Dhru Purohit Show - Doctor Shares the Number One Factor that Predicts How Long You’ll Live with Tyna Moore, ND

Episode Date: August 5, 2024

This episode is brought to you by Lifeforce, LMNT, and Lumebox.  Metabolic health is key to true longevity. Without actively focusing on metabolic health, the risk of chronic disease increases. Whether cardiovascular disease, cancer, or type 2 diabetes, improving metabolic health through lifestyle changes can lead to long-term health and meaningful transformation.  Today on the Dhru Purohit Show, Dhru sits down for a second round with Dr. Tyna Moore to discuss the critical importance of metabolic health, whether or not you choose to use a GLP-1. Dr. Tyna explains the science behind why metabolic dysfunction is linked to most chronic diseases and outlines a four-step plan to improve metabolic health. She also covers essential labs to get, how often to test, and what optimal levels look like. Additionally, she provides tips for beginners on implementing resistance training and highlights the importance of community. If you're seeking inspiration to kickstart or optimize your metabolic health, this episode is for you! Dr. Tyna Moore is a board-certified naturopathic and chiropractic physician and the founder and owner of Core Wellness Clinic in Portland, Oregon. She specializes in non-surgical pain management, natural pain solutions, and regenerative injection therapies for orthopedic and musculoskeletal conditions. Moore has a Doctor of Naturopathic Medicine (N.D.) from the Western States Chiropractic College and a Doctor of Chiropractic (D.C.) from the National College of Naturopathic Medicine.  In this episode, Dhru and Dr. Tyna Moore dive into (audio version / Apple Subscriber version): Recap of the facts from round one (00:00:08 / 00:00:08) Starting with metabolic health and disease pathways (2:25 / 2:25) How GLP-1s Are Applied and Their Optimal Use (11:58 / 8:41) 4 Steps to improve metabolic health (21:48 / 17:00) Labs and optimal levels (46:13 / 41:15) How to start resistance training (1:12:48 / 1:07:50) Keeping diet simple for sustainability (1:21:21 / 1:16:23) The importance of community and having a tribe (1:3400 / 1:29:00) Sweat it out (1:35:00 / 1:30:00) Optimizing Metabolic Health: What to Expect and How Long It Takes (1:37:00 / 1:32:00) Community questions: where to find a doctor, micro-dosing, HRT, and individualized approach (1:39:38 / 1:34:40) Also mentioned in this episode: An Honest Conversation About the Pros and Cons of Ozempic For Adults Dr. Tyna's Course Ozempic Uncovered For more on Dr. Moore, follow her on Instagram, YouTube, or her website.  This episode is brought to you by Lifeforce, LMNT, and Lumebox.  Right now, you can save $250 on your first diagnostic and get personalized suggestions. Optimize your longevity and track your progress; go to mylifeforce.com/dhru!  Right now, LMNT is offering my listeners a free sample pack with any purchase. Head over to DrinkLMNT.com/dhru today. Lumebox is offering my community $260 off their FDA-registered portable Red Light device! That's over 50% off! Go to thelumebox.com/dhru and get your Red Light device. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Tina, welcome back to the podcast. You know, we had an incredible first episode together. And 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 GLP1 agonists like Ozempic and Weigovie. 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 will use them in targeted ways for individuals. They could actually be the unlocked 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 pathway 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 pathway. 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 got to 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 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 metabolically 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, 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 in some of it, you know, the fat goes down the right pathways and we have myelination around our nerves. We have the building blocks of our brain and cholesterol and our steroid hormones. So the idea is 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 optimized. And unfortunately, in U.S. adults,

