Ep. 182 – Uncovering the Impact of Emotions on Hunger, Cravings, and Weight with Dr. Adrienne Youdim

Today, I am honored and delighted to have Dr. Adrienne Youdim joining me! Dr. Youdim is an internist specializing in medical weight loss and nutrition. She is the author of Hungry for More: Stories and Science to Inspire Weight Loss from the Inside Out.   

Before doing her fellowship, Dr. Youdim was a perfectionist who wanted to excel, exceed, operate, and fix people. Then, she became pregnant. This changed everything for her and thus, began her introduction into the space of obesity medicine.

Dr. Youdim points out that exploring our relationship with food is an opportunity to explore our relationship with ourselves. When we answer the call to address our hunger with self-awareness and radical introspection, we can engage in the life-changing work of managing our hunger from within.

In this episode, we take a deep dive into different types of hunger. We discuss the pendulum bias, beliefs about weight gain, and why Dr. Youdim feels that there should be compassion at every size. We unpack the normalization of body dissatisfaction and shame and discuss the importance of understanding the epigenetic changes associated with weight loss and weight gain. We also talk about the role of hormones in weight gain and weight loss, how to differentiate between needing and craving, how traumas and beliefs play into obesity, and the importance of lifestyle medicine. Be sure to stay tuned for more!

“The practices or habits that make us gain weight are the very things that kill our productivity and affect our mood.”

Dr. Adrienne Youdim

IN THIS EPISODE YOU WILL LEARN:

• Dr. Youdim discusses weight-related beliefs and bias and explains why health at every size is a fallacy.
• Dr. Youdim explains how she fell into the obesity medicine space.
• What prompted Dr. Youdim to focus predominantly on different kinds of hunger in her book?
• Navigating away from shame and inadvertently projecting our traumas onto our children.
• Overcoming epigenetics and the generational patterns that impact our health and lifestyle choices.
• How sleep deprivation can negatively impact our mood, set us up for metabolic disease, and even change our hunger hormones.
• What does alcohol do to our brains that negatively impacts the quality of our sleep?
• How abuse, trauma, stress, and emotions are linked to illness, emotional eating, and obesity.
• What causes us to regain weight after dieting, and how can we combat it?
• Adopting a balanced approach to weight maintenance and changing body composition.
• The impact menopause and perimenopause have on body composition.
• Using the emotional hunger brought on by menopause and perimenopause as an opportunity for growth.
• Learning how to differentiate between needing and craving food.
• Learning how to approach food from a place of mindfulness.

BIOGRAPHY 

Adrienne Youdim, MD, FACP, is an internist who specializes in medical weight loss and nutrition. Her mission is to transform the weight loss narrative into one that is both empowering and compassionate, inspiring people to live more physically and emotionally fulfilling lives. Dr. Youdim draws on best medical practices in the field of obesity medicine and on her patients’ value system, trusting that we all inherently know what we need. 

Dr. Youdim believes that navigating our hunger is a process that requires, introspection, self-acceptance, and a sense of agency. One of the principles of her practice is to provide both inspiration and information. Dr. Youdim encourages her patients not only to consider the tools and logistics of a weight loss plan but also to consider the motivating values that inspire them. She gives her patients information relevant to their weight-loss journey, including resources to promote self-awareness, journaling exercises, and mindfulness practices. 

Dr. Youdim is a nationally respected teacher, speaker, and thought leader in her field. She also hosts the Health Bite podcast. In her private practice, she follows an integrative approach that blends evidence-based medicine with a mindful lifestyle change, creating a customized treatment plan for each patient, whether for primary weight loss or to treat obesity-related diseases. 

After receiving her degree from the University of California San Diego School of Medicine, Dr. Youdim completed her residency training and fellowship at Cedars-Sinai. She holds multiple board certifications awarded by the American Board of Internal Medicine, the National Board of Physician Nutrition Specialists, and the American Board of Obesity Medicine. She is also a Fellow of the American College of Physicians. 

Dr. Youdim served as the Medical Director of the Cedars-Sinai Weight Loss Center, then brought her passion and expertise to her private practice in Beverly Hills, California. She currently holds positions as Associate Professor of medicine at UCLA David Geffen School of Medicine and Clinical Associate Professor of Medicine at Cedars-Sinai Medical Center. 

Her credits include a long list of publications, such as scientific articles in medical journals, chapters in nutrition, obesity, and metabolic syndrome, in the professional and consumer editions of The Merck Manual, as well as editor of the soon-to-be-released Wellness Section. Dr. Youdim is also editor of her comprehensive textbook, “The Clinician’s Guide to the Treatment of Obesity.”

Dr. Youdim has been featured on Fox News, CBS News, Good Day LA, Dr. Oz, The Doctors, and Dr. Phil. She has also been on NPR radio and highlighted in W Magazine and the Los Angeles Times amongst other media outlets. 

With years of clinical experience and understanding of what her patients need, Dr. Youdim created Dehl Nutrition, a line of functional nutritional bars and supplements created for health-conscious people on the go to make it easy to live well. 

Dr. Youdim is proud and immersed in her cultural and religious heritage as a Persian Jewish woman born in the United States. She resides in Los Angeles with her husband (her high school sweetheart), their three children, and their puppy. In her spare time, she can be found running, reading, cooking with her family, and wearing her signature red lipstick and high heels.

Connect with Dr. Adrienne Youdim

On her website

On Instagram

You can buy a copy of Dr. Adrienne Youdim’s book, Hungry for More: Stories and Science to Inspire Weight Loss from the Inside Out, from Amazon.

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website
• Check Out Dry Farm Wines: www.dryfarmwines.com/cynthiathurlow

About Everyday Wellness Podcast

Welcome to the Everyday Wellness podcast with Cynthia Thurlow! Cynthia is a mom of 2 boys, wife, nurse practitioner, and intermittent fasting and nutrition expert. She has over 20 years experience in emergency medicine and cardiology, but pivoted to focus on food as medicine. She loves to share science-backed practical information to improve your overall well being and is grateful to be interviewing leaders in the health and wellness field.  Her goal with Everyday Wellness is to help her listeners make simple changes to their everyday lives that will result in improved overall wellness and long term health.

TRANSCRIPT

Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health and wellness goals and provide practical strategies that you can use in your real life. And now here’s your host Nurse Practitioner Cynthia Thurlow.

