Ep. 187 – Strategies for Biohacking Metabolic Health with Dr. Alexandra Sowa

Today, I am thrilled and honored to be talking to Dr. Alexandra Sowa. Dr. Sowa is a dual board-certified physician of internal medicine, specializing in metabolic health, and clinical instructor of medicine at NYU Langone. She has served as a health expert for national media outlets and print publications like SiriusXM, CBS News, NPR, the New York Times, U.S. News, World Report, and more. In addition to her private practice in NYC, she is the founder of SoWell Health, a consumer metabolic health company.

Over the years, people kept complaining to Dr. Sowa about weight gain, decreased endurance, brain fog, and irregular periods, even when their doctors had told them they were healthy and their labs looked fine. When Dr. Sowa checked their labs, however, she would immediately see that they had metabolic syndrome, an underactive thyroid, a vitamin deficiency, and in 90% of the cases, insulin resistance too.

During the turbulent period of the pandemic, Dr. Sowa finally had the time to sit and think about how she could help those patients. She came up with a unique solution and developed a home-testing kit to assess and address the symptoms of people’s metabolic health issues.

In this episode, we discuss the scope of metabolic health in the U.S., and Dr. Sowa explains how she came up with her Weight Biology Kit. We talk about the importance of making the right nutritional choices and improving your health by making better lifestyle decisions. We dive into the role of using technology to monitor health, the influence of alcohol, and using Naltrexone to overcome alcohol cravings. We also unpack the notions of cheat days and biohacking in the wellness space.

Remember to check out Dr. Sowa’s Weight Biology Kit, a point-of-care testing kit for insulin resistance. Stay tuned for more!

“Eighty-eight percent of our population has evidence of metabolic dysfunction in their labs.”

Dr. Alexandra Sowa

IN THIS EPISODE YOU WILL LEARN:

• How Dr. Sowa came up with her home-testing kit to address people’s metabolic issues.
• Insulin is often the first biomarker to become dysregulated as people move towards insulin resistance.
• Dr. Sowa explains why insulin is a better predictor than blood sugar of where people are in terms of their metabolic health.
• Why do people with high insulin levels gain weight even if they are calorie-restricting and eating very little?
• How does nutrition impact metabolic health?
• The two most important things you can do to improve your health if you have elevated insulin, and you show signs of insulin resistance.
• Three lifestyle changes that, in addition to better nutrition, can be instrumental in helping improve fasting insulin and blood sugar levels.
• The disruptive role alcohol can play in your metabolic health.
• Some tips for overcoming alcohol cravings.
• Why is it best to avoid having cheat days?
• The benefits of journaling, as a motivator for changing behavior.
• The roles technology and biohacking can play in metabolic health.
• The eight areas that get tested in Dr. Sowa’s core point-of-care home testing products.
• Dr. Sowa explains what the HOMA-IR score is.

Connect with Dr. Alexandra Sowa

On her website

On Instagram (@getsowell)

On Instagram (@alexandrasowamd)

SoWell – Unlock Your Metabolic Health

SoWell – The Weight Biology Kit

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 had the distinct honor of interviewing Dr. Alexandra Sowa, who is a dual board-certified physician of Internal Medicine, specializing in Metabolic Health and Clinical Instructor of Medicine at NYU. Today, we dove into the scope of metabolic health in the United States, the importance of nutritional choices, and how to optimize health including other lifestyle choices like sleep and stress management, physical activity, the role of depersonalized medical advice, the role of technology and monitoring health, the influence of things like alcohol, naltrexone, the concept of cheat days, and biohacking in the wellness space. I hope you will enjoy our conversation and don’t forget to check out her point of care testing for insulin resistant, The Weight Biology kit. Dr. Sowa, it’s so nice to connect with you and I have been really excited about this conversation.

Alexandra: I’m thrilled to be here. Thank you for having me.

Cynthia: Yeah. So, when you reached out to me on social media, and we started having this interaction about something unique that you came up with during the course of the pandemic, that address metabolic health, I would love for you to share with listeners organically how this came to during these turbulent last two years?

Alexandra: Yes. Okay, so, I am an obesity medicine physician. I’m a dual board-certified in Internal Medicine and a field called Obesity and Metabolic Health Medicine. I have a private practice, and people would come to me complaining of symptoms that say, “I have unexplained weight gain, decreased endurance, brain fog, irregular periods. But my doctor says, I’m healthy and here are my labs. I’ll show you. They said that my labs look fine.” And then, I would look at the same set of labs with my specialty training, and I would see right off the bat, you have metabolic syndrome, you have an underactive thyroid, you are vitamin deficient.

Then, the one thing that was always missing that I would always add on would be looking at fasting insulin in combination with fasting glucose. In 90% of the patients who came to me complaining of these symptoms, I would find something called insulin resistance. It just happened over and over again for many years. During the pandemic, I really had some time to sit and think, how can I bring my specialty practice to more people? The solution came to me through at home lab testing, where I could order a panel for people just like I would in my private practice and make these things like fasting insulin and the specialty interpretation available to more people, because with the pandemic it became even more clear how we need to be getting a hold of this metabolic health epidemic that we have.