We're looking at, you know, 2018 data showed that 93, 94% of U.S. adults have busted metabolic health. So we're looking at a whole group of individuals in large are metabolically 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 caramelize in the face of extreme sugars. And insulin is being cranked out of the pancreas in an attempt to regulate all this. And insulin is pro-grow, 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 connected to poor metabolic health? Just name a few. Cardiovascular disease is 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 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. 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. Faddy 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 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 type 2 diabetes. and they will say, oh, you have hit the magic number on your labs. You're a type two diabetic now. The damage has been happening for 15, 20 years, and some of that damage is of the microvasculature. 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, if 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 no one says boo about. They're totally normalized, but God forbid, we try an intervention with a GLP1. 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 three 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, oh, Dr. Tina thinks everybody has metabolic dysfunction. And here we are. And everybody quite literally 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. 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 GLP1, 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 OZempe, Weigovie, 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 optimized. 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 individual's on them at whatever dose, I think most folks are being dose 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 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 in 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 they haven't done anything to change their lifestyle, including protecting their muscle, strength training, taking the opportunity. There's this window of neuroplasticity that happens when you're on them as well because of these neuroreactics. 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 counseled 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 back 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 big clincher. Some folks need help getting started. And they just can't. 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 and getting moving is so difficult that we use the GLP1 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 didn't withhold the peptide and say work harder and then I'll 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 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 metabolically healthy or not, what test you run on patients, what tests you recommend people get. But before we do that, just to 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 actually might be more frail 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 a fair critique of how it was being used early on? that people were obsessed about just looking thin, but that you could be thin and weak and potentially not that much better off metabolically, 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 was what helped me finally get over it and being skinny is addictive. So it's really easy. And, you know, in Hollywood,

would. 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've 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'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 looked atrocious and I was skinny fat. My metabolic health was a 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 and 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 absolutely no way to live your life. There's no longevity. And if we've seen anything, if I look back at like the Stevie Nix 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 Ronstad 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. The 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, 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 shit 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 70 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 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, skinny. And 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. We 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 laps. They were a mess. You were metabolically 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 have 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, dextas scans, whatever it is that you look at to help people figure out if they're metabolically healthy or if they're not. All right. 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 an 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 out 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 were going to come back messed up.

Got it. So if somebody is, you know, and it's an inch for the waist circumference. Doesn't matter. Centimeters, anything. Just measure yourself. Take a string and get up against the wall and, 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 do it in feet and inches, then make sure you keep both the same. Yeah. And 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 musculature 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 a quarter. 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 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 and sidious creep. I really do try to keep blood pressure under control. 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 microvascular 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, 120 over 70 is a good round number. I actually have a free guide on my website that has like the literally the international criteria for metabolic dysfunction. So people can go download that and check all this.

Do you know the URL offhand? We can mention it. We can put in the show notes too. Yeah, it's just at Dr.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 asked 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 got to 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, you said, you've got to limit the salt in your diet. Yeah. Right? That's the almost the first.

recommendation and many times the only recommendation 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, it's 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 Lebevere. It's coming from bread rolls. Yeah. And ultra-processed foods, it's the packaged 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. I couldn't imagine living without salt. Like salt and coffee or my two. I mean, I travel with salt everywhere, multiple vials of it. 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, Dr. 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, you 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 waste 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 these 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. I started early. I was like, 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 Dr. Richard Johnson, who's been on this podcast, that we don't want people, you know, having a lot of sodium concentration 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 metabolically 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 is coming from packaged foods, and if you don't get to the root issue, which was what today's conversation is about, metabolic health, you're going to be running in circles. You can go on an extremely restrictive 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. Is that accurate? Yes.

And the kidney issues you just mentioned and the high uric acid are also due to insulin resistance and metabolic dysfunction. So that goes back to that constantly. So as folks age, they will start to see cysts on their kidneys and they're benign sys and sometimes they'll get biopsyed and they'll be like, hmm, we're not sure. 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 shit together. So we were going down the line of things that you look at and things that our audience can look at. If you haven't got 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. Great, if you can get that. You can just do it at home by following the instructions you have. What's next from there?

You were 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% that they have metabolic dysfunction. 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 waist circumference that's starting to expand or has expanded maybe for some time and she's aging. So her vessels are getting flopier. 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 waist 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 Caucasian folks can actually pack on more visceral fat in the midsection and not have such deleterious results on their vascular. So that's a whole thing too.

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 because I was under muscle, 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 growing 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 Twinkie, Sprite, Coca-Cola. the vegetarian I was. I get it. Right. So you get it. Yep, I did that. I call that a mac and cheesotarian. Yeah, exactly. So some people have 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 and 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 got to 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 the way 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 component, 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 gynecumastia in that population, which is like breast enlargement in males. And I'll see more propensity towards subcutaneous adipose tissue. And so 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 generations of being undermuscled. But 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-muscled. 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-muscled. 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 wonder, too, like, are genes getting turned on? Is there an epigenetic component? And I add one more thought to that. Yeah.

So a 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 Gudroth. 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?