Cynthia: Today, I have the distinct honor and pleasure of connecting with Dr. Adrienne Youdim. She’s an internist who specializes in medical weight loss and nutrition and is the author of Hungry for More: Stories and Science to Inspire Weight Loss From the Inside Out. We dove deep into different types of hunger, we talked about the pendulum bias and beliefs of weight gain and how she believes that there should be compassionate every size, we talked about the normalization, body dissatisfaction, shame and the importance of understanding their epigenetic changes to weight loss and weight gain, the role of hormones in weight gain and weight loss, differentiating between eating and craving, the role of experienced traumas and belief in obesity, and the importance of lifestyle medicine. I hope you will enjoy this conversation as much as I do. Please check out her book on Amazon.

I would love for you to kind of start the conversation about weight-related beliefs. We were touching on this before, we really started recording in the context of social media and the context of comments that we get on social media unknowingly, seemingly, we’re told that we are being insensitive to a group of people or groups of people. As a female physician, where do you think that we’re heading in terms of the messaging that we are providing to not just young women, but also young men and other adults?

Adrienne: I’m always fascinated by the pendulum of things. We tend to live at the extremes, and are unable in our thoughts and our actions to navigate the middle ground. I talk about this in the book as well. How do we navigate that middle ground? And in terms of I think, weight-related beliefs and bias, it’s similar. We came from a time in which we had no real awareness about the degree to which we held biases against people who were overweight and obese. Nowhere, right? Not in the healthcare profession, not in media, not in television. These are spaces in which biases exist. Having a picture of an obese abdomen or a big abdomen and cutting people’s heads off, I can understand may have stemmed from a desire of privacy concerns, but really takes away the humanity of the individual. So, we do need to talk about that.

But the way in which the pendulum has shifted is that, we should essentially keep our heads in the sand as to what the adverse effects are of excess weight. By the way, the practices or habits that make us gain weight are the very things that kill our productivity, that affects our mood, so the impact of our diet, or sleep, or exercise is profound, not only in terms of our excess weight, but just how we want to live, our vitality, our energy. So, this countermovement now which is, and this is going to be controversial to say that, I don’t believe in this countermovement of Health at Every Size, because it’s a fallacy. You can be overweight and be healthy, but the likelihood of you not being healthy is higher. Just like you can smoke and not get lung cancer, but the chances of getting lung cancer are higher.

So, as a physician, I am not going to say, Health at Every Size, but I am going to say compassionate every size. I am going to say that we do have to address the biases because I fell victim to it as a child, a teen, and young adult, and I have two daughters that I care for and don’t want to fall victim to. The statistics show that over 80% of women out there, even underweight women have body image issues. And that is fed through our biases and our societal tone around this topic. So, let’s navigate that middle ground. Let’s empower people that they can do the right thing for themselves, but do it from a place of self-love, self-compassion which, by the way is associated with more effective habit change as well. So, you meet that objective of doing what’s right for yourself when you can meet yourself where you’re at.

Cynthia: So, share with the listeners, because I think you have such an interesting background. You know, it sounds like during your fellowship, you pivoted and were given an opportunity which has now blossomed into this amazing career. Did you ever think that this would be the space in which you would be practicing as a physician, was this a complete surprise too?

Adrienne: Complete surprise. I would say that I was a gunner [laughs], you know, the type of person who was highly perfectionistic, wanting to excel and exceed. I wanted to do something where I was doing something, and back then that meant operating or doing procedures, fixing people. That’s what I wanted to do with my medical background. I actually matched in a highly competitive fellowship, where I would be doing things to people and decided to get pregnant because I had a few years before I would start my fellowship. Then of course, I got pregnant and everything changed. How could I do a fellowship at LA County Hospital where I had matched and be on call every third night? So, I cried a lot, and I dropped the fellowship.

It’s funny how this came about. How it came to be, because it really felt serendipitous how I fell into the space of obesity medicine. I was looking for something that was kind of on the fringe, but I wanted it to be evidence based and academic, and actually the science behind excess weight, and the hormones, and I’m a major science geek, and I find the science fascinating. But I realized and I share this in the book that I, on some level was destined to be here, to not only heal my own wounds, but also because I really believe in empowering people to transform their lives by examining their relationship with food, their relationship with their bodies, and their hunger.

Cynthia: A lot of the focus of the book is hunger through different lenses, which I found really interesting. So, when we’re talking about hunger, it could be on many emotional levels, physical levels, physiologic levels, psychological levels. So, what does hunger represent or manifest for you? Through the work that you’ve been doing, obviously, of these beautiful case studies that you dive into and a different area of focus through each chapter, but what got you wanting to focus predominantly on that as a vehicle with which to write your book?

Adrienne: So, as a physician– as a physician grounded in Western medicine, I prescribe appetite suppressants. I provide dietary strategies that address physiologic hunger. How can we suppress hunger so that we can consume less and lose weight as a result? Very black and white. But as I was speaking with my patients and prescribing these things, it always dawned on me that there is another hunger at play. And I wanted to also prescribe a new job, or a therapist, or reevaluation of their relationships because these hungers that people were experiencing on the side was needing to be seen and was inadvertently being soothed. That’s what we do. We soothe our hungers. I say to my patients, “If you’re a goody two-shoes, you’re going to soothe it with a cookie or you soothe it with wine, or cigarettes, or drugs, or sex, or whatever that dopamine hit may be.” That’s actually built into our physiology.

Emotional eating is actually physiologic. Our hunger hormones go up when we are stressed and we seek to soothe that hunger. It took me a while to give myself the permission really to have these conversations with my patients. But I realized, this is precisely what is needed is to address the emotional hunger, the spiritual hunger alongside with the physiologic hunger.

Cynthia: I think, it’s a very comprehensive way to look at things. I know when I started as an NP a long time ago, we were back in the card-carrying days of calories in-calories out. That was the focus. You’re eating too much, you’re not exercising enough, and this was oftentimes what I would tell my middle-aged patients. Now, that I’m a middle-aged person, I know, it’s so much more complicated than that. So, one of the things I found really interesting as I was starting to read the book was that, we have this embedded body dissatisfaction that you mentioned can start as early as six years old. I wonder how many young women and men, I mean I have all boys, start the comparisonitis, whether it’s social media images, whether it’s print ads, whether it’s things they see in movies, or on TV, how many of us start at a very young age comparing what our bodies look like to individuals that we’re seeing in social media or the media itself, and how do parents navigate this, especially, because we’re such a visually oriented culture?

