Andrew: So, Kira, can I ask you, then, if we talk about these insidious signs and symptoms, what should we be first looking for, even before people present to clinic?

Kira: Oh. Oh, gosh. What a great question. What should we be looking for? There’s just so many signs and symptoms. I just think anybody not feeling optimum, sluggish, weight gain… We will go into hormone balance as well. But just anybody needing to be aware of what’s going on with their body. I don’t even know if I have a, I don’t know, Lara, set signs and symptoms you wanna…?

Lara: Yeah. I would say the classic sign of insulin resistance is feeling hungry all the time, and being more prone to episodes of hypoglycemia, or low blood sugar, which is kind of counterintuitive, I’ve realized, because a lot of my readers and patients think, well, okay, insulin resistance, pre-diabetes, so that must mean high blood sugar. But actually, blood sugar can be normal in the early phases of insulin resistance. It can even be low at times. And that’s from the metabolic dysfunction itself, sort of not being able to have this steady supply of energy, you know, supplying the cells with energy, so people get blood sugar crashes, and have to eat snacks just to kind of keep their energy up. That’s a classic sign. Other common signs and symptoms are elevated cholesterol. You can get sort of changes in liver function tests, mild ones. If a doctor, if any, if a doctor has ever mentioned fatty liver, that is almost always insulin resistance, not always, because of course, there are other causes. But, again, I’ve talked to many patients who have been told they have fatty liver. They’re quite puzzled by that. They don’t understand that that’s actually related to a metabolic issue.

And then, of course, weight gain, but specifically the weight gain around the middle, or the visceral fat, that apple-shaped weight gain. And it’s important to say that it is possible to have insulin resistance but have a fairly normal body size. And conversely, it is also possible to have maybe a higher BMI, such as what happen with, like, a strong, what’s called gynoid shape, or hip-bum weight shape that women can get. Women can have that and actually be relatively metabolically healthy. So, it’s not synonymous with weight gain. But yeah, you can tell I’m quite passionate about insulin resistance. I think it’s…

Andrew: Yeah. Well, there’s so many questions that stem from that, so forgive me if I’m gonna forget a few. But firstly, one of the things I wanted to just ask you about, and I’ll ask you, Kira, was women overtaking men with cardiovascular disease. This has been seen since the 1980s, I think. But, you’ve also spoken about the paucity of good research on women. So, is this a case that women weren’t researched, or are we really truly seeing a flip, an increase in cardiovascular disease in women over men?

Kira: That’s a great thought. Look, I think it’s both. We have, you know, women are cardiovascularly…is that a word? But our cardiovascular system is quite protected until perimenopause. And then when we’re starting to lose hormones, we lose a lot of that protective buffer that the hormones gave us. So, the cardiovascular risk greatly increases once we’re hitting peri and menopause and beyond. There is risk before that, more genetic and lifestyle, but our risk…we’re very buffered because of hormones. So, the big risk then comes when peri hits. And that is half of women’s lives, they’re now gonna be at greater risk. So, we don’t have the same risk as men until we start losing those hormones. And then we have quite great risk. And then the issue becomes, we haven’t researched women, especially in cardiovascular risk, but we haven’t researched women nearly to the level of men. And so, we also don’t recognize a lot of the early signs and symptoms. We don’t recognize, like, women presenting with a heart attack or myocardial infarction, it can be a totally different set of symptoms, which get dismissed even in emergency, or with ambulance, or just by general people. They almost can have these predronal symptoms for a few days while things aren’t going well. And so there is a lot of education now around what the extra, different symptoms can present. But, again, it goes to the idea, or goes to the fact that women, through all stages of life, have a lot more… I don’t really wanna say medical gaslighting, but a lot more dismissive symptoms that we’re told just to live with it, or that’s normal, or your pain, just deal with your pain when things are getting pretty bad. So, I think it’s a coupling of everything for them. And then we have insulin resistance coming, and then it increases cardiovascular risk on top of that.

Andrew: What you said just sparked anger in me, because I have actually seen this. Women being told, “It’s all in your head.” We know the endometriosis story. “It’s all in your head.” Actually, no. Other end of the body, mate. But I’ve seen, just so that you know, I’ve seen women doctors dismiss women for this. And it’s just…I’m befuddled. But anyway, Lara, you had something to add to that. Forgive me.

Lara: Well, I was just interested. So, did you have some statistics suggesting that overall heart disease is increasing in women? Because one thing, and I haven’t seen those numbers, but one factor is smoking, right? Like, men used to smoke a lot more than women did. And so, the quitting smoking, collectively, as a society, has changed some of the numbers around cardiovascular disease.

Andrew: Right. So, the stuff that I’m going off, I mean, I was looking at even things from Cedars-Sinai. I haven’t looked at the Australian Institute of Health and Welfare, AIHW. But I do remember reading something years ago that women were overtaking men in certain types of heart disease. Now, whether that was cardiovascular disease, I’m not sure. But Cedars-Sinai attributed it to the introduction of women, post the 1980s, into the, in equivalent amounts in the workforce. And I think it goes much further than that, but anyway… I think that’s

Kira: Oh. Oh, oh. It’s the late ’80s and the early ’90s when we started actually allowing women into clinical research in any numbers. So, the likely…like, I’m making an assumption here, but the likelihood is our stats were probably higher than we ever knew. But, you know, it’s, life’s too dangerous for women to be in clinical research, or, it was. And depending on what country you’re in, there still are or are not laws around the inclusion of women in research. We are getting a lot better, but it’s not… Some countries just have guidelines, not laws.

