Today, I am thrilled to reconnect with one of my favorite physicians, Dr. Lara Briden, a naturopathic doctor specializing in women's health.
Dr. Briden is on a mission to help women achieve natural menstrual cycles without relying on hormonal birth control. She has authored several books, including her latest, Metabolism Repair for Women.
In our conversation today, we dive into why we cannot consciously control energy balance, the impact of ultra-processed foods, epigenetic factors in obesity, the significance of satiety hormones, the role of muscle, and the effects of visceral fat versus subcutaneous fat. We also discuss ways to assess metabolic health and explore various treatments.
This insightful discussion with Dr. Lara Briden is bound to captivate and inform all our listeners. Stay tuned for more.
IN THIS EPISODE YOU WILL LEARN:
Why energy balance is not under our conscious control
How the regulatory mechanism in the body naturally reduces hunger and burns energy
How ultra-processed foods were created to be addictive and lead to overeating
How the adiponectin hormone impacts insulin sensitivity and satiety
The importance of maintaining muscle mass and avoiding sarcopenia, particularly during menopause
The difference between subcutaneous and visceral fat
Measuring and managing visceral fat
How High triglycerides often indicate insulin resistance
The limitations of the fasting insulin test
Using the entrainment of circadian rhythm to improve metabolic health
The benefits of addressing gut problems for improving metabolic health
“One of the best ways to promote good adipose hormone signaling is to maintain sensitivity to those hormones. A lot of that comes back to reducing insulin resistance.”
-Dr. Lara Briden
Connect with Cynthia Thurlow
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Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Lara Briden
On her website
On social media: @Lara Briden
Transcript:
Cynthia Thurlow: [00:00:02] 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 is 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.
[00:00:29] Today, I had the honor of reconnecting with one of my favorite physicians, Dr. Lara Briden. She's a naturopathic doctor with a focus on women's health. Her mission is to help women achieve healthy, natural menstrual cycles without the use of hormonal birth control. She is the author of multiple books including, most recently, Metabolism Repair for Women. As stated, she is one of my favorite voices in the women's health space and is a joy to interview.
[00:00:58] Today, we spoke at length about why energy balance is not under our conscious control, the impact of ultra-processed foods, epigenetic switches for obesity, the importance of satiety hormones, the role of muscle, the importance of different types of fats, visceral versus subcutaneous, ways to determine metabolic health treatments, and more. I know you will love this conversation as much as I did recording it.
[00:01:29] Dr. Briden welcome back to the podcast.
Dr. Lara Briden: [00:01:32] Hi, thanks for having me. Nice to see you again.
Cynthia Thurlow: [00:01:34] Absolutely, absolutely. And I was just saying that there's no one really speaking uniquely to women's metabolism and metabolic health uniquely and with that very defined lens. Let's start the conversation today about why energy balance is not under conscious control. Because I think that there are a lot of people who think that they're going to will themselves through weight loss, and there's so much more to it than that. And it's really a great position to start from for this conversation.
Dr. Lara Briden: [00:02:05] I think like so much of my work that came directly out of conversations with patients and from their perspective, putting myself in their shoes, and I could see, I mean, they're describing feeling very, very hungry all the time, and just assuming that how it is or that's normal, and that they must withstand that with willpower, and that sort of assumption that everyone else must be withstanding it with willpower. And so, I was trying to reframe it and make the point that obviously, if you're hungry, you're going to eat. Because we're animals, as you know, I take the angle that we're biological creatures, we're no different from the rest of the animal kingdom in lots of ways. And so, if we're hungry, we're going to eventually eat. That is just a fact.
[00:02:50] And so a far better strategy is to find ways to naturally feel less hungry to achieve ongoing satiety, which is a little different than just the satiation at the end of a meal. It’s just feeling good between meals, you're getting enough energy. And then looking at the research and seeing this beautiful biological system that is the human body, and realizing that the regulatory mechanism in the brain, which is a collective collection of various neurological aspects and signals, but it does up and down hunger and energy expenditure pretty much at the same time.
[00:03:28] So, it totally makes sense from a survival perspective that if that part of the brain is convinced that everything is okay, there's enough energy coming in, there's no crisis that it needs to prepare for, [chuckles] then it will naturally make you feel less hungry and at the same time burn more energy through all these various unconscious, actively compensatory mechanisms, which is obviously very different than thinking any extra calories that I need to burn, I need to actively burn with exercise. Because as you know, the research around exercise is a little puzzling in that we've known for a few years.
[00:04:03] I think it was Herman Pontzer is that the scientist who discovered that on the days when we burn a lot more calories with exercise, the rest of the body's calorie energy expenditure mechanisms dial it down because they're trying to conserve energy. And of course they are again from animal survival perspective, the body has to have a certain budget every day. [chuckles] It can't afford to just lose 1500 extra calories one day.
Cynthia Thurlow: [00:04:29] Yeah, no, I think that we have to reframe metabolism. We have to reframe this energy balance model. I mean, you and I both trained during the time when it was calories in, calories out. And I remember saying, horrible-- I cringe when I think about this now. You just need to exercise more and eat less. And that was the prevailing philosophy in the early 2000s. And I remember probably by 2010 saying to a colleague, like, “I don't think this is working.” The patients are frustrated, we're frustrated. And I said my frustration stemmed from my patients being frustrated. Not that I thought they were being noncompliant, but I think in many ways it is so much more than just calories in, calories out, and there's a lot of growth science individuals that will still talk about how, “Oh, you just need to track your calories.” And I always say it's far more complex than that.
Dr. Lara Briden: [00:05:23] Well, it's just because I heard, I think it's scientist, Ben Bikman, who you may know, he said, “We're not a closed system,” so that'd be fine, [Cynthia laughs] like the actively counting calories in and calories out that would be fine if were like a simple system, but we're a complex system. And so, for example, again, as I've just explained on the calories outside, there's so many different ways for calories out that and the brain is unconsciously controlling most of those. And so, there's been quite a bit of hubris or this oversimplification to think that we can micromanage a system like this that has evolved for millions of years to, [laughs] in many ways, conserve energy or survive. So, we can't trick our bodies. We have to work with our biology, which is theme of my book.