Adrienne: To answer your first question of how many of us, I would say, all of us.

Cynthia: Mm-hmm.

Adrienne: I have received feedback from people who have read this book, who have said that they related to the stories, whether they are thin or large, whether they are– I even have one of our trainers, a boxing trainer for my husband and I. He’s a middleweight champion boxer in perfect physical shape. He says that he could relate to these stories. We all do this, we all compare, we all shame ourselves on some level at some moment in time. So, the first step is really to just normalize that. To normalize it and take the shame out of it. This is a very human experience. Don’t look to your neighbor and assume that that person is not having the very same experience you are. That translates into our parenting too, because how much of what our children is experiencing is not only societal, but also the shit that we’ve put on them unknowingly. We don’t do this on purpose, but we are not aware of how much of our own trauma around this, we inadvertently bestow upon our children.

The first step to navigating it is really looking within. I share stories in the book, but I even few weeks ago had a patient come in– or a parent come in and brought in his 16-year-old child, and I usually don’t see adolescents. I’m an adult physician, but I kind of had my arm twisted because this father was so impassioned about having his daughter seen for weight loss. But I said, “You need to come in,” because I will talk to the parents. He kept telling me that this was about health. And yes, the child had gained 15 pounds during COVID but I pushed him on that, you know, was there an abnormal lab test, was there a family history of diabetes? No. So, I push and push and finally, he responded, and they were of a particular ethnicity, close knit ethnicity. He said, “I don’t want my daughter to marry American, or a black, or a Mexican. Essentially, what he was saying was that he was worried about belonging. As an immigrant, I suspect, he was struggling with his own belonging or lack thereof. So, it sounds very harsh what the father said, but you can still have compassion for him, too.

Cynthia: Yes.

Adrienne: Knowing that he’s also coming from his own pain point and he was inadvertently bestowing that onto his daughter. So, the hard work [giggles] begins within ourselves to be aware of where we’re coming from. When we know better about our own story, then we’re better able to navigate that with our children.

Cynthia: I think that’s such an important point. I remember growing up, my mom is first generation and my grandfather was Italian. He was very harsh and domineering. My mom grew up feeling a lot of shame about her weight. Consequently, she was a closet emotional eater. One of the things I remember her saying to me when I was probably a teenager, which is that I don’t want you to have the issues I have with food. So, my brother and I grew up in a pretty healthy environment, but I do recall my father–, my parents were divorced. My father saying to me as I went off to college, you know, these are the things he was worried about. He was most concerned that I was going to gain weight. He’s like, “I don’t want you to go off to college–“

I’m thinking of a million things a father could choose to say to their child. His greatest first concern was that I was going to gain weight when I got to college. I remember thinking, I was like, “What a strange thing for a dad to say their daughter?” But he didn’t say that to my brother when he went off to college but you’re right. We will project things onto our children unknowingly. I’m sure it came from a good place, but it was one of those things I can laugh about it now, and of course, he denies it happened. But I’m like, “Dad, that was like–” not you know, don’t do drugs, don’t not go to class, don’t not get good grades, but it was like, please, don’t gain the [unintelligible [00:14:32].” But the kinds of layers of pressure that we ourselves unknowingly put on our children or messages that we share with them, and I love that you talked about shame and I know Brene Brown is obviously this incredible shame researcher, and on so many levels, shame about any one thing. Shame because you look different, shame because– I remember being a shame growing up because I had very full lips. I got made fun of all the time.

The irony now is that people spend thousands and thousands of dollars to have what we have naturally, but the things that make us different sometimes are the things we’re the most ashamed about or at least that was certainly my experience growing up, and yet, you get older and then you appreciate those things. When we’re talking about shame in relation to hunger or a relationship with food, how do we navigate that? That was one thing as I was reading your book really sat heavily on me like, “It’s very hard to reroute people’s thought processes, or the way that they think about themselves, or their relationship with food.”

But I feel like shame is such a big part of it because I cannot tell you how many friends in college I was in a very popular sorority, a lot of girls that were bulimic and anorexic, and they would hide all of their food issues. They tried very hard to do that. And they would talk openly, though about the shame that they had, shame that they vomited, shame that they purged, shame that they didn’t eat, shame that they were the size they were at 18. It’s so pervasive. It weaves itself through every stage of our lives and if we address it, I guess proactively, then that’s one thing. But I think most people, unknowingly, those little micro traumas we are subjected to throughout our lifetime cumulatively can add up and manifest in very different ways.

Adrienne: Yeah, you know, that really was the essence of why I wrote this book. Because I was collecting all of these stories and working in Beverly Hills. I have a clientele of actors, and producers, and celebrities, and CEOs, and philanthropists, all of these people, and I can tell you that whether you are a fortune 500 executive, or an actress, or stay at home mom, or a caretaker, or a student, we all experience the same hungers. I was very deliberate in sharing my personal stories for that reason, too. Because I wanted people to know that, even though I’m on this side of the desk, advising you, does not mean that I am immune to the human condition and that is very powerful.

When you can see the common humanity behind your struggles, it is such a breath of fresh air to know that it’s not just me that everyone is having this experience. So, I have had the privilege of being reminded every day in my work by talking to others that this is our human condition. But for those people who don’t have that privilege, you have a choice in what thoughts you seek to engage in, and reminding yourself that this is a collective experience, this is a common condition or the human condition, I think goes a long way to helping you disengage from those thoughts that brings about feelings of shame.

Cynthia: One of the things that you talk about in the book is the scarcity mindset, which I think can be applicable to so many things that go on right now that you mentioned, how there are epigenetic changes. There are changes that can occur over time when there’s been a degree of food restriction and I will make this relevant to my listeners, because I get a lot of questions about whether or not fasting is appropriate for pregnant or breastfeeding women and my answer is always no. As I was reading your book over the weekend, I highlighted a page, I mentioned that, we were going to be talking today, and I said, “This is one of the reasons why I’m not a fan of fasting for pregnant women.”

