Episode 38: Understanding Metabolic Health: From Insulin Resistance to Longevity with Dr. Meredith Sweeney

What is metabolic health, and why does it matter for your energy, weight, and long-term wellness? In this episode, we’re joined by Dr. Meredith Sweeney, a former bariatric surgeon now practicing longevity medicine, to unpack what’s happening under the surface.

We dive into insulin resistance—how it develops, why it's so common, and what it means for your overall health. Dr. Sweeney explains how continuous glucose monitors (CGMs) can help you better understand how your body responds to food, exercise, sleep, and stress—without getting too caught up in chasing perfect numbers.

We also explore VO₂ max and metabolic  testing, and how they relate to your fitness and longevity. Dr. Sweeney shares the science behind zone 2 training, HIIT, resistance training, protein needs, and fasting—helping you build sustainable habits that support metabolic resilience and long-term health.

Find Dr. Meredith Sweeney:

Sano Longevity 

Follow on Instagram:

@sano_longevity

thestartinggatepodcast.com

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The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Metabolic Health with Meredith Sweeney

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment.

And before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz, two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We will help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome back to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz So today we are going to dive into metabolic health. What is metabolic health? Why does it matter and how do we optimize it for a longer, healthier life? I feel like this is something that's coming up. You're seeing the word metabolic health a lot more in the media and so we really wanna help you understand what metabolic health means and get into some things about how lifestyle can influence that and talk about some terms you may hear, like insulin resistance or.

Continuous glucose monitors. 

We're really excited to introduce our guest today. We have Dr. Meredith Sweeney. She practiced for years as a bariatric surgeon, and now has opened a new practice in Louisville, Kentucky called Sano, where she [00:02:00] focuses on longevity medicine. So

can you tell us a little bit about yourself and how you ended up in this spot in your career? 

All right. Thank you for having me. I took a weird turn in my career within the last year, and it seems like I went from one extreme to another, and they seem disjointed, but I'll tell you how they're actually very related.

So I did my fellowship in bariatric surgery back in 2011 in Louisville, and I have done that for the last 12 years, 13 years. 

You did that for several patients of mine. 

Oh, no kidding. Yes. Yes. And they love, they loved you. Good. So you, that's always the answer you wanna hear, right? If we share patients, you wonder what's coming?

What's the next sentence gonna be? Did I score well or did I score low? So bariatric surgery is fascinating. I got to make a difference in so many patients' lives over 10,000 pounds, my patients have lost The thing about bariatric surgery as a professional [00:03:00] is most of my job was actually spent outside of the operating room in the office, speaking with patients about how to use the tool that is their surgery to its maximum benefit by altering their lifestyle and by altering their lifestyle.

I'm referring to what you just talked about, getting the best metabolic health that they can. So I learned to do surgery for five years in residency and then specifically bariatric surgery for that one year in fellowship. No time was spent teaching the nutritional and the lifestyle aspects of optimizing your metabolic health.

Post COVID I 2021, I started to go to conferences because I had this yearning to learn. What I needed to be doing for patients outside of the operating room. Technically, I was very gifted at doing the surgeries, but my patients needed more and I wanted to give that to them. So I started to go into metabolic health conferences.

Low carb was one of the names of the conferences longevity conferences so that I could [00:04:00] give them a whole picture of what they needed as far as their healthcare to make the surgeries work. So going from bariatric surgery over to a field of longevity medicine, which is highly rooted in metabolic health, is not a far stretch at all.

I've been studying this myself and taking a deep dive down the longevity and metabolic health rabbit hole for over five years now. And it only helped my patients. And then I just, I grew such a passion for it, totally nerded out on it and ended up just. Really taking a step off the cliff and deciding,, this is what I wanna pursue full-time.

I wanna help people live longer, healthier lives using, mainly their 

lifestyle. Yeah. I love how you said, , you gave them the tool of surgery but, that's just one of the tools that they had and they weren't learning the other things to really optimize how they can use that tool to benefit them.

The surgery itself is an incredible launchpad to get someone to better health and of course better [00:05:00] health. We're talking about losing massive amounts of weight, but if you're not making the food changes, the exercise changes, the lifestyle changes to go along with that tool, you're not gonna get either the maximum benefit out of it.

Or what we would see more commonly is patients would lose weight and then they would gain it back because they just didn't have the. Armamentarium of knowledge to be able to make the right choices in the grocery store and when they're cooking, and when they're eating, and when they're moving their bodies.

 A question I have is when we talk about longevity medicine, what. would make a patient come to a practice that focuses on longevity? 

Longevity medicine is, it's almost like a made up field. I'll be the first to admit that. So what is, how do I describe it? Is the better answer to that question.

I help people optimize their health now using the data and the science that has proven to keep them their healthiest when they're 80 and 90 years [00:06:00] old. So I'm not only treating people now with specific interventions to make them healthy when they're 90, no, you're gonna see benefits now. I want you to feel great now, but also the side effect is that when you're 80, you're gonna be running around, playing with your grandkids, traveling the world, lifting your own suitcase, going to the bathroom by yourself, opening your own jar of pickles.

These are things that we take for granted. But if you're very intentional about how you treat your body now in your thirties, forties, fifties, sixties, then you can be your ultimate self. In those later decades, we are all going to die. Death is inevitable, and at some point there's going to be a level of decline, and that's inevitable.

But the length of time that we're declining is up to us, so we don't have to be declining for the last two or three decades of our life i'll speak for myself here, but I wanna be functional as long as I possibly can, [00:07:00] and then have a quick decline and that's it. Bye. I don't wanna be just slowly declining , losing my brain faculties, losing my physical ability for 20 years before finally it's time to say goodbye.

I don't even know if that answered your question. Longevity. I think that's great. Helping 

you optimize your health now at the roots, at the cellular level so that you are pretty awesome and you're doing everything that you wanna do in your later years.

We save up so much money for retirement, and I have an annual meeting with my financial advisor to make sure that everything's in line with how I want it to look when it's finally time for me to retire. But we need to be doing the same stuff with our health. 

I think that's great. because when talking to patients many times.

Their goal and their focus is you work so hard to reach retirement, the last thing you wanna do is spend all of your retirement going to doctor's appointments, taking medicines, and not being able to do everything that you've worked so hard for to get there. So I agree with [00:08:00] that, that it's something that we should be thinking about way ahead of time, because many times we don't even start thinking about longevity until we're 60 or 70 when it feels like it's closer.

But really we should be doing these things at a much earlier point of our life to make the biggest impact. 

Sure. So we all have to eat and we all have to move our bodies, but there are very intentional ways that we could be doing these things that are gonna , set us up for success in our later years.

I can't wait to hear all your advice on those exact things today.

Yeah. 

Just to get us started, can you give us a general idea of what do you think of as metabolic health? 

 Let's not do a dictionary definition. What does it mean in real life? It's your body's ability to produce and use energy efficiently.

