April 17, 2025 • 52 mins
Have you ever wondered why weight creeps on during menopause, despite your best efforts?
Dr Lucy Burns pulls back the curtain on what she calls the "metabolic triad of menopause" – a perfect storm of declining estrogen, rising cortisol, and increasing insulin resistance that creates the ideal conditions for stubborn weight gain.
As a GP who retrained in lifestyle medicine after experiencing her own health challenges, Dr. Burns offers a refreshingly honest perspective on why traditional approaches to weight management fail so many midlife women. Using the powerful analogy of a locked woodshed, she explains how high insulin levels essentially padlock your stored fat, making it impossible to access no matter how much you restrict calories or exercise.
What makes this conversation truly valuable is how Dr Burns connects the dots between hormonal changes, metabolic health, and practical lifestyle solutions. She introduces her "six S's for success" – sustenance, sleep, stress management, strength training, sunshine, and social connection – as foundational pillars for reclaiming metabolic health during menopause and beyond.
The discussion takes fascinating turns through hormone therapy considerations, the psychological aspects of food addiction, and why so many of us grew up alternating between strict dieting and giving up entirely. Throughout, Dr Burns maintains that improving metabolic health should be the primary goal, with weight loss simply being "a happy side effect" of addressing the underlying hormonal imbalances.
If you're exhausted by diet culture but still concerned about your health during menopause, this episode offers a science-based approach that works with your changing physiology rather than against it. Discover why muscle is your "metabolic organ," how stress impacts your ability to lose weight, and practical steps to break free from the metabolic challenges of midlife.
Ready to stop blaming yourself and start understanding the real science behind menopausal weight changes? Listen now and discover why it's time to focus on metabolic health, not just the number on the scale.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Sonya (00:01):
Welcome to the Dear Menopause podcast.
I'm Sonya Lovell, your host Now.
I've been bringing youconversations with amazing
menopause experts for over twoyears now.
If you have missed any of thoseconversations, now's the time
to go back and listen, and youcan always share them with
anyone you think needs to hearthem.
This way, more people can findthese amazing conversations,
(00:25):
needs to hear them.
This way, more people can findthese amazing conversations.
Welcome to this week's episodeof Dear Menopause.
I am delighted to be joinedtoday by Dr Lucy Burns.
Dr Lucy (00:34):
Lucy, welcome to the show, Sonya.
Thank you so much for having me.
It's an absolute delight.
Sonya (00:37):
It's always a pleasure to have like-minded smart women on
the podcast, and I know myaudience are going to love what
we're going to talk about today,which is predominantly
metabolic health.
So, Lucy, before we do that,why don't you share a little bit
about who you are and what?
Dr Lucy (00:55):
you do Absolutely.
So my name's Lucy, I'm a medicaldoctor in Australia and I
started my life off as a GP andthen, interestingly, toddled off
.
I worked for Defence for a longtime, which sort of sounds weird
, but it suited me that we livenear a Defence base.
And so I stepped out of generalpractice and saw mainly young
(01:17):
people, came back into generalpractice and saw the older
population, sort of midlife andbeyond beyond, and realised in
the 15 years that I'd been outthat this explosion of chronic
disease had just taken over andthat people who were 55 were not
the same as they were 15 yearsprior, that 55 had suddenly
(01:41):
become, you know, the new 75.
It was like what?
And so, on top of all of that,a zillion drugs moving into the
space and us having to knoweverything, and I thought, oh,
this can't be right, I need togo step back and sort of look at
the root cause.
And so I went and retrained asa lifestyle medicine doctor then
(02:04):
, looking at the root cause of alot of our chronic disease
around insulin resistance, andso that then became my little
passion and really talking aboutinsulin resistance, the
management of it with you know,yes, potentially some
medications, but really how canwe improve lifestyle to optimize
that and prevent chronicdisease so that we can live our
glory years having fun yeah?
Sonya (02:26):
absolutely A couple of things I want to ask you in
there what year was this whenyou kind of dipped back into
being a GP after those 15 yearsin defence?
Dr Lucy (02:34):
Yeah, about 2018.
Yes, a little while ago now.
And look like lots of people,you end up in an area because
it's somehow all about you.
So it was, it was all about meand, interestingly, I had spent
an entire lifetime, you know,dieting, going on a diet or
(02:54):
going on a bender.
So I was really good at dieting.
I'm really diligent, reallystrict, good going to the gym,
doing all of the things.
I was either all or then doingnothing, doing nothing and just
eating donuts and everything,until I get to the point where I
think, oh my God, I can't fitinto all my clothes going back
into it.
And that was all fine untilwell, it secretly wasn't that
(03:16):
fine, but I thought it was fineuntil I got to a point where it
sort of wasn't really working.
And then I just thought youknow what I'm sick of this
dieting business.
I'm just going to make peacewith my elastic waist and pants.
You know, my husband stillloves me.
I'm not a bikini model, I don'tneed to worry.
Except then I actually gotpre-diabetes and fatty liver
disease.
Wow, this is not good.
(03:37):
I don't want to be a doctor withpre-diabetes and fatty liver
disease and so, yeah, that wasreally, I guess, part of the
impetus and seeing that, itwasn't just me, it was all the
patients, as well, that washaving this.
Sonya (03:49):
We come from a generation of dieters, don't we?
I remember when I was reading alittle bit about you before we
met and came together to talk,and there was something that you
said that really jumped out atme because I totally resonated
with it, and that was having thefat wardrobe and the thin
wardrobe, which is, you know,that's what you had.
You had the clothes that youwore when you had had those
(04:10):
binge periods and you'd, youknow, got so exhausted by the
dieting.
You know, you had your fatwardrobe and I, as much as I,
have followed a similar path toyou with making peace and just
being so completely exhausted bydieting, not to mention unwell
and not serving me any longer.
But I still find that I holdonto clothes in my wardrobe for
when I fit into them and I have,I catch myself now and go.
(04:33):
No, they can go.
Dr Lucy (04:34):
They can go.
Yeah, yeah, yeah, yeah,absolutely.
And I and I remember, you know,maybe having like going to an
event, maybe a wedding or aformal function, and sort of
praying that the dress will fit,and thinking, oh my god, if it
doesn't fit, what am I going todo?
And you know, then you'd go.
So then you'd, you know, crash,start to try and squeeze into
this dress and, yeah, yeah itwas.
(04:54):
It was totally exhausting and,yeah, at the end of the day,
left me in a situation that was,yeah, you know, yeah, not ideal
from a health perspective no,no, and so I guess that that
then became part of what I, whatI started doing, which was,
yeah, lifestyle medicine aroundmanaging, you know and again, I
use the word weight looselybecause everybody knows the
(05:17):
phrase weight loss but I'mreally talking about metabolic
health, and when we improve ourmetabolic health, weight loss
comes along for the ride as asort of just a little side
effect, but it is not the goalper se.
Sonya (05:30):
Yeah, I love that, that shifting of the goal from being
yes, you'll get some weight loss, you know, like you say, as a
happy side effect.
Dr Lucy (05:37):
But it's not our overarching goal.
Sonya (05:40):
No One of the other questions that I have for you,
and I'd love for you to expandon this, because it's something
that I have recently becomeaware of and I'm really excited
about.
I believe that this is thefuture of healthcare and that is
the lifestyle medicine.
So can you explain for anyonelistening that doesn't
understand the differencebetween medicine and lifestyle
(06:00):
medicine and also what wasinvolved in that upskilling for
you?
Dr Lucy (06:05):
Yeah, absolutely so.
I mean in general medicine, ittreats disease.
So we talk about preventivecare, but it's really even
preventative care.
What we're looking at ismeasuring risk factors and then
working out well, high bloodpressure, that's a risk factor
for cardiac disease.
So the preventative care is totreat the blood pressure.
(06:26):
We are not very good atprescribing lifestyle changes
within the current confines ofour medical system, and there's
lots of reasons for that.
It's usually time-based, as oneof them, but I think for a lot
of doctors, they think lifestyledoesn't work and so they'll
give it lip service and they gooh, yeah, yeah, lifestyle, but
(06:47):
really what they're going toneed is this blood pressure
medication, or what they'regoing to need is you know, or
what they need is weight loss,and then they won't need a blood
pressure medication, whereaslifestyle medicine is a way that
we can not only prevent diseasebut we can actually treat it.
So it includes, you know, knowagain, moving your body, but
(07:07):
moving it in a way that is notactually harmful, because not
all movement is good for us, aswe know.
But so, you know, there'smovement, there's nutrition.
It clearly fundamentalnutrition, and you know, the
reduction of ultra processedfoods would be the number one
thing that we look at and sleep,optimizing sleep, stress.
So there's a whole lot ofpillars which I call we actually
(07:30):
use the little phrase the sixS's for success, so which is
sort of a success successes.
So the six S's, as I rememberthem, are sustenance and that's
just because that is a good wayto fit nutrition in with an S.
So we do sustenance, we dosleep, we do stress management,
we do strength training, we dosunshine and social connection,
(07:54):
I know, and when we can optimisethose, then we absolutely
reduce our risk of furtherchronic disease.
But we can even improve andtreat chronic disease.
So for me it's really about thenbeing able to de-prescribe, so
actually take people off theirmedications is exciting and so,
yeah, so that's sort of how thatstarted.
(08:16):
So, yeah, I went throughthere's the Australasian
Lifestyle Medicine Association,I did their training and I'm now
a fellow of that college.
There's some and again, likeeverything I think there's, it
was initially.
Their nutrition component wasinitially plant-based, and I'm
not plant-based and in fact I'vegot some thoughts around
(08:38):
plant-based nutrition.
I'm an omnivore, very proudomnivore, and so.
But at the end of the day,rather than looking at the
differences, I think that reallywe want to look at, well, where
are the similarities?
And it really is around thatreduction of ultra processed
food.
And then I guess part of thenwhat I did was I thought, well,
(08:59):
it's all very well to have thesesuccesses, you tell people this
is what you need to do andthat's all great, but then
actually the implementation iswhere people fall down.
So the knowledge is step one,but the implementation is step
two.
And so I went and had a look.
I'd already had quite a lot ofpsychological medicine training
as part of my general practice.
Mental health was something Iwas really interested in.
(09:21):
But then I did hypnotherapycourse, which has been again
life-changing and reallyexciting on many fronts, but
also then a whole heap onbehavioral change and
understanding how our brainworks, and then, I guess, being
able to distill science intofunny stories that then people
can relate to and go yes, I cansee that and I can probably do
(09:43):
that now.
Sonya (09:43):
Yeah, that's fascinating.
I am really very interested inlifestyle medicine.
I've got a girlfriend who'sjust started studying herself.
She's a nurse, very highlyqualified, highly experienced
nurse, and she's constantlygoing.
Oh my God, I've just learnedthis, sonia, this is right up
our alley, and I truly dobelieve that this is the way of
(10:05):
the future.
Obviously, there are needs formedical interventions at
different points in time, butlifestyle has to be those
pillars that you talked about.
You know so important, and Ithink, with the way I look at it
is the way that our society hasevolved and where we're kind of
heading, they've become evenmore important to be reminded of
.
Dr Lucy (10:32):
Yeah, absolutely, because the environment that we
live in is not conducive tothose lifestyle pillars.
They don't happen easily, so wehave to, I guess, hijack our
current environment to make themeasier.
It won't happen without someintention.
Sonya (10:43):
Yeah, and it's funny, isn't it?
So even the things like youtalked about the sunshine being
one of them, and the socialconnection they're things that
it sounds a bit wistful, Isuppose.
Sometimes when you kind of go,you know these are things that
our grandparents did and theydidn't think about doing them,
they were just a part of theirlife.
But we do have to actually nowwork at making those things part
(11:04):
of our life.
Dr Lucy (11:05):
Yeah, yeah, because otherwise that won't happen.
Our life is we get up, we go towork in the dark.
If we even go to work, some ofus work from home.
You don't.
You know.
You can have days and dayswithout going outside.
A hundred percent agree, youknow I find myself sometimes
like I'll get up.
Sonya (11:20):
It's now darker in the morning, so I could get up in
the morning.