So, you talk about the Dutch Hunger Winter of the 1940s, and you talk about the multi-generational impact of food scarcity, and how that can epigenetically and hormonally shift things significantly. So, I’d love for us to kind of veer the conversation a little bit in that direction, because I find this really, really interesting. When you look at families that have generational obesity or you see patterns that are happening, I think about a family member in particular who did live through some pretty horrific things in World War II was always very tiny, had food, had issues with access to food, probably didn’t get the nutrients you needed to grow taller, be a bigger person, and so. This in particular, I found fascinating, but I think listeners would also enjoy hearing a little bit more about this.

Adrienne: It’s funny that you should bring up epigenetics because as you know, I have a podcast, too called Health Bite, and that is the segment that we dropped today-

Cynthia: Oh, funny. [laughs]

Adrienne: -was on epigenetics as well. I find the science behind this incredibly fascinating and the Dutch Hunger Winter that happened in the 1940s is a really beautiful, real life case study of how this played out. So, essentially, this was the time in which the Dutch were exposed to famine because of their healthcare system, they collected very detailed medical records on families who were exposed to famine, and then went back and studied the individuals six decades later, 60 years later to see what their health status was. What they found was that individuals who were in utero during famine, so their mothers were pregnant with them while their mothers were exposed to famine, had what we call epigenetic changes as compared to their siblings before after.

Now, what is epigenetics? Basically, our genetics or our genes, our DNA is made up of genes, which translate into our hair color, our personality, our physicality. And then, we have areas before our genes, the code for these important things that can be turned on or turned off through chemical modifications. That is called epigenetics. We know that our behaviors, our lifestyle, and our environment can create these chemical modifications. So, what they found in these individuals who were exposed to famine in utero is that, certain genes were methylated or demethylated, and that’s basically a molecule was attached to that area to turn on and off genes that put them at greater risk for metabolic consequences, insulin resistance and diabetes, lipid abnormalities, heart disease, and even schizophrenia.

When they went back 60 years later, they found that those changes were embedded in the DNA and that those people had those adverse effects. The good news here is though that even those changes are reversible. So, for me my kind of MO is all about agency. We talked about this before. We started recording how our goal is to empower people, and I know, Cynthia yours is as well. What can give you more sense of agency, than knowing that you can impact your genetics and the genetics of your progeny through your actions? It is so powerful and beautiful that we have that ability to do that. So, when we talk about lifestyle behaviors, how we eat, how we move our bodies, how much sleep we get, things that make you have a healthy weight, but also healthy cognition, and healthy mood, and healthy productivity, and so many things impacted by these lifestyle choices that we make. And knowing that we can actually impact our children’s genetics that way is powerful.

Cynthia: I think, on so many levels, I wish, even though, I’m I was trained in primary care as an NP, I always did acute care, but I wish we did more. Obviously, you are at the forefront of obesity medicine. But I wish, we as healthcare providers talked more about the lifestyle piece because that’s the most important piece. Unfortunately, we’ve conditioned a lot of our patients to ask for pills, and quick fixes, and really lifestyle medicine. Once you start making those changes and it’s like the snowball effect, it has such a profound improvement on every other facet of our lives that unfortunately, we began to condition patients like, “Okay, we’re going to go to our healthcare professional, and we have this symptom which requires a pill.” When in reality, we need to do these six other things that we did those it wouldn’t have ended at the point where we need the medication.

Now, I always think about Audrey Hepburn, because I believe in the 1940s, and they explained how petite she was. I was watching a documentary about her and they were talking about specifically, it was probably the lack of access to food during World War II that may have explained why she was such a tiny, very petite person. She just didn’t have the micro or macronutrients to be able to grow. I think she was actually tall but very, very petite that they postulated that may have contributed to the lack of growth.

Adrienne: So, interesting.

Cynthia: Yeah.

Adrienne: Can I also just speak to the healthcare aspect, and this is, well, maybe it’s in defense of my healthcare colleagues, but maybe not. Because I think, it’s not just the fact that our healthcare system is geared towards disease and I agree with you that is not– We should put eggs in that basket, but we certainly could do a lot for humanity by taking a preventive approach. But it is also our human essence to want things quickly, to want things fixed, to fear the work that is required of us. So, I would check that instinct in ourselves. Because again, if we want to speak from a place of advocacy and empowerment, we have the opportunity to implement these things at any point in our lives. There are studies that have shown that even lifestyle in your 60s and 70s can impact your likelihood to go on and develop diabetes.

While it’s great to start young, the ship has not sailed, even if you’re 70 from making these changes, like movement and healthy eating in order to impact your health and wellbeing. So, yes, it is a societal thing, it is a healthcare thing, but it is also a human temperament and we need to challenge that in ourselves.

Cynthia: No, I couldn’t agree more. We like the instant gratification. It’s harder when we realize– It’s going to take three or four weeks for this to feel normal. I’ve got an intermittent fasting group right now, and they’re in the midway point, and so, for many of them, the ones who come to intermittent fasting, because they want to change body composition, lose weight, I tell them to stay off the scale to monitor, the non-scale victories. Inevitably, this is the point where people start getting a little frustrated if they’re not getting whatever the perceived focuses for them. I just always say like, “Trust the process. You may not be able to see the benefits that you’re doing.” But we know that the benefits are profound just by changing the way that we’re eating. In essence, changing the way we look at structuring our macros, and looking at timing of protein, and carbohydrates, and fats, and so, there is a beautiful kind of dance to figure out what works for each individual.

Now, you kind of touched on some of the lifestyle piece and one aspect of your book that’s so incredibly aligned with, what I talk a lot about is the role of sleep and how sleep deprivation can have a profound negative impact, if not the quality of sleep that our bodies need for restorative helpful sleep. So, let’s talk a little bit about sleep deprivation and the impact that has on mood as well as our risk for metabolic disease. Because I think on so many levels, that metabolic piece is always very fluid in all of these conversations. But it’s probably the area of the book where I took the most notes, because I was like, “Oh, this is such great nuggets of information that I know would be really helpful.”

Adrienne: I think we all know the correlation between poor sleep and mood. We know that, we don’t get good sleep, we can be irritable, and cranky, and reactive, and unfocused. What people don’t know as much is the link between poor sleep quantity or quality and metabolic effects. They have shown in studies where people who are exposed to sleep deprivation in as little as two nights can experience insulin resistance. Meaning that their insulin levels are measured to be higher, why? Because the insulin is not as effective, it’s resistant. It’s not working as well. When people are sleep deprived, as little as two nights of sleep deprivation can increase insulin levels. What we also know is that, sleep deprivation can change hunger hormones.