88% of our population has evidence of metabolic dysfunction on their labs. 88%. So, what I was seeing in this 90% number in my practice is throughout the population. So, I developed at home testing kit, our first kit hit the market was called The Weight Biology kit, and we were addressing the symptom of weight, because that’s what I most frequently saw in my private practice. And we test for eight biomarkers in this kit at home with the finger prick test. You do not need your doctor to order it. By coming through us, we have doctors who are ordering it, and interpreting it, and then, releasing the results to you, and explaining it in a way like I would in my private practice.

It’s been such a hit with people that we’re expanding our kit offerings now and looking at other diseases under this metabolic dysfunction umbrella. So, we’re releasing, I think, by the time that this podcast is out, we should be able to order our PCOS Biology kit helping women who think they might have or already have a diagnosis of polycystic ovary syndrome. And then, just more globally looking at insulin resistance and metabolic health. So, a little bit of a long explanation, but this company was routed first in a private practice and just in a desire to make this testing more available. I’m so excited to be here to talk to you about it.

Cynthia: Well, any of my listeners know this is completely up my alley. I practiced as an NP in cardiology for 16 years, and I kept telling my colleagues, we are missing opportunities because unfortunately, in traditional allopathic medicine, we have a bucket like you meet a bunch of diagnose criteria, you can fall into this bucket, and we weren’t thinking globally, we were very narrowminded if someone had a thyroid issue unless they were acutely sick in the hospital, we send them back to primary care, and a lot of the markers that you’re talking about and are specific to this home weight loss kit are markers that I was looking at that I was saying to my patients, your triglycerides are higher, HDL is low.

This is a sign that, yes, perhaps there’s some genetic susceptibility that your HDL is low. But really, this is more a reflection of lifestyle choices that you’re making. So, when we’re thinking about the scope of metabolic health, it is important for people to understand that it’s more than just lab markers. There are lifestyle contributors that exacerbate this. So, from my perspective, so much about our modern day living and our modern day lifestyles are feeding this metabolic disorder issue. Certainly, over the last 20 plus years of me working in medicine, I went from being in a preventative cardiology center, and then, going into a large private practice in the Washington DC area, obviously, working with very bright individuals, but blinders on not thinking about a lot of the advice that we were giving our patients good intentioned, but advice nonetheless that was not particularly helpful. I think about things as benign as saying, exercise more, eat less and it’s really not an exercise more or eat less issue, it’s a hormone issue and why insulin in particular is such a critically important hormone.

I, oftentimes, even when I do webinars or I’m doing IG Lives, I’ll say, every single person, male or female on this needs to check a fasting insulin. If your primary care provider, internist, your GYN, whomever is not comfortable, we need to find you someone else, because it’s that critically important. So, let’s talk about how insulin oftentimes is the first biomarker that will dysregulate as we’re trending towards this path of insulin resistance, and let’s be really clear, the study that you mentioned at the beginning of our discussion about that 88.2% of Americans, it’s the UNC Chapel Hill study from 2018, I can guarantee that number is larger, especially, after the past two years. So, let’s talk about why fasting insulin oftentimes is that first biomarker that we need to be looking at, we need to know those numbers, and what value range do you personally like to see with your patient population?

Alexandra: Okay. Oh, so much good stuff today next year. Okay, so, let’s start with insulin. So, in traditional medicine, one, we are taught to manage and only look for disease states, that is where we go wrong, because in metabolic dysfunction, metabolic syndrome, insulin resistance, type 2 diabetes, it takes years to develop. So, I actually always tell people, “Don’t be scared of getting a diagnosis.” You had said that starting with labs are just one part. It really is lifestyle and nutrition, and that’s how we reverse it. I like identifying it on labs, because I think, it’s incredibly empowering, because it takes away this idea that weight or symptoms that you might have, or how you’re feeling is all a willpower thing. Instead, you can say actually, “No, I have a hormonal imbalance. Let’s focus on that,” and it gives you something very clear to work toward.

The problem in traditional medicine is that, we only have been taught to look at blood sugars, and then, in a little bit more complex way, something called hemoglobin A1c, which is the average blood sugar over three months’ time. The problem is that, blood sugar is the second thing to react and insulin is the first. And insulin’s job is it’s secreted by the pancreas in response to a glucose load. If insulin is working, you’ll bring down that blood sugar into an appropriate range. But what happens for the 20 years before blood sugar shoots up into an inappropriate range when we’re attaching it on traditional screening metrics is that, insulin numbers are creeping up. You need more and more insulin to handle, to wrangle that blood sugar and take it to parts of your body, your brain, your muscles for use.

So, insulin is a much better predictor of where we are metabolic health wise rather than glucose, because by the time that glucose is elevated, your insulin levels have been high for a very, very long time, and your pancreas is getting on the cusp of burning out. It’s getting very tired. The longer your body goes learning that it needs higher and higher insulin levels, the harder it is and the longer it will take to reverse it. You still can absolutely, 100%. But the earlier we can catch it, we can really delay so many of the negative symptoms that come with hyper insulin levels, and then eventually high blood sugars. So, what are we looking for with insulin?

One of the reasons that most doctors will not order this test, will have never heard of it, if you ask them to order it, they’ll say, “I have no idea.” Because we really don’t learn about it, and we previously thought that in order to get an accurate level of insulin, you had to do something very complicated in the hospital. You had to do have glucose pumps and clamps, and it needed to be highly scientific and regulated. But the more and more we’ve studied it, the more and more we realized no, we can actually take this at one point in time. So, if you go to Quest Lab, other problem is that if you go to a traditional lab to screen for insulin, their range, I think, is upwards of a normal range of up to 30.