Andrew: Yeah. Lara, if I can I ask you…

Kira: Australia, I’m looking at you.

Andrew: Yeah. Absolutely.

Kira: Yeah.

Andrew: Lara, can I ask you, you mentioned a few of those early symptoms of glycemic dysregulation, and whether it be normal, high, elevated, or depressed, with their glycemic measurement. That smacks of what we see in Hashimoto’s, where, you know, the gland that we’re dealing with is an efficient pump, if you like, an efficient producer of the hormones. And so, damage doesn’t really get to be 100 percent until a whole lot of the gland is damaged, and there’s only a certain portion left. Similarly, in the thyroid gland, it can sort of take the load, if you like, during the damage of Hashimoto’s. So, you can go, have elevated thyroid hormones, depressed thyroid hormones, or they can present as euthyroid until a certain point. Is that what we’re seeing? Is it that the pancreas, what are we talking, alpha cells, beta cells, are being damaged, and we only see the full metabolic dysregulation when a lot of those cells have been damaged?

Lara: Broadly, I mean, I think the concept you’re talking about is this idea of metabolic reserve, that there’s some resiliency built into the system at first. And as it starts to fail, then you get less ability to maintain homeostasis, for sure. I think one difference from thyroid, though, is a key part of insulin resistance or metabolic dysfunction is actually what’s happening in the cells and the mitochondria, and the cells that are receiving the insulin signal are supposed to be receiving the insulin signal. And to be fair, that’s a factor in thyroid disease as well. You can certainly get some degree of resistance to thyroid hormone. But it’s not analogous in that, yeah, I don’t really think about the pancreas so much. In fact, I don’t even sort of talk about the pancreas so much in my latest book on metabolic health. I’m talking more about the mitochondria, the cells themselves, a lot about the liver, and all the other organs that are responding to insulin, and that are also working together with the pancreas to try to control blood sugar. But yes, you’re right. In terms of what you described, the dysregulation of blood sugar is end-stage. There are much earlier problems with insulin resistance, including a lot of inflammation, and just including the chronically elevated insulin itself, that’s causing problems, really, years before blood sugar goes out of range.

Andrew: You mentioned inflammation there. Can you talk to us about that, about what role it plays?

Lara: Well, yeah. Well, the state of being in insulin resistance or being metabolically inflexible is a state of inflammation. It’s bi-directional. So, chronically elevated insulin creates inflammation to some extent, and also, underlying other causes of inflammation can create insulin resistance. I’ll give an example that would be interesting, too, as naturopaths, because, of course, everything always comes back to the gut. So, there is quite a bit of research, Andrew. I’m sure you would have come across the term metabolic endotoxemia before. I think that’s a really important one. This is about, essentially, the LPS, like, the endotoxins coming from the gut via intestinal permeability, inducing insulin resistance in the rest of the body, in part by the way it inflames the visceral fat directly, because it’s in close proximity, the intestine’s right there. And then, of course, it affects downstream from that. It affects the liver, and it affects the body’s ability to respond properly to insulin, to metabolize energy properly.

And how many of us clinicians… There’s two patient stories in my new book about metabolic health, where you fix the gut, and then their sugar cravings just go away. I mean, one of the patients is someone who, she knew she should stop having sugar. She was really craving sugar. She was trying to mentally make these changes. And I was like, well, let’s just wait, because you do have SIBO and intestinal permeability, or in one case, you have blastocystis going on, you know, parasites in the gut. So, let’s focus on the gut and then see what happens. And that is a good example of how dynamic metabolism is, metabolic health is. It’s not in a separate compartment from the rest of health, right? Like, it’s affected by gut health, it’s affected by hormone health, it’s affected by the nervous system in a big way. It’s probably ultimately controlled by the nervous system, actually, I would say even more so than, say, by the pancreas. It’s a very dynamic part of our health, and it goes very deep, right to the level of the mitochondria, which is why there’s so many, you know, just so many factors, so many interconnections.

Andrew: Yeah. Kira, can I ask you, then? You deal with a lot of athletes, and exercise is an important component in metabolic health. Talk to us about how important exercise is, how does that tie into inflammation, or managing inflammation, like, people who over-exercise, for instance, or try to keep up with somebody who’s at a higher level of exercise, and they just get inflamed?

Kira: Yeah.

Andrew: And yet there’s that concept that some stress is good, even for our mitochondria.

Kira: Yeah. Oh, my gosh. That was, like, five questions. So, and Lara…

Andrew: Yeah, sorry.