Cynthia Thurlow: [00:06:08] Yeah. And I think that that's an important distinction, that there are things and aspects of our physiology that are unique, and so working with our physiology, not against it. And with that being said, I feel like there's so much about our modern-day lifestyles that works against our physiology. And the prevailing gorilla in the room is the ultra-processed food industry. That's a 400-billion-dollar-a-year industry that is focused on profits and certainly not our health. And I would love to pivot and talk a little bit about what ultra-processed foods do to our metabolism, not in a positive way.
Dr. Lara Briden: [00:06:47] Yeah, well, they're doing something very bad. As you know, one expert said, “If we're being slowly poisoned by this modern food supply,” and of course, we're surrounded by it. So, the other thing is that's the phrasing, which I quite like, which is not my original phrasing, but scientists talk about it as the food environment, which very much goes back to, we're animal living in a-- This is the food that's being presented to us as kids. Not through anybody's fault, exactly. It's just this is what's everywhere, and this is what you get when you go out for dinner, you are served it on the plane. That's in all the convenience stores, of course, this is what people are going to eat because it's what's there.
[00:07:23] And in terms of the mechanisms of what is going so wrong, the scientists are all scrambling to figure that out. It's a combination of things. I do think. I'll list what I think are the top of some of the big ones. And I'd love to hear your thoughts as well. But I do think that the vegetable oil, I do think the high dose omega-6 is part of the problem. And you'll see, I mentioned it in the book. I don't maybe feature it quite as prominently as I should have, but it's there. I think people need to just be aware that the scientists have their eye on this as something, a dramatic factor that's changed in the last 50 to 70 years, and then below that, I mean, it's just what they call acellular carbohydrates.
[00:08:04] Well, we know it as refined carbohydrates, but when those hit the gut, something very weird is happening. They're not signaling the satiety hormones and all the normal hormonal machinery that's supposed to be communicating between the gut and the brain, that is not happening. So, the brain is very confused. It's almost like it doesn't know any food is even coming in. It's very strange. And then it's also promoting that same type of refined carbohydrate is unfortunately causing bacterial overgrowth in the gut. I actually think. through my naturopathic lens, I look at all of this and I think the gut is a big player, small intestinal bacterial overgrowth, intestinal permeability, problems lower down with the gut microbes.
[00:08:46] And what's interesting is that just to give a low-carb diet, as an example, obviously there's various mechanisms by which a lower carbohydrate diet can help to improve things, but one mechanism is that it reduces bacterial overgrowth, basically. It has antimicrobial effect in the gut and reduces intestinal permeability. So, I think that's to give a longer answer. Those are some of the big things in ultra-processed food. There's also emulsifiers which also contribute to intestinal permeability. There are a lot of the environmental toxins, some of the big ones that they call obesogens or obesity-promoting chemicals, are in ultra-processed food. These are plastics and things that end up in the food either as additives or in the packaging.
[00:09:28] So, yeah. Can you add to the list what are your thoughts? Anything I've missed? Like things I've missed, obviously sugar.
Cynthia Thurlow: [00:09:33] Yeah, no. I was going to say the nonnutritive sweeteners and certainly high fructose corn syrup, understanding that it's processed so differently in the body. I echo a lot of what you say, and I also think about just overall damage from antibiotics. And it's not one round of antibiotics, it's that most of us have had multiple or near continuous rounds of antibiotics without realizing that kind of sets up, the gut microbiome kind of primes it. The other thing that I think about is just the cumulative net impact. I don't think it's having one hostess Twinkie is going to do it for most people.
Dr. Lara Briden: [00:10:12] No.
Cynthia Thurlow: [00:10:12] I think it's the volume of processed foods. We've gotten so far away from what we recognize as real food that we are missing phytonutrients and protein needs. And you're absolutely correct that the processed food industry creates food to be as addictive as possible. This whole bliss point lighting up dopamine in our brains, making us not recognize that we're even eating any food like substance. And then we tend to overeat. The joke is, my teenagers are now both driving, and one of them said, “Oh, I went to a graduation party and there was this food,” I won't even name it. And they said, “I had never eaten it before. And so, I ate it.” And before I knew it, I ate half a bag of this chip. And he was recognizing that, “Mom, I didn’t feel like I had eaten that much.”
Dr. Lara Briden: [00:11:01] Yeah.
Cynthia Thurlow: [00:11:02] And I said, “Well, those foods are designed to be hyper palatable, highly processed, highly addictive, lighting up your brain, creating that feedback loop if you want more and more and more.” And we know if we look at the research, individuals that consume ultra processed foods are going to consume at a minimum, an additional 500 calories a day. And so, you start thinking about cumulatively over time that can really add up.
Dr. Lara Briden: [00:11:24] There's a multi-transgenerational effect happening as well. So, this epigenetic effect, which is very frightening, actually, when you think about this. So, what this means is some of the negative effects of this exposure to the modern food environment switches on and off genes that create even more. So, increase the risk of insulin resistance and metabolic dysfunction in subsequent generations which means, the scientists have observed that problem is amplifying with each generation. So maybe when I was a kid in the 70s, I could get away with eating a lot more Oreo cookies or I certainly did. Us in the 70s, our diet, well, my personal family diet wasn't that bad, but there was a lot of junk food out there.
[00:12:04] For sure. It's not new, but we seem to cope with it better, I think, than young people are today, because they're almost born with a higher risk. And it's so sad to think about epigenetics that way and think that the compromised metabolic health of kids and how they're just set up to have a harder time right from the beginning, but that's just the reality. And the other thing, yeah. So, fructose, I'll just, before we leave the topic of fructose, you must have tagged one of your previous episodes. Did you interview Richard Johnson?
