Weight Loss and Women’s Health
We're going to be talking about digestive hormones, which is something that is new to me to explore.
Dr. Awad is a board certified family physician out in Minnesota. She's also a certified life and weight loss coach. So that's really important to distinguish those two degrees and certifications. She also hosts a podcast and it's called Vibrant MD. That's actually one of my questions for you later is to tell us a little bit about that. And she talks about women's health. She talks about weight loss and she also talks about food and nutrition. And she really loves helping women on their weight loss journey by optimizing their digestive hormones. So this is really exciting because for me, this is a whole new look at and a whole new perspective at that weight loss journey.
Dr. Sueldo: -So my first question to you, and we'll go ahead and get started is how did you become interested in this as a family physician? You sort of shifted over and did the certification. What does that process look like?
Dr. Awad: -Sure. So I, I've always been one of those kinds of food as medicine doctors. So I've, you know, always counseled people on good nutrition and eating in a way that serves their health goals. So that’s always been my thing. But then after gaining weight myself and having difficulty with it, I started looking for what's a better way to lose weight. Cause honestly, we don't get a lot of teaching about it. And there's a lot of that eat less, move more stuff that doesn't really work. So I've, you know, I had tried a few things and they all worked terribly or put me into yo-yo dieting where my weight went up and down. And then I started meeting these doctors who kept saying, ‘Oh, I eat low flour, low sugar.’ And I met a bunch of them and they kept weight off for a long time. And I kept saying, well, what is this? All these women doctors are talking about. And they said, you know, follow the insulin cycles, follow the digestive hormones. So I really delved into it and researched it. And I thought, ‘Oh, this is really the way to natural permanent weight loss.’ From there, I found out that I also eat all of my feelings. If you had asked me, I'd say, yeah, I'm a stress eater. But then I found out I also ate anger and frustration and sadness. And then I also, it turns out, ate happiness, excitedness. Any big feeling was an eating event for me.
Dr. S: -Gotcha. So that's really interesting…how you became sort of in tune with that and like recognizing that.
Dr. A: -I found that through life being coached by a life coach. And so then I thought this, some of this mindset shift is, is something I want, another tool I want in my toolbox. So I ended up going and getting certified and have really enjoyed, you know, online coaching people to, to lose weight, kind of optimizing their digestive hormones, but also looking at what their blocks are. We all have different things. So that's where the coaching part gets in.
Dr. S: -And how is the life coaching and the weight loss coaching different?
Dr. A: -They were wrapped up together.
Dr. S: -So you were honestly the first person to talk to me about insulin and digestive hormones. Can you introduce us to that? Because this is new for me too. And I'm really excited to learn. Can you just give us a little bit of background, a little bit of information about that?
Dr. A: -I can. And do you mind if I tell you just a little bit of how I ended up doing some fertility? So I do want to tell your audience that I have not had any issues with infertility. And so this is, that has not been my struggle in life, but I was doing this kind of weight loss with insulin cycles. I have a cousin who's an infertility specialist in Indiana. And he said, ‘Oh, well, how are you doing the weight loss?’ And I explained this stuff about normalizing insulin. And he said, ‘Oh, Oh, actually, a bunch of my patients, that's their exact problem'. Can you build me something?’ And I said, ‘well, you know, I'll work on it’. Then I had another friend who's someone that I went to medical school who said the same exact thing when she asked me what I was doing. So I said, ‘well, okay, I'll build this without being an infertility specialist, just so that your audience knows. So the thing is that I found out in researching is not only are insulin cycles important, but our culture and what we have decided is normal works against our natural hormone cycles.
Dr. S: -Okay. Can you expand a little bit more?
Dr. A: -Yes. So if you look at people in the late sixties and early seventies, they pretty much ate three meals and did not snack in between meals. They sat down to watch TV and they didn't eat while they were watching TV. When I'm coaching people or guiding them, I can't tell you how many people say, ‘well, of course I eat when I'm watching tv every night. That's normal.’ And also even events, every event we go to now has food. Whether it's a sporting event, a social event, no matter what, there's food popcorn and you know, soda for the movies. And you almost can't go to something that doesn't have food.
And then there's also some peer pressure if you don't want to eat. If you say, oh, I just had dinner, you'll still get people who try to give you a guilt trip to eat more.
Dr. S: -Just try this. Yeah. So with digestive hormones, which ones are there?