But they weren't eating meat then. They were just, they were fit. 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 prevalence 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. is 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 that 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 looked 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 train, if you focus on getting metabolically healthy, if you dial, in your diet, if you dial in your body composition, right, you can change all this stuff around. So nothing puts a limit on you getting fit. 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 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 was describing how the gym, last time she went and had the belt thing that, you know, that's shake you up that you see in that archival footage of what it looked like to be in the gym back in the 60s of 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 does change. I do think based on ethnicity, 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 purebred roots, you might have a harder time with a white man's food. You know what I'm saying? Totally.

I think that you look like the Native American population. Yes. Yes. I think that that is going to have 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 getting a little thick here. And then a few years out of school, he was very fit again. And 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 his 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 folks, I'm a mutt, right? I'm a super mutt. But 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 muts.

And they live a whole lot longer than the pure breads I've had. So I don't know. Does that make sense? There's a lot we don't know. Yeah. There's just some thoughts there. 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 string 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 string training and Dr. Gabriel Align was a big part of that. And I connected with this group here in Los Angeles called Ultimate Performance that is very on you coaching and very on top of it. They make you track all your calories primarily because people generally have never audited their calories. And that's the first time. 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, 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 under-eating 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 under eight 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 160, 170 grams. I was eating often many days like 80 grams of protein. 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 of the gym with the trainer, and tracking my macros, so I get some sense of making sure that I'm eating enough, which was my problem, and that I'm getting enough protein, I saw firsthand 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,

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 strained 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 lab work. We're going to get to lab work in a second, but these are all things that you can take an audit in at home.

Anything you want to add to that? sleep if people aren't sleeping regularly and well and going to bed like a grown-up 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 at their phones all night and then they don't go to bed and then they, you know, stay up on them, whatever. And I'm guilty to my husband bitches at me. He's like, why are you on your phone this late? I'm like, I can't sleep. I know. I know what I'm doing. It's not helping.

But that piece is huge, huge, huge, huge. So if someone says, my sleep is atrocious, I'm not ever, 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 macros. 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 race 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 you're a woman, 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 aberrant 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 aberrantly high fasting glucose in the morning, and it's just because your cortisol's off the charts. And so an example is, you know, 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 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. Blood tests. 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. Aemoglobin A1C is a three-month marker of how sugared up your red blood cells are. So it's a nice marker to have.

And let's go back to the glucose. I want that at or below 90. 90 is the number. If you're at 90, 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 depends. I'm not going to give 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 without cortisol.

You're probably stressed the F out. And you need to reevaluate your life. And you're probably not sleeping well. One morning, a little anecdote is my fasting insulin is usually around like three and a half for somewhere right around there. I think that's considered like good, optimal. Good is anything below five, right? Insulin, yeah.

We'll get to that one second. But I'm bringing it up because one morning I was dealing with like 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 110 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 of 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 is pretty healthy, dowing things in. I've even seen that with A1C, 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 had learned through Chris Cresser a friend of mine that some individuals their blood glue the red blood cells stick around a little bit longer so it can look like they have elevated A1C have you ever seen that before mine runs a little bit high but it's usually in conjunction with how stressed out I am 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 A1C 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 a.m. is kind of stressful. Yeah. You know, for me, that's not like the ideal way. I start my day. So there's that. So that glucose is the snapshot in time is what I tell patients. your A1C is the long-term marker. So a lot of times folks will have a great normal blood glucose, fasting glucose, but their A1C's high. And I'm like, you've been cheating. You know, something is a rye or something's off 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 5.5. I think 5.5 is where I draw the line. And 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'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 it can, 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 shit when they're down there. Like in general. Like I felt like shit 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 sensitive to your estrogen. It's sensitive to your cortisol. So not to say that's an excuse to ride with an elevated insulin, but we got to look further beyond that. We don't just stop there. If that's elevated, 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 a woman who's walking into menopause? Like, what are the other factors? What are some other markers? I like. I loved running a high sensitivity C reactive protein that just gives us, it's a nonspecific 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 sed rate as well because it gives us a little bit different look at inflammation. And so 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. Yeah, everyone should run a C-reactive protein. Sed rates are cheap. Said rates are really cheap, too. 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 got a fire. What does sedent rate stand for? It's sedimentation rate. So it's a marker of your red blood cells. Got it. What else? I don't 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. ESR. ESR is another. a rethrow sedimentation rate. It's cheap. I think it's a very inexpensive ad on. The other thing I'd add is get your labs ran through. I always use lab co-ops in my practice so patients could get labs.