I can still walk my dog outside, but it might be darker than it
was previously.
Then I go to the gym, which isinside, yes, and then I'll come
home and I will work in front ofmy computer and I have to
remind myself to get up.
Go outside, you know, take awalk, get the sunshine, get the
fresh air, because it is way tooeasy to just spend all your
(11:42):
time inside.
Dr Lucy (11:43):
Totally, totally and again.
And I mean going outside iskind of something that's
relatively easy, like it's notpainful, there's not a lot of
barriers, but we still havetrouble doing it, whereas you
know nutrition, moving your body, they're a bit harder, so you
can imagine the barriers forthat are even more intense.
Sonya (12:03):
You mentioned that addressing metabolic health, and
particularly through the use oflifestyle medicine, can have a
huge impact on chronic disease.
So can you explain what youmean by chronic disease, what
some of those diseases are, andthen we'll kind of dive into
your recommendations aroundavoiding those?
Dr Lucy (12:22):
Yeah, sure.
So again, if we think about,the biggest chronic disease that
we are facing these days istype 2 diabetes and obesity.
So, again, obesity is atriggering word.
I get it.
It's been used as a slur, it'sused as a marker that people are
lazy and gluttonous, and all ofthat.
(12:44):
It's nothing to do with that.
It really is.
It's a condition where, again,our metabolic hormones become
deranged.
Our body becomes very, verygood at storing fat and it
starts storing it in areas thatit was probably never designed
to store, so in particular, inand around our organs.
So we can end up with thingslike fatty liver disease and,
(13:06):
interestingly, fatty every otherorgan disease.
So yeah people hear about fattyliver, but there's fatty
pancreas and fatty heart, andthese also cause separate
diseases in themselves, and whatends up happening then is that
we really accelerate the risk ofcardiovascular disease as well
(13:26):
with some of these conditions,and so people end up having
heart attacks or strokes earlyin life.
With type 2 diabetes, they endup with neuropathies.
They lose their vision.
Other thing that it exacerbatesreally is things like arthritis
, and all of that affects theway we move.
So, at the end of the day, thechronic diseases affect our
(13:49):
functional capacity, and so wecan't do anything like you have
to go, you need a walkie frame,you've got to go to spend your
life going to doctors, togetting pills, potions, hip
replacements, and I kind ofthink, wow, people work hard
their whole life, they workreally hard.
Australians are hardworkingpeople.
They want to enjoy theirretirement, the glory years, as
(14:12):
I call them and yeah, they'recrippled by chronic disease of
varying sorts.
They're taking a lot ofmedications, it's expensive and
that's not how it's supposed tobe.
Yeah, and I guess you know, anda slightly different tact, but
another emerging set ofconditions is autoimmune
(14:33):
conditions, which are separateto these other ones.
So these things that I wastalking about are really related
to insulin resistance.
As the core driver, autoimmune,is separate, highly likely to
be related to our lifestyle, butit is tricky to determine
exactly which part of ourlifestyle because it's going to
(14:53):
be multifactorial.
Sonya (14:54):
And when you're talking about autoimmune disease, can
you give us a couple of examples?
So thyroid, is that somethingthat falls into?
Dr Lucy (15:01):
autoimmune?
Yeah, absolutely, and that wasone of, again, one of my light
bulb things.
When our general practice andintergeneral practice, at that
15 year gap, where, again, justlooking after young people in
defense, young people don't,they don't have chronic disease
usually yet Coming back andgoing, oh, my God, everybody
seems to have Hashimoto's.
What is going on here?
So, yeah, increasingHashimoto's, increasing celiac
(15:25):
disease, and again, some ofceliac is because we've got
better at detecting it, but it'sactually just more prevalent.
They would be the two biggestones that I've seen that are
increasing.
And then you know there'srheumatoid arthritis, but that's
been around for a long time.
It's just the rate at whichwe're getting it now.
Inflammatory bowel diseasewould be another one, wow, okay.
Sonya (15:43):
Yeah, so what I'd like to explore with you and you did
touch on this very briefly howour hormones play a part in some
of this metabolic health and alot of the things that we've
just talked or you've justtalked about.
There are things that we talkabout when it comes to menopause
symptoms and also the impact onour quality of life long-term
(16:05):
post-menopause.
Dr Lucy (16:06):
Yeah, absolutely so, you're right.
I mean, everything I just spoketo about then applies to both
men and women.
And what we have as women andthis is where my interest in
menopause has come in to play isrecognizing that pre-menopause
estrogen in particular what afrigging super hormone that is,
(16:26):
isn't it?
It is it's so protective,cardioprotective, and it's got
so many brilliant propertiesthat then, when it disappears,
it kind of unmasks all of theseother risks into chronic disease
and the thing that I guess thatI see a lot of and is and I've
(16:47):
kind of just coined this phrase,I don't think it's a real
phrase, but I call it themetabolic triad of menopause.
And so what happens is, asestrogen declines estrogen is
really good at being insulinsensitizing.
So as estrogen declines, ourinsulin levels will go up, our
insulin resistance will go up,and as estrogen declines,
(17:10):
interestingly, our cortisollevels will go up.
So these three have a littletribe, because another
interesting thing is that ascortisol goes up, estrogen can
go down as well.
So again, we look at that areain the adrenals, which I know
you're really well educated in,but we always think of estrogen
(17:31):
as just being made in ourovaries and obviously that is
what stops once we hit menopause.
But estrogen is also made inthe adrenal glands, as is
cortisol, and so we have thissituation where if we're making
extra cortisol, for whateverreason lots of stress or a
pathological process well, thatwill cause estrogen to go down.
As estrogen goes down, cortisolgoes up.
(17:52):
So as cortisol goes up, insulingoes up.
So, or a pathological processwell, that will cause estrogen
to go down.
As estrogen goes down, cortisolgoes up.
So as cortisol goes up, insulingoes up.
Sonya (17:56):
So there's this little triad, that kind of-.
There's this real interplaygoing on, isn't there constantly
between cortisol and estrogen.
Dr Lucy (18:02):
Absolutely so, then we can go.
Well, actually, we can helpthis process by again bringing
back lifestyle into it.
Because if we can help thisprocess by again bringing back
lifestyle into it, because if wecan reduce our insulin
resistance with lifestylechanges and look, a powerful
driver is for us.
We advocate a low carbohydratelifestyle.
(18:22):
This is not a no carbohydratelifestyle.
People always go how can youget rid of a whole macronutrient
?
It's like, well, I'm notgetting rid of it, yeah, it's
just reducing it.
So reducing your carbohydratesreally powerful driver of
insulin resistance.
Improving stress managementLike again, I cannot
underestimate the effect ofchronic stress and I think what
(18:47):
people think is that in order tohave a stress-free life, they
need to run away, they need togo off to a tropical island and
you know, then they can't,there'll be nothing to To be
stressed about.
Yeah, exactly, but you know Idon't own a tropical island.
I don't know many people thatdo.
I mean, it sounds reallyappealing.
(19:07):
It does.
It does, although,interestingly, if you go to a
tropical island all by yourself,well then you're dealing with
loneliness, which is another oneof the S's that we have to
measure.
I think we have thisexpectation that the only way we
could be unstressed is to nothave any external stressors, and
so if everything else outsideof our environment was hunky
(19:28):
dory, then we wouldn't bestressed.
But again, that's not realistic.
So it's really looking aroundthe stress cycle and we need to
have periods where there is somestress, because that's normal,
and we also need to have periodswhere we rest, because that's
also normal, and that's howwe're supposed to be.
But women in particular are notvery good at that.
We don't actually ever stop.
(19:49):
We, you know rest is consideredlazy, we're not being
productive, we're not makinggood use of our time, so we fill
up any periods that might wherewe could potentially rest with
and that's conditioning, that'ssocietal conditioning, that and
you know, modeling from familiesas well, probably from previous
generations of women within ourfamilies.
Sonya (20:08):
Yeah, yeah, that's that's created.
We're stuck in that cycle nowaren't we Of that stress cycle?
Dr Lucy (20:17):
Yeah, yeah.
So again, yeah, it's, it'sbeing so, it's so.
It's chronic stress as opposedto acute stress.
Acute stress just meansshort-term high, you know, and
then resolves.
Chronic stress is this lowlevel, but chronically always on
.
So we're always gettingstressed when we don't sleep
properly.
All of those things reallyimpact again that cardiac
metabolic triad.
So that and part of the thingabout the cortisol levels is
(20:39):
that cortisol does increase ourglucose.
It's its job.
One of its jobs is to increaseblood glucose and that was all
designed so that if we needed torun away from something, that
we had enough fuel to do so.
Sonya (20:55):
To do so, yeah, so what we've got then is declining
estrogen, increasing cortisol,increasing glucose, so hence the
insulin.
Dr Lucy (21:06):
Yes, yes, so that's where that side comes from.
It.
Declining insulin increases.
Sorry, declining estrogenautomatically increases insulin
anyway, because it's one of itsthings that it does.
There's some extra componentsin there as well, because we
know that declining estrogen,you know, affects our muscle
(21:26):
mass.
Muscle is our metabolic organ.
The more muscle we have, thelower our insulin.
The less muscle we have, thelower our insulin.
The less muscle we have, thehigher our insulin.
And so there's this hugelycomplex interplay between
estrogen and our metabolichealth, which is why women got
premenopausal women areprotected and then go through
(21:47):
menopause, their cardiac riskfactor skyrocket.
They've got no idea.
No one told them that Suddenlytheir lipids are all over the
place.
They've developed hypertension,they've put on weight around
their belly, they've got fattyliver disease and thinking, holy
hell, what happened?
Yeah, yeah.
Sonya (22:02):
So then, and this is one of the areas that I find really
fascinating so if we talk abouthormone therapy for just for a
moment I know that's not what wecame on to talk about, but one
of the conversations that hasbecome very loud and it's a
really strong narrative now thatis used from clinicians and a
lot of doctors when they'retalking about the benefits of
taking hormone therapy is notjust that immediate symptom
(22:25):
management side of things, butthe longevity impacts, so the
things that we're just talkingabout there, so the healthy
bones and the healthy heart andthe cognitive protection as well
.
So am I right, then, inassuming that if somebody was to
use hormone therapy, so there'sthat hormone top-up, if you
(22:45):
like, that that does also helpprotect against some of these
metabolic diseases that you'retalking about?
Dr Lucy (22:52):
so I think the tricky bit is that initially.
So we've known about this facewith estrogen for a long time.
That's not new news, it's notmy news, it's it's old news.
And then again, back in 2000,women's health initiative study
we all know that.
And they'll give an oralestrogen.
And oral estrogen goes throughthe liver, which increases the
(23:13):
clotting, which is not so greatfor cardiac health and increased
there for the some heartdisease or heart attacks in
women who were already a bitolder.
So this wasn't women in their50s, but women who were starting
this oral estrogen in their 60sand 70s.
So we know that for them thatwasn't ideal.
(23:35):
However, transdermal estrogen myfavorite thing in the world it
has no effect on clotting, noneabove your baseline.
And now we know that,particularly if it started
within 10 years of menopause,that it is cardioprotective.
So those women who startedsomewhere within that 10-year
(23:57):
period will go on to maintaintheir cardiac benefits while
they're taking it.
So the cardiac benefits do stoponce you stop.
So if you're only planning totake it for a few years to
manage your flushes, you're notgoing to get the long-term
benefits from it, and we knowthe same is true with bone
health.
The same is probably orpossibly going to be true for
(24:21):
brain health, and it seems to belikely, but there's just not
the data yet.
But it's promising.
Sonya (24:29):
But I think, coming back to what we did come on to talk
about, is that, even forsomebody who does choose to use
hormone therapy, that theseother pillars that you're
talking about need to also beconsidered.
So the two things need to gohand in hand.
That you, you know.
I think one of the things weneed to always talk about if
someone is taking hormonetherapy is that it's not a
silver bullet.
And, yes, you do get thatestrogen protectiveness back,
(24:52):
but you must also be addressingthe lifestyle factors that
you're talking about as well.
Dr Lucy (24:58):
Yeah, absolutely.