Now, if you have a fasting insulin of 30 in the morning, you are in advanced insulin resistance, and likely already have evidence of prediabetes and the type 2 diabetes. I like my numbers to be at least below eight, ideally, below five. That is when your body is optimally understanding how to take in carbohydrates, how to wrangle them, how to deal with them. When it starts going over 10 into the teens upwards of 30, your body needs such high levels of insulin to handle that blood sugar and your blood sugar might be in an ‘okay’ range, but those high levels of insulin are making you feel everything that all of the symptoms, you are tired, you are hungry, you are gaining weight like crazy, even if you are calorie restricting and eating like a rabbit, you are gaining weight, because insulin is a fat storage hormone and insulin in excess is a hunger hormone like you can’t even imagine.

So, if you wake up with an insulin level in the teens and the 20s, you are going to be so hungry and you’re going to want carbohydrates because that’s what insulin signals your body to do. As soon as you eat that carb, that is going straight over as fat, even if you’re running a marathon, even if you’re burning all of the calories and eating nothing but 800 calories a day, your body doesn’t understand the calories in, calories out method when you have this imbalance. So, insulin is just in my opinion, the absolute only place we should really be starting when we’re looking at the symptoms associated that we still commonly feel and especially, in relationship to weight gain.

Cynthia: Well, I think, it’s really important as you say, the empowerment piece allowing patients to have some vested information that they can tangibly hold on to you know in this day of Dr. Google and information accessibility, I think, it’s really, really important, whether it’s you, or Dr. Ben Bikman, or Jason Fung, or some of the low-carb MD docs, you know, Brian Lenski, and Dr. Tro, those the people that I think about in the space along with you, they’re really doing an amazing job talking about this and helping you empower patients. So, they can advocate for themselves because that’s really what it comes down to.

So, I don’t want anyone who’s listening to think that insulin is all bad. Obviously, insulin, when it’s working efficiently is very, very important, but most of us have such significant hormone dysregulation in our bodies that it’s not working efficiently. A lot of what you’re talking about is helping people understand the things they can do to harness improving their hormonal profiles in their bodies. So, let’s pin it and talk a little bit about some of the nutritional impact on metabolic health. I think for anyone that listens to this podcast regularly, they know what you’re going to talk about. But it’s something I talk about frequently, but it’s important for us to hear it again and again because it reinforces better habits.

Alexandra: Yes, let’s say one more time, we need insulin.

Cynthia: [laughs]

Alexandra: Insulin is incredibly important and we should not villainize it. But where it goes awry as you were saying is that for most of us really, truly like if you get fasting insulin back and it’s really high, do not feel alone. It’s you and at least 50% of our country and likely higher will show these elevated insulin levels. So, it’s just so common. It’s common because we’ve created a culture in which the food around us, the world around us, the environment around us is they’ve tried to convince us that grains, and carbohydrates, and fruits, and sweets, and processed foods, and fast foods should be normal. There’s something wrong with us if we can’t stay away from them. They’re hyperpalatable and they’re highly, highly addictive.

So, if you find this number, it should be actually exciting. Because the thing is, we have tools and we’ll talk about them about what to do about it. So, your listeners I hope already know this. But the two main things that we can do when we find elevated insulin and we have signs of insulin resistance are, one, we’re going to decrease carbohydrate. The second thing we’re going to do is, we’re going to learn how to intermittent fast, and we are going to utilize time restricted feeding to our benefits. This idea that we should be eating all the time and grazing is a made up one and is not one that our bodies are good at handling.

Especially when we have insulin resistance, our goal should be to give our body a break and to get that insulin level down as much as possible. If you’re snacking, especially, on traditional snack foods, if you’re having pretzels, if you’re having cookies, fruits with nothing else paired with it, then, you’re going to have these blood sugar spikes, and more importantly insulin spikes. And your insulin will never be allowed to come down and rest. The longer we can go between eating meals and then focusing on meals that are high in healthy proteins, and fats, and low in all of the refined carbohydrates, and low in starchy vegetables, we’re really focusing on leafy greens, the lower we can keep that insulin level down and the lower you can keep the insulin level down in the most consistent levels, it’s amazing. You’ll start to feel better, and you’ll start to see weight loss, and you’ll reverse all your symptoms. Yeah, and in about 12 weeks’ time and even much faster than that, but I like to give people 12 weeks, you will see all of your insulin numbers come down. It’s very reversible when you attack the high insulin levels with lifestyle. Consistency does become key but that’s the beauty of it. I have people who come to me with insulin levels in the 50s, and then, within 12 weeks, I will get them down to 10.

Cynthia: That’s unbelievable.

Alexandra: Yeah.

Cynthia: I mean, 50 is, I have not seen a 50. I’ve seen a 30. But wow, that’s incredible. I think on so many levels, it’s so important for us to understand that we do have to keep reframing these discussions so that people understand, they do you have the ability to switch course, they do have the ability to change things. I think it’s very, very important for people to understand that the meal frequency piece in particular, which is something obviously that I’m a huge fan of less meal frequency, no snacking. I remind my teenagers that they need to snack in between meals, it’s because they did not put their meals together properly and we really don’t do a good job as healthcare providers talking to our patients about nutrition because we aren’t taught much in our own education, and much of what we taught is focused on my plate. It’s focused on farm subsidized products, it’s focused on this kind of methodology that we need a lot of “heart healthy grains.” Anyone can see me and I think it’s profoundly detrimental that we’re not talking about what’s most important, which is keeping our blood sugar stable, not having these massive fluctuations in blood sugar lability as well as insulin as well.

