I am delighted to have Dr. Bindiya Gandhi joining me today! Dr. Bindiya is a Double Board Certified Family Physician & Integrative Medicine Practitioner with expertise in Functional & Holistic Medicine. She is also a Certified Yoga Instructor & Reiki Master and trained in obesity management. Dr. Bindiya is passionate about intertwining western medicine & yoga to heal the mind, body, and soul. Her mission is to educate, empower, and inspire people to live healthier lifestyles!
Dr. Bindiya struggled with various health issues while doing her residency. She had acne, menstrual irregularities, and unexpectedly started gaining weight. She also suffered from migraines, developed a rash on her face that would not go away, and discovered that she had celiac disease. Later, when trying to fall pregnant, she realized that there was more to fertility than what she had learned in medical school. Now, she helps women with weight-loss resistance and fertility issues by addressing leptin.
Leptin is the key satiety hormone. In this episode, Dr. Bindiya and I dive into why leptin is vital from a metabolic health perspective. We talk about what leads to leptin resistance and the impact of leptin on the body. We get into detoxification and how a dysregulated gut microbiome can influence food choices. We discuss inflammatory markers, the importance of protein, and why stress reduction is vital. We share tips for working towards better anti-inflammatory choices and some simple ways to tap into the parasympathetic nervous system. We also explain why you need to avoid too much fruit and over-fasting, and we clear up some common mid-life misconceptions.
As we record this podcast, Dr. Bindiya is two weeks away from the delivery date of her third baby! I hope you gain a lot from today’s illuminating conversation with her! Stay tuned for more!
IN THIS EPISODE YOU WILL LEARN
How Dr. Bindiya became interested in and passionate about helping her patients understand metabolic flexibility and leptin resistance.
What is leptin, and why is it important from a metabolic health perspective?
How does yo-yo dieting mess up the metabolism?
You need just the right amount of leptin in your body. Dr. Bindiya talks about the impacts of leptin.
What happens when your leptin levels are low?
Some of the more common tests Dr. Bindiya uses to help support her patients.
Weight loss resistance can sometimes indicate that your body is storing toxins from the environment, food, or personal care products. Dr. Bindiya talks about the importance of detoxification.
If you think you might be leptin resistant, you can do the quiz on Dr. Bindiya’s website.
How can your gut microbiome influence many of your food choices?
Why do you need to pay attention to your inflammatory markers?
You can reduce stress to address leptin resistance.
Some of my favorite simple and free ways to tap into the parasympathetic nervous system.
Some tips for working towards better anti-inflammatory choices.
Why getting enough protein is vital.
Some common mid-life misconceptions.
“In our society, the common yo-yo dieting has messed up our metabolism.”
-Dr. Bindiya Gandhi
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Bindiya Gandhi
On her website
Take Dr. Bindiya’s quiz
Transcript:
Cynthia: Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
Today, I was joined by Dr. Bindiya Gandhi. She's a double board-certified integrative and functional medicine doctor, who has helped thousands of women transform their overall health and improve weight loss resistance. In particular, I wanted to interview her for the podcast because of her strong interest in leptin. We dove deep into what is leptin, and why it's important, how does it work, how does it involve with bone mass regulation, immune function, balancing heart rate and blood pressure, regulating thyroid hormone, or menstrual cycles, brain protection, and the mitochondrial rich beiging of fats. We've talked about testing, symptoms of leptin resistance, the role of weight loss resistance and toxic load, how to address leptin resistance, specifically, stress management, intermittent fasting, and nutritionally, we really overemphasize the need to avoid and limit fructose in particular, the role of detoxification, balancing the parasympathetic nervous system, as well as our adrenals, and focusing in on midlife misconceptions. I hope you will enjoy this conversation as much as I did. I've gotten so many questions about leptin. I hope this will help answer a lot of the concerns that you have. Good morning, how are you?
Bindiya: Good. How are you today?
Cynthia: Good. Well, listeners don't know this about you probably, but you are within two weeks of your delivery date with your third baby. So, I'm really excited that we were able to carve out time in both our schedules to connect, and talk about a very important hormone which is leptin.
Bindiya: Well, thank you so much for having me today.
Cynthia: Yeah. Talk to us about obviously, you've got training in obesity management. So, what got you so interested and passionate about helping patients understand metabolic flexibility, leptin resistance, and how all these things have allowed you to grow a really thriving practice in the Atlanta area?
Bindiya: Honestly, Cynthia, I'll tell you. It essentially fell into my lap. I struggled with my own medical issues. In residency, I thought it was really healthy. In medical school, I was at an ideal weight. I ran all the time, I ate whatever. Literally, I'm not going to lie. I was one of those girls, I could eat whatever I wanted, but I would run it off and it would be fine. When you get to residency and things start changing. You're under a lot more stress. I ended up having a lot of menstrual irregularities, acne, hormones started going awry, and I was like, "What is going on?" And I was still eating the same. I was, by the way, eating healthy. Even though, I can eat what I wanted, it was still on the healthier side. Ended up realizing that now I'm gaining weight and I was like, "What is going on here?" I started having some early thyroid issues and it started freaking me out. I was like, "Something's not right." I remember going to tons of doctors at my residency program and no one was able to help me. They were just giving me prescriptions. It was like an antifungal, anti-steroid, antiviral, antibiotic, you name it, because I was having this rash on my face that really was the thing that caught my attention. It was like there is rash on my face that would not go away. Despite the fact that I had acne and the fact that I had some menstrual irregularities and some migraines, it was the rash on my face that caught my attention that was like, "Okay, we've got to fix these things."
