108: The Metabolism Reset with Lara Briden

Hotflash inc – the platform designed to find the true truth in perimenopause, menopause and beyond – makes a return to the podcast world this week! 

In the first episode back journalist and host Ann Marie McQueen interviews Lara Briden, an expert in women's health and author of the new book The Metabolism Reset.

They discuss the complexity of this entire subject, insulin resistance, the impact of modern diets, and the importance of understanding how our bodies respond to different types of food and exercise. 

Briden, a naturopathic doctor and author of period repair manual and hormone repair manual, shares her valuable and moderate insights on achieving metabolic health through tailored approaches, emphasizing gentler methods and the importance of addressing underlying health issues like gut health and autoimmunity. 

This episode aims to help listeners understand and manage their metabolic health effectively during the menopause transition.

00:48 Introducing Midi Health

01:21 Lara Briden's Influence and new book

02:04 Conversation with Lara Briden

03:31 Understanding Metabolic Health

05:42 The Role of Hunger and Satiety

14:50 Impact of Modern Food Environment

21:30 Debate on Vegetable Oils

28:06 Navigating Food Allergies in Restaurants

28:27 Understanding Metabolic Endotoxemia

28:47 Gut Health and Metabolic Health Connection

29:54 Patient Stories: Gut Health and Insulin Resistance

34:52 Exploring Insulin Resistance

37:27 Signs and Diagnosis of Insulin Resistance

40:30 Treatment Approaches for Insulin Resistance

43:20 Perimenopause and Insulin Resistance

43:34 The Importance of Movement and Protein

49:29 Final Thoughts and Reflections

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Transcript

Lara Briden: 0:00

For people who just feel like they don't have the energy or any kind of movement. I would just say that energy is coming. That energy comes from a healthy metabolism.

Ann Marie: 0:09

I'm Anne Marie McQueen, journalist and proud 50 ish woman, and we are here looking for the true truth in perimenopause, menopause, midlife, and beyond. Opening our minds to other possibilities is not always easy. Hot flash ink. You're all woman to me. All right, Anne Marie. Anyone who listens to this podcast will know that I've had a hard time finding help with my perimenopause and menopause symptoms over the years, whether it was trouble sleeping or extreme anxiety or even vagina stuff, I've encountered roadblock after roadblock and doctors who don't know anything about taking care of women like me. It made everything harder than it had to be. That's why I'm so happy that there are companies like mini health, stepping into the gap and sponsoring podcasts like this. They're supportive, comprehensive, and holistic approach to the menopause transition will provide you what we all need. Most a personalized care plan. Their virtual care clinic is to use and covered by most insurance plans. You can chat with your specialist during an appointment or message 24 seven. You don't have to deal with this alone. Any longer book your visit today at join midi. com. That's J O I N M I D I. com. Hi there, welcome to Hotflash inc recently I spent some time in a critical care ward and all the nurses there were reading a book and talking about a book. And healing their cycles and increasing their fertility, getting pregnant.

1:34

And I kept hearing about it every day I was there. And finally one of them said, I said, what book is it? And they said, it's period repair manual by Lara Briden. I said, I know her. She is a friend of mine who I've never met because she lives in New Zealand and I live in Abu Dhabi. You would have told someone that I knew a celebrity. And, um, when I was leaving the ward, one of the nurses yelled out, tell your friend, we love her book. And I said, well, she's writing another one. And this one is going to be a doozy. And so today I'm speaking to Lara Bryden because her third book, The Metabolism Reset, is the book you need to read to cut through all of the confusion. And I have read it, all 400 pages, and I can tell you that it is worth your time. And this is the book. It should be the best selling New York Times number one book for everyone, but also for women in period menopause and menopause. I hope you enjoy our conversation. It is a very, very interesting,

Ann Marie: 2:35

bye, Lara.

Lara Briden: 2:36

Hi, Anne Marie. Nice to see you again. You too.

Ann Marie: 2:39

And as always, we've been talking for ages. I could talk to you all day, a little bit before I pressed record. Um, well, I thought you were tackling the impossible dream when you said you were writing about metabolism, you know, when you're a little bit nervous for your friends and you're thinking, okay, like I know if anyone can do it, you can do it, but I'm nervous for you. And just because we know this is a crazy subject, it's a crazy subject. I think you've done a really good job. I've read the whole book and I would encourage other people to read it because it makes things seem much clearer and gentler. So congratulations

Lara Briden: 3:14

thank you. Thank you so much. And the fact that you read the whole entire book before interviewing, that's really nice.

Ann Marie: 3:21

On my computer, by the way.

Lara Briden: 3:23

I know I'm sending, I'm going to send you a print copy, but yes, you were very good to do that on your screen.

Ann Marie: 3:28

Uh, you must've got twisted up a million times, but you, you did it. And so the whole book is about doing things in a different way. So when you set out, what were your goals in tackling like such a problematic and huge issue?

Lara Briden: 3:43

I wanted to try to get to the heart of things. Like, as I say in the introduction, my, my primary passion is still menstruation and women's hormones and women's health, but like so many aspects of health, especially mental health and hormonal health. Metabolic health underlies that. So this is like a way to kind of go deeper to try to explore some of the things that really work for metabolic health. And the other thing was one of my goals. And I just say this to you off air already, but I really, it sounds silly, but like, I just really wanted to write a book that wouldn't make things worse for people. You know, I just, I've just sit for through my own patients. I think I've just. From 25 years of working with patients, I know the cycle of kind of hope. Oh, this is going to be the diet. You know, this is going to be it. This is going to be the diet. And then, oh, I failed at that. And then, and it's usually because, you know, we're women and we just sort of blame ourselves. My patients would put it through the lens of, well, you I failed again, you know, I tried something else that seemed like it should be doable and then I failed at that. So I guess I'm having time will tell what people can do with the information in the book, but I really set out to create a system of troubleshooting that you can't fail at. Like I say, you know, getting what you need as a biological creature is never going to fail. Like there, you know, You know, it's not about, you know, the number of kilos you might lose. I didn't make any promises around that, but I do think most everyone has the opportunity to get metabolically healthier and what that road to metabolic health is going to look for each individual person. It's going to be a little different, but the only way forward is step by step. And I think that's not something people can fail at. They can stumble. And they can like, you know, get started and then, Oh, no, that was hard. And, you know, I decided to do these things and I haven't been doing them, but the trick is you just then keep going basically just that's okay that you stumbled and kind of went backwards. You just sort of keep going. So I hope, you know, that's what the book delivers.