So, our physiologic hunger, and we eat for reasons other than hunger of course, but our physiologic hunger is managed by a constellation of hormones that are released from our gut, in our stomach, in our pancreas in response to nutrient intake. It makes sense that if you were to eat something that once that food hits your stomach, that this particular hormone ghrelin, for example, that is involved in inducing hunger at the level of the brain is suppressed. You eat, hunger signal shuts off. But they’ve shown that sleep deprivation actually will increase your ghrelin level by about 30%. So, that hormone that is telling your brain you’re hungry goes up. And the hormone leptin, which is released from your fat cells, which actually signals energy sufficiency or fullness goes down. So, the hormones that are managing your hunger are shifting in the direction to promote greater hunger. I always joke about the times in my life, you know, when I was a college student, I was pulling all-nighters. I would wake up jonesing for a doughnut- [laughs]

Cynthia: Yeah.

Adrienne: -without fail. The studies actually show that not only does our hunger go up, but our desire for highly palatable foods aka high fat, high sugar foods go up when we’re sleep deprived. So, I do prescribe medications, but I always tell my patients, “Here I am prescribing a medication to manage your physiologic hunger. And if you are doing things in your lifestyle that are undermining that, that are shifting those very hunger hormones in an opposite direction, then we are undoing with one hand, what we’re doing with the other.” So, the lifestyle piece and the sleep in this case are so critical.

Cynthia: Well, one of the things you mentioned in the book is that, a third of Americans get less than seven hours a night of sleep and so you start thinking about the role of metabolic health and how for many people, they think of sleep as being something, “I’ll do when I’m dead.” That was my mother’s standard mantra. She’s is now [crosstalk] retired. [laughs] She always said, “I’ll sleep when I’m dead.” But I think about as a teenager or 20 something you mentioned pulling all-nighters, I think all of us spend a lot of our college years doing that. You can seemingly bounce back really easily and then there’s a tipping point. I always feel like it’s when I had children in my 30s that all of a sudden, the bounce back effect and certainly now I’m older, the bounce back effect of feeling if I take a redeye back from the West Coast. It’s a day or two to feel like, “I’m back to my normal degree of cognition,” and much to your point, when you’re sleep deprived, you don’t crave broccoli, you’re going to crave junky foods. You’re not going to crave good food, your body’s going to want Doritos, and pizza, and things that are not going to help balance your blood sugar well at all.

Adrienne: Yeah. Absolutely, all true. I was going to say something and quite honestly, I lost my train of thought.

Cynthia: [laughs] Good [crosstalk] It doesn’t just happen to me.

Adrienne: [laughs] Oh, my. The statistic that you mentioned was pre-COVID, too. So, how many of us have shifted our routines to Netflix thing at night? And now that the world has opened up somewhat, people are now having to wake up early again to take their kids to school, or to head back to the office or whatever the case may be, but that nighttime piece has not shifted back. They are sacrificing their sleep and it does have consequences. I also want to speak to the “I’ll sleep when I’m dead,” because I was very much of that persuasion myself that I could push my body to the Nth degree to get what I wanted out of it. What I tell my children now is don’t work harder, work smarter.

Cynthia: Yeah.

Adrienne: Because in terms of like school for example and cognition, we know that sleep is the time in which we cement memories. So, you could stay up an extra two hours and cram more information in your brain that is not going to be cemented, what a waste of time that is, or actually call lights out, and go to sleep, and be able to retain what you have learned. So, let’s rethink the way we are doing things. It’s not about grit and grinding all the time. It’s about efficacy. Does it really matter is what we’re doing really giving us the outcome that we seek, and if it is not, and the science is telling us that it is not, then it behooves us to rethink our habits and our patterns.

Cynthia: Well, and the net impact of COVID on sleep quality makes me reflect on the amount of women in particular that have shared or disclosed that their drinking habits changed enormously during the peak of the pandemic. So, in the book, you talk a lot about what happens in our brains when we drink alcohol, which is not to suggest. I’m saying that people shouldn’t drink but being aware of the net impact on sleep quality and certainly for a lot of middle-aged women who listen to this podcast, this is particularly relevant. What happens to our brains when we consume alcohol that impacts our sleep quality? Because I do talk about this, but it always helps to have it reinforced by another colleague, so that it gets people laser focused and very transparent about how some of their lifestyle habits can impact their sleep in negative ways.

Adrienne: Yeah. I also share in the book that I was of that cohort as well. We were drinking wine, we’ve always been wine drinkers, and that the wine drink consumption increased during the pandemic. I have to tell you that, as a physician, who has lectured on the Mediterranean diet and spoken about the benefits of alcohol, I have really rethunk all of that. Because alcohol has negative effects that we don’t talk about, increases risk of brain– of breast cancer with every additional glass. Even one glass of wine at night, which is considered very moderate consumption increases an individual’s risk of breast cancer. So, there are adverse effects to alcohol that should be discussed. I also want to speak to the moderation piece because we have these two camps of either those of us who can tolerate our alcohol or those of us who are “alcoholics.”

But guess what? When you are using something, anything for that matter whether it’s alcohol, whether it’s sugar, whether it’s smoking to soothe, to give you that dopamine hit, and your body’s response to that naturally is by upping the ante. So, we know that when we engage in any behavior on a regular basis, the amount that you need going forward to get that dopamine hit increases. So, your body doesn’t release the dopamine as quickly as it did three months ago, six months ago. That is a major bait to your brain of getting you to engage in that behavior over and over again.

Number one, let’s call it what it is, okay? This is a substance that when used to soothe is baiting your brain to increase the consumption. It does have negative effects. I’m not shaming, we can make choices, I still enjoy a glass of wine, but I don’t want my head to be in the sand about what the implications are there, and I think it’s important to discuss. When it comes to our sleep, we know that it does have a seductive quality initially. So, everyone knows that if they have alcohol, the initial effect is to feel at ease, to feel more relaxed, and maybe to feel sleepy. That is the changes or the neurochemical changes that occur in the brain in terms of our GABA receptors and other receptors that are affected that help give you that ease or sleepiness. But the brain likes to be in equilibrium. So, it counteracts that Gabaminergic effects or that soothing effects by also kicking up those neurotransmitters in the brain that promote that are stimulating, and it can promote anxiety, which is why people sometimes get anxious with alcohol or angry and combative with alcohol.

