Lose Weight By Improving Your Leptin Sensitivity, with Dr. Bindiya Gandhi

So leptin's job is to tell your brain whether or not you have enough fat stored to fuel your body and burn calories at a normal rate. So when this communication is off, you're more likely to be overweight. And, you know, this is why it's so important to kind of learn about this hormone and see if this hormone is impacting your metabolism.

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Welcome to the Five Journeys podcast. Live like youe Matter. Our guest today is Dr. Bindi Agandi. She's double boarded by the American Board of Family Medicine as well as the American Board of Integrative and Holistic Physicians. By the way, she's wicked snot. Her goal is to help her patients achieve optimal health by incorporating her primary care experience with functional and integrative medicine. And in 2017, she opened Revive Atlanta MD to provide her patients with the utmost quality of service and care. Welcome, Dr. Bindia. Thanks for being with us.

Thank you so much for having me today.

Yeah, it's a pleasure. And the topic is one that's not only needed, it's really interesting.

So, so psyched. I was like, I have a hard time explaining leptin. I'm so happy you're gonna.

I'm so glad to be here to do so.

But let's start from the beginning. You do a lot of work with patients with weight loss and they often hit a plateau. What is that? And why do women get stuck there?

So, you know, I will say that in all my years of practice, I have noticed that women tend to struggle a lot more with weight than men do. Sometimes they will go on a diet with their significant other and their significant other loses. We way quicker, faster, and women always struggle. And the number one reason this is is because we have hormones that are not accounted for when we're talking about the weight loss equation. So you guys know this. In medical school, we've often been taught that, you know, it's a calorie in, calorie out, mathematical equation when it comes to weight loss. And unfortunately, that's not what it is. There's a lot more that goes into it. And for females, unfortunately, it's a lot of hormones and that can actually make weight loss challenging. Or if they do lose weight, they can hit a plateau or sometimes even more than that, they gain the weight back after they decide that that diet, that short lived diet, was too hard to sustain and too hard. And so that's where things get problematic. Right.

And we know that yo yo diets are the worst thing you can do for your health.

I'm so anti diet. I always say to people, you're not going on a diet, you're going on a program. Because a diet implies something temporary. And we're looking for a sustainable long term behavior that's going to work for.

Exactly, exactly. I'm all about lifestyle changes. And unfortunately, you know, our society has kind of taught us about quick fixes. You know, we've been told that you need, you need to do the slim fast or whatever, quick shake or whatever the fad diet is at the time. And so many women and men, you know, but mainly women do these yo yo dieting. And that actually messes up their metabolism in the long run. And a lot of my patients, and I'm sure you guys can relate to this too. A lot of times people start dieting in their teens, mean it starts very early, unfortunately. And that can start messing up your hormones very early, very early on. So by the time they get to the 30s and 40s, their metabolism needs to be reset.

Okay, so how do hormones affect weight loss?

Yeah, so first of all, we have tons of hormones, okay? We have cortisol hormones, we have dhea, we have testosterone, we have progesterone, we have sex hormones, we have insulin hormones, we have leptin, we have so many different hormones. And you know, the conventional doctor is not looking at all these hormones when you go and complain about, you know, hey doc, I'm having trouble losing weight. So these hormones are so important because they all play a different role in your body. But you know what, more importantly, they all work together. And so when one hormone is off, it starts impacting other hormones. So if you're stressed, we'll just use this as an example. When you're stressed, guys, and your cortisol and adrenal function is off, then guess what? That starts impacting your thyroid. Over time, it starts impacting your estrogen metabolism, your testosterone for men. So it really starts impacting other hormones, hormones. And so that's why it's really important to address all these hormones, especially when we're talking about weight loss.

Yeah, so what you're talking about is something called cortisol steel, right?

Yes.

Where there's sex hormones or stereogenic hormones, where estrogen, progesterone, testosterone, and cortisol. So if you're using a lot of cortisol, we talk, at least I talk to my men, about do you want to be stressed or do you want to have sex?