Ann Marie: 5:42

Well, the whole thing reframes this from Certainly the way I've grown up that, um, it's my fault, uh, that I don't have willpower that I haven't been able to master whatever cravings I have or exercise enough to, it's about metabolic dysfunction and insulin resistance and how those are impacting. And it's more of a brain issue than anything else. So

Lara Briden: 6:10

Fundamentally, I was thinking about this this morning, the thing that people need to understand, and the science is very clear on this. The things that have gone wrong in the, you know, the evolutionary mismatch or like our, our animal body in this current environment, food environment that we find ourselves, has essentially changed. impaired or in the words of one scientist kind of broken the satiety mechanism, the hunger regulating mechanism, not broken permanently. It's like I do, it is fixable. But what that, the result of that is people through no fault of their own, just from the generation they've been born into may feel quite abnormally hungry, like really, really hungry, hungrier than was what their brain was intending. And the other thing about it, hunger and its opposite satiety, which is like satiation, but broader. It's like, you know, this satiety is this feeling of, you know, having enough energy, not eating, not naturally not eating to snack between meals, um, hunger and satiety and energy expenditure toggle together. So this is what this is. And we know this, we see this all the time. We see this with, um, the, like the new medications, like the GLP one medications that everyone's talking about, like they reduce hunger, but they also increase energy expenditure. This is how it works. So when. Hunger goes down, energy expenditure goes up, and vice versa. When hunger goes up, energy expenditure goes down. And that's the brain, that's like the survival mechanism that we've evolved to, yeah, survive. Basically, if, um, if the brain is convinced, there's lots of food around, we don't have to, you know, eat as much, and also we can burn off some of this energy, that, that's, that, yeah, that's something that can just happen naturally. And it can't be. There's ways we can influence that for sure, and I know this, I'm speaking mainly from my experience with years and years of patients, but we can't micromanage it. We can influence it, and we can trust the body to find its way home. To that, you know, healthy regulation, but you certainly can't impose upon it some calculation that you've made of calories, like, I mean, I shouldn't be too scathing of the calories in calories out thing, but it's just, it doesn't work like that. Like that, that's not how your brain or your mitochondria are all these different parts of your metabolism. They don't care what numbers have been calculated. Like, that's not how it works at all.

Ann Marie: 8:36

Just yesterday, my friend was showing me her new meal delivery app and she opened it and it said 1200 calories. And I was like, Oh gosh, what are you doing? I know it's more than that. And I was reading your book and it's 2000 calories, anyway, there's so many top lines and I don't want to, I don't want to take away from the book and I don't want to get too bogged down at the same time, but when you're talking about calories in, calories out, dying so hard, this concept dying so hard, it's all based on that. If you could sort of tell people how they can begin to shift from that, reading your book is a good start. But how, how can they just make that beginning shift to let that go?

Lara Briden: 9:17

Yeah, I think the thing, the way to, I mean, the beginning to let that go is just to understand how dynamic the system is, like, it just, how intricately dynamic it is. Here's an example of a bit of research that came out a few years ago that was very startling to everyone. Everyone kind of sit back and think, okay. Because we had this logic as well. If you do more exercise, you'll burn, you'll burn more calories. Like that's logical, right? Cause mechanic, you know, physical activity uses energy. Sure. Um, Actually, because the body is super smart and we're evolved to survive. What happens is if you burn exercise, if you bring energy with exercise, your body dials down all the other energy expenditures to compensate to try to keep energy expenditure stable, which totally makes sense from a survival perspective. You can't have like one day. You know, 100, 200, 000 years ago, where you have to sort of spend all day walking or move camp or something or carry a bunch of heavy stuff and suddenly require that you need, suddenly you need twice as much food just to survive that day. Like, you know, the energy expenditure is extremely dynamic, it's dynamic between individuals. It's dynamic within individuals, depending on part of the menstrual cycle. It's just like so many factors, the nervous system is very involved in that. So once you start, Thinking about that and how it actively calibrate, you know, dials up and down to burn more calories one day or less calories. Someday the other days you start to realize what, you know, trying to micromanage a system like that makes no sense. And, um, there's a, there's another kind of reframing of calories in calories out that I recently heard, which is that Really, if you think about this sort of energy balance concept that people lost weight because they ended up burning more calories than they took in, that's only something you can look at as happened after the fact. That's not something you can set out to do. Because of this, The diet, how dynamic energy expenditure is, and also because of hunger. So, you, you can't really, no animal, including humans, cause we're animals, can withstand hunger. Like, mentally. That, that's, that's not, it's a very strong drive, it's very ancient. It's like one of our main drives, and you can withstand it for a little while. I give the analogy in the book. Like you can control your eating behavior or your hunger, like, um, really to the extent you can in, that you can control breathing. So we can control our breathing sometimes, if we're doing a breathing exercise, or we can hold our breath, but eventually you're just, you're going to have to just breathe. And in a larger timescale, eventually you're just going to have to eat. If people are hungry, they're going to eat. Eventually. And so the strategy then is to find ways to dial down hunger and it's very doable. These are all the signals of safety and satiety that I talk about in the book. These are when it's going well and your gut is healthy and your liver and your nervous system and you're naturally just feel less and less hungry. And then the outcome of that, that you can think about after the fact is that, Oh yeah, well, eventually I reached the point of, you know, consuming fewer calories than I was expending, but that's. A very different approach than setting out to do it and when every time we hear like all diets fail, you know, 90, 99 percent of diets fail. They're all talking about setting out intentionally to consistently eat less. And of course that fails because people get hungry. So I would just for everyone listening, I would just assure you it is possible. To achieve greater satiety and just naturally not need the sugary snacks or like just not want them. That is possible. It's a different, the way to get there, it's going to be different for different people, but it is always possible.