I kept asking questions, and they kept medicating me, and I kept spending more and more money on prescriptions, and nothing worked. I spent money on biopsies and procedures and nothing, no answers. It wasn't until I was seen by an allergist, immunologist, and I begged myself, I begged to be seen by them, and they basically told me it was in my head. They were like didn't want to do any testing, did not want to do-- I kept thinking, "Am I deficient in something? Is this a deficiency in something?" They're like, "No, you're just a stressed-out resident. You're fine." I just remember being that was the turning point where I was like, "Whoa, something is not right." I can't believe that. I've been in residency, for at this point, it was probably two years. Two years and my hormones in life have changed so drastically. I feel crap, like something's not right. I ended up, by the grace of God was able to find a really good functional medicine doctor, integrative doctor, worked with her. I was able to identify that I had celiac, was able to identify that I had all these food sensitivities, some gut dysbiosis.
And honestly, when I cut out the gluten, lost the weight, kept the weight off, my thyroid issue that I had completely has been 100% normal since then, which is really, really good, because both my parents have Hashimoto's. It's definitely something that I was able to catch really early and have been able to manage over these years naturally, and the weight has definitely stayed off, and so, then when I built my practice, I started helping a lot of women with fertility, probably around the same time that I was trying to get pregnant. I was having difficulty getting pregnant and realized there's a lot more to fertility than just [chuckles] what we think, what we're taught in medical school. So many other things that I learned about stress, thyroid, how the other hormones impact. And then I started learning more about leptin and I was like, "Whoa, we've got to talk about leptin here." I started learning more about how leptin impacts your thyroid, your adrenal hormones, and fertility. That's where I am here today. Now, I'm helping all these women, predominantly women, who are have a little bit of weight loss resistance mainly because no one talks about leptin and no one's addressing it.
Cynthia: Well, it's always amazing to me when clinicians go on their own healthcare journey and for you not being satisfied with conventional approaches to the symptoms you were experiencing. And for listeners, once you have one autoimmune issue, so, Bindiya has celiac. It makes you more susceptible to other autoimmune issues-
Bindiya: Yes.
Cynthia: -and that really opens up Pandora's box literally making you understand that it's this complex and a relationship between stress, and the immune system, and gut health. And so, let's really start the conversation. I think most listeners have heard of leptin. But what exactly is it and why is it so important? I want everyone to be thinking from a metabolic health perspective because leptin resistance as one example goes hand in hand, oftentimes with insulin resistance. We're going to make sure all these concepts are really clear. But let's unpack leptin, because I think on a lot of levels it's a poorly understood and appreciated hormone, but actually a really important one.
Bindiya: Oh, yeah, I agree. Leptin is actually known as your satiety hormone. That's what most people know it as. But it's really important, because it's actually produced by your fat cells and it communicates with your brain, which is really why it's so important. Because it lets your body know if you're full, if you need to eat, do you need to burn more calories at a faster rate, at a slower rate? It's essentially regulating your metabolism and it also lets you know, "Hey, you need to eat more or maybe you need to stop eating," essentially controlling your appetite. What ends up happening is, for many reasons, predominantly in our society that common yo-yo dieting has really messed up our metabolism. You're probably aware of this, your listeners are probably aware of this.
Most females actually start dieting when they're in their teens. This is why eating disorders happens so early on. It starts in our teens, we get to college, then we're maybe gaining more weight that freshman 15. Our metabolism is constantly changing. Then we're like, "Oh, my God, I'm going to get married. I need to lose all that weight again." It's this constant fluctuation of weight gain and because of that, that really over time slowly messes up our metabolism. Our metabolism hasn't really stayed stable throughout our whole life, then we're pregnant and then we're postpartum. All these different life things start happening, and slowly, slowly, we start noticing that leptin, this one hormone that we could get away with eating certain things when we were younger really is impacting how we're able to enjoy food and really metabolize our body as we get older. It really starts slowing down and we start developing something called leptin resistance. Mainly it's because of this miscommunication between our brain and our fat cells that we over time cost to ourself.
Cynthia: I think for listeners to better understand and appreciate leptin, we think of it as this key satiety hormone. And obviously, the more adipose tissue or fat tissue we have on our body, the greater the likelihood we're going to have increasing amounts of leptin resistance. It was interesting, when I was prepping for our discussion today, one of the statistics I read was really interesting. With low leptin, you have a fivefold increased risk of anxiety and depression.
Bindiya: Yeah.
Cynthia: We think about it just being an appetite regulator, but yet, there are a lot of other things that leptin does that. I like to think of it like a buffet. There's just about every organ in the body has a complex interrelationship with leptin. What are some of the other things that leptin can impact that people may not be as aware of?
Bindiya: Yeah, oh, my God, I'm so glad you brought this up. We definitely don't want leptin to be high, but we certainly don't want leptin to be low. When leptin is on the other end of the spectrum, you mentioned it, anxiety is huge, sleep disturbance is another one. The other thing that it really does impact for a lot of females, especially in their fertility years is fertility. If your leptin levels are too low, we start noticing that it impacts your ability to get pregnant. Your body essentially sometimes thinks that you're in starvation mode and so it's going to hold on to any weight. It's going to slow down your metabolism. It's trying to protect you and if it is trying to protect ladies are not going to get pregnant, because your body doesn't think you're in a very safe place to carry a child. There're so many different things that really go on when it comes to leptin. We definitely don't want it to be high, but we definitely don't want it to be low. Again, it's one of my Goldilocks hormones. It's got to be just right.
Cynthia: And I'm sure it's probably unique to every individual. I know when we're talking about intermittent fasting as a strategy, I remind women that your menstrual cycle is a barometer for whether or not that strategy is working for you. And so, much to your point about this Goldilocks effect that you want to have just the right amount of leptin for your body. What I was surprised by when I was working on our prep for today was it's involved in bone mass regulation, it's involved in immune function, it supports our blood pressure and our heart rate, which I had no idea about. Even though back in the day when I was in cardiology, we thought about a lot of other hormones.