But these two effects don’t happen at the same time. The sedating effect happens first and then the simulating effect happens later. So, whether we perceive it or not, and most drinkers will perceive that several hours into their sleep, they have an awakening, but some people may not even perceive it, but they are having an awakening in terms of their sleep architecture. We know that when sleep is disrupted in that way, it affects our hunger hormones. So, there is this very close link between alcohol, sleep quality, and hunger, and weight gain that is not necessarily all calories, but also affecting the metabolic consequence of affecting our sleep quality or architecture.

Cynthia: It’s all really important because one thing that, again, it’s not a judgment, it’s an observation, but kind of mommy drinking culture, even pre-pandemic, I lived in another part of the state up until a few months ago, and there were always these mom groups, and it got to a point where I was working as an NP, so, I had to be up early and in the hospital. But the amount of drinking that went on at these events was so much that it was no longer something that I could do and then go to work in the morning. Even if I had a glass, it would just make me instantly, I was always the sleepy person. I would drink alcohol and want to go sleep. But I think, it’s also important that we’re cognizant, we’re aware, we’re honest with ourselves about our habits, so that if we’re having a desire to lose weight, or if we have a desire to get more active, or to change what we’re doing that we’re at least having those conversations with ourselves.

Sometimes, we have to get a little bit raw to have those understandings. I have several women that just started working in one of our group programs and we are doing a whole 30, so they’re not having alcohol. In the first two weeks, they just said, “I didn’t realize how much my alcohol years was a crutch.” Their words for feeling as I was uncomfortable experiencing or feeling as I didn’t want to have, or I was bored. It became something that became a habit, so that they wouldn’t have to unpack those feelings. And this is my segue into talking about the role of abuse, whether it’s verbal or physical, and how that crops up in obesity. So, this has been interesting for me to see as a clinician with patients that have chosen to disclose these kinds of things. But then, how these micro traumas and for some people, their macro traumas, how this influences their relationship with food and you know, whether they see or perceive food as a coping strategy or a way of burying feelings not experiencing uncomfortable feelings.

I found this really interesting that you touched on this in the book. I did such a beautiful job of talking about the dose dependency that for some people, they may have to have experienced certain types of abuse over a period of time that can bring this up for them. I think about a very dear friend who had a lot of sexual abuse in her childhood and had very specific texture tendencies with food, he was very open about the fact that she was an emotional eater because when those feelings started coming up, she was so uncomfortable. She didn’t want to deal with it. So, eating allowed her self-medicate, if you will. So, I think this is really a very interesting aspect of the book talking about that interrelationship.

Adrienne: Yeah. I think, what has the last two years really taught us? The fact that emotions affect our hunger. By the way, emotional eating, I think, when we talk about emotional eating, we have this image of like a girl who just got dumped, and is sitting in front of the TV with a pint of ice cream sobbing into her Häagen-Dazs. That’s not the only shape and form of emotional eating. But boredom, anxiety, uncertainty, who has not experienced uncertainty in the last two years? Happiness, excitement, emotions trigger our hunger. That’s also physiologic. We know that our hunger hormones are affected by our emotions. So, again, the first thing I like to say is, we talk about emotional eating and how people would disclose it or not disclose it. Newsflash, we are all emotional eaters. It is built into our physiology.

Now, we may be aware of it. We may be aware that I’m feeling boredom right now and I’m not going to take that bait. But the experience is universal and it is built into our physiology. That again, in and of itself, I think is so powerful. Because then you’re not operating from this island of siloed shame, you’re operating from a place of understanding and knowing what our physiology is and therefore empowering yourself with the knowing too that we need mechanisms, we need coping mechanisms, we need strategies, to be aware of our experiences, and our feelings and emotions, and our habitual reactions to them. So, in working with patients, things as mundane as–

For example, I had a patient who said, “Every time she sat down at her desk in the morning, she would have this desire to get up and go back into the kitchen.” She loved her work, and it wasn’t about the stress of the work, and so, what was it? We realized that the clutter at her desk was making her anxious and that feeling of anxiety would make her want to get up from her desk and soothe it with food. So, emotional eating doesn’t have to even be this trauma triggered thing, but the link between trauma, and obesity, and other health conditions is really fascinating. The story begins with Dr. Felitti who was a physician at Kaiser Permanente in San Diego. In the nine days, he ran a preventive health clinic where he was helping people lose weight. And he noted that some of the people who experienced very significant weight loss and weight regain, and weight regain is a whole other– and we could talk about the physiology behind that, too, but what he noticed in one particular individual who shared with him that when she lost weight it reminded her– it made her feel more desirable and she did not want to be desirable because of her history of sexual abuse and there’re so many layers to this. But he went on to do a large study with the CDC and they collected over I think, 17,000 surveys of adults where they assessed adverse childhood events or ACEs. These could have been things like physical, verbal, or sexual abuse. But it could have been other more benign things like fear of being spanked. So, you weren’t actually spanked but your parents- [crosstalk]

Cynthia: [laughs]

Adrienne: -like scared you, or marital discord, or severe addiction in the family. Being even exposed to things not necessarily affected personally, predicted the likelihood for people to go on and be obese later in life, and obesity is just the clinical term that refers to essentially 30 pounds of excess weight. So, people who had one ACE or adverse childhood event had 8% likelihood to be obese or have a BMI of 30 or greater, had almost 20% increase in having severe obesity, a BMI of 40 or greater, which translates into roughly 100 pounds of excess weight. People were at higher risk for certain cancers, heart disease, and autoimmune disease, unbelievable and correlation one might think is maybe addiction like, “Okay, so, someone who had abusive or traumatic childhood is more likely to smoke cigarettes and then go on to have lung cancer. That may be the case. But when they took into account behavior such as smoking, the correlation still existed and they found that actually it was an epigenetic phenomenon.

Cynthia: Wow.

Adrienne: So that childhood trauma methylated the sequence of genes that were involved in lung cancer and put people at a greater risk. So, again, this is so important I think in terms of talking about traumas or even adverse conditions because in our minds we think of trauma having to be something really profound like rape, but it could even be verbal abuse. Actually, verbal abuse or maybe you don’t even call it abuse but that kind of stress that comes about from difficult tone in the household was the number one predictor of obesity later in life. Not sexual abuse, not physical, but verbal abuse.