Cynthia Thurlow: [00:12:35] I did.
Dr. Lara Briden: [00:12:36] Yeah.
Cynthia Thurlow: [00:12:37] I've interviewed him twice. He is such a-
Dr. Lara Briden: [00:12:38] Great.
Cynthia Thurlow: [00:12:39] -lovely person. And he got me looking at fructose completely differently.
Dr. Lara Briden: [00:12:46] So, I do feature him, as you saw in the book, quite a bit. I haven't met him, but I loved his book. And I'm an evolutionary biologist originally, so I love his deep dive as to when these couple of genetic mutations happened that made us more vulnerable to fructose. And anyway, in the show notes, you can put links to your interviews with him.
Cynthia Thurlow: [00:13:04] I definitely will. And it's interesting, earlier today, I interviewed an endocrinologist, and she was mentioning that your preconception weight and health, both the male and female, are critically impactful for the subsequent health of your offspring before you even get pregnant. And so, when she said that and then we're talking about this epigenetic, turning these genes on or off, it just makes you realize that it's not just a happenstance, there really is this continuity that goes on intergenerationally, if we are not aware and cognizant of it.
Dr. Lara Briden: [00:13:43] Yes. Yeah. And we need to try to break the cycle.
Cynthia Thurlow: [00:13:45] Yes.
Dr. Lara Briden: [00:13:46] And that needs to happen collectively. And so obviously, there are things individuals can do. That's why people are listening to podcasts like this to find out what they can do for themselves and their offspring and their families. But also in the background, people are trying to work to create society wide changes, because big picture, that's really what's going to help. And just to circle back to the personal responsibility, calories in, calories out approach, this sounds like a conspiracy theory, but that's been actively promoted by the food industry. They love that messaging. That is perfect for them because it's like, “Oh, no, no, the problem's not this food that we're putting everywhere and surrounding people with and actively promoting. The problem is personal willpower and why people just need to not eat too much of it.” They've just been actively working to promote that narrative. But I do think you're right. I think maybe the time is coming when there's a critical mass of people, more and more people just going, this is not-- Yes, you're saying energy balance is not under conscious control. This is not something we can keep finger wagging at people too.
Cynthia Thurlow: [00:14:54] Absolutely. Well, I think about the tobacco industry. For many, many years, there was deflection, deflection, deflection from the research and the connection between smoking, cancer risk, and emphysema and all these other health problems. And finally, there was enough of a Groundswell movement that they were held accountable. And so, my hope, and I say this very sincerely, my hope is that we can have a Groundswell movement that will do the same for the ultra-processed food industry. Because I think about my children's future children.
Dr. Lara Briden: [00:15:29] Yeah, of course.
Cynthia Thurlow: [00:15:28] And I think about the young people that they're talking about how these generations are potentially less healthy than previous generations. And that really shouldn't be the case, given everything that we know. So, we had touched on satiety. We had talked a little bit about why satiety is so important.
[00:15:47] Let's talk about some of the hormones, because some of these may be unique or new for some of the individuals that are listening. And let's make sure we talk about adiponectin, because this is a hormone that I think is so interesting and one I wish all of us knew a little bit more about.
Dr. Lara Briden: [00:16:04] Well, there's so many hormones that feed back to the brain and influence the signaling of how hungry we should be and how much energy we should burn. And they tend to come in pairs. [chuckles] So, well, first I'll just mention the gut hormones. And so, this includes the GLP-1, which is the basis for the new medications, the new Ozempic and similar medications. And GLP-1 is just one of several hormones signaling from the gut to the brain to say, “We're good, we've had enough food.” And so then beyond that, there's the pair of hormones, insulin and glucagon. What's interesting, actually, is insulin technically is a satiety hormone, but with insulin resistance it loses that power, and it loses control over something called glucagon, which is a hunger hormone.
[00:16:52] And then the pair you're thinking about, are the hormones that our fat cells make talking to the brain and that would be leptin and adiponectin. Actually, they both have some insulin sensitizing properties. Leptin is more strong on the satiety perspective. Have you interviewed other people about adiponectin? Because I'm curious to get your angle on it, yeah.
Cynthia Thurlow: [00:17:17] This is one of those nerdy things that I was like, “Oh, I'm so glad you talked about adiponectin, because it's got this inverse relationship with body fat.”
Dr. Lara Briden: [00:17:26] Yeah.
Cynthia Thurlow: [00:17:27] And the more I learn about adiponectin, the more important it is to foster ensuring that this hormone is working properly because it impacts so many things in the body.
Dr. Lara Briden: [00:17:37] It's true. I guess it's not just insulin sensitivity and satiety. Yeah. And I said it's working in comparison with leptin. So, I think one of the best ways to promote good adipose hormone signaling is to maintain a sensitivity to those hormones. And a lot of that does come back to reducing insulin resistance, keeping insulin down.
Cynthia Thurlow: [00:18:01] Well, and it's interesting because we're really looking at an obesity crisis, a metabolic health crisis. Here in the United States, 92% to 93% of Americans are not insulin sensitive anymore. And so really helping build awareness around this for listeners, so, they can be asking the right questions, they can be looking for the right information. And one of the big aspects of our health that impacts insulin sensitivity is the role of muscle. And this is one of my favorite things to talk about because it's tangible. We can see muscle hopefully. We can work muscle and women have some attributes that make us more likely to have bigger glutes. We have more slow twitch muscle fibers. All these things work to our advantage to a point.
Dr. Lara Briden: [00:18:51] Well, we have more, what's called intracellular fat deposits. So, that is our baseline, then female muscle is better at burning fat compared to carbs. Both male and female are always burning a mix of the two. But we have this superpower. We should be, especially during our reproductive years, we're fat burning machines, actually. And yes, especially and then, yeah, we do tend to have more muscle on the glutes, which is great for, because it's good. It's the largest muscle in the body. It's really good for stability. And maintaining muscle mass is one of the best things we can do for metabolic health. It's true. We're talking about this a little bit off air.