Dr. A: -I would say the one you have to pay the most attention to is insulin. And insulin is meant to pulse. When you eat, your body turns everything into glucose, and then your insulin comes in to take care of it and pull it into the cell so you can use it. But insulin is also a fat storage hormone. So if we eat all day long, our body not only sends a normal amount of insulin out, but when we eat all day long, things are almost like they're getting too noisy with the hormone cycles. Maybe, I don't know if this... will resonate with you at all. Some hormones need to pulse and some can be constant because it changes what happens in the body. So if you have your body sending insulin all the time, your body stops paying attention to it somewhat. Although it will keep using it as a fat storage hormone. So when your cells are having a hard time with all this noise of insulin around all day long, then it doesn't pay as close attention. So then the body says, ‘oh, no one's paying attention. Send more insulin.’ So you actually have your insulin levels get higher and higher, and all of that is fat storage. So naturally, that's how it works.
But the people in the late 1960s who ate three meals would have a little bit of insulin that would come out and take care of breakfast, a little bit of insulin that would come out and take care of lunch, and a little insulin that would come out and take care of dinner. And so they naturally kept a normal weight.
Dr. S: -Gotcha. Okay. Okay. And how do the hormones, so what you're saying is we've gone from this kind of pulsatile type secretion, and now this sort of constant release and this constant release really focuses more on fat storage. Is that what i'm hearing? Does that make sense?
Dr. A: -It's still doing the thing that's supposed to do the, the, it's still, pulling the blood glucose out of the blood (into cells), because if our sugar just went high and high and high, that would kill us. So it's still doing that part, which is its job. But it's supposed to pull it out. And then, you know, a little goes in the liver for storage for later. And then the rest goes into fat, which can be used later. But if all we do is constant, that all we do is store, store, store. And then when you eat, you actually never pull from your fat. You never pull that little extra energy from your liver, all you do is just burn the sugar that you have at the moment.
Dr. S: -So you continue to accumulate basically. Gotcha. Okay. And so I get, you know, a lot of my patients, they really struggled with weight their whole lives. This is not a new thing. I always counsel about it based on the impact that it has on fertility. So I'm counseling on it from a fertility standpoint. Um, but it's typically not the first time they've heard about weight as an issue and it's something they've struggled with their whole lives. So tell me, when you encounter those patients as a life coach and weight loss coach, how do you kind of change the mindset or kickstart the change or what is gonna be different this time around, I guess?
Dr. A: -Yeah, people who have struggled with it for many years are their own special case. Because there are some things about, um, obviously about biology and genes that we all have different shaped bodies. And some of that is just there. If you struggle with weight for many years, your body actually gets used to that. And so you have to look at weight loss a little differently. You still use the insulin cycles. What I'm trying to do is one of the, one of the tips I was going to give to your audience is, can you try eating just three meals and no snacks? And I can talk about what that is, but I'll tell you, it's very different for someone who has had some weight issues for a few years and for someone who's had it for a very long time. If you've had weight issues for a few years and you can, when you're in between meals, you can sit there and think, am I hungry now or am I not? You know, would I eat a plain piece of chicken if someone offered it to me? You know, so if you haven't, been overweight for very long, you can really rely on those feelings.
If you have had weight struggles for a long time, your brain will actually tell you, yes, I'll eat that plain chicken all day long. So you have to do some planning on how to eat three meals that are going to nourish you very well and have time in between where you don't eat and time overnight where you're not eating. And you have to do it with your planning brain because in between it will take, it takes a long time. I was doing some reading and I don't feel like we have a lot of great research on this, but people who look at this say it takes two years till you can trust your hunger signals again if you've been overweight for a long time.
So yes, you really have to plan out. It's not even a matter of measuring and counting, but just looking at what's on your plate and saying, ’Will this be enough to get me till dinner?’ Eating it and then letting yourself just not eat until dinner. Does that make sense?
Dr. S: -Yeah, it totally makes sense. So you have to rely more on planning and scheduling than your own potential signal. So if you're thinking you're hungry, it may not actually be ‘true hunger’, so to speak. Now, I do want to touch on something because this is a little bit different than the advice that I've heard from other professionals, where I have mainly been advised on five to six small meals a day, trying to eat in the first hour of waking to basically keep your metabolism up and running.