Ann Marie: 13:09

Well, it's kind of, as I've gotten older and sort of passed through menopause and midlife, one thing I'm realizing is that the muscling through things, the hardness and the struggle that we think we need to bring to change. often isn't necessary. Some of the changes and the most positive growth is actually very easy. I'm not saying it's easy. It's actually very gentle and subtle and you're not muscling and struggling and grinding. You know, like in the book, you say calorie counting only works with a healthy metabolism, but if you have a healthy metabolism, you won't need to count calories.

Lara Briden: 13:48

Exactly. Exactly. So on that topic, on the, what you've just been saying, being soft, I'm going to read, I'm just finding it in my own book, actually. The Mary Oliver poem, a few lines here. Hang on. I thought I should find it. Oh yeah. Mary Oliver poem. You do not have to be good. You do not have to walk on your knees for a hundred miles through the desert repenting. You only have to let the soft animal of your body love what it loves.

Ann Marie: 14:18

There you go. Yeah. So throughout the book, there's so many things to talk about, but if, if you could sort of talk top lines of what people need to look at or can look at to start this process. You mentioned throughout Johnson safety switch, and I think that's a very, very top line. But if you could just sort of talk about that and then just some broad strokes.

Lara Briden: 14:43

Sure. So that around, um, Johnson's, uh, fructose survival switch. So that, that actually falls into the. Chapter. So the part of the book where I explain, try to explain at least my reading of the current science and it's all still very much up for debate what's happened, but something has gone very wrong with our modern environment and the metabolic regulatory mechanism. of humans. So, and part of it that he's talking about there is, um, so he's a scientist called Richard Johnson. He's a lovely guy. Actually, we could interview him one day if you wanted to do a deeper dive into all of that. But he has a book out there as well called, um, Nature Wants Us to be Fat. And because I'm an evolutionary biologist, I really loved kind of his, analysis of that. There were a couple of times in our evolution where we evolved a superpower to be able to store fat, basically. It was like, you know, it was our survival power compared to even other animals, like, you know, our, some of our relatives at the time. So, and part of that is triggered by certain combinations of nutrients in the environment that would have been happening around the time of. Um, autumn or, you know, winter is coming sort of situation. So one of those is fructose. Now, I had to, I had to a little bit to bring up fructose because it's so controversial and people, you know, it's one of the areas in this field where there's been a lot of combative, quite startling level of combative debate around it. So I'll just say for what people, for what it's worth, let me phrase it this way. He's talking about the ways high dose fructose, not fruit, you know, we can sort of just reassurance everyone that we're not saying fruit is bad for everyone. That is 100 percent not what I'm saying. Um, not what he's saying either. But there's some evidence that certain high doses of certain And not just fructose, but some other things to, um, act almost like signals or drugs. I mean, drug is maybe a poor analogy, but just like signals to the regulatory mechanism to shift into insulin resistance slash fat storing mode. And so. You know, so my book very much so building on that understanding that some of the signaling has gone very wrong clearly in our modern environment, which is why there's now epidemic of metabolic dysfunction and insulin resistance, then we can think about in those terms. Well, what are the other the opposite signals to that? You know, what can we. How can we send the brain the right signals and part of it is sheltering from sugar so I do, I like that you liked that phrasing I've had some other nice feedback about that sheltering from, and by sugar I do mean like high dose sugar I mean desserts and soft drinks and sweet drinks and, um, And depending on the person, you know, a little bit of sugar is fine, but it really depends on the person. And I try to explore some of the nuance around that, but I framed it as sheltering because it kind of is a departure from obviously the diet, the diet culture approach, which is that those foods are bad. You know, you're sinful almost if you have these foods, it's not that it's not, you're not a bad person for eating those things. It's that those, some of those foods are actively potentially harmful for your, physiology and your metabolism, depending on the person, especially as people who might be very vulnerable for different reasons. And so the decision to not have them is taking care of yourself, like, just like you would shelter from the weather or shelter from other bad things. You need to, you know, give your body and in this case, you know, the, your brain, the regulatory mechanism in your brain, it's best chance to kind of make the right decisions and feel better about things. And You know, I think the sheltering to the, another way of think about it, I mean, the science is pretty clear that poor humans have been to some degree kind of bombarded by ultra processed food and some of these foods, like it's a, and those are strong words to use, but like it is this sense of damage to, we've been, I mean, some people have been very damaged by the food supply, not through any fault of their own, just the generation you happen to be born into. And there is also. In this, there is some multi generational thing. So this is, I think it's worth mentioning if people haven't heard of this epigenetics. So the problem seems to be amplifying generation after generation because the food, not just food, but the environment that we're exposed to. We, um, we can, we pass on, which is weird. Actually, they only discovered this like 20 years ago or so. Like, like we pass it on to offspring and it's like, you know, that all the different switches in the DNA gets switched on and off and get, it's not that the DNA or the genes themselves change, but the switching on and off of them is carried forward into the next generation. And so, yeah, we're now getting. You know, kids showing signs of prediabetes and like that would that never happened 50 years ago, like 50, 60 years ago, kids could eat just the most appalling diet. Like I grew up in the 70s, we had a lot of sugar, like, you know, just terrible stuff. But it was not taking the toll that it is now because partly because of this epigenetics. So I mentioned that just because if people find like I say in the book, like if If people find they're just metabolically struggling, certainly maybe compared to their friends and don't understand why it's like that's partly why it's just it's a combination of the genes you inherited, combined with maybe a few generations of exposure to some of this damaging food and again not anybody's fault everyone was always just doing the best they can and feeding kids the best they knew how so it's the if there's anyone to point the blame at it is. the food industry for sure. And, uh, I mean, that's people have, I would say that's another book and people have written books about that. And I touch on it a little bit and how I think future generations are really going to have to sort that out. Like they need to be reigned in, um, in terms of, you know, Just regulating some of these, like, food like substances that, um, are not really even food anymore.

