Episode 79: Why You Can’t Lose Weight: Insulin Resistance and Metabolic Inflexibility with Ben Gonzalez, MD

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Dr. Ben Gonzalez:

If you don’t have the tools in your body, to respond to the good things, you’re gonna do the exercise and the and the and the proper eating and the and eating and then yeah, you’re gonna improve, you’re going to lose some weight, you’re gonna get a little cardiovascular benefit from the exercise, but what’s going to happen in the end, in the end, you’re going to your metabolism is going to be in the same exact place. So when you move a little bit out of the good habits, you’re just going to gain the weight back. And especially if you’re going to really watch your calories and be calorie caloric restrictive and you lose not only cow, not only fat, but muscle going to happen when you gain the weight back, are you going to gain the muscle weight back? No, you’re going to gain fat back which is going to see just because basically, it’s going to make you more metabolically inflexible.

Dr. Andrew Wong:

If you’ve ever struggled to lose weight, despite dieting and exercising, you’re not alone. Many people experience weight loss resistance, and it can be frustrating and discouraging. In today’s episode, we’re thrilled to have Dr. Ben Gonzalez, medical doctor and functional medicine expert to discuss weight loss resistance and insulin sensitivity. Dr. Gonzalez who explained how functional medicine looks at the root causes of weight loss resistance, including insulin resistance, inflammation, hormone imbalance, and gut health issues. By addressing these underlying factors, we can overcome weight loss resistance, and achieve our health goals, including a healthy metabolism. Welcome back to the CH podcast. Stan, great to see you.

Dr. Ben Gonzalez:

Thanks. Great seeing you too. Thanks for inviting me.

Dr. Andrew Wong:

So we had Dr. Gonzales on our podcast for Episode 28, which is a really insightful conversation on how gender bias can impact your health care. And we highly recommend checking that episode out. But today we’re going to shift and pivot a bit and talk about something I think we’re all really wanting to learn more and take a deep dive into which is weight loss resistance and metabolic flexibility. So these are kind of buzzwords that you know, people talk about this doctor, Dr. Google is an expert on this everyone and their aunts and uncles are experts on this. But let’s talk with the expert here about this Dr. Ben here. What does that mean, Ben in terms of metabolic flexibility, and how does that relate to issues with weight loss resistance.

Dr. Ben Gonzalez:

I guess one of the reasons why that terms thrown around a lot is because of the fact that we’re starting to realize decades of discussion on this. But I think the lay public and providers are starting to realize that weight loss and the maintenance weight loss isn’t just about eating less or exercising more, it’s about training your body to improve its metabolism. And first before I guess before jumping into weight loss resistance and metabolic flexibility, flexibility, I think we need to talk about three specific terms directly related to all of this or like the weight loss resistance, or at least introduce these terms together. Because they’re tied together, when you think of these things together, the study of obesity and metabolic management is is complex. And yet medical providers on talk to patients about losing weight and the discussion becomes linear, right? And far too simplified. Unfortunately, this linear and diluted approach to weight loss tends to set the patient up for failure. And we’ve seen this over and over and over, get these programs out, patients lose weight, January 1 rolls around, they do all the right things, and they lose weight. And, and and then what happens when picking it back. And don’t get me wrong, we all know that the discussion of weight loss as well is labor intensive. We know this for the physician. And and it takes a lot of time. But we still need to understand these three specific terms. And so the three specific terms aren’t related to weight loss and weight loss resistance are these insulin resistance, metabolic flexibility, and the respiratory quotient. And this is important for for providers to understand all are related to each other in context of energy metabolism, and in the body. And a must be addressed concurrently. So the first term I mentioned was insulin resistance, right? So insulin resistance, the single you know, insulin resistance to me, and as well established is the single root cause of all non infectious disease processes now, wouldn’t you agree to that?

Dr. Andrew Wong:

Yeah, I mean, it certainly drives a lot of the things we see downstream that we diagnose conventionally, right?