You're saying that really the focus should be on the three broken-up meals and then overnight. Is that what I'm hearing?
Dr. A: -I would say if someone is probably having some issues with insulin resistance, then yes, because otherwise you're just pulsing insulin all day long. And there are people, I will tell you also, there are many ways to lose weight and some people will lose weight with that grazing lifestyle. But many will not.
Dr. S: -Okay. No, that's very helpful. And so again, the rationale of doing the three broken-up meals and then the overnight is to basically kind of reset or retrain the insulin into going back to pulsatility mode. Is that, does that make sense? Is that correct?
Dr. A: -Yes, that is what I recommend.
Dr. S: -Gotcha. Gotcha. Okay. Um, okay. So now I want to shift away from the body and talk about food. So the external piece of this. I want to understand how foods impact our digestive hormones. Let's start there first.
Dr. A: -Okay, well let's do that. along with talking about what makes a great meal. Okay, perfect. So if you're going to do your three meals, what I recommend is that you have protein and fiber and healthy fats in each meal. Okay.
Now protein helps you stay nourished longer. It's a slow digester. So it's a good one to have because it gives you energy and it stays in your system and digests slowly. So it's good for nourishing your body when you're not going to eat in between meals.
The healthy fats are super important because they actually keep you from getting hungry till the next meal. So they're essential. And they're one of the things that we often avoid, but really making sure that you have some olive oil or avocado oil, nut butter, and possibly even full-fat dairy will help you get from one meal to the next. Anytime that I look at a meal, I think, I underfed myself. I'm really hungry and it's not dinner time yet. It's usually because I didn't have enough fat in that meal.
And then the fiber is great because that's vegetables and berries mostly, although other fruits can be in there too. But the great thing about fiber is many things. One of them is that fiber activates ghrelin, which tells your brain that you're full. So it does help you with the fullness cue.
Dr. S: -Okay. And can you just for the audience, what ghrelin is?
Dr. A: -Ghrelin is another digestive hormone and it tells you when you're hungry and it tells you with your full, and it doesn't recognize liquids. So when you drink a soda, it doesn't react. So when you drink that, you're getting the sugar and the calories, but ghrelin is not recognizing it as nutrient. So your brain is still saying, where's my ghrelin? It's not telling me I'm full. But it's super receptive to fiber. So if you have blueberries or if you have, you know, carrots or whatever is your favorite vegetable or berry. Those are the things with the most fiber or even, you know, Metamucil with Stevia or, you know, some sort of fiber supplement that, that will tell your brain that you're full. And actually you are, because you need a certain amount in your stomach and it fills and, and nourishes you. So it's not a, it's not a false signal. It's a true signal of nourishment.
Dr. S: - I'm going to recap. So protein, healthy fat, and then fiber are the three. And you should have those at all three meals, breakfast, lunch, and dinner.
Dr. A: -Yes.
Dr. S: -Okay. And then I'm going to actually ask you two more questions. One is that, some people tend to eat much later today. Some people tend to eat much earlier. So for example, my high school boyfriend, his family ate at like 9:30 at night. But then, like, you know, other families will eat at 5.30 or 6 o'clock. Do you have a recommendation sort of relative to bedtime?
Dr. A: -I don't. I think there are some different kinds of ways that people do this. The research, you know, some people say that eating at night makes it hard to lose weight. But I usually coach people to do the weight loss that works with their life. So if you're going to eat at 9:30 at night, though – then maybe you want to think about when are you going to start? Looking at, if I was a 9:30 at night person, then when am I going to finish my dinner? Like if I'm going to finish it at 10 PM, I'm not going to start having any food before 10 AM.
Dr. S: -Gotcha. Yeah. OK, that's actually really helpful to know. So perfect segue to my second question is a lot of my patients and I'm going to ask myself included, I do like coffee and that's my breakfast and that gets me through the morning until lunch. I am the first to admit that that's not good. But can you tell us kind of what happens in the body with that and why that breakfast meal is so important?
Dr. A: -What do you put in your coffee?
Dr. S: -Two creamers.