Now, when we’re thinking about avoiding these highly processed hyperpalatable foods, decreasing our meal frequency, what are some of the other things that we can be doing now. Again, I’m leaning towards a couple things in particular to come to find have a profounded impact on how we are able to capitalize on blood sugar control and insulin as well because they oftentimes go hand in hand out, but what are some of the other lifestyle pieces that can be so instrumental for helping your patients improve their fasting insulin and blood sugars?

Alexandra: The three additional elements to nutrition. One that would be sleep. We really overlook sleep. Sleep apnea and insulin resistance go hand in hand. So, I want everyone to get screened for sleep apnea. it is a condition in which you really interrupt your REM sleep once you’re exhausted but more importantly than that it really has an effect on our cardiovascular system long term. It raises our cortisol at night and you wake up just ravenous and the cycle will continue. That stress at night when you should be sleeping is so bad for our body’s inflammation, and our long-term health that we need to make sure screen yourselves for that. You can hop over to my website at getsowell.com. We have a screening tool accessible for sleep apnea.

But if you don’t have sleep apnea, just even sleep. So, interestingly, I found in the pandemic that a lot more of my patients are getting more sleep because they’re working from home, and there has been an improvement actually, when so much else has gone wrong. It’s been great people like, “Oh, for the first time in 20 years, I’m sleeping seven hours again and I have more energy. And now, I can attack the things that I hadn’t been able to do before.” So, sleep is a very big component. You don’t want too much, you don’t want too little, and you want it to be good quality.

Then, the second thing in relationship to that is stress. So, when we’re constantly running around like chickens with our heads cut off, your stress levels will be so high that it can become near impossible to get your insulin levels down. If you are sick in the hospital and you’re not even eating anything, you’re not even eating carbohydrates, your insulin levels can spike. That’s natural. It can be actually very protective, but long term, if we’re seeing it every day and we don’t have a reason for it other than just chronic stress in our lives, your blood sugar and your insulin levels will go up.

So, that is not something you can fix honestly as easily as diet. It needs constant attention, meditation, adding in exercise, which we’ll get to next. Really having some very healthy habits to hone in on your stress levels and you know, work from home environment that can actually be like, “Okay, every hour, on the 55 mark, I’m going to get up, I’m going to walk around my house, I’m going to do some deep breathing, and even if it doesn’t feel like I’m in a hyper stressed place, I’m going to remind my body that we’re going to come down from this environment.”

So, then, finally, the final element, and I’m so interested to hear if you what else you might add, but it’s exercise, is movement. Now, most people have an idea that weight loss and physical symptom improvement will be dramatically improved if they get on their Peloton bike and ride into the sunset for two hours a day, run a marathon, and set these very big lofty goals. In fact, what actually happens, if you go from zero to 100 with exercise, you will actually end up stressing your body out. You will release cortisol, you will release all sorts of stress hormones that will make you feel so depleted, and actually hungry, really, really hungry. So, we don’t want to go to the extreme.

But what we want to do is to pull in smart exercise, especially, at the beginning of any change. If you were to get a new diagnosis of elevated insulin or insulin resistance, you don’t want to just go to the extreme. You want to say, “I’m going to start doing 20 minutes of walking a day. I’m going to start there and I may do it consistently and see how I feel, okay and then, I’m going to add in some strength training. Then, I’m going to be smart about when I exercise, I’m going to go out for a walk after my meals, I’m going to utilize that glucose right away, I’m going to get it over to my muscles as fast as possible, and I’m going to kind of be old school about it.”

You know this idea of going for a walk after dinner, so, my grandparents used to do that. Well, we should be doing that we should be moving more right after we eat. And really taking small goals when it comes to physical activity, but making sure we’re moving. In the pandemic, we’ve stopped moving. Even here, I sit at my desk and I have never sat in the desk more in my whole life than over the past two years. So, it’s important to remember we have to move.

Cynthia: No and I love that and the irony is during the pandemic what my husband and I started doing because we couldn’t do anything else. We were in Washington DC, which over the first three months of the pandemic was really shut down. So, we would walk the dogs. Now our dogs love that they get four to five miles a day of walking either in the beginning of the day, end of the day, and I used to jokingly make fun of the people in our neighborhood who walk at night, and now, we are those people. So, I think, it’s absolutely brilliant and I always mention to clients and the patients that it’s such a simple way to help with insulin sensitivity if you–

My largest meal of the day is lunch. I’m usually very active in the morning, very active in the evening. And so, some of them have higher carbohydrate, like today was a higher carb day. I had some squash or some Bolognese. So, I got to walk and right before we got on just 10 minutes, you know, walked one of my dogs down the street and back up the street. And it’s so good to get sunlight exposure, it’s really good to get out in nature, get your sunglasses off, we’re so conditioned to being shaded all the time that I remind people how important it is to get sunlight on your retinas.