Dr. Ben Gonzalez:

Yet, do we understand this physicians understand this providers understand this the single root cause of all non infectious disease processes, yet We under diagnosed and we under appreciate consistently. I mean, there’s over 100 million people in the US with insulin resistance, and most don’t even know it. And why? Why don’t they know it? Because the healthcare system ignores it. And we tend to vote up, oh, patient, Jane, you know, you’re pre diabetic, just just, you know, we’ll check in next year, just make sure you exercise more and eat less, we have to treat it in the same way you treat the diagnosis of diabetes, insulin resistance, is that just a giggle? I guess. definition is the condition in which all the cells in the body become less responsive to, to the hormone insulin, right. And the top three cell types that are most affected are adipose fat cells, liver and skeletal muscle cells. And brain cells don’t are not far that are not that far behind. So one of the biggest contributing factors in this country, in the healthcare systems here, the providers are not recognizing insulin resistance early. And in fact, ignoring insulin resistance until it becomes diabetes. So So that’s enough about beating up the first term, the second term metabolic flexibility. Metabolic flexibility is the ability for the body to switch between different fuel sources for energy production efficiently. And the three major energy fuel sources, of course, are fat, carbs, and protein and particular free fatty acids, glucose and pyruvate, and amino acids. So this ability is important for maintaining energy balance and preventing the development of metabolic diseases. And addressing that, of course, the most underappreciated thing when it comes to weight loss, and that simple weight loss maintenance. And of course, the third term is the respiratory quotient. I’m not going to get too geeky on you. And like I said earlier, wave your arms. If I start getting too geeky, we like geeky, we like okay, all right. So respiratory quotient is that measure of the ratio of carbon dioxide produced expiration to oxygen consumed during metabolism and respiration. So the respiratory quotient reflects the type of fuel being used for energy production is a great thing to measure when you’re trying to figure out what’s going on with metabolic flexibility. So those three terms need to be understood when you are trying to manage your patients. And if you’re a patient listening to this, those are the three things your doctor needs to think of when they’re talking to you about weight loss and metabolism improvement.

Dr. Andrew Wong:

Ben, can we go more into the archy? Respiratory quotient? Oh, yeah. How would that be measured? Practically? Or how would that be assessed? Clinically?

Dr. Ben Gonzalez:

That’s the hardest part, right? The respiratory quotient, you know, to do it right. And to do it very accurately, you put a patient at chamber right put the put them into a chamber and then and measure the experts are exploiting co2. And then they measure that and then that number that we try to get usually is between point seven and one with that being the primary source at point seven fuel source, and while the respiratory quotient of one indicates that carbohydrates are the primary fuel source and anything below point seven, that’s when you start getting into ketosis. Right. Um, but for practical purposes, it’s, you know, that’s another discussion, I think we can go over maybe towards the end, as we talked about the practical measurements of metabolic metabolic flexibility.

Dr. Andrew Wong:

Great, well, that’s a great overview of weight loss resistance and metabolic flexibility. And like you said, so many people are under under under diagnosed or even not diagnosed with this, what are some of the root causes of metabolic flexibility? And specifically, I guess you could talk about nutrition or gut health or other functional causes there.

Dr. Ben Gonzalez:

Yeah. Well, some of the root causes of metabolic inflexibility, well, first recognizing, you know, the practical way to recognize metabolic in flexibility is that individual who comes up to and says, or if this happens to where, oh, Dr. Gonzalez, I get hypoglycemic and I must eat because I start to pass out or I get lightheaded. That’s the first clue that that person is metabolically inflexible. Their body is so shifted towards what needing carbs. They’re they deplete their, their glycogen, their liver, and they deplete the number one storage unit of glycogen and that’s the skeletal muscle right? So deplete that rapidly and then your body’s inflexible, you’re metabolically inflexible, meaning you’re not able to switch to fats for taking care of the needs of your energy. You’re depleted and you act depleted, you feel depleted. So recognizing that’s an easy way, you don’t need any lab to recognize that, right? So that person who just got to have the carbs, or the other, the other aspect of that, and recognizing is when somebody eats carbs, and then they crash, they don’t get the Hey hyperglycemia, they just crash, they get tired. So that’s metabolic inflexibility. And it can be caused by a variety of factors to include sedentary lifestyle, poor diet, of course, the top two things, obesity, chronic stress, sleep disturbances, just regular aging, and there’s some specific genetic predispositions as well. And we can get into that later on as well, in the more geeky stuff. So first, recognizing it’s pretty easy. So the root causes top two things, frankly, a sedentary lifestyle, poor diet, you know, city, sedentary lifestyle, I’m sorry, you know, people weren’t just sitting all the time, we’re late night watching TV, just simply standing up in my own office, I have standup desk, right, and just that in and of itself, can help get you into the right place. And then of course, the poor diet. As we mentioned. I processed foods, refined carbohydrates, you know, constant sugar, eating that bagel, and orange juice in the morning. And that’s what you have for breakfast, and you’re training your body just to shift towards the use of carbohydrates. And then, like I said earlier, the obesity, chronic stress, sleep disturbances, that’s a big one, that’s another contributor to metabolic and flexibility. The disruption of sleep, whether it’s whether it’s self imposed, like watching TV, or on the computer, late at night, or social media, or just regular life, regular life stressors that get in the way of sleep. And like I said, aging and genetics. So those are the big contributors to metabolic and flexibility.

Dr. Andrew Wong:

Great, so so just to tie that back to the to the beginning, you know, for our listeners, metabolic flexibility, and insulin resistance, and weight loss resistance, are all related. And as we just were saying in the beginning, and some resistance is likely the root cause of most of our non communicable diseases that we’re dealing with chronically in our country and probably around the globe. And in terms of lifestyle factors that you outlined, like nutrition and sleep and movement, where do you recommend people start? And maybe if you have any specific tips on those on those kind of basic pillars first?

Dr. Ben Gonzalez:

Yeah, well, first, you want to be practical, right? We want to be practical, we speak to our patients who own Elvis and change their lives. No, I want you to change your diet and go and give them a specific crazy diets to go on. Or you say, Okay, I want you to go get a personal trainer and start doing hit, you know, high intensity training, we want to start with basics basic changes, this is changes that turn into smaller habits that turn into bigger habits that cause long term change in metabolism. So what I always start with my conversations with patients, when it comes to improvements, and that’s to cut out one or two things at a time, or some quick tricks, like if somebody has a number that they’re trying to improve, whether it whether it’s a weight loss number, or whether it’s a lab number that they want to improve, I tell them to write that, write that number, just the number itself on a, on a piece of paper on a sticky note. And on a couple of sticky notes, the same number and put it on your mirror in the bathroom, put it on the frigerator or the pantry in your kitchen. And those are those little reminders to make the positive choices for improvements, the small reminder small little reminders to make those positive choices and so he’s so here are some of the practical advice First, clean out your frigerator in your pantry, just clean it up get that junk out of there and and stop buying it so you can eat what you don’t have right you can’t That’s right. Right now unless of course my grandkids bring over their name

Dr. Andrew Wong:

then everything and then you have to eat it because it’s your grandkids

Dr. Ben Gonzalez:

that’s right I will feel it from a baby I hope that’s that’s honestly that’s another kind of sign when you people like when you see some people when they see a picture of a chocolate cake on on TV or they see the picture of some chocolate. They want to blink the screen. I mean that’s how desperate they are for the carbs right. And others oh it doesn’t bother me Dr. Gonzales but then you show him a hamburger or pizza and there goes the drooling and the licking of his screens right? So we got to change that. We digress. We have to change those make those small habits change so clean up the frigerator clean out the pantry something as simple as As I have this little timer on my computer I have, I have one right now that I carry with me and I have one at home. And that little timer, I flip it over, it’s like a little egg timer things that that you flip over. And I flip it over. And when it runs out, that’s when I step away from the computer, and I stand up I do I do, I get really specific. So I’ll do a, I’ll make myself do some push ups at the clinic or do some stretches from certain yoga moves in the clinic. And so it’s a habit, I do it, I even started to do it when I was talking to you a couple of minutes ago, because it’s become a habit so so I’m moving, I’m not asking people to go to the gym three times a week and to hit, I said, do high intensity training, I said, I’m just telling them to start moving. If you do that, and that alone, it’s amazing the changes that can happen to your body and your metabolic flexibility. Just making that a habit. Now, it’s not going to happen overnight. It’s not going to happen in a week, it’s not going to happen in three weeks. But if you make it a habit, in about six to eight weeks of doing those things, you start noticing differences, noticeable differences in your focus in your sleep. And in the way you can start losing weight. I had a staff member of mine, he changed one single thing, he stopped snacking, after eight o’clock, just one single thing, everything else was the same. And he lost 10 pounds in six weeks. That’s all he did. Sometimes it’s just the simple thing. And that’s, you know, it’s part of the problem with New Year’s Day, right? Our resolutions that people make these big changes, and they don’t stick with them. And then they go back to their old habits. It’s the smallest things that make a difference.

Dr. Andrew Wong:

I agree. I didn’t want to ask you a rabbit hole question about about carb counting or go yes, sugar sugar counting? Did you? You know, we all kind of, I think agree that you know, calorie counting is a bit overrated. Of course, it’s about food quality, and you know, macro composition. But in terms of the carbon sugar question, obviously, it’s going to be different for each person, depending on how much weight they’re trying to lose, or you know, how flexible they want to be metabolically. But do you have a general goal of what you would consider a low carb diet? Or, you know, if someone’s trying to go on a diet that doesn’t have too much sugar? What What kind of grams? Are you thinking about per day there?

Dr. Ben Gonzalez:

What’s interesting about that, you know, I’m, I’m the obesity obesity expert. And whenever we’re a weight loss center, so to speak, and I don’t like that term weight loss center with that we’re known as right, I consider what we do metabolic repairs. So that’s kind of the narrative that we kind of switched to our patients. We try to teach them that. First of all, we don’t care about your weight. We honestly first thing I sell to my to my weight loss patients, I just don’t care about your weight.

Dr. Andrew Wong:

I like that I like that metabolic prepare, I think that’s a more accurate way to represent really, it’s a make sense what’s happening physiologically, right? Yeah.

Dr. Ben Gonzalez:

And it switches it helps with the mindset of the patients, like, you know, is this the first time I’ve heard a doctor tell me they don’t care about my weight, you know, a 245 pound five foot four patient that I saw yesterday, the first thing I said to her and she, she she looked up at me and I thought she was gonna stand up and walk out of the room. She because she’s like, this is why I’m here is why I’m here. And I saw the desperation arise, like, why don’t you? Why don’t you care. And then then, of course, I finished the narrative by saying, Look, if you don’t, if we’re going to do what’s called, we’re going to take care of your metabolism. If we if you don’t have the tools in your body, to respond to the good things, you’re going to do the exercise and the and the in the proper eating and the and eating and then yeah, you’re going to improve, you’re going to lose some weight, you get a little cardiovascular benefit from the exercise, but what’s going to happen in the end, in the end, you’re going to your metabolism is going to be in the same exact place. So when you move a little bit out of the good habits, you’re just going to gain the weight. And especially if you’re going to really watch your calories and to be calorie caloric restrictive and you lose not only cow, not only fat, but muscle. What’s going to happen when you gain the weight back. Are you going to gain the muscle weight back? No, you’re going to gain fat back which is going to see just because basically it’s going to make you more metabolically inflexible. So to answer your question, it’s interesting in the same way that I talked about, exercise, I talked about this with calories, unless I’m being very specific or specific condition for a patient. We don’t get into macronutrient macronutrient management as much in our in our metabolic repair programs. We shift of course like if somebody says is totally carb heavy. My vegans are a good example that my vegans and vegetarians, who are carb heavy, and they’re not understanding why they’re not losing weight. You know, my potato chip ice cream vegans are not understanding, we shift that idea of, of watching their carbs and protein, and then we give them the macronutrient breakdown. So I tend to stay away from being specific on macronutrient management. And it turns I know that sounds kind of counterintuitive, especially as some of the dogs that are listening right now where they’re all there’s a percentage of, and I’m not gonna say any percentages here on purpose. It turns out when I started doing that, and that was about 15 years ago, it turns out that my patients, it started to spill over into my patients attitude towards okay, it’s not about watching the carbs and the protein, a little heavier on the protein. Of course, that’s another discussion. It’s about watching what I choose to eat, making it Whole Foods, and then fitting it to that specific, whether it’s a gender specific or age specific or metabolic problem specific. making that shift, it turns out, that’s the best thing for the patients. So they stopped counting, and instead they start choosing the right things. I hope that makes sense. I know I

Dr. Andrew Wong:

answered. Yeah, no, it does. It does. And I think I think it does have to be an individualized approach. Because you mentioned gender, I think it’s probably a good segue into a question on metabolic flexibility between your how you approach it with males versus females? Is there a difference? Or is there a lot of overlap there?

Dr. Ben Gonzalez:

Well, there’s, I appreciate you asking that question. You know, I’m a metabolic, or I’m a medical feminised, about all this stuff. Yeah. Because there is a big difference. Does it make sense to anybody? Let me say it this way. Does it make sense to anybody to tell, to tell a patient to exercise more and eat less, and expect the same outcomes for a postmenopausal Woman versus a 20 year old woman who hasn’t had a baby versus a 60 year old male who is morbidly obese to a 35 year old male who’s just inactive. Does it make sense anyway to expect the same outcome? And the answer’s no. In fact, telling somebody as a provider, telling a patient to exercise more and eat less is bad advice, I would argue poor advice from us. Why? Because they should expect more. I’m not saying you know, it’s good advice from a personal trainer. From from, you know, from a personal trainer or your basic dietitian, it’s okay, advice from them. But from the provider who, who should understand metabolic flexibility and flexibility and metabolism improvement, we need to be more specific for that individual and answer your question between men and women. Of course, there’s definitely a difference. The approach to improving metabolic flexibility is generally similar. For both males and females. However, there are definite some some definite differences, lifestyle factors affecting metabolic flexibility in men and women, for example, hormonal differences, right? So women and men have different hormonal profiles, which can affect metabolic flexibility. For example, women typically have higher levels of estrogen, which can affect carbohydrate metabolism, and insulin sensitivity. One of the big fears of the hormone replacement therapy for my pre menopausal pre menopausal women is oh, I’m gonna gain weight. And when do I start these hormones. And I remind them, that when they were in their 20s, and 30s, at their best, hopefully at their best weights, their hormones were much more elevated. It’s not just about how high or how low, it’s about the ratio of your hormones, and about, about the ratio of hormones and about how they’re working your body through the cycle through your cycle. And so, um, and I tell my patients, you’re going to be surprised that you’re going to notice body composition improvements, you’re going to notice body fat differences when I do replace your estrogen. And lo and behold, that’s what usually happens. That fear, of course comes from birth control the synthetics, of a synthetic progestins that synthetic synthetic estrogens. The conjugated estrogen estrogens that, that the body just doesn’t recognize and responds differently. So that’s one thing body composition is another thing. So what is the what is the fire of metabolism? The fire of metabolism is muscle mass. So if you know men and women have different muscle mass, right, that’s your Fire metabolism. And so like any other fire, part of the problem with starving that fire with low calories, is your body gets used to low calorie. So your metabolism begins to slow down and slow down and slow down so that you eat a few more calories after starving yourself for a while what happens then you accelerate weight, your fat loss, you accelerate metabolic inflexibility. And so men have more muscle mass. So that’s why men tend to lose weight. When you give the same advice to a man and a woman. They tend to lose weight a little easier than women. That’s one of the reasons along with hormonal differences. And so you have to shift your advice for women more towards managing their muscle mass, whereas with men you don’t. So that’s another exercise preferences. How many men have you told? Andy, how many men? Have you told to go? Go do Tai Chi or yoga and watch the look on their face? Really? Do I gotta do that? Dr. Gonzales, I want to do the gym stuff, right? Or when you you know, there are differences, the bottom line and exercise preferences, So be cognizant of that. And the first question I asked my patients, I don’t give any advice, or exercise without first asking them, What do you like to do. And that’s what I focus on. And maybe if I have to move it around a little bit, but try to stay towards that their center of what they want to do for exercise. And there is a difference between men and women on how they respond, exercises, different exercises. And of course, I, you know, weight bearing exercises are important for both. And then of course, nutrient requirements as another big difference between men and women. A lot of people don’t, a lot of people don’t know this, and a lot of doctors don’t appreciate this, that probably one of the primary micronutrients that we ignore, that have to do with insulin resistance is magnesium. Magnesium plays a powerful role in multiple different things over 300 enzymatic processes right in the body. Well, magnesium actually plays a powerful role, especially for women in insulin resistance, and insulin and insulin metabolism. So I’m so getting in we’re going to talk I, you know, I’d like to talk a little about this, but I want to address too much from this, this is talking about the different labs that we that I would prefer to get into that. Yeah. So when we when we get into that, I’ll talk more about that. But, but but getting your magnesium levels and managing those magnesium levels and getting him into the optimal range is another important difference between men and women.