If they tried to run it through their insurance, it was going to be thousands. And if I ran them, it was like $200. 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 tests. 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. That's just me putting on my tinfoil hat, but I've been that way decades before 2020 happened. 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 inflammation, D won't come up. And it's the 25-O-H vitamin D. It just won't come up, but they might have a high 125. So these are extra add-ons, but vitamin D can be quite inexpensive. And right now I have no idea why, but 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 poorer 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 50 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 know we're not getting as much sun. And that's typically how

we've always gotten vitamin D. So if people are not making up for that with some supplementation, they're going to run into problems. Where do 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 50. What's your goal of where you want your patient to be... 50 to 80, 50 to 80, especially walking into winter. Yeah. 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 2020, I was not allowed to talk about that without fear of 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 5,000 I use 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, probably the last two winters. I've been a little lazy about it, but my D still remains in a... How much time do you spend in the sun every day? Oh, I get out in the sun every single day. Yeah. 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'm feeling it at age 50. I'm starting to see the signs. I'm like, I think I need some lasers.

I need somebody to resurface this. But I always say I'd rather die tan than die of all of the vitamin D. deficiency related cancers. 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 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, everybody's not really that healthy, but when they hear about these labs 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 the oldest female ninja warrior. Oh, awesome. She was on this podcast. Amazing.

You would love her. I think everybody calls her, her friends call her Ginny. And she got diagnosed, diagnosed with osteopena by her doctor. 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 a trainer. There's plenty of things you can do. Strengthen your back. That'll help you do pull-ups in the first place. Yeah.

Start off with resistance spans if the weight seemed too heavy. And little by little, she stuck with it. And by the time that she turned like 70, 72, she was competing in her first official competition as the oldest American ninja warrior. That's amazing. I think I've seen her on Instagram. She's been on all these viral wheels. You can do it at any age.

You can do it at any age. She added a ton of muscle mass and she feels amazing. And then she went back in to check because I think osteopenas on the way to osteoporosis. And they said, you must have gotten misdiagnosed because there's no evidence here that you have osteopena 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 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 of your bones. It's literally diabetes of the bones. And osteoarthritis is diabetes of 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 waist 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 one so much. So that's a whole other thing. 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 the start of fatty liver. And what often happens, it's completely been normalized. And your 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's 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 lipids, your cholesterol, your LDL, your HDL, your triglystorides. If your cholesterol and your triglystorides equal each other, you are in trouble. So let's say your cholesterol's creeping up at 220 and your trigs are at 120. 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 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 understood 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 his shirt off and you were like, damn, that guy's in good shape. His trigs were off the chart. His cholesterol

was creeping up and- Like all the chart, you know, like what would that look like? It was in the 200s. 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, he also. had elevated LDL and low HDL, right? That's not good. We don't want high deal. 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 ID, 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? And he was getting a soda every

day. He was going to Carl's Jr. and getting his lunch at Carl's Jr., 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 waist or compass is really so important in anybody 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 trouble brewing. It was soda. He was drinking soda. And so then he switched. to diet because he thought, I 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 looked a little bit better.

And not that I'm a fan of diet by any means. But yeah, so Carl's Jr. 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 100 and you don't want your HDL below 45. We want these in 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, Dr. Mark Twyman, Michael Twyman.

And one of the things that he talked about with me is I don't have familial hyper-cholestronea but I am a hyper-reabsorber of cholesterol. Yeah. So that leads to high LDL and also my APOB traditionally has been high. Is he worried? he looks at it as these things are shots on goal. And if your goalkeeper is really strong, 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 all 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 APOB is arthrogenic. Is that the word? Arthrogenic, yeah. It does, 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 case, you just have to weigh the pros and cons and the risks that are there. So after looking at all the different solutions, I said, oh, wow, I wouldn't actually, I got these genetic tests 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 azetamide. 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've got to make the decision because you're the patient. But here's the pros and cons. They are shots on goal. And your endothelium is 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 best scan that he 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 Zetamide. And let's see, I may decide differently, but I'll tell you,

it definitely lowered my Apo B where I previously was at like 160. I've gotten down to, you know, like 90, around 90-ish, 80 around there. So again, all pros and cons that you're just trying to weigh off in your journey of, you know, trying to decide how to make yourself healthy. Yeah, 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 lab markers are saying in conjunction and then I'm more interested in how that individual's living their life. So 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 A1C, a C reactive protein, and, you know, a couple other markers. And he said, you know, you guys consider this normal. And this patient's 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.