Dr. A: -Okay. So the only problem with that is that you're, or it's not even, I mean, I'm not even going to call it a problem. Okay. What I would say is that breakfast is optional. Breakfast is the first meal that you have, whether you have it at 6 a.m., 10 a.m., noon, whenever you break your fast. So if you want to have a longer time with no insulin, going on for natural weight loss, then a person can do what's called bulletproof coffee, which I'm sure it's kind of an intermittent fasting buzzword, but basically people put fat in their coffee if they want to add something to it, or with their tea. So that can be MCT oil, some people do butter if you're a butter person, or a tablespoon of heavy cream, because those things are pure fat and will not wake up your insulin cycle. So that'll wait.
Dr. S: -So if that's all, not opposed to it, it's just what you're putting in, okay. So then I'm going to go on another tangent here. A large part of my population is a PCOS population and they tend to have a certain level of insulin resistance. There's certainly much higher risk for insulin resistance and diabetes, that we know. What is your recommendation? Because again, sort of what I have been advised and, from talking to other colleagues is things like intermittent fasting is actually not good for them. Things like keto, not good for them. So what is your opinion or educated information for us?
Dr. A: -Why have you counseled them against intermittent fasting?
Dr. S: -Because of the fasting, the metabolism changes that occur, basically the body goes into starvation mode. Again, this is what is explained to me. Starvation mode so it holds on to every calorie versus when you're eating regularly the metabolism is more regular. They already have difficulty with weight loss so when they're doing those long periods of fasting and they're holding on to every calorie it tends to be counterproductive.
Dr. A: -I think I can see how that can happen, especially if they're not eating enough food. I'm frequently counseling people to eat more food. I would say that I would counsel people who have PCOS that they need some time in between eating. Because they need to have that time where the insulin falls. That could be three meals, no snacks. I'm not a PCOS expert, but I think that intermittent fasting would not be a bad thing for someone to try. As long as they're eating protein, fiber, and healthy fats at those meals.
And the other thing I would say is that it's worth trying for a little while and to remain open and curious because everybody's body is a little different too. So maybe someone would want to try for two weeks doing three meals and no snacks. A lot of people with that, if they have enough food at the meal so that they're not hungry in between, will lose weight with just that. Okay.
Dr. S: -Okay. No, that's great. And I love that concept of, staying open and curious and really working with someone to try and identify what's best for you. Because I think, you know, this is a concept that I've really started to incorporate in my counseling in the last few years. And it was a conversation I had actually with a personal trainer. And she, I was referring some patients to her to work with. I really loved her body positivity and what not. And she really, insisted on what you mentioned at the beginning of our talk, which is the different body types. So in the same way that if you look at any species in the animal kingdom, there's not just, let's just say horses. There is 20 different breeds of horses and they're all different. So humans are the same way where there's going to be multiple different body types and really acknowledging and respecting and honoring that particular body type.
And so really thinking about being your best self, your strongest self, and how your body is going to react. I really, I really love that. That advice. That's wonderful. I'm going to bring us back to food. You mentioned about fiber, berries, etcetera. What are some of the foods that you would say are, you know, the most impactful of the digestive hormone and then the foods to avoid?
Dr. A: -Well, really vegetables and berries are your very best for fiber. Okay. In fact, I go to these conferences for culinary medicine where all the doctors who love to talk about healthy food go and, and there's, there was one I went to and everyone gave a talk about what they eat in a day at the end of their talk. Everyone ate berries every day, once a day. So that's my big secret tip. If you want to know what, doctors who love nutrition eat, berries every day is awesome. But then, like I said, and then the oils, the only two oils you need in your kitchen are olive oil and avocado oil. Okay. Because those are healthy and you can use them for everything. Okay, awesome. And then protein can be plant-based, can be... Meat if you want, you know, whatever you like.
Dr. S: -So I love that because you actually segued into my next question for you. I want to spend, and we're literally at 25 minutes, which is crazy, but I want to spend a little time talking about plant-based diets because there's more and more attention being given to plant-based diets. Tell us a little bit about kind of where that comes from, what the thought process is, and sort of what your opinion is on that.
Dr. A: -Sure. Well, the thing about plant-based diets is that you get people eating more of the things that are proven to not only help them live longer, but live better, happier, you know, feeling well, having better mental health, all these things. That's what we get with a plant-based diet as we go. More beans. They're in the Mediterranean diet. They're in the plant-based diet. They've got a lot of fiber. They keep you full. Once you get used to eating them, start small and then move up, then you get less gas with them. But there's just so many benefits that way.