Sex or stress?

Right, right.

I like that. I'm gonna have to start using that line.

There you go. And it's the same thing for women also, because obviously, the more stressed you are, the less hormones you have. It's a much more complicated cycle.

We know.

The result is the same. Let's put it that way.

Sex or stress, baby?

Yes. Yes, for sure.

So how does leftin. Because leptin is a. Is a whole different world that not many people have talked about or know about. So talk to us. What is leptin?

So let's talk about leptin, because many people don't know what leptin is. So first of all, leptin is your satiety hormone. Your own fat cells actually produce this hormone. And what it does, it actually communicates with your hypothalamus, which is a part of your brain that regulates this metabolism. So leptin's job is to tell your brain whether or not you have enough fat stored to fuel your body and burn calories at a normal rate. In other words, it lets you know if you're properly satiated or. Or can you stop eating until you're hungry again? Now, what ends up happening is people with leptin resistance are often dealing with a miscommunication, which means their brain is not able to communicate with their fat cells appropriately. So they're not getting the right messaging. And this prevents them from getting the memo that they're full so they can stop eating. And when this happens, leptin levels circulate at higher levels than they should, which can actually lead to changes in appetite, food cravings, weight gain, sleep disturbance disturbances, mood, anxiety, and actually so much more, it can actually impact fertility in some women. So when this communication is off, you're more likely to have inflammation, insulin resistance, more likely to be overweight. And, you know, this is why it's so important to kind of learn about this hormone and see if this hormone is impacting your metabolism.

So this is. When it's too high, it leads to this, or when it's too low, it leads to this.

Oh, we're not even talking about when it's too low. We haven't even had that discussion yet. Because when it's too low, it causes a whole slew of Other problems. When it's too low, your body thinks you're in starvation mode. And so when your body thinks you're in starvation mode, your body's going to hold on to a lot of fat. Your metabolism, metabolism is definitely off. It starts impacting your thyroid for females, it starts impacting your fertility. So less likely to get pregnant when your leptin levels are low.

So what affects the leptin levels? What are the basic factors?

Yeah, so so many different things impact leptin, right? So first and foremost it starts off with, you know, our standard American diet that we've been eating, right? So, so foods that we've been eating that are high processed, high fat, high sugar causing digestion issues, leaky gut, food sensitivities, dysbiosis, or an imbalance of good and bad bacteria, toxins impact this. So being exposed to environmental disruptors like phthalates, sulfates, all those good things, those are hormonal disruptors, infections that you could have been exposed to that you may not be aware of. Chronic stress, guys, that is such a big one because it impacts so many different things. Inflammation, hormones, your thyroid, your adrenals, sometimes even genetics. So there's so many different factors that are starting to impact your leptin hormone.

So basically everything that we do in functional medicine is a piece of this puzzle.

Yes, yes, for sure.

So I have just a. Is everybody obese or overweight with leptins resistance or.

No, not always. You'd be surprised. Like I have patients that come into my clinic and like I'm thinking about some females that come into my clinic and they have probably normal BMI, probably a body mass index of, you know, 24, 25, you know, that's within that normal range. But their leptin levels are like in their 20s, 25. So not always. They don't have to always be morbidly obese or overweight to. To have an abnormal leptin level. Sometimes I'm seeing that. And for this patient specifically that I'm thinking about, you know, her, we brought her leptin level downs from 25 to actually we brought it down to 11 and that was over three month course she lost a total about 10 pound pounds. But the biggest thing was working with her on her thyroid. When we improved her T3 function, that's what helped her lose some of the weight because before she had tried everything and we couldn't. She couldn't, she couldn't. She was not budging. Like she had tried intermittent fasting, tried everything but balancing her thyroid hormone really Helped her kind of lose those £10.

So, so we've covered some of it. But can you go over how do people get more sensitive to the leptin so that they don't have to put out as much? How do you become more leptin sensitive?