And again, my favourite thingis it's not this or that, it's
this and that, and thatsometimes taking MHT or HRT can
help you implement yourlifestyle factors, because
suddenly your joints aren't sosore.
Sonya (25:12):
So you're happy to go.
You're sleeping better, you'vegot a bit more energy, yeah.
Dr Lucy (25:15):
Yes and again.
You know, because life's alwaysyou know all about me or
whoever's talking For me.
Part of my interest inmenopause became again when,
despite doing all my lifestylestuff, having been the world's
best sleeper and rarely stressed, I started getting hot flushes.
Not hot flushes during the day,night sweats, night sweats,
(25:36):
waking up at 3am thinking whatam I doing awake.
And then, interestingly, I wokein the morning with just this
ridiculous anxiety in the pit ofmy stomach.
It'd be like I'd wake up goingand I think what am I worried
about?
What's going on?
What am I worried about?
Be like I'd wake up going and Ithink, what am I worried?
about what's going on.
What am I worried where?
And I'd have to do this littletalk myself off the going.
Well, there's nothing worrying,don't need to worry.
And so I thought, oh my god,I've got menopause.
(25:59):
Well, actually, I didn't thinkmenopause at first.
I thought, oh my god, I must beworried about.
You know, I'm now a businessowner.
I'm worried about the businessI must be worried about about
something, and it was really thenight sweats that I needed the
treatment for.
I thought I needed a treatmentfor.
So I got treatment for that andwow, amazingly, I also started
to sleep a bit better and theanxiety went away.
(26:21):
And that's when I've gone, ohmy God.
Sonya (26:22):
And I find these conversations so fascinating
when they're with cliniciansbecause the amount of stories
that I hear from doctors,specialists, nurses, that all
had their own experience, likeyou, where they had all sorts of
symptomology and then themenopause, and then they realize
that hang on a second, yeah,and you kind of go and this is,
(26:44):
you know.
This leads us into an area thatis where I'm so um prominent
with my voice is like if youdidn't know, yeah, how the hell
were we supposed to know what'sgoing on?
Dr Lucy (26:57):
I know, I know, and again it's like you know, you
feel like such a goose.
I'm thinking, oh my god, I'm so, how?
How could I have been so, Idon't know stupid or blind, or
thick.
I'm thinking, oh, anyway, I'mnow more like.
Now.
I feel like I'm thick.
I'm thinking, oh anyway, I'mnow more like.
Now.
I feel like I'm vigilant, likeI'm on this menopause oh my God,
you know you've got itchy skin.
Oh, it's probably menopause,but yeah, the thing is that it
(27:24):
probably is.
Yeah, I think now it's.
I think back, and you know,again I've got another patient I
can remember prominently abouther.
She came again because I'd setmyself up as a weight management
clinic and metabolic healthclinic and she was coming to me
to talk about her weight and shewas just talking about her bone
(27:45):
, her fatigue, and she said Ifeel so weak, I'm so tired and I
just don't feel strong.
And I sort of thought, oh, I'vegot an idea what's going on.
I feel so weak, I'm so tiredand I just don't feel strong.
And I sort of thought, oh, I'vegot an idea what's going on.
I don't know.
Let's just keep talking aboutlifestyle and talking, talking,
talking.
She was doing, doing, doing.
But she honestly just had suchterrible fatigue and she told me
(28:06):
she goes.
Oh, I went and saw a menopausedoctor, Dr Ginny.
This is back in 2018.
And I'm thinking, oh right, andI knew nothing about menopause,
dr Ginny and I go okay, that'sgood, she goes.
Oh, she's put me on some youknow testosterone.
And I'm going, oh gosh, anyway,she found a million bucks.
And so now I'm thinking I justdidn't know, I didn't know about
(28:28):
it then, and you don't knowwhat you don't know.
No, no.
So now I'm sort of going radio,okay.
So I guess you know.
So I do.
I totally love estrogen.
I think estrogen is fantastic.
Progesterone I have a fewdifferent ideas, perhaps to some
other people around it, becauseprogesterone unfortunately, it
can cause insulin resistance.
(28:48):
Okay, I haven't heard thatbefore.
No, well, progesterone is.
So its main job is to balancethe lining of the uterus and
stop it becoming gigantic.
And then its other job is inpregnancy.
So its job is to maintain thecorpus luteum, or the little
cyst, the fetus, when it's firsta fetus and then over time it
(29:10):
maintains the pregnancy and it'sthe thing that causes women to
store fat when they're pregnant.
So for women that, particularlyif they're genetically
predisposed to insulinresistance so maybe they have
polycystic ovarian syndrome ormaybe their parents have type 2
diabetes they can stack on tonsof weight in pregnancy.
(29:32):
And again, it's all about me.
This happened to me inpregnancy.
I was a person and I went offto my exercise.
I did my bloody thing on theball that you do Pilates all the
pregnancy exercises.
I'm eating well, I'm not havingmy moldy cheese, I'm not eating
sushi.
I'm doing all the right things.
(29:52):
And you probably stoppeddrinking as well, yeah, oh, yeah
, god, yeah, no, no alcohol,yeah, 35 kilos again in
pregnancy and I was like holyhell.
Interestingly, I didn't havegestational diabetes back then.
If I was having my glucose testnow I would have, because the
criteria has changed, yeah, soso again, it's progesterone is
(30:17):
the thing that is the, andprogesterone comes from your
placenta, so it's the thing thatthen causes your body to store
fat.
It's the thing that produces agestational diabetes.
As soon as the placenta's out,everything reverts to normal.
So it is one of the reasons why, when in menopause, then, women
are starting to gain weight isbecause they're losing their
estrogen, but their progesteronestays around a bit longer.
(30:40):
It does, yeah, yeah, and forsome women, the progesterone
component of their MHT can stillcause them to store body fat.
Sonya (30:49):
Okay, but we need to weigh that obviously against the
risk of uterine cancer.
Dr Lucy (30:55):
Absolutely.
I'm not saying don't takeprogesterone, Absolutely not
Okay cool.
So there's a couple of thingsthat we can do, though, so,
first of all, if you don't havea uterus, well then, you don't
have to take progesterone foryour uterus, but the other thing
that we need to balance, then,though, is that, for some women,
progesterone is helpful forsleep.
Sonya (31:16):
It's that chill hormone as well, isn't it?
So it can take the edge offanxiety.
It can take that.
Help with that sleep, yeah.
Yeah, it can, she's a trickylittle sucker then, isn't she?
It is.
Dr Lucy (31:27):
It is a little yeah, and again, I've also seen women
who start their progesterone andactually can make them anxious.
So it doesn't, it's notsedating for everybody.
So I think for me this, andagain, this is everyone's
different, but my kind of way Ilike to manage progesterone is
to try and keep it local ifpossible.
So again, that might be aMirena, it might be just using
(31:49):
Prometrium vaginally, vaginally,yep, and that will keep it
local and that is less than ofan effect on your insulin
resistance.
Balancing that up with thesleep side of things.
But I think also sometimespeople and again there's a
little bit of chat amongst insome of the Facebook groups
(32:09):
around the you know the benefitsof progesterone and so they're
using it for the sleep,potentially before the estrogen
is optimized.
So and again this is justlooking for me personally and
some of my patients are theyneed a bit more estrogen first.
So estrogen, again, you know,probably too much information
(32:29):
sharing here, but I've had ahysterectomy so I didn't need
the progesterone.
Sonya (32:32):
Progesterone yep.
Dr Lucy (32:33):
So I've just plonked my estrogen up a little bit.
Add a little bit oftestosterone and I'll sleep like
a baby again.
Sonya (32:40):
Okay, yeah, testosterone can be the missing key for a lot
of people and unfortunately itis a.
How do we?
How do we phrase this?
It's a tricky area right now,with some conflicting views on
whether testosterone should beprescribed or not as a part of
hormone therapy, but I believethat what I've been told and
(33:03):
what I've read is that there's alot of anecdotal evidence and
there is some research underwayto show that there can actually
be some benefits for women withtestosterone, particularly, like
you say, on the sleep andthings like that and the
cognitive function as well andmuscle mass, because
testosterone is good for muscle.
Dr Lucy (33:23):
Yeah, absolutely.
And so yeah again, I kind of inmy head just about every
post-opausal woman is hyposexualdysphoria disorder, hsdd,
that's if you have that, that'syour, that's the tga approved
use of testosterone yeah, butyou know again, as doctors we
use a lot of medications offlabel, a lot you know for and
(33:45):
for lots of things you know we,we will use um I'm going to give
a great example there.
Sonya (33:52):
I was prescribed antidepressants not because I
was depressed, but because I hadhot flushes as a result of my
radiotherapy and chemotherapy,and that was an off-label use of
the antidepressant.
Dr Lucy (34:04):
Absolutely, and we will use antidepressant, a different
one to those ones.
We use that for bed wetting inchildren.
Wow, I know that's a bitoff-label.
There's lots of things that weuse off-label, but they don't
come with the same controversythat testosterone comes with.
So I kind of think, again, youneed to understand how to use it
(34:27):
.
You need to know the guidelines, not the guidelines.
You need to know the risks.
You need to understand how touse it.
You need to know the guidelines, not the guidelines.
You need to know the risks.
You need to know the benefits.
You need a discussion, but itcan certainly be prescribed
safely.
Sonya (34:36):
Yeah, hmm, yeah, most of my listeners are curious,
obviously, about all the thingsthat they can do to improve
their longevity, their qualityof life and, you know, symptom
management from a short-termperspective as well.
So, lucy, let's talk aboutweight loss, because I think
that that is absolutely a hottopic for so many women in this
(35:00):
space and there are a lot ofoptions at the buffet table when
it comes to weight loss.
Now we have injectables thathave become a new player, but
also a very, very prominentplayer.
We have the old diet regimestill rearing its ugly head.
(35:23):
You know the eat less, exercisemore life deprive, deprive.
As a demographic, we areabsolutely hammered with options
to solve our belly fat, tosolve our meno belly.
There's some awful marketingout there.
Tell me, from your perspective,what you have found to be the
(35:47):
and obviously I'm imagining it'svery nuanced for everybody that
you see as a patient but whatdo you find has the best results
and why?
Dr Lucy (35:54):
Yeah, absolutely Great question, and I think that
you're right.
There's not only many optionsat the buffet table, there's
also many opinions on how youshould do it.
Everyone's an expert.
At the end of the day, it isway more complex than we've been
led to believe and that thereis no simple solution.
And anyone that's offering youa simple solution is just trying
(36:15):
to sell you something, becauseit is a complex interplay of
metabolic hormones.
A complex interplay ofmetabolic hormones, insulin
resistance and again, I loveinsulin.
(36:36):
Insulin resistance is at theheart of fat storage, and the
way I like to describe it is ifwe imagine that our body is a
bit like a house and we'retrying to heat it with a
fireplace.
So when you're heating afireplace, put some kindling in
a little stick, some paper.
You then put some logs on tokeep it going.
Our fuel is very much like that.
So our kindling is glucose,which is short-acting
carbohydrates, and that gives usenergy and that's all lovely,
(36:59):
and then we should probably putsome fat on and that will.
What is our long storage andthat keeps us going and fuelled
for hours.
What happens with insulinresistance is that, you know, in
our fireplace there's no actuallogs available.
They're in a woodshed, storedout the back and they're not
neatly stored.
(37:19):
And you know, some people havea very large woodshed and it's
got lots of wood in it and sotheir body.
You toddle out to the woodshedto try and get a log to put on
your fire and the woodshed'slocked and the lock big padlock,
and the lock is insulin.
So I didn't know this.
Another thing I didn't know,god knows what I was doing in
medical school.
I didn't know that insulinstops fat breakdown.
(37:43):
So if you have high bloodinsulin, you can't break down
your fat.
And it was like what?
And so it's like you go to thewoodshed, you go to get a log,
the log's locked away, so youcome back to your fireplace.
(38:04):
By now you're hungry, you'repretty tired, you're a bit
cranky and your brain startsgoing oh, my God, you've got to
eat, you're starving.
And it starts really tellingyou that you need some fuel,
because by now there's only afew embers.