Kira: …come in if you wanna come in on the inflammation one. Exercise is, I mean, we know how important it is, but especially in insulin resistance or metabolic inflexibility, if we’re saying, you know, yes, we need the body to be in this healthy state, we need the right nutrients, we need that gut health, and decrease the inflammation, support the nervous system, all of that holistically comes into play. But unless you have or are working on fitness, you are not… Oh, my gosh. So many things. You’re not stretching the cardiovascular system, but you’re also not creating mitochondria. We gotta remember, mitochondria are residing in all of your muscle cells. You know, there’s millions of them. But unless you’re building muscle or maintaining muscle, especially as we age, we are drastically losing mitochondria, and their ability to function can decrease as well. So, it’s, you know…oh, my gosh. There’s so many things to be done there, working on mitochondrial health, in building muscle, actually doing… You know, the big thing, again, this is, you know, women, once they hit peri and beyond, but really, it’s for everybody, we’re realizing how important doing weights is over constant cardio, or high, thrashing cardio, you know, people doing HIIT classes all the time, hoping they’re gonna burn fat.

It’s, yes, hypothetically, that’s working, but only to a degree, and then over-training, creating too much stress on the body, creating too much inflammation, there’s that fine line between how much exercise is optimum versus too much, and it’s different for each person, male, female, different body shapes can cope with different volumes of stress as well, we’re finding. So, there’s that whole, I mean, it’s a whole spectrum of what’s working for your body might not be working for somebody else. But the more we’re exercising, and creating, you know, mitochondrial biogenesis, the better we are for maintaining the right physique that we’re looking for, optimum physique, because it’s more engines to burn more fuel. People often forget, the only place we’re burning fat in the body is inside the mitochondria. So, we need healthy mitochondria in able to allow, you know, both fat, carb, and protein burning, which is a big thing. And if we’re unfit, if we’re low in muscle, if we’re insulin resistant, the problem is, with insulin resistance, or the issue, is you, at a lower level, or lower level of fitness, lower, you know, issues with insulin, we will pop into carb burning. I’m being very unscientific here, but you pop into more predominant carb burning quicker the less fit you are. So, it’s also this slow process for people, as they gain fitness and mitochondria health, that they will, their engine will start to burn better, but we need to give it time. And if we’re going too high-intensity all the time, we’re not… Yes, it’s great for the body, but we’re not assisting…we’re not slowly getting the mitochondria to do a better job.

Andrew: Yeah.

Kira: I hope that made sense.

Andrew: Lara, have you got anything to add to that? I just want to ask a question after that about types of fat.

Lara: Yeah. Yeah, well, I was just gonna, two things. So, in an Kira and my upcoming webinar for practitioners, about metabolic health for women, we are gonna talk about different body types. Pretty much what Kira just touched on there, like, different body, not just shapes, but I would say different nervous system types, different metabolic types, really. People do better with different types of movement. So, some people love that kind of, that high-intensity, rapid sort of movement. Some people are gonna do better with the slow strength training or the walking. And it’s a lot to do with the nervous system. So, we’re gonna explore that in some detail. I’m really looking forward to our usual back-and-forth, when we do our duet-style webinars. We have fun together, sharing our knowledge.

And then the other thing, just to touch on what Kira was talking about there, which is just an important detail, that I sort of want everyone to understand. In a healthy, with a healthy metabolism, with healthy insulin sensitivity, healthy metabolic flexibility, our default, when we’re at rest, or engaged in light activity, is fat-burning. Fat-burning is our, actually, what, where we’re supposed to be. And in a healthy state, we should really only tip into more predominantly carb-burning when we’re engaged in high-intensity exercise. As a caveat, we’re always burning a mix of fuels. I don’t want anyone to go away thinking we’re only burning fat. It’s always a mix, but it should be predominantly fat-burning when we’re healthy, at rest. Yeah.

Andrew: You know, I think the point there is you get these people that go, “I’m gonna burn fat,” and they’re, like, this tense, and [vocalization 00:20:28] and they’re not enjoying the exercise. “I have to go to the gym. I hate it, but I’m gonna,” you know, that sort of thing, rather than going for a bush walk, or going for a walk along the beach, and enjoying the walk, and moving the rest of their body, not just their legs, and, you know, the picture in my mind that is conjured is the blue zones. And I picture this, you know, grandmother from Corsica, climbing down the mountain steps for the, her love language, which is cooking for her family, and collecting the herbs and the vegetables out of her garden, that’s a little bit down the path, and putting them in a basket, and walking up. She’s bent over, she’s moved her hands and her upper body, and then she’s doing the walking and carrying extra weight, da, da, da. And then she goes, and all of this is involved with a love, you know. And I think if we could engender that in our patients, to love what, while they’re exercising. to really enjoy it. It’s a major flip, going right back to inflammation there.

Kira: Yeah. Can I just say, too, exercise is not a punishment for anything we’ve done or anything we’ve eaten. Exercise should be joyful, and again, part of what we’ll explore, but the whole body type, or nervous system type, what types of exercise suit you, so that they don’t put too much stress on the body, because some body types can go really hard early in the morning, and they can handle that high, high cortisol. Other body types are gonna really struggle…you know, they’re more sensitive to that morning high cortisol, and we’d be better off exercising in the afternoons. And just finding the exercise that you love, absolutely. Bushwalking, hiking, gardening, my god, you know, if you’re talking blue zones, gardening is some pretty hard exercise. My body hurts gardening. But yeah, whatever is working for people. It’s not…yeah. And I find for a lot of people, too, and I, you know, it’s kind of getting away from naturopathic principles, more into exercise phys, but also, you know, socializing while you exercise is a big thing for some people. And that’s incredible, especially for women, for our nervous system. You know, we have all this research around being with other people being so great for our nervous system, and calming us, and I think we forget that, and then we suffer alone, thinking we have to do all this exercise by ourself.