Ann Marie: 20:45

Well, you mentioned about the tobacco companies took all their expertise about getting rid of the smoke, uh, yeah.

Lara Briden: 20:52

Philip, Philip Morris, I had to fact check that a couple times before I put it in the book just to make sure, I'm like, am I, like, rubbing my eyes, like, am I dreaming, is that what I, so Philip Morris bought, general foods craft with the third one. I'm hopefully I've got the, the, the details right through the kind of early eighties into the early nineties. Like, and then they just were like, right, we've got all this knowledge and, you know, you know, just machinery to start making people addicted to ultra processed food and boy, did they succeed.

Ann Marie: 21:25

It shouldn't have been allowed. It should have, it should have been, it should have been a law against it. You would think. Uh, you go into also very gently because another hot topic is vegetable oil, sometimes called seed oils. And I see fighting about this a lot. And if you Google them, you'll either find out that they're healthy for you or you'll find out that they're bad for you. It's crazy.

Lara Briden: 21:48

Yeah.

Ann Marie: 21:48

And I know. So can you, from your measured perspective, can you just sort of, yes. That's what the problem is.

Lara Briden: 21:56

Okay. Well, the first thing to understand that makes the whole thing a little confusing, and granted if people are confused, you, that they're totally understandable. So this is about linoleic acid or omega 6, um, particular kind of polyunsaturated fatty acid, which is an essential fatty acid. So it happens to be an essential nutrient. So there's that. So it's obviously not bad, all bad, um, but it's, to be fair, it's pretty easy to get enough. Okay. Omega 6 just from, I think it comes from, you know, nuts and seeds and grains to some extent. So whole foods are going to deliver, um, Omega 6 and there's, there is some Omega 6 in animal foods as well, just naturally, but then the problem is the amount of it and the sheer amount. And it's the amount of it in that's coming all in the form of processed. Packaged food, basically. I was talking with another in another interview the other day and she was pointing out. Yeah, it's not just because you say to people vegetable oil and then they say, Oh, well, I don't have any corn oil or canola oil, you know, in my cupboard. It's like, no, but it's in all those packaged foods that you like. It's in everything. Like if you read the label, it's got vegetable oil. That's, that's what's there.

Ann Marie: 23:02

Healthy food. It's in a lot of healthy food. It's in nut milk.

Lara Briden: 23:05

It's in everything. Yeah, and so scientists are concerned that the ratio of omega 6 to omega 3 is part of the problem. And there is, has even been an inkling that the ratio of omega 6 to saturated fat may be a problem. Now, this is where, yes, it's very much depending on who you ask, as you saw in my book, I multiple times say, well, depending on who you ask, you know, especially around saturated fat. But, um, I, I am in the camp where I do think there's, we're being exposed to too much omega 6. I think we do need to shelter from it. Yes, I, I do. And I have been sheltering it from, from it for decades. So certainly, you know, that by sheltering it from it means cooking with, you know, butter or olive oil. Fortunately, extra virgin olive oil is, um, mostly something called oleic acid, which is very different. Oils are always a mix of things. So there is a little bit of linoleic acid and lots of different things, but like, you olive oil or coconut oil or butter or people used to cook with obviously saturated fat and lard and things like that. And that's been a massive shift. And so there is, I'll just touch on that a little bit because it's interesting. It's not definitive. None of it's definitively proven, but there's little signals coming from the research, like little interesting glimpses of things. One is there was a study in the citations in my book, or I can provide it for the show notes if you want, where they've, They've estimated that basal metabolic rate has declined in our modern generations compared to previous generations. So that's just your basal energy expenditure. Nevermind all the other, um, compensatory or up and down energy expenditure that you get from like brown fat and stuff like that. That this is just your basal rate. And, um, in the paper, they talk about possibly from the shift from saturated fat to vegetable oil. And I think there could be different mechanisms in that. I think there is some evidence that high dose omega 6 potentially promotes insulin resistance, which is a big central part of metabolic dysfunction by different mechanisms, which is quite interesting. And then there's the fact that missing C 15 saturated fat. Do you know about this? It's called pentadiet. Anyways, it's a 15 carbon saturated fat, which is so the scientists are so excited about it that they like they've released it as a supplement now so you can actually supplement this type of saturated fat called C15. It's mainly in dairy, lamb, I think certain types of seafood, and so we used to, we collectively, you know, used to eat a lot more of that, and it's very important. important metabolically sort of in terms of maintaining metabolic rate and insulin sensitivity and things like that. So that's a longer answer to the whole seed oil. They're called seed oils big to differentiate them from fruit oils. So fruit oils would be olive and avocado and I I know there's a lot of combative debate about it out there. Look, I mean, occasionally, obviously, I eat out in restaurants. Like, I occasionally eat, I will eat things that have seed oils. I mean, you have to, like, you can't avoid them entirely, but I think we can, logic, it seems logical to me to try to avoid them. When cooking, you know, as much as possible at home and cooking at home, and I suspect the needle will move on this. I think we're still in the debate stage, but if it starts to become more proven, I think we're going to start to see maybe in some of the, you know, restaurant already some restaurants are talking about, you know, cooking with, um, cooking without vegetable oil. So we'll see if that happens in the coming years.