Bindiya: [laughs]
Cynthia: We didn't think a lot about leptin impacting vital signs, but I thought that was really fascinating.
Bindiya: Yeah. I'm so glad you're bringing this up, because for example, when your leptin levels get really low, it starts increasing your risk of osteoporosis, osteopenia. The link there goes back to estrogen. There's estrogen-leptin connection. When your estrogen levels drop, what happens commonly during perimenopausal, postmenopausal years, what ends up happening, you're more likely to end up being osteopenic or having brittle bones as I like to mention it. There is definitely a connection with so many different things with your leptin level is just not talked about and mainly because conventional medicine doesn't really do much about it. That's part of the problem.
I talk about leptin all day all the time. But if someone listening to this is like, "I want my leptin levels checked. How do I get this checked? Where do I stand?" You can go to your primary care doctor, you can go to your OB-GYN, you can go to your endocrinologist. And chances are, they're probably not going to check this hormone because they're not taught about this hormone, they're not educated about this hormone, and it's not something that I learned in medical school, unfortunately. It was something that I learned even after residency when I did my functional medicine in depth training. So, it's not that conventional medicine, essentially, unfortunately, they don't know what to do about it. They're like, "Okay, so, we're not going to check this because if you get a number and I don't know how to interpret it, it's a liability. So, let's not check it at all." That's what it comes down to.
Cynthia: No, and it's interesting, because I've had some mold exposure. One of the hormones that they do test regularly on me is leptin. What's interesting is, leptin is correlated with your body max mass index. When you get your leptin score, usually you get, here's your BMI and this is where your levels should fall between. I found it really interesting, when I looked at that into the interrelationship of looking at mycotoxins and how my body has responded to that. My functional medicine provider was saying, "Yeah, this is definitely not a hormone that most allopathic trained providers are drawing." And then there's also the confusion and you're right. If anyone who's listening and says, "I've had that experience. I go to my healthcare provider. They don't want to draw certain labs." Even if it's something benign like a fasting insulin it's because we are also then responsible for those results, even if we don't know how to interpret it. So, you can understand why there's a little bit of friction-
Bindiya: [crosstalk], yep.
Cynthia: -that goes on. But when women come to you with weight loss resistance, I assume this is one of many tasks that you like to look at to determine what's going on. When you're looking and someone who comes to you and says, "I've really been struggling with weight loss resistance." Maybe they have Hashimoto's, maybe they're in perimenopause or menopause. What are some of the common tasks that you will do to help support your patients in a broad approach? Because obviously, in the context of working with someone directly, you're going to have personalized recommendations. But what are some of the more common tests you will look at? That was a question that came up frequently, when individuals knew that we were connecting today.
Bindiya: Yeah, so, you guys, I am a big data girl like that.
Cynthia: [chuckles]
Bindiya: Again, I'm really nerdy. The more tests, I'm able to get the better, because I like to look at the whole pictures. I don't like to just look at one number. That's why a lot of times when people come to me from their endocrinologists or their primary care doctors or their GYN, whoever it is, I'm like, "Give me all that information. I'm going to look at it, I'm going to have a baseline, and then I'm going to order some more tests," because the more information I have, the better. I'm going to start off with basic things like a complete thyroid panel, which has your TSH, your T3, your T4, your free T3, your total T3. I love checking antibodies because predominantly a lot of women have never had antibodies ever checked, right? I know, we're not talking about thyroid health in general but sometimes, they'll have a positive antibody and have normal thyroid levels and thyroid functions. It's nice to get the whole picture. So, that's why I do that.
I check adrenal hormones, I'm checking fasting insulin, I'm checking hemoglobin A1c different, because they're checking different things. I'm checking glucose levels, your complete metabolic panel. I'm always checking a basic ANA with reflex just to see, could you potentially have an autoimmune condition that you're unaware of? Another thing, I commonly see all the time, a lot of times women feel like crap and they've been told everything is normal but they haven't even had a basic ANA checked. When that ANA comes back and it's positive for something like scleroderma or rheumatoid arthritis, they're shocked, but I'm like, "No, I'm not, because I'm hearing it from you in history." There's just some of the things. And then I get into female hormones in depth. I'm checking pregnenolone, progesterone, testosterone, sex binding globulins, estrogen, and of course, leptin. [laughs] I'm just checking all these things and it's literally the whole picture of what is going on because all these hormones are connected and they all tell me a story of who you are, what you've been through, what you're about to go through, and where you are in your life.
Cynthia: I think that's super helpful because I am fully transparent that when I worked in cardiology as an NP, we were only dealing with either emergencies or we'd send someone back to their primary because we don't manage thyroid unless you're dying. Sometimes, there are reasons to be hospitalized for extreme thyroid problems. But other than that, cardiology, we're like, we would check a TSH, we would check a free T4 and then we were like, "You're fine." And I've come to realize that that only gives part of the picture. If you suspect you have a thyroid problem, you suspect, or you have confirmed Hashimoto's, or you maybe have had Graves, you really do need a full thyroid panel. That's one thing. I, sometimes, have to literally just spell it out like, "These are the labs you need to do. Ask your healthcare provider to do them for you," so that we can really get a comprehensive sense of what's going on.
Now, something that I think is interesting when you're working with women that are weight loss resistant and obviously weight loss resistance is a huge issue for middle-aged women. We get very maligned. They're oftentimes blown off by their healthcare professionals. I was actually told in the beginning of perimenopause that, "Cynthia, don't you just accept the fact that you have this extra five to 10 pounds on."