Andrew: Yeah. Get a dog, and exercise with it. Or, get a cat and watch it while you’re exercising.

Kira: There was something else I wanted to say about exercise, but… Yeah. Keep going. I’ll think of it in a minute.

Andrew: Can I just go back to, when you were mentioning fat? We’ve got different types of fat, brown versus white, and there’s some research showing that you can actually change that. Have we got any more research on what we can do to effectively change to having more brown fat, and therefore more of a thermogenic body type?

Kira: Lara, you want that one?

Andrew: Yeah, Lara. Sorry.

Lara: Well, there are lots of theories. I mean, the research around brown fat, and beiging white fat into brown fat, is, I think, all pretty new. I don’t know, but Kira, I’d like to hear what Kira thinks. I don’t think there’s much, sort of, evidence-based, conclusive, this-is-something-you-can-do-for-sure. I mean, it’s only been, like, 20 years since we even discovered that adult humans have brown fat.

Andrew: Yeah.

Lara: Before that, we thought only infants and hibernating mammals had it. So, this is all quite new information. I mean, I think the research is clear that people who do have more active brown fat do tend to have healthier metabolism. Like, they tend to be more insulin sensitive. Some of that’s gonna be genetics. Some of it’s just luck. I mean, I don’t know. There’s different factors. What do you think, Kira? Is there anything, any tried-and-true recommendations for that? Exercise is one way, potentially.

Kira: Exercise. It’s definitely genetic. You know, carrying fat is, let’s be honest. Carrying fat is so genetic. It’s, you know, and it’s also, have you turned on those genes that are, you know, your body’s starting to store more as well. So, it’s genetic lottery, and then, how well you keep some of those genes turned off or not. But with brown fat, you know, the one thing that comes to mind is cold exposure. But I went down a rabbit hole on this the other day. How much research we have on females and cold exposure versus males is also questionable. And I like cold exposure. I like the idea of it. But again, we take ideas and then we go so hard with them, and we do it all the time, and I would question for the female physiology. And there are people pointing out too cold might be too much for a female body, or, you know, we might not need to be as extreme as we think. But I don’t know how much deep research there is on that yet. I think that’s kind of up-and-coming. But I would, you know, it’s just like people talking about fasted training. Fasted training, you know, exercise in the morning, while fasted, yes, you hypothetically will burn…we know you’ll burn a few more grams of fat, but eating before training actually helps stabilize cortisol. You know, cortisol will not go as high during training if you’ve eaten a little bit, especially carbohydrate before training, but protein can work. And there are theories that, you know, especially for certain body types who are more sensitive to cortisol in the mornings, it might be better eating before training, just a little bit something, to attenuate that rise in cortisol, so the body’s not freaking out all the time that, you know, it’s starving. So, oh my gosh, it’s a little bit of everything works really well. But as humans, we’re, like, “More is better.” And then we dig ourselves a hole, I think is really where my opinion is coming to.

Andrew: So, is this what you’re going to be covering in your webinar. You gonna be covering different body types, different genetic types, obviously, and then how there are commonalities between…that we all should do. And then are you gonna branch off into how that body type, for instance, a gynoid body type, might be better served by a certain type of exercise, and perhaps eating patterns, and then an android type body type might have a different set of specific regimens to stick to?

Kira: Lara, you want to explain what we’re

Lara: Well, actually, the body types we’re gonna touch on, and it will just be part of the webinar, is actually the ph360, sort of six body types, which are more based on kind of an expanded version of the ectomorph, mesomorph, kind of endomorph types, but from a female perspective, in our case. And so, but the webinar is a half-day webinar. We’re going to… It’s sort of a, it’s a look, a closer look at insulin resistance, and how to assess that, and how to treat that, and recover, and Kira’s gonna talk a bit more about the metabolic flexibility she’s just been describing, this sort of, moving this, what’s called sort of a crossover point between burning fat and burning carbs, and basically being able to stay in fat-burning for more of the time, or predominantly fat-burning for more of the time, which is beneficial for, yeah, metabolic health, and just for feeling better too. So, it’s not just about, you know, it’s definitely not just about obtaining a certain body composition or anything. I mean, I really don’t even really like the term body composition. I think it’s about having energy, and feeling good, and having a reduced inflammation, reduced risk of heart disease, and all the downstream consequences of insulin resistance if it’s not addressed. And for everyone listening, insulin resistance, or pre-diabetes is 100% reversible. It’s gonna be a little bit different for every person, in terms of how long that takes, and what strategies they want to employ. There really isn’t a cookie-cutter, one-size-fits-all, which is why we need a half-a-day webinar to explore it. And of course, it’s also the topic of my new book on metabolic health. So, I’ll be drawing on some of the things I learned when I was writing that book. Yeah.