Ann Marie: 26:32

Well, it's incredibly expensive. And I know when I was trying to get a meal plan. There's so many meal plans over here, and I was asking around, I only found two that you, that, you know, that set out to use it. So people do need to know that things will be labeled healthy. Right. This is a big sort of scam kind of, and I don't even know. They, if they know and they're doing it on purpose or they don't even know,

Lara Briden: 27:00

well, this is why vegetable oils are so prevalent is they're cheap. This is why, this is why they're in processed food and all restaurant food, not because. Well, I mean, there was the 1970s whole, like, you know, to get away from saturated fat, but they thought vegetable oil was good. But like, it was actually also, it was very convenient for food processing companies because it's extremely cheap. So yeah, so with the, With the meal plans. You mean like the meal delivery services?

Ann Marie: 27:23

Meal delivery. I'm single. So I sometimes, sometimes when I'm trying to, I don't have time and I'm coming back from a trip or something, I never liked them. I never liked them, but it, it amazes me that there's 150 healthy meal deliveries and two that I can find that are using, that are using. But I mean, it's, to shift your business to using avocado oil or olive oil, you would, we would have a much different bottom line, I think.

Lara Briden: 27:49

Totally. Well, they're going to have to charge more. They will have to charge more. So in the book, I do talk about the meal. So using those meals, delivery services, and then maybe just taking the other ingredients, but using your own oil or your own sauces, like maybe just substituting a good quality olive oil. And that's one way to handle it. I think. Yeah.

Ann Marie: 28:07

I have started saying in restaurants that I'm allergic. Yeah, I've turned into that person still. Probably it's being used somewhere, but that I heard that from someone else and I feel like that's a tip because you know, they often say now, do you have any food allergies? And it's like, why? Why? Yes, I do vegetable oil. So there are so many things in there, you know, circadian rhythm, um, metabolic disease. Despite gut dysbiosis, is that am I saying that correctly? Yeah. Metabolic endotoxemia.

Lara Briden: 28:42

Yes.

Ann Marie: 28:43

Can you explain that?

Lara Briden: 28:44

Memory. Yeah. Yeah. Well, so this is where I bring, I do bring my naturopathic, you know, lens to some of this. I mean, it's in the science too. It's not just, um. a naturopathic opinion, but gut health has a huge impact on metabolic health. And so what you just described, the word you just said, metabolic endotoxemia, that's when essentially from intestinal permeability and the moving into the body of What's called lipopolysaccharide or LPS, only just for people who are interested in the technical terms. People don't have to remember those and it creates quite a bit of inflammation and it actually also sort of moves in potentially into the body, generally into the blood supply, but also just can affect the visceral fat specifically. And I find that extremely interesting that intestinal permeability can promote the hypertrophy of visceral fat and hypertrophied or enlarged or unhealthy inflamed visceral fat actually sends all these weird signals to the brain and like can directly interfere with all the, all the signaling around satiety and hunger. So the inflamed visceral fat can actually just make you abnormally, abnormally hungry in the simplest terms. And the gut can affect that. And now I have a It's so interesting because I mean, of course, I've got lots of patient stories in the book. And then I'm still seeing patients, not as many as I used to, but I had some patients recently. And she, she, it was almost like she was straight out of the book. I'm like, you could have been a patient story. So she, all we had I'll just give it as an example. So she did have quite strong insulin resistance. We knew that from some blood testing. We did. That wasn't actually her main focus though, which is totally fair enough because she also had pelvic pain and she had SIBO. We are listeners know what SIBO is or yeah, small intestinal, small intestinal bacterial overgrowth. Yeah.

Ann Marie: 30:28

You go into it.

Lara Briden: 30:29

It's just when there's a overgrowth of the gut bacteria in the small intestine where they're not, there's really not supposed to be that many bacteria in the small intestine. It's quite common. It's, it's when people be bloating after meals and a lot of intestinal bloating, it's a major driver, not the only driver, but it's a major driver of intestinal permeability. So I just really want to help her with her gut and her pelvic pain to start with. And so I did the old naturopathic thing, which is okay, let's do eight weeks of gluten, wheat free, dairy free. And, um, she was already eating some whole foods. So her diet wasn't bad, but she was just having like, you know, normal stuff, yogurts and bread and all the things. And so. And I was really just trying to toggle the pain. Like I was trying to reduce the pain. So I gave her, um, you know, some weeks off wheat, wheat and dairy. And then I did give her the herbal medicine, Berberine, which is in the book, but I didn't prescribe it for her insulin resistance. I actually prescribed it for the gut to help, to knock back SIBO like to, for its antimicrobial effects. And I talked to her, she'd been about five weeks doing that. And she felt the pain was gone, which was great. And bloating was much better, but she said, and my afternoon cravings for sugar, just Disappeared. Like completely just went away and I was like, yeah, that's showing in action. That's the dynamic system. I mean that she didn't. So what a better way to come at it than be like, I'm going to mentally like, you know, using my sheer willpower, stop myself from having the sugar that I'm craving. And in her case, You know, by treating the underlying inflammation, which was treating the gut really, she, um, just had that natural relief. Now I'm not saying that's going to be like that for every single person. This is why the books, the troubleshooting manual that that is a common scenario actually, but it's not the only. Way is not the only way to achieve better satiety, but looking at all of this and all the metabolic debate and some of the low carb diets, I have to say, I think one of the, one of probably several mechanisms that low carb diets can improve metabolic health is by improving gut health. That's because a low carb diet is almost by definition, the diet for SIBO or yeah, um, bacterial overgrowth. So it's a low carb diet is antimicrobial for the gut. It's like it, um, Yeah, I can, in a good way, knock back some of that overgrowth in the small intestine. So I've actually got two, I realized there's 10 patient stories in the book. I was trying to illustrate all the different ways, you know, types of interventions or things that people respond to, but two of them are actually about treating the gut, which makes sense that that represents my patient population too, because, well, just to say again, I mean, I'm a naturopathic, I'm a naturopath. So we do come back to the gut quite often. And, uh, I had to, of course, put that in there.