 When you put food in your mouth, when you put air in your body, it has to go through processes to turn that into energy, which every cell in your body uses to function. So this translates to [00:09:00] how well your brain is functioning. Are you feeling like you're running on all cylinders? How well are your muscles functioning as far as exercise and physical movement?

Even your organs digesting food. Every cell in your body has to be producing energy for all of these basic life functions. And the better and more efficiently that you can do, that translates to your level of metabolic health. 

why do you think so many people. Have poor metabolic health, but maybe don't know it.

this comes up a lot in the media that, our nation is metabolically unhealthy, but I don't think anyone ever goes to the doctor and their doctor says, oh, our number one diagnosis today is you're metabolically unhealthy. Why do we not pick up on this? Why is it something we don't really talk about in conventional medicine?

Great question. I think for a long time it was difficult to measure and something that we can't assign a measurement to that you can see in black and white is going to be like a nebulous concept. So let's just [00:10:00] not talk about it because it's something out there that we can't really define very well.

But we can now, and there are things that I do in my office, like breath analysis, vo O2 max testing, lab work continuous glucose monitors, all of these, give me a picture of someone's metabolic health that I can show them in black and white in a report. And then define a plan to improve those different areas.

So metabolic health, it's a big, broad term, but you're right, it was nebulous for a long time, but now we can really measure it, define it, and make improvements in it. 

Yeah, I think for so long too, we just looked at it as, you mentioned it can affect your muscles or it can affect your brain, and so we kinda looked at those different effects, but we weren't good at bringing it back to the base of this is a problem with metabolic unhealth and then it's causing these other things instead.

We were just looking at those individual ways that it manifested [00:11:00] for somebody, 

Or even we waited until someone met the definition of metabolic syndrome. We should have stepped in way before we met that definition. 

 Metabolic health, if you think of it as the root of a tree, there are so many branches that come off of this tree that we deal with at the end.

Conventional western medicine. We're gonna deal with the end of this disease process when we could really be intervening at the root and making the entire tree better without looking at each individual branch. 

So speaking of that, because I do think that we're doing much better thinking about lab markers, and you had mentioned this, what are some of the lab markers that you think are important to pay attention to early on that maybe sometimes we don't in conventional medicine, think about until maybe they're, way out of normal range that you're using to help bring awareness about metabolic health?

So from a lipid standpoint, I think triglycerides are a little bit under valued in terms of their importance in our [00:12:00] overall metabolic picture. Everyone focuses on LDL, it's the bad one. But we really need to be talking about the triglycerides as well and our lifestyle and how that affects the triglyceride levels.

Then there's hemoglobin A1C. Most people have heard of this one. This is the three month measure of your blood glucose. You can conceivably test it every three months, and if you're gonna make changes in your nutrition, you will see measurable differences. But we're missing the mark here because by the time a hemoglobin A1C starts to elevate, we could have intervened, like you said, years earlier, maybe even decades earlier.

What we need to be looking at is either continuous glucose monitors, so these are small devices you can place on the back of your upper arm. You can learn so much from your lifestyle using one of these monitors. But , we can easily check a fasting insulin level, and that is diagnosing metabolic dysfunction way before you're gonna see it in an A1C.

And I tell my [00:13:00] patients that Sono longevity, I'm neurotic about this one. We are gonna try to get as low as we can with that insulin level. The conventional lab breakdown will tell you that over 10 we should start being concerned. I shoot for even less than that with my patients. But the truth is that most people, when they come in to see me, and 93% of America is the most recent number I heard, are already insulin resistant, which means that fasting insulin level is high, but we're not checking it.

We're missing the boat and our opportunity to intervene when things are easier. 

 I agree because that's something talking to patients is we don't wanna wait till you have diabetes. That's what for so long we used an A1C for is just looking at that. But we should be waving our flags so much sooner because it's easier to fix it.

The earlier we recognize that we're developing this problem instead of giving someone the hardest situation to improve. We need to [00:14:00] intervene so much earlier. Because the longer you let insulin resistance go, the harder it's going to be to reverse. 

I 

used to tell my bariatric patients, I want you to come and see me when you've put on 10 pounds, not when you've put on 50 because.

 That's easy. Look at 10 pounds versus 50 lift those weights, and one of them's gonna be a lot easier to take off than the other. So let's get involved earlier when reversing this potential damage is easier. And this brings up the link between glucose monitors and this insulin level. So how does one relate to the other?

I love, this is one of my broken record conversations that we talked about. Just basic metabolism 1 0 1. When you eat starches and sugars and to some extent protein, but negligible, your blood glucose goes up as your body is digesting that food and , your. Body has to do something with that glucose in the blood.

It can't just let it sit there. Eventually you would go into a coma [00:15:00] if it just kept accumulating, so your pancreas steps in and secretes the hormone insulin to safely move that glucose out of the bloodstream and into safe areas of depot, but basically insulin's job is to control the blood glucose and get it out of there and somewhere safe.

So the more blood glucose spikes that you have, the more insulin needs to be released. And eventually all the cells with little gates on them for insulin, they start to see insulin too much. And they're like, I'm gonna ignore you. I'm not gonna pay attention to you anymore. It's like the mom that keeps hearing mom.

That's what I was 

thinking about too. Yes. 

Eventually it takes you longer to respond to that child. 'cause you're like, I've heard this a million times before, so here's what your cells do., Hey insulin, I've seen you a lot. I'm just gonna ignore you. And so the pancreas has to pump out more insulin and more insulin in order to do the same job.

And finally, you end up in a state [00:16:00] of elevated fasting insulin, which is the lab value that we're talking about, which is also. In commonplace called insulin resistance. So this is the precursor now to pre-diabetes, which is of course the precursor to diabetes. So glucose monitors we can watch in real time, whatever we're putting in our mouth, how high that glucose is going, which is a surrogate marker for every time our body is having to release insulin.

And I also tell patients all the time, you can think of insulin as the fat storage hormone. ' . Most people want to lose a little bit of weight. So if they hear about a hormone being a fat storage hormone, that really clicks in their head like, okay, I wanna limit the release of this fat storage hormone, which is insulin.

So our job, if we wanna lose weight and get to better metabolic health, is to limit the frequency and duration of our insulin release.

So speaking of insulin resistance, why should we care about it? How does it affect us?

[00:17:00] I love this question because it's, goes back to my analogy about dealing with the root of a health problem as opposed to pruning the individual branches. If you deal with the root and we think of the root as insulin resistance, what branches per se are we gonna see improve? Insulin resistance is the base of a lot of dementia.

It is probably the root of Alzheimer's disease, so dealing with it the decades before may prevent you from getting any of those. Also infertility insulin resistance shows up as PCOS in women, which leads to difficulty having children in men. It shows up as erectile dysfunction. In our body weight, of course, it shows up as obesity and then it shows up as diabetes, but it also can have impacts on your brain health and things like depression and anxiety.