Dr. Andrew Wong:

Great. I want to ask two more questions about lifestyle. And the first one relates to the potentially for gender differences, or, you know, at least personalized medicine, intermittent fasting, how do you feel about intermittent fasting? Who is a good? Who isn’t a good fit for? Who is it maybe not a good fit for? How would you apply that to, you know, in your practice, when you work with patients that are trying to get more metabolically flexible?

Dr. Ben Gonzalez:

So this is how I do it. I don’t tell them I’m, I’m recommending I don’t say the words, intermittent fasting. That’s how I do it. So I sneak a smart, I sneak it in, I don’t use the word fasting, I don’t use winnaman fasting. And when I do or if a patient brings it to my attention person say Yeah, well, let’s, let’s modify this to fit you. So immediate, just saying those words, I’m kind of gets the patient a lot more comfortable instead of just another doctor saying you got to fast and all the complications of fasting. But intermittent fasting is one of the most powerful tools you can use for, to improve metabolic flexibility. And, and so I do incorporate intermittent fasting and in fact, one of my I have a, a program. It’s a very simple, very basic program that I call the Athena five pounds in seven days a challenge. And I named it you know, lose five pounds in seven days just to catch attention, but that’s not its purpose. Its purpose is to teach me and the patient, what the patient’s body and the patient themselves is willing and not willing to do. And the Athena five and seven Challenge is a combination of intermittent fasting, a detox and a cleanse, and an elimination diet. And it’s all wrapped in one. And there’s a checklist at the end. There’s a there’s a very powerful checklist. At the end of the day, I want the patient to follow the checklist, and then tell me what and they weigh themselves every single day for 10 days. The challenge is a seven day the diet itself is seven days, or the last three days. I want them to weigh themselves as you can probably already guess to see how that patient responds how their body responded due to those four things that I mentioned, and, and then what the patient’s willing and not willing to do that checklist, I do this thing, once a quarter, I do this challenge once a quarter just to keep myself in check. But it’s powerful in that it introduces the concept of cleaning up your diet, intermittent fasting to the patient, and you know, it’s a formal thing, and they, and they give me the checklist, and then this checklist, I’m not gonna get into the checklist, it’s 10 things, but it gives me an idea, when I see the checklist of what a patient as long as they’re honest with their answers, and I was, you know, as the patient answer, answer, honestly, don’t answer for me or for family answer, honestly, with these, because this will be a powerful tool to use afterwards, and helps me God helps guide me into my advice for afterwards whether it’s a specific program, and this, of course, tied to their labs and everything else that we correct. So did I answer your question?