Ann Marie: 33:11

And of course. To, just to explain to people, the visceral fat is different from the fat you can grab. It's in underneath and by your organs. And this is where you'll feel a thickening, but you won't necessarily, or like, you know,

Lara Briden: 33:26

you can't squish it,

Ann Marie: 33:28

but you will notice a larger, the expansion and discomfort.

Lara Briden: 33:33

It'll be quite hard. The people, I mean, it depends on how expanded or how, like, hypertrophied or grown it is, but people, the most, the one I've seen most from patients is this hard little, like, bulge right under the ribcage, this, like, Um, and people find it quite uncomfortable, but like you can't put calipers, like you can't, and it is possible, obviously you can also have squishy subcutaneous fat on the belly as well. That's not the belly fat that everyone's talking about. The visceral fat, the unhealthy belly fat is inside the abdomen. And um, yeah, the good thing about it though, it's, it's, uh, it's the first to reduce actually reduces more quickly than subcutaneous fat, which is a good thing. And here's the interesting thing. I did put it in the book. I'll just mention it. For everyone today that I just love this female physiology, lower body subcutaneous fat, especially bum fat is arguably actively anti inflammatory. So there's a bit of research showing that if you're going to have hyper, you know, hypertrophied visceral fat or that unhealthy belly fat, and you can't always tell by looking, but you can sort of maybe tell by waist measure. If you have that, it's, it's actually good to also have quite a bit of subcutaneous fat because it seems to sort of mitigate or offset some of the risk, which is

Ann Marie: 34:48

Also speaks to this amazing capacity of the body to balance. And now I should've asked you this at the beginning what is insulin resistance and how do you know you have it?

Lara Briden: 34:58

So I'm in the books about metabolic dysfunction, which is kind of a nebulous term, but what I'm precisely talking about is. Metabolic inflexibility and insulin resistance. And the two terms are quite similar and they overlap quite a lot, but there's, and they reinforce each other, but metabolic inflexibility is this reduced ability to access body fat stores for energy and, you know, kind of a more heavy reliance on more in the, in the glucose burning mode of. physiology, never exclusively. We're always burning a mix of the two fuels, fat and carbs, fat and glucose. Um, but insulin resistance is basically the situation of certain tissues, not all the tissues in the body, but especially the, the liver, um, is, has a reduced sensitivity to the hormone insulin and that's associated with chronically elevated insulin. And the chronically elevated insulin is part of, um, The problem, because it actually, when insulin stays high, it impairs fat burning. So this is how it kind of feeds back to metabolic inflexibility. It's hard to access your body fat stores for the energy you need, not just for weight loss, but like to actually have energy and be able to go between meals without eating. Cause you have to be able to, you know, get that energy chronically elevated insulin, um, impairs that it does lots of other bad things too. So. Chronically elevated insulin is a hidden, it's common, I mean, some estimates are it's almost one in two adults, like it's quite a lot of people, and it can progress to pre diabetes and diabetes, but with, with insulin resistance, insulin is chronically elevated, but glucose can be normal for, for most people. like a couple of decades like that. In fact, with the, with insulin, the early stages of insulin resistance, um, glucose would sometimes be low. Like I had this very interesting conversation with someone on my social media where about, I did a post about hypoglycemia or low blood sugar. And she's like, Oh, well I get low blood. She's like, I get low blood sugar. Therefore I thought I must not have insulin resistance because insulin resistance is about high blood sugar. And I have low, so I must have the opposite. I'm like, no, no, no, no, no, no. Actually low blood sugar is a common symptom. of insulin resistance. Um, especially something called reactive hypoglycemia or like low blood sugar a few hours after eating is a classic symptom of insulin resistance. So, You know, I've heard it talked about, we need to sort of shift the focus from all about glucose to actually thinking about, um, the hormone insulin. Another really classic sign in answer to your question, how do you diagnose it? Um, we can talk about a few of the blood tests, but one thing I want to say right away is fatty liver. So fatty liver is a sign of classic sign of insulin resistance. There are other explanations for fatty liver. So obviously the doctor needs to, but you know, rule out other things, but if there's no other explanation that it is insulin resistance. That is definitely kind of what's going on. And I, again, a lot of my patients don't understand that they think, well, I've got, you know, they, they sort of have these. like thinking separate things are going on. Well, I've got this, I can't lose weight. And also I've got, you know, fatty liver, they might not have connected them, but insulin resistance is what ties them together. So there's different ways to test. I have a whole chapter on assessment depending on, it doesn't have to be expensive. It doesn't have to be fancy testing or anything. People can do it on their own, you know, partly on their own. And then probably just looking at some of the normal blood tests that their doctor has already done. Like, for example, Um, a couple of the classic signs of insulin resistance are high triglycerides, which most people will have had done as part of just a lipid panel, um, especially high triglycerides and low HDL. That ratio is really common and, um, high ALT. So I do mention it cause people might have that. So in women. ALT is quite sensitive. So, um, a good marker. So in women, it should be below 19. I think it's international units per liter or something like that. The units are the same in most countries, I think for ALT. So if, and so I'm not to get too technical on everybody, but they can pull out their old blood result that they had. And again, just to acknowledge there can be. other explanations for that. Certainly if a lot of the liver enzymes are out of range, then, and if the doctor has said there's some other reason for what's going on with their liver, then, then it's something different. But if, if there's, if it's just sort of a standalone finding, then high ALT is a sign of both fatty liver and insulin resistance. So, and also you can measure the hormone insulin, but measuring glucose or blood sugar is not a way to diagnose insulin resistance.

Ann Marie: 39:29

I mean, theoretically you would think that it would be a standard test and you could catch people early and then. Advise them, but it's not nearly at that place. It seems like you can just look at how you feel and say, Hey, I might have the early stages of insulin resistance and then pull some of the levers that you mentioned in your book.