Insulin resistance could be dealing with the metabolism of the brain and making those conditions worse. High blood pressure. resistance has a place in causing high blood [00:18:00] pressure, which then leads to heart disease. So there's so many upstream effects of insulin resistance that if we deal with it at its root, we're gonna see so much improvement or just so many diseases not happen in your later years.

Like the chronic diseases of aging, the things we were scared of, dementia, cancer, heart disease, all of these things probably started decades before they actually get diagnosed, and they could have been prevented decades earlier by optimizing your metabolic health. 

And I know in practice, in primary care, many times people can feel like they have nothing going on.

And then all these conditions happen at once because it's been this buildup of insulin resistance and then the whole metabolic effect just starts impacting all the organs. And within two years you're like, how did I accumulate five different chronic conditions so fast? And it really was not addressing possibly that insulin resistance for the decade prior [00:19:00] that could have made the big difference in, in that accumulation that hit all at once.

Correct. I hear this so often that the whole system seems to have crumbled at once and. I've got this specialist that I have to go see now and this specialist and it's sad, but then you'll take a pill for this specific disease, a pill for this disease, maybe a surgery for that disease.

But if we deal with the underlying cause, maybe we can make them all improve. Not maybe we can, 

Since you've mentioned CGMs, this is something Sarah and I have been wearing lately as well. I need to get a new one again. 

We did our 

own experiments and it is so eyeopening.

It really is. I texted her one day, I was like, oh, never eating a pretzel rod again.

 This was licorice for me. It was like, oh 

shoot, okay, that's what's gonna happen. Or just doing, things that I counsel patients on and just trying it out and see what happened. Like eating late night snacks. Oh my goodness, [00:20:00] that was crazy. Eating a snack before bed. And what would happen to your glucose?

It was crazy to me, like I knew it, but seeing it in real time was such great feedback to be like, this is why we don't do this. 

There's something really powerful about seeing things in real time. It's like you, you know that sitting down and eating a bag of Doritos isn't healthy for you, but having to see it on your phone, on your app actually with that feedback is much more profound and impactful to us in terms of our food choices going forward.

And there is so much to learn from wearing a CGM even for a short period of time that I think it should be required adult learning. 

Yeah it's been very insightful. I'll tell you one thing that I really enjoyed seeing was just walking for five or 10 minutes, nothing extreme, walking at a regular pace for five or 10 minutes.

Every time it would bring my glucose down. Every single time. And so that was really neat to see, and especially doing [00:21:00] it after a meal, but anytime during the day it would bring it down, which just reinforced. Keep moving. 

 So the, these things can be used to reinforce positive habits, like going for a walk after a meal and also lean away from those obviously detrimental habits, eating large , starchy, or sugary meals later at night.

 Our bodies are less sensitive to the effects of insulin the later we go in the day. So the same meal, let's say you're gonna. Consume, I'm just gonna use Doritos as an example. 'cause I started with that. Let's say you're gonna consume Doritos. It is actually healthier for you to do that earlier in the day as opposed to later in the day because your cells are more sensitive to the effects of insulin and you're not gonna get those wildly high spikes in your blood sugar as opposed to eating that at night.

But what do we do in America? We consume so many of our calories, especially the ones that are higher in carbohydrates later in the evening. And then we sit down and we turn on the DVR and we're in the couch [00:22:00] until we move our bodies to our beds. And this is the worst thing that we can do for ourselves.

So your carbohydrate intake should be centered earlier in the day when your body is more responsive to it and when you're up and moving around and actively using that glucose as you're digesting it. 

another thing that I found really interesting when doing this is. The order you eat your food.

And I don't know if this is something that you talk to patients about, but really trying to not eat large carbohydrate loads on their own without any other form of protein or fat. And seeing that in real time was very eye-opening. 

I love that. I get every sono longevity patient gets this document.

It's quite large about all the tips and tricks for how to keep your blood glucose in line. And what it does is it allows you to eat your food in such an order that you can still have the foods that you love. For example, I love sushi. A world without sushi is just not worth living to me. , I've found that I can eat it in a [00:23:00] way.

That it's much healthier for me if I eat a fiber filled salad before my sushi, and if I go for a 10 or 20 minute walk after that meal, the effect on my blood glucose is significantly smaller than if I didn't do those two things. Consuming fiber, proteins and fat prior to your starchy vegetables at dinner, like potatoes, just leave them to the end of your meal.

You're gonna have a significantly healthier meal overall. , Another good tip is if you're gonna go to a Mexican restaurant or an Italian restaurant, they bring out the bread or the chips and salsa at the beginning of the meal. Okay? Tell yourself, I'm allowed to have these things so you're not depriving yourself, but I can't have them until after I've eaten my meal.

So two things. One, you won't be as hungry to crave those things. You will consume less quantity of that item. And two, it's gonna spike your blood sugar significantly less than if you were to do it on an empty stomach. So these are all tricks that still allow you to eat food that you want but have [00:24:00] that be less of a poor effect on your metabolism.

Yeah, it really is interesting just to do your usual thing, see what your blood sugar does, then make a change in it, see what your blood sugar does, and , it's fun to watch. That immediate feedback. 'cause it really does make more of an impact when you can see it right away than when you check an A1C a few months later after you've made some changes.

 And you don't know what you did exactly to change that A1C. But with your glucose monitor attached to your arm, , there's no mistaking it. Every patient leaves my office with a glucose monitor. 

 One thing I would like to discuss with you, some of the negatives of the continuous glucose monitors, I think with proper education can make them not be a negative.

But sometimes when patients are using these, they suddenly become fearful of all carbs and even healthy foods, just trying to avoid any spike at all. And I know that is something that you have to. Educate people on. , What is some of the best advice that you give [00:25:00] patients on trying to still eat a wide variety of foods and not leaning solely into, protein and high fat foods that won't cause the spike as much and not be fearful of seeing that?

That is so great because I did see early on in my practice that it was creating too much fear in some patients, and we were almost swinging into an unhealthy emotional state when it came to foods that we do want to eat. Things like non-starchy vegetables, the broccoli, the cauliflower, squash lettuce.

These are all nature's carbohydrates. We should be consuming them. We should not be fearful of small increases and decreases in blood sugar. That's physiology. That's how we were made. So my analogy is, if you're looking at an EKG. You never wanna see that EKG go flat because it means you're dead. So what you wanna see is some heartbeats in there.

So in your CGM tracing, you wanna see some heartbeats in there. That's normal. That's physiological. We're not going for asystole, we're not [00:26:00] going for death. 

I, 

that's, that 

one's good. 

That's good. 

So it's okay to eat some fruit, but you may also just wanna play around with, when are you eating fruit during the day?

See how it affects you. I think it just really allows you to look at your habits and then you can play with them and see does anything improve that. But yeah, don't let these numbers make you think that you can't eat any fruit or beans or those things that we want you to get in for your health too.

How about what you've seen With exercise. I know that some people get worried about exercise increasing glucose or cortisol and how have you seen that play out with your use of CGMs? 

Okay. This is another thing. We should not be scared of. The glucose elevations that happen with exercise because.