But also thinking about just hormone imbalance, like where a woman is in her menstrual cycle and recognizing some hormones are more insulin sensitizing versus others that are not thinking about women that are closer to perimenopause, the five to 10 years preceding menopause or menopause. It’s almost as if the level playing field changes and shifts again, and I’m sure you probably have a practice of women who will say, “I’m in my mid-40s, what I did in my 20s and 30s, I can’t do anymore. I can’t do CrossFit five days a week, I can’t eat the same way that I did.” So, acknowledging where we are in time and place and recognizing that we can’t it’s not a bad thing. We can’t necessarily do the same things.

One issue that I see with women in particular, it’s obviously not gender specific, but I work only with women is the alcohol use. So, maybe someone was an occasional alcohol consumer pre-pandemic and since, the pandemic that’s just ramped up, and I do find alcohol for many people really can be problematic if they’re trying to lower insulin, lose weight, and think of it as a very benign thing and actually, I don’t drink at all anymore. I think, the pandemic for me and it’s not a judgement. I just have to point out like I was only a social drinker, we’re really not doing any socialized thinking I’ve realized, “I actually don’t want to.” So, I’d love for you to speak on, do you see the same kind of situation with your patient population with alcohol?

Alexandra: it’s so interesting. I didn’t hit on it. For me, alcohol falls into the sleep and the stress category, even more so than the nutrition category. We, yes, it’s so interesting as people have gone through these stressors, and specifically, I do also find, too, that as women age and hit this like menopausal, perimenopausal period, they can actually be drinking more consistently than they ever did when they were younger, and it’s a release, and it feels like a way to control symptoms. But what it does actually is it really increases inflammatory markers and interferes with our sleep. I really don’t think people want to admit this. But it is very disruptive, and it will increase all of your inflammation and your insulin too. I actually have seen a many people over the course of pandemic who I had seen, had very in-control numbers before they came back to me. The only thing that had changed was more regular alcohol and with it, everyone thinks, “Okay, well, I’ll gain weight.” But what you also see are this insulin resistance increasing, so, then the weight doesn’t just come on in relationship to calories. It comes on like an avalanche, like a snowball because your insulin resistance is increasing and that’s because even if you’re sticking to lower carbohydrate alcohols which we can talk about, you’re still seeing this inflammation come on.

For many people, wine feels sophisticated and healthy because we’ve been told that a lot in studies, but if you dig into it, they all have money behind them of companies who want you to buy wine. [laughs] And yes, limited quantities, that can be fine. But in regular usage, the carbohydrate and especially, people have it at night, if you get their hands on wine, you’re going to have this carbohydrate hit and it’s going to stick with them throughout the night and decrease the quality of their sleep, their insulin will never get a chance to come down because it’s dealing with this blood sugar load that has come on late at night and they wake up next morning feeling both hungover, but then have this kind of hidden effect of the extra sugar.

So, in my practice, it’s something we take off the table when we’re really trying to change symptoms. It’s something we can add back in, but it’s something you need to take away to realize how much better you feel about it. I’m actually, I’m about eight months pregnant, and this is my third time, it’s my third child. I always forget how good you feel actually when you don’t drink for so, so, so long. I’m not a heavy drinker. Either it’s more social, but it doesn’t even faze me anymore and I feel so good. Every time I’ve done this, “Okay, I should just totally give it up just like I do for pregnancy.” [laughs]

I think this time I might because I’ve got all these other symptoms going on, but it’s not complicated by was it the glass of wine we had last night. So, I would encourage people, it seems like a hard one but it’s actually pretty easy. Give yourself about two weeks without and then beyond that, you won’t think of it as much. If you’re using it as an emotional crutch, we need to find something else for you to substitute at night to release. We need to pick up an adult coloring book, or crochet, or go for a walk, or get on the treadmill, or like binge watch your favorite TV, but do something else with your body, not pouring a glass of wine and unwinding that way. So, it’s very doable and it will make a big improvement on your metabolic health.

Cynthia: It’s interesting because drinking culture piece and for full disclosure, I’ve been very open about this. I grew up with an alcoholic parent, and I think alcoholic children either as they become adults, they either had one direction, either they’re not big drinkers or they are big drinkers. So, I know, I got teased a lot when I was younger because I was never a big drinker. Ironically, went out last night with another couple in our new city and went to this new restaurant, its amazing German restaurant, and they had all these craft cocktails, and I looked at the young woman and I was like, “Well, I think, I’m just going to stick with my water and actually, I’m cold. So, can I have hot tea?” She leaned over and she’s like “Oh, I’m a reformed alcoholic and so, I totally get it.” I was like, “Oh, no. No, I never had a problem and I don’t judge anyone that has. I just know that I feel a whole lot better when I don’t drink.” So, now, that’s just kind of become my platform.

For a lot of people, I find drinking alcohol less often, their sleep is better, they may not get hot flashes. That was almost a guarantee. If I drank, I would have a hot flash and my sleep would be terrible. And since, I have otherwise been very asymptomatic kind of transition from perimenopause to menopause for me, the hot flashes are more. I don’t care how good the wine is, it is not worth what it does, how it kind of arose my sleep quality. So, definitely something for me. I kind of pack in the back of my head like, remember how you felt the last time you drank and that’s why we don’t drink.