[00:19:30] And just to highlight that we do tend to lose our ability to hold muscle with menopause, because some people maybe don't know this, but estrogen is an anabolic or muscle-building hormone, which I love. Both estrogen and testosterone are anabolic or muscle building. And so, when we're younger we have that advantage and then when we lose not all, but a lot of our estrogen with menopause we have to work a little bit harder with building muscle but it doesn't mean it's not possible. We can always, always build muscle. That's the great thing. It's a natural antiaging organ that we can actively promote.
Cynthia Thurlow: [00:20:05] Yeah. And I think it's important for people to understand that sarcopenia will happen if we're not working actively against it. And so, it's the muscle loss and muscle strength loss with aging. And the concern is that if we are building and maintaining muscle throughout our 40s, 50s and beyond, we are less likely to fall, we are less likely to be frail, we are less likely to be less physically active. And I speak from personal family experience. We don't want to be heading that direction. What are some of the things that you like to talk to your patients about to help avoid sarcopenia? beyond the obvious thing, we have to eat enough protein, we've got to lift weights. When do you typically initiate the conversation about hormone replacement therapy if that's appropriate for them?
Dr. Lara Briden: [00:20:53] Right, yeah, we can talk a bit about the role of potential-- I mean, the evidence does support the use of estrogen therapy potentially for that purpose. I'll just say a couple of things about muscle. So, something else that's sarcopenic is alcohol. So, it is worth mentioning that. And also having more muscle, it feeds and it sends various signals to the metabolic regulatory mechanism, including it helps to balance or can improve what's called sympathetic tone or adrenaline. We tend to think of adrenaline as bad, but it does play a beneficial role. And having a certain amount of sympathetic tone can actually help with just natural burning of visceral fat and reduction of hypertrophy visceral fat, which as listeners might know, is the dangerous type of fat inside the abdomen.
[00:21:37] Yeah. So, I think as to the question, at what point could a woman benefit from using estrogen therapy for the purpose of metabolic health or building muscle? I think—[crosstalk]
Cynthia Thurlow: [00:21:50] I didn't mean to put you on the spot. I was just thinking it was just like an organic thought that popped into my mind. [laughs]
Dr. Lara Briden: [00:21:54] I know. Yeah, no, no it's fine. As you know, this has become quite a heated discussion. I don't know what other guests you've had in terms of should everyone take estrogen. Obviously not everyone can, because some people if they have a personal history of breast cancer, they can't. And then I think some of those people are being feeling very left out of the conversation. I'll just say I think it's one of many factors, right? Like, it's not a make or break factor. I think some amount of natural body identical estrogen therapy can help, but so does, as you say, moving the body, some type of resistance training. I'm a little naughty, I don't know. I never sure how often to [Cynthia laughs] confess this, [laughs] but I don't lift weights, which I may still, I may still do it. I haven't ruled it out, but I just love yoga so much that I can't. It's like anytime I have either do outdoor walking, climbing big hills, which I love, or because you get the outdoor time or I'm on my yoga mat, doing what I need to do.
[00:22:51] But to be fair, I do, that does include plank and resistance bands sometimes and squats. I've decided to share this sometimes in interviews just to make people feel, well, there are human and if they really don't want to or for whatever reason can't access weight training, it's like, at this point in their life, just do something like, it's okay. You don't have to feel like you're failing at yet something else and which speaks a little bit too.
[00:23:20] I was talking to someone yesterday who said such kind words about my book. She said she really had the feeling from the book that no one is left behind, that there's always something you can do. You don't have to join the exact set of things that the cool people are doing. There's other ways to accomplish this and there's lots of ways to move the body. And depending on people's starting place too, I mean, even just some pretty simple things can help to prevent the muscle loss or sarcopenia that you're describing.
Cynthia Thurlow: [00:23:49] Yeah. And I think it's important to be inclusive and understand that people are starting from different positions. There could be people listening that have been sedentary for a long period of time. And maybe just doing 5 or 10 minutes of walking a day is a lot to start with. And certainly, I never want the example to be that everyone has to do what I do. I acknowledge that I'm at the stage of life I was not joking, but I was being serious. After my dad passed, I said, okay, it's time to hire a personal trainer. Because of the reasons that my father became very frail, fell and hit his head. And that was the beginning of the end for him, was the acknowledgement that I have to personally, to feel like I'm doing all the things to avoid that trajectory because I'm my father's daughter. I mean, we are same type of physical body type and very similar physically.
[00:24:46] I was like, “If I don't do all the things, I will be in the same position.” So, for me, personally, because of my personal story, very important. But for everyone that's listening, finding some way to honor your body that feels aligned for you, like, “I should do more yoga. I should,” [laughs] but it said the thing for me that I lean into is Zone 2 training or lifting weights. But I acknowledge that one of the reasons sometimes the things I try to avoid doing are the things I need to do. And so it just reminds me that I need to make a mental note of, probably should scoot that into my schedule at some point this month.
Dr. Lara Briden: [00:25:22] Yes, I agree. Yeah. Well said.
Cynthia Thurlow: [00:25:24] With that being said, let's talk a little bit about some of the unique aspects to body fat. I think that this is endlessly interesting to me when we're talking about subcutaneous fat or we're talking about visceral fat, which we know is the one that's pro inflammatory and tends to release substances into the bloodstream, whether they're cytokines, tumor necrosis factor, etc., that can be nonbeneficial, but helping people understand that there's different types of fat and we want to be conscientious about avoiding the visceral fat, which is the one that has the most negative net impact on our body.
Dr. Lara Briden: [00:26:03] Yeah. And just to frame that, so to understand what a negative effect hypertrophied or enlarged visceral fat can have, just think about it as, remember that it's an organ. It's an endocrine organ. We talked 20 minutes ago about it. It releases hormones, adiponectin, and leptin. So, when the visceral fat in particular is enlarged or hypertrophied, it starts behaving strangely, and it's not sending out the right messages to the brain. So certainly, again, talking with my patients, people are still always thinking, even when they're thinking about belly fat or we always say belly fat. I've started not saying belly fat anymore.