In order to not see them, we would have to be sitting around doing nothing. So how on earth does that make sense from our health? It doesn't, physiologically our bodies have to mobilize sugar for us to [00:27:00] use it to contract those muscles to do whatever exercise we're doing. So that is the effect that you're seeing.

The glucose, yes, it's being released from its storage sites, whether that's glycogen from your muscles, your liver, or from your fat cells. That sugar is temporarily appearing in your blood glucose monitor on your CGM, but then your body's using it up right away. Your muscles are using it because they're actively contracting doing the movements that you're doing.

So this is physiologic. We should not be scared of it. We should continue to do those exercises. Myself, every time I do a high intensity exercise, my glucose spikes a lot. It I shouldn't say a lot. 20 points the equivalent of eating a meal. And so should I not do that? Absolutely not. I should be doing that.

This is a stress on my body that my body needs and wants. 

Yeah, I know. I'm kitty. You got a text. When I started wearing one, I was like, oh no, it's going up. I just ran. What did I do wrong? And then I was like, pause, Sarah. This is [00:28:00] what it's supposed to do. But when you're trying to minimize some of those spikes and you're looking at it, it can be very frightening to see that and be like, oh my gosh, like I'm doing something wrong.

But no, it's what your body needs to do to be able to do that harder cardio. , I noticed such a bigger difference when I would go for a longer run versus when I was doing just strength training and how that impacted my glucose. But that doesn't mean, again, with proper education and knowing, okay, I am okay with this kind of spike because that's what it's supposed to do.

not just think that I should never do cardio ever again. 

Yeah, some spikes are good and they're physiologic. The same thing happens with saunas or with intense heat for a lot of people. You will see that glucose go up, but , it's a hormetic or a good stress on your body that you actually want.

So , those, I would consider good spikes. Spikes related to a Snickers bar, not so much. 

Yeah, so I think it is helpful if you are someone out there thinking [00:29:00] that you want to get better understanding and control of your blood sugar and you're thinking about using A CGM. You need to make sure that you either are using it through a program that's going to give you a lot of support so that you can interpret your data appropriately and not cut back on good habits that are actually helping you, even though it seems like they may be making your blood sugar go up or you need to be working with a physician or practitioner that has some.

Training and experience with this to help you navigate that and make sure you're making good choices. that's something I know that you do a lot, Dr. Sweeney. Yeah, 

I do. some other things that I'm not sure everyone realizes is the impact of just stress in general or poor sleep as well as just being ill.

There's these other things that aren't even food or exercise that impact people's levels when they're wearing a CGM. 

And I have seen this to varying degrees in different patients. I can see all of my patients' data on my portal as long as they log into my clinic. I can see their data in [00:30:00] real time as well.

And I've picked up on some things that have taught me quite a bit. The. Elevated blood sugar with sauna. I learned that through a patient. I didn't learn that through myself. But stress is a big one. , When your body is under a feeling of stress, it doesn't matter whether that's stress because you have a meeting at work that you don't wanna do or stress because you're exercising.

Your body releases cortisol, mobilizes, glucose to get you ready to fight. That is the fight or flight hormone. , It mobilizes glucose to get you ready to go. , Historically, this worked for us when we were cavemen and we would get ready for a tiger to chase us.

But it works the same way now when we're having a big meeting with a boss that we don't necessarily like all the same hormones are released and that glucose is mobilized 'cause it's getting us ready to go. A lot of my patients are actually physicians and I had one, she had a particularly stressful day in her office, and every Tuesday afternoon her glucose would spike , it wasn't rocket science to figure out [00:31:00] what was going on, even though she hadn't eaten anything. So stress. And also, like you mentioned, sleep and poor sleep specifically will make you more insulin resistant so that glucose is not moving as well as it should and it's maybe sitting around in your blood longer than it should.

Yeah. 

Even I had one bad night of sleep when I was wearing one and my fasting glucose the next morning was 10 points higher than it had been the whole week before. So it was like a pretty immediate effect. 

 Yeah, absolutely. And with women with our cycles, our fasting glucose will elevate and dip slightly with different hormonal changes during our high hormone days and low hormone days.

 these devices are. Pretty accurate, but they're not exactly accurate. So if you're worried that it's reading, 10 points higher than your fasting glucose that you had as a physical blood draw, there is some variability. I think it's better to really be focused on what's the change that you're seeing , [00:32:00] as opposed to that specific number.

Do you find that too? Absolutely. 

And this is something that I've had to counsel people on starting from the beginning of their CGM journeys, because from one device to another, that baseline can look up to 20% different. And the companies that make these devices even admit we have 20% variability.

But what you can trust, like you said, Dr. Dotson is , the relative increase. So whether I'm starting at 80 and bumping up 50 with a candy bar, or I'm starting at a hundred and bumping 50, I still know that 50 is the same and this is a food that I need to pay attention to in my life. 

Yeah.

And even the first time you put one on that first day, it can do some really crazy numbers at first as it's trying to calibrate. So it takes time to really get a good idea of trends and using these for a little bit longer than even just two weeks to see what's going on. Just because each monitor can be slightly different because of their guidelines and how they're made.

So it's nice to [00:33:00] use one for a good period of time to understand your trends and pay attention to those instead of those exact numbers. Correct. 

We have really gotten into some of the nitty gritty about glucose monitors, but it doesn't need to be even that hard.

It is very intuitive, so I don't wanna scare anyone away from using one. I think, like I said, it should be required adult learning, at least for a month or so, to get an understanding of your body and how it deals with the food that you're choosing to eat. It's not something you have to do forever. Easy 

If you don't want to.

Oh, I agree. 'cause some people like it just to understand those specifics of their own habits and then once you understand how your body responds, you don't really need the data anymore. 

And so what is it that you really counsel your patients on as far as lifestyle when they are trying to keep their glucose under control and manage any insulin resistance.

We've already hit on the top ones, which would be stay [00:34:00] two carbohydrates that were made in nature that human beings have had no interruptions with. If the carbohydrate you're consuming comes in a box or a bag and it has a list of chemicals in it, some of the things you can't even pronounce, then these are things we probably shouldn't be consuming in massive quantities frequently.

If it came from the Earth in its natural form and it has one ingredient, most likely on the safe side. Secondly, the order that you eat your food is extremely important, and how you move your body around meal times is very important as well. Also, one of your biggest protectors against. Metabolic disarray is putting on muscle.

And so , I talk a lot with my patients about the importance of resistance training or weight training. Same concept. I just, I interchange the terms, but resistance or weight training are the same things to me. And that just means that you're putting your muscles under overload.

You're stressing them, you're lifting something heavier than it's [00:35:00] used to lifting. And that can do amazing things for your metabolic health and your ability to deal with the food that you're gonna consume. You can almost think of it as the more muscle you have, the more you can get away with.

I was actually commenting to Sarah today that her arm muscles were looking great. 

Thanks for that. Yeah, the audience can't see us, but she's wearing a tank top and she's got very nice deltoids. 