So, for those that are trying to navigate not consuming alcohol, or consuming lower carbohydrate alcohols, or going with a mocktail, what are some of your suggestions? Because I think that there’s also this misnomer that a low-carb wine, a low-carbohydrate beverage is going to be superior. But for what it sounds like, it’s still puts you on that slippery slope, and especially if we become less insulin sensitive as the day goes on if you’re consuming that all in the evening that could really set you up for disrupting metabolic health.

Alexandra: So, one thing I want to start with yours, probably, a little different than maybe, I don’t know if your listeners have heard this before, but I know, we’re talking mostly about lifestyle. But there is actually a tool in my toolbox that I use as a physician to help people cut back on alcohol cravings right at the beginning, if they find it really hard. Some people might think like, “I can’t even listen to you guys right now because I don’t want to give it up.” For many people, alcohol is not a physical dependency but it’s an emotional dependency. There is a part of the brain that lights up every day at about 7 o’clock and will say, “In order for you to unwind or in order for you to continue on with the day, I’d like you to have a glass of wine.” And it might just be one glass. It really might not even be more than what’s recommended for healthy, but it feels like you can’t do without it.

If that’s the case, there is a medication called naltrexone on the market. Interesting with naltrexone is part of one of the weight loss, the five, actually now, six FDA approved weight loss drug called Contrave, and they combine it with a drug called Wellbutrin, and it cuts back on all sorts of cravings for the things that don’t serve you well. So, if that is food, you cut back on food kind of cravings, alcohol. I’ve even used naltrexone in patients who are Diet Pepsi addicts, or Diet Coke addicts in my practice.

So, just as a little bit, there are some other tools that aren’t widely known, and in most primary care practice, they really wouldn’t know about this medication. It’s generic and it works really well and it’s not something you need long term. But sometimes people will benefit from it to try to say, “I just need it, I don’t have a physical dependency. I have talked to my doctor about it but in order for me to make this transition, a little bit of this medication for a short amount of time can be very, very helpful.” So, just throw that out there because I don’t think people know about it enough.

But the other thing to think about are really setting your goals about it and writing them down like actually, pen to paper. Because if you just say, “I’m going to go dry January because everyone else is doing it” or if you set it with a negative tone like, “I’m going to give this up because I need to lose five pounds,” it’s usually not very motivating, and you will get it up very fast, and then, you’ll perpetuate the cycle of beating yourself up, and you’ll see, I knew you couldn’t do it. So, I really ask people to set very clear goals about why they’re putting a stop to drinking. Even if it’s just short term, like I said, two weeks kind of get into it and to reevaluate. Write down your goal the day before, tell yourself, make a little plan for how you will execute on your goal while you’re doing it, and then, what you’ll do if it goes off course, so, you need to make sure that, if it goes off course, well, okay, when of course, then the next day like you try it again. So, repeating this cycle, I really encourage people to keep a journal for everything in their lives, but especially when you’re trying to do transitions like this.

And then. when it comes to you, if you’re bringing it back in moderation and really want to be aware of your insulin sensitivity when it comes to alcohol, I say very slow and steady is how you should introduce it and you should know how you respond. I have so many people in my practice who are very low carbohydrate and I always tell them when it’s time to reintroduce alcohol, you need to decide what works for you. So, some people respond very well to the low sugar wines and feel great on it, and then, others will say, “I still get that terrible sugar hangover feeling and I feel sick to my stomach.” It’s not really a hangover because it’s not excess alcohol, but it’s the sugar that gives them– they’ll have stomach upset, they won’t feel well the next day, they’ll be very dehydrated. Those people might do better with a clear liquor or a spiked seltzer as their treat, and they have to just take try and just stop at one glass because you have to know how you respond and I usually find it’s one or the other.

The very important thing is, sometimes, people think, “I’m going to have a cheat day and I’m going to blow it out of the water. I’m going to eat all of the things and I’m going to drink all of the things” and there is nothing worse, you will feel horrible. I can predict it. I warn everybody. Most people listen to me. and then, sometimes, they say. “Oh, I should have listened to you.” Because if you’re going to have alcohol, do not make that the whole meal a cheat. Because the added sugar of a pasta dish if you haven’t been eating it with the alcohol, you think it’s just going to get it over in one fell swoop. But instead, your body will not be able to handle it and you will have a reaction. Like everyone well on some level either it’s headache, it could be nausea, vomiting, diarrhea, it could be the next day, you can barely get yourself out of bed, but something will happen. So, when and if you do decide to drink, pair it with a normal meal, whatever you’ve been eating, however many carbohydrates you’d been eating, whatever you’ve been doing in the weeks before, so that you can feel good.

Cynthia: Well, I love those tips and it’s interesting. Naltrexone, I have always been more familiar with it in conjunction with autoimmune disorders like Hashimoto’s, when some people are really struggling with symptoms. So, it’s interesting to know that that’s another way or strategy that you can introduce with your patient population. I love what you mentioned about the cheat day because I will share the same information. I always say, if you’re going to enjoy something whether it’s you’re going out to eat and you’re going to have a nice dessert, I don’t know if there are many nice desserts. But desserts at restaurants are a catastrophic disaster or if you’re at home and you’ve decided like Saturday you’re going to have something special whether it’s an appetizer, or that glass of wine, or the dessert, but to do all the things is going to set you up, especially, if you’ve been eating pretty healthily up until that point. Unfortunately, there’s a strategy that I use in one of my classes, where people will do their normal fasting schedule for five days, they’ll have one 24-hour fast, and then, they’ll have one, I refer to it as a feast day, but the feast just means you’re having a wider feeding window, you might have more protein with each meal as a way to remind your body that you’re not in this deprivation state.