Lara Briden: 39:48

Yeah.

Ann Marie: 39:48

So what would be just some of those, if people are listening, like what would be some of those signs, the hunger?

Lara Briden: 39:55

Yeah, well, increased hunger. So I've normally increased hunger, weight gain around the middle, especially that thickening hard, like kind of quite hard, like solid around and you can measure the waist, um, to kind of get a sense of that. Um, just some other high blood pressure, high cholesterol, skin tags is a common one. So there's a few signs and family history of insulin resistance, family history of pre diabetes, having a history of pre diabetes. Polycystic ovary syndrome, potentially, depending on the type of polycystic ovary syndrome. Yeah, a history of gestational diabetes can be a risk as well. So all these things. And then in terms of Treatment. Yeah, there's not, that's the whole point of my troubleshooting approach in the book. There's, there's some general guidelines, of course, but there's not one size fits all for, for reversing insulin resistance. It, it really is, the approach I take is, um, identifying what are the metabolic obstacles that are present. Preventing your body because your body wants to be insulin sensitive. It's trying to get there. Like it would like to be healthy. So what is, you know, what is it that is potentially standing in the way? And one of the examples I do give, I talk through a number of different things, um, but I do want to tie in Hashimoto's thyroid disease. Cause the, it's quite common in women and it does. inter intersect with all of this and it does, you know, increase the risk of insulin resistance, probably by a few mechanisms. So I have at least one patient story where that was kind of, you know, her main, in that patient's case, like that was the metabolic obstacle she needed to, um, tackle to try to turn insulin resistance around together with all the normal things, you know, like sheltering from sugar and ultra processed food and eating enough protein and, um, potentially eating, you know, the good kinds of, um, oils

Ann Marie: 41:46

and Hashimoto's is. Autoimmune. Can you explain just briefly?

Lara Briden: 41:50

Yeah, it's an autoimmune thyroid disease. So it's when the immune system has formed antibodies or inflammation against the thyroid. And it's not exclusively women, but it's mainly women. It's very rare to come across. Men can get other kinds of autoimmune thyroid disease, but the Hashimoto's one is mainly women. And um, Yeah, it's, it's quite common. I think we're starting to get an idea now from the science of why autoimmune disease in general is more common in women, but thyroid is usually the first one to show up. It's not unusual to have constellations either. So if women can get, um, autoimmune thyroid sort of happening and then they might be at risk for other autoimmune processes, but, um, yeah, and autoimmune. Fortunately, there's ways to improve that. A lot of it, again, comes back to the gut and intestinal permeability.

Ann Marie: 42:39

Did you know I also have a Substack? That's a fancy way of saying I have a newsletter. Each week I share research, news, products, tips, and tricks from the world of menopause and midlife. Sometimes they even write an essay about my own life and what I'm going through. Hot flash ink on Substack is where I pull together everything that's here and in the menosphere and break it all down so we can try and make sense of it all. Join more than 5, 000 women, practitioners, CEOs, and more, and become a subscriber today. Subscribe! You can also get my podcast and special video and audio drops. You can't get anywhere else. Sign up today at hot flashing. substack. com. Okay, so we talk about perimenopause a lot here perimenopause and insulin resistance. Have a special relationship, not a good relationship. Yes. What's going on there?

Lara Briden: 43:31

No, the way I frame it now. for people who just feel like they don't have the energy or any kind of movement. I would just say that energy is coming. That energy comes from a healthy metabolism. So you could just start with some of the simpler things like the supplements I talk about, or some of the, you know, getting up, getting more protein, or just like some of the getting circadian rhythm, taking your coffee outside in the morning, getting some light, because circadian rhythm is huge in all of this. Start with the easier things and know that you're going to start to have more energy for moving. The body. And so when that energy starts to appear, like, you know, harness it and carve out some time in your day because movement is pretty crucial, but it doesn't have to be, you know, exercise, I guess, you know, it has to be, we do need to build some muscle, especially that's the other thing that happens at menopause. Actually, that's the other part of the puzzle. We, cause estrogen is normally anabolic and helps keep our muscles, especially the bum muscle kind of keeps a lot of muscle happening. And yeah, we do start to lose that. I'm a bit naughty. Actually, I was I did an interview this week. She was so shocked when I told her I don't actually do strength training. I thought she was going to fall off her chair like she was just she looked really shocked. I'm thinking she may end at that part out actually because um, so Um, you know, in my defense, I'll just say

Ann Marie: 44:52

I say in the Middle East, no, look, you do mention this in your book and we are hard at protein, protein, protein, which just, I'll just interject that you also really clarified that for me, that we're designed to eat protein and seek protein. So a lot of our hunger might be that we're not eating enough protein. That's why, that's why that's a biological reason for why you might still be hungry. You're not eating enough protein. Your body wants it. But we're just yelled at these days to eat protein, so much protein, protein all the time and lift heavy, lift heavy, lift heavy. Because you don't lift heavy, but you are, how do you justify that?