 I noticed that as well. This is something that. I had to change in my own habits though, because I came from the philosophy of just doing more cardio to be healthy and did not really have resistance training anywhere.

Since high school sports had, I even thought about resistance training and it was a major change I had to make in my life. Knowing the research and the positive outcomes that you get with it, and I do feel like that is something that at least we're doing a better job about teaching women, but I feel like women in general for many decades did not [00:36:00] get this knowledge of the importance , of resistance training for their health overall and specifically their metabolic health.

I have a very similar story. I didn't start my own resistance training journey until a couple of years ago, and it has been life changing and I'm never going back. I did not know it was possible to feel this good, and I didn't know it was possible to have definition. I just thought I was one of those people that would never have a collarbone, but I just thought it wasn't built that way.

But with incremental but consistent workouts, and I'm talking five or 10 minutes a day, most days not spending hours in the gym or anything, I have transformed my body composition to drop excess fat and put on muscle. It doesn't have to be intimidating, and that's one thing that I talk with my patients about is let's just start small and do something for five or 10 minutes.

Every day or five days a week. And you will see measurable differences in your [00:37:00] metabolic health. It will lower your fasting glucose, which , you will see that in your fasting insulin levels as well. But also it releases many chemicals. When you are building muscle tissue, you're actually releasing endorphins, which are the happy hormones, and you're also releasing and creating something called brain derived neurotropic factor, which causes you to grow more brain cells.

So as we age, in order to maintain our brain health exercise specifically, resistance training is one of the best things that we can do for our brains. 

 Yeah, and we are actually gonna talk about that more in an upcoming episode 'cause we really wanna talk about brain and dementia prevention and things.

So look forward to that This fall can wait but I think it can be a little bit confusing for people, especially if you are on social media, like looking for things to do for your health. And definitely the resistance training is getting a lot of attention. [00:38:00] I think you hear a lot of different things, like there's some people that are saying, oh, , the only thing that's really gonna make a difference is lifting super heavy so that you can only do, less than 10 reps.

And then there's people that are saying, that might bulk you and you should tone and you should do lots of reps of low weights. And then there's people saying everything in between and I think it can be. Really confusing. I like what you said about just getting started. 'cause that's what I definitely think too.

I always just, if I can just commit to a few minutes, I can at least get that done. But what do you recommend to people that are trying to consume a lot of information and just feel confused about what to do? Oh, that's such 

a great question. The first thing I suggest to people is. Do anything, anything that you're doing this month than you weren't doing last month from an exercise standpoint, guess what?

You're getting healthier. We're making a difference. We're moving the needle. If we are talking specifically about building muscle [00:39:00] tissue, then the exercise physiologists are probably the experts there. I am not, but I will tell you that lifting loads that are progressively heavier that you continue to feel a subjective sense of difficulty are important for boosting your metabolic rate and getting those metabolic benefits.

Lifting two pound weights for a hundred repetitions is not going to get you that boost to your metabolic health. You do need to be lifting heavy things, and that just means it should feel difficult to you if the weight that you're using to do whatever exercise. Let's say, just to break it down and make it easy, let's talk about a bicep curl.

Everyone I think is familiar with what a bicep curl is. If you're lifting the weight and you can do 10 or 20 of 'em and you still don't feel taxed at the end of that, then it's time to get a heavier dumbbell. You need to be lifting to the point where your muscles feel that burn, where you feel like you cannot do another one or two repetitions, and that's where you are getting that metabolic [00:40:00] benefit.

 I think that is something that is left out of the education aspect of resistance training because it's really easy to start with something that is simple, just using resistant bands or even body weight and hit a plateau and not continuing to build muscle because you have to take it up a notch and get a heavier weight and keep on moving down the spectrum in order to hit your overall goals.

My Christmas present this year was a new set of weights and that was amazing. Not just because it was a Christmas present, but because it showed the work that I had put in the year prior that I am now moving up a few pounds with each exercise that I'm doing now. Like you said, it is important to mention to women here, this doesn't make you bulky.

In order for women to bulk up, it takes way more than we're gonna talk about on this podcast. I'm, we're not even gonna go there. I lift heavier weights than I've ever lifted in my life, and I am the smallest I've ever been. , What you do [00:41:00] with your nutrition and lifting heavy weights and removing some of the the fat composition from your body is not going to make you have giant Popeye muscles.

So talking about this, I know you have a lot of different ways that you can measure how someone's doing with their exercise and their muscle health and things.

Tell us a little bit about how you look at that more in depth. 

 In my office, I have a body composition analysis scale that tells me precisely how much fat they have, where it is, how much muscle they have, and where it is. That way we can follow people as they're losing weight or gaining weight and making sure that we're.

Taking it from the right category. We never wanna sacrifice our muscle mass in favor of a smaller number on the scale. I have never met a person that says, I wanna lose a bunch of weight, but I wanna lose all my muscle and just be a walking bag of bones. No, this, that, that's not how we should do it.

That is sacrificing your longevity. So it's very important for me , when I monitor [00:42:00] people's weight, to make sure that we are looking at the subfractions of what that weight is made up of. So that's one thing that every patient that walks into my office is going to do. Another thing is that I do.

Metabolic breath analysis. , This measures 23 different biomarkers using just your breath. So you do wear a mask on your face, and I can do it in either a resting component that gives me their resting metabolic rate, how many calories they're burning. Also indications of their cellular and mitochondrial health, as well as their heart rate variability, their breathing frequency as it relates to their parasympathetic or sympathetic nervous system.

And it helps guide nutrition choices. When I know how many calories someone is burning at rest, we can help define how they should lose or gain weight and how we should go about that. You could take the same technology and. Make someone exercise either on a treadmill or in a stationary bike, [00:43:00] and now it's called a VO two MAX test.

So this very precisely measures the oxygen going in, the concentration, going in, the concentration coming out, as well as the flow and the volumes that patient is taking. The VO two max is your maximal ability to use oxygen during exertion. This is very strongly correlated to longevity, but what we probably care about more, it's very strongly correlated with your health span.

So the higher your VO two max, the more healthy the more. Able bodied you are going to be as you get older. If someone, let's say an 80-year-old has a vo O2 max that is in the top 10% of their age group, they are more likely to be able to walk around the block, walk their dog without having to stop play with grandkids.

Do simple things like carry a bag of groceries from destination A to destination B that same 80-year-old if they have a [00:44:00] VO two max in the lower percentile. They're not doing those things, they're not able to do those things. So we can train our VO two max as we age to make sure that we're keeping up with all those metrics that we want to still be able to do.

VO two max is a very strong predictor of abilities as we get older. I wouldn't be able to call myself a longevity physician if I did not test VO two max in my office. 

Lemme ask you this too. I noticed that my friend has a newer Apple Watch than me and we were looking at the data it was giving her and it was giving her a VO two max on her Apple watch, which obviously is not.

