How Leptin Resistance Can Affect Your Weight, Health and Fertility, with Dr. Bindiya Gandhi

Hi, I'm Dr. Tabitha, the functional gynecologist. I'm a board certified OB, GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling with hormone imbalance, weight gain period issues, anxiety, insomnia, you name it, then you've come to the right place. I want to be your functional gynecologist. So welcome. Hi ladies. Welcome back. So this week we are talking about leptin. What the heck is leptin? It's a hormone, so it has a lot to do with our appetite. I'm really excited for this episode because we don't talk about leptin very often. Leptin usually keeps our appetite suppressed and under control, whereas ghrelin is the opposite hormone. That's our hunger hormone and they kind of work against each other to keep keep us feeling full or feeling hungry. But so many of our other hormones impact these hormones. And my expert guest today is going to talk about leptin and leptin resistance and why it's such an important issue to figure out if that's what's going on with you. So I'm really excited for this episode today. So let me just sing. Dr. Baby Bindia's raises Dr. Bindia Gandhi is a double board certified integrative and functional medicine doctor. She helps thousands transform their overall health. She's the medical director, Atlanta Functional and Integrative Medicine, Revive Atlanta, Maryland. It's a comprehensive clinic focused on total body healing, including decreasing inflammation, improving hormone balance, helping women get pregnant, weight loss resistance, chronic stress, gut health and more. After dealing with her own medical crisis and eventually improving her overall health to rebalance her hormones and conceive naturally, she's been focused on finding the cause of the issues instead of treating the symptoms. And she holds a special passion for female hormonal cases. She's worked with a listers including professional singers, athletes and the like. Reclaim their health. Her podcast Reset, Renew, Revive has given gained tons of traction since its launch in April 2020 and she regularly engages with her community of over 24,000 followers via Instagram where she produces compelling content and education material to continue to inspire people to live healthier lifestyles. So definitely follow Dr. Bindia on Facebook and Instagram. Those links are in the show notes and she's got a leptin quiz that she's going to talk about. Those links are in the show notes as well.

So.

So I'm really excited to talk about this because it's newer research. You know, we continue to learn about the human body and we have so much left to learn about the female human body, especially because it's so complex and we really are just now trying starting to understand how our hormones interact with our other systems and affect one another. So definitely you want to be seeing a doctor who is up to date on the research, who is open minded, a lifelong learner who wants to get to the root cause of your issues and not just put a bandaid on and get rid of your symptom. Right? That's the biggest difference. That's the biggest philosophy in functional medicine. So let's talk to Dr. Bindia. I would love it if you'd hit the subscribe share this with all the women in your life and spread help me spread the word because this work is so important. All right, let's get going. Well, welcome, Dr. Bendia, to the Functional Gynecologist podcast.

Well, thank you so much for having me, Dr. Barber.

I'm so excited for this conversation because nobody talks about leptin. So how the heck did you get into this area?