Sometimes, people interpret that to me, it’s a day I get to eat whatever I want from the time I wake up till the time I go to bed, and inevitably, they wake up the next day and they feel wrecked. Like you mentioned, you might be nauseous, they have really had poor sleep quality. Unfortunately or fortunately, the Oura ring has so nicely aligned when I get up in the morning, I feel good and the data almost, I mean, 99.9% time completely aligned, so I can be really honest with myself. But if I’m more often than not, it just re-affirms for people why they want to make better decisions because when they eat a certain way, a way that nourishes their body, nutrient dense foods, generally, lower carb people don’t have to be ketogenic, but less carbs are usually better and certainly, really dependent on where you are in life stage. I’ve teenage boys. They seemingly are impervious to anything they eat. They’re athletic, and I remind them I’m like, “Enjoy this time in your life.”

Alexandra: [laughs] Yeah.

Cynthia: Because things will change at some point. However, they’re much more insulin sensitive than probably a middle-aged man might be. So, really important that people have context of sometimes, those “I went off the rails” are opportunities to re-affirm why you make the choices that you do. That kind of the reframing of our thinking, so, we’re not thinking lack. We’re thinking this is my choice, because I choose to feel better, I want to feel better as opposed to saying, I can’t eat those things anymore. It’s like, “No, no, I choose not to.”

Alexandra: This is also where I find journaling and writing things down to be incredibly important in my practice 100% of people have to log, and it’s not even calorie counting or macro counting, it’s just I want to see these associations, and I want you to put into writing that you felt terribly after this, so that we don’t repeat it again, and then, it’s so empowering. Most people when without guidance and accountability, I’m hearing podcasts like this, this is part of the accountability and guidance. If they wake up feeling that way, then it will just turn into a multi-day kind of binge really of things that don’t serve their body in an attempt to fix it because it’s what we’ve been taught and sticks with us.

So, the idea of, “Oh, I have that reaction to this food,” and I always remember where it recommended this in my medical practice for things like headaches. Like if headaches are your problem, write it down and start to see the associations. But feel good about the fact you’re like, “I recognize this. Okay, next time I do this, I won’t do it again.” And you’re right, because it’s incredibly powerful behavior change motivator.

Cynthia: Absolutely and I love that you’re encouraging your patients to write it down so that it becomes transparent. They may not be able to make those associations until everything is written on paper and they can reflect back on it. So, that is certainly helpful. One thing that I definitely want to make sure we touch on is the role of technology in metabolic health. Obviously, your point of care testing is critically important. Do you have other either apps or biohacking devices that you’re a huge fan of? Everyone obviously knows, I have a couple that are like my favorites, but I’d love to hear what yours are.

Cynthia: Okay. So, the first one is not so tech advanced, but I find Google Excel spreadsheets to be incredibly helpful for having people write down their food and pairing it with hunger and emotions, any notes, it’s really easy because it’s across all devices and it’s free. I think it’s easy and people don’t get frustrated because they can’t find their specific meal and we take that element out of it. So, that’s the most basic. Other things that I really like, oh, you know what another low-tech thing I love is a travel scale. So, you can find a travel scale on Amazon for about $25. It’s the size of the Kindle. People can get so derailed unnecessarily on vacation and it ruins point of the vacation if they don’t keep tabs on their progress. So, that’s something that a lot of my patients like, “No, you’re crazy enough. I won’t travel home without it. I actually love having this thing with me.” [laughs] So, those are some two like low-tech things that I think are very helpful.

For my patients getting into ketosis, I was so fortunate to have been taught by Dr. Eric Westman at Duke and he taught me, if people are feeling better and losing weight, then they’re in ketosis. We don’t need to check for it. But I do find the Keto-Mojo or ketone testing tool can be a really good gamified way to keep up with your progress if being in ketosis is your goal. And really, to be honest, I also love– I’m so low tech. Even though, I have a tech company, I really like a paper measuring tape also for people. So, we’re talking about metabolic health and doesn’t necessarily need to be weight loss focus, but a paper measuring tape can be very helpful in mapping your progress if this scale isn’t showing as much and it can also give you a baseline of waist circumference and carrying central obesity, which that’s where insulin resistance is toward the fat, that’s really in our belly.

So, I like people to take some assessments at the beginning of their journey when it can be really exciting. When the scale is not moving but you are like, “I just lost two pounds on my waist and I thought I did from my pants, but I really did.” You’re going to see such huge benefits in your overall health when we reduce that number, what else. I think those are it, I’m a little bit old fashioned I think. [laughs]

Cynthia: No way. I think that’s totally fine. I think, for all of us, we probably have stuff that we lean on and certainly stuff that’s helpful. Now, I want to kind of pivot back to talk about your point of care testing because when we’re talking about metabolic health, I think, this is important kind of point to end on, we’re really speaking to as you mentioned, waist circumference, we’re speaking to blood pressure, we’re speaking to fasting glucose, obviously, insulin is that free precursor. The one that I think is even probably more, dare I say more important, triglycerides and HDL. So, you mentioned that there were eight areas that are tested in this point of care testing at home, which I love the concept of this.