And so, honestly, you're nowstarting to think well, I'll get
some coffee and I'll get youknow, and you grab something
quick, a muesli bar, a chocolatebar, whatever you can get,
because your brain actuallyneeds some fuel.
And so then it goes oh, thankGod, and then you're fine for
(38:25):
again another hour.
You still can't get a log.
So you're constantly having toeat these six small meals a day,
or snacks or whatever it is tokeep your body fueled long
enough all day.
And so it wasn't until, honestly, I just thought, really so it
wasn't until I realized that youactually need your insulin
levels to get to a certain lowpoint in order for your body to
(38:48):
be able to access that woodchip,the stored fat, to burn it.
So we really need to have lowenough insulin to access your
fat.
So how do we do that?
Well, again, insulin is raisedin response to glucose.
So if we can lower the amountof blood glucose we use, so
(39:11):
lower the amount of kindlingessentially which sounds weird.
You're thinking, why would youdo that?
And this is where you startincreasing your dietary fats.
So again, as an ex-dieter, I wasalways scared of fat.
I had years of Vegemite, yeah,yeah.
Or even dry toast with Vegemite, because that was low calorie
(39:33):
and low fat.
Yeah, yeah, yeah.
And those horrible diet yogurtsthat were somehow lemon
cheesecake flavored but madewith chemicals.
All of that, no fat in any ofthat.
So again, no, no fuel.
Whereas now you go okay, well,you can add, add some fat back
in, add some fuel back in, andthen, over time, what happens is
your blood insulin levels willlower and you suddenly have
(39:55):
access to your own stored bodyfat and this miraculous thing
happens where you're notactually hungry that's like,
really I'm not hungry, what andit's because suddenly your body
has access to its own fuel againand it will start using it and
you go oh, thank God.
And so really, that reducinginsulin is the number one thing
(40:15):
that needs to be done for peoplethat are insulin resistant or
have hyperinsulinemia, which forpeople that are overweight,
that's the majority of us.
Sonya (40:22):
Okay, and is that identified through a blood test?
Dr Lucy (40:32):
Yeah, you can certainly have a blood test, but there
are a few kind of hallmarks thatmight come in.
So if you have lots of skintags, so skin tags under your
arm, under your boobs, aroundyour neck, again, everyone might
have a couple.
So one or two is no big deal,but if you have a lot, that's
usually a sign of insulinresistance.
Yeah, if you have ever hadgestational diabetes or
polycystic ovarian syndrome, youwill have had insulin
resistance.
If you store the majority ofyour fat around your belly, then
(40:56):
that is usually insulinresistance.
And then there's this slightlyunusual, more advanced sign,
which is something calledacanthosis nigricans, which is
patches of pigment that happenunder your arms or in your groin
.
So you'll be, you'll have thesesort of dark patches under your
arms groin, sometimes aroundyour neck, some people on their
forehead or forearms.
So they're all signs of insulinresistance.
(41:17):
And then you know pre-diabetes,type 2 diabetes.
They're all diseases of insulinresistance.
Sonya (41:31):
Wow, my brain is firing off in all sorts of different
directions because I'm seeingall these connections between so
we talked right at the verystart about decreasing estrogen,
increasing cortisol and thenthat increasing your glucose,
which is obviously going to playinto that insulin, insulin yes
lock on the on the firewood door.
Yeah, and you know, and so weknow then, and you know, and
(41:54):
also that shifting of weightbeing stored in the body to
around the belly.
You know, if we just look atthat, so cortisol stress
shifting weight to the bellyvery much.
We just look at that, socortisol stress shifting weight
to the belly very much.
Menopause symptoms.
Dr Lucy (42:08):
Yeah, absolutely Absolutely.
And when people go, I don'tknow if that's true.
All we have to do is look at,if I prescribe cortisone to
somebody for their asthma ormeasuring something, if they're
not long enough, what do theyget?
Belly fat and type 2 diabetesand, interestingly, osteoporosis
.
So a whole heap of thingsrelated to their cortisol and
(42:31):
cortisone.
They're the same thing.
If we give insulin to somebodywho has type 2 diabetes, they
gain weight.
And doctor's advice my adviceused to be it was so
embarrassing again oh, make sureyou don't gain weight.
It's like what?
Like that was it.
Make sure you don't put on toomuch weight.
Sonya (42:50):
I got told that at my cancer diagnosis it was between
being diagnosed and my treatmentstarting I went and saw a nurse
at the centre where I was goingto be having my chemo.
It was at the private hospitalwhere I was treated, so it was
this cancer center, I guess, andI don't remember a lot about
the appointment, but I doremember her saying to me
(43:11):
whatever you do, don't put onany more weight.
And at the time I was like,well, I'm totally screwed,
because I've, since getting mydiagnosis, I've eaten a block of
chocolate and drunk a bottle ofwine pretty much every day, and
you know, I know that I've puton weight just through stress.
So that was horrifying and ithas stuck with me as one of the
pieces of advice that I wasgiven at such a traumatic time
(43:34):
in my life.
Dr Lucy (43:35):
Yeah, absolutely.
And I mean, you know, I think,to break that down, there's
multiple reasons why people willput on weight.
So one, you know one might beyeah, well, you're eating.
You're eating chocolate andalcohol.
There is no point saying tosomebody who is distressed just
don't do that, like that's,that's unhelpful, that's a
coping mechanism.
Half the time, yeah, so you'rebasically pulling out their
(43:58):
coping mechanism and notnecessarily giving them any
others.
Second thing, of course, ofcourse, is we know that and
again, I don't know whattreatment you have, but lots of
people have dexamethasone aspart of their chemotherapy.
Wow, that's cortisone.
Sonya (44:11):
So lots of people will gain weight on top of all of
that, and I took steroids aswell, prior to my each chemo
treatment.
I mean, I have photos of myselfwith this massive moon face.
Honestly, my face was like thatproverbial full moon, and it
was the steroids.
Dr Lucy (44:28):
Yeah.
And the cortisol is a steroid.
Yeah, so I think.
And then, on top of that youknow, suddenly your estrogen's
gone, like all the reasons whyyour body is going to start
storing extra fat, but the?
Sonya (44:40):
advice is Don't put on any more weight.
Dr Lucy (44:42):
It's like saying to you don't breathe, don't breathe.
So yeah, I know I'm slightlymodified to have given rubbish
advice like that too, but again,I think you know it's what,
what, what people do like what,what people eat, how they sleep,
all of that's really important.
But but if, again, if theycan't implement or don't know
(45:03):
how to implement it consistently, again people don't have skills
.
They often think the reasonthey can't do it is they're weak
, they haven't got any willpower.
You know they're notdisciplined.
Sonya (45:13):
Especially for a generation that does come from
the diet culture yeah, wherethat's pretty much what you've
been led to believe.
They're like you diet which isnever good for you, and yet then
you fail and leave.
They're like you diet which isnever good for you, and yet then
you fail, and then that's like,well, it's your fault, you
didn't stick to the diet, or youobviously ate too much or you
didn't do enough exercise.
Dr Lucy (45:31):
Totally.
I mean and again, we got soldthis you will lose one kilo a
week and you will do thisterribly hard thing for 12 weeks
.
You'll lose your 12 kilos oryour 10 kilos or whatever you
get, you'll get to goal.
Then you'll go to maintenance,and the maintenance, the promise
of maintenance, was more food.
Yay, and honestly, it's just,it's just garbage.
It's so not how it should work,but to to be honest, there are
(45:55):
some people who do have troubleimplementing a lower carb
lifestyle, and it's not the onlyway to reduce your insulin
resistance by any stretch.
I'm not the the.
I recognize there's a number ofways to do it, but I think
taking, looking at processedfood and the way processed food
is marketed to us, uh, the wayit is produced, the way it is
sold to us, the way we haveconsumed it, and understanding
(46:18):
that there is quite an addictivecomponent to that is really
important as well.
And again, you, you know, forsome people I have this we talk
often about the three buckettheory of addiction.
The three buckets are there'sthe first bucket of the people
who don't really care about thesubstance.
So they'll be the people thatyou know have one glass of wine
once a year.
(46:38):
Or a glass of champagne at awedding.
They might put a raffle ticketon, they might have cake, you
know, once in a blue moon.
They really don't care about it.
They take it or leave it.
The next bucket are the peopleof the heavy users.
So they're people that might,you know again, they might be
drinking three or four nights aweek.
They don't realize it'spotentially a problem, it's not
impacting them that much, butit's probably more than ideal.
(47:01):
It's the same with, you know,the gambling.
These are my like, particularlyyoung men these days, who are
all encouraged to bet with matesand, you know, they're spending
a significant amount, part oftheir income, on gambling.
And it might be people who are,you know, eating.
Every time they get stressedthey eat, or every time they're
bored they eat.
So they're probably overeating.
(47:23):
And then you've got the thirdbucket, which is actually
probably the really intense sortof addiction.
So people who, even withgambling, they've lost their
house, alcohol, their marriagehas declined.
They still can't do it.
And I see it.
People with type 2 diabetes orsignificant health complications
who still can't stop theirchocolate addiction or just for
(47:46):
whatever reason.
Well, lots of underlyingreasons can't quite change, and
so what happens is that again,people, the processed food
company in particular, it'sgiving people who are in the
third bucket.
It tells them all the reasonswhy they should have this.
You know, have this a Sn theset.
You're not yourself without asnickers, you know it's a party,
(48:07):
it's a celebration.
You must have chocolate yes, ifyou're lonely, if you're crying
on the bus, some little boy willgive you chocolate.
That's the current cabri's ad.
You know it's all about, um,emotions and feelings and they
play to that and and then theysay, oh no, we didn't tell you
to eat a block a day, like youknow you don't.
You shouldn't be that, youshould be like the other person
(48:30):
who just does it once a year,like that's not our fault, and
so they take zero responsibilityin the problem that they've
created.
And so I guess the thing thatcertainly when I started, was I
was a little bit naive, likelots of us, but maybe when we
start and then over time, withmore and more experience, I
realized there is actually areally narrow little minefield
(48:52):
that you have to navigatebetween diet culture and you
know many of us feeling shameand guilt for not being able to
implement some of the things, oryou know, the whole falling off
the wagon or any of that versusthis real phenomenon that the
processed food industry isabsolutely trying to get you
(49:12):
stuck into their food hook lineand sinker and anyone who says
that you can eat that inmoderation.
Not everyone can, and so it'sabout working out in there all
the other things.
Sonya (49:24):
I think what you've really wrapped up today is that
metabolic health, weight gainversus weight loss it's very
complicated, it's very nuanced,it's psychological, it's
physiological.
I think what you've done hasproven exactly why there can't
be one fix that's going to workfor everyone.
Dr Lucy (49:46):
And we haven't even talked about the GLP-1s and
where they fit into it.
They absolutely have a role.
They absolutely do.
However, I think that there isthis phrase and I really loved
it.
I saw it somewhere on LinkedIn.
It's not my phrase, but I'mgoing to borrow it called
careless prescribing, which iswhere people have prescribed
this, but without the whole uh,they're not given full knowledge
(50:08):
of their side effects.
They're not given had adiscussion around how, how long
you need to take it for how, howdo you come off them?
What happens if you come offthem?
How, what dose you know?
Like none of that.
And then, on top of that, againa bit like we mentioned earlier
with mht and hrt, it's not in.
It's not in isolation.
(50:29):
If you just do this inisolation, then the the problem
is is certainly not fixed.
It's just another piece,another tool yeah.
Sonya (50:38):
So uh say it's a very large buffet, yeah, with um.
You know a lot of people at theparty that are trying to tell
you why you should eat theirdish that they made that's on
the buffet table, yeah.
But yeah, take it all with agrain of salt and understand
that there is a lot at play herefrom a hormone perspective.
(50:59):
You know, like you say, what'shappening with your insulin,
what's your stress levels,what's causing all of that?
Yeah, it is a very big pictureand it's not a simple one-stop
fix.
Lucy, if anybody wants tounderstand more about what you
do, how you work with women, inparticular in this midlife phase
of life, how do you help people?
Dr Lucy (51:18):
Yeah, yeah, thank you.