Well, you know, first of all, let's talk about what leptin is, because leptin is a hormone that nobody talks about and it's so important. But, you know, my journey started really back in medical school when I realized that in my pharmacology class that I did not want to keep prescribing medications, only to prescribe more medications. So I remember sitting in my pharmacology class and Dr. Marcos was my professor and we were talking about antihypertensive or blood pressure medications. And at that time, you know, if you gave a prescription for blood pressure, something like amlodipine, the side effect would inevitably at some point be leg swelling. And I remember being like, that doesn't make sense. And he goes, bindia, it's not the side effect. It's actually the mechanism of action. It's going to eventually happen. And I was like, whoa, so someone's going to come in for blood pressure and I'm fixing one problem and now I've got to fix their leg swelling the next visit. Like, I was like, that doesn't make sense. Like, that's so bizarre. And so I knew very early on that there was more to medicine than just pharmaceuticals. That's also very early on when I was dabbling with my own stress management. I had become yoga certified in medical school. I became Reiki certified in medical school. And I remember my colleagues saying, what are you doing that for? Is insurance going to pay for that? Like, what. Why are you doing some of this stuff? But I knew that I wanted to heal patients in other ways. There had to be other ways than what I was taught in medical school. Fast forward to residency, when life gets intense and hectic. And I thought I was eating well, thought I was meditating and exercising like I should, but that chronic stress really took havoc on my hormones. It really took havoc on my gut. You know, when you're in residency, you're not sleeping well, You're. You're just. You're in a constant state of adrenaline rush. 24 7, right? That's. That's just what life is. And long story short, I was having a lot of GI issues. I was having a rash on my face, I was breaking out, irregular menstrual cycles, headaches, you name it. Like, nothing. Nothing. I mean, it was just like I was this new person with all these medical problems. It's like I turned. It's like I turned 29, 30, and then all these medical problems happened, and I was like, this is. This cannot be right. Later found out that I had celiac. Later found out that that was a big problem of what was happening. And again, this whole time, I thought it was healthy. I was working out, I was eating well and I was meditating. I was doing all these things that I had learned during medical school to do, but those things weren't working for me anymore. And that's when I discovered functional medicine. Worked with a functional medicine practitioner, got to the underlying root cause of my problems, and then started helping other women and other patients kind of achieve their health goals. But when it comes to leptin, this is something I. I've learned fairly recent over the last 10 years, because I will say I wasn't taught about leptin in medical school. I wasn't even taught about leptin in. In some of the programs that I did, right? My. My advanced training. It was something that I learned after the fact because it's such a newer hormone that nobody talks about. So leptin is actually produced by your fat cells. And so what it does, it actually communicates with your hypothalamus, this, the brain that regulates your metabolism. And leptin's job is to tell your brain whether you have enough fat stored up to fuel your body and burn calories at a normal rate. And in other words, it lets you know if you're properly full or if you can stop eating or if you. If you need to eat some more. And so what happens is sometimes this communication is off, and this impacts your waistline, like, literally. Because when this communication is off, it prevents. Your brain is not getting the message that you're full. And so sometimes you're overeating, sometimes you're eating in between meals. And leptin, when it circulates at higher level, it actually not impacts just your weight, but it starts impacting your appetite. Food cravings, sleep disturbances, anxiety. It can actually impact fertility and so much more. So much more. Yeah.

Oh, my goodness. So you hit on a key point that it's produced in fat cells. And so the point of leptin is to prevent you from getting fat, essentially. Right. It's an appetite suppressant to help control your appetite. So explain what's going on with that.

Yeah. So that's so important because a lot of times people are not aware that, you know, the foods that we eat, everything that we put in our body, right. Our brain is supposed to get a message saying, you know, that's enough food that keeps you full. But if you like. If you look at. This is why sometimes portion control can work for some people and can't for other people. Right? Because if your brain is not getting the message that you're full from eating whatever's on your plate, you can trick it in many ways that you try to. But if your brain is not getting that message, you tend to overeat. You tend to kind of keep fueling yourselves because your fat cells are like, I need more. I need more. And your brain's like, okay, yep, give her more. Give her more. So it's that miscommunication, but it's really important because when this miscommunication happens, other things start happening too, right? Inflammation starts happening. Insulin resistance starts happening. And not only do you become overweight, but it actually increases your risk of cardiovascular diseases and other medical problems as well. So it's not just about overeating, and it's not just about your fat cells not getting the message. It's really about understanding and resetting your metabolism in the appropriate way so your leptin levels can circulate at a normal level and not be circulating at a higher level.

Okay. And, you know, I kind of think of it the same way that insulin works. You know, your blood sugar goes up. Insulin has to respond and be produced to go out and take that blood sugar, bring it into the cells, and store it. And if we're not hearing the signals, we got to make More insulin. Right. And so we get this elevated insulin. Insulin resistance. Is that what's happening with leptin?

Yes. Yep. Exactly. Some of the same things. So, you know, unfortunately, as females, we have other hormones as well. Right. So we tend to have higher circulating leptins in general as well. Right. So as compared to men or counterparts. So sometimes this can be a challenging challenge as well, because not only are we dealing with leptin, we're dealing with. We're dealing with our adrenal hormones, we're dealing with our thyroid hormone, we're dealing with our sex binding hormones or sex hormones. So all these. All these hormones actually kind of communicate with each other. So it's really important for us to kind of be aware of what's really going on with our metabolism and our body. And more importantly, when we're talking about leptin resistance, when that communication is not happening, the levels will circle, will start getting higher and higher and higher. Mainly because we're feeding it. We're like, oh, we need to eat more, we need to eat more. So when we eat more, the levels would keep going up. And that's what causes leptin resistance. This is why I have some patients in my clinic who, they'll come see me and I test leptin. I'm very particular about testing leptins in your blood work, and they'll have a circulating leptin level of 70s. Now, just so your audience is aware, leptin should actually be seven. So that's a big difference and a big number. And yes, in some patients, sometimes you can obviously tell someone's overweight and you can suspect that their leptin levels are higher. But sometimes you'll get somebody with an average normal BMI body mass index, and their leptin levels will still be a little bit higher. So there's a lot more that goes into it than just kind of saying, yes, you're overweight. The correlation is overweight, obesity and leptin levels being off.