Lara Briden: 45:30

Right. So I'll just say a couple, and I'll say there is actually just to make things even more complicated that, you know, there's a, there is a place for occasional low protein. I have a small section in chapter 13, like there are some intimate, if people are really deep into insulin resistance and have like serious problems. Um, anyway, you can look at that section and follow some of the, you know, research that I point to from there. There can be a place for not continuously low protein, but kind of cyclic low protein can move the needle a bit on things. But because protein is an interesting nutrient that way, but in terms of my own, what I do, so. Yeah, I'll just, I'll never forget that interview. She did look very, very shocked. So I, I do believe about the, the, the lifting and I may still do some in my life, but I, I guess what I have done, cause I love walkings. I can't get enough of it. Like I go for like three walks a day and I love yoga and I, and I totally acknowledge that not everyone does. I get that. Like it, I like it for all the nervous system, autonomic nervous system benefits. Like I, I I'm like the kind of person, I'm like a little, like I say to my husband, like, I can't understand, like, I honestly genuinely can't understand how. You don't do yoga. Like how can you survive? Like, how can you sleep or like, how, how could anything actually happen if you don't do yoga? That's my, in my body, that's how much I need yoga and totally acknowledging that some people don't. feel that way or have a nervous little like nervous, anxious, nervous system like mine. But what I've, what I'm doing, listening to the research is I am doing some strength components to yoga, like in pretty serious ones. Like I was doing some squats and planks and stuff the other day and I thought, you know what, I wonder, I'd be curious to know if some of these heavy lifters, what the hell they would be doing with this, you know, yoga pose at this moment where my glutes are trembling. And like, so there is this different way to build muscle. You know, there's Pilates, there's there, you can use your own body weight for some of this strength building. And one of the things I worry about with, you know, to clear a message around like around juice, you have to lift heavy. And that's the only thing you can do. And I, sometimes I hear from patients like, well, for whatever reason, I can't do that. I don't want to do that. So I just, what's the point? Like, I just won't do anything then. And I think most experts agree, just find something you like doing, like some way of moving your body that you genuinely, but at least if not enjoy, like at least can tolerate and are going to be willing to do it on a consistent basis because this is not just a one time thing, right? Like this has to be, Every week something.

Ann Marie: 47:52

Yeah, has to be far better. And I don't know that we have the long term studies to compare this or that. I'm the I'm like you, I struggle with weightlifting. And then I try to remember the, you know, generations before me. I don't remember anyone at Barry's. Or, uh, F 45 doing like a weight test or like, you know, I don't know if they have barbells. I think that they were okay, because they were doing their regular life lifting and bending and stretching. So I don't know. People will say, but Anne Marie, they all died at 50, but we know that that's not true.

Lara Briden: 48:25

Oh, they didn't. I mean, to be fair, our more ancient ancestors were probably just lifting a lot of barbells. Just doing a lot of stuff like carrying their grandchildren and like, like setting up camp and probably just a lot of general lifting. So, I mean, I believe, I believe the research on the lifting. I don't dispute that. I just, um, I'm just saying we're not perfect, right? Like we have to find the thing and there's only so many hours in the day. And I guess through my lens, I'm not, I am just not willing to give up yoga or lifting at this point because I need yoga to sleep. So. Yeah. You have to wait.

Ann Marie: 48:57

This is what I love about you. You're just that you're gentle confidence in the face of overwhelming discussions otherwise, but we don't need to feel worse about what, about what we're not doing at this time. I think that's probably even, you know, I don't have any studies to back it up, but I think that's probably even more damaging. So while I can't thank you enough and, you know, this book is, is really quite something I would encourage everyone to read it and I'll, uh, follow what you do next with. Great interest. Thank you so much, Lera. Always a pleasure. Yes.

Lara Briden: 49:27

Thanks, Emory. Thanks.

Ann Marie: 49:29

thank you so much for listening to my interview with Lara Briden. One of the things that I was just so impressed at with her book is that this is a time when we need to start coming back to ourselves. And looking at ourselves as a biological creature who needs to be cared for and well. In the interview, you heard Lara talking about, you know, you have to do things for your pet every day.

49:54

You have to do things for yourself every day. And I absolutely love that. I personally need to spend more time on social interaction. It's not that I don't have friends I do, but I can tend to be kind of a loner because I am an introvert and. I've been grieving the death of my father and I haven't wanted to be around anyone, but I realized now that I need to. And I kind of think the overarching thing that her book does is it sort of pulls back the curtain on this Wizard of Oz, like scenario that our bodies in where it's just a bunch of levers that move. And when you pull one, another one goes up. Like an orchestra, it really is an orchestra. And so she gives you the tools to say, okay, let's go in and hear, what are some of the easiest things to address some levers to adjust that will create cascade effect. In our interview, and she says your energy is coming, I think we all need to remember that this is about energy. It's not just about being thin, please can we put that down? And can we focus on, do I feel like getting out of the chair? Do I feel like getting up in the morning? Am I sighing because everything is hard? Or do I have energy? It's the food I'm putting in my mouth, working and going right down into fueling my mitochondria. It's the food I'm putting in my mouth, working and going right down into fueling my mitochondria. And my journey in the last couple of years, because she talks a lot about, you know, endotoxemia and intestinal permeability and SIBO, and I had all of these things. And my experience in this journey has been, yes, it's been a lot of work, but yes, I don't have to work so hard. The weight does kind of fall off. And the energy comes and that is a beautiful, beautiful thing of being human. So I can't recommend this book enough. I suggest you get it and read it and get a pen and get a notebook. And, you know, I'm not going to tell you what to do, but if you're on a plan that starts Monday, or you think weekends are hard or You know, you've got to be good and you need to get back to what you're doing, or you need to do it this way, or you're confused by what everyone's saying. This is the book that will help you start to pay attention to the beautiful cues that your body gives you because you'll start getting them. Thank you so much. See you next week. Hot Flash Inc. was created and is hosted by Ann Marie McQueen, produced and edited by Sonya Mac. The information contained in this podcast is intended for informational purposes only and is not intended for the purpose of diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your health care provider, read all labels, and heed all directions and cautions that accompany the products. Information podcast should not be used in place of a consultation or advice from a health care provider. If you suspect you have a medical problem, i. e. menopause or anything else, or any healthcare questions, please promptly see your healthcare provider. This podcast, including Anne Marie McQueen and any producers or editors, disclaim any responsibility from any possible adverse effects from the use of any information contained herein. Opinions of guests on this podcast are their own and the podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about a guest's qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have direct or indirect financial interest in products or services referred to herein. This podcast is owned by Hot Flash Inc Media.