I run a company called RealLife Medicine with my beautiful
colleague, dr Mary, and withthat we have online membership
and programs really around thephysiology and the psychology of
weight management and lovely,beautiful, supportive community,
very safe and trauma-informedcare and all the things I think
that are lovely.
(51:39):
And then again recognizing thatsome people need some more
nuanced and individual care, andso I run a telehealth platform
as well and that's called RLMTelehealth, so they can find us
on all the socials at Real LifeMedicine, or our website is
rlmedicinecom.
Sonya (51:58):
Beautiful, and I will link through in the show notes
to all of those wonderful placeswhere people can get in contact
with you.
Lucy, it's been such a pleasure.
Thank you so much for sharingso much of your wisdom with us.
There's a lot to take away fromtoday's episode.
Dr Lucy (52:13):
Well, thank you very much for having me.
It's been delightful.
Welcome to the Dear Menopause podcast.
I'm Sonya Lovell, your host Now.
I've been bringing youconversations with amazing
menopause experts for over twoyears now.
If you have missed any of thoseconversations, now's the time
to go back and listen, and youcan always share them with
anyone you think needs to hearthem.
This way, more people can findthese amazing conversations,
(00:25):
needs to hear them.
This way, more people can findthese amazing conversations.
Welcome to this week's episodeof Dear Menopause.
I am delighted to be joinedtoday by Dr Lucy Burns.
Dr Lucy (00:34):
Lucy, welcome to the show, Sonya.
Thank you so much for having me.
It's an absolute delight.
Sonya (00:37):
It's always a pleasure to have like-minded smart women on
the podcast, and I know myaudience are going to love what
we're going to talk about today,which is predominantly
metabolic health.
So, Lucy, before we do that,why don't you share a little bit
about who you are and what?
Dr Lucy (00:55):
you do Absolutely.
So my name's Lucy, I'm a medicaldoctor in Australia and I
started my life off as a GP andthen, interestingly, toddled off
.
I worked for Defence for a longtime, which sort of sounds weird
, but it suited me that we livenear a Defence base.
And so I stepped out of generalpractice and saw mainly young
(01:17):
people, came back into generalpractice and saw the older
population, sort of midlife andbeyond beyond, and realised in
the 15 years that I'd been outthat this explosion of chronic
disease had just taken over andthat people who were 55 were not
the same as they were 15 yearsprior, that 55 had suddenly
(01:41):
become, you know, the new 75.
It was like what?
And so, on top of all of that,a zillion drugs moving into the
space and us having to knoweverything, and I thought, oh,
this can't be right, I need togo step back and sort of look at
the root cause.
And so I went and retrained asa lifestyle medicine doctor then
(02:04):
, looking at the root cause of alot of our chronic disease
around insulin resistance, andso that then became my little
passion and really talking aboutinsulin resistance, the
management of it with you know,yes, potentially some
medications, but really how canwe improve lifestyle to optimize
that and prevent chronicdisease so that we can live our
glory years having fun yeah?
Sonya (02:26):
absolutely A couple of things I want to ask you in
there what year was this whenyou kind of dipped back into
being a GP after those 15 yearsin defence?
Dr Lucy (02:34):
Yeah, about 2018.
Yes, a little while ago now.
And look like lots of people,you end up in an area because
it's somehow all about you.
So it was, it was all about meand, interestingly, I had spent
an entire lifetime, you know,dieting, going on a diet or
(02:54):
going on a bender.
So I was really good at dieting.
I'm really diligent, reallystrict, good going to the gym,
doing all of the things.
I was either all or then doingnothing, doing nothing and just
eating donuts and everything,until I get to the point where I
think, oh my God, I can't fitinto all my clothes going back
into it.
And that was all fine untilwell, it secretly wasn't that
(03:16):
fine, but I thought it was fineuntil I got to a point where it
sort of wasn't really working.
And then I just thought youknow what I'm sick of this
dieting business.
I'm just going to make peacewith my elastic waist and pants.
You know, my husband stillloves me.
I'm not a bikini model, I don'tneed to worry.
Except then I actually gotpre-diabetes and fatty liver
disease.
Wow, this is not good.
(03:37):
I don't want to be a doctor withpre-diabetes and fatty liver
disease and so, yeah, that wasreally, I guess, part of the
impetus and seeing that, itwasn't just me, it was all the
patients, as well, that washaving this.
Sonya (03:49):
We come from a generation of dieters, don't we?
I remember when I was reading alittle bit about you before we
met and came together to talk,and there was something that you
said that really jumped out atme because I totally resonated
with it, and that was having thefat wardrobe and the thin
wardrobe, which is, you know,that's what you had.
You had the clothes that youwore when you had had those
(04:10):
binge periods and you'd, youknow, got so exhausted by the
dieting.
You know, you had your fatwardrobe and I, as much as I,
have followed a similar path toyou with making peace and just
being so completely exhausted bydieting, not to mention unwell
and not serving me any longer.
But I still find that I holdonto clothes in my wardrobe for
when I fit into them and I have,I catch myself now and go.
(04:33):
No, they can go.
Dr Lucy (04:34):
They can go.
Yeah, yeah, yeah, yeah,absolutely.
And I and I remember, you know,maybe having like going to an
event, maybe a wedding or aformal function, and sort of
praying that the dress will fit,and thinking, oh my god, if it
doesn't fit, what am I going todo?
And you know, then you'd go.
So then you'd, you know, crash,start to try and squeeze into
this dress and, yeah, yeah itwas.
(04:54):
It was totally exhausting and,yeah, at the end of the day,
left me in a situation that was,yeah, you know, yeah, not ideal
from a health perspective no,no, and so I guess that that
then became part of what I, whatI started doing, which was,
yeah, lifestyle medicine aroundmanaging, you know and again, I
use the word weight looselybecause everybody knows the
(05:17):
phrase weight loss but I'mreally talking about metabolic
health, and when we improve ourmetabolic health, weight loss
comes along for the ride as asort of just a little side
effect, but it is not the goalper se.
Sonya (05:30):
Yeah, I love that, that shifting of the goal from being
yes, you'll get some weight loss, you know, like you say, as a
happy side effect.
Dr Lucy (05:37):
But it's not our overarching goal.
Sonya (05:40):
No One of the other questions that I have for you,
and I'd love for you to expandon this, because it's something
that I have recently becomeaware of and I'm really excited
about.
I believe that this is thefuture of healthcare and that is
the lifestyle medicine.
So can you explain for anyonelistening that doesn't
understand the differencebetween medicine and lifestyle
(06:00):
medicine and also what wasinvolved in that upskilling for
you?
Dr Lucy (06:05):
Yeah, absolutely so.
I mean in general medicine, ittreats disease.
So we talk about preventivecare, but it's really even
preventative care.
What we're looking at ismeasuring risk factors and then
working out well, high bloodpressure, that's a risk factor
for cardiac disease.
So the preventative care is totreat the blood pressure.
(06:26):
We are not very good atprescribing lifestyle changes
within the current confines ofour medical system, and there's
lots of reasons for that.
It's usually time-based, as oneof them, but I think for a lot
of doctors, they think lifestyledoesn't work and so they'll
give it lip service and they gooh, yeah, yeah, lifestyle, but
(06:47):
really what they're going toneed is this blood pressure
medication, or what they'regoing to need is you know, or
what they need is weight loss,and then they won't need a blood
pressure medication, whereaslifestyle medicine is a way that
we can not only prevent diseasebut we can actually treat it.
So it includes, you know, knowagain, moving your body, but
(07:07):
moving it in a way that is notactually harmful, because not
all movement is good for us, aswe know.
But so, you know, there'smovement, there's nutrition.
It clearly fundamentalnutrition, and you know, the
reduction of ultra processedfoods would be the number one
thing that we look at and sleep,optimizing sleep, stress.
So there's a whole lot ofpillars which I call we actually
(07:30):
use the little phrase the sixS's for success, so which is
sort of a success successes.
So the six S's, as I rememberthem, are sustenance and that's
just because that is a good wayto fit nutrition in with an S.
So we do sustenance, we dosleep, we do stress management,
we do strength training, we dosunshine and social connection,
(07:54):
I know, and when we can optimisethose, then we absolutely
reduce our risk of furtherchronic disease.
But we can even improve andtreat chronic disease.
So for me it's really about thenbeing able to de-prescribe, so
actually take people off theirmedications is exciting and so,
yeah, so that's sort of how thatstarted.
(08:16):
So, yeah, I went throughthere's the Australasian
Lifestyle Medicine Association,I did their training and I'm now
a fellow of that college.
There's some and again, likeeverything I think there's, it
was initially.
Their nutrition component wasinitially plant-based, and I'm
not plant-based and in fact I'vegot some thoughts around
(08:38):
plant-based nutrition.
I'm an omnivore, very proudomnivore, and so.
But at the end of the day,rather than looking at the
differences, I think that reallywe want to look at, well, where
are the similarities?
And it really is around thatreduction of ultra processed
food.
And then I guess part of thenwhat I did was I thought, well,
(08:59):
it's all very well to have thesesuccesses, you tell people this
is what you need to do andthat's all great, but then
actually the implementation iswhere people fall down.
So the knowledge is step one,but the implementation is step
two.
And so I went and had a look.
I'd already had quite a lot ofpsychological medicine training
as part of my general practice.
Mental health was something Iwas really interested in.
(09:21):
But then I did hypnotherapycourse, which has been again
life-changing and reallyexciting on many fronts, but
also then a whole heap onbehavioral change and
understanding how our brainworks, and then, I guess, being
able to distill science intofunny stories that then people
can relate to and go yes, I cansee that and I can probably do
(09:43):
that now.
Sonya (09:43):
Yeah, that's fascinating.
I am really very interested inlifestyle medicine.
I've got a girlfriend who'sjust started studying herself.
She's a nurse, very highlyqualified, highly experienced
nurse, and she's constantlygoing.
Oh my God, I've just learnedthis, sonia, this is right up
our alley, and I truly dobelieve that this is the way of
(10:05):
the future.
Obviously, there are needs formedical interventions at
different points in time, butlifestyle has to be those
pillars that you talked about.
You know so important, and Ithink, with the way I look at it
is the way that our society hasevolved and where we're kind of
heading, they've become evenmore important to be reminded of
.
Dr Lucy (10:32):
Yeah, absolutely, because the environment that we
live in is not conducive tothose lifestyle pillars.
They don't happen easily, so wehave to, I guess, hijack our
current environment to make themeasier.
It won't happen without someintention.
Sonya (10:43):
Yeah, and it's funny, isn't it?
So even the things like youtalked about the sunshine being
one of them, and the socialconnection they're things that
it sounds a bit wistful, Isuppose.
Sometimes when you kind of go,you know these are things that
our grandparents did and theydidn't think about doing them,
they were just a part of theirlife.
But we do have to actually nowwork at making those things part
(11:04):
of our life.
Dr Lucy (11:05):
Yeah, yeah, because otherwise that won't happen.
Our life is we get up, we go towork in the dark.
If we even go to work, some ofus work from home.
You don't.
You know.
You can have days and dayswithout going outside.
A hundred percent agree, youknow I find myself sometimes
like I'll get up.
Sonya (11:20):
It's now darker in the morning, so I could get up in
the morning.
I can still walk my dog outside, but it might be darker than it
was previously.
Then I go to the gym, which isinside, yes, and then I'll come
home and I will work in front ofmy computer and I have to
remind myself to get up.
Go outside, you know, take awalk, get the sunshine, get the
fresh air, because it is way tooeasy to just spend all your
(11:42):
time inside.
Dr Lucy (11:43):
Totally, totally and again.
And I mean going outside iskind of something that's
relatively easy, like it's notpainful, there's not a lot of
barriers, but we still havetrouble doing it, whereas you
know nutrition, moving your body, they're a bit harder, so you
can imagine the barriers forthat are even more intense.
Sonya (12:03):
You mentioned that addressing metabolic health, and
particularly through the use oflifestyle medicine, can have a
huge impact on chronic disease.
So can you explain what youmean by chronic disease, what
some of those diseases are, andthen we'll kind of dive into
your recommendations aroundavoiding those?