Right. So does that help them feel vindicated? Like, oh, my gosh, now I know why I can't lose this. Wait, why I have these cravings?

Yes, for sure. Because a lot of times people, you know, sometimes people have cravings and they have no earthly idea what they. And most of the times it's craving the sugar foods, the sweeter foods, the. The higher carb, comfort foods. Like, I'm actually hearing a lot about that today. Everybody seems to be craving comfort foods. And that's unknown. Unknown why? It's like, I don't Know why I need to be eating the bread or the rice? Like, I just. My body needs it. And so you kind of listen. And it's important to listen to your body. I understand. But sometimes we're fueling it with the wrong types of foods. Right.

And sometimes the signals and messages you're hearing are what you want to be responding to in that way.

Right, exactly, exactly.

Sometimes it's more of a warning sign, like, hey, so once you find out you have elevated leptin, then what do you do?

Yeah, so great question. So one of the first things that I have people do is actually go to my website, it's drbindiamd.com/quiz, and take my leptin quiz. It's 11 questions and kind of understand. Could you possibly have leptin resistance? I've broken it down into three different phases. Leptin clear, leptin sensitive, and leptin resistance. So if your leptin level is between 4 and 7, you're in the clear. Probably don't have a leptin issue. That's awesome. Great news. Leptin sensitive is if you're in 8 to 10. And that means you're a little bit leptin sensitive, a little bit of. We got to tweak some things, but we don't need to do a large, big overhaul. When you're above 11, that's when we know that you're leptin resistance and you have a lot of stuff going on that we need to kind of fix. Those are just guidelines that we use in our quiz. But what we do is I like to track in blood work, so I often will track my patients and clientele, and we will kind of do blood work very strategically, very periodically to kind of see is this leptin level going down. But ideally, we want to make sure that our leptin is at 7, and that's where the magic, magic number is.

Okay. Do you often see insulin shift as well along with leptin?

Yeah. So here's a great one. So again, I just. Because I was just reviewing labs earlier with another patient today. Their A1C can be 100% normal. Their A1C can be like 5.2, 5.0, but they're still leptin resistance. So there is a correlation with your leptin resistance. When you improve, improve your leptin resistance. If you have some underlying insulin resistance, that stuff will improve as well. But there is no direct correlation of insulin resistance and leptin resistance. Does that make sense?

Yeah. Yeah. So complex, you know, it's never straightforward when it comes to our hormones. So you touched on this a little bit. As women, we have a lot more going on. Our hormones, our sex hormones are cycling every month. Is leptin involved in that or does it get affected by that?

Yes, yes, great question. So you know, first of all, your hormones are going to change actually. Your hormones are changing throughout the day. You know, different times of the day, your hormones are changing. But yes, as a female, you know, we do have a four, approximately 28 day cycle that we do have to pay attention to. And leptin will kind of be able little bit higher, especially to the tail end of your cycle. And mainly the reason why is because when progesterone starts rising, you're craving some foods usually that your body needs. This is typically around the time where your body needs to eat a little bit more carbier foods and a little bit more, what's the word? Yeah, a little bit more carbs. And that's mainly because you need those, you need those healthy carbs. I don't want to re. Emphasize healthy because your two things are either going to happen at the, at the tail end of that four week cycle. Either you're going to conceive and your body's got to get ready for fertilization and to kind of get this baby to come to fruition. Embryo, I should say. That's either what's going to happen or it's going to shed. Right. And you're going to have a cycle. So it's really important to be aware that if you are testing leptin levels, you know, to the second the tail end of your cycle, it probably will be maybe a little bit higher.