Testing her oxygen. Do you know how reliable those are from wearables? If people are getting information that way? 

I know anecdotally based on tests that I've done in my office and what my patients tell me that their wearable is telling them I have a whoop band, for example. And mine was two points off, so that's not bad.

Yeah. Yeah. That's pretty good. So if you can't find somewhere to do a [00:45:00] VO two max test, by all means use that. But I think even more importantly, use it to track your changes. Yeah. If you're going to make changes to your physical fitness routine, you can trust that your Apple Watch today versus your Apple Watch three months from now after you've instituted those changes.

If it shows you a measurable increase, then you're doing great. I obviously have the clinical grade. Yeah. Ability to do that in my office. And then I draw labs in my office as well, but we've already touched on that. So that's what I do. That's my favorite thing to do, is to do VO two max tests in my office.

I always tell patients I'm going to get slightly annoying at the end because your brain is going to tell you that you need to stop exerting yourself , but your body probably still has a little bit of fuel left in the tank. So I want them to push themselves even beyond what they think that they can do so that we do get to that maximum.

I also say it's not a VO two minimum test, it's a VO two maximum test. So give it your all. It's not something to be intimidated by. It takes 10 to 15 minutes for most [00:46:00] people, and the data is so worth it. And what kind of numbers are we looking for when we talk about VO two max? So you're looking at the liters of oxygen that you're consuming.

And it is standardized for your weight. So a VO two MAX score, it's usually between in the teens up to the fifties, sixties, and beyond.. Now vo O2 max naturally declines with age. So an 80-year-old with a score of 20 may still be in the top percentile for their age, but for a 20-year-old, that would be really bad.

So it

Looks at 

a percentile of 

For age and Right. It's always, 

Broken down by age. When you look at a graph of VO two max, there's this natural down slope as the age is on the X axis and the VO two max is on the y axis. And as the age goes up, the. Level of VO two max always goes down.

But if you're still in the highest percentile for your age group, that means that you are doing wonderfully. 

And if we're trying to improve that, where do [00:47:00] patients get the most bang for their buck? 

The way that I do my test, you don't only get a VO O2 MAX score, you also get breakdowns into your recovery capacity, your metabolic rate during activity, , three different metrics of your lungs.

So I can see if there's any deficiencies in any one area we can work on that area. But a training protocol just to boost VO O2 max is gonna be cardio focused as opposed to resistance training. And specifically high intensity work is going to give you more bang for your buck as far as just that one metric we call VO O2 max.

And again, why we need both. Aspects of exercise in our life because they're doing different things, right? 

When Sonal longevity patients leave my office, they get an exercise prescription. And it's always some combination of zone two training, high intensity training and resistance training. We should talk about zones.

I was gonna say in the, I just mentioned that. Let's go to zone training. Okay. So when you do [00:48:00] a VO O2 max test, you get your max heart rate. And then when you break that down to five different zones, you get these, parameters of your heart rate. So for example, my zone two, which is 60, to 

70% 

of my maximum heart rate.

And then you get up to zone four and five, which are now 80 to 90% of your maximum heart rate, or zone five is now a hundred percent of your maximum heart rate. You've reached that peak. So these different zones have different clinical benefits. If you're looking at a cell under the microscope, you're gonna see different benefits at different heart rate zones.

Zone two is the subjective feeling of going for a brisk walk or a slow jog, maybe an easy bike ride. You're getting, maybe slightly breathy, but you're not out of breath. You can sustain it for quite a while, maybe a couple beads of sweat, but nothing crazy. So you feel like you're working, but you can keep doing this for quite a while.

This is zone two. When you do a vo O2 max test, it will be very clearly [00:49:00] defined what heart rates those are that you should sit in between for your zone two. But zone two has a lot of mitochondrial benefits. These are the little energy producing portions of your cells that we want to be functioning their best so that our bodies function their best.

So zone two, you get a lot of boost to your mitochondria number. You actually produce more of them and their function, they actually function better when you spend some time working out in zone two every week high intensity, now we need to go up to zone four and five to get those benefits.

That, that was gonna be my next question. 'Cause I think this is something that we previously just preached a lot of high intensity cardio. If you're not dying when you're done, then you didn't do any work. And I think that was wrong. So how frequently should people even be thinking about doing high intensity cardio versus that zone two?

This varies per person. I think that's individually decided and it's based on a multitude of factors, how frequently I'm going to tell someone to do high intensity versus resistance [00:50:00] training versus zone two. There's almost always a combination of those three, but it really varies per patient.

I myself choose to do one high intensity workout a week, and I feel like that's going to keep training my VO two to stay where I want it to be. A high intensity session should be getting your heart rate up to those, 80% of , it's maximum. So now we're talking zone four or above. Sustaining that for 30, 60, 90 seconds, and then having a brief period of recovery, maybe one to three minutes where you can get your heart rate back down into probably zone two, and then doing that over and over again four or five, six times, and then you're done.

That's your high intensity interval training. 

What do you do for your high intensity training? 

I prefer to run. But biking would be reasonable as well. I'm not a swimmer I guess that could or a rower. Rowing is also a cardio thing, but where are we gonna do that? Unless it's on a machine? I don't.

Yeah. So that's my personal choice. I just run all out [00:51:00] and then I recover and then I do that again. This release is an incredible amount of catecholamines. The adrenaline epinephrine, you feel amazing after a high intensity interval session. It might suck while you're doing it. Some people say that, but one, the benefits are worth it.

And two, you're gonna feel great afterwards. 

 So for somebody that has realistically about 20 to 30 minutes in their day to exercise, you would maybe do. Zone two for a few of those days. High intensity for one day and resistance training for two days? Or how would you recommend for them? 

Again it's patient specific.

If we're really working on their metabolic health, if they've got a lot of weight to take off, I'm gonna push them more towards resistance training actually. 'cause that's going to get the best boost to their metabolic health. And the more muscle you can build, the higher your resting metabolic rate, which means that you're burning more calories at rest, you're more likely [00:52:00] to be able to take off weight.

And I think that again, is a little counterintuitive because so many times we're just looking at being like, how many calories did I burn? Yeah. 

And that's, and your treadmill or your bike or your elliptical is gonna give you that readout where when you're doing strength training, there is no readout.

Correct. Unless you're wearing maybe a fancy wearable. But yeah, the old way of thinking, like you had mentioned earlier of just keep moving steady state cardio, you'll burn so many calories. That's gonna be the best thing for your weight Loss is not true. It does not work for most people.

Yeah, that's, 

it's been true for me Lifting weights has helped me being able to maintain weight loss better than anything I've done before. 

yeah. And it protects you against weight gain. For women especially that are going to be entering into the perimenopause and menopause stage of life.

The more muscle you can put on going into that stage the more protected you are against that inevitable, it gets harder as we get older. The more protected you are against that weight [00:53:00] gain. Now, that's not to say that you can't make measurable differences once you are through that stage or in that stage, but.

Putting on muscle earlier is going to give you more laxity during those years. 