Kira: Yeah. And where… Sorry. I know

Andrew: Can we go into therapy? Oh, sorry. You go.

Kira: Yeah. So, it’s, you know, body typing is only one little thing we’re going into, because it’s, you know, it’s a little lens that we have to, you know, look at between each person, because it’s not one-size-fits-all, but, you know, I’m the numbers girl when it comes to our lectures, of doing much more like, we’re looking at macros, we’re looking at…we are gonna look at calories, because you can’t not look at fueling a body, not calorie-counting per se, but we’re gonna look a lot at how the physiology of the body is operating in insulin resistance, or when somebody is moving away from it, and the things that are gonna, the things we need to be doing to get there, to a more, you know, a better state, rather than insulin resistance, so, it’s very much, we’re very much not teaching just the science. We’re teaching, or presenting very much a how to, what to go do with this, right? You need something to go do, rather than just learning the theory.

Andrew: Let’s go into what we can use alongside our exercise and our diet therapy. What do you find most to have merit? Things like, you know, for instance, polycystic ovarian syndrome, with, you know, using myo-inositol, for instance. Now, Professor Annabel Teede [SP] basically dismissed myo-inositol in her, I’ve gotta say, it was a fantastic podcast on polycystic ovarian syndrome. This was a medical one. And I suspect, though, that one of the reasons she dismissed it was because many of the supplements out there that have myo-inositol in them have a paucity of dose. They have, you know, a few, 20s or, you know, scores of milligrams, or maybe a couple of hundred milligrams. But I’ve seen gram doses of myo-inositol being employed. Where do we go here?

Lara: Well, I could speak to…

Andrew: Lara.

Lara: Yeah. Go ahead. Yeah. I mean, I… Inositol is quite an important supplement for metabolic health. I’ll just preface it, though. I’ll just say, just again, it’s kind of a bit of a paradigm shift around this, but the, I guess my key message around metabolic health, and I explore this in my book, and I’ll explore this with Kira in our webinar, but it’s not separate from general health, right. Like, it’s really not. It’s not like we’ve got the things we need for, to be, you know, to feel good and have energy and have general health, and then the things we need for metabolic health. They’re one and the same. So, this is where the troubleshooting approach comes through in my book. I’ll explore that a bit in the webinar as well. Like, you really do, you know, fix your health, and you’ll fix your metabolism. This is, like, similar to the principle from my first book, on period health. It’s fix your health, and you’ll fix your period. They’re not separate. So, this is why I give examples of fixing, for some people, fixing their digestion, and they’ll, you know, fix their metabolic health.

So, there’s different ways to access it, different levers you can pull, but, in answer to your question on inositol, it is a particularly well-researched supplement for insulin resistance. And there’s not a paucity of data, actually. There’s a huge amount of data on inositol for the insulin resistance of polycystic ovary syndrome, and perimenopause. I mean, I would say it’s one of the most evidence-based supplements out there. So, I’ll have to circle back and listen to the podcast where she maybe, I guess, didn’t feel like it, you know, crossed some kind of finish line to arrive at treatment, but it was included in the international guidelines for PCOS, both in 2018 and in the updated ones now. So, it’s one of the few supplements that’s actually come pretty close to crossing that finish line to get there, so… And I know a lot of doctors use it, and it’s, well, just speaking anecdotally, it’s extremely popular in the PCOS space, and you’re right. It’s gram dose. Yeah.

Andrew: I think her opinion was based on the paucity of doses that we have in supplements.

Lara: Oh, the low doses. Yeah. No, it’s a gram dose. It’s probably four to six grams a day to get there. And yeah, it’s one of those, it works in each and every cell, right, so we need quite a lot of it, because we have quite a few cells. So, one of the things it’s doing is, it’s doing different things, but it improves the signaling of insulin, directly enhances insulin sensitivity. It also improves thyroid function and sleep and…yeah.

Kira: Yeah.

Andrew: Now, I didn’t know that about thyroid.

Lara: Yeah. It amplifies TSH inside the cell. It’s an intracellular messenger. So, it kind of…if I’ve got the right…I’m not a biochemist, so I don’t have the exact sort of details of what it’s doing, but it’s kind of relaying the message of different hormones inside cells. And it’s, yeah, it’s pretty popular. And one, a couple just fun facts about inositol. We can make some of it. So, the body does make some. So, there’s that. I mean, we traditionally would have had a lot more in our diet, because the, I think it’s a type of phospholipid inositol is quite high, in high concentration in organ meats. So, I do  in my book on metabolic health, I do talk about our disconnect from our traditional diets, and how that has, in part, set us up for metabolic dysfunction. Chapter one is called “Metabolic Dysfunction is Not Your Fault.” Some of it is the drastic change in our food supply, and also environmental toxins, which we haven’t even really touched on yet. But that is having a epigenetic or an intergenerational effect, so that now, I mean, this intergenerational effect is pretty important.

