Metabolic health and wellness are measured through how our bodies process food. An imbalanced diet could sometimes lead to this metabolic dysfunction which causes our body to have trouble handling, circulating, and storing the fuel that we feed to it. This dysfunction could lead to various chronic diseases. In this episode, Dr. Lucy Burns, general practice and lifestyle medicine physician, shares her knowledge to unlearn some toxic diet cultures to help us improve our health and wellness. Linked to our imbalanced diet, she also discusses the role of glucose and carbohydrates on diabetes and cancer. Tune in to this episode and hear Dr. Lucy Burns talk about how you can avoid these chronic diseases and achieve a healthy body.
I have Dr. Lucy Burns. She comes to us from Australia. She's from Real Life Medicine. Welcome.
Thanks very much for having me.
Tell us a little bit about how you got into the medical profession.
It was quite a while ago. If I'm going to be honest, in Australia, to get into medicine at university, you have to get a certain amount of marks. I had the marks and I thought, “I'll tottle into medicine.” I wanted to go in and get a degree that when you come out, you've got something. You can do a Bachelor of Science but when you come out, you're not a scientist. You've got a degree. I was like, “I need to come out and be something.” I did have law and physio on my choices as well. I’m so glad I didn't do those because they would not have been a fit. Maybe the universe was calling to me because medicine is my calling.
What type of medicine do you enjoy working on? What gets you excited?
Initially, I did what is called general practice in Australia and what you call primary health care for a long time. What I noticed was that since the start of my medical career and I've been a doctor for many years, the type of health problems that I was seeing was changing. The number of chronic diseases was increasing astronomically. When I first started, 50 was still well but now, lots of 50-year-olds are sick. They’ve got Type 2 diabetes or metabolic health or needed hip replacements.
I was seeing people who have been working hard their whole lives and by the time they’re ready to move into retirement, they spend their life trotting around going to doctor’s appointments to survive. I thought, “This is no good. We've got to move further upstream and find out what is going on.” I did extra training then in lifestyle medicine and psychological medicine to get to the root cause of some of the conditions. The thing that I see most is probably obesity medicine and Type 2 diabetes, which I love. Lots of people send me their patients because a lot of doctors don't love that. It's too hard. It’s wonderful.
When you say metabolic health, does that lead to folks that are having a hard time metabolizing the food or detoxing? Tell us a little bit about what that means.
When I was training, there was a syndrome called Syndrome X. We didn't even have a name for it. It was a combination of things like fatty liver, hypertension, central obesity and prediabetes. It was rare. We hardly ever saw it. In the population of people over 50 in Australia, up to 80% of people have metabolic syndrome. It's what some people might call pre-diabetes. It leads to so many other things other than diabetes but certainly, cardiovascular disease. It's also an inflammatory process. It's the root cause of lots of our problems related to chronic diseases as we get older.
I certainly have heard a lot of this in the States too. A lot of folks that I know in their 40s and 50s are pre-diabetic. What's a typical protocol that you like to follow when someone comes into your office and you suspect that this is what you’re looking at? What do you think about doing next?
The thing that is driving metabolic syndrome is a hormone called insulin. Most people have heard of insulin. It's a hormone made by the pancreas. Its job is to regulate our blood glucose. It’s very good at it. I always call the pancreas a workhorse. No matter how much glucose you have in your body, your pancreas will try its best to move that glucose out of your blood and pop it into your muscles.
When we have high blood glucose, it's toxic to our arteries and the little cells at the end. The pancreas therefore can make a phenomenal amount of insulin but the problem is that insulin has a whole pile of other side gigs. One of them is that fat storage is good at storing fat and stopping our body from being able to break down the fat.
It gets your glucose, shoves it into the fat stores and then it’s never to be seen. It has a couple of other things where it's like a growth hormone. It grows things. It's a risk factor, particularly for cancer and the thickening of our arteries. It grows the small muscles in our arteries. It’s a big indicator of chronic cardiovascular disease.
The thing is that we have a population that has huge amounts of a high circulating fat storage hormone. Back in the olden days, people would go, “I'm just fat. It's my hormones.” People would scoff but that's true. Insulin is a hormone. It is true that your insulin will cause you to store phenomenal amounts of fat and not be able to break it down.
What kind of protocol do you like to follow to confirm this and then treat it? What do you like to do?
I can test the insulin. Unfortunately, you can't test it at home as you can with a blood glucose level. You can test it in a lab. I will usually order fasting insulin. For most people, I will order what's called an insulin curve. Maybe many of your readers have heard of a glucose tolerance test. We do them, particularly in pregnant women. It's a two-hour test where you have to drink glucose and then you measure your glucose levels at 1 and 2 hours.