So, yeah, I mean, one of the things that we want to do, like I mentioned, is cut out the fruit sugars. Very, very important. Or fruit. The other thing I usually recommend is like force people to eat. Seriously, force people to eat three meals a day, four to six hours apart. The other little trick that I think is so important that many people forget is, you know, starting your day with high protein breakfast. Protein is really important. It keeps you full, which is really important. So you're not going to get hungry within two hours after eating it. And it really kind of gets your metabolism kind of kicking in gear. So starting off eating, but making sure it's protein in the morning and not like a donut or a bagel or whatever cereal that you could be used to eating, but a nice protein breakfast really starts fueling that metabolism. Those are just some of the quick tricks that I'll tell people to do, but they're so effective because those things really start resetting your metabolism. The other thing that I really, really, really, really will stress is making sure you're managing your stress. You know, all of us are stressed and I don't know about you guys, but you know, it's at all times of the year, it's not just during the holidays, it's not just when kids go back to school, it's to live in the world.

We're all stressed out in Western society.

Yeah, we're all stressed out. So managing your stress is so important and making sure you're sleep. So when you're managing your stress, we're going to improve that cortisol steel, we're going to improve the other hormones, we're going to improve our insulin resistance, we're going to improve our blood sugar balance and making sure we're getting good quality sleep. So the combination of making sure that we're managing our stress and there's so many ways that we can do that. You have to find something that works for you. Whether it's journaling, whether it's meditation, whether it's movement yoga, whether it's breathing techniques, whether it's having a gratitude practice, seeing a therapist, you know, whatever aligns with you, you've got to do something that really calms that cortisol down. And that's so key because you need that cortisol to be at a nice healthy low level so your other hormones can do what they're supposed to be doing. And again, sleep is so important because when your cortisol's spiking before it should, you're waking up in the middle of the night. Or when your cortisol's spiking before it should, you're not sleeping at night. So we want to make sure that we're kind of addressing both.

What are the specific treatments for leptin that's we talked about a huge cause. Is there a specific treatment that's leptin associated versus kind of a general health associated? Because we all know we need to eat well, we need to get rid of the toxins, et cetera. Is there something that's specific for leptin?

Yeah. So one of the things that unfortunately the other thing that's happening is leptin starts impacting our detoxification, it starts impacting our liver. Liver is also, again, where T4 to T3 is being converted. Now, one of the things that I will say is the other thing that gets congested in our liver is toxins. Like we mentioned, specifically high fructose corn syrup or fructose. Now, so fruit is something that I usually will have people avoid short term because the body can't tell the difference between processed fructose and natural fructose from fruit sugars. Right. And so when you eliminate this, this natur starts decreasing your leptin resistance and improving your leptin numbers significantly. And most people are not aware of that, but that's because of the congestion that's happening in the liver.

So would you put them on a low fodmap diet for the fructooligosaccharides? Does it go that far? It's just straight up fructose?

No, it's not a low fodmap diet. It's literally just decreasing or cutting out fructose or fruit for a little bit to kind of reset that their metabolism.

So fruit avoidance, the natural decongestant of your liver?

Yes, yes. Yeah. I mean, so, you know, a lot of times people, you know, when they, they look at me like I'm absurd when I say, you know, stop eating fruit. There's so many good things about fruit. We have a lot of antioxidants, a lot of great properties. But what ends up happening is a couple things when we eat fruit. Right. So for some people who are insulin resistant or not even aware that they could be insulin resistance, that's already being impacted when you're e fruit, and most of the time, they're not just eating one fruit, they're eating many fruits. They're using fruit as a snack. They're using fruit as an alternative to sugar, which, by the way, is much better than eating, like, an apple pie every day. Don't get me wrong. However, the body, unfortunately, when it's that off or the metabolism has been kind of impacted, it can't tell the difference between where that blood sugar spike is coming from, whether it's fruit, or whether it's from a chocolate bar. And it really starts, and especially fructose really impacts that liver. So we have to kind of cut it out for a short amount of time. And that really, honestly promise guys, that really resets the liver and it really resets the leptin.