So, we are now getting teenagers with pre-diabetes, in some cases type two diabetes, and fatty liver. That was unheard of 50 years ago. And it’s not like 50 years ago, our diets were perfect. I don’t know about you, Kira, but, like, you know, I would eat a whole row of Oreo cookies, or, you know, chips, or, like, you know, I wasn’t a… I had, in many ways, there was a good diet in my house, but not perfect. But we, back then, in the ’70s, we, there was not, in the ’70s and ’80s, when I was a kid and a teenager, there was not the insulin resistance and obesity that we’re seeing now. So, this, something has…do you hear what I mean by amplifying each generation? This is epigenetics. So, kids are being set up, like, in utero, and even before they’re born, actually, with, you know, genes being switched on and off to be extra vulnerable to our modern environment, including our food environment.

Andrew: Kira, anything

Kira: Yeah. Yeah, and… Yeah. Well, we just have that old, you know, ultra-processed food is the big word, you know, everyone’s now using, and if we look around, it is. It’s not just the liquid calories coming from sodas. Although there is research I read a little while ago saying teenagers get somewhere between 60% and 80% of their daily calories via liquid, which is just a frightening statistic. I think that was a U.S. statistic. I’ll just put that there. Yeah. Well, you can buy Big Gulps over there. You know, in Australia, our size of drinks is actually smaller than over there.

Andrew: The “Super Size Me.”

Kira: But, yeah, ultra-processed food really hit in the late… Well, I think it was the late ’50s, early ’60s, and then by the ’70s, we have a lot more of it. And, yeah, what’s happening with our genetics? Is it getting turned on or not? So, I had this discussion the other day with some other practitioners, and they were commenting that I am always lean. If people have or have not met me, I’m not a super-skinny person, but I’m very fit and tall. And Lara and I always joke about this. I’m built like a little, like a big Viking, and Lara’s built like this tiny little… We’re very different body type. So, we love lecturing on this stuff, because it’s so different for each of us. But, you know, even if we’re coming from a genetic background that’s not great… I definitely own every obesity gene that you could inherit from…my genetics. It’s just about that diet and lifestyle, not turning it on, or keeping it quiet, keeping it, you know, asleep, that’s gonna come into play for a lot of people as well, if you don’t feel like you’ve won the genetic lottery, which I definitely didn’t. Which is why I studied nutrition.

Andrew: Let’s go back to, we’re circling back a bit here. Lara, you were talking about how important the gut is, you know, and you fix the gut…

Lara: Yep.

Andrew: …everything else falls into place. Talking about supplements that we can employ here, ordinarily, we would think about employing bacteria, probiotics, and obviously, to go with that, prebiotics, to help them stay and proliferate in the gut. But what about other things like berberine, where it’s got this sort of other effects with helping blood sugar control? How do we employ it responsibly, where it doesn’t become an “anti-infective,” i.e. decimating the good guys? How do we employ it effectively? What dose do we use? How long should we use it? What are the caveats to use?

Lara: Well, there are lots of different opinions about this. So, I’ll just point out that berberine, obviously, is a superstar for metabolic health. It’s also very popular. It’s quite similar to metformin in some ways. For example, they both stimulate something called AMPK. It’s a kinase that’s very involved in metabolic signaling. But they also are both, as you pointed out, antimicrobial, antibiotic. And that is possibly how, in part, how they work, by reducing the metabolic endotoxemia that I talked about earlier. So, especially if they’re knocking back a SIBO, or a small intestinal bacterial overgrowth, that is driving intestinal permeability and metabolic endotoxemia, that could be one mechanism by which they’re working. In terms of your question, like, how to dose it, I can tell you what I do with my patients. And then, to Kira, we can hear from Kira, and then we can see what you think, Andrew.

I mean, certainly there are products out there that seem to be recommended to dose them ongoing, daily. That’s not what I personally, it’s not how I personally use berberine. I tend to use it, and the way I talk about it in my book, I think it’s secondary to, say, magnesium or inositol, or choline is another important nutrient that is a part of these five key metabolic nutrients that I identify in the book. And then berberine is, like, an accessory one, that would be particularly helpful, I think, if there’s SIBO. So, if there are gut problems, then I would typically do, like, an eight-week course of it. I don’t do it every day, because there’s some research that berberine works better if you take it maybe five days a week. So, I might say, you know, take this berberine product twice daily, weekdays only. You just need to take a little break on the weekends, take it for one bottle, then take a break, then do another bottle. And all, of course, that’s after screening for any contraindications, because berberine can interfere with certain medications. It’s not safe during pregnancy or breastfeeding. I think it’s not suitable for people who are taking metformin. I think it has to be metformin or berberine, not both. Although metformin can be combined with inositol or magnesium or some of the other ones. So, that’s kind of my view. I’m open to change on this. Like, I’m open to new information and revising my opinion about berberine. I know there’s lots of debate about how to use it. What do you do, Kira? How often do you prescribe it?

Kira: Yeah, I tend to do kind of four to six weeks on and then four to six weeks off. I hadn’t read that research about not every day, but I’m always under the assumption my clients forget to take supplements a few days a week, like I do.

Lara: Yeah. It’s a safe assumption.

Kira: I’m a huge fan of berberine over metformin. I mean, if people are on metformin and it’s working for them, that’s great. But from a physiology perspective, there is some research saying metformin inhibits muscle growth. So, I’m always keen… Again, legally, I would never take anybody off any drug, but I’m keen for the more natural, you know, I’m keen for berberine over metformin if I can, especially if we’re trying to grow muscle, which is growing mitochondria. So, I just, I struggle with that one a bit because I’m working with so many athletes. But I have a lot, you know, stats came out this week that 40% of Olympic female athletes potentially have PCOS. Did anybody see that stat?