Bindiya: No, can you believe that? That's so rude. [laughs]
Cynthia: And it made me mad, it made me really angry. But one thing that's important for people to understand is that sometimes, weight loss resistance can be a neurotoxic clue that your body could actually packaging up toxins you're exposed to in your environment, your personal care products, your food, and it's doing to protect you as annoying as it is to deal with weight loss resistance. Are you seeing this? I'm sure you probably aren't alone with-
Bindiya: Oh, yeah.
Cynthia: -female patients. Can we talk a little bit about that? I can talk about it, but it's always more helpful to have another person talk about it, speak to this issue because we're bombarded by a very toxic environment, seemingly benign things that will categorically. I feel middle age is a special point where maybe your bucket's been filling, filling, filling all these years, and maybe it's perimenopause that tips the bucket over and then all of a sudden, they become problematic.
Bindiya: No, I think that's really wise that we're bringing this up because people are not aware of. Let's just go back to thyroid a little bit. When we go back to our thyroid, even though our thyroid gland is here by our neck, it's actually metabolized in our liver. Most of our hormones including estrogen and leptin are metabolized in our liver. That's where we need to start paying attention to our toxic load. A lot of times, even, for example, triglycerides, this is the fat that's accumulated in the liver. This is usually predominantly associated with insulin resistance, or prediabetes, or that kind of thing. Everything really is going on in the liver. We don't see the liver, we don't feel the liver, we feel fine. We don't really know what's going on. It's hard to justify what's going on in the liver. Even when I get basic, I've been doing this for a little bit while. I can start telling trends by looking at your basic liver enzymes, if your liver is starting to act up and start working a little bit harder. But again, the average physician who's doing your CMP, which is your complete metabolic profile that has your AST, ALT, and your alkaline phosphatase on there, they're looking at it, and they're like, "Oh, it's not in the red, it's fine." I'm looking in the nitty-gritty, I'm looking at the numbers, and I'm like, "Ooh, you're in the 20s, why are you in the 20s? What's going on there?" I'm being extra vigilant.
When it comes to detoxification, I'm not going to get technical. But there's Phase 1, there's Phase 2 of detoxification and it really is important. All our hormones are literally metabolized essentially in the liver. If we don't pay attention to our personal care products, the foods that we're eating, whether we're eating organic or not, all the pesticides that were exposed to, all the chemicals that we're inhaling, and these things are over a cumulative period of time. It's not just something that happened yesterday for many of us. It's things that have happened that we've been exposed through for many, many years. These things really do slow down our liver, they congest our liver, and this is one of the reasons why I actually tell people, one of the foods that we need to start minimizing or restricting, especially if we think you've got leptin resistance, or we believe that your leptin level is off is fruit. Because the body can't tell the difference between fruit sugars and fructose which is chemically made. Because of that it goes straight to the liver, it congests the liver, it starts slowing things down, and when we start eliminating these toxins, which fructose technically ends up being a toxin, we start seeing direct correlation and improvement in your leptin numbers. There're so many different things that impact the liver, but specifically, we know that there are studies showing that fructose or fruit sugars really does impact that.
Cynthia: Well, I think it's very relevant because this weekend, I'm not sure if you're familiar with Dr. Rick Johnson, but I just interviewed him, he has a new book, and he's the fructose doctor and researcher, and we really dove into why fructose can be so incredibly toxic to our health. I think people think of fructose as being a little benign. One of the big takeaways from my conversation with him which I keep parroting to my teenagers, who don't have soda at home, but when we go out, I have to cringe, you don't want to drink your sugar.
Bindiya: Yeah.
Cynthia: And certainly, not liquid fructose. It's terrible. I think you're better off having if you're going to choose to have a low glycemic piece of fruit versus a soda to recognize that that liquid sugar is so toxic to your body. Not naturally occurring and there's no buffer to its absorption, whereas with a piece of, if you decide to have a tart apple, let me say tart, not sweet, not the honey crisp, a tart apple, and you have a little bit of fiber that will slow the absorption of that fructose, that's very different than having you know the Frappuccino of the day at Starbucks that has 50 grams of sugar, which is awful for you in terms of health and wellness.
Now, when we're talking about leptin resistance, so, let's focus a little bit on this because this is, again, an area that I think is not well understood in terms of the conventional life public. You can have insulin resistance, and you very likely also are leptin resistant, which means that they're, what I always refer to as you have a starved brain with an obese body. These are the people that you might go into a store or a restaurant, and they have a massive amount of food in front of them, and they might be morbidly obese, but a lot of that is because there's this dysregulation of communication in the body. Hormones are chemical mediators, they are chemical communicators in the body, and if they're not properly balanced and regulated, your appetite cues are not going to be-- For me, if I sit down eating a steak, I'm full. I can step away from the table, but if someone has leptin resistance, they're probably not going to crave the steak. They're probably going to crave carbohydrates, they're probably going to crave hyperpalatable foods that are going to actually potentiate this dysregulation.
Bindiya: Yeah, actually, I'm going to rewind a little bit because I think there's something that I really want to bring up too because going back to leptin, many people who are listening are like, "First of all, how do I know if I'm leptin resistance? Could I potentially have an issue going on?" One of the first things I'm going to have you guys do is go to my website drbindiyamd.com/quiz and it's an 11-question quiz to understand what your symptoms are. Because I go through 11 questions to identify, "Could you potentially be leptin resistant, leptin sensitive, or leptin clear?" It'll give you a number. And then based on that, we can identify which category you're in. Now, traditionally, what I like to do is, I like to test it in a perfect world. If you're able to see me or if you're able to go to a practitioner that's able to test it and then identify what that number is. Now, I love that number between seven and 10. When that number is below three and four for females, that is not good. When it's above 11, 12, then it's also problematic.