It's 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, it's easy to neglect it. 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 that, is there anything else that you want to say on the lab conversation? No, because all that's really inexpensive and really easy to get a hold of. 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? You know, you don't necessarily

need the said rate, but it's nice to have in conjunction 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 us 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. 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 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 shit out of people. It's just too much. And sometimes that's the goal of these companies. Yeah, because they got something to sell 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 tests 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 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? 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 luckily, I have the support of my sisters who are actually probably leading a lot of the efforts in my brother-in-law, Dr. Neil Patel, just even getting your parents to do some strain 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. buy the sauna and put it in their basement. That's what I did.

I was like, here's the sauna, going it every day. So now we've covered the basics. Okay. People know how to know if you're metabolically 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, shit. Okay. I am in the 85, 90% of people that are metabolically unhealthy.

You've already talked about some of those things that are there. resistance training, right? Non-negotiable. Non-negotiable. Is there any tips 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 50s, 60s, 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. Dr. 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. Strength 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 competent at 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've got to 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 get this, right? We have to work to tolerance and we have to build upon a foundation. 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 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. 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 Barry's 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 it 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 work up 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 cases, 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 have made a lot more money just shooting them up, but that's not the right thing to do. Oh, that's 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, you don't have to 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 sport.

And just like there are sports where people get into all the statistics and this team versus another and they get so emotional about stuff. And it's also, it's a sport. Right. In that same way, we got to 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. live my life like he does 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 can 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 two 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 orthorexia 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 much. 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 mammogram. 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 medicine 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 no one 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, poke in 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's risk 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,

lot of individuals, many of your friends, contemporaries who have been on this podcast too, have been talking about it. 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, none of the other shit matters. Yes. Amen. And the same thing goes with even our last conversation, which is the topic of OZempic and GLP-1s, 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 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 if resistance training and first understanding your labs and where there are, if 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 macros. 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 under eating 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, a pound, you know, a 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 mover. 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 they're dealing 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

dentition 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 dentition 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 respectful of that and try to work with it. I didn't even tell my grandmother that I started eating meat. She would have been, you know, if you care about your grandparents' health, that'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, 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 issue. 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 foods. Of course. Of course. Yeah. And like, you know, convenient stuff that's out there. It's just like trying to feed two or three boys, you know, and a husband. And 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 to 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 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 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. What's the answer if somebody's in that situation or somebody they love is in that situation? Protein powder. Or even is it a bigger answer? Like, you know, I know, I know this is like such a complex issue, but is it the answer? Is it community? Yeah, it is. Right? 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 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's snacky foods are easier, I'm a snacky food girl. I grew up like latchy kid eating whatever. I was like ultra carb addicted, ultra-addicted to ultra-refine 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 patience. 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 stop doing that.

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 as 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 making 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 your 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 gobble 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 it's controversial, but I love the vegetables that are actually fruits. So zucchini, squashes, things like that, those are actually fruits because they have... 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 its oak.

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 50 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. When that was a whole trend, that was out there. But you had great digestive juices.

then. Yeah. And that same salad now, it's like 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. And 50's not old. 60's not old. If we like take care of our body, our body is so resilient. But even for me to see like, wow, I'm not digesting as well as I did before. That's interesting to notice. So I definitely have seen that.

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 really do. I think that as folks age, their L cells, the parts of their gut that contain the L cells that are supposed to be secreting the GLP1, are probably going through an atrophy, and they may not have such a vigorous GLP1 production.

And it's really easy to say, oh, just eat less and move more and take these herbs and your L cells will produce, you know, these probiotics and we'll crank it up and will promote GLP1 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 is 24 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. took care of, including these little old 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 can 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, 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 old ladies, but those little old ladies were very active. I was not taking care of sick people.

Got it. These were not complicated, complex cases. So even in that group, what I'm telling you is happening. So, 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 see 65 year old women trying to follow the advice of

a 25 year old strengthening coach online. and I'm like, may have a mismatch, a 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 your strength training, don't worry about the carbs. Don't overdo it.