Asking people to eat food they don't like is just unhelpful.
You can also measure people's insulin at that same time. It gives such a great picture of how much insulin their body produces in response to a standard amount of glucose. We'll see a normal curve, which looks like a bell curve. I hardly ever see that. I see crazy graphs where it's still skyrocketing at the two-hour mark when it should be almost returning to baseline. It indicates to me that people’s poor little pancreas is pumping out stuff to try and keep the body from getting Type 2 diabetes.
You can then also add in some other tests. We would do something like your hemoglobin A1C levels. We check CRP. Some of your readers may be familiar with that. It’s a test of how inflamed your body is. As a side note to that, we know that fat that’s stored around the middle, abdominal fat, is highly inflammatory. Fat in itself is an organ so it makes things. It makes hormones and inflammatory mediators. It sends these inflammatory cytokines around the body and causes inflammation in all different parts of our body, in particular, your gut and vasculature. Those are your little arteries and little veins. You can certainly test for inflammatory levels.
Interestingly, when our body has started to store lots of fat, a lot of it is driven by carbohydrates. Whenever we eat carbohydrates, insulin comes out to play. Our Australian diet and I’m sure the American diet is similar, is very carbohydrate-based. Even for people that think they're eating “healthy,” it’s still carbohydrate-based. We have cereal or toast for breakfast. We have sandwiches for lunch. We might have pasta, rice or potatoes for dinner. There are a lot of carbohydrates involved with that and not a lot of protein. We talk to them about perhaps being able to reverse some of these disease processes by using their lifestyle. That’s looking at your food and then the other modifiable things in a lifestyle that can make such a big difference without the side effects of taking medication.
Do you find that you have to get rid of all carbohydrates to reverse them? Is it decreased a lot, a little or once a day? Is there a rule of thumb based on how bad it is?
If somebody has severe metabolic syndrome or they've developed Type 2 diabetes, reducing their carbohydrate load to a small amount, which is about 50 grams or under a day is phenomenally effective at reversing this whole process. Some people don't want to count carbs because it's like dieting. For a lot of people who have metabolic syndrome, the thing is they’ve done lots of dieting. They’re not lazy or stupid. It’s not that they don't care about themselves but they’ve fallen into the trap of life and processed food. I'll often say to them, “There is a simple formula. Pick some protein.” That can be whatever protein you like because asking people to eat food they don't like is unhelpful.
I’ll say to them, “Pick some proteins. Protein is meat, eggs, fish or dairy if you can tolerate dairy and soy if you can tolerate soy.” It's important to recognize that not everybody can tolerate everything for many reasons. You can pick legumes if you're not too insulin-resistant. If you're insulin resistant, legumes are packed with carbohydrates. They may or may not be helpful. You can also pick some veggies. I pick the above-ground ones. Avoid root veggies, in particular, potato and sweet potato. Sweet potato has got its whole past like a health halo. It's not that great.
You can add a bit of fat. There's nothing wrong with some fat. Particularly, fat is very good for vitamins and brain health but a certain type of fat. You want unprocessed, not seed oils like canola, grapeseed oil or sunflower. You want some olive oil. If you're eating meat, you can have the fat on the meat. If you don't eat meat, you can have oily fish and those sorts of things. Also, herbs are a snapshot of everything you need.
You're also doing work with fertility and women that are trying to get pregnant. Talk to us about that.
One of the leading causes of subfertility in the Western world is something called Polycystic Ovary Syndrome or what we call PCOS over here. PCOS is an insulin problem. Insulin drives so many things. It's the king or queen hormone. It can affect metabolic health for things like fatty liver and Type 2 diabetes but it can also change, in younger women, our reproductive health. It alters the balance then of your estrogen, progesterone and testosterone. That’s the thing that causes infertility.
To make a baby, your ovary has to make a cyst. That little cyst has an egg in it and then the egg gets released. It comes down the little tubes and into the uterus. The cyst is a follicle. It probably should be called Polyfollicular Ovary Syndrome. It is normal to have some follicles but what happens with PCOS is that the follicle or the cyst develops and no egg is released. Every month, you'll have multiple cysts growing and no eggs. No egg means no baby.
How do you suggest changing this so that the eggs are being produced?