One of the things you mentioned earlier when we talk about leptin, usually it's correlated with your body mass index. But that's not always a fair correlation because we have people that body mass index traditionally is based on your height and your weight. It's a calculation that gets spit out. But if you have more muscle mass on you or even water weight, it's not accurate. There's a lot of nuances with when that number is reported as well. Now, when we're talking about insulin resistance, insulin resistance is usually based on your hemoglobin A1c. Hemoglobin A1c usually between 5.7 and 6.4 is when you're considered insulin resistance. When you're 6.5 and above, you're actually in that diabetes zone, which is something that we're trying to avoid. I have seen in practice where you can still be leptin resistance without being insulin resistant. I've also seen the opposite where you can be insulin resistant as well as being leptin resistance. There's definitely a direct correlation with your appetite, with your metabolic function for sure. But for some people, sometimes, there is no correlation. So, that's the first thing that I want to say.
The other thing that I want to mention too is, there is a very strong correlation between your sugar-carb cravings and that's why when you do my 11-question quiz, that's one of the questions is, "Are you gravitating towards sugar, carbs, and sweets?" Here's the thing. A lot of times people think of like, "Oh, well, I don't eat desserts. I don't think I'm craving carbs or I don't think so." But what about the other foods that you're eating? What about the fruit, okay? Fruit is considered sugar, essentially. What about all the rice, the beans, the pasta? There're so many other foods that are carbier. You may not be eating key lime pie every day, you may not be eating chocolate or desserts every day, but you're still gravitating towards carbs and you're eating more of that than protein. There is a correlation there with your appetite and that's where the whole thing with leptin is really important, because leptin does essentially control your appetite, leptin lets us know we need to be eating more or eating less. So, that's where the insulin resistance. If you're more likely to be insulin resistant, you're more likely to also be leptin resistant based on the foods that you're eating.
Cynthia: It's really interesting because we're not saying that carbohydrates are bad. We're saying that our cravings can oftentimes be an indication that we may have some degree of hormonal dysregulation. It's interesting, it could be as simple as I know that you probably do gut microbiome testing, I use the GI map. And if I really think someone has Candida, there are other types of tests I can do beyond that. But it's always very interesting and quite humbling when you yourself find out. I've done a lot of travel, especially even during the pandemic, we've done quite a bit of travel. I picked up a parasite or two.
Bindiya: Oh, no. [chuckles]
Cynthia: And also, picked up some Candida. What's interesting is, I actually said to my integrative medicine doc, I was like, "I don't have those kinds of cravings." And she said, "Not everyone with Candida as an example, necessarily is craving carbs like it's their job and it might be for you, it might be maybe you're craving a little more root vegetable." But whatever's going on with the gut microbiome can also govern a lot of the food choices we're making.
Bindiya: Yeah.
Cynthia: This is the gut microbiome especially if it's dysbiotic or unhealthy bacteria, I will say, weeds in the garden, it may cause us or it'll create a hospitable environment that it's going to crave a certain type of fuel source and that could very well be the carbohydrates. But I just wanted to tie that in to say that you can have disruptions in the gut microbiome that can drive a lot of those food choices as well. And I would imagine there's lots of patients that have leptin, insulin resistance, and have significant gut microbiome imbalances.
Bindiya: Yeah. There're a lot of things that we're looking at or a lot of things that we're paying attention to when it comes to treating leptin. Gut microbiome is definitely one, detoxification is another one, inflammation is the other one. Most people, again, are walking around with elevated CRPs, homocysteine, ferritin, and even what we call something sed rate and they're unaware of it. Sometimes, people are aware because they feel crappy and they're like, "I feel awful." But again, the traditional conventional doctor is not checking some of these levels. But markers of inflammation also tell us what is going on with the body, what is going on with your gut microbiome, how you're actually feeling? Because sometimes that's a precursor to-- See, you probably do have an autoimmune issue that you're unaware of and that's what's causing the inflammation. Sometimes, it's your gut microbiome is causing the inflammation like Candida and sometimes it could be inflammation because you've got an underlying cardiac event that's about to happen or metabolic issues that are going on. There're so many reasons for inflammation but this is something that I also particularly check in with labs as well because inflammatory markers tell me a whole story and it's really important to pay attention to those.
Cynthia: Absolutely. I'm so glad that you brought that up that inflammation equals oxidative stress equals a mitochondrial dysfunction. Most people north of 40 have some degree of mitochondrial dysfunction. If you have a chronic disease, you definitely have mitochondrial dysfunction. To back up a little bit, the mitochondria are the powerhouses of our cells and we're really speaking down to each individual cell, if it's not properly generating the right amount of energy through the right pathway without getting super overcomplicated. If those cells are not generating the right amount of energy at the right time, it can also can contribute to some of the symptoms that you very likely are seeing fatigue, lacking energy, making you more susceptible to certain chronic diseases. So, how do we actually address leptin resistance? What are some of the first things, broad concepts that you work on? You've mentioned already detoxification, reduction of inflammation, the gut microbiome. What are some of the other strategies that you use within your practice to help with this?
Bindiya: One of the big things that I end up doing because again, I clinically see this is, I really help with stress management. Stress management really is a big deal. Now, we'll talk about this, because you're the intermittent fasting guru. Even with intermittent fasting, we have hormetic stressors. That is still some stress on the body. And so, when we're constantly in a state of stress, because maybe we're going through a divorce or maybe because our mom is really sick in the hospital, whatever life stressors are throwing, or you're transitioning between jobs, or wherever you are in your life, understand that that is a big stress. That's not only going to impact your metabolism in general, but that's also going to start impacting your thyroid function. This is why we need to really address the thyroid function from a different perspective. When you start doing things that you think you're really healthy and things that you did when in your 20s, where you could run six miles a day, seven days a week, when you're doing that at 42, your body cannot handle it like it did. You're adding more stress to your body.