Is there any data for, like, intermittent fasting with leptin?

Yeah. So one of the things that I've seen over practice is intermittent fasting has been a great tool for so many people. But what ends up happening with so many people with intermittent fasting, especially women, they tend to do intermittent fasting and they get results. Probably as soon as they do it, they're like, oh, this is wonderful. They'll lose a couple pounds. And then what happens is their metallic metabolism slows down and it no longer works for them. Right. And that's because they're not accounting for their other hormones. They're not accounting what's happening to their thyroid during this time. They're not accounting for what their progesterone, estrogen, other stuff is going on, their stress hormones. Intermittent fasting is not great for women who are stressed. If you're already stressed at baseline and now you're doing intermittent fasting, your body's already sensing that stress and it's going to hold on to every calorie, every weight. So it's not necessarily the best idea. And I tend to see a leptin go up during this time. And instead of helping leptin resistance, you're actually hurting it. So one of the things I actually have people do, and again, people think I'm absurd when I say this is I actually force women to and men to eat three meals a day. Three meals a day, but keep them about four to six hours apart because you want to reset the metabolism, you want to reset the communication that's happening between the fat cells and your hypothalamus. And when you're eating three meals a day, spread out four to six hours, your body's getting the message, hey, I'm Getting enough fuel and it starts kicking it up into gear.

So do people notice that their weight starts to shift?

Yes, it definitely does.

It's so counterintuitive. Right? I'm going to eat more and lose weight.

Yeah. And this is why again, you know, we've been taught wrong for so many years. We've been taught to over exercise, we've been taught to starve ourselves. Now we've been taught to intermittent fast and like, you know, don't eat for 24 hours or whatever it is and you lose weight. But people are not losing weight. They're stuck at a plateau. And so we basically have to recommunicate with our brain. So it understands how to nourish our soul and our body in appropriate ways. So it kind of resets our metabolism.

All right, so yeah, so sleep is one thing, right? Because sleep we need a lot of. Then the question is exercise. Because exercise, it's stressful. Too much exercise is really stressful. Not enough exercise, you're not getting rid of the stress hormones. Where's the middle ground? What's right for the leptin story?

Oh, well, you know what? I'm going to tell you something that you probably have heard already. It's moderate exercise, right? So when you're exercising too much and you're training for that marathon, that's putting a lot of stress on your body and that is counterintuitive of what we want. Right. And that communication with our brain. So we want moderate exercise. And so what that means is moving your heart rate and getting some heart very heart rate variability, but you're not going to extremes. So maybe you're working out three to four times 30 to 40 minutes a week. You're not doing anything too excessive. Moderate exercise is important because it lowers leptin levels in patients and it also decreases insulin resistance. So you want to get some movement, which is important. So we don't want to do the high interval training, we don't want to be training for a marathon. We don't want to be going to spin classes two times a day and doing excessive hot yoga classes because over time that is negative and counterintuitive to what we should be doing. But doing moderate movement, walking, just moving, getting some heart rate variability, that's very effective.

Nice.

I was just thinking as you were talking, I've never trained for a marathon. I've never done a hiit training class, I've never done a spin class and I've never done hot yoga.

So.

Okay, I don't have to cut anything out we're good here.

Yeah. So I, you know, I'll encourage people try things if they, if they aren't already. Like things like bar Pilates, you know, walking, maybe get like low impact strength training workouts. So you want to move your body, but you want to try different things.

So let's, let's go back kind of big picture wise. So I do find that I agree with you. I see men and women, and women definitely have bigger challenge most of the time for weight loss. And I also, intermittent fasting for women is definitely much more challenging than for men in terms of the results. They don't. Either they get it and they don't keep it or they just long term doesn't seem to be as good for women. So person comes to you give us kind of your flow. How do you work it? What's the big picture?