Don't overdo the added sugar, etc. But don't be fearful of carbs. In fact, going low carbs, 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 those things. So don't for your 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 crap 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've really

got to 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 talked about exercise. We talked about diet. You 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. Anything you want to say about that? Well, you are who you spend time with. Quite literally, our microbiomes are contagious. So we are who we spend time around. So pick your friends carefully and find your tribe, though. That doesn't mean 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. 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 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 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. But you got to 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. Any other big components that are there? Sleep. Sana, I'll throw sauna in. Just getting hot. You know. 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. 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 my jam. Yeah, some temperature variation, some positive stress that we're bringing to the body to add some resilience. Yes. And I am not keen on protocols. Just get hot. Get as hot as you can. Two tolerance. Water is a beautiful, beautiful tool and treatment. In naturopathic medicine, we call it hydrotherapy. It is to 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 stoker. 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 on. 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. The 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 metabolically healthy. They hear about these main components. they take it seriously and it's not their 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 in on their diet, then strength training, then 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 metabolically 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 metabolically 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 all those markers I mentioned really start to improve. So I have heard from so many people like, well, 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 way 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-1s. 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-muscled and doing all the things, you will start moving towards metabolic dysfunction, period. 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 in 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 re-bring 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 hard. I know. I'm getting this question, too, from everybody. It's really hard because doctors aren't seeing this. And I have asked every single person who comes to me who says,

I'm microdosing GLP-1s and then this is happening or this, and I'm like, what's your dose? And they tell me, and they're not microdosing JLP 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 microdose and they say, oh yeah, we microdose. And they're giving the standard low dose, 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? Well, with some aptly times. With somalactlytide, it's 0.25, and with Trezepotide, it's 2.5 milligrams. These are milligrams. So I just know all that to say is I don't think that the doctors get what I'm trying to lay down here. Yeah. There's not enough education across the board.

Yeah. Because if they're doing 2.5 or 1.5, you're really talking about a microdosis one. It depends. It totally depends on the person. A fraction of that. Yeah. Like 50%, 10%. Depends.

It literally depends on the. person in front of me. I cannot answer that. I mean, 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 adept 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 of 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-1s. 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 course. And they heard my, you know, the way that I'm 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're getting it. 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. Ideally. And if you, that's going to be. Actually, that's probably one of the best recommendations you could have. Yeah. Yeah. Who has long term use of peptides? Yes, period. Has been using them. Yes.

They're more likely going to have the mindset that's needed for if you choose, like I have zero interest or need for doing any kind of microdosing with gLP ones. 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 years. I don't think it matters, honestly, because I was a really excited. Like, as a young doctor, I was really enthusiastic and I listened to my patient. 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 70s.

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 had here is that if they're, if somebody's interested in microdosing, 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 microdosing. Is that accurate? Like the question that we had here is that should I be worried if they're not using a compounding pharmacy? Some folks need of microdose 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 metabolically busted. Microdosing, I will say this again and again, is microdosing,

for it to work, it's reserved for those who are metabolically optimized. So folks coming in saying, well, Mike, I get messages. I listen to your podcasts and I try to microdose and it didn't work. And I find out they've got 60 pounds to lose. Those are not microdosing candidates. Got it. Got it. Any other caveats there of who is and isn't a candidate that you want to 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 neat. I got to 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're messaging me. I'm microdosing 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 microdosing 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 them metabolically 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're you, because you're going to be, because you're going to be able to, because you. you mentioned 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 hormone intervention yet. Should they first start with somebody on that and then consider this? Or should this both be tackled at the same time? Potentially the gLP and the hormones too. I'll get it. 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 apply adrenal thyroid, even progesterone quite safely to most individuals, even if they're really metabolically 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 metabolically 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 ones in all cases are a beautiful place to start, but they work much better. We even have a very small study, but 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 bi-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 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 of those things. Sure. So, Dr. 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, you know, dives deep into a lot of the conversation that they need to hear and know about to blow some of the mists out of the water, learn about some of the other benefits that we haven't discussed. And then I've got hours content on my podcast. It's called The Dr. 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. 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. I also appreciate your enthusiasm for the special. 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 foundationally, I really get that you believe that the true pathway to health and true longevity is being metabolically 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 foundation 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 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 metabolically 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 got to lay the health platform and you got to 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 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.