Cynthia: Well, I mean, that’s profound. I’m sure everyone that’s listening is thinking what I’m thinking, our parents do the best they can as we’re growing up. They do the very best they can and yet whether it’s perceived stress or as actual things that are going on, they have the power to be able to do these epigenetic changes. So, that’s a lot to process. Wow, that’s unbelievable. I got a lot of questions, ironically, you brought it up, you touched on it, of women who are asking, what actually is happening when they have this weight regain? When they have dieted, or they’ve changed their frequency of eating patterns, or they’ve started exercising, they’re looking at better quality sleep, they lose weight, and then they get this rebound effect? Is that physiologically, the fat cells resetting themselves like there. you know, this feast-famine issue or is there something more to it that is underlying that process for them?

Adrienne: There’s a lot of things that happen physiologically when we lose weight. Let’s remember that our genetics is very much preserved from the time that we were in scarcity. So, back when we were hunters and gatherers and food availability was not what it is now, it was scarce and so our bodies evolved to hold on to energy because the fear was that there wouldn’t be sufficient energy next month. And so it developed the means in order to hold on to calories, hold onto fat. When a body loses weight, that is seen as a threat. Even though we’re in a different time, we’re in a time of abundance, and that weight loss is actually helping our bodies, if we have diabetes, or sleep apnea, or what have you, it is perceived as a threat. So, it causes all of these counter regulatory processes that promote weight regain.

For example, hunger hormones go up, and they stay up even a year later after you lose weight. Just knowing that though that hunger, and I don’t advocate for hunger, I don’t advocate for starvation diets. I have a very balanced approach. But if you’ve eaten what you know to be sufficient, and you’re feeling hunger, don’t be afraid of that. Normally, that’s your body’s way of getting you to regain weight. Why? because it’s afraid it of scarcity and t is not operating from a place of what most of us are privileged to have which is abundance. Another thing that happens is that the metabolism drops. Now, it’s true that if you do “crash diets” or don’t eat the right things that you can lose more muscle and have a greater drop in your metabolism.

However, any time you lose weight, your metabolism will drop. Why? Because think about it. Your metabolism is the energy that is required of you to live and if you have 20 pounds less of flesh, and fat, and cells that need to be kept alive, then your metabolism, the amount of energy that you’re using to stay alive is less. So, your metabolism will drop. What does that mean? That means you can’t go back to eating what you used to eat in order to maintain. Your diet will forever need to be changed in order to maintain that weight loss or your energy expenditure through exercise needs to be such to compensate for that. So, it’s frustrating. [laughs] It’s frustrating but if we can know that that’s what’s happening, then at least we know we’re operating from a place of understanding, we know what we’re dealing with. When we do have that experience, we’re better prepared to combat it.

Cynthia: I think it’s really helpful to know that this is kind of a normal physiologic response to weight loss as opposed to people thinking like, “What in the world is going on?” Because a lot of what I talked to women about is eating for satiety, which for a lot of people that were growing up in the low fat, non-fat movement they haven’t been satiated for years and part of why they’re eating frequently is because they’re not satiated, their blood sugars dysregulated, and they’ve gotten in this bad habit, and I see so many women that do this, they have breakfast, and then they have an energy slump in the middle of the morning, and then they have a sugary coffee, and then they crash again before lunch, and the same thing repeats in the afternoon and the evening.

I think, once– in many ways it’s been my experience, once people are restructuring macros, and their blood sugar stabilized all of a sudden, things seem to quiet down a bit. I don’t know if that’s been your experience. I’m sure there are– a lot of different modalities are there. I would imagine nutritionally and depending on who you’re working with there’s probably a lot of different paradigms that you align with. But is there one that you lean towards that you find is most effective as it pertains to weight maintenance or changing body composition right now?

Adrienne: Yeah, I mean, I have a very balanced approach. I don’t promote fad diets of any sort. If somebody wants to do keto and “jumpstart,” there is something to be said for the motivation that we gain when we’re able to lose weight quickly. So, sure, you want to be more restrictive than you need to for the first 10 pounds, that’s fine. But my overall approach is very balanced and I do find that people under consume protein to a very great degree. It’s true that the RDA or what the government tells us that we need is 40 to 50 grams a day, but the science shows us what we need for weight loss and weight maintenance is closer to 80 to 100 grams of protein a day and that’s for a few reasons.

Number one, protein is a satiating– most satiating macronutrient. It actually suppresses hunger hormones all throughout the day. They’ve shown that 20 grams of protein for breakfast for example will help curb ghrelin. Remember, that’s the hormone that makes you hungry even at 4 PM. That’s the witching hour. [laughs] So, there is something to be said for higher protein. There is also something to be said for eliminating processed sugars because yes, when you eat sugar that easily enters your bloodstream and that’s simple carbohydrates, your body responds to that surge of sugar by surging the insulin and then you literally crash, your blood sugar plummets. And that crash is experienced as irritability, fatigue, the mid-morning slump, and it is also perceived as cravings and hunger. So, eliminating that is helpful.

I am not a no carb person because a Pop Tart and a cup of lentils is very different. We all know this. We all, I think, intuitively know what we do for ourselves. So, when you have a cup of lentils for example, that fiber and that carbohydrate is stabilizing your blood sugar. It’s giving you a more steady rise so that you’re energized by the carbohydrate as opposed to yanked [giggles] by the neck. So, I do believe in a very balanced approach that promotes lean proteins, complex carbohydrates, lots of fruits and vegetables for the antioxidants, and vitamins, and minerals that it gives us. That’s the way that we can maintain as well is by being balanced. It’s not sexy, though. It’s not sexy. People want me to stay “Please pee on a keto stick and that’ll be the answer to all your problems.”

Cynthia: Oh, [crosstalk]

Adrienne: Sorry, folks. I wish, it was so easy, right?

Cynthia: Yeah. Well, but I love that our philosophies are very aligned that protein is something that most if not all, people are under consuming and that when I’m working with people north of 40, trying to maintain muscle mass, when sarcopenia really becomes an issue or muscle mass, aging, and bone changes, and all sorts of things. Is there anything special or unique that you do with your perimenopause and menopausal females? There were a couple of questions that came up around this and the next one is on cravings. But I know this is a lot to unpack. So, I’m just curious if you go about things differently with women of this particular age group than younger women.