This is why one of the big things that I work on with my patients and my clients is stress reduction from different angles. Whether it's incorporating yoga and meditation. Oftentimes, you guys think I'm crazy when I tell you this. When I actually say we've got to work out less, because it's literally reducing the stress load on your body. But there're so many different angles that we really have to address when it comes to what is causing stress and how our thyroid is interpreting our metabolism. But more importantly, that T3, free T3 correlation to leptin is very direct. We need to make sure that we're balancing that appropriately. Otherwise, it's harder to bring our leptin and our other metabolism hormones down.
Cynthia: I think it's a really important distinction to make that we're not saying no exercise, we're saying less intense exercise.
Bindiya: Yeah.
Cynthia: I find a lot of women, north of 40 not picking on anyone. But if you're exercising at 45 or 50 like you did at 25 or 30, you very likely are exercising in a way that is going to contribute to dysregulation of these hormones. I use the best example. I used to live in Northern Virginia, and had lived in a beautiful neighborhood, and I would see these women-- I lived in this neighborhood for almost 20 years. Over those years, the same women running the same five to 10 miles every single day start looking haggard. They start telling me that they have all this truncal or abdominal obesity. They're struggling with weight loss and it's because their cortisol is up in response to this exercise, this is not saying exercise is bad, you have to do different types of exercise. As a personal example, Saturday night, we were flying back from Utah from a business trip. We got on a long layover in Chicago. We didn't land in our new city until 1 AM and we sat on the tarmac for 45 minutes while our poor pilot was trying to communicate to get a gate for us, so, we could deplane. I got about five hours asleep Saturday into Sunday, and I set my alarm last night. I was like, "Okay, I'm going to bed early, I'm going to get up and go to gym." Well, at 6 o'clock, my body did not want to get out of bed. The old me would have pushed myself out of bed, would have gone to the gym, would have slogged through a strength training workout, and come home and instead, I let myself sleep an extra hour.
The distinction is, you have to be smart about how you're exercising, when you're exercising. For most, if not all women, I find as we're getting older, we have to just be more conscientious about where we are in our menstrual cycles, where are we dealing with-- Is there extra stress, you have a family member that's sick, you have a kid that's sick, your husband's traveling, whatever it is that's going on, just be leaning into that and really giving yourself grace, because I think as women, we tend to do a tremendous, tremendous disservice to ourselves because we're constantly pushing. It's like the rushing woman syndrome, which is a syndrome I'd never heard of before until I interviewed Dr. Mindy Pelz. She brought it up and there's a great book out there talking exactly about this. And most women, probably listening to this podcast could probably benefit from reading that book as well. But the point I'm trying to make is I'm completely in agreement and alignment that we need to do less. We actually will be healthier if we do less and we aren't pushing ourselves all the time. There's no shame in sitting on the couch and binge watching something on Hulu, or reading a book, or skipping a workout. When what needs to be facilitated is that your body feels safe and relaxed and you are tapping into that parasympathetic, autonomic nervous system, parasympathetic--
Parasympathetic is the rest and repose side. Sympathetic is the, I'm being chased by a rabid animal. And yes, it's important to have both. But most people are stuck in that sympathetic overdrive and not enough parasympathetic, which allows us to digest food and be relaxed. For anyone that wears an Oura Ring, this is one of the things that allows me to stay really attuned to how stressed is my body really looking at those data marks. I'm not suggesting everyone has to do that. But what I found really interesting when I was prepping for our conversation are the things that can tap us into the parasympathetic that are completely free and don't require anything. You don't have to buy an Oura Ring, but I think some of my favorite ways are gargling, humming, singing, breathing. I think breath work is really important. Laughter, all of these things and I'm sure they're probably items that you discuss with your patients. Do you find that most of your patients are surprised to know that there are simple things they can be doing to support the parasympathetic nervous system?
Bindiya: Yeah, I definitely think so and honestly, we really need to start catering towards improving our adrenal health in general because it really is important. You mentioned earlier, I've been fortunate I can test on myself over the last few years. But I'll tell you this. What ends up happening for so many females is, they're not sleeping at night, which then causes sugar cravings. It then causes them to want to eat a little bit more carbs the next day. Then they're pushing themselves, because they're in a very stressful job situation. All these different things start impacting your blood sugars that starts impacting your cortisol production, and then impacts your leptin metabolism. It's really important to say, "Okay, where do I need to slow down, what can I do during the day, do I need to take five minutes to just breathe and go for a walk or do I need to just journal for a couple minutes? Do I just need to sing my favorite 90s song?" Whatever it is that you need to do. But it's essentially that the three things that I tell people, "Think about when you were younger and money wasn't a factor. What brought you joy? Was it reading, was it writing, was it just like drawing and doodling?" Think about those things that you did that really just gave you that inner spark. Go back to that, because that is what your soul really needs and is asking for.
Cynthia: Absolutely. I think it's really important that we give ourselves the opportunity to really investigate that. I think it's hard when we have little people at home. I know certainly 10 years ago, when my kids were four and six, they're now 14 and 16. There was a lot less time for me to think about those things. Now, I'm at a different stage with my kids. And so, I lean into the things that I find joyful and that's very different for each one of us. I definitely want to make sure we talk about the nutrition piece, because obviously whether it's leptin, or ghrelin, or thyroid issues, what are some of your tips as it pertains to making sure we are working towards better anti-inflammatory choices, what's your area of focus that you'd like to do in terms of leptin concerns?