Eating real food is the first step. If you do that, you’re 100 miles ahead of the pack. You reduce carbohydrates in that real food. Getting rid of the sugar, pasta, rice, white potato and flour, the five big white things, makes a phenomenal difference. Your body won't be producing as much insulin. That gets time to balance that side of the track and then your other hormones will fall into line. It’s such a simple thing in theory but I realize it can be hard for people to put it into practice for multiple reasons. In particular, addiction to sugar and carbohydrates is a real thing. It's everywhere.
As a doctor, I was addicted to sugar. I had pre-prediabetes. This was what led me on my path to change from general medicine apart from seeing the plethora of chronic diseases coming in. You often have the little path that you're working on and then when you find your way through the forest, you want to tell everyone else and help everyone else about it as well. Sugar addiction is massive.
What led me on my journey is different but then, with all these families and all these doctors I'm speaking with, including yourself, the topic of sugar, carbohydrates and glucose comes up a lot. What do we do when we're faced with this around food marketing and food science? How are we going to educate ourselves and our families? Do you have any thoughts on any of this?
If we're waiting for the government to regulate, that won't happen. It certainly won’t happen in Australia. Australia produces enormous amounts of sugar. In one of our states, it’s their whole industry so they’re never going to do that. The food lobbying groups are hugely influential and extremely wealthy. We can't wait for that.
It comes back to that grassroots level of educating people if we can. Social media is a great platform for a lot of that. It's also unpacking the dirty marketing tricks that these processed food companies will do and use to keep consumers baffled. That’s what they want to do. They don’t want you to know the truth because once you see it, it smacks you between the eyes and you go, “How could I have not seen this?” You don't see it because they don't want you to see it.
The only person who's going to care for you is you. It's not your fault, but it is your responsibility.
There’s shiny packaging. There are stars on packets that say, “High in fiber. Good for the gut.” Anyone can write anything. I could put a packet of processed gobbledygook and write, “Good for gut,” on it and nobody can stop me. Being aware of what you're eating and recognizing those dirty and sneaky tricks is so important. The health food companies are not there to help you get healthy. The health food companies are there to make money.
There are a couple of big ones. There are two issues. One, you've got processed food companies like Coca-Cola. Coke is not pretending to be healthy. We know that Coke is a sugary drink. Nobody will dispute that. You've got those companies and then you've got the second company, which pretends to be healthy. They market to children. They're producing things like yogurts, muesli bars or breakfast cereals. Parents buy them thinking they're helping their kids but they're not. That is what riles me.
The thing that was eye-opening for me too was when I started developing and working with the formulators, manufacturers and doctors to put the supplements together based on what we needed in our family. I didn't realize that if they're not in pure form and they're processed, it doesn't get into your body. Saying things like, “This bar has omega-3 in it,” it doesn't. If you think it got cooked, it didn't. It’s all very interesting to me. Do you have certain supplements that you like to make sure folks are taking as they're going through this journey?
I like to make sure that people are taking stuff that is appropriate for their needs. You're right about the quality of supplements. The supplement industry is a bazillion-dollar industry. It’s pretty unregulated. It’s important for people to know to not buy the cheapest one on the shelf because it’s going to be full of rubbish with a sniff of something. They can write on the label, “Improves heart health.” People go, “I've got a dirty heart. I need that.” It goes back to making sure people are educated.
We're down in the Southern hemisphere of Australia. Vitamin D is a big problem for us. A lot of us work inside. We have short daytime periods. For the Northern states, like Northern England, Northern Europe and those sorts of countries, we see different disease processes related largely to vitamin D. I love vitamin D. I ask people to try and get it from the sun. Don't go and cook yourself in the middle of the day but get some sunshine in the morning and the late evening without sunscreen. Sunscreen blocks your vitamin D. It’s like Goldilocks. You want a little bit of sunshine but you don't want too much. Too much is harmful and too little is harmful. We've got the messaging probably not quite right there.
If people have high blood glucose sometimes, I'll use berberine as a supplement. It’s very popular. It needs to be managed and monitored if you're using medications because sometimes, that means the actual drug medications can be reduced, which is great. I love omega-3. Omega-3 is a phenomenal anti-inflammatory. It’s found in a lot of food but not a lot of food that people eat.
A lot of people don't eat seafood. We can try to encourage people to eat fish if they can. Particularly, kids from an early age. It’s about training your palate sometimes. One of my kids is a fish-holic. She's phenomenally well and intelligent. She's eaten fish for a long time. That's a one-off thing but it's important.