So then do you try to check it on a certain day of a woman's cycle or not?

I don't know. I usually don't because usually when I'm interpreting blood work, I'm interpreting based on when their last cycle was.

Okay, cool. So what about intermittent fasting, time restricted feeding, does that play into hormone?

Yes. Yeah. So what you and I have been talking about is leptin resistance. Right. There's so many different things that can actually cause leptin resistance. Right. So intermittent fasting is actually, can be a game changer for so many women. Keto diets can be a game changer for so many women. Different, different protocols can, can be a game changer for certain women. But guess what happens after a while. This is what, this is what I want to stress. After a while what ends up happening is your body starts thinking you're in starvation mode. Okay? So when your body starts thinking in starvation mode, it's going to hold on to everything. This is why sometimes women will do keto for like two months or intermittent fasting and they're like, oh my God, Doc, I lost all this weight. I feel so great. And then they can't lose a single pound. Like, they're like, I'm not doing anything different, like, why can't I lose a single pound? Your body starts thinking you're in starvation mode. And your body will start holding on to fat cells. Right? And your body will hold on to the fat cells. And what ends up happening is your metabolism has unfortunately slowed down. So when you lose weight, eventually, slowly over time, your metabolism slows down because it doesn't need, it's kind of reserving that energy, doesn't need to expend that energy. This is why also when you, when you, if you track your workouts and if you track your caloric intake, when you start losing weight, you don't need the same caloric, calories and food wise that you did when you were a little bit more, when you weighed a little bit more. Same thing with like working out. You could do the same workout, but you're actually burning less calories because your body's kind of reserving that for, oh, I don't know if we need to kind of burn all this extra energy like we do. Because part of it is your body starts thinking, when is the next meal? Am I going to get fed again? Your body starts going into survival mode and this is why your metabolism slows down. So for people that have done things like many, many yo yo diets or have tried intermittent fasting or they've tried different other things, they start having inability to lose weight and they start kind of slowing down their metabolism.

Yeah. Oh my gosh. I couldn't agree more. I have a seven week program where I teach feast famine cycling because you need to remind your body that it's not starving, you are having times of fasting so that your body can heal and conserve, you know, production of insulin and really get control of that blood sugar, but you want it to not turn down that metabolism as a result. So I think that was such an important point. Yeah. Oh my goodness. And I think that if women really got in tune with their cycles and realized, hey, I do need a little bit more starchy, you know, complex carbohydrates during my luteal phase when I'm needing that progesterone and just like give yourself some Grace and go eat a sweet potato. Like, how much better would it be?

It's okay. Even. Even eating a little white potato, it's not going to hurt you. It'll be okay.

I know, exactly. I think that's so important. So how does the thyroid play into this as well?

So thyroid really has a big role when it comes to leptin resistance, and mainly for a couple of reason. So first of all, if you have an autoimmune condition like Hashimoto's, which is an autoimmune thyroid condition, you know, that can impact. That can be inflammation that can cause your leptin to be a little bit off. But more importantly, what we see is people that have chronic stress. Right? People that have chronic stress, they tend to have something called low T3 syndrome. And so this is where it gets a little bit complicated. Now, kind of going back to what I was saying before. If your body thinks you're starving, your body's going to hold on to everything. And when your body thinks you're starving, one of the first things that physiologically happen is your T3 will start, your T4 will not convert to T3, and then your T3 will be a little bit low. Reverse T3 will start becoming a little bit higher. And that's what becomes a little problematic. And you start kind of getting into that EU thyroid or low T3 syndrome. And so this is very common in a lot of my patients that I see that have underlying thyroid issues or underlying, sorry, leptin issues. And so we kind of have to fix that low T3 syndrome, and we kind of have to fix that underlying thyroid issue. That kind of the whole thyroid picture. So it's not just looking at your tsh, it's kind of looking at the other numbers and how they're working together to kind of see how to balance your metabolism.

Yeah. I would say that most women don't realize they have this issue because their T3 and reverse T3 are not even being measured by their conventional doc. Right?

