeing this and I I have asked every single person who comes to me who says, I'm micro dosing GLP ones and then this is happening or this and I'm like, what's your dose? And they tell me and they're not micro dosing GLP ones. They're taking the standard dose. The doctors are hearing this term now because I've been on the podcast circuit and they're hearing the term micro dose and they say, oh yeah, we microdose and they don't. They're giving the standard low dose. The the starting dose. So I don't and that can be too much for a lot of people. So finding somebody. And what is that? What is that typically? What what is point two five and with trazepatide it's 2. 5 milligrams. These are milligrams. Um so I just know all all that to say is I don't think that the doctors get what I'm trying to lay down here. Yeah. So. Yeah. There's not enough education across the board. Yeah. Because they're doing 2. 5 or 1. 5. You're really talking about a micro dose is what? It depends. It totally depends on the range. A fraction of that. Yeah. So. Like 50%? 10%? Depends. It literally depends on the person in front of me. I cannot answer that. I mean I I it depends on who's in front of me and what we need to do short term and long. But bottom line it's not a low dose. It's going to be a fraction of that and that could include a big range. Yes and some folks may need that low dose. So it depends on how a depth someone is at functional medicine and I'm finding that a lot of functional medicine doctors are not really adept at doing all the things. There's a lot doctors out there who are functional medicine doctors who cannot or will not prescribe hormones and I really think hormones are a big piece of this picture and there are functional medicine doctors that cannot or will not prescribe GLP ones and so they're completely missing that piece and so there's there's a lot of confusion happening I feel like I'm going out trying to spread this good message and yet I'm creating a big monster and a lot of big confusion so I have a program where I am training doctors inside of and so that's helpful. So they'll be like certified by you. They're not going to be certified but at least we know they took my Okay. And they heard they heard my they you know the way that you're a little bit more likely to probably get better care. Yes and then I know that in the longevity medicine community doctors are getting it. So folks are showing up saying and they're getting it and I know some of my naturopathic doctor colleagues who are really into peptides already. They were already into bioidentical hormone replacement. They they they're getting it. They no training necessary. They're like I get what you're laying down. So I know they're out there but you have to find somebody who already knows how to work with peptides. Yeah. Ideally and if you that's going to be actually that's One of the best recommendations you could have. Yeah. Who has long term use of peptides? Yes. Period. Has been using them. Yes. And they're more likely going to have the mindset. Yeah. That's needed for if you choose like I have zero interest or need for doing any kind of micro dosing with GLP one so I'm not a candidate but if somebody is the best indication is find a longevity doctor who already has a good amount of experience working with peptides. Yeah and hormones. And hormones. Yes. How many years would you say? If you were looking at a resume and somebody said I have X amount of I don't think it matters honestly because I was a really excited young like as a young doctor I was really enthusiastic and I listen to my patients so I took a lot of input from them. So I had these old guys come in that were like hormone experts from way back in the day because they were bodybuilders. You know these guys are in their seventies. They taught me about testosterone therapy replacement. So you know young you have more opportunity for somebody to work with you. Older you're going to have somebody with a lot more experience. Yeah. And so the other question that we here is that if they're, if somebody's interested in micro dosing, they find somebody who think who they think is a good practitioner to hold their hand on this journey, to listen to them, to take feedback, to adjust accordingly, and they're willing to work on their metabolic health. If that physician is not using a compounding pharmacy, then, they're not micro dosing. Is that accurate? Like the question we had here is that should I be worried if they're not using a compounding pharmacy? Some folks need a micro dos is the actual starting dose. Got it. So, the pen and the standard brand name Might be very appropriate for them. That would be somebody who probably has more weight to lose, who's really much more metabolic busted. Microdosing, I will say this again and again, is micro dosing for it to work, it's reserved for those who are metabolic optimize. So, folks coming in saying, well, Mike, I get messages. I listen to your podcast and I try to micro dosing it didn't work and I find out they've got 60 pounds to lose. Those are not micro dosing candidates. Got it. Got it. Any other caveats there of who is and isn't a candidate that you add in? Like if you have more than 60 pounds to lose, you're saying. Well, even 30 pounds might not be. It really depends on how much muscle mass they have, what other therapeutics and interventions they're doing, what kind of lifestyle they lead, you know, that really dictates the dose and that dictates where I'm going to go and I have found that I've got to ramp it up on some people who are not as compliant with the lifestyle and other folks are just I'm I gotta bring them down. I have colleagues who are listening to me who are finding it and they're getting themselves on it and then they come they they're messaging me. I'm micro dosing and this is happening and I'm like, honey, pull the dose down. You don't need that high and they're taking a tiny little bit. So, people's version of what they think my micro dosing strategy is is all over the board and so, that's the other component of my program is half of the people in there are just the general public and I really explain this in detail in conjunction with all the other therapeutics. It's