Dr Lucy (12:22):
Yeah, sure.
So again, if we think about,the biggest chronic disease that
we are facing these days istype 2 diabetes and obesity.
So, again, obesity is atriggering word.
I get it.
It's been used as a slur, it'sused as a marker that people are
lazy and gluttonous, and all ofthat.
(12:44):
It's nothing to do with that.
It really is.
It's a condition where, again,our metabolic hormones become
deranged.
Our body becomes very, verygood at storing fat and it
starts storing it in areas thatit was probably never designed
to store, so in particular, inand around our organs.
So we can end up with thingslike fatty liver disease and,
(13:06):
interestingly, fatty every otherorgan disease.
So yeah people hear about fattyliver, but there's fatty
pancreas and fatty heart, andthese also cause separate
diseases in themselves, and whatends up happening then is that
we really accelerate the risk ofcardiovascular disease as well
(13:26):
with some of these conditions,and so people end up having
heart attacks or strokes earlyin life.
With type 2 diabetes, they endup with neuropathies.
They lose their vision.
Other thing that it exacerbatesreally is things like arthritis
, and all of that affects theway we move.
So, at the end of the day, thechronic diseases affect our
(13:49):
functional capacity, and so wecan't do anything like you have
to go, you need a walkie frame,you've got to go to spend your
life going to doctors, togetting pills, potions, hip
replacements, and I kind ofthink, wow, people work hard
their whole life, they workreally hard.
Australians are hardworkingpeople.
They want to enjoy theirretirement, the glory years, as
(14:12):
I call them and yeah, they'recrippled by chronic disease of
varying sorts.
They're taking a lot ofmedications, it's expensive and
that's not how it's supposed tobe.
Yeah, and I guess you know, anda slightly different tact, but
another emerging set ofconditions is autoimmune
(14:33):
conditions, which are separateto these other ones.
So these things that I wastalking about are really related
to insulin resistance.
As the core driver, autoimmune,is separate, highly likely to
be related to our lifestyle, butit is tricky to determine
exactly which part of ourlifestyle because it's going to
(14:53):
be multifactorial.
Sonya (14:54):
And when you're talking about autoimmune disease, can
you give us a couple of examples?
So thyroid, is that somethingthat falls into?
Dr Lucy (15:01):
autoimmune?
Yeah, absolutely, and that wasone of, again, one of my light
bulb things.
When our general practice andintergeneral practice, at that
15 year gap, where, again, justlooking after young people in
defense, young people don't,they don't have chronic disease
usually yet Coming back andgoing, oh, my God, everybody
seems to have Hashimoto's.
What is going on here?
So, yeah, increasingHashimoto's, increasing celiac
(15:25):
disease, and again, some ofceliac is because we've got
better at detecting it, but it'sactually just more prevalent.
They would be the two biggestones that I've seen that are
increasing.
And then you know there'srheumatoid arthritis, but that's
been around for a long time.
It's just the rate at whichwe're getting it now.
Inflammatory bowel diseasewould be another one, wow, okay.
Sonya (15:43):
Yeah, so what I'd like to explore with you and you did
touch on this very briefly howour hormones play a part in some
of this metabolic health and alot of the things that we've
just talked or you've justtalked about.
There are things that we talkabout when it comes to menopause
symptoms and also the impact onour quality of life long-term
(16:05):
post-menopause.
Dr Lucy (16:06):
Yeah, absolutely so, you're right.
I mean, everything I just spoketo about then applies to both
men and women.
And what we have as women andthis is where my interest in
menopause has come in to play isrecognizing that pre-menopause
estrogen in particular what afrigging super hormone that is,
(16:26):
isn't it?
It is it's so protective,cardioprotective, and it's got
so many brilliant propertiesthat then, when it disappears,
it kind of unmasks all of theseother risks into chronic disease
and the thing that I guess thatI see a lot of and is and I've
(16:47):
kind of just coined this phrase,I don't think it's a real
phrase, but I call it themetabolic triad of menopause.
And so what happens is, asestrogen declines estrogen is
really good at being insulinsensitizing.
So as estrogen declines, ourinsulin levels will go up, our
insulin resistance will go up,and as estrogen declines,
(17:10):
interestingly, our cortisollevels will go up.
So these three have a littletribe, because another
interesting thing is that ascortisol goes up, estrogen can
go down as well.
So again, we look at that areain the adrenals, which I know
you're really well educated in,but we always think of estrogen
(17:31):
as just being made in ourovaries and obviously that is
what stops once we hit menopause.
But estrogen is also made inthe adrenal glands, as is
cortisol, and so we have thissituation where if we're making
extra cortisol, for whateverreason lots of stress or a
pathological process well, thatwill cause estrogen to go down.
As estrogen goes down, cortisolgoes up.
(17:52):
So as cortisol goes up, insulingoes up.
So, or a pathological processwell, that will cause estrogen
to go down.
As estrogen goes down, cortisolgoes up.
So as cortisol goes up, insulingoes up.
Sonya (17:56):
So there's this little triad, that kind of-.
There's this real interplaygoing on, isn't there constantly
between cortisol and estrogen.
Dr Lucy (18:02):
Absolutely so, then we can go.
Well, actually, we can helpthis process by again bringing
back lifestyle into it.
Because if we can help thisprocess by again bringing back
lifestyle into it, because if wecan reduce our insulin
resistance with lifestylechanges and look, a powerful
driver is for us.
We advocate a low carbohydratelifestyle.
(18:22):
This is not a no carbohydratelifestyle.
People always go how can youget rid of a whole macronutrient
?
It's like, well, I'm notgetting rid of it, yeah, it's
just reducing it.
So reducing your carbohydratesreally powerful driver of
insulin resistance.
Improving stress managementLike again, I cannot
underestimate the effect ofchronic stress and I think what
(18:47):
people think is that in order tohave a stress-free life, they
need to run away, they need togo off to a tropical island and
you know, then they can't,there'll be nothing to To be
stressed about.
Yeah, exactly, but you know Idon't own a tropical island.
I don't know many people thatdo.
I mean, it sounds reallyappealing.
(19:07):
It does.
It does, although,interestingly, if you go to a
tropical island all by yourself,well then you're dealing with
loneliness, which is another oneof the S's that we have to
measure.
I think we have thisexpectation that the only way we
could be unstressed is to nothave any external stressors, and
so if everything else outsideof our environment was hunky
(19:28):
dory, then we wouldn't bestressed.
But again, that's not realistic.
So it's really looking aroundthe stress cycle and we need to
have periods where there is somestress, because that's normal,
and we also need to have periodswhere we rest, because that's
also normal, and that's howwe're supposed to be.
But women in particular are notvery good at that.
We don't actually ever stop.
(19:49):
We, you know rest is consideredlazy, we're not being
productive, we're not makinggood use of our time, so we fill
up any periods that might wherewe could potentially rest with
and that's conditioning, that'ssocietal conditioning, that and
you know, modeling from familiesas well, probably from previous
generations of women within ourfamilies.
Sonya (20:08):
Yeah, yeah, that's that's created.
We're stuck in that cycle nowaren't we Of that stress cycle?
Dr Lucy (20:17):
Yeah, yeah.
So again, yeah, it's, it'sbeing so, it's so.
It's chronic stress as opposedto acute stress.
Acute stress just meansshort-term high, you know, and
then resolves.
Chronic stress is this lowlevel, but chronically always on
.
So we're always gettingstressed when we don't sleep
properly.
All of those things reallyimpact again that cardiac
metabolic triad.
So that and part of the thingabout the cortisol levels is
(20:39):
that cortisol does increase ourglucose.
It's its job.
One of its jobs is to increaseblood glucose and that was all
designed so that if we needed torun away from something, that
we had enough fuel to do so.
Sonya (20:55):
To do so, yeah, so what we've got then is declining
estrogen, increasing cortisol,increasing glucose, so hence the
insulin.
Dr Lucy (21:06):
Yes, yes, so that's where that side comes from.
It.
Declining insulin increases.
Sorry, declining estrogenautomatically increases insulin
anyway, because it's one of itsthings that it does.
There's some extra componentsin there as well, because we
know that declining estrogen,you know, affects our muscle
(21:26):
mass.
Muscle is our metabolic organ.
The more muscle we have, thelower our insulin.
The less muscle we have, thelower our insulin.
The less muscle we have, thehigher our insulin.
And so there's this hugelycomplex interplay between
estrogen and our metabolichealth, which is why women got
premenopausal women areprotected and then go through
(21:47):
menopause, their cardiac riskfactor skyrocket.
They've got no idea.
No one told them that Suddenlytheir lipids are all over the
place.
They've developed hypertension,they've put on weight around
their belly, they've got fattyliver disease and thinking, holy
hell, what happened?
Yeah, yeah.
Sonya (22:02):
So then, and this is one of the areas that I find really
fascinating so if we talk abouthormone therapy for just for a
moment I know that's not what wecame on to talk about, but one
of the conversations that hasbecome very loud and it's a
really strong narrative now thatis used from clinicians and a
lot of doctors when they'retalking about the benefits of
taking hormone therapy is notjust that immediate symptom
(22:25):
management side of things, butthe longevity impacts, so the
things that we're just talkingabout there, so the healthy
bones and the healthy heart andthe cognitive protection as well
.
So am I right, then, inassuming that if somebody was to
use hormone therapy, so there'sthat hormone top-up, if you
(22:45):
like, that that does also helpprotect against some of these
metabolic diseases that you'retalking about?
Dr Lucy (22:52):
so I think the tricky bit is that initially.
So we've known about this facewith estrogen for a long time.
That's not new news, it's notmy news, it's it's old news.
And then again, back in 2000,women's health initiative study
we all know that.
And they'll give an oralestrogen.
And oral estrogen goes throughthe liver, which increases the
(23:13):
clotting, which is not so greatfor cardiac health and increased
there for the some heartdisease or heart attacks in
women who were already a bitolder.
So this wasn't women in their50s, but women who were starting
this oral estrogen in their 60sand 70s.
So we know that for them thatwasn't ideal.
(23:35):
However, transdermal estrogen myfavorite thing in the world it
has no effect on clotting, noneabove your baseline.
And now we know that,particularly if it started
within 10 years of menopause,that it is cardioprotective.
So those women who startedsomewhere within that 10-year
(23:57):
period will go on to maintaintheir cardiac benefits while
they're taking it.
So the cardiac benefits do stoponce you stop.
So if you're only planning totake it for a few years to
manage your flushes, you're notgoing to get the long-term
benefits from it, and we knowthe same is true with bone
health.
The same is probably orpossibly going to be true for
(24:21):
brain health, and it seems to belikely, but there's just not
the data yet.
But it's promising.
Sonya (24:29):
But I think, coming back to what we did come on to talk
about, is that, even forsomebody who does choose to use
hormone therapy, that theseother pillars that you're
talking about need to also beconsidered.
So the two things need to gohand in hand.
That you, you know.
I think one of the things weneed to always talk about if
someone is taking hormonetherapy is that it's not a
silver bullet.
And, yes, you do get thatestrogen protectiveness back,
(24:52):
but you must also be addressingthe lifestyle factors that
you're talking about as well.
Dr Lucy (24:58):
Yeah, absolutely.
And again, my favourite thingis it's not this or that, it's
this and that, and thatsometimes taking MHT or HRT can
help you implement yourlifestyle factors, because
suddenly your joints aren't sosore.
Sonya (25:12):
So you're happy to go.
You're sleeping better, you'vegot a bit more energy, yeah.
Dr Lucy (25:15):
Yes and again.
You know, because life's alwaysyou know all about me or
whoever's talking For me.
Part of my interest inmenopause became again when,
despite doing all my lifestylestuff, having been the world's
best sleeper and rarely stressed, I started getting hot flushes.
Not hot flushes during the day,night sweats, night sweats,
(25:36):
waking up at 3am thinking whatam I doing awake.
And then, interestingly, I wokein the morning with just this
ridiculous anxiety in the pit ofmy stomach.
It'd be like I'd wake up goingand I think what am I worried
about?
What's going on?
What am I worried about?