But you can eat a plant-based diet that is not healthy. I do talk about the whole food plant-based diet. Yeah, so people talk about the whole food plant-based diet, which is, you know, that's a way to look on the internet if you want more information to look at the whole food plant-based diet, because that'll tell you which things are really going to help you out. But I have a person in my current weight loss program who's vegan. And she said, she's having some trouble because I've suggested that she eat a savory breakfast. And she has white bread with peanut butter on it, the kind that has a lot of sugar in it. Or she says, Oh, she really likes banana bread for breakfast. And basically she's having, you know, a lot of flour and sugar for breakfast, which is basically almost the same as cake, which is basically dessert. And so for weight loss, that's not helpful. And it's actually just not helpful for nourishing yourself for your day.
And a lot of people we get used to with these things, we train ourselves or everything that we have in us, our brain, our body, our spirit wakes up and says, banana bread. Because we've trained ourselves into that and we can train ourselves out of it as well, to a savory breakfast that has: protein, fiber, and healthy fats in it. But it takes a bit and, and so you know, usually people after a couple weeks are like, you know what? I'm starting to not miss the banana bread. I'm starting to not miss the, you know, those things.
Dr. S: -So what, what is that transition time? Two weeks, three weeks?
Dr. A: -A couple weeks.
Dr. S: -I want to ask you and you can feel free to give sort of an example. Um, that's not you if you prefer, but what is your, what is a typical day for you to look like with food?
Dr. A: -Sure. I template each day differently depending on what I'm doing. So another thing I tell people is, is make your days what they are. So I usually eat three meals and no snacks. Okay. I am not on a weight loss journey at this point. I have lost my weight and then maintenance. So I usually will have dessert twice a week. I have it with my meal. I never eat that alone because then if I eat it at the end of my meal, then it rounds out. I have kind of a normal, meal sugar curve that doesn't spike up so I don't eat desserts and things by themselves anymore. So I'll do that.
Then I do have one day where I have a bunch of midday meetings and because I don't eat a lot of sugar and flour in general, I'm able to eat just two meals that day, breakfast and dinner. And then there's about once a week, my husband, he's the cooker of breakfast and I also am a big lover of somebody else cooking food for me. So one day a week he's at the YMCA swimming. So he doesn't make me breakfast. And so I actually just wait, if I'm working from home, then I'll just wait till I'm hungry and have breakfast or else I just at noon plan on eating my first meal of the day at noon that day. I don't like to do an eight hour eating window every day. I don't feel like that's been good, I've experimented with it and feel like I'm not getting enough food.
Dr. S: -Okay. Awesome. So, Is there?.. so I guess I'm answering here. I was going to say, you know, what would be the most impactful for weight loss, but it sounds like that's really dependent on each person's individual case and their body type.
Dr. A: -Yeah. You know, there are lots of experts who will say you should do, if you want to do intermittent fasting, you should do the eight hour eating window. I just think that we should all experiment a little and see what we like. ‘Cause I get many people who come in to be coached for weight loss who say, I don't want to fast. And I say, well, let's not fast then. If that sounds terrible, don't do it.
Dr. S: -Yeah. And I guess the other thing too is what's the shift that happens that takes it from ‘I'm going to try one more thing and fall off again in a month or whatnot’. Like how does it really become a lifestyle? I guess that's where I'm going with the question.
Dr. A: -Sure. Sure. Um, the way it really becomes a lifestyle is to choose foods that you already like for the weight loss. After doing some different diets, I was like, oh, I figured out how to optimize my own hormones, but to do that, I had to not have flour at every meal and not have sugar at every meal and not eat all the time. But I said to myself, you know what? I gave up pizza for six months for this one diet. I am never giving up pizza again. I love it. Um, it has a lot of flour in the crust, but there's some other good things about it. I put vegetables on it cause that's what I like and cheese. So I was like, I'm not giving that up again. And so a lot of people come to me with that, you know, or they have culturally appropriate food that they eat, we want to eat whatever you're going to want to eat on maintenance now.
Dr. S: -Because you know, you don't want to diet. You want to know that there's an end in sight. The goal is to really make it a lifestyle change. That's awesome. That's awesome. This has been super educational. I really appreciate your time.
Dr. A: -Thank you!
*This content is intended solely for educational purposes and is not to be construed as medical advice. For personalized recommendations concerning your specific healthcare needs, kindly consult with your healthcare provider.