Bindiya: Yeah. I definitely for generalization will say a couple things. Minimize your fruit consumption. And everybody again thinks I'm crazy when I say that. But especially, if you think that eating four pieces of fruit a day is good. I will say, "Guys, keep it to low glycemic fruits. If you enjoy fruit, keep it to low glycemic fruit and try to eat it in the morning when your metabolism is the highest." Usually, if you're breaking your fast around breakfast is what I would say. Stick to berries. People get in trouble when they start doing fruit salads and they're eating like they're using fruit as a substitution for that sweet, unhealthy dessert that they really want like, "Oh, I'm going to eat a fruit after lunch, I'm going to eat a fruit after dinner." Don't do that. Again, we've talked about this. There're so many great properties of fruits, a lot of antioxidants, a lot of polyphenols, a lot of great stuff, fiber, too. Not all fruit is bad, but understand your hormones, where you are, and to identify, "Okay, how much fruit can my body get away with?" That's the first thing that I would say.
The other thing that I really would encourage is minimally a 12-hour fast is completely appropriate. Every day just resetting your body for 12 hours is completely appropriate. Especially, for us females, we can get into trouble if we're doing longer fasts, if we're doing 24-hour fasts, 36-hour fasts. Even for some of us 18-hour fasts, especially if we're doing that five days a week. So, understand your fasting cycle. I know you talk about this a lot. But understand who you are, what you can get away with, what you can't get away with. I love what you say, but pay attention to your menstrual cycle, females. Sometimes it's harder to pay attention to your menstrual cycles, especially if you're postmenopausal, or you're in that perimenopause and you're like, "Well, I don't know if I'm supposed to have a cycle this month or not." I totally understand that. But pay attention to your energy, pay attention to if you're now fatigued if you're fasting. If you're now exhausted, if you can't get through a workout, because you're like, "Oh my God." Or, now, you're going to bed a lot earlier and you're feeling more sluggish. Start paying attention to you because many of us are not paying attention to that. So, minimally, 12-hour fast is completely safe, completely fine, and very appropriate.
The other thing that I actually highly recommend that a lot of people do that we're not doing enough of, and I'm not going to-- Sometimes, I'm even guilty of this because I've got young kids, but not a good reason is we're not eating enough protein. We're just not eating enough protein. We need to make sure we're eating protein throughout the day, three meals a day with protein. There needs to be some sort of protein in that meal. Ask yourself, "Is there greens?" A good three things I asked myself at every meal. "Is there your greens in this meal? Okay, good. Is there protein? Okay, good. Is there enough healthy fats and fiber? Great, okay." Probably, a good decent meal. When you've got young kids, and you're on the go, and you've got picky eaters, sometimes, things can get complicated, but there needs to be some sort of protein. And you know what? We are at a place in our life where we have a lot of good plant-based protein too. You don't have to necessarily go ahead and eat animal protein, but there needs to be some sort of protein at your meal. Maybe that means you're getting more beans and more lentils, maybe you're adding additional collagen, bone broth, whatever it is. There needs to be protein at every single meal to slow down digestion a little bit, to regulate your blood sugars, but more importantly, to regulate your metabolism and to fix leptin.
Cynthia: I love that you brought up the fruit piece. It's interesting. There's a young woman that I follow on Instagram and she's lost a lot of weight, which is incredible and she's maintained a significant weight loss. But every time she talks about what she eats in a day, every single meal or snack is honest to God, it's like there's a piece of fruit involved. I just think like, "That's not a sustainable strategy." But a lot of people are fruit addicted. I use the best example. There was a lovely diabetic cardiovascular patient that I had for many years and I sent him to the registered dietician. I was like, "Okay, I don't have enough time to talk to you about nutrition, but let's send you to the expert." He came back and he was telling me about his experience and how great it was. I said, "Okay, well, tell me what you eat in a day." This man was a diabetic, who already had a sugar handling problem and he was eating six bananas a day.
Bindiya: Oh, my God. I'm cringing [laughs].
Cynthia: And I said, "You have a sugar handling problem." This is for anyone. "If you are insulin resistant or diabetic, you should not be eating six pieces of fruit a day." Maybe you have a quarter cup of berries and that's like your allotted fruit for the day. But a lot of people and I agree with you wholeheartedly, swap out their addiction to candy and ice cream with consuming a lot of fruit and it's still a fruit sugar. It is still something that especially if you're leptin, insulin resistant, or suspect that you really have to monitor that it doesn't mean never, it just means you make the best choices in small quantities. I do think it's really important. He brought up the over fasting piece, because for a lot of women, they assume that a little bit of fasting is good, then a lot of fasting is better. I regularly am answering or my team and I are answering questions in the DMs in our groups.
Sometimes, I have to ratchet it back and just remind people like, "Maybe you need to do a 14-hour fast and maybe you only fast two weeks out of the month," because you're perimenopausal, and you're really struggling around your menstrual cycle, or especially if your peak fertile years. Dr. Bindiya is a prime example. She's still in her peak fertility years. She would not be a candidate to fast every single day, 12 hours of digestive rest is completely appropriate. I think the challenge is that a lot of women overfast in a desperate attempt. I say desperation with love. I'm not using as judgment. A lot of women are so desperate to lose weight that they're like, "If I can just fast longer, it equates with I'm going to lose more weight and that's going to make me happier." I think that's a really important distinction.