Be like I'd wake up going and Ithink, what am I worried?
about what's going on.
What am I worried where?
And I'd have to do this littletalk myself off the going.
Well, there's nothing worrying,don't need to worry.
And so I thought, oh my god,I've got menopause.
(25:59):
Well, actually, I didn't thinkmenopause at first.
I thought, oh my god, I must beworried about.
You know, I'm now a businessowner.
I'm worried about the businessI must be worried about about
something, and it was really thenight sweats that I needed the
treatment for.
I thought I needed a treatmentfor.
So I got treatment for that andwow, amazingly, I also started
to sleep a bit better and theanxiety went away.
(26:21):
And that's when I've gone, ohmy God.
Sonya (26:22):
And I find these conversations so fascinating
when they're with cliniciansbecause the amount of stories
that I hear from doctors,specialists, nurses, that all
had their own experience, likeyou, where they had all sorts of
symptomology and then themenopause, and then they realize
that hang on a second, yeah,and you kind of go and this is,
(26:44):
you know.
This leads us into an area thatis where I'm so um prominent
with my voice is like if youdidn't know, yeah, how the hell
were we supposed to know what'sgoing on?
Dr Lucy (26:57):
I know, I know, and again it's like you know, you
feel like such a goose.
I'm thinking, oh my god, I'm so, how?
How could I have been so, Idon't know stupid or blind, or
thick.
I'm thinking, oh, anyway, I'mnow more like.
Now.
I feel like I'm thick.
I'm thinking, oh anyway, I'mnow more like.
Now.
I feel like I'm vigilant, likeI'm on this menopause oh my God,
you know you've got itchy skin.
Oh, it's probably menopause,but yeah, the thing is that it
(27:24):
probably is.
Yeah, I think now it's.
I think back, and you know,again I've got another patient I
can remember prominently abouther.
She came again because I'd setmyself up as a weight management
clinic and metabolic healthclinic and she was coming to me
to talk about her weight and shewas just talking about her bone
(27:45):
, her fatigue, and she said Ifeel so weak, I'm so tired and I
just don't feel strong.
And I sort of thought, oh, I'vegot an idea what's going on.
I feel so weak, I'm so tiredand I just don't feel strong.
And I sort of thought, oh, I'vegot an idea what's going on.
I don't know.
Let's just keep talking aboutlifestyle and talking, talking,
talking.
She was doing, doing, doing.
But she honestly just had suchterrible fatigue and she told me
(28:06):
she goes.
Oh, I went and saw a menopausedoctor, Dr Ginny.
This is back in 2018.
And I'm thinking, oh right, andI knew nothing about menopause,
dr Ginny and I go okay, that'sgood, she goes.
Oh, she's put me on some youknow testosterone.
And I'm going, oh gosh, anyway,she found a million bucks.
And so now I'm thinking I justdidn't know, I didn't know about
(28:28):
it then, and you don't knowwhat you don't know.
No, no.
So now I'm sort of going radio,okay.
So I guess you know.
So I do.
I totally love estrogen.
I think estrogen is fantastic.
Progesterone I have a fewdifferent ideas, perhaps to some
other people around it, becauseprogesterone unfortunately, it
can cause insulin resistance.
(28:48):
Okay, I haven't heard thatbefore.
No, well, progesterone is.
So its main job is to balancethe lining of the uterus and
stop it becoming gigantic.
And then its other job is inpregnancy.
So its job is to maintain thecorpus luteum, or the little
cyst, the fetus, when it's firsta fetus and then over time it
(29:10):
maintains the pregnancy and it'sthe thing that causes women to
store fat when they're pregnant.
So for women that, particularlyif they're genetically
predisposed to insulinresistance so maybe they have
polycystic ovarian syndrome ormaybe their parents have type 2
diabetes they can stack on tonsof weight in pregnancy.
(29:32):
And again, it's all about me.
This happened to me inpregnancy.
I was a person and I went offto my exercise.
I did my bloody thing on theball that you do Pilates all the
pregnancy exercises.
I'm eating well, I'm not havingmy moldy cheese, I'm not eating
sushi.
I'm doing all the right things.
(29:52):
And you probably stoppeddrinking as well, yeah, oh, yeah
, god, yeah, no, no alcohol,yeah, 35 kilos again in
pregnancy and I was like holyhell.
Interestingly, I didn't havegestational diabetes back then.
If I was having my glucose testnow I would have, because the
criteria has changed, yeah, soso again, it's progesterone is
(30:17):
the thing that is the, andprogesterone comes from your
placenta, so it's the thing thatthen causes your body to store
fat.
It's the thing that produces agestational diabetes.
As soon as the placenta's out,everything reverts to normal.
So it is one of the reasons why, when in menopause, then, women
are starting to gain weight isbecause they're losing their
estrogen, but their progesteronestays around a bit longer.
(30:40):
It does, yeah, yeah, and forsome women, the progesterone
component of their MHT can stillcause them to store body fat.
Sonya (30:49):
Okay, but we need to weigh that obviously against the
risk of uterine cancer.
Dr Lucy (30:55):
Absolutely.
I'm not saying don't takeprogesterone, Absolutely not
Okay cool.
So there's a couple of thingsthat we can do, though, so,
first of all, if you don't havea uterus, well then, you don't
have to take progesterone foryour uterus, but the other thing
that we need to balance, then,though, is that, for some women,
progesterone is helpful forsleep.
Sonya (31:16):
It's that chill hormone as well, isn't it?
So it can take the edge offanxiety.
It can take that.
Help with that sleep, yeah.
Yeah, it can, she's a trickylittle sucker then, isn't she?
It is.
Dr Lucy (31:27):
It is a little yeah, and again, I've also seen women
who start their progesterone andactually can make them anxious.
So it doesn't, it's notsedating for everybody.
So I think for me this, andagain, this is everyone's
different, but my kind of way Ilike to manage progesterone is
to try and keep it local ifpossible.
So again, that might be aMirena, it might be just using
(31:49):
Prometrium vaginally, vaginally,yep, and that will keep it
local and that is less than ofan effect on your insulin
resistance.
Balancing that up with thesleep side of things.
But I think also sometimespeople and again there's a
little bit of chat amongst insome of the Facebook groups
(32:09):
around the you know the benefitsof progesterone and so they're
using it for the sleep,potentially before the estrogen
is optimized.
So and again this is justlooking for me personally and
some of my patients are theyneed a bit more estrogen first.
So estrogen, again, you know,probably too much information
(32:29):
sharing here, but I've had ahysterectomy so I didn't need
the progesterone.
Sonya (32:32):
Progesterone yep.
Dr Lucy (32:33):
So I've just plonked my estrogen up a little bit.
Add a little bit oftestosterone and I'll sleep like
a baby again.
Sonya (32:40):
Okay, yeah, testosterone can be the missing key for a lot
of people and unfortunately itis a.
How do we?
How do we phrase this?
It's a tricky area right now,with some conflicting views on
whether testosterone should beprescribed or not as a part of
hormone therapy, but I believethat what I've been told and
(33:03):
what I've read is that there's alot of anecdotal evidence and
there is some research underwayto show that there can actually
be some benefits for women withtestosterone, particularly, like
you say, on the sleep andthings like that and the
cognitive function as well andmuscle mass, because
testosterone is good for muscle.
Dr Lucy (33:23):
Yeah, absolutely.
And so yeah again, I kind of inmy head just about every
post-opausal woman is hyposexualdysphoria disorder, hsdd,
that's if you have that, that'syour, that's the tga approved
use of testosterone yeah, butyou know again, as doctors we
use a lot of medications offlabel, a lot you know for and
(33:45):
for lots of things you know we,we will use um I'm going to give
a great example there.
Sonya (33:52):
I was prescribed antidepressants not because I
was depressed, but because I hadhot flushes as a result of my
radiotherapy and chemotherapy,and that was an off-label use of
the antidepressant.
Dr Lucy (34:04):
Absolutely, and we will use antidepressant, a different
one to those ones.
We use that for bed wetting inchildren.
Wow, I know that's a bitoff-label.
There's lots of things that weuse off-label, but they don't
come with the same controversythat testosterone comes with.
So I kind of think, again, youneed to understand how to use it
(34:27):
.
You need to know the guidelines, not the guidelines.
You need to know the risks.
You need to understand how touse it.
You need to know the guidelines, not the guidelines.
You need to know the risks.
You need to know the benefits.
You need a discussion, but itcan certainly be prescribed
safely.
Sonya (34:36):
Yeah, hmm, yeah, most of my listeners are curious,
obviously, about all the thingsthat they can do to improve
their longevity, their qualityof life and, you know, symptom
management from a short-termperspective as well.
So, lucy, let's talk aboutweight loss, because I think
that that is absolutely a hottopic for so many women in this
(35:00):
space and there are a lot ofoptions at the buffet table when
it comes to weight loss.
Now we have injectables thathave become a new player, but
also a very, very prominentplayer.
We have the old diet regimestill rearing its ugly head.
(35:23):
You know the eat less, exercisemore life deprive, deprive.
As a demographic, we areabsolutely hammered with options
to solve our belly fat, tosolve our meno belly.
There's some awful marketingout there.
Tell me, from your perspective,what you have found to be the
(35:47):
and obviously I'm imagining it'svery nuanced for everybody that
you see as a patient but whatdo you find has the best results
and why?
Dr Lucy (35:54):
Yeah, absolutely Great question, and I think that
you're right.
There's not only many optionsat the buffet table, there's
also many opinions on how youshould do it.
Everyone's an expert.
At the end of the day, it isway more complex than we've been
led to believe and that thereis no simple solution.
And anyone that's offering youa simple solution is just trying
(36:15):
to sell you something, becauseit is a complex interplay of
metabolic hormones.
A complex interplay ofmetabolic hormones, insulin
resistance and again, I loveinsulin.
(36:36):
Insulin resistance is at theheart of fat storage, and the
way I like to describe it is ifwe imagine that our body is a
bit like a house and we'retrying to heat it with a
fireplace.
So when you're heating afireplace, put some kindling in
a little stick, some paper.
You then put some logs on tokeep it going.
Our fuel is very much like that.
So our kindling is glucose,which is short-acting
carbohydrates, and that gives usenergy and that's all lovely,
(36:59):
and then we should probably putsome fat on and that will.
What is our long storage andthat keeps us going and fuelled
for hours.
What happens with insulinresistance is that, you know, in
our fireplace there's no actuallogs available.
They're in a woodshed, storedout the back and they're not
neatly stored.
(37:19):
And you know, some people havea very large woodshed and it's
got lots of wood in it and sotheir body.
You toddle out to the woodshedto try and get a log to put on
your fire and the woodshed'slocked and the lock big padlock,
and the lock is insulin.
So I didn't know this.
Another thing I didn't know,god knows what I was doing in
medical school.
I didn't know that insulinstops fat breakdown.
(37:43):
So if you have high bloodinsulin, you can't break down
your fat.
And it was like what?
And so it's like you go to thewoodshed, you go to get a log,
the log's locked away, so youcome back to your fireplace.
(38:04):
By now you're hungry, you'repretty tired, you're a bit
cranky and your brain startsgoing oh, my God, you've got to
eat, you're starving.
And it starts really tellingyou that you need some fuel,
because by now there's only afew embers.
And so, honestly, you're nowstarting to think well, I'll get
some coffee and I'll get youknow, and you grab something
quick, a muesli bar, a chocolatebar, whatever you can get,
because your brain actuallyneeds some fuel.
And so then it goes oh, thankGod, and then you're fine for
(38:25):
again another hour.
You still can't get a log.
So you're constantly having toeat these six small meals a day,
or snacks or whatever it is tokeep your body fueled long
enough all day.
And so it wasn't until, honestly, I just thought, really so it
wasn't until I realized that youactually need your insulin
levels to get to a certain lowpoint in order for your body to
(38:48):
be able to access that woodchip,the stored fat, to burn it.
So we really need to have lowenough insulin to access your
fat.
So how do we do that?
Well, again, insulin is raisedin response to glucose.
So if we can lower the amountof blood glucose we use, so
(39:11):
lower the amount of kindlingessentially which sounds weird.
