111: The Truth About Weight Loss, Visceral Fat, and Metabolism with Dr. Ashley Lucas

There's no question about the fact that we have a metabolic issue in our society. I think less than 10% of Americans are metabolically sound. That the number of diseases that are caused by diet and lifestyle is upwards of 90%. And our metabolic health, as I have said repeatedly, is. Is completely disregarded by mainstream medicine. And if we screened for metabolic health with the same vigor and fortitude that we do for breast cancer, we would be in a far different place. So because of the importance of metabolic health, I brought someone on the podcast today who completely focuses on. On metabolic health and specifically weight management, since that is what we mostly associate the end result of metabolic health with. So, Dr. Ashley, welcome. I'm so happy to have you here.

It's my pleasure. Thank you for having me. I've been really excited. Excited about this.

Absolutely. So, in preparing for this interview today, I learned something fascinating about you, which actually, I am a frustrated dancer at heart because I was. I was never actually good enough to do it, but I love to dance. And you're a former ballerina.

I was a ballerina back in the day, a long time ago.

Well, I know it wasn't last week, but it wasn't that long ago. Feels like it. Yeah. Tell me about that. Yeah.

You know, my mother put me in ballet when I was very young, probably four or five years old, and I absolutely loved it, but I was naturally not talented. So I feel you there how you say that you're a frustrated dancer. Because I was as well. I just had this passionate pursuit, just this passion for the pursuit of it. And I was very dedicated toward it, despite not physically conforming to the demands. As a result of that, I chronically under eight. I counted calories. I was told that I was fat countless times. I was told that I had wide hips and that someday I would have kids easily. My Russian instructor told me. And so it was very challenging for me. I was injured all the time. I had stress fractures in my feet. I. I had a stress fracture in my back, and I still deal with the pain from that to this day. I had a fairly successful career just because I was so obsessed and dedicated toward achieving specific goals. So I performed in probably 400, 450 nutcrackers during my career. I dance professionally with multiple companies across the United States. I was selected to perform up in New York City. That's every dancer's dream. I thought I had finally made it. But in find, instead of finding myself in the spotlight, I landed in the er. I had no idea what was happening with my health I was fearful of my health, feelings, the future. And after a whole bunch of tests, the doctor just said that I was underfed, I was over exercised, and that my body just physically couldn't keep doing it anymore. So that is when my career ended. It was 20 plus years of struggle and sacrifice. It was, you know, you're saying that your son plays football at an elite level? You know, that it was my identity, probably like playing football for him is his identity. And it was all I knew, all I did. So it was a very challenging time in my life when I had step away. But I learned a lot and I understood the struggle when it comes to weight and having to, you know, conform to a specific body composition, but the body just not listening.

Yeah.

How old were you when I left ballet? Yeah, I was in my mid-20s.

So I'm curious because to look at you now, it doesn't look like you struggle with weight, but you did. Oh, yeah, right. Can you tell us a little bit about that?

Yeah. You know, so we all have our different, different weight struggles. And mine was that I was probably always about 15 pounds above where I needed to be for the sport. So I couldn't get the roles that I would have otherwise been able to, to accomplish. And I felt like no matter what I ate, what diet I fit into, my body would not see the results. I was too fat for the sport and it hindered me. And so, you know, as a result of that, I was just injured all the time. I lost my menstrual cycle. I had fractures like I share throughout my body because I wasn't fueling the way that I needed to as an athlete. So for me, it was a constant struggle. I couldn't eat very many calories because I had just shut down my metabolism from restricting calories and exercising a lot. And I, I tanked my thyroid. It was just a huge struggle for me. And I really believe that that's why I had to step away from the sport early, too early in my career.

Yeah, but your body was telling you something, right? And we often don't listen to the whispers. We, we only pay attention to the screams.

I. I only pay attention to the screams.

So now I know that you said that you were 15 pounds above where you needed to be for the sport. That is a sport that is definitely geared towards being on the lighter side of things. In retrospect, were you overweight at all.

If you looked at the normal spectrum of body composition? No, I was within a normal weight for, if I went to the doctor, but for that specific sport. It's like being a gymnast and going to the Olympics. I was at that level. If you are carrying 15 pounds of excess fat weight, it doesn't sound like much to the average individual just wanting to achieve a certain body composition. But that individual wouldn't have been able to perform or flip or move at the speed at which they need to do. Same thing for me, like, I just. The. The men would not be able to lift me in the way that they needed to. I wouldn't have looked the way that was required. So for me, it was a huge struggle, even though it wasn't that much on the scale.

Mm. It's interesting, though, because I think that from an athletic standpoint, at least, things are changing. And even. I'm a huge. I'm a tennis player, I'm a huge tennis fan. And you look at these. I mean, I shudder to call them girls, because they're not girls, but you look at the girls now in tennis and they are much bigger than they were historically. And the athletes across the board are bigger, they're taller, they're more muscular, they have more weight on them, even to the extent that we see some of them, and we would consider them, if we saw them in our office, overweight. But they're. They're conditioned that way and they. They play at higher weights to be stronger. It probably doesn't apply to ballet. It may or may not apply to gymnastics, although we are seeing that the gymnast body now looks different than it did 20 years ago or 30 years ago.

Yeah, I would agree with that. Yeah. I think in the field of ballet, it's. It's shifting, but not. Not significantly.

Yeah, I.

And I do think that the stigma around it is still there. You know, with. I don't know how you feel about Serena Williams now on a GLP1 drug, saying that she has always been overweight and has always struggled, and here she was this amazingly strong, fit athlete.

Yeah.

And, you know who. Who says that she was overweight?

Yeah. I don't know. Although I know that there was always talk. And I don't know if she was or wasn't using performance enhancing drugs, but there was. There was talk about her using them. And, and, you know, we look at athletes. I don't know if you recently watched the US Open, but Taylor Townsend is definitely one of those players who is on the bigger side. And if you did her, you know, BMI or whatever, she's. She's definitely going to come up on the higher side of things. Is she overweight? I Don't. I don't know. I don't know. I. I think that certainly in, in our world where we're, we're more concerned about the metabolic indicators than we are about the numbers on the scale.

That's right.

So, you know, I, I don't care so much what the numbers on the scale look like. I care more about what, what does your blood pressure look like, what, what does your triglyceride to HDL number look like, what is your fasting glucose, what's your fasting insulin. Those are the things that I care about.

And my numbers, though, all of those numbers for me when I was dancing were terrible because I was eating such a terrible diet at the time. You know, that was when if it was fat free, it was okay.

Yeah.

So I was eating everything fat free.

Terrible point.

Terrible. I. I would eat candy corn till it would just burn my throat, but, you know, it was fat free, so I thought that it was fine. I would count fat grams. I remember getting through a day thinking I accomplished so much if I ate 5 grams of fat or less in a day, and my triglycerides were through the roof. HDL was low. I was in my mid-20s. I was pre diabetic.

But. But, you know, you would eat two pounds of candy corn before you would have an avocado.

Oh, for sure.

Right. Like that was. That was considered the devil's food or a handful of nuts. Right. Like you would just.

Or red meat, you know, I didn't eat red meat because I was told if you eat red meat, you know you're going to have heart disease and get fat.

Yeah, well, Dean Ornish will still tell you that.

Yeah, well, Cornish needs.

So I know that you got to a turning point where your body basically didn't give you a choice. Right. Like here you are, you landed in the emergency room and your body just said, you cannot do this anymore. It was giving you every indication that what you were doing was not going to work and that you were done doing what you were doing. So how do you go from that to helping 10,000 people to manage their weight?

Well, I had an identity crisis. I didn't know what to do. I understood, though, how significantly nutrition, or really lack thereof, impacted my own sport performance as an athlet athlete. And so I decided to go back to school and learn what happens when you chronically under eat and how do you successfully shift your body composition in a way that supports your metabolism while you're doing it. And then I understood, coming from an athletic background, that 80% plus of any change comes from the mind. So I wanted to look at the cognitive behavioral aspects associated with creating true sustainable changes. So I went back to school and I earned my PhD in sports nutrition and chronic disease and studied exactly that. After earning my PhD, I still felt like I wasn't a true expert in the field of weight management. So I decided to go back to school yet again and become a registered dietitian because I thought that that is what was required to really understand how to help people with chronic weight struggles. But there I learned everything that I did when I was dancing and didn't see success. You know, eat less calories, move more again, avoid red meat if you're diabetic, eat more carbs, eat more grains. And just none of it made sense to me. It didn't fit in alignment with my research on energy metabolism. So I ended up flipping everything upside down, doing quite the opposite. Completely changed my health. My husband comes from a background of just morbid obesity, and his genetics high susceptibility changed his life, his, his numbers. And that's really how I created PhD weight loss, which is my company to date, where we have served over 11,000 people nationally, helping folks drop collectively almost 500,000 pounds.

Wow.

So it has been so much fun and I feel so blessed to have the opportunity to take my struggles and be able to help others either avoid what I went through or help them come out the other side for, for those who have been struggling like I did for the majority of my life in even more significant ways.

And you know, there was a lot of problems and maybe there still are problems with all of the misinformation and, and the bad messaging that we have been getting. And it, it's still true in, even in the athletic populations where these kids that are coming up, I'm not sure that they're getting much better information than they did 20 and 30 and 40 years ago.

No, they're not.

And for many people, the messaging is still, if you want to lose weight, eat less and exercise more. And for the kids that they want them to gain weight, like, you know, in, in the football world, they want these kids to play heavier, but they're not being told how to eat in a way to build muscle. And you don't want to just gain fat because that's not going to help you in any way.

And like, once we gain these fat cells, we, we aren't getting rid of them once we increase the size of a little bit.

Because people, I don't think people understand that. Mm.

Yeah. Once we gain the fat, we're not going to get rid of it. We can shrink the size of the fat ce, but once it gets pretty big, it's going to have this propensity to get bigger again. So once we are, let's say, fat during our life at one period of time, it's going to be easier for our body to get back up to that set point rather than the leaner set point. So these kids can, can do some long term damage to their body and to their metabolism because our metabolism can only tolerate so much before we're like, oh my gosh, I just, I just can't take it anymore.

Yeah.

So it is, and it, what we.

Do works both ways. It works both ways, right. And that is part of that yo yo phenomenon that you describe is that you kind of set the bar towards being obese when you create more fat cells because even if you diminish their contents, they want to equilibrate. Right. They want it back and it takes less to gain it back each time.

That's right.

So.

What do you think of all of the use of the GLP1 drugs? Because that is really, I, I forget what Dr. Tina called it like voluntary anorexia or some. So she described it as some sort of anorexia. What do you think of those drugs?

Well, I think there's a lot of misuse of them in my practice. We don't use them. I have just found when we can create a metabolic shift in the body when we actually eat the way that the body needs to eat. And, and the, at the correct time, we can get rid of the food noise, we can get rid of what, what people call food chatter where we're thinking about what we're going to eat next. While we're eating, we can get rid of that. We don't have hunger or cravings. And you know, my clients are dropping for most men drop about three pounds a week on average. Most women about two to two and a half pounds, which is quicker than the speed at which we drop the weight on these drugs. Plus we're not losing the amount of muscle mass and we're able to keep the weight off. So we're dropping it faster, we're dropping more total weight and we're able to keep the weight off much more successfully with these drugs. We see that the majority of folks gain back the majority of what they've lost around 80% within about a year of stopping the drugs. And most people don't take the drugs longer than a year because of Side effects or because of cost, for one reason or another, they're getting off of it. There's new drugs coming out where people will drop weight faster, but then they regain it faster. So I see great success. I know that I have a biased opinion because I've helped a lot of people do it through changing the way we think about food. I do think mindset is a huge piece of it. By shifting what we're eating and when we're eating, I think that the companies where they just drop ship the medication to your doorstep and you're just taking these drugs without focusing on what you're eating when you're eating. The mindset, I think that there's a lot of deep work for folks that needs to be done. When we're going through a weight loss process, I think that weight loss is an addiction recovery process for a lot of people. And if we're simply taking a medication like you shared, where we just reduce appetite and we're not learning or changing behaviors, then there's a big, big issue, and it's very, very dangerous. So I think the way in which we take them, there's potential these days for microdosing for specific conditions. I think in some of those scenarios, it can be helpful. But overall, the way that we're utilizing them, I think that it's very scary. And I think people who don't really need to use it, like, if you have less than 40 pounds of excess fat weight to drop, this should not be your answer. The risks significantly outweigh any of the benefits there.

So I think, I mean, we do still see a considerable amount of muscle loss, and that ends up being problematic for people because you can lose weight but not gain metabolic health.

Yeah, you're skinnier, skinny fat, you weigh less on the scale. But body composition is what really matters. And what I mean by that is the percentage of muscle versus fat versus belly fat that you are carrying matters more than your weight on the scale.

Yeah, absolutely. So I think for some people, it's very obvious that they need to lose weight. For other people, those skinny fat people, it's not so obvious. How do you help people to know where they are from a, you know, a body composition standpoint?

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For us, it's helpful to use a tool and the tool that we use is a body composition scale that measures the percentage of muscle versus fat versus belly fat. Looks at metabolic age. You can get one of those scales. A Tanita is a good brand. Renpho R E N P H O is inexpensive scale that it might not be super accurate, but at least it's showing you trends and you can see how you're moving. And if you're dropping muscle versus fat, you could ask your doctor to get an MRI and look at how much fat, specifically the belly fat is what matters. When we're looking at body composition. You could get a DEXA scan, which is really the gold standard when it comes to measuring body composition. But if you go to the doctor and they say that your BMI is high, BMI is not a good indicator of overall health or wellness because BMI only looks at the height to weight ratio. So you could take a football player who has significant muscle mass and not much fat, who weighs 200 pounds versus someone in the stands in the crowd who weighs 200 pounds but is mostly fat and very little muscle. They have the exact same bmi, but their metabolic health and their body composition is quite different.

Yes. So a football player, a weightlifter, someone who has a significant amount of muscle mass. That BMI is going to be very misleading.

That's right, yeah.

So there are a lot of people out there talking about weight loss and I know that you do it differently. So can you take us through your process a little bit so that we understand how it's different?

So the first step is looking at the belly fat, or in the medical community, we refer to that as visceral fat. And it's really important to understand the belly fat, that visceral fat, because it's a different type of fat than the rest of the fat throughout the body. It's not the type that you can pinch or melt or sculpt or freeze off. And we actually get quite a few referrals from plastic surgeons of folks who go in and they're like, could you just lipo this fat out? And they're like, sorry, we can't suck this fat out because this visceral fat is deep down in and around the organs. Yeah, it's thick and it infiltrates the organs. So if you are carrying belly fat and we took a slice of your liver, it'd look like a Kobe beef steak, you know, the marbling in and around it. And over time, this fat mass in the organs actually gets its own blood vessels, it grows its own blood vessels, it gets its own oxygen supply and it starts to secrete hormones. So a lot of us are not aware that the belly fat is actually this active organ almost in there. You could think of it like a tumor. And all it wants to do is get fatter and fatter as fast as possible. Now, when you have this belly fat, it creates metabolic dysfunction. So let's say you consume this breakfast that they would say in the dietetics world is healthy. They would say, you know, have some steel cut oats, have some blueberries, some vanilla organic yogurt, and maybe an egg with it. Right. Well, the majority of that breakfast is metabolized into sugar, and the body can only tolerate one to two teaspoons of sugar at any given time. And that breakfast with an average serving size is probably 19 teaspoons of sugar. And the body's going to mount this response to try to get the sugar out of the blood. I'm not saying that it's bad, but that amount of sugar for someone who has belly fat, what's going to happen is I want you to think that you have this dysregulation of the energy. So the majority of those sugar calories goes in to feed the fat mass first. So now your muscle cells aren't getting the energy or those calories like it should. And so the brain doesn't get a signal that it's been fed. So physiologically, you are still starving Inside. And that's why, perhaps after a meal, you're standing in the pantry or the fridge doors are open, you're like, what am I doing? I just ate, but I'm. My body is still hungry. That's because you're having this disproportionate flux of energy that's not going into the areas that it really should. So I say that weight gain isn't our fault. It has nothing to do with you. It's not a flaw in personality. It's not a lack of discipline or a lack of willpower. It's all hormonally driven by this thing that just wants to grow. So we continue to increase our hunger. We have more hunger hormones being secreted. We're not as full easily, metabolically. We're slow. We're slow and sluggish. We think we're lazy, but we're not. It's the. The last thing this fat mass wants us to do is get up and expend a lot of energy.

Yeah.

And so we're in this fat storage mode. And that's why if you're listening to this and you're like, I don't really eat that much, and I still put on excess fat weight. That is a big reason why, is because you've got this belly fat that's keeping you fat, that's keeping you hungry and craving and slowing your metabolism.

So this is a concept that so few people understand, and so many. So many women I know, so many of my breast cancer patients are in this boat where they don't. They say, I don't eat that much. I don't understand how I'm not losing weight. And it's because of this whole phenomenon and. And the monster that. That belly.

Right.

That visceral fat that's being fed first.

That's right.

And when it comes to inflammation, which we know, inflammation tends to be the root of all diseases, including cancer, this belly fat actually secretes interleukin 6, which is a major inflammatory hormone linked to increased cancer risk. It secretes aromatase, which takes men's testosterone and converts it into estrogen. So now their sex hormones are off, and so are ours. But as men continue to gain fat, you'll see it more around the chest, the throat, and the head because of the shift in hormones. And now they have increased risk of high blood pressure and sleep apnea. So it is just this thing that causes inflammation to course throughout the body. And that's why I always say visceral fat is like kryptonite and this is the fat that you do not want. If you have the majority of fat, you know, in your arms or your legs, you might not like the look of it, but it doesn't have the same negative impact of that deep belly fat. So the number one thing we do in our practice is focus on the belly fat and assess how much fat is likely in there and how much, you know, excess fat weight we need to get rid of. That's why the program is really customized. The length of the program is dictated by how much excess fat weight the individual is carrying. So the length of the program is different from for each person. And I found that if we don't fully collapse the belly fat, if we don't get rid of it, then it's just a matter of time until it eats its way back up again. Because like a tumor, if you only get a, you know, rid of a portion of it, it's just a matter of time until it grows back.

Yeah.

So we need to make sure that we get everybody within their healthy range where they're not fighting against this, where we can actually see a metabolism go from slow to sluggish to more fast and deficient. So that's the priority.

So are you using DEXA to determine the amount of belly fat that someone has from the onset? And is that what you, is that the metric that you're following? Are you following percentage or, or volume of, of visceral fat?

We use, in our offices, we use a professional grade scale that shows us it's within about 5% accuracy of the DEXA scale scan. For our nationwide at home clientele, we will advise them and recommend to get a DEXA or to buy a scale that's within this range that we can see. There's things that you can do at home too, to assess how much belly fat, like if you lay on the ground and the fat spills over to the side, that is the type of fat that we don't necessarily have to worry about. But if it's laying there and you're. It's protruding up, then that is significant belly fat.

Yeah. Wow.

So if you still have that DEXA scan, is that. Yeah, DEXA scan is the gold standard. Right. Okay. So you're focusing on the belly fat. Is there something that you would do differently when you approach someone to, to get that, to get the metabolic focus to be around getting rid of the visceral fat?

So unfortunately we can't specifically spot check, so you can't come in and say, I just want to drop the fat in My stomach, not in my butt or my chest. So what we can do is focus on minimizing muscle loss so that we are promoting the highest percentage of body fat loss possible. And we do that through eating the appropriate macros for that unique person and their metabolic state. So we're looking at how much fat to protein to carbs that that individual is consuming to be able to optimize that. And we find when we're able to do that and not severely restrict calories, we're able to burn that belly fat pretty darn efficiently. But again, you have to drop enough weight to actually tackle the belly fat, because I've found that we lose weight in the opposite direction that we put it on. So if you put it on in the belly first, that is going to be the last to go. And what happens is we drop a lot of weight and then we think we look and feel good enough, but that depot of fat deep down in the belly is not gone yet. Kind of like the last bit of that almost kind of tumor like fat. And then it's very high risk of regaining all the weight that we've dropped.

So are there things that you do, along with being thoughtful about the diet, that help to ensure that you are not. I mean, you can't avoid losing some muscle mass, right? It happens to everyone when they're losing weight, right?

Yeah. Even shrinking the cell wall, size of the fat cell will, when you get a DEXA scan or stand on one of these scales, show as reduced muscle loss. As reduced muscle, you know, because that, that actually is muscle in there. Your spleen, your liver, all the organs are going to get a little bit smaller. And that on a body composition scale, looks like muscle. And then if you are, let's say you start off at £250 and now you're £150, you're less of a body. And so you're not going to need as much muscle or build as much muscle because you're just not carrying around that backpack anymore. So you will see some muscle loss no matter what route you go. But unlike a GLP one, you know, it shouldn't be at 40% of the weight dropped being muscle.

Right. Which is what we are routinely seeing with the GLP1s.

Yes.

Is about a 40% reduction on average. Yeah. So is there anything else that you, that you talk to people about in order to help them to preserve muscle mass?

Yeah, the type of movement in terms of.

Of metabolic health.

Yep, movement. So I, I look at exercise not as a weight loss tool, but More as a wellness tool for most people coming in, we meet them where they are with movement. If they're not used to moving at all, we'll start there and then increase. I think a 30 minute brisk walk every day is the first thing that we implement because that is so important for metabolic health. And then from there we continue to increase with a focus on lifting something heavy, some kind of resistance training. So once we get a 30 minute brisk walk dialed in and again, if someone's listening to this and you cannot move, you still can drop weight and be healthy. So no excuses, no procrastinations, There is a way. But if you can slowly incorporate and get up to that 30 minute brisk walk a day, that's great. And then lifting something heavy, it doesn't have to be going to the gym or something overwhelming. Yoga is not going to cut it though. It needs to be some kind of overload of the muscles and then dropping cardio. If you're doing too much kind of chronic cardio, just getting on the elliptical machine, trying to burn calories, that's actually going to support the body to holding on to excess fat. Especially if you've got a high stress lifestyle and you just get on there and try to do some, some cardio or go run long distance or get on the bike and try to just. This was me after I stopped dancing. I felt like I need, I was used to expending energy all day and I thought, oh my gosh, I'm gonna pack on the pounds so quickly if I don't just exhaust my body in another way. And so I picked up cycling and I would cycle 250 miles a week. And I just kept putting on fat, specifically around the belly. I was so inflamed, still eating the way that I shared.

Yeah.

And so, so if you're doing this, it's, it's not going to support, support you and your healthy metabolism.

Yeah, over exercise is a real problem.

It is.

I mean, I even see it in, in the breast cancer population. There are people who come to me, they're not overweight, but because they are over exercising, they are overstressed and their metabolic numbers look, look terrible.

That's right.

They look like people who are cortisol dominant even though they haven't developed the characteristics necessarily. But if your body thinks you're running away from a saber toothed tiger all the time, which is what people who are exercising all the time are doing a lot of endurance exercise, your, your immune system is going to essentially be shut off because if you're running away from a saber 2 tiger and going to imminently die because you're being eaten by said tiger and you don't need to fight off the common cold or whatever other thing that would potentially kill you in, in the long run because your, your immediate threat is that saber toothed tiger. And we just don't have an evolved enough immune system to be able to distinguish between what these real stressors are and what they aren't. So we see any kind of stressor as a saber toothed tiger. We just haven't evolved.

That's right. Yeah. We think, oh gosh, we're just gonna go train for a marathon and drop all this weight and then we don't lose weight. Or if you're like me, put on some excess pounds thinking, what the heck here I'm trying so hard and I'm not eating anymore. But the body's just in that fight or fight flight.

Yeah.

Scenario.

You know, it essentially thinks that there's a war to fight. So it's making sure that it has its stores.

That's right.

And so it's in storage mode because it thinks like it's, it's not safe, it's dangerous and you're not going to get rid of your stores. In fact, you're going to try to build them up if you're, if you're in danger.

Yeah. So we do look at that. You know, if someone's exercising too much. Not the right type. I think high intensity interval training can be a helpful addition. If a person already has the walking down, if they're already lifting heavy things a few times a week and they want to add something more, that would be the next thing that we layer in. But short and sweet. And again, looking at the lifestyle, if they are super stressed and that's not something that we might add in there, but those are the, the primary focus around exercise. And then we talked about stress very shortly here. But that's a big deal. Minimizing stress or shifting the way that we perceive stress is going to be important. We'll see clients doing everything right and saying, oh, I'm working so hard, the scale's not budging, I'm eating everything right. And we dive into either stress or lack of sleep. And those are generally the top two things. You know, how we think about food, how we think about our life is just as important as to what we're putting into our body. And we don't give it that much significance. Stress or sleep. But oh my gosh, they are huge when it comes to fat loss and preserving muscle.

Yeah, yeah. And we, we actually don't give them enough consideration. And we, we are so trained to think that we can power through it or muddle through it. And there's a whole stigma around sleep in our society. It's definitely getting better and people are understanding the importance of it. But in, even in the short term, a lack of sleep will make you make poor decisions the next day. Right. You're hungrier, you're looking for that energy, so you don't feel like moving, you don't feel like doing what. What your body should be doing. So. And then, of course, long term, lack of sleep has terrible consequences and is associated with all kinds of chronic diseases. Being overweight, cancer, heart disease, diabetes. All of it.

Yeah. There's a study looking at two groups of individuals. One group who slept more than seven hours, one group who slept less than seven, and the group who slept more, ate more and weighed less than the group who slept less and ate less. You know, when we sleep, our hormones regulate. We have a decrease in ghrelin, which is the hunger hormone. We have an increase in leptin, which helps us to feel full. So it really is significant. I know my husband's a physician, and when he. And probably with you, like during residency, you probably had to do nights. And I know when he was up through nights, his cortisol was so high, usually he could say no to the donuts in the physician dining room, but on nights, it was like he couldn't even say no. I mean, the cravings were so significant.

Your body is just looking for that quick fix. And it's not, it's not even like a lack of willpower. It's that your body is saying, I need energy. And what it wants is sleep. But.

Right.

Unfortunately, that's just not an option. I mean, I'm. I'm a trained surgeon. Sleep was considered a luxury that we could not afford. And, you know, if I wasn't on call every third night, it was because I was on call every other night. So, you know, there were five, six years where I didn't have the luxury of sleep. And I'll tell you that you make a lot of bad decisions. Thank God that, you know, they weren't in the operating room. They were mostly in the cafeteria. But that. It is just. It's a really. It's nearly impossible to make good decisions when you're not sleeping.

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Yeah, it's tough. You know, I believe that the body never makes a mistake. So if you are craving those foods, it's because physiologically the body is doing something to try to protect you. Craving carbs to give you the energy so that you can make better decisions, so you can try to think quicker on your feet. Cortisol's elevated again. It's the whole tiger scenario. The body's thinking, oh my gosh, I need this quick energy. Where can I get it from? The donut is the answer.

Yeah, surely, absolutely. I want to back up to something that we started to touch on before, and that's that we talked about the American Diabetes association and the recommendations that they have around food and because, you know, you can get your mindset right and you can prioritize sleep, but if you are eating a high glycemic diet, no matter who you are, you're gonna suffer. And I still can't understand why, like the ADA recommendations are the way that they are. Our food pyramid is the way that it is. It absolutely supports being overweight, being obese.

Being diabetic, being dependent, I think on big food and big pharma. Yeah, unfortunately, yeah. I remember when I was during, it was during my dietetic internship. I was in the MNT class, medical nutrition therapy, and we were learning about diabetes and I thought, well, it sounds to me like diabetes is carbohydrate intolerance. Right. We just, we're not tolerating carbohydrates to the same degree as we did when we were metabolically well, and if that's the case, then why wouldn't we reduce carbohydrates? Not necessarily that we need to follow a ketogenic diet or a severely low carb diet, but it sounds like we're not tolerating the 200, 300 grams of carbohydrates or the 6 to 11 servings of grains a day.

Yeah.

You know, and so when I asked that question, they're just like, well, you want a diabetic to consume 50 to 60 grams of carbohydrate in every meal so that you know how much insulin to give them consistently. I'm like, well, I'm so confused because isn't the goal to get them off of insulin? Well, no, not. You just want to. It just kept coming back to consistency for medicating and that right then I was just like, something feels very off to me and I just can't tell a diabetic who's intolerant to carbohydrates at the same level as, say, the other individual sitting next to them who doesn't seem to have diabetes yet. I can't keep telling them to eat the food that's causing their blood glucose spikes. It just doesn't make sense to me. Yeah.

So what are your, what are your rules around food? What is your guidance around food? How do you tell people to compose their diet so that they can gain metabolic health?

Yeah. So understanding that everyone's different in their tolerance level. So I would say, like if someone is type 2 diabetic or pre diabetic, they do not tolerate carbohydrates in the same way as, say, your son playing football or someone who is very active and more naturally lean. We all have our different tolerance level of them. And the ticket is to find where our tolerance level is. And that's what we really help clients do, is understand where their tolerance level for carbohydrates is. Usually I start with protein. Protein is going to be the key to help support healthy metabolism, healthy muscle mass. So generally 0.8 grams to 1 gram of protein per pound, optimal body weight. So if you are 250 pounds right now, but your optimal body weight is 150 pounds, then you take 150 and multiply that times 0.8. I'm not great at math, but that would be how many grams of protein in a day might be a good target for you. We know that the first meal and the last Meal that you eat in the day is the most important to have the biggest amount of protein in it to help with muscle synthesis. So you want to make sure that you're getting a good bolus of protein in the morning and in the evening. Now, I don't think you have to eat breakfast, but that first meal of the day, whenever it might be, you want to make sure is protein forward. For that reason. Then we look at fats, and fats help you stay satiated, help with your hormone balance, help with your reproductive function for your skin, hair, nails. So you don't want to be like me in my dancing days where I didn't eat any fat, I now embrace fat and I do not fear it at all. So if you like cream in your coffee, have real cream in your coffee. If you're going to eat an egg, I think an egg is nature's perfect multivitamin. So eat it with the yolk. I would say get rid of white, white egg beaters. Anything that comes, like processed in a carton that doesn't come from nature usually isn't as good as the form that comes from nature. So eating whole food in its real form, getting plenty of protein, not fearing fat, and then finding where that carb tolerance level is. If you have weight to drop and you're, you have PCOS or your insulin resistant, you have high fasting insulin, diabetes, pre diabetic, I'd say probably like 50 to 80 grams of carbohydrate a day.

And what are you using to assess their metabolic health? Like how, when, what do you do? When do you do it, how do you follow it?

For us, it's mainly signs and symptoms. So hunger, cravings, the speed of weight loss, their blood glucose levels, those are really the things that we look at and we can find if someone has hunger or cravings or blood glucose levels are elevated, they're not dropping the expected average weekly rate of fat loss, then something's off with their macros and that's when we continue to tweak them. Also, as you slim down, your needs change. So your meal plan is a very dynamic process, shifting as you're, you know, going through your journey.

Do you feel as if people need less food as time goes on? Are you seeing that?

Not necessarily. For quite a few people, I find that once they get rid of the belly fat, their metabolism actually is faster and they need to consume more. Once they hit maintenance, they'll continue to drop weight. The body does plateau with where it needs to be, but for some, we just need to Keep increasing the intake so that their body doesn't keep dropping and weight.

Yeah. Because I think once you get into a cycle, it just, it, it tends to continue that way for a little while.

That's right.

But I also find that when people are eating a nourishing diet, they, they need less. They're not snacking because their body is getting what they need.

It's so true. If we ate a nutrient dense diet, foods that, you know, come from the earth, adequate protein, we really don't need a ton.

Yeah.

Like you know, 90 of the food in the grocery store is just junk masquerading as food and it's excess and it's waste.

Yeah. Food like substances. Yeah, yeah, absolutely. And then what about supplements? Where do you fall in that, in that supplement world?

I think the supplement world can be quite wild. If we're eating a very nutrient dense diet, then we don't need a ton of supplementation for the majority of people. There are a few supplements that I find can be helpful. Magnesium. I'd say what, 75% of us are deficient in magnesium. I know I have to take about 800 milligrams of multiple forms of magnesium a day. I think my life doing that too busy and stressful and I just burn through it really quickly. If you're looking at your magnesium levels, look at your RBC magnesium level. So the amount of magnesium that's in the blood cell rather than just like serum magnesium to see where you are. I think a good level is around 5.8 or so is a good target. I know I just had mine measured and I'm at 5.5 after taking 800 milligrams for months. So yeah, that one's important. I think for a lot of people, vitamin D, especially in the months of the winter months are, is going to be important. Starting right now about October to May, we're not able to create the active form of vitamin D from the sun. So taking some vitamin D with vitamin K to help the absorption, those two together can be helpful. I do think there's a lot of research around creatine and can be really helpful when it comes to maintaining muscle mass. So about 5 grams of magnesium a day.

Creatine.

Yeah.

So and I think Omega 3 is, if you're not getting some seafood in the diet, cod liver oil. I like it comes with vitamin D and really well absorbed vitamin A. We actually don't utilize the beta carotene we get from like carrots and veggies. We get vitamin A. We can utilize more from fat sources like egg yolk or liver. Actually, I think if you're open to eating liver, I can't stand the taste of it, unfortunately. But liver is a powerhouse, just like a whole egg. These days you can get ground bee grind organ meats in with it. Ancestral Blends is a brand where they blend that all together. I still can taste it, but if you make like spaghetti sauce or burgers out of it, it masks it decent.

I am, I the, the plug that I'll give to my friend James Barry is that he makes a product. That's right pluck. And he's pretty good. It, it really is tasty. And I challenge anyone to be able to taste the organ meat in that. They are, they're. They're seasonings made from organ meat and they're really delicious. I mean, my kids love the garlic one and have no idea. I mean they, they would never take the time to read the label. So they just think it's, you know, some form of garlic powder or something. So he, he does an amazing job that his company is called Pluck. But cod liver oil I think is one of our best sources of vitamin A. And what you referred to is the fact that actually genetically many of us cannot convert beta carotene, which is the precursor to active vitamin A, which is retinol. And there are, there is a certain percentage of us and it's not low, it's like somewhere around 20%, I think that just genetically lack that enzyme that converts beta carotene to vitamin A or doesn't do it efficiently. I know I'm one of those people. And if you're one of those people, though you may be like me and feel drawn to be plant exclusive, your body is saying no. And as much as I would love to be a vegan all the time, because that's where I like, that's what my heart is drawn to. My body. I've never been so sick as the times in my life where I've been purely vegan. So I'm the same way. Yeah.

So I wish that it. I just. They don't think humans have evolved yet enough to be able to do that and be purely plant based. As much as we want it and maybe in the future we.

And, and I do think that there are some people who do it very well and they are very good about taking their supplements. I am not good about. In fact, I'm looking at my supplements right now as we're having this podcast, realizing that I didn't take any of them today and I have more days than not where I don't take any of my supplements. And it's not because they're not right in front of me. They are. I just, for some reason I have a mental block about doing it. I'm very good at eating all of the foods that you're supposed to eat, but I'm very, very bad at taking supplements. And so, you know, for someone like that, veganism is very dangerous. I mean, I got to the part where I had horrendous neuropathy, I was tripping and dropping things all because I was so B12 deficient. So B12 deficient. And I just didn't, didn't know my thyroid completely crashed. Like I, I've had some very, very serious illnesses in my life brought about by my own doing because I was completely plant based and didn't supplement.

Yeah.

So I, I, I think if you are eating in a way that you're covered, although the vitamin D thing for everyone is hard, but if you're eating in a way that's, that you're, you're pretty covered in terms of your nutrients supplements, then you probably don't need too much in the way of supplements. But I don't think anyone's getting away with no vitamin D and no magnesium.

Yeah, just the lifestyles that we lead are pretty stressful. We're not getting out in the sun or if we do, we cover up with sunscreen. Just an SPF of 15 will block 99% of.

Well, also we have to remember that it's the UVB that allow for vitamin D2 to vitamin D3 conversion. And they're only a fraction of the art, the full spectrum sunlight. And you have to have like 75% of your skin exposed in order to effectively convert. And who's doing that? Yeah, at a specific time during the day. Right. Midday sun. Who's doing that? I remember the guy who invented the energy light, which is one of the vitamin D lights, lives in Scottsdale and he figured he's outside exercising for hours every day, he's hiking, he's playing pickleball. I mean he's doing what everyone does when they live in Scottsdale. And he went and had his vitamin D checked convinced that it would be like 60 or 70 or 80. It was like 13. Wow. I mean it's just, and that's Scottsdale where he's outside all the time. So it just goes to show you that, you know, we, we are beings that evolved from situations and circumstances where we were all exposed all the time and so we kind of minimized our vitamin D as to not make too much and now we're not exposed at all and everyone's vitamin D deficient. And if we are exposed, we created this whole culture where sun is bad and sunblock's good. And now we have a vitamin D deficient population.

Yep, we do. I have one of those lights, actually. I like it. I do think there is something to having the body go through the process of converting vitamin D to the active form. I'm sure there's so many processes we don't even understand that are key in the conversion process of it as well.

Those lights are actually far superior to supplementing and the half life of the supplement and the utility of the supplement is far less than those lights that where your body makes it and converts it itself. So you, you, you are correct in, in saying that. And, and that vitamin D plays into all whole bunch of disease states, including obesity.

That's right, it does.

Well, this was, it was wonderful to have you here and metabolic health is so incredibly important and your, your role in helping people to lose weight and achieve metabolic health is, is extremely timely and important right now. So I just wanted to thank you for the work you do and for joining me today on the pod.

Thank you so much. Thanks so much for having me.

Of course. Where can people find you?

Let's see. Well, my website is myphdweightloss.com or you can follow me on social media platforms everywhere. Instagram, Facebook, LinkedIn, tick tock. I think Dr. Ashley Lucas for that. And I have a book on the website called 5 Steps to Reset the Scale that can be checked out. And then I do have a small supplement company where I have created an electrolyte mix to support people along the journey of weight loss. And that's called drashleywellness.com amazing.

So we'll make sure to link all of those in the notes. It was so great to have you here today. Keep doing the good work. We so appreciate it. And for all of you that joined me, thank you so much for being here and I hope you learned something and that you can take something away from this and go on and improve your metabolic health and know that I will be back next week, same time, same place. It's Dr. Jen. Bye for now.