Bindiya: I think that's really great to bring up, too, because a lot of times-- This is again, this is to tie it back to leptin. A lot of times when you start fasting, what you're really doing is you're cutting your calories significantly over time. And initially, most women, whether they're doing 14-hour fasts or now they're doing 36-hour fasts are like, "I feel amazing, I've lost all this weight, great." But what ends up happening is you then hit a weight loss stall. For so many females, probably, maybe within a month, they feel great, they've initially lost that weight that they want to lose, but then they hit this plateau. What ends up happening is because you quickly and drastically cut your calories, your body now thinks you're starving and that's where that miscommunication with leptin starts happening because it's like, whoa, your body doesn't know when you're going to get fed again, your body doesn't know when your next meal is going to come, your body doesn't know what's going to happen next. So, it's like, "I'm going to save every single ounce of calorie that we get. Let's store it because she may never feed me again or I don't know if my next meal is going to be 36 hours or 48 hours."
This is also where females really get into trouble when we're doing prolonged fasting all the time and excessively and this is one of the things that are really slowing our metabolism over time. It's finding that fine balance of how can we be metabolic flexible, when can I eat more, when can I eat less, and correlating that back to what's also going on in your life at that time. We mentioned earlier if you have a lot going on, guys, maybe you hold off on fasting. It's okay. It's not the end of the world, right? But it's finding that balance of what works for me where I am in my life today and tomorrow.
Cynthia: I think that's a really important point to make. And certainly, don't compare yourself to what everyone else is doing. Just do what works for you. There's no shame whatsoever in taking a break. I'm very transparent in 2019. When I was hospitalized for 13 days, I did not fast for months and months and months because I just was not in a position to add another stressor to my body that was already overstressed. Now, I want to be respectful of your time, but I want to wrap things up today talking a little bit about midlife misconception. Most of the women that are listening to this podcast are north of 35, north of 40. So, what are some of the common misconceptions you as a clinician see with your patients, things that people find some pricing that are obvious perhaps to your eye, but things that they're probably not thinking about enough?
Bindiya: To me, this is probably an easy one, but there's a big misconception when it comes to weight loss that it's calorie in, calorie out. That's a huge misconception. It's not just calorie in, calorie out. I'll give you an example of, again, stuff I could get away with in my 20s, I couldn't get away with in my 30s. I know that it doesn't sound that many years a different. But I'll give you the example of, if I wanted to lose a few pounds in my 20s, I would just run a little bit more, I could go on the Special K diet or the SlimFast, little shake for a couple of days, and I can drop some pounds. That doesn't work when you're older. The reason why is because not only are there different hormones that are playing into your life, but also the macronutrients and the foods that you're eating really do impact your nutrient metabolism. All the things of calorie in, calorie out, it does not make sense as we get older. When you're younger, again, you're technically more metabolically flexible, your stress load is a little bit less, you're able to get away with a lot of stuff, you are not when you're older and that's a big misconception.
The other big misconception and again, I've fallen into this trap when I was in my 20s and I could get away with it. Overexercising in your 20s. You don't need to do that when you're in your 40s and when you're older. The reason is because your metabolism is different and we need to pay attention to our body. Do things that you enjoy. If you enjoy running, by all means, do it. But you don't need to run 10 miles a day. Find that balance. Maybe you're just running three miles a day, maybe you're mixing your runs with walks, maybe you're mixing your runs with some yoga sessions, or some Barre classes, or some high intensity training, whatever it is it's finding balance. I think that's really key as we get older, especially from working out perspective. We don't need to work out seven days a week and we don't need to run 10 miles a day like we used to. And again, that's obvious to me. But if you had told me this, if we had had the same conversation when I was in our 20s, I would have ignored you. I'm not going to lie. I would have ignored you.
Cynthia: [laughs]
Bindiya: Because I enjoyed running, and it was what gave me joy, and it was something that I love doing. Same thing. I was a big, hot yoga Ashtanga girl, but all that intense yoga that I was doing worked for me when I was younger. It doesn't work for me that I'm older. I need a different type of yoga flow.
Cynthia: I think it's all about honoring who we are as individuals at every stage of life and I'm so very grateful that we were able to connect prior to your baby being born. Let listeners know how to connect with you. You have an amazing podcast. How can they take your quiz and find out more about leptin concerns?
Bindiya: Yeah, for sure. Everything is under @drbindiyamd. So, it's D-R-B-I-N-D-I-Y-A-M-D. I'm on Instagram, Facebook, Twitter. I'm not really active on Twitter, but if you want to follow us, I do. My website is www.drbindiyamd.com and I do have a free leptin quiz. You guys definitely need to take this quiz. It really just puts things into perspective for you. It's drbindiyamd/quiz. If you end up finding out that you do have leptin resistance, I highly recommend that you do our new Metabolism Makeover Course. It's a 30-day course that you can start and do anywhere at your own time to just reset your leptin levels. Because again, many people, first of all, I'm not getting this number checked by their primary care doctor. But understanding, "Okay, this does sound like me. Let's talk about these things."
We didn't even really talk about this, Cynthia, because there's so much to talk about leptin, and your gut dysbiosis, and your microbiome. But if you've got food allergies, food sensitivities, and all that other stuff, it really does impact inflammation and that really disrupts your gut hormones as well. We take care of all of this in 30 days and help reset your metabolism. You can definitely follow me there, you can definitely purchase the course, and do so much more. It's a whole world that unfortunately so many people are just not aware of and I'm hoping that to continue to bring more education where people can feel empowered to say, "You know what, I need to get this leptin level checked, I need to follow this number, and I need to improve it," because I know improving this is going to improve so many other things.
Cynthia: Awesome. Well, I know that my listeners will find this conversation truly invaluable. Thank you again for your time.
Bindiya: Of course. Thanks for having me.
Cynthia: If you love this podcast episode, please leave a rating and review, subscribe, and tell a friend.
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