like a full-blown lesson on how I approach a patient to get a metabolic well and I think that having an education is the key component to finding a good physician. If you come in educated and your docs willing to listen to you and you have the data and you have the information and you have the clinical rationale, most docs are willing, I have found to work with you especially in the functional medicine community. They're going to be more open. So, my goal in there is to really educate people so that they can take full control of their health. So, another question we have here from somebody who wrote in is if my because you hormones and bioidentical hormones. If we have a woman listening today and they're in that stage of their life, perimenopause, menopause, they haven't had hormonal intervention yet, should they first start with somebody on that and then consider this or or should this both be tackled at the same time? Potentially the GLP and the hormones too. And I know it depends but what are the big picture framework that they could be thinking about? So I just taught this module inside my program and the bottom line is depends on the hormone. So we can Applied adrenal thyroid, even progesterone quite safely to most individuals, even if they're really metabolic compromised, we start to get into trouble with estrogen and testosterone and pathways that they go down when we have a lot of adipose on the body. So, we need the estrogen to bring the metabolic health to dial it in but putting estrogen in a metabolic dysfunctional individual is a disaster I've seen in clinical experience. It's like trying to hit a moving target. So, this is where I think GLP ones are a beautiful addition early on because they need the estrogen so we can get their insulin sensitivity back up and without the estrogen we cannot get the cells to function properly but we don't want to put estrogen in a hot mess of inflammation so I think GLP one in all cases are a beautiful place to start but they work much better we even have a very small study but we have we do have some data showing people lost more weight and had better outcomes when they were on HRT so it's a both and a good doc like We just talked about is going to know how to do that. And they're going to weigh out the pros and cons and personalize it and put that together. Yeah and I talk about that again really in depth. I explain all of this by hormone inside my program. So at least folks can have a better understanding what is they're putting in their bodies. Where can people go to both if you could remind the audience if they're interested in the program. We have some practitioners that are listening. They might might want to check that out and then you also have a free four part series that people can watch and anybody can sign up for that as well. Just remind everybody where they can go to get both Sure so Doctor Tina. com D R T Y N A Tina with a Y and right at the top you'll find my free four-part video series which is free to everyone and it really deeps that you know dives deep into a lot of the conversation that they need to hear and know about to blow some of the mist out of the water learn about some of the other benefits that we haven't discussed and then I've got hours of content on my podcast it's called the Doctor Tina Show and folks can I think there's 10 hours of free podcast content there as well so tons of free content. If they're interested in the program and really diving deep into this to understand what they're doing which I think is the key for folks who aren't going to be able to find the right kind of practitioner. They're going to have to educate themselves. That is you'll find that through the four-part video series. Tina, this has been fantastic and I'm so glad we got a chance to do this in person and I get a chance to meet you in person. Yeah. I so appreciate your enthusiasm for the space and why I'm in particular so happy that we took the time to do today's conversation. I know it won't be our last podcast together is that found I really get that you believe that the true pathway to health and true longevity is being metabolic healthy. Everything else happens after that and so we can't let biohacking hijack the conversation. We can't let the minor things out there hack the conversation and we can't just think that the only solution. This is not what you're saying. You're talking about the personalized thing is a drug intervention. You've never said that but some people are out there advocating. We need the of lifestyle that leads to metabolic health and if there's some tools in the toolbox like peptides that can make that easier for you people, it's no different than why people use testosterone, hormone replacement theory or why some people are on Viagra for for instance. So, I really get that for you and your framework because it's the truth and it's your clinical experience. Metabolic health and being metabolic healthy is foundational to our health and I so appreciate for you advocating for that on today's podcast. Thank you. Thank you for having me on again. This is so fun and I'm glad I got to have this opportunity to explain all of that because I think it's nuanced and I think that we have tools like you said, those sweeten the deal but you gotta lay the health platform and you gotta lay the foundation and that's all work and that's all an individual's input on taking care of themselves. Well said. Tina, thank you so much. Thank you. Hey, YouTube. If you enjoyed what you just saw, keep watching for more great content on how to improve your brain and your life. More information than ever out there and we haven't fixed it yet. Now, for a lot of reasons, we've gone after the wrong targets like just the description of diets alone and the way we put people on a diet where it's this, you know, we're we're lowering calories and we're giving them this ultra processed food that makes them hungry is just mean and it doesn't work. It's ineffective.
DR. BERG
A Lezioni d’italiano
Free People Other | Free People Movement Righteous Runsie Nwot | Color: Tan | Size: Os
Products
Who's Afraid Of Little Old Me Wall And Art Print
Products
Allodynia vs. Hyperalgesia: What’s the Difference?
HSD/EDS