No. So unfortunately, I hate, I don't mean to dog other doctors, but even endocrinologists are not checking reverse T3 and T3 and total T3. And it really is important to kind of, to kind of assess this hormone. And this is why, this is why one of the reasons that if you've done intermittent fasting for a while, if you've done a lot of yo yo dieting, if you've done Weight Watchers and you've done low carb and you've done. You've Done all these things. One of the first things that I will tell you to do is actually stop starving yourself. You actually have to. You. You kind of mentioned this earlier, but you kind of actually need to eat real food because we've got to kind of improve that thyroid resistance because that's what's happening. And while improving that thyroid resistance, we're improving the leptin resistance. Yeah.

Oh, my gosh, that's such an important point. Like, you really need to start loving on your body and reassuring it that it's going to be okay and you're not starving to death. And I want us.

And I know I kind of alluded to this earlier, but, you know, females, our body is. We are made completely different than our male counterparts. Like, they can get away with intermittent fasting and they can get with. Get away with keto, and they can get away with all these things. And yes, we're jealous and whatever, but the problem is they don't have the extra hormones that we do that really do play a part in our full metabolism. So we do have to be mindful of our cycle. We have to be mindful of what's going on with our body for 28 days at a month time and kind of just be aware of all these other components that are impacting us.

Yeah, without a doubt. I mean, mentally, we might want to be powerhouses and like, doing all these badass things, running businesses and, you know, running marathons and doing all these things. But our physiology wants to get pregnant and carry a baby. That's like, why our bodies go through what they go through every month. And you can either fight against it or you can work with it. And you'll be so much better off if you just work with it.

And you know what? I heard an amazing quote. I'd love to share it because. Because this is very timely. Regret is more bigger than resistance. We need to stop resisting. Like, we resist way too much, and we need to. It's finding that balance of getting in tune with our body, listening to our cues of our body, but not resisting and trying to do what everyone else is doing.

Yeah, I couldn't agree more. I find that to be the same with the universe. Like, if you really want things to happen, you need to not be so resistant and fight against it. You know, just listen and work with it. So I love that. That's so good. So women should potentially get their leptin levels checked. They really need to remind their bodies that they're not starving. And most likely this is affecting their thyroid and down regulating their metabolism and really adding to this weight loss resistance issue. Is that, like, the full picture or am I missing anything?

No. So, I mean, here's the other thing that ends up happening. So we've been talking about, you know, people who have been, you know, leptin levels kind of circulating at a higher level. But there's also a population of people who have leptin levels at a really low, low level, which can just be as problematic, especially for women who are trying to get pregnant. This impacts fertility and it impacts. It impacts anxiety as well. So if your leptin levels are now circulating low because you're not eating enough or your body thinks you're starving, not only will your thyroid get affected and other things, but low leptin can be problematic just as much as high leptin. Okay. Again, like, everything we do, it has to be about moderation, and it's finding that balance that works for you. We don't want to slow. We want our metabolism to rev up just enough to kind of do what it needs to do on a daily basis for us. But we definitely don't want it to completely slow down and shut down. We need to kind of have it work with us.

Yeah. Oh, I love that. And you mentioned fertility. So is this something that we should be looking into when it comes to fertility?

You know, I think it's not a bad idea. You know, there still probably needs to be a lot more research that needs to be done as far as, like, studies and that kind of thing. But what they. What we have noticed is two things. If your leptin levels tend to be low at baseline, it makes it harder to get pregnant, because that's probably also impacting your T3 and your thyroid conversion. The other thing is, if your leptin levels are circulating at a higher level, there is data before you get pregnant. There is data saying that you're probably more likely to end up with gestational diabetes during this period, too. So it's really kind of important to. I think it would be important if you're getting a fertility workup to have leptin be a good marker to kind of say, okay, we need to pay attention to some of these things.

Oh, my gosh, without a doubt, I see that being on the horizon. That sounds like some awesome work, because we really need to understand that fertility is way more than just our ovaries and our vagina. Right. It really is our endocrine system and everything working together. So do you have one patient story, success story that you'd Love to share with us about leptin.