Omega-3 supplements have the good and the bad. Sometimes, they're packaged in the rubbish. They oxidize and lose their potency. Even in their potencies, they've got a nanometer or a nanomole within some complex. It's not good for us. I do love omega-3 because getting that omega-3 to omega-6 ratio is important. To clarify why it's important, omega-3 is an anti-inflammatory molecule and omega-6 is a pro-inflammatory molecule. The inflammation itself is not terrible. We need an inflammatory process to fight disease and infection.
In the olden days before processed food came along, we would eat in our diet a ratio of about 1 omega-3 to 1 omega-6. That’s nice and balanced. Over time, we started to increase our omega-6 and the ratio was about 1 to 4 but now, the ratio is about 1 to 60. People are consuming 60 times the amount of inflammatory omega-6 compared to omega-3. We want to improve the balance. We can do that in two ways, which is to increase omega-3 but most importantly, to decrease omega-6. Omega-6 is found in those seed oils. We call them vegetable oils. A good old Crisco is full of omega-6. It’s in all of those corn oils, seed oils and soybean oils. They're in about every processed food product because they prolong the shelf life and they're cheap.
Is there anything else that I forgot to ask or mention? Everything is educational. It's incredibly helpful.
A lot of women who come to me that are overweight or are developing Type 2 diabetes feel an enormous amount of shame and guilt. They've done this to themselves. People go, “I've let myself go. I can't believe this happened.” I'll often say to these gorgeous women, “It's not your fault,” for two things. One, women spend a lot of their time looking after other people. They’re looking after their children. Some have children with special needs but even without special needs, they’ve got children that need to be cared for. They’re driven around everywhere. They’ve got appointments and sports. They’ve got to be fed and clothed.
They’re also working and looking after elderly parents. There is no time to look after themselves. They keep saying to themselves, “I'll do it. I'll look after X, Y and Z.” I say to them, “This isn't your fault. What you need to do is make time to put yourself first. You're the linchpin of your family. Without you, everything falls apart. As the linchpin, you need to be looked after and cared for.” We can do that. The only person who's going to care for us is us. It's not your fault but it is your responsibility. We go, “Let’s put you up the path of people being cared for in your family. You don't get to have the drugs of the coffee anymore. You need to go up the top and have the cream from time to time.”
What do you find are some of the easier things for people to do and say, “I'm sorry but this is my time. This is what I need?” It’s finding that strength and support. They may or may not have the voice or the support at home.
It’s a bit of both. Looking at your logo, it does take courage at times to be able to say to other people, “I'm not doing that. My needs come first.” We probably will never use those words because they don't necessarily feel for us. Women feel selfish if they look after themselves. Motherhood has been a selfless profession for hundreds of years.
It’s about getting clear in your mind what are the things that you need to do to care for yourself. That might be dedicating some time to make sure you've got real food in your house or do a bit of meal prep. It might be saying to somebody at work, “I'm not staying late. I have to go home and do X, Y and Z.” It might be catching up with a friend and doing some walk. It might be saying to your bestie, “Let's not have cake. Let's go for a walk instead.” There's stuff that you can do in there that doesn't have to be announced to the world, “Sorry, everybody. I'm looking after myself. You don't count.” It's stuff that you can incorporate into your life.
One of the cheapest, easiest things to do that makes an enormous amount of benefits to our wellness is getting good sleep. What we often do as moms is sit on the couch after dinner and go, “The kids are all in bed. This is my time.” We don't want our time to end so we stay on the couch for hours, because as soon as we go to bed, our brain goes, “It’s all going to start again.” I call my bed my rejuvenation palace. Magic happens while you're asleep that is free and has no side effects. To moms out there, get your seven and a half hours of sleep. At least give yourself the opportunity to do that by being in bed for that long.
So much magic happens while you're asleep. It’s is free and it has no side effects.
On nights when I'm uptight, it’s helpful for me to take magnesium and then try to meditate as I'm trying to fall asleep. It seems to help.
Magnesium melatonin is helpful for people with reversed sleep-wake cycles but mostly, it's your nighttime routine and giving yourself that opportunity to wind down, not watching Netflix on your screen.
Thank you. We appreciate it. If anyone wants to connect with you further or has any questions, where can people find you?
Our business is called Real Life Medicine. Our passion is helping people but in particular, women. We prioritize their health, particularly if they're overweight and want to look after that and either reverse or prevent metabolic health so that they can live long and happy lives into retirement and beyond. We have clients all over the world so it's good. They can find our website at RLMedicine.com. We're on all the socials as @RealLifeMedicine.
Thank you so much. We’re happy you’re here.
Thank you for having me, Pamela. It was delightful.