Lara: No.

Andrew: No.

Lara: That’s intriguing.

Kira: Yeah. Oh, yeah. Well, so, Olympics is on this week, when we’re filming this, and… But it makes sense, because they have higher androgens, and a little bit higher androgens makes you a better athlete for a lot of different sports. So, big conversation. And I think that’s beautiful to know for the people with PCOS, is 40% of these elite athletes are dealing with that.

Andrew: That’s quite stunning. I thought it was androgen dysmorphology, but it could be just androgens driving it. Is that what you’re saying?

Kira: We don’t know. You know, I would love to see

Lara: Well, I think what’s happening…

Andrew: Really interesting.

Lara: I suspect what’s happening is that, sort of, the higher-androgen women are the ones that succeed at sport, for some sports. Gonna depend on the… And the thing is, there’s a sliding scale of androgen. Like, at what point do you cross over to being androgen excess, you know, sort of? And also, we’re all higher-androgen when we’re younger. That’s true for men and women. So, this is, it’s a hormone we slowly lose.

Andrew: But it tends to trash that old concept of polycystic ovarian syndrome was that syndrome X, where the apple-shaped obesity, and da, da, day. It just trashes it. Doesn’t it?

Lara: Oh, well, it’s… Oh, I hear what you’re saying. To have androgens, but not insulin resistance.

Andrew: In Olympic athletes.

Lara: It’s completely possible to have androgens with that… Yeah. Well, of course. They don’t have insulin resistance. No, of course. So, no, PCOS is not…

Kira: They’re doing an awful lot of exercise.

Lara: PCOS is not… I would say the research suggests that at least, well, it depends on the individual, but I think there’s many cases where the androgens come first. And then in women, androgen excess promotes or causes insulin resistance, and in the other direction as well, so it could become a vicious cycle.

Andrew: Gotcha. Okay. So, moving on, we’ve spoken about stress quite a lot. Let’s talk about things that we would ordinarily use, magnesium. There’s certain beautiful herbs, the ashwagandhas, the ginsengs, the American ginseng. Just saying. I love American ginseng. Are there any particular herbs and nutrients that you employ for stress? And particularly, I’m gonna ask this on a personal level. What about those women that run on stress?

Kira: Lara, do you wanna go first?

Lara: Well, I mean, of course, my combo is magnesium plus taurine. I talk about that in all three of my books. They both support GABA. Although, to be fair, there are some people who don’t feel great on taurine, but most of us do. And there’s just a new product, a new supplement, which I just ordered for myself to try, which is a particular version of a magnesium taurine chelate. I think it’s, like, lipophilic or something, or, like… It’s got some extra absorbable, so it apparently crosses the blood-brain barrier. I should have researched this better before mentioning it today, but it’s a magnesium taurine combo that is supposed to be extremely calming. So, yes. So, that’s a good combo. I’m also a fan of adaptogens and some of the anxiolytic herbal medicines. I’ll mention, I’ll give a plug to glycine as well. Glycine is one of the other, that’s one of the five of my five metabolic nutrients. So, glycine is also very calming, and is done well in terms of treatment for metabolic dysfunction and insulin resistance. It works in a few ways, but one of the ways is probably calming the nervous system. Promotes sleep.

Andrew: But what dose do we have to employ of glycine there?

Lara: Gram dose. Three grams. Yeah. Probably. I mean, you’re getting some with the magnesium glycinate. So, you get… I just had a quick look, like, at your standard dose of magnesium glycinate that would deliver 300 milligrams of magnesium, sorry, I think gives you about 1 point something, maybe 1.4 grams of glycine. It’ll depend on the product. But the therapeutic target range for glycine is about 3 grams. So, people can top that up if they want. I saw someone on Twitter the other day talking about glycine saying, “This can’t be right.” You know, it tastes sweet. It tastes nice. It has no side effects, and it helps you sleep. It’s like, where’s the catch? You know, where’s the downside?

Andrew: Kira, anything to add?

Kira: Well, I’m all about the magnesium. Taurine as well, obviously. And I’m all about the nervous system herbs. Yes, adaptogens as well. You know, any and all adaptogens, but especially withania or ashwagandha. I’m huge on schisandra, because it’s also, we’re getting that little bump for the liver. I think it’s an forgotten…not forgotten, but we… Yeah, I just think it needs a bigger plug. Yeah, schisandra, withania. I especially, I use them in combination in the mornings for people. I love the ginsengs. The ginsengs, I think, are kind of forgotten these days. And I, especially Siberian ginseng. Love it. I do love the American ginseng as well. We don’t talk about that enough in Australia. And, oh, nervous system herbs. So, I’m loving the magnesium with nervous system herbs at night, just to help pull everything down, better sleep.