Yeah, I mean, goodness, I have helped so many people over the last few years just improve their leptin resistance and mainly get to the point where they have, they can lose weight and keep it off and not have any issues. And so one particular story I love to share is actually of a male patient. They have leptin resistance just as well. So one of my male patients, 30, probably 35 year ish old male at the time, came to me, leptin levels were 54, was having a lot of other issues as well. So, you know, a lot of mood issues, a lot of, a lot of gut issues, a lot of stuff going on that we were kind of working on with him. But over a six month period we took him from 54 to the last time we checked was 10. It was amazing. So, but he put in the work, he was determined to do it. He, we did a completely overhaul and he's not only lost the weight, I think his total weight loss, if I'm not mistaken, I think has been £40. But he's kept it off. That's the thing. It's losing the weight and keeping it up because there is no yo yo dieting. Right. It is about changing the metabolism, changing the conversation with food, improving some of these things so that you can actually live a normal healthy life and not be worried about, oh my God, am I going to gain that pound if I eat this cookie or whatever it is?

That's awesome. I think that's the most important power is you're keeping it off. So are you tailoring their food plan and what they're eating to them for any specific reason or does everybody seem to do well on one situation?

No. So, you know, my approach is a little different. I am doing like personalized protocols for a lot of my patients, starting with diet supplements. You know, sometimes people need prescriptions, sometimes they don't. So kind of a whole different dynamic, personalized approach to kind of getting them the results that they want. That's when I see people literally have amazing transformation because our hormones are different, our gut health is different, what we're exposed to from inflammatory perspective is different. So everything that I do is very individualized. And when we do that, that's, that's when people just get. Feel amazing.

Yeah. Oh my gosh, I love that so much. So where can my listeners follow you and get that quit?

Yeah. So you can, if you want to learn anything about me, you can go to www.doctorbindiamd.com. that's-R B I N--I-Y-A M D.com and if you want to take my free quiz, do it. It's 11 questions and we can learn if you're leptin sensitive, leptin clear, or leptin resistance. And that is drbindiamd.com forward/quit.

Awesome. I'll have all those links in my show notes. I think everybody needs to take this quiz, you know, I mean, that is really good information to have. And then, you know, like, do I really need to tackle this or not? But you also work with people and do comprehensive functional medicine. You know, all that holistic care right down in Atlanta.

I do, yeah. So we have a clinic in Atlanta, it's called Revive Atlanta to MD and we do in person appointments as well as virtual appointments. And yeah, it's been amazing because we've had so many people transform their body, their lives, their health, but even so much more than that, like they improve their self esteem, their self confidence. And so it's not just about the scale. We all love the scale in our favor, but it's about other things that happen when you have the energy, you have your confidence back and you have the ability to live your best life, like fully enjoy life. So yeah, it's been awesome.

Oh, that's awesome. Okay, everybody needs to follow Dr. Bindia. The links are in the show notes. Thank you so much for being on today. This was awesome.

Thank you so much for having me today.

All right, ladies. I hope you found that interesting. I know that I did. I love that we're really starting to put the pieces of the puzzle together when it comes to women's health and how our body functions and how all the intricate systems work together to help us feel amazing. So, you know, I hope you got one golden nugget out of it. I know I did. I love that she, she mentioned that when you do intermittent fasting, you also need to make sure you eat enough when you do eat. You know, I teach the feast famine cycle. And so even though you have times where you're restricting and you're not eating, you're doing these fasting periods or time restricted eating, when you do eat, you want to make sure to remind your body that you're getting enough nourishing, healthy, healthy foods, enough healthy fats, enough clean, lean proteins, enough fiber, and that you really aren't restricting when you are eating. That's the key for women when it comes to fasting and hormonal health. So that was my key takeaway. And I hope you got something to add it to what you're already doing. Because remember, we're just, we're moving forward.

Forward.

It's one step at a time every day. It's a journey that we're on together. And I am feeling so blessed and honored that you allow me to be on this journey with you. Please let me know what you want to hear about. Send me your questions. I love all of it. So don't hesitate to reach out and work with me one on1@doctor Tabitha.com if you feel like you need, need, you know that actual one on one support. Because I work with women all over the country. I'm licensed in over half the country. If we need a medical license for your care, sometimes we don't. Sometimes we really do just need to work on diet and lifestyle, work on healing your gut. Oftentimes it's healing your gut more than anything. And so I can do that with everybody. So don't hesitate to reach out. Like I said, please follow me on Instagram at The gutsy gynecologist Dr. Tabitha got hacked. Don't follow that. Don't listen to any of that. But I am here for you ladies. So go out and have an amazing week and I will see you next time. Bye.