I guess, I mean, so I'm, I'm someone that's making multiple changes with some of these patients, right? Like always addressing nutrition first. How can we optimize your nutrition? What can we tweak and fix and improve upon? You know, so if that means you're intermittent fasting, we're, we're stopping that intermittent fasting. If you're someone that's snacking all the time, maybe I'm stopping the snacking, right? So whatever it is, we're, we're changing and making some dietary changes and we haven't even really talked about this yet. But you know, if they have like gut issues or food sensitivities, I'm addressing all of those things as well. So, you know, but yeah, nutrition, nutritional changes is the first thing that I'm going to be making recommendations of exercise and movement. So if they're over exercising, I'm going to have them scale back a little bit. If they're not exercising enough, I'm going to have them kind of pick it up a notch. So kind of meeting them where they need to be. But stress management is a big piece, right? So maybe I'm teaching them different forms of meditation, maybe I'm teaching them different breathing techniques because it's very important for them to kind of manage their stress. You know, I'm probably going to be making recommendations for supplements that can help with stress and kind of things that can optimize their, their adrenals in an appropriate way, especially if I feel like their adrenals are burnt out or whatever. And then supplements are huge, right? I definitely include supplements because if I find out that you're insulin resistance or you have a lot of Inflammation that I'm going to be incorporating nutraceuticals to kind of improve some of those things. If you have an autoimmune condition, if you have a thyroid condition, kind of work with the patients to kind of come up with a very personalized protocol based on that.

I mean, it sounds like someone who's having difficulty losing weight or having disruptions in their satiety levels or even fertility issues could pretty easily say okay or fat loss resistant. We could say, okay, I might have a leptin issue. So someone who thinks they might have an issue, then what? How do they evaluate it, how do they address it? What happens next?

So what I will usually tell people and encourage people if you think that you may have a leptin issue and sometimes the symptoms can be, sometimes you kind of have an idea of what the symptoms could be. Right. So if you're eating all the time, you're constantly hungry, like you just ate a meal and like two hours later you're, you're wanting another meal. That can be part of it. If you know you've done yo yo dieting for so long. So constant cravings, always fatigue, exhausted, worsening of your hypothyroid symptoms, gaining weight no matter what, like you've tried everything and you're like, I'm eating well, I'm exercising, I'm not losing a pound. What I will recommend is people start off and take my leptin quiz. You can go to www.doctorbindiamd.com quiz and take my free quiz. It's literally like a minute and it goes through a series of questions to see like, could you possibly be leptin resistant? And if you're not, could you be leptin sensitive or are you leptin clear? So that's the first thing I'll people do. Now if you work with, first of all, I want you to work closely with a functional medicine provider that you're comfortable with, that you trust, that's familiar with leptin. Because I want you to make sure that you're also getting your levels checked. Because having this level checked is very important. Because once we know your baseline, we can kind of work with you and say, okay, your leptin is 50. Wow, we've got to get you down to seven. Let's, let's, let's do this and let's do this in a functional medicine approach that gives you the long term results and data so we can reset your metabolism. So I highly recommend that you closely work with, with a functional medicine provider to start getting your lab tests. If you go to a conventional doctor and ask for to have your leptin test, chances are guys, they're probably not going to know what leptin is or even wanting to do the testing. I've had patients, you know, go to endocrinologists all over the country and have asked to get this test done. And endocrinologists look at them and say, what is leptin? So you definitely want to work with a functional medicine practitioner.

So this has been a huge wealth of information. Right. So people I'm sure are listening, going, wait, I think I have a leptin issue. Where can people find you and find out more about you?

Yeah. So you know, everything is under drbindiamd.com or Dr. Bindyamd on Instagram, Facebook, on LinkedIn, whatever. It's D R B I N D I Y A M D and you.

Mentioned you have a quiz on your website and you have course. So everybody should check that out also if you have questions. Yep. Awesome. It's been truly an honor and a pleasure to have you on and I know I've learned a lot, so I hope everybody else has also.

Thank you so much for having me on, guys.

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