[00:26:39] I'll just like, try to be a bit more precise about visceral fat, because belly fat can be still the subcutaneous fat on the belly, the rolls that you get around your belly button. That's not what we're talking about. This is inside and it feels quite different. But patients describe it as this hard, almost roll or shelf under their ribcage. Yeah, it's deep inside there, and it's quite hard. It doesn't jiggle or move around, and it's hard to detect. You can't use calipers or anything like that. This is where waist measure comes in, which is a fairly good approximate measure of what's going on there. You can see it with a DEXA, if anyone's doing that sort of thing or you could see it with an MRI, for example. But people aren't having MRIs for that reason.
[00:27:26] And it's almost continuous with or quite related to fatty liver. And again, speaking from my conversations with my patients, of course, we as clinicians know, fatty liver is metabolic disease most of the time. It can be caused by alcohol and other things, too but if there's no other obvious explanation, then it's from insulin resistance, and it's promoting insulin resistance, so it's integrated right into the metabolic dysfunction. And yet I've had many patients who said, “Oh, my doctor says I have fatty liver.” And they're thinking, what can I do for my liver? They're not connecting. No one has connected the dots for them that this is--
[00:28:02] I just want to highlight a couple of symptoms of insulin resistance that I've come to realize from my work with patients that people don't understand. So, one is fatty liver, and the other one is a tendency to hypoglycemia, especially reactive hypoglycemia. I had someone on social media, this is a really important moment for me when I was talking about insulin resistance, and she said, “Oh, well, I know I get low blood sugar, so therefore, I must not have insulin resistance,” Because it makes sense, right? because of the messaging that insulin resistance is prediabetes and that's associated with high blood sugar.
[00:28:40] And I don't know how many other people are out there thinking, if I get low blood sugar, that must rule that out when it's exactly the opposite, because having chronically elevated insulin with insulin resistance can actually increase the likelihood of episodes of low blood sugar, especially couple hours after eating low blood sugar, which is called reactive hypoglycemia. So, yeah, so this is a bit of a tangent from visceral fat, but, yeah, visceral fat is also very involved in this core pathology, part of insulin resistance versus subcutaneous fat, especially in women, especially bum fat is actively anti-inflammatory, arguably, which is super interesting. In fact, subcutaneous fat, I think, has many potentially health-promoting properties. It's involved in immune function.
[00:29:23] And I did find at least one paper where they talked about some of the inflammation and cardiovascular risks from visceral fat are actively mitigated by also having a lot of bum fat. So, put it this way, if you're going to have hypertrophied visceral fat, and you can't always tell by looking, it's actually safer and healthier to also have quite a bit of bum fat. So, this is why this is-- [crosstalk] [Cynthia laughs] yeah.
Cynthia Thurlow: [00:29:49] As much as women complain about subcutaneous fat, it's helping us understand that there is benefits from having that superficial fat, which is different than the deep visceral fat that can be around the pancreas, the liver, the heart. This is where my patients used to tell me, my male patients, my inseam is getting shorter. And I would think to myself, and it was because they kept buying pants to fit underneath their big bellies, and I would have to remind them, “This is not the direction we want to be going in. We have to genuinely work on this.” And for a lot of people, they thought it was cute, and I would remind them, “Visceral fat is not cute. It's actually a sign of poor metabolic health.” And so, I'm so glad that you mentioned this in the book. And there's now a new acronym, for a long time, it was NAFLD, now it is MASLD, metabolic dysfunction-associated steatotic liver disease, but it's [crosstalk] adults.
Dr. Lara Briden: [00:30:46] It's a mouthful.
Cynthia Thurlow: [00:30:47] Yes. 52 [crosstalk] adults. So, most people out there don't realize, and you did mention how do we test diagnostically for things like this? I had Dr. Sean O’Mara on, and he's a fan of everyone getting an MRI. And I was like, that's great, but that may not financially work for everyone. So, there are DEXA scans and some DEXA scan readers do a better job with this than other, but we're really looking at body composition, and this is where even a bioimpedance scale or even the waist circumference that you measure, which is an easy way. For women, we're looking for a waist circumference less than 35 inches. I know, sorry, not the metric system.
Dr. Lara Briden: [00:31:27] I do centimeters, but yeah, yeah, yeah.
Cynthia Thurlow: [00:31:27] Yes, I know. And it's funny, it's like in medicine, most things are in the metric system, but we still talk about inches for metabolic syndrome. For men, less than 45 inches, but that is quite a large way. So, when you start to get to that point, it's a clue that you probably have some degree of visceral fat.
Dr. Lara Briden: [00:31:46] Another couple easy markers that people want to just look. These will be reports they already have from their doctors. So, they don't have to spend a lot of money, getting diagnosed. High triglycerides is a classic and this goes along with insulin resistance, which we can assume goes along with hypertrophied visceral fat and probably fatty liver. High ALT on a blood test for women higher than 19, I think it's just international units per liter. So, I think the official cutoff is like 28 or something. For optimal health and for optimal insulin sensitivity, it should be less than 19. So that's something people can easily look at. And then along with that, they'll usually be low HDL.
[00:32:29] So that combo of high triglycerides, low HDL, high ALT, high waist circumference, that is starting to look very much like hypertrophied visceral fat and insulin resistance. And those are all metrics people contract. So, as they make the various changes, including building muscle we've just talked about, and reducing inflammation, treating the gut, I would say, and sheltering from those ultra-processed food factors, vegetable oil, high-dose fructose, they'll start to see those metrics changing. And importantly, they'll be changing potentially even before there's huge changes on the scale. So, obviously, many of us experts are trying to divert the attention from just your weight on a scale to some of these other markers.