In fact, for full transparency to the listeners, when we connect to the first thing, I said was, I have to bring him on the podcast because everyone needs to understand that they have the ability to do this at their homes without having to wait until they have an appointment with their healthcare professional. So, let’s talk a little bit about that, and then, I want to talk about the HOMA score and why that’s so important?

Alexandra: So, in our kits, the foundation and it changes a little bit between all the kits that we’re offering, but in our core inaugural product, the Weight Biology kit, we’re testing for our cholesterol markers that you just mentioned. So, we’re testing for triglycerides, HDL and LDL. We are looking at the blood sugar category of fasting blood sugar, hemoglobin A1C, and fasting insulin. Then, we’re also looking at thyroid stimulating hormone and vitamin B12. In other kits, we are opening it up to hsCRP, vitamin D, we’re looking at female health hormones, AMH, but in our core products, those are the eight.

Now, you’re probably thinking but I’ve had people look at those maybe except for insulin. We’re looking at them differently. So, we are putting them together not as enough. The LDL is bad, but we’re really honing in on the fact that the good cholesterol, HDL, we need that to be higher, we want to want your triglycerides to be down, we’re screening you for something called metabolic syndrome. We’re using the fasting glucose and fasting insulin together with the HOMA-IR score. And so, you don’t need to go digging around the internet to how to calculate it. We do that for you and we tell you where on the spectrum of insulin resistance you are.

So, what is HOMA-IR score? It’s a validated mathematical modeling tool that allows us to take fasting glucose, and fasting insulin, and give you a predictive score of where you fall on the insulin sensitivity spectrum. What I find so fascinating about it is, that we will see evidence of insulin resistance 20 years before we start to see dysfunction in the more traditional screening metrics like fasting glucose and hemoglobin A1c. Now, we’re still looking at those in our kit because they’re important as part of the whole picture. But really the special sauce’s I’m looking at fasting insulin and again if everything else is normal and that’s a little high, best place to be in. Because you have the ability to transform the next 20, 30, 40, 50 years of your life, because you got this power and knowledge now of what it looks like. In our kit, in our portal, you’re not just getting the lab results, we’re giving you an explanation. So, we are screening you for metabolic syndrome. We’re looking and providing tools for sleep apnea guidance, emotional eating. We’re having you dig deep like, “Gosh, this has really come out of nowhere or some of my lifestyle habits factoring in where should I start first.”

So, we’re using different cut offs in our lab interpretation than you would at a traditional lab for like, there’s no way you’ll ever see an insulin of 30 being in the normal range on our kit. So, we can go much lower. So, that’s really what we’re doing. It’s not just this ease of pricking your finger at home, and popping in mail, and never having to really beg. Honestly, people have to beg, borrow, and steal to get fasting insulin at most doctors’ offices. So, you can do it at home but then you get the knowledge about what to do with it. So, then, when it comes to a program like yours, this is why I love talking to you because we have place to send people and say, “Okay, well, we’ve recommended intermittent fasting, and lifestyle, and nutritional changes here.” You’ve identified it now. Now, you’re really motivated. This will work. This will work, and you’ll come back, and you test your labs again, and you’ll see how it works.

Cynthia: No and it’s exciting for so many reasons, not just the fact that if consumers do this test, there are actual physicians that work directly with you that are looking at the results. So, it’s not as if they’re kind of innocuous, they’re in this innocuous vacuum, and maybe sort of kind of people are keeping their eyes. They’re actual clinicians that are looking at these results. So, obviously, if people are on one end of the spectrum or the other, you will reach out to them. I think that’s incredibly invaluable. Well, let listeners know how to connect with you on social media, how to connect with you on your website, obviously, we have all your links. I was so impressed with our conversation that we are going to be integrating this testing with my two-signature program starting in January. People will have the opportunity to purchase these test kits. I’m actually going to encourage the people on the intermittent fasting program to do a pre and post, meaning, take the test before they start and take it at the end and look at the data to see the improvements.

Alexandra: Yes. It’s so motivating. It’s just much more motivating than saying like, “I want to fit into skinny jeans.” But no, I’m actually transforming my health and I want to hold on to it and maintain it. So, we’re really excited to be partnering with you. So, you can find us on our website at getsowell.com. By the time this airs, we will have a website relaunched with new additional products and more testing kits. We really listen to you. So, we want your feedback because we are releasing things based on what people are asking for and you can find us on social media, on Instagram at my personal handle @alexandrasowamd and @getsowell. And I love your questions and your questions, well, I will do Q&A. So, just drop them in my DMs, and I’ll answer them, and I love hearing from you. And again, I’m creating this for people who I know need it. So, tell us more what you want and we’re making it.

Cynthia: No, thank you so much for the work that you do. I know that this certainly makes things easier for me because more often than not, when I refer people to their primaries, I get that well, my doctor, my nurse practitioner, my whomever doesn’t know how I went. I appreciate that the clinician is being honest and saying, “I don’t know how to interpret the data.” But if more and more people are asking this at their clinicians, my hope is that we can start screening and doing a better job at preventative health care. Because that’s really what it’s about. We don’t want anyone to develop diabetes. We don’t want you to develop insulin resistance. We want you to be able to be on top of these markers so that you can impact your health in incredibly beneficial ways. Thank you for your time.

Alexandra: Thank you.

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.