You're thinking, why would youdo that?
And this is where you startincreasing your dietary fats.
So again, as an ex-dieter, I wasalways scared of fat.
I had years of Vegemite, yeah,yeah.
Or even dry toast with Vegemite, because that was low calorie
(39:33):
and low fat.
Yeah, yeah, yeah.
And those horrible diet yogurtsthat were somehow lemon
cheesecake flavored but madewith chemicals.
All of that, no fat in any ofthat.
So again, no, no fuel.
Whereas now you go okay, well,you can add, add some fat back
in, add some fuel back in, andthen, over time, what happens is
your blood insulin levels willlower and you suddenly have
(39:55):
access to your own stored bodyfat and this miraculous thing
happens where you're notactually hungry that's like,
really I'm not hungry, what andit's because suddenly your body
has access to its own fuel againand it will start using it and
you go oh, thank God.
And so really, that reducinginsulin is the number one thing
(40:15):
that needs to be done for peoplethat are insulin resistant or
have hyperinsulinemia, which forpeople that are overweight,
that's the majority of us.
Sonya (40:22):
Okay, and is that identified through a blood test?
Dr Lucy (40:32):
Yeah, you can certainly have a blood test, but there
are a few kind of hallmarks thatmight come in.
So if you have lots of skintags, so skin tags under your
arm, under your boobs, aroundyour neck, again, everyone might
have a couple.
So one or two is no big deal,but if you have a lot, that's
usually a sign of insulinresistance.
Yeah, if you have ever hadgestational diabetes or
polycystic ovarian syndrome, youwill have had insulin
resistance.
If you store the majority ofyour fat around your belly, then
(40:56):
that is usually insulinresistance.
And then there's this slightlyunusual, more advanced sign,
which is something calledacanthosis nigricans, which is
patches of pigment that happenunder your arms or in your groin
.
So you'll be, you'll have thesesort of dark patches under your
arms groin, sometimes aroundyour neck, some people on their
forehead or forearms.
So they're all signs of insulinresistance.
(41:17):
And then you know pre-diabetes,type 2 diabetes.
They're all diseases of insulinresistance.
Sonya (41:31):
Wow, my brain is firing off in all sorts of different
directions because I'm seeingall these connections between so
we talked right at the verystart about decreasing estrogen,
increasing cortisol and thenthat increasing your glucose,
which is obviously going to playinto that insulin, insulin yes
lock on the on the firewood door.
Yeah, and you know, and so weknow then, and you know, and
(41:54):
also that shifting of weightbeing stored in the body to
around the belly.
You know, if we just look atthat, so cortisol stress
shifting weight to the bellyvery much.
We just look at that, socortisol stress shifting weight
to the belly very much.
Menopause symptoms.
Dr Lucy (42:08):
Yeah, absolutely Absolutely.
And when people go, I don'tknow if that's true.
All we have to do is look at,if I prescribe cortisone to
somebody for their asthma ormeasuring something, if they're
not long enough, what do theyget?
Belly fat and type 2 diabetesand, interestingly, osteoporosis
.
So a whole heap of thingsrelated to their cortisol and
(42:31):
cortisone.
They're the same thing.
If we give insulin to somebodywho has type 2 diabetes, they
gain weight.
And doctor's advice my adviceused to be it was so
embarrassing again oh, make sureyou don't gain weight.
It's like what?
Like that was it.
Make sure you don't put on toomuch weight.
Sonya (42:50):
I got told that at my cancer diagnosis it was between
being diagnosed and my treatmentstarting I went and saw a nurse
at the centre where I was goingto be having my chemo.
It was at the private hospitalwhere I was treated, so it was
this cancer center, I guess, andI don't remember a lot about
the appointment, but I doremember her saying to me
(43:11):
whatever you do, don't put onany more weight.
And at the time I was like,well, I'm totally screwed,
because I've, since getting mydiagnosis, I've eaten a block of
chocolate and drunk a bottle ofwine pretty much every day, and
you know, I know that I've puton weight just through stress.
So that was horrifying and ithas stuck with me as one of the
pieces of advice that I wasgiven at such a traumatic time
(43:34):
in my life.
Dr Lucy (43:35):
Yeah, absolutely.
And I mean, you know, I think,to break that down, there's
multiple reasons why people willput on weight.
So one, you know one might beyeah, well, you're eating.
You're eating chocolate andalcohol.
There is no point saying tosomebody who is distressed just
don't do that, like that's,that's unhelpful, that's a
coping mechanism.
Half the time, yeah, so you'rebasically pulling out their
(43:58):
coping mechanism and notnecessarily giving them any
others.
Second thing, of course, ofcourse, is we know that and
again, I don't know whattreatment you have, but lots of
people have dexamethasone aspart of their chemotherapy.
Wow, that's cortisone.
Sonya (44:11):
So lots of people will gain weight on top of all of
that, and I took steroids aswell, prior to my each chemo
treatment.
I mean, I have photos of myselfwith this massive moon face.
Honestly, my face was like thatproverbial full moon, and it
was the steroids.
Dr Lucy (44:28):
Yeah.
And the cortisol is a steroid.
Yeah, so I think.
And then, on top of that youknow, suddenly your estrogen's
gone, like all the reasons whyyour body is going to start
storing extra fat, but the?
Sonya (44:40):
advice is Don't put on any more weight.
Dr Lucy (44:42):
It's like saying to you don't breathe, don't breathe.
So yeah, I know I'm slightlymodified to have given rubbish
advice like that too, but again,I think you know it's what,
what, what people do like what,what people eat, how they sleep,
all of that's really important.
But but if, again, if theycan't implement or don't know
(45:03):
how to implement it consistently, again people don't have skills
.
They often think the reasonthey can't do it is they're weak
, they haven't got any willpower.
You know they're notdisciplined.
Sonya (45:13):
Especially for a generation that does come from
the diet culture yeah, wherethat's pretty much what you've
been led to believe.
They're like you diet which isnever good for you, and yet then
you fail and leave.
They're like you diet which isnever good for you, and yet then
you fail, and then that's like,well, it's your fault, you
didn't stick to the diet, or youobviously ate too much or you
didn't do enough exercise.
Dr Lucy (45:31):
Totally.
I mean and again, we got soldthis you will lose one kilo a
week and you will do thisterribly hard thing for 12 weeks
.
You'll lose your 12 kilos oryour 10 kilos or whatever you
get, you'll get to goal.
Then you'll go to maintenance,and the maintenance, the promise
of maintenance, was more food.
Yay, and honestly, it's just,it's just garbage.
It's so not how it should work,but to to be honest, there are
(45:55):
some people who do have troubleimplementing a lower carb
lifestyle, and it's not the onlyway to reduce your insulin
resistance by any stretch.
I'm not the the.
I recognize there's a number ofways to do it, but I think
taking, looking at processedfood and the way processed food
is marketed to us, uh, the wayit is produced, the way it is
sold to us, the way we haveconsumed it, and understanding
(46:18):
that there is quite an addictivecomponent to that is really
important as well.
And again, you, you know, forsome people I have this we talk
often about the three buckettheory of addiction.
The three buckets are there'sthe first bucket of the people
who don't really care about thesubstance.
So they'll be the people thatyou know have one glass of wine
once a year.
(46:38):
Or a glass of champagne at awedding.
They might put a raffle ticketon, they might have cake, you
know, once in a blue moon.
They really don't care about it.
They take it or leave it.
The next bucket are the peopleof the heavy users.
So they're people that might,you know again, they might be
drinking three or four nights aweek.
They don't realize it'spotentially a problem, it's not
impacting them that much, butit's probably more than ideal.
(47:01):
It's the same with, you know,the gambling.
These are my like, particularlyyoung men these days, who are
all encouraged to bet with matesand, you know, they're spending
a significant amount, part oftheir income, on gambling.
And it might be people who are,you know, eating.
Every time they get stressedthey eat, or every time they're
bored they eat.
So they're probably overeating.
(47:23):
And then you've got the thirdbucket, which is actually
probably the really intense sortof addiction.
So people who, even withgambling, they've lost their
house, alcohol, their marriagehas declined.
They still can't do it.
And I see it.
People with type 2 diabetes orsignificant health complications
who still can't stop theirchocolate addiction or just for
(47:46):
whatever reason.
Well, lots of underlyingreasons can't quite change, and
so what happens is that again,people, the processed food
company in particular, it'sgiving people who are in the
third bucket.
It tells them all the reasonswhy they should have this.
You know, have this a Sn theset.
You're not yourself without asnickers, you know it's a party,
(48:07):
it's a celebration.
You must have chocolate yes, ifyou're lonely, if you're crying
on the bus, some little boy willgive you chocolate.
That's the current cabri's ad.
You know it's all about, um,emotions and feelings and they
play to that and and then theysay, oh no, we didn't tell you
to eat a block a day, like youknow you don't.
You shouldn't be that, youshould be like the other person
(48:30):
who just does it once a year,like that's not our fault, and
so they take zero responsibilityin the problem that they've
created.
And so I guess the thing thatcertainly when I started, was I
was a little bit naive, likelots of us, but maybe when we
start and then over time, withmore and more experience, I
realized there is actually areally narrow little minefield
(48:52):
that you have to navigatebetween diet culture and you
know many of us feeling shameand guilt for not being able to
implement some of the things, oryou know, the whole falling off
the wagon or any of that versusthis real phenomenon that the
processed food industry isabsolutely trying to get you
(49:12):
stuck into their food hook lineand sinker and anyone who says
that you can eat that inmoderation.
Not everyone can, and so it'sabout working out in there all
the other things.
Sonya (49:24):
I think what you've really wrapped up today is that
metabolic health, weight gainversus weight loss it's very
complicated, it's very nuanced,it's psychological, it's
physiological.
I think what you've done hasproven exactly why there can't
be one fix that's going to workfor everyone.
Dr Lucy (49:46):
And we haven't even talked about the GLP-1s and
where they fit into it.
They absolutely have a role.
They absolutely do.
However, I think that there isthis phrase and I really loved
it.
I saw it somewhere on LinkedIn.
It's not my phrase, but I'mgoing to borrow it called
careless prescribing, which iswhere people have prescribed
this, but without the whole uh,they're not given full knowledge
(50:08):
of their side effects.
They're not given had adiscussion around how, how long
you need to take it for how, howdo you come off them?
What happens if you come offthem?
How, what dose you know?
Like none of that.
And then, on top of that, againa bit like we mentioned earlier
with mht and hrt, it's not in.
It's not in isolation.
(50:29):
If you just do this inisolation, then the the problem
is is certainly not fixed.
It's just another piece,another tool yeah.
Sonya (50:38):
So uh say it's a very large buffet, yeah, with um.
You know a lot of people at theparty that are trying to tell
you why you should eat theirdish that they made that's on
the buffet table, yeah.
But yeah, take it all with agrain of salt and understand
that there is a lot at play herefrom a hormone perspective.
(50:59):
You know, like you say, what'shappening with your insulin,
what's your stress levels,what's causing all of that?
Yeah, it is a very big pictureand it's not a simple one-stop
fix.
Lucy, if anybody wants tounderstand more about what you
do, how you work with women, inparticular in this midlife phase
of life, how do you help people?
Dr Lucy (51:18):
Yeah, yeah, thank you.
I run a company called RealLife Medicine with my beautiful
colleague, dr Mary, and withthat we have online membership
and programs really around thephysiology and the psychology of
weight management and lovely,beautiful, supportive community,
very safe and trauma-informedcare and all the things I think
that are lovely.
(51:39):
And then again recognizing thatsome people need some more
nuanced and individual care, andso I run a telehealth platform
as well and that's called RLMTelehealth, so they can find us
on all the socials at Real LifeMedicine, or our website is
rlmedicinecom.
Sonya (51:58):
Beautiful, and I will link through in the show notes
to all of those wonderful placeswhere people can get in contact
with you.
Lucy, it's been such a pleasure.
Thank you so much for sharingso much of your wisdom with us.
There's a lot to take away fromtoday's episode.
Dr Lucy (52:13):
Well, thank you very much for having me.
It's been delightful.
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