[00:33:12] And also the thing that will change along with it that should is increase satiety, because we started the conversation talking about how one of the main symptoms of all of this is to feel a lot hungrier than normal. So, people should just naturally start to feel, yeah, better between meals, not needing to snack, not needing to use willpower to not snack, but actually not needing to snack.
Cynthia Thurlow: [00:33:32] Yeah and feeling satiated. I think that’s key. And for triglycerides, ironically enough, when I worked in clinical cardiology, we used to say less than 150 mg/dL. And I would tell everyone listening, we did a five-part lipid series with Dr. Tom Dayspring. And I would argue we want those triglycerides less than 75. Ideally, I like mine under 50, because that is demonstrating that you have good insulin sensitivity. So, for a lot of people, including I have a family member who I won't call out, but this individual showed me their labs one day, and I took a look at their triglycerides and their HDL, and I said, “What did your doctor tell you to do?” And this individual said, “Oh, they said, my labs look great.” And I was like, “Mm, We need to have a separate conversation.”
[00:34:20] Having said that, typically you'll see triglycerides 200, 300. Some people have really high triglycerides. Sometimes, it can be things that are genetically mediated. But when you have an HDL of 25, 30, 35, along with those high triglycerides, it is definitely a good sign that something is going on. And I would just tag onto that when I'm looking at fasting glucoses, a lot of people are comfortable with a fasting glucose in the 90s. And I always like to bring up Dr. Robert Lustig, who has taught me that a fasting glucose of 90 to 99 is not benign. It increases your likelihood of developing diabetes by 30%. So, what we're looking for when we're looking at a fasting glucose, 70 to 85, is probably ideal. And then concurrently with that, looking at a fasting insulin. But you brought up an interesting concept around fasting insulin that I hadn't thought about, that I would love for you touch on, because-
Dr. Lara Briden: [00:35:19] Yeah.
Cynthia Thurlow: [00:35:20] -everyone knows I talk about fasting insulin a lot, but you can get some variants on results.
Dr. Lara Briden: [00:35:25] Yeah, let's troubleshoot fasting insulin as a measure a little bit. But one thing I'll just say about the triglycerides that's also very interesting. People should definitely, including myself, I'm going to go and listen to your five-part lipid series. [laughs] But triglycerides, I'm sure you talk about it in the series, but the liver makes triglycerides, right? Just for anyone who doesn't know that, the reason high triglycerides is a marker is because this is a downstream excess triglyceride production by the liver is a downstream effect of insulin resistance. And also, yeah, it's involved in the pathology of it. So, yeah, I also, as a clinician, have used insulin, either fasting insulin or a dynamic insulin, where you take a fasting and then you do, it's oral glucose tolerance test but with measuring insulin as well.
[00:36:14] And so, I know, and maybe you can even speak to this because you've interviewed so many experts. But there has been quite a conventional resistance to the idea of measuring insulin, I think in part because the real focus has always been on glucose and not recognizing the underlying role, the fact that insulin can be chronically elevated for decades before glucose really starts to go out of range. In fact, as I've just explained, glucose can be low at times with a high insulin, chronically elevated insulin. But there are some difficulties around the test itself, which may be part of the resistance or reluctance for it to be embraced. But one is, as I mentioned in the book, I interviewed Katherine Sherif. She might be a good guest for you if you haven't interviewed her before. Have you talked to her before?
Cynthia Thurlow: [00:36:57] I have not.
Dr. Lara Briden: [00:36:59] Okay. So, she seems to know a lot about insulin resistance, and she's a PCOS expert. [Cynthia laughs] She just pointed out that insulin itself is really unstable in pathology samples, so it needs to be frozen directly after sampling, which for a lot of labs is hard to do. And so, if it's not handled properly, it can be abnormally low or artificially low. And, of course, the other thing about insulin is that it does fluctuate every, I think, 90 minutes or something. So, you could also just get unlucky and get it. But basically, what could happen is someone could have insulin resistance, as in chronically elevated insulin, but not be able to detect that with a fasting insulin test.
[00:37:37] So, as I say in the book, if your fasting insulin is high, that's insulin resistance. If it's low, you just don't know because it could be one of those things. The sample wasn't handled properly, or it's cycling. You caught it at a low point naturally or it does tend to come down quite quickly, which is good. Like, even just with low-carb diet for a couple weeks, it'll come down. If you've done a lot of exercise in the previous days, it'll come down or if you fasted more than the 12 hours, it'll come down. So, there's lots of reason.
[00:38:07] So I am at the point where I still think it's a useful test, but if someone has all the other signs, like high triglycerides and high waist measure and skin tags and all the other things, and high blood pressure is another symptom, or fatty liver and their fasting insulin happens to be low, I'm like, well, that doesn't negate all those other signs, does that? Would you agree with that?
Cynthia Thurlow: [00:38:26] Oh, absolutely.
Dr. Lara Briden: [00:38:27] Cynthia if does make sense? Yeah.
Cynthia Thurlow: [00:38:28] And it's interesting. I've interviewed Ben Bikman several times, and he has talked about how he doesn't think, at least not in their near future, there will be a at home insulin test. And I think it probably has a lot to do with some of the things that you identified from the researcher that you spoke to. And to me, this is where clinical expertise really wins out, that you can have a test that doesn't fit the clinical picture, but you may have six or seven other signs that are suggestive, and that's where I would say that's was probably an aberrant test, and I'm going to focus in on the things that confirm what I think we are looking at.
Dr. Lara Briden: [00:39:07] Totally. There's also a test called C-peptide. I don't know if Ben talked about that when you interviewed him. I haven't had access to that as a clinician. I have never ordered that for a patient. But I think it seems like it's maybe more stable or an easier way to screen for high insulin because it tracks with insulin so.