Adrienne: Well, again, let’s understand first what’s happening to the body during menopause. Essentially, the change in relative testosterone to estrogen, so, as women of course we have testosterone as well it’s not exclusively a male hormone.

Cynthia: [laughs]

Adrienne: But when our estrogen levels fall, that relative amount of testosterone is what targets excess weight in the midsection. So, that’s why perimenopause women start to complain about, the midabdominal bulges happening. So, that’s physiologic. There’s also– women start to lose muscle mass in their 30s. So, way before menopause, but then that accelerates during menopause. So, that’s another reason why protein and exercise by the way are so important because if you’re not consuming adequate amounts of protein, then you are going to lose more muscle at a more precipitous rate. So, I really emphasize those features of adequate protein as well as movement and exercise. But I also like to talk about what’s happening in our minds? What’s the emotional hunger that is occurring in perimenopause?

If you’re a working mom, you’re looking at empty nesting, and you’re wondering if you should have worked, and you’re maybe grieving the fact that your child is growing up or leaving the nest. If you’re weren’t working mother and decided to dedicate your life to your children, you’re questioning that decision because now your children are leaving, and don’t let the door hit you on the way out, right? You have maybe a different relationship with your partner at this time of life. So, there’s all of these emotional hungers that are happening in parallel with the physiology of perimenopause and they are all important to address. I find it really– there’s a beauty in this because yes, it’s that midabdominal bulge is smack in the face and it’s frustrating that you can’t eat and do what you did in your 30s. But it’s also a wakeup call to become aware of what your true desires, longing wants are. If you answer that hunger, it’s an invitation to live in alignment with what you deserve to live fully well and wholeheartedly. So, yes, we can grieve the change in body composition and the change in, I always call it, “We’re no longer shiny new pennies.”

Cynthia: [laughs]

Adrienne: -The 20-year-olds are like, “Shiny new pennies?” No, we’re not. But you can also use it as an opportunity.

Cynthia: Well, it’s such a refreshing perspective because I think, when I see other females speaking about this middle age transition stage, there’s a lot of focus on lack as opposed to abundance. I think being grateful and looking at things from a different lens can really be a beautiful way of reframing. Now, I want to be respectful of your time and there’s just one other area that I want to kind of touch on. You mentioned the book differentiating between needing and craving. So, this is one of those things that when I was reading the book, I was like, “This makes so much sense” and this is one of those tidbits that I think will help tie up this beautiful conversation that we’ve had. Differentiating between needing and craving food, touching back on the hunger, talking about mindfulness, and presence, and connection, and how important things are, and reframing a lot of our relationship with hunger, whether as you mentioned is it emotional, spiritual, physiologic, and our relationship with food. How would you kind of tie that up?

Adrienne: You know, food is so many things. I come from a Persian and Jewish background where culturally and ethnically our food is so important. It’s how we commune, it’s how we show love, it’s how we gather. I maintain the ritual of cooking Persian food Friday night, even though I was born in Southern California and I speak English to my kids as a way of anchoring my children to family and community in a ritual that we do every week. It is all of that. But food is also fuel, right? The way in which we choose to fuel ourselves has effects emotionally and physically. So, understanding again that balance of navigating that food can be love, and culture, and community, but food can also be fuel and holding that duality in mind requires balance.

I also think about when we talk about craving or desire of like, what is enough, how much is enough? Because I think, your listeners will agree that you can have one bite of chocolate cake or whatever that thing is for you, and you can have 10, and you can still desire more. If we chase that desire, we won’t stop until we’re sick to our stomachs. So, how can we learn to be satisfied with the first x amount of bites. However, you deem is sufficient for you as opposed to chasing that craving or desire, where there will always be another bite that is desired. And holding that tension, knowing that if we can sit with that desire, it’s uncomfortable. We get triggered to act when we are craving something. But if we can sit with it and no, we’re not going to break you can experience that like itch, but it’s not going to break you. In fact, if we can tolerate that we develop the resilience to be with that more often and without having to act or react. That’s a powerful place too knowing that you can shape what instincts are craving that your body is triggering you to do. This also makes me think of and I could go on a million tangents of this whole concept of listening to your body. A lot of times people in the wellness space will say, “Listen to your body.” If your body wants something, then it wants it, it needs it. So, listen to it. If we’re going to listen to our body, then let’s really see how that plays out, okay and I am not anti-anything. You want to have some sugary snack, my personal advice is sour gummy things. I’m obsessed with

sour gummy things.

Cynthia: [laughs]

Adrienne: And I’ll eat them. But if your body is telling you to consume that big, heavy meal, and it feels comfort in the moment from comfort food, what does your body tell you 30 minutes later when you’re lethargic? What does it tell you 60 minutes later, 90 minutes later when you have brain fog? So, if you’re going to listen to your body, you have to listen to your body not just in that moment, but be mindful of what your body is telling you throughout the rest of the day. When we approach our food from that place of mindfulness, then you don’t have to listen to Dr. Adrienne, or Cynthia, or anybody else. You can allow your body to tell you what it needs and how it’s going to respond, but it requires true mindfulness, which is different than that instant gratification that we get when we have our sour gummy worm. [laughs]

Cynthia: Such an important distinction. This has been such a valuable conversation. I’m so very grateful that we carved out this time together. Can you let listeners know how to connect to get your book, reach out to you on social media? Obviously, we’ll have all the links in the replay, but what’s the easiest way to connect with you outside of the podcast?

Adrienne: Yes. So, I am on Instagram @dradrienneyoudim. You can find me there and there’s links to my website dradrienneyoudim.com where you can find blogs, you can sign up for a weekly newsletter as well as learn about the podcast, Health Bite, where I hope to offer small actionable bites every week. It’s not about being perfect. We don’t need to be perfect in order to be effective. So, if we can just make small changes every week towards our wellbeing, then we are ahead of the game. And thanks for having me, Cynthia. It’s been great speaking with you.

Cynthia: No, I really enjoyed your book and we’ll definitely be recommending it to clients as well.

Adrienne: I appreciate that.

Presenter: Thanks for listening to Everyday Wellness. If you loved this episode, please leave us a rating and review subscribe and remember tell a friend. And if you want to connect with us online, visit the link in the show notes.