Dr. Andrew Wong:

Yeah, well, you’re meeting them where they’re where they’re at, it sounds like you’re tying it into a more comprehensive program versus just saying fast, which I think for a lot of people does raise those alarm bells, like, Oh, don’t deprive me of food, right? That kind of thing.

Dr. Ben Gonzalez:

And it’s interesting, after they do this program, then they, what happens is, they start to recognize what their body likes and doesn’t like, and then when they start if they if they follow it as closely as possibly not perfectly but as closely as possible. And, and then they eat something poor. And then they go to a pizza, or they go to a sugar. And their body reacts to that. I use that. I use that whole heart as hard as I can I throw it in that patient’s face, I say, See, here’s what your body’s rejecting, just like it would if you’ve ever, ever had a cigarette for the first time. If you ever cigarette for the first time, what happens when you come, you got automatically your coffee cup, your body’s rejecting that smoke. But after a while your body can get used to it and then off since he’s doing that it’s a habit. And then and then your body is okay with it. And I love it when a smoker tells me that, you know, having a cigarette calms me down. When actually it’s the opposite. It feeds into the addictive behavior of the high stress that it puts into your body. And I use that as an analogy for the different poor food choices. Yeah, your body likes it. Yes, you recovered from that crash, you know, if you had the sugar, but that’s your body telling you that? Yeah, you’ve got some bad things going on. You got to feed a habit and we got to get you out of that habit.

Dr. Andrew Wong:

But for intermittent fasting do you have that’s great do for intermittent fasting, I’m wondering if you have a certain number of minimum hours that you would recommend that would be beneficial for on and off there?

Dr. Ben Gonzalez:

Yes. And again, depending on the individual, depending on on their metabolic and flexibility, because I don’t want to put somebody too long on someone who’s got a pure carb issue. Right,

Dr. Andrew Wong:

right. And this is not official medical advice, please go see your doctor nutritionist practitioner, we always say that disclaimer.

Dr. Ben Gonzalez:

Thank you. Thank you. So you know, you know, the even the 12 and 1218, and six, you know, where you, you have an early dinner, you don’t eat breakfast, you drink plenty of water throughout. I’m even Okay, with lemon and lime. I’m even Okay, with certain amino acids. And that’s another discussion about, you know, the program, my program approach certain amino acids that won’t break the fast, but will allow your body to maintain muscle mass and maybe even absorb whether you have a good gut or a bad gut. Okay, so 18 Six is my usual. But, you know, we talked about intermittent fasting. You know, there’s there’s fasting, there’s food restriction, you know, there’s different ways of managing fasting, mimicking diet and stuff. Yeah, there’s the fasting mimicking diets, of course, that are powerful, too, that help mimic that. Things that that’s things that I do personally, to help keep my body in check to keep my inflammatory markers down.

Dr. Andrew Wong:

Great, great. And then I think we should touch on before we get into the labs sleep and stress because I think if those are not managed, everything else goes out the window, right?

Dr. Ben Gonzalez:

Yeah. Oh, absolutely. I think sleep is probably one of the most underappreciated and under discussed, issues that we have, unless of course, you have sleep apnea, and then all of a sudden it becomes your issue, and this is what’s causing all your problems. But we don’t want to wait for someone to have sleep apnea number one. Number two, not everybody has sleