52: Unlock the Secrets to Beating Insulin Resistance and Reducing Breast Cancer Risk with Dr. Bindiya Gandhi

Hello and welcome to the Kenya Breast podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turned functional medicine physician, I'm on a mission to empower women to live their breasts and need best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment, and holistic approaches to support overall well being.

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Hi, it's Dr. Jen, and welcome back to another episode of the Keeping a Breast Podcast. I AM your host, Dr. Jen Simmons, and today we are going to talk about something that is so important that is affecting nearly two thirds of Americans. And it doesn't matter if you're young or old or anything in between. We are talking about the overweight and obesity epidemic that we have in this country right now. And especially we're going to talk about a topic that is not terribly well known but needs attention. Because after all, I think that most of you are here because you're concerned about breast health. And you know that I say that breast health is health, and in order to be healthy, you. You must have metabolic health. And part of that, probably a large part of that is having insulin balance and also having leptin balance. So we're gonna talk a lot about that hormone today because it is the least known in that whole metabolic health conversation. And so I brought you an expert to talk about that today. So I am delighted to introduce Dr. Bindi Agandi to. Dr. Gandhi has made her focus her passion into medical weight loss, and she is helping people do that in an integrative fashion, in a way that makes sense, that is sustainable, that people can take over a lifetime. Because we all know that fad diets don't work. And we all know that ultimately we have to figure out a way to sustain our bodies in a healthy way over our lifetime. So, Dr. Gandhi, welcome. I'm so happy to have you here.

Thank you so much, Dr. Jen, for having me on today.

I would love for people to just get to know a little more about you. So if you wouldn't mind just sharing your story and talking about why you do what you do?

Well, like many of us, you know, it was my own personal journey that really led me to what I do today. Right. I started off in medical school, eager to save the world, you know, and at the time, while I was in my pharmacology class, I remember specifically learning about the mechanism of actions. I was told pretty early on that the side effects were normal. You know, every time we give a prescription, that's the mechanism of action, so we should expect the side effect. And a light bulb went out at the time. And I was like, that doesn't make sense. So why are we going to be prescribing these medications? And so I. So I'm going to be prescribing them 10 medications for one condition because everything is a side effect, and I have to now treat the side effect. And already that was a red flag. And I did not like that. Right. I was taking care of my own mental health at the time. I thought I was exercising while I was doing a lot of yoga, running. I was doing a lot of meditation. I thought I was doing things perfectly. And as I started my residency, I continued those great habits, but learned very quickly that residency is a whole different ballgame. And that stress level is beyond intent. You know, you're not sleeping, you're not eating. And, you know, in the conventional world, as women physicians, we know that we're essentially underdogs, you know, and especially, especially in residency, you know, so it's pretty grueling, pretty intense. It was around that time I started developing a rash on my face.

And.

I was. I went to the dermatologist and they basically told me that it was nothing. They took biopsies, and I tried every prescription under the sun from steroids, antifungals, antivirals, anti whatever. I tried it. I was desperate, and I knew something wasn't right. And I kept asking questions, do I have an autoimmune condition? And they just brushed me off. And they're like, actually go see the autoimmune allergist next door. And I was like, oh, okay, sure. And when I went to the autoimmune allergist doctor, I was actually baffled because I'm begging them to test me and to do some stuff. And they're like, you're just a stressed out resident. This rash is insignificant. And I was like, okay. Mind you, at this point, Dr. Jen, I had been dealing with it for about two years, right? And so I kept digging and I was like, Something's wrong. There's gotta be some nutritional deficiencies. There's something wrong with me. Long story short, found an integrative and functional medicine doctor and actually got diagnosed with celiac. And once I eliminated gluten. Yeah, once I got eliminated gluten, like, life got better, you know?

So how old were you? How old were you at the time?

I was probably 30, actually. I remember that I was. I literally had. I felt like I was falling apart at 30. And I was like, this. This can't be right.

So I would love for you to just talk about that a little bit, because people think that you have to have gut symptoms in order to have celiac disease and that there's no way that you're going to get to 30 years old with. Not without knowing that you have celiac disease. And I can't. It's not unusual for me to diagnose celiac disease in someone who's coming to me for breast cancer.

Yes. Yes. So I will tell you that I probably have had abdominal issues my whole life. Like, and most of my problems, unfortunately, have been constipation. I've never was the person that had diarrhea on and off abdominal pain as long as I can remember, but it was kind of like, oh, just drink more water. And, you know, every time I went to the doctor's, kind of brushed off. Right. Even in adulthood, I was pretty constipated. I wish I had the typical. I would eat gluten and then run to the toilet. Maybe I would still eat gluten today, you know, I don't know. But, yeah, it was. It was severe constipation, unfortunately.

Also, I think it's interesting that people recognize when they have diarrhea that they have an issue.

Right.

They don't recognize when they have constipation that they have an issue. So.

No. And.

And it's because we don't talk about it enough.

We don't talk about it enough. And, you know, it was normalized. It was normalized for me to have constipation because it was like, oh, well, that's your normal. You go once a week. And I was like, oh, okay, cool. I'm special. I go once a week. Like, and. And when I was younger, I was probably embarrassed to poop, really. You know, so to go once a week, I was like, this is awesome. You know, until I realized what was really happening underneath and how toxic I had become.

Yeah, yeah, yeah. It's crazy. Okay, so you get diagnosed with celiac, and you. Did you just Stop eating wheat and the. And the like known gluten things, or did you have to do even more than that in order to get better?

Yeah, no, for me, fortunately, at the same time, I ended up doing food sensitivity testing and some allergy testing at the same time. And so there was a lot of foods that I thought were healthy for me. So, for example, one of the culprits back then was oatmeal, because I was a cheap medical student and then a resident, I was eating Quaker oats or the equivalent of that, because it's really inexpensive. It's inexpensive and it's healthy. Right.

It's inexpensive at the start store. It's very expensive to you.

Right, right. And I didn't know that. Right. And so, by the way, it was not organic. It was not gluten free. It was, you know, quicker. What, Quaker Oats, $1.99 for the biggest. The biggest thing you can get. Right.

Yeah.

But that is a big hoax. Like, oatmeal is not a health food.

Yeah.

And everyone needs to know that. Your organic overnight oats that are, you know, soaking and whatever. It's not a health food. Sorry.

Yeah, sorry. It's not a health food. Yeah. So, you know, unfortunately, I. Or not unfortunately, fortunately, I cut it out. And, you know, that was a huge culprit. And then I also cut out gluten. Hardcore. I went hardcore because I was like, this is serious. I don't want to get cancer from this. I know that. I know the data. I don't want to die from this. I want to have babies. And. And so I thought, you know, I did everything that I was supposed to do. And. And that was kind of what fueled me to, okay, I'm going to go study with Dr. Andrew Weil. I'm going to do the integrative medicine fellowship when I got done with residency and learned functional medicine. And that's what I ended up pursuing. And of course, during that time, I was also trying to get pregnant. Right. And so I figured, well, I already knew that I have celiac, and if you have celiac and it's untreated, then it makes getting pregnant hard. So I thought that was. That hurdle had already been dealt with. Unfortunately, it took me a longer time to get pregnant, and I didn't understand why. Again, I thought I was the epitome of good health. I'm, like, eating well now, even healthier than before, Right? Yeah. Exercising, meditating, doing yoga, learning all this nutritional stuff from my fellowship and implementing it. And I did not get pregnant. And I was, what? Just what's going on here? Right. And trial and error learned I was probably too healthy. You know, once I started digging into hormones and realizing that there's all these hormones. Leptin was one of them at the time. That having too low leptin levels can actually impact fertility. And. Yes, can actually can be problematic. Right. Having too low estrogen can make it hard for you to get pregnant and all these other things. So, you know, once I. Once I learned what I needed to learn, it was. I joke about it. Now I'm like, it was easy to get pregnant. Now I have three wonderful daughters, and now I'm trying not to get pregnant.

Gotcha. Gotcha. But, you know, thank God for those children.

Yeah.

So I want to back up a little bit, because to me, it's a big leap of faith that you get diagnosed with celiac, even though it took a long time. So I can understand that you probably had some frustration with the system because it took a long time. But how do you go from there to, I'm going to do an integrative medicine fellowship. Because I even went to a medical school. I went to Jefferson. I mean, it was called Jefferson at the time. Now it's called, like, the Sidney Kimmel School of Medicine or something like that. I don't know. And at the time, we even had an integrative medicine department. That's amazing. It is amazing. But at the time, I remember going through medical school thinking like, this was us and that was them and that, you know, maybe they. Those were the guys that were, like, a little out there, and very few people even spent time with them in their department because it just wasn't. It wasn't considered mainstream yet. So how did you. How did you go from I have a celiac diagnosis to I'm gonna do an integrative medicine fellowship?

Honestly, I think for me, the biggest thing was, you know, going back to my pharmacology class, and I was like, I don't want to just be a pull, push, push pills. I don't want to do that. I don't want to. There's more to medicine. And as I learned with myself, like, nutrition is important. Nobody's talking about nutrition. No one's talking about what to eat, how to eat, the specifics of diet, which is so important. That's just the basic foundation. And then I wanted to learn more about supplements, and I wanted to learn about, like, them. How they interact with the body. And that's when I was like, I gotta learn about functional medicine. I gotta Learn about how our body's detoxifying, and I've got to learn about how their hormones all play together. And I mean, it's. And this is. This is. People ask me this all the time, like, what is the difference between integrative and functional medicine? And integrative is really important because we're incorporating different modalities of medicine. So nutrition is obviously a big part. Supplements, sometimes you're incorporating mind body techniques like acupuncture, a lot of stress reductions. This is where I get to incorporate my meditation, yoga, Reiki, all the stuff that I learned in medical school that people thought I was weird learning about. But now I can incorporate this in my patients. And then the functional medicine is kind of getting to the root cause. Right. This is the important part. Yes. In my world and in what I do at my clinic, in my practice, we use functional testing. I like to do fancy testing. Unfortunately, insurance doesn't like to cover some of this testing, but it's so important because it tells me about your mitochondria, what's working. Do you have a methylation issue? Do you have a detoxification, calcification problem? All these other things that most conventional doctors are not looking at. And I even look at genetics just like you do, Dr. Genesee, what are your risk factors when it comes to cancers? And how can we nip things in the bud? It's about prevention instead. And instead of. And being proactive now than dealing with the consequences later. Yeah.

And you know, the reason that the insurance companies don't like to pay for functional testing is because it's not a quick fix. Right, Right. Like when the functional tests are performed, they're performed for the purposes of figuring out what the root cause illness is and then helping people to restore their health. Because we really are perfect beings. Right. We are. We were created perfectly by God. And it's only due to our environment. Genetics play a tiny part, but it's only really due to our environment that we have dysfunction. We either don'. Get what we need or we have what we don't need.

Right.

And from an insurance company standpoint, they don't understand the formula. Right. They're used to diagnosis, treatment, diagnosis, treatment.

Right.

And so when they don't understand the formula, they don't get involved. And also, there's no room in our current system for health.

No. Our healthcare system is broken, unfortunately.

Very broken. Yeah. Okay. So you somehow become enlightened, which is really. Which is really amazing because it's hard to become enlightened. And most of us I mean, I'm totally included in that category. We don't get enlightened until we have our own healthcare crisis. And it's only at that time that we recognize that the system is not going to take care of us. The system is insufficient in so many ways. And we go looking for answers, and that's where we find them.

Yeah.

Okay, so you go and you decide that you're going to do this, this fellowship training, and you come out, how do you decide to go to specialize in weight loss? And how did you learn about leptin and, and all the hormones? Because we really don't get that much training.

Yeah, that, that's perfect. So, you know, when it, when it came down to hormones, first of all, just the whole pregnancy, getting pregnant, trying to get pregnant was. I learned everything I could about hormones at the time. Dr. Jen. There was a lot of things going on. My hormones are all over the place when I've been at points where I've been estrogen dominant and I've been on the other end of the spectrum where I've had low estrogen. So I know that this feelings and symptoms of both. Right. And being at both ends of the spectrum and then also kind of just learning at the same time. Patients were coming into me. I was doing a lot of, like, hormone replacement therapy. And then I started seeing patterns. People were cut. This is way before semaglutide days, but people were trying to lose weight, and I was working on their gut health and trying to improve things and helping them to lose weight. And I started noticing a pattern with a lot of my patients when it came to a lot of weight loss resistance. And I started paying attention to the little hormone that many people don't talk about called leptin. And how this was impacting so many different things. It was impacting their metabolism, is impacting their thyroid, it was impacting insulin. It was impacting overall metabolic health, bone density, so many different things. And I just essentially went crazy. Like, oh, my God, I see this pattern, I see this pattern, I see this pattern. And again, it was literally from my patients that I learned more and more about leptin. And, and just that's. That's where I am today. It's, it's. The problem is it's such a new hormone that there's not much information about it. So I kept searching and looking and putting my anecdotal clinical study patients and figuring this stuff out. Yeah.

So obviously being overweight and being obese is an epidemic now.

Right.

We have more overweight and obese people than ever. It's not getting better. In fact, it's getting worse. Despite the, the new drugs on the market, it's still getting worse. So let's first talk about leptin. What is it? What does it do? What do people need to know about leptin?

Yeah. So leptin is a hormone that is produced by your fat cells and it communicates with your brain and it lets us know if you're hungry, full, do you need to eat more, do you need to eat less? It's also known as our satiety hormone. So in a perfect world, after we eat a meal, we're supposed to get a memo saying, I'm full, stop eating. Right. Well, unfortunately for some people, they're not getting this message and this is why they're constantly hungry. They're constantly eating between meals. They're never satisfied. Right. Their proportions are, they're eating probably two or three times than they should because they're making it. The, the communication and the messaging from the brain to the, to the leptin hormone is off. And this is a huge, huge problem.

So is this, you know, the people that are the grazers that are just eating all day long, does that have something to do with leptin?

Yes. And, and here's the thing. It, Leptin unfortunately impacts so many people. Right. Like you may think that you have to be overweight and, and obese to have this really high leptin levels. But I'll see people that have, I'll call normal body mass index and they still have leptin, elevated levels of leptin. Right. So there's no. Well, let me rephrase that. We know why this is happening, right? We know that there's many factors that are causing this, the communication to be off, but it can happen to anybody. So we don't assume that one person or one body type is prone to leptin resistance and another isn't.

So you just mentioned elevated leptin levels. So what should they look like and where do you see the dysfunction? So if someone was going to learn about where their leptin level should be, what would they be learning?

Yeah. So first and foremost, if you're, if you're listening to this conversation and you're like, oh my goodness, I need to learn more about leptin. And one of the things I would highly recommend is you go to my website, Dr. Bindymdash Quiz and take this 11 question quiz. It'll let you know if you're leptin Sensitive leptin resistant or leptin clear. And what that means is you're just answering a few questions like, what's your blood pressure? Like, what's your waist circumference? Like, what are your triglycerides? Like, are you constantly eating? It's a few easy questions that you just answered. It'll give me an answer. Now, if you are leptin resistant, that means that your body is having a hard time communicating and you're more likely to have a harder time losing weight. This is the perfect population of people or women. I'll use women specifically who are eating well, exercising well. They're doing everything by the textbook to lose weight. And they're not having. They can't even lose a pound. In fact, they're like, Dr. Bendia, I'm actually gaining weight. I don't understand what's wrong with me right now. This is definitely what leptin resistance looks like, Right? Traditionally, leptin is a marker that we check through your blood work and we, you know, we'll look through the labs and kind of see what that lab number is. Now, when they report the lab number, I always like to explain this. They usually will put your body mass index beside it. I ignore that part because everybody's body mass index is not accurate. It's not taking into consideration muscle mass. It's not taking in consideration percent body fat. It's a little skewed. It's just literally a number that's based on height and weight, and that is not appropriate. We're more than just height, weight. Okay, guys. Yeah. And so, absolutely.

And, and to your point, for people who are more muscular, that body mass index is almost certainly going to be off because muscle weighs more than fat. And the more muscular you are, the more it's going to seem that you're too heavy for your height.

Exactly. And remember, as we age, we want more muscle, guy. So, yes, 100, 150%. So, yeah. So leptin in a perfect world should be between 7 and 10 when we check it through the blood, if it's More than that, 11 and above, most likely you have some sort of leptin resistance. And now I will say that it's very, very easy in my world to bring that leptin down. I have patients that have had had leptin in like the 1-50s before. I've had patients that come to me in their. It's 60 and we can normalize it pretty quickly. Right. It is definitely something.

And someone with a leptin that's Elevated like that. These are the people that are resistant in that their receptors start to not see it, right?

Correct. Yeah. This is why they're, like, doing all the right things. They think that they're, you know, they're, they're, you know, following this meal plan that their trainer gave them, and they're at the gym and five days a week and they can't lose weight. And they're always wondering, what am I doing wrong? And part of it is it's not them, but it is them, right? It's okay, well, now we know what the problem is, let's fix it and tweak it so we can optimize your metabolism and have your metabolism work for you.

Where does leptin resistance come from?

So this, you're gonna laugh, but we do this to ourselves, right? It is the food that we're eating. It is the medications that we've been taking. It is the stressors, the environmental triggers. It's all the things that probably contribute to dysbio, imbalanced microbiome. It's all these things that are probably also contributors to breast cancer. Surprisingly, it's all these things that we're ignoring. There may be some genetics involved and predispositions and in our, in our food environment, but I will say majority of the things that, that cause leptin to, to become resistant is, is unfortunately our lifestyles.

So can we talk some specifics? Like what in particular is driving leptin resistance?

Yeah, so for females specifically, or I should say everybody, actually, and I should say specifically, in our American culture, it's the yo yo dieting. I don't know about you, Jen. I think we've talked about this before, but many of us, you and you and myself included, have probably dealt with some sort of like eating disorder at some point or extreme dieting or extreme perfect. Of course you are. Yeah. But I mean, it's these crazy diets that we put ourselves on that then change the receptors in our brain. Right. When you are going through extreme starvation, whether it's extreme keto or anorexia, bulimia, whatever it is, or, you know, on the other end of the spectrum, you're eating the standardized American diet. You know, the communication is off. You know, everything that we do is extreme. There's never, there's nothing that we, majority of us is literally mid row. We're either at one extreme or the other. And that extreme behavior is really what's changing our metabolic communication with our brain. The body gets confused. It doesn't know if it needs to Store food because it doesn't know if you're going to feed it again next time or it doesn't know if you're going to eat again.

And this is why chronic dieting is a problem, right?

Yes, yes. The body gets confused. It needs routine, it needs structure. And we're throwing this off every time, every time by doing extreme fasting or whatever new fad we're, we're on this week.

Do you not believe in fasting?

No. So I will say I love fasting. For the right people at the right time. I am, I love fasting and I think there's a lot of great benefits to it. However, you need to make sure that when you're fasting you're working with a professional who knows about fasting, your body, your hormones, it can, etc. To see if it's the right time for you. The duration matters, how you do it, what you eat. So many women get fasting wrong. You know, it's not just about the time period. Are you overeating during that time period? Are you under eating during that time period? There's so many different factors that are important when it comes to fasting.

Yeah, I think you make an excellent point there because so many people think fasting, oh, well, I shouldn't eat. Well, that's not what it's about. It's about containing your eating during a prescribed window of time. But you're not supposed to be starving yourself. That's not what fasting is.

Yes.

I mean there are times when you're doing a water fast and you're not, and you're not bringing in any nutrients or sustenance. But those are very limited periods of time. And most of the time when we talk about intermittent fasting or time restricted eating, all we're saying is that you're taking a break from food for a prescribed period of time so that all your other systems can work and do what they're supposed to do. But we're not talking about abstaining from eating.

Yeah, and I've seen, I've seen different ends of the spectrum, especially when people do fast where the, the allowed time period that they're eating, they end up overeating or they over consume the calories in that four hour window, whatever period that is. Right. That' not good. Like what's the point of fasting if you're gonna, if you're gonna overeat during that short period? And then the other extreme where you're not even getting your basic nutrient value and calories during that Short window. So again, it needs to be done right. It also depends on, like, are you going through a divorce and fasting? Like, there's so many different things, like how are you feeling? Are you already feeling sick? Should you be fasting when you're feeling sick? There's so many different factors that we need to consider when you're fasting, because fasting is a hormetic stressor. And if you're adding, if you're adding stressor upon stressor upon stressor, you're just causing a lot more commotion. And again, probably worsening your leptin numbers instead of helping it. So if you do, if you do intermittent fasting or time restricted fasting appropriately, you can actually improve your leptin numbers. However, if you're doing it not so well, it can actually worsen your leptin numbers.

And I've seen it in. And I do want to mention that if you are doing time restricted eating or intermittent fasting, you need to pay attention to what time of the year it is because we are so tied to circadian rhythm. So please know that your fast during the winter months are longer because the days are shorter and your fasts during the summer months are shorter because the days are longer. And we're meant to eat when the sun is out. And, and also bear in mind that when you're eating that way, well, anytime you're eating, we should be eating more in the earlier part of the day and less in the later part of the day. As we approach sundown, our metabolism drops right towards the end of the day. So we need to make those really good choices at the end of the day. Right. Like if you're dieting all day until dinner and then dinner, you eat like a sumo wrestler. This is not going to work out for you.

No, no, exactly.

So you know, the time of day that you eat and what you eat at that time of day is very important. And just shifting it around.

Yeah.

So you also mentioned that there were some drugs that are associated with leptin resistance. What are they?

So let's talk about the prescriptions that, you know, many people are on. Specifically chronic use of antibiotics. You know, it changes the microbiome, right? It changes our gut bacteria, it changes the way things are working in our stomach. That's just one example. You know, but many of our patients, many people are probably are, you know, I think the average patient, I can't remember the statistic, is probably on like three or four prescription medications a day. You know, all those medications are doing something to your stomach and your microbiome. So, you know, they're all impacting the way your gut flora, they're all impacting digestion and so much more. So just prescriptions in general, antibiotics I can definitely call out. There's a lot of other ones too that you know, antidepressants and a lot of other things that can start changing your things. But that doesn't mean you stop all your medications. By all means, you need to have a conversation with your doctor about your prescriptions. But prescriptions, I will say, are also a culprit of, you know, adjust and changing your metabolism.

I would imagine that's something that you're working very intimately with with your patients to look at these, these chronic medications that they've been on and work with them to get off of them. I mean, the first thing that comes to mind that I'm sure has some involvement here is the acid blockers. And you know, we saw that, we saw that class action lawsuit come through last week where, you know, these medications, these proton pump inhibitors, they were designed to be taken for two weeks. And I think the last I looked, the average people are on them is two to four years.

So.

And this has profound effects on your gut health.

Yep, exactly. I mean, that's a great point. You know, a lot of times when patients are prescribed prescriptions, it's literally meant for a short amount of time. What ends up happening is a patient will go from doctor to doctor and doctors just keep re prescribing the medication, you know, and this is why we have all these unfortunate problems in our healthcare system right now.

Yeah, I feel like if we're gonna have a conversation about being overweight, we have to address that 800 pound gorilla in the room. So I'm curious as to what you think about the semiglutides.

So I will say first of all, the GLP1 medications are fantastic. I think there is a time and place for people who need it. In my clinic, in my practice, I do use it on patients that are severely leptin resistant and that maybe have a lot of insulin resistance or diabetes in conjunction. Right. So it's not for everybody, but there it is. It is meant for a group of people. Now, one thing I will say about it is I have seen some amazing results with Semaglutide and Madrono and all the brands and sisters and whatever you want to call them, because it really does a couple things. It gives you satiety messaging. So that's one thing that's happening with leptin resistance. People are not getting the natural cues to stop eating. With these prescription medications, they are getting the message to stop eating, which significantly helps. So not only are we seeing weight loss, which is great, it's just profound because they're eating less and they're changing the. They're really changing the brain. These patients that are severely leptin resistance, they're thinking about food all the time. They're thinking about food 24 7. Right. Even, like, you and I are like, I don't even remember the last meal I had. Right. You and I probably are like that. But some of our other patients are like, oh, my God, is it time to eat yet? Is it time to eat yet? You know, and so I just nodded.

But I do want to say, in all fairness and honesty, I'm obsessed with food. And if I gave in to all of my desires and whims, I would be well over £300.

I'm with you on that.

I have, literally, this is a lifelong battle for me. And my grandmother was overweight. My mother's has been overweight my whole life. And I very much carry every bit of their genetics. So I am someone who has developed a lot of healthy habits. I am not perfect. And I'm not. I'm not terribly thin either. I have a very athletic build. I'm a lifelong athlete. But I work at it every single day. And if I'm being honest, I white knuckle my way through it.

Yeah, No, I agree. Listen, I've been there. I totally get it. It's not easy. And that's why these prescriptions are very helpful for these patients. Because sometimes it's a little bit more than desire and discipline. Right. Sometimes it's literally changing the chemistry of the brain. And that's why these medications work really well. And it also causes slowed gastric emptying. So they're getting the sensation that they're full, their appetite has changed, and it's decreasing a little bit. They're not getting the cues that they're hungry all the time. And so I think it works really well in a certain population. And directly, I see leptin numbers come down really nicely with. With this prescription.

Now, if you. If you stopped it, would those numbers go right back up again? I mean, they're talking about that people need this for life.

So. Yeah, great, great point. So, again, the way I work with patients, probably a little bit different than the average doctor, right, that's prescribing this. I'm also changing up their diet and having them eat a certain way while we're we're putting them on this prescription. We're making sure that they're keeping their muscle mass intact and we're actually increasing our muscle and changing their body composition while losing actually fat. That's the thing that we work on is fat loss and, and not necessarily weight loss. I think that's that that conversation actually needs to change as well. So we really work on their body composition. I'm teaching them how to eat. So if they're following our plan to the T, not only do they lose the weight when they come off the prescription, they're able to maintain the weight with the healthy lifestyle changes that we've made during the journey. So it's not. I always tell people, if you're looking for a quick weight loss medication, don't come to me like, I'm not the doctor that's just going to write this prescription. You want that? There's a million doctors in the city or in the country that can just write your prescription. My plan is not that the medication will help. In conjunction, what we're doing now, I've seen two extremes, right. I've seen it where people never did, never just wanted to eat what they wanted to go, they wanted to go back to eating the Mickey D's and, and the Taco Bell and the standard American diet. Yes. They gave their way. They did gain their, their weight back. They sure did. I've seen it come back for a lot of people. Okay. And then I've also seen the opposite, where they continued eating like they should, getting their protein and continue exercise, really being mindful and focusing on the lifestyle changes. And they've done fantastic. They've done fantastic.

So it is possible to come off if you change your habits and change your lifestyle.

Yeah, but.

But overall, like, change your metabolic health. Because what I do hear in the reports is that for a lot of these people, yes, they lose weight, but they're also losing up to 45% of their muscle mass. And that is really central to your metabolic health, of course. So they may have a low number on the scale, but the truth is they're still fat.

They're still fat. They're skinny fat. They're skinny fat. I see this all the time. This is why we have body composition scales in our office where we're tracking this.

Can you explain to people what that means and what the implications of that are?

Yeah. So one of the things that I wish everybody did and it was more accessible and it kind of is, it's just checking your body composition. So in our Clinic, we are not just looking and focusing on your weight. We're also checking how much muscle mass in pounds do you have? How much percentage of muscles do you have in relative to your body fat? Right. Body fat in pounds as well as body fat in percentage. And we use at our clinic the inbody. And that's, that's my favorite scale, you know, and you can even get one cheaply from Amazon and track it yourself at home. I'm sure there's tons of other smart scales that track as well. It's just finding one that works for you. And in our clinic, that's what we track on. Because I can track patients progress. Are they gaining weight? Are they losing weight? And we know where to course. Correct. It's not just about. Because if you look at, if you just look at one number, you're like, of course you're losing weight. Amazing. You know. Right. But we need to make sure. Are you losing body fat? Are you losing muscle? Because if you're losing muscle, we need to course correct. We need to change something. But if you're losing fat and you're preserving your muscles or potentially even gaining muscles, then that's amazing. We're doing a good job. So it's all about body composition. It's not just focus on one number.

Yeah. And why is body composition so important? Help people to understand.

Yeah. So as we age, we start losing muscle mass. Right? Muscle mass and is so important for our over metabolic function and making sure our blood sugars stay low, making sure that we have good heart health. We need to make sure overall we're preserving muscle mass. Now one of the things that also declines as we age, ladies and gentlemen, is our testosterone. And as that declines, that drop in testosterone causes us to lose body muscle mass and actually is the reason why we have more body fat. And so we need to change that conversation and change the way our hormones are working as well as how our body composition is and how our muscle mass is working. And when you're younger, nobody cares. We're not paying attention to that stuff. But as we get older, we need to preserve our bone health, we need to preserve our brain health, we need to preserve all these things. And it all comes back to how much muscle do you have? We want to live longer independently. And this is why this matters. Yeah.

So when you talked about having an in body scale, that's what you use in your office. Is that something that people should be using at home and what parameters should they try to be meeting?

You know, honestly, here's my thing. I am a big data girl. I love data. I love tracking devices. I love blood sugar monitors. You name it, I probably have it, I've probably done it. However, if you don't know what you're doing, don't, don't even dabble into it. Don't even start because it's gonna, you're gonna obsess about numbers that don't mean anything. That's the first thing. Two, if it's, if it's gonna cause you more stress, don't do it. Like, if you like. For some patients that have blood sugar monitors, they freak out. They don't. They, they overreact, take it off, you know, that's the first thing I'll say when it comes to body compositions. I love that. Because obviously we want more muscle mass, right? But we also pay attention to your body fat. If your body fat is between, you're probably in a very healthy range. Once we get to 25 to 30%, you're in an overweight. And then obviously 30% above is obese, kind of similar to our body body mass index. The percentages are pretty much equivalent there, right when it comes to body fat. So we need to pay attention now for other. On the other end of the spectrum, if your body. Body composition, we know where we are today. We're also tracking it for the future. And then obviously seeing our progress, are we moving in the right direction?

So are you pretty much using leptin resistance as the decision as to who you're using, though the, the weight loss drugs are and who you're going to try to approach without them?

Yes, 150%. Because there are some people, I can look at their leptin number and I'm going to be like, there's no way they're going to lose this weight naturally. And if they are, it's going there. It's going to be tough. Like, it's going realistic. It's going to be super tough. Have I treated leptin resistance naturally without semaglutide? Yes, I have. These patients have had to work really hard, and just because they have leptin resistance doesn't mean they need a prescription. That's the first thing I will say too. The other thing too is it makes it easier. It makes it easier for these patients to move in the right direction. And that is why we have a tool. And if it, if it fits the person in the profile, we do offer it to them. Right. But that's not everybody. I have. You can definitely improve your metabolism naturally, and you can Definitely lose weight without these prescriptions for sure.

And we know how important all of this is. In fact, there was just a study out today. I forget, I forget which journal it was in. Maybe it was in breast. I got contacted about it this morning. I can't remember. And pretty much it said everything that we know, which is that if you are overweight or obese, that is over fat, then you have a greater chance of not only getting breast cancer, but your outcomes are far different. And the people that have that, that are overweight or obese, they have worse outcomes, worse response to therapy, higher risk of recurrence. I mean, all of these things that we intuitively knew, and now there are an. Any number of studies that, that kind of prove this. And, and I always say, you know, people get so focused on the breast cancer diagnosis and they think that's the thing. And the truth is that the thing is whatever caused the breast cancer diagnosis. And as we started to talk about in the beginning, this is all about root cause diagnoses. And so if you are overweight or obese, that is the thing, because it's that that's going to lead you to all of these other diagnoses. And so for almost everyone, I say your breast cancer diagnosis, I know obviously it is no gift. Right. It's no blessing, but it is an opportunity. And, and the vast majority of my patients that I work with, that stay on my program because, you know, just working with me, there's no magic there.

Right.

Right. Spoiler alert. There's no magic there.

It's.

You have to do the work. And these people wind up way healthier after their diagnosis than they ever were before.

Agreed.

Because we're getting to the root. And for so many women, that root is because their body composition is wrong.

Yeah. I can definitely, you know, share the story. You know, my mom got diagnosed with breast cancer almost a year and a half ago now, but she is way more healthier now than she was when she was first diagnosed. Not only has she lost weight, she's eating a lot cleaner organics, she's taking more supplements, taking care of her health. I mean, unfortunately, it is a wake up call. It is a wake up call. But agreed. People should and probably are way more healthier after the fact if they learn what the root cause of their cancer was and is and how to fix it.

Yeah. So let's just talk to the. Talk to everyone starting today. What are your major tips on how to be knowledgeable about where you are in terms of leptin, in terms of Body composition. How do you find out where you are in terms of metabolic health? And then what are your top tips to. To fix it?

So, guys, like, if you go to your doctor today and say you want your leptin tested, they're gonna look at you like, what? They don't even know what leptin is. I know you can go, you can even go to your endocrinologist and they're not going to want to test it for you. It's. We were talking about this earlier. It's a medical liability, unfortunately. They don't know how to interpret it. They don't know what to do with it. Yeah. So they're not going to.

It's the same thing with insulin, really.

Right.

Doctors are not measuring fasting insulins for people.

Plus, you know, we talk a little.

Bit about why that's important, too, because we didn't, we didn't really tie that piece in.

Yeah. You know, first of all, just to touch upon it, doctors are not checking because it's a liability. We don't, we don't. But we also don't have diagnosis codes. That's probably the biggest reason why we're not checking these things. There's. There's no diagnosis code that is approved. Right. But insulin, insulin sensitivity and insulin resistance sometimes will go hand in hand with leptin resistance. And not always. I always like to explain that just because I've seen both. I've seen someone that's insulin resistant also be leptin resistant, but I've also seen the opposite, where sometimes just someone is just insulin resistant. Their leptin levels are perfectly normal and vice versa. So. But insulin sensitivity is important. And I will check multiple ways, not just the hemoglobin A1C fasting glucose, but fasting insulin is also important. I also check things like adiponectin and other things to kind of get the full picture, because if you just check one way, someone may look great. Right. I also like to caution and say the hemoglobin A1C that we often check, it's a 0.2 up or 0.2 down. It's not always accurate. Right. And that's these numbers, you know, they, these labs are sometimes, are just guiding points, you know, and, and they're all different. But, but what you need to know is, is kind of get the whole picture of what's going on with you and put it in context with your lifestyle, what you're doing, what you're eating, what you're not doing, because then it'll all make Sense.

I love that. So again, I would love to know where, give people something actionable so that they can really start to take control of their health. Because obviously not everyone's going to be able to work with you, of course. How do you know that you have a problem and how do you know that you need to work with you? Are there, are there some, are there some tells that can tell people I don't have my better, my metabolic health?

Yeah. So first thing, like I said, I.

Think the statistic is like less than, less than 10% of Americans are metabolically healthy. Is that correct?

Yeah. I mean, you'd be surprised how many patients are actually healthy. I mean, not very many, honestly. But what I will say is, you know, the quick way, if you're, if you're thinking that you're leptin resistant, do the quiz. At least you'll get a guideline from there. What I would recommend if it, if you do the quiz and it comes back that you're a leptin resistant, it actually will tell you what to do. Right. That's kind of how we have our quiz. So whether you're leptin sensitive, leptin clear, leptin resistant, it'll tell you what you need to do and work on if you're leptin resistant. A couple things that I highly, highly, highly recommend. First of all, first of all, stop starving yourself. Stop starving yourself. Let's change our metabolic health. Let's change the communication of our metabolism by actually eating. That's the first thing. People look at me and they're like, what you want me to eat? I'm like, yeah, I actually want you to eat. I actually want you to eat three times a day, three meals, about four to six hours apart, spaced appropriately. And I also make sure that you're getting enough, adequate protein. So at every meal, protein is non negotiable. Whether that's about 20 to 30 grams of protein and we'll figure that out together. Or yourself, if you're working with a trainer, another provider, that's, that's where I start because that is a great basic foundation. And then I'll layer, add an add upon that once I learn more about their other hormones, right. Kind of figure out what their estrogen is doing, what their testosterone is doing, what is their communication of what's going on with their thyroid. Then I'll, I'll play with some of those hormonal things. But that's the basis of what I tell everybody to do. The other thing, the other thing that I'm sure many of us are probably, hopefully all doing is, you know, we're doing all the great things. We're eating clean, we're eating organic, we're following, you know, EWG's Clean 15 and Dirty Dozen. We're doing the best that we can. Watching are the toxins that we're kind of exposed to our environment. You know, all those things are slowly helping. You know, we can't be perfect. I'm guilty of, you know, we can't be perfect, but we can do the best that we can and that will overall decrease inflammation and make sure our liver is working like it should and improve leptin resistance over time.

Yeah, yeah. And the other piece is the exercise piece.

Yes.

Because as we age, the way that we move our bodies, you have to move your body like every single age, from non negotiable through, through the elderly. Like everyone has to move your body, their bodies. But you have to also lift heavy things because you need to, you need to build that muscle.

Yeah.

And that, that is something that becomes non negotiable because of what we talked about before. Because muscle mass is the key to metabolic health.

Yes.

And if you lose that muscle mass and it gets harder and harder to maintain, I mean, you, you stress that protein is non negotiable at every meal and it's the same thing in the exercise world for lifting heavy things. Like, it's just non negotiable because it's the only way that we are going to maintain our muscle mass is to call on our muscles. Right. To demand that they work.

I highly urge you, start as young as your twenties. Start young ladies. Start lifting early. Don't be scared. You're not going to look like a man. I've been there. I had that mentality too. I totally get it. And now that I lift weights, I'm like, what was I thinking back then? Like, what was I thinking?

It feels so good to be strong. It feels so good. I know. Last year when I went through my back surgery, I had spinal fusion last, actually last summer at this time. And when you recover, you pretty much like sit in a chair for eight weeks and you will be astounded at how quickly you lose all of your muscle.

Yeah. I can only imagine it has taken.

Me the better part of a year to come back and it is just so, such a relief to feel strong again.

Yes.

I felt really weak for a long time.

Oh, I can only imagine. Yeah.

So it's just so important to be strong. Strong and it's really the only way that you're going to maintain your health and live for a very long time and die young.

Yeah. And it's not like I said, guys, it's not always about the weight on the scale. It's not just a number on a scale. It's much, much more than that. It's much, much more. Yeah.

And it's, it's all the signals that metabolic health is also sending to your brain.

Right, exactly.

Because it ends up being the key to our mental health and our mental acuity as well. And when you are in that leptin resistant state, you actually don't have the same brain capacity. That's a very pro inflammatory state.

Yes, it is.

And that that inflammation is transmitted directly to your brain. So if you want to keep your health, you want to keep your body and you want to keep your. And in fact you mentioned a tie in to osteoporosis and I know people are very, very concerned about their bone health. So if you want to maintain your bones, if you want to maintain your body, if you want to maintain your mind, then this piece is so very important. You have to, have to, have to get your metabolic health in line. So Dr. Gandhi, thank you so much for being here today. This was a wonderful talk. Remind people again where they can get, how they can get to your website and how they can take your quiz.

Yeah. So you can definitely, you know, go to our website. It's Dr. Bindiamd D R B I N D I Y A M D forward slash quiz. That is where you will find the leptin quiz and then it'll take you through a few questions to answer and it'll let you know if, if there's something to worry about or not and then even some actionable steps, apps to do for those people. Also interested, I do have a metabolic makeover course for people who can't work one on one with me. It is a course that you can do anywhere, anytime, at your own leisure that kind of like helps you reset your metabolism. It's super easy, super effective and it takes only 28 days. It's not personalized. So that's the difference. And that's what I do with my one on one patients in my clinic in Atlanta. But it is a great way to start and you will feel amazing just implementing some of these changes. And you can always follow me on Instagram, TikTok, Facebook, I don't know, all these social. YouTube I guess. Right? Dr. Sometimes I can't even keep up with where we're at these days. It's all the same. It's Dr. Bindia, MD. And you'll find wonderful resources there. You know, we try to keep it juicy for you guys.

Amazing. Amazing. And we'll be sure to link to our all of that in the show notes. So if you enjoyed today's episode, please like it, Please share it with the people around you who you love so that we can all help to lift each other up. Because as my friend JJ Virgin tells me, a rising tide lifts all boats and we need to be there for one another to lift each other up, to help to motivate each other, to help to support each other and to help to keep each other accountable. Because really the only way that we're going to do this is by doing it together. So thank you so much, Dr. Abednia for coming here today and for sharing your experience with all of us and your knowledge with all of us and to help all help for helping all of us get to a better, healthier place. I'm so grateful.

Thank you Dr. Jen for having me on today.

My pleasure. And with that, I will say that I will see you next week, same time, same place. Bye for now.

Thank you for joining me on this episode of the Keeping a breast podcast with Dr. Jen. I hope you found the discussion informative and empowering. Remember, breast health is health, so by staying, staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Dr. Jennsimmons and remember, my Jen has two N's. So until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.

Sam.