Cynthia Thurlow: [00:39:25] Yeah. I have a couple colleagues that are using that test, and they've told me that they'll use it when they really believe fervently, they have someone who's insulin resistant, but they haven't caught a test that has confirmed it. Like, maybe the insulin was borderline or their fasting glucoses have been all over the place. They'll do a C-peptide to definitively, they feel more comfortable saying, “Okay, yes or no.” But obviously metabolic health is so dynamic. As you've mentioned, it can change within days or weeks. I would really love to touch on the big picture things that you feel are important for metabolic health. We've talked about strength training. I know one of the common questions that comes in, everyone loves supplements.
[00:40:12] I don't want to necessarily focus on that, but if you have a few supplements or a few lifestyle strategies that you think are the most efficacious could even be low-lying fruit things that people can walk away from. Obviously, I want them to read your book. And I was telling Dr. Briden before we started recording that I love how accessible, it's so well put together and makes the information so accessible that your books are books I recommend all the time to my patients.
Dr. Lara Briden: [00:40:41] Aww. That's so sweet. Thanks. Yeah, there is as people see in the book, it's a troubleshooting manual. So, depending on the individual, there truly are perhaps different priorities. We've definitely, I mean, we can agree building muscle is a priority. Sheltering from ultra-processed food, sugar, vegetable oil is a priority that usually just involves finding a way to cook at home. And then I guess another low-hanging fruit, if you will, is trying to entrain circadian rhythm, body clock and it's so funny when you read the quotes from the researchers in circadian rhythm. From their perspective, metabolic dysfunction is all about that, they're like, this is the thing. This is the main thing. Of course, all researchers think whatever they're looking at is the main thing, [Cynthia laughs] but I think they could be [laughs] like, there's a lot to that.
[00:41:24] So. And that involves getting morning light, getting outside, eating to a schedule that could include some version of intermittent fasting. But probably I might, I think in training circadian rhythm, a big part is a big hit of protein by a certain, I'd say by 10. Could be earlier or it could be-- but that does a lot to entrain body clock. So, there's different things you can do. And then I guess I would say another common one. Just go back to what I said at the beginning about how one of the damaging effects of ultra-processed food is bacterial overgrowth in the gut. I do feel like if there's a gut problem, fix the gut problem. I realized to this 10-patient stories in the book, this was totally unintentional, but two of them are about gut-related things.
[00:42:05] And like, two of them, maybe two and a half, are like where they fixed their gut and then their body shape just drifted to normal. The metabolic health just improved without doing a lot else in their case, that's because they had other good things in place. And then I'll touch on supplements. I've put forward what I call the five missing metabolic supplements. I always, in my interviews, I'm like, “People don't have to buy the book to learn what I think are the five. I'm happy to share them, and then people can research that or look in the book for more information.” I don't sell them myself. There's lots of different brands. You can get these. Often, they will come combined, which makes it a bit easier.
[00:42:41] But so one is magnesium, which I'm sure you've had lots of guests talk. Probably. last time I was with you, I talked about magnesium. It pairs very well with the amino acid taurine, which is both of those two are like a dynamic duo for mitochondrial health and other benefits as well. Number three would be choline, which is missing from the modern diet. So, two, choline and number four, inositol, we used to historically get them from organ meats. So, I do think this is another problem with the modern food environment, is we are not consuming the organ meats that we used to. We were organ meat-consuming animals historically, I think. And even as recently as in the 70s when I was a kid, we had liver every week. I just remember being served liver or kidneys probably once a week.
[00:43:27] I mean, I was a kid fortunately, I didn't mind them. I remember it, obviously, so it must have stuck with me as maybe not my favorite, but it was something we had. How about you, when you were a kid? Was organ meat on the menu?
Cynthia Thurlow: [00:43:38] Well, my mom's Italian, and so I remember every week we had liver and onions and bacon and my brother, because I thought the liver was so metallic, I would eat the onions and the bacon. My mother was one of those moms who would not let you leave the table till you ate. So, I would be stubborn and sit there. But my brother and I still talk about this to this day, that my mom was a little bit ahead of the times in terms of, she made her own bread. Everything was made from at home even though my mom worked full time, she was very, as a typical Italian mom, like lots of vegetables and lots of clean things. But yes, we had organ meat every week.
Dr. Lara Briden: [00:44:19] I think those of us who did, I think, were sheltered from the metabolic catastrophe to some extent. I think that would have set us up another example of metabolism being supported during childhood and having a long tail long as, I mean, not to totally speculate, but the fact that we're both in our 50s, I think. Yeah. And still reasonably metabolically healthy, some of that is going to be from childhood, and not only just the hopefully good things that we're doing now. Yeah, so that's a big case for organ meat or supplementing inositol and choline. And then number five in my list is glycine. There's a lot going on with research around glycine right now.
Cynthia Thurlow: [00:45:00] [crosstalk] glycine.
Dr. Lara Briden: [00:45:02] Yeah. It's the main amino acid in collagen, which I think is one of the reasons collagen is so popular but you can also just take glycine.
Cynthia Thurlow: [00:45:09] Yeah, it's interesting. I have not necessarily every night, but my consistent, like I take Taurine every day, I take magnesium and inositol for me, has been such a game changer because I do all the right things. But I can dial in on 2 g, 3 g for whatever the dosage I need. I've now gotten very comfortable determining how much inositol I need and glycine I use as needed but I find it incredibly calming. And I think that in light of the fact that I'm a proponent of lifestyle as medicine first, which I know you are as well, I think supplements can make a big difference in filling in the gaps. I mean, obviously, I think for a lot of perimenopausal, menopausal female, HRT can be a total game changer.
[00:45:57] And it's interesting, when I look at an intake form on a patient, 99.9% of the time before I even get to their medication list, I know if they are on HRT because of their sleep quality. And so, I think it goes without saying that there's no shame in taking HRT. It's a very personal decision, but for a lot of people, they are white knuckling, middle age, and they're not getting good sleep quality. And I think sleep for us really is not just about the quality of deep and REM sleep, but it is so intricately connected to metabolic health, and you can't outrun poor quality sleep. I always say, “If I can't get you to sleep through the night, I can't get you to lose weight.” It is that foundational to our health.