 We always like to bring up all the pillars of lifestyle medicine when we're talking. Do you have any recommendations for your patients as far as managing stress and how that can affect their metabolic health and their weight?

This is such 

a good segue. How did you know , one of the best ways for managing your stress is to move your body? And now we don't need to get into the nuances of, is it high intensity? Is it zone two? Is it resistance training? Just move your body. And that is one of the best things that you can do for your stress and for your sleep.

The more you move your body during the day, it's not rocket science. The better the deep sleep you're going to get at night. Also with stress. We, in my practice, talk a lot about breath work and meditation and just intentional. Time to [00:54:00] yourself. So even if that means if you're in a busy job or you've got a bunch of kids stepping into another room, closing the door, and taking 10 big.

Belly breaths and taking that time for yourself, that will make a difference. So stress has to be managed, and so you can do it in very effective ways that are also gonna benefit every other bucket that we talk about. In longevity medicine, I have four buckets. I am sure you guys have something similar, nutrition, exercise, sleep, and stress.

And so every patient of mine gets a roadmap or a game plan in each of those areas, but they feed off of each other tremendously. 

They definitely do. We did a whole sleep series and talked about the importance of exercise for sleep. So I was glad that you brought that up again because that was one of the things that Dr.

Wetzler brought up as a huge helper for insomnia is just making sure you're exercising so you get good sleep. 

 Do you have anything that [00:55:00] you feel like is important that someone can do for their health that we see trends in? Do you have any strong feelings about intermittent fasting or, how much protein someone should be getting?

Wow. I have a lot of strong feelings about a 

lot of things. Just ask my husband. 

These are all over social media, so the okay. It'd be nice to hear your take on those two buckets. Okay. 

So we have to talk about protein. We wouldn't be able to have a longevity discussion without addressing protein, so I'm glad you brought that up.

We already touched on the importance of building muscle. So in order to build muscle, you have to feed muscle. It's building blocks, which is protein. We have to be getting adequate amounts of this in our diet, and for most people, a safe bet is one gram per pound of ideal body weight. And you wanna consume that at various periods throughout the day.

You wanna spread that protein intake out. You're not gonna probably get it in one sitting. That would be a whole lot of, let's say, [00:56:00] meat to eat in one sitting. So you do wanna spread your protein out throughout the day. And this is extremely important because one, it sends a signal to your brain that you're full and it keeps you full longer, you're more likely to avoid cravings and giving into the.

Immediate cravings of maybe some of those starchy or foods or some of those treats if you have more protein on board. And then of course you need it to build muscle. Other things that are commonly talked about, intermittent fasting. This is a good one to talk about because I think the evidence is pointing us away from longer fasts.

 I was almost nervous you were gonna ask this because I think that it's very complicated right now. It and complicated. Yeah. And 

usually when patients ask me, I was like, we just don't like we're getting messages from the whole spectrum right now. So when we, when that happens in medicine, it makes us be like, we just don't know yet.

Okay. 

I have feelings. And I'll tell you what my, how my feelings stand today. I used to be a big faster, , I would fast for three days at a [00:57:00] time. I wanted that cell turnover, what we call autophagy, where you clear out the bad cells, make room for good cells. I used to do that. I used to do like an 18 six schedule where I would not eat for 18 hours and then consume my calories only during that six hour window.

I think that this is a slippery slope if the goal is weight loss. If your goal is longevity, there probably is a role for longer fasts from time to time. But for weight loss, this is extremely nuanced and I think we're just starting to learn how nuanced it is as far as if it's going to help you or hurt you.

And for a lot of women, I think just following longer, fasting schedules can get them in trouble. Your body when it's fasting, potentially, if you're not doing it right, which begs the question of which is what's right but if you're not doing it right, you can send your body into a state of alarm 'cause it feels like it's not getting energy.

And when your body feels like it's not getting energy or a low energy state, it's [00:58:00] more likely to store fat and to hold onto it for emergencies. So it's actually gonna work against you with weight loss. that was a lot. So I think it's a hot topic. I am not sure I understand all of it just yet.

I think for weight loss, it is not as cut and dry as we once thought it was. And if you're going to use intermittent fasting as a strategy for weight loss, you should really work closely with a practitioner that can monitor and make sure that you're getting the appropriate food at the appropriate time and not getting food at the appropriate time.

And this is very nuanced and emerging. 

Yeah. I, one of the hardest things I find for patients that do pretty small eating windows is getting enough nutrients in these other things that we're trying, getting enough protein, getting enough fiber, it becomes very challenging when your window is so small.

 when we talk about weight loss. A lot of times we're trying to improve other markers of health and we don't want to just lose weight but not improve health in other ways and feel better. And so [00:59:00] that is something that I noticed that seems very individualized on people who do well with intermittent fasting versus those who can not

In general. 

Yeah. And how you feel like I'll tell you, Sarah does not do well. I 

do not do well. Kitty has seen me when I skip a meal and it is not pretty. Nobody wants to see that. 

It's also very gender specific. I think men tend to do better with it than women. From a weight loss standpoint, they can institute it easier and it tends to work better for the population of males than it does for females across the board.

If you were looking at a hundred men versus a hundred women doing intermittent fasting, you're gonna see the male population do better. They're just not as complex as we are. to make it really easy, just eat when the sun's out. Don't eat after the sun goes down.

I think that's a safe thing for most of us to abide by. And that's not gonna get anyone in trouble, and it's probably gonna make most of us healthier. 

Yeah, that's an easy way to, to think about it. And just remember, anytime you make a change in your diet [01:00:00] and habits, just make sure you schedule a time to stop and reflect and think about, is this working for me?

Because you may make a habit change thinking that it's gonna be really beneficial and it may not be, and you may need to alter that or try something else. So always make time to reassess and reflect on how it's impacting you, 

And how it's impacting you, not versus how social media says that it should be impacting you.

 are just overwrought with information and everyone's opinions and there's good stuff and there's also really not good stuff out there. 

Absolutely. speaking of social media is I feel like there is more and more information in the longevity world being pushed about different supplements.

Is this something that there are specific supplements that you feel are applicable to most people to help with longevity or is this go back again to a very personalized approach for each patient? 

 anytime I start a supplement discussion, I start it with the [01:01:00] fact that there is nothing on the market that's gonna move the needle more than addressing your nutrition, your sleep, your exercise routines, and your stress management.

Thank you for that. Yes. 

It's just the little tiny sprinkles on the icing on the 

right. The icing on the non-diabetic cake. there's so many things out there, and there's so much information. It's really hard to decipher what's good, what's bad. There are really fancy things that we can use to intervene at the mitochondrial energy creation stage.

Things like NAD or the precursors to NAD or even methylene Blue. and as far as what I recommend to patients, it's very patient specific. It's based on their lab work, their metabolic testing, their body composition, and their goals. Creatine is one that, I recommend more and more often, almost across the board.