One of the things we haven’t touched on today, and I’m not meaning to take it away from supplements, is circadian alignment, and the research on circadian… And it’s a big part of our talk. It’s a big part of the bit that I’m talking on, is circadian alignment and misalignment. You know, one week of circadian misalignment starts to show insulin resistance signs. So, really getting back to rhythm of when we should be eating, when we should be sleeping, the rhythm even of our digestive system, which often isn’t talked about. You know, our insulin works better at different times of the day. So, that’s, you know, I’m a huge, back to supplements, on great magnesium herbal supplements that help you sleep, I think are a big part of this picture. As well as mitochondrial supplements, you know, things that help… You know, we forget about ATP, and actually energy creation in the cell. There’s so many nutrients that we can easily be deficient in. And we then don’t make as many ATP per glucose unit, or per fuel unit. And it comes down to how good we feel, how much we can do per day.

Andrew: Yep. Can I…there was something I’ve been meaning to ask, and it goes right to the beginning of our chat, when we’re talking about mitochondria. We would ordinarily think about, yes, CoQ10. It’s just the automatic nutrient that we think of for mitochondria. How do you use it, though, when we’re talking about balancing it, if you like, with inflammation, or stressing the mitochondria? Do you use magnesium always alongside it? Can I get a comment from you, please, Lara, just about if and when you use CoQ10?

Lara: I don’t prescribe it that often. I’m, not that I think it’s not good. I mean, I think it’s certainly…occasional…I’ll prescribe it for maybe fertility or certain aspects. But I think, I mean, my go-to, and we’ve been talking a lot about magnesium. The mitochondria love magnesium. They seriously love it. It’s like, it’s, you know, it’s inside their, you know, it’s part of their key electrolyte, or it’s a mineral for functioning. And also, just mitochondria, I’m starting to think of them quite differently, actually. They are not…they’re way more than just, like, one little cog in the machine. Like, they’re super dynamic. And there was just some research, which unfortunately did not make it into my book, because it’s that new, it just came out in the last month or so, that mitochondria change just in response to positive versus negative experiences. being with a person we love, or, you know, going camping, well, your mitochondria will be like, “hooray.” Like, you know, they’ll multiply.

Kira: Oh, my god. That’s amazing.

Lara: Yeah, it’s pretty amazing. So obviously, Kira mentioned… Yeah, Kira mentioned, you know, moving the body, building muscle stimulates mitochondria. Mitochondria respond to every hormone, especially estrogen and thyroid hormone. They, mitochondria really…certain things they don’t like. Obviously, just any kind of… Well, overeating. Any kind of energy excess in general is quite stressful for mitochondria. But sugar in particular can be quite stressful for mitochondria. Alcohol, for sure. And also, I’ll just inject a little maybe controversial point about a food substance that might be toxic, or not toxic, but harmful to mitochondria in high dose, would be linoleic acid, or omega six. This is the whole seed oil controversy. We couldn’t have a podcast about metabolic health without touching on the seed oil controversy. But if seed oils are causing a problem with metabolic health and insulin sensitivity, it’s via what they’re doing to mitochondria, I think, as, amongst other things, probably. Yeah.

Andrew: Kira, anything to add there, with regards to CoQ10?

Kira:  A, I want that research, Lara. Send it through.

Lara: Yes. I’ll send it.

Kira: we get ready to do lectures, research kind of goes back and forth a lot. Look, for mitochondria, for ATP production, if we think about that, we’re looking at all the B vitamins. You know, B1, B2, B3, often, you know, they’re not the heroes that everybody talks about, like 9 and 12, 5, 6, but we need all the Bs, alpha-lipoic acid, we need zinc, we need… There are so many things needed, you know, all those micronutrients. And if you don’t have, you know, the right ingredients, you’re not baking the right cake. That’s probably a bad analogy, but… But yeah, you know, a lot of the basics need to be there.

Lara: So, quick question around mitochondria. Do you know why, I’m sure you both know this, but do you know why brown fat is brown?

Kira: Oh, I

Andrew: The amount of mitochondria? Really?

Lara: It’s packed with mitochondria. And some of that brown is from the iron in mitochondria, so iron is another important nutrient for them as well.

Andrew: There’s something I had on my list, and we just haven’t got time to go through iron dynamics today. Will you be covering this in your webinar, though? Iron dynamics? Because it’s a huge issue.

Lara: Yeah. Oh, I’ll touch on iron. I think we’ll touch on iron, just because we’re gonna…

Kira: We’ll squeeze it in.

Lara: But we probably won’t go into it as much detail as some of your other guests, so you might have to

Andrew: Oh, I wish I had two hours to podcast with you guys. There’s so much we could talk about. Guys, unfortunately we’ve run out of time, but I’m glued… Like, I love listening to you guys and learning from you. Every time, there’s always a new thing that I learn from both of you. Thank you so much for sharing your time with us today. I really look forward to this webinar. Everybody, if you have any interest, you really need to be attending this webinar. You’re going to be listening and watching two experts, true experts in this field, that can help guide you, and therefore your patients through these difficult quagmires of metabolic health. Lara Briden, Kira Sutherland, thank you so much for joining us today.

Lara: Thanks, Andrew.

Kira: Thanks for having us.

Andrew: And thank you, everyone, for joining us today. Remember, we’ll have all of the show notes for today’s podcast and the other podcasts on the Designs for Health website. Thank you so much for joining us. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”