[00:46:45] And so I love that you have, over time, introduced me to a lot of new supplements, and certainly the listeners as well. I would love to just touch on one last subject, something that I've gotten more interested in. The more I've understood the implications of chronic stress on our physiology, but also the interrelationship with adverse childhood events. So, for people listening, understanding that our experiences as children, even if we have perceived it's not a big deal, if we have a high ACE score, not just the impact on chronic stress, but also weight loss resistance, autoimmunity. Dr. Sara Gottfried just wrote a book on the autoimmunity piece interrelated with ACE. But I love that you talk about that as well. I think it's really, really important to reinforce it.
Dr. Lara Briden: [00:47:32] Well, it's certainly showing up in the research. It was a strong signal that individuals with higher-- It's going to be not just the actual events that happened but how they process that. And that'll vary between individuals, but it does correlate quite strongly with later in life, poor metabolic health and food addiction, which we haven't really talked about today. And I think the researchers trying to work it all up. But I think it's really probably, in the simplest terms, it's about a calibration of the nervous system at an early point in life, a very influential point, which is not to say it can't be influenced later. It can, but it will just be a nervous system that's at a set point of more fight or flight or more distress.
[00:48:20] And I think, as I hope has become clear, and we've talked about some of the hormonal aspects on metabolic health, but I'll just say the nervous system is huge, absolutely huge, especially the autonomic nervous system, the sympathetic and parasympathetic, they, in a way, control metabolic health. It's hard to overstate how important they are and of course, the hypothalamus is the boss of metabolic health, and that's where the metabolic set point lives in the brain.
Cynthia Thurlow: [00:48:44] Lipostat.
Dr. Lara Briden: [00:48:45] The adipostat, yeah, the Lipostat. So, deciding how hungry we should be, how much energy we should burn, that's all happening in the nervous system. So, I think it's just about facing reality. I ended up changing. So, the chapter one of my book is called, “Why weight gain is not your fault?” or something like that. My other possible title for that chapter was, “The reality of your situation.” Sometimes, we just have to look at the reality of our situation. And I think having a nervous system that's calibrated to be more agitated at times, and that is just a reality. I mean, somewhere on that spectrum, and I certainly do not have a calm nervous system. And I think number of years ago now, I just came to terms with it. It's like, I just need more relaxation. That's where, for me, yoga comes in.
[00:49:32] And there's many different ways people manage, but you just maybe look at my partner. He's so chill and relaxed, it just falls asleep in a second and doesn't worry about things, doesn't fret, just forgets about things. I'm like, “Well, that's not me.” [Cynthia laughs] but I have a very hyper-charged nervous system. But maybe I think the good thing about that, too. I think people can always try to see, maybe in some ways, that's added to something good, like I'm more alert or I'm more-
Cynthia Thurlow: [00:50:02] Absolutely.
Dr. Lara Briden: [00:50:03] -receptive, or there's always a flip side to it. So, if people are feeling quite sad that maybe they had a difficult childhood and that's led to some of these metabolic problems, just know it's also made you who you are, and it's just the reality.
Cynthia Thurlow: [00:50:17] Yeah, absolutely. And I think there were so many different directions this conversation could have taken, and I love everything related to the autonomic nervous system and the vagus nerve. And I do think, because I've now started speaking more about this on the podcast, that I have a very high ACE score. And I always say that I am an example with a lot of work, both internal and external work, there's a lot that I have to do to calm things down. And so, my autonomic nervous system is primed to be fight or flight, freeze and fawn. And so, I just acknowledge every once in a while, something will come up for me, and I'm like, “I need to work on that.” There's a little scab, and I'm like, “Okay, we need to work on that.”
[00:51:03] So, we're all a work in progress. And if you do have a high ACE score or you tend to run a little bit more anxious, there are ways to work around that and retrain your autonomic nervous system.
Dr. Lara Briden: [00:51:16] Yeah.
Cynthia Thurlow: [00:51:17] There's so many things that you can do. I found personally that Reiki and energy were hugely helpful for quieting that autonomic nervous system, along with some of the supplements I talked about that, for me, will get me out of that the kind of fight or flight mindset and just breathwork, connection to nature, all of which are very, very important. Well, I always love connecting with you. It's been such a pleasure. I loved your book. I hope listeners will check it out and obviously enjoy our podcast discussion. It goes without saying, you're always welcome to come back on the podcast. Please let listeners know how to connect with you and how to purchase your new book, The Metabolism Reset.
Dr. Lara Briden: [00:51:56] Yeah. Thanks, Cynthia. So, I'm easy to find larabriden.com is my blog, website, and all my social media is @larabriden and this book, it's interesting, actually. So, it's got two titles. So, it's The Metabolism Reset in Australia, New Zealand. It's called Metabolism Repair for Women everywhere else, which is a little quirky, but it's just my publisher and I decided to go this way, [Cynthia laughs] and then I've got a couple other books, Period Repair Manual for women of any age for menstrual problems, and Hormone Repair Manual for perimenopause. And, yeah, I just want to thank you for such a great conversation. Metabolism is such a dynamic topic, isn't it? almost every interview I do on this topic is a little different. It takes different angles.
[00:52:35] And I love that we covered a lot of ground, but we ended up on the nervous system. And I think, yeah, maybe we'll have to come back and have a whole deeper dive into autonomic balance. And because it's pretty central to not just metabolic health, but a lot of things. And also, in closing, the autonomic nervous system is one way that metabolic health connects with general health, and there's lots of other ways. So, I'm sure you've had guests talking about metabolic psychiatry. So, there's lots of people looking at the connection between metabolic health and mental health. It's a bidirectional relationship. The same is true for women's health, which is why I wrote this book, because metabolic health is so integral to everything else.
Cynthia Thurlow: [00:53:15] It really is. Thank you again.
Dr. Lara Briden: [00:53:17] Thanks.
Cynthia Thurlow: [00:53:19] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
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