I like creatine, so it's probably worth discussing that here. But other than that. Supplements are just, they are meant to supplement what [01:02:00] you're already doing with your life. So we have to turn it back to your lifestyle every single time. And there's fancy stuff and it's expensive, and whether you should spend your money on it or not is always something to evaluate and to weigh the risks and benefits.

Creatine, however, is a molecule that our bodies produce naturally. Men have a higher concentration of it than women, and like so many things, it decreases as we age. So it is necessary to perform energy. Processes. What creatine does , on the molecular level is it donates a phosphate to a molecule called ADP to make it into ATP.

And ATP is the energy currency of your cells. Every process that happens in your body happens at the effect of A TP. So the more we can do to boost the production of ATP is going to give us more energy in whatever cellular target we're looking at. Creatine has traditionally been thought of in the muscle building world.

[01:03:00] Bodybuilders used to load creatine to make their muscles bigger, to put on more muscle faster. And it almost got a bad wrap because of that. 'cause it was used in those type of doses and only associated with that population. But when you take it at a dose of three to five grams a day, it has tremendous benefits for not only helping to put on muscle, get more bang for your buck, essentially with your resistance training routines.

But the brain health, we have to talk about the brain boosting benefits of creatine. Creatine, since, it helps with energy production. It's going to help in the areas of your body that use the most energy and those are your muscles and your brain among others. But your brain uses 20% of your energy in your body, but it only weighs 2%.

So proportionally, your brain is using up a lot of energy and anything that we can do to allow your body to create energy easier, like supplementing with something like creatine is going to make your brain function better. It [01:04:00] helps after a night of sleep deprivation, I have physician patients that work all night in their specific fields, and if they don't take their creatine, , they feel worse off the next day.

In terms of how they're firing, are they firing on all cylinders or is the brain a little bit lagging behind? It helps with depression symptoms. It has been recently studied in the Alzheimer's space to help with Alzheimer's symptoms. Brain health is, I think, the biggest benefit of creatine 

now, for a long period of time, we were very concerned about it impacting the kidneys.

Can you reflect on that and how we should use that in interpretation when we're looking at labs? So at the doses 

that I mentioned, it has not been shown to impact the kidneys or the liver. I've also heard people come to me and say I can't, my doctor said I'm gonna go into liver failure. Respectfully, that has not been proven in the literature.

So I disagree and I think it's safe for almost all patients. 

Yeah, I used to be very fearful of it when a patient told me [01:05:00] that they were taking it, and then I did a lot of research and then I did research again for a family member that was taken. And each time I do research, I find the testing safety wise seems to be growing and growing.

There's really. Very few things that you need to be worried about. If you're taking these regular doses of creatine, like the, three to five milligrams a day, That's right. 

We don't grams. Grams. Yeah. We don't need to be scared of it. I almost everything that I recommend to my patients, I do myself.

I'm wearing a glucose monitor right now. I take creatine, these nutrition recommendations we've been talking about, that is the lifestyle that I choose to live. And so creatine, I can tell you personally, it does help with my cognitive function. My brain just, I'm sharper with it. Hopefully that's translating in this podcast.

Yes. 

. Definitely. I'm glad you brought up that supplement, because I, that's probably the one I'm asked about the most. 

So someone starts taking that supplement, , and they see you in a month, what are some of the things that you're asking to see if they're noticing a difference within a month's time? 

 Mood [01:06:00] is one I hear very frequently. They feel a bit more lighter, maybe less depressed symptoms.

I have not heard a patient yet say, yep, I feel like my workouts are more effective and I'm building muscle faster than I would've otherwise because how are we gonna measure that we're not? But. Cognitively here's where it comes across. People notice it when they don't take it.

So the effects are subtle, but you notice it more when you don't take it that you're feeling a little bit slower. You are not interacting with the world maybe as efficiently 'cause your brain just isn't producing energy as well as it could have otherwise had had that creatine on board. So people mention to me more , what they feel when they don't have it.

But you may not notice an effect immediately if you. Start taking it that week.

And that lends to our lifestyle medicine conversation. It's hard to prescribe things that people don't notice, that immediate change. We live in America, we want immediate results. We want the Amazon Prime of nutrition changes.

I [01:07:00] want it here tomorrow. I want my 20 pounds to be off tomorrow. But the things that I recommend take a while to one, work into your habit and then a while to show their effects. , My goal, what I wanna hear from patients six months or 12 months after starting to work with me, is I didn't know it was possible to feel this good.

And it doesn't happen overnight, but you are gonna notice six months from now, holy moly, I feel amazing. But it's little increments that happen every day. Maybe subclinical that you're not gonna pick up on, but then one day you're gonna look in the mirror and be like, wow. Huh. I didn't know that I could have that line there in my arms.

Exactly. 

It appeared. Yeah.

Yeah. . 

Thank you so much Dr. Sweeney. You have taught us a lot today, and I think you've given us a lot of great takeaway points. being an expert in longevity medicine, you really are trying to help people to optimize their health now for two reasons, both to feel better now, but [01:08:00] also to feel better and be independent when you're in your later stages of life so that you can enjoy life now and enjoy life all the way to the end.

So I think that's a great way to think about it. And in the light of pursuing that health for the long run, you really need to be in tune to your metabolic health. You need to be paying attention to any. Emerging insulin resistance, paying attention to how your glucose is doing and really making sure that you're eating whole foods, getting your carbohydrates from things that were made by nature.

I liked that thought of how to think about your carbohydrates and then thinking about your exercise really coming from the do anything. If you do anything, you are getting healthier. I think that's a great way to think about it. And then after you get to where you are being able to do things on a regular basis, then you can really start fine tuning it with [01:09:00] thinking about your zone two and your resistance training and even going all the way to looking at your VO two max and correlating that with your health span and how you're doing so.

Remember that in order to live a long and healthy life, you really need to think about all of these things. Make sure you're thinking about your nutrition, your exercise, but don't forget about sleep and making sure that you're managing your stress and really making sure you're enjoying life too, because that is a big part of it.

So I think this has been a great talk and you've given us a lot of great thoughts about CGMs, and Sarah and I have enjoyed experimenting with those, so we'll probably bring that up more later too. But how could someone come see you and get all this personalized advice? 

Thank you so much for having me.

This has been equally as enjoyable for me and I've learned things from you guys. So thank you again for this opportunity. I am located in Louisville. My website is sano longevity.com, and that's [01:10:00] SANO. But I'm also pretty active on Instagram,, I try to share really useful day-to-day information to help motivate people and give them little tidbits, of things that they can weave into their daily lives to help make themselves healthier now and for the long run. 

Yeah, her Instagram account is great.

I follow her, so definitely recommend it. And we will of course link to that in the show notes if you want to add that to your follow list. . 

So hopefully you all have enjoyed today's show and be sure to leave us comments, share this show so other people can learn about longevity medicine.

And if you have any ideas for upcoming shows for us to do, please send us a text by clicking the link below or email us at contact at the starting gate podcast.com. Look forward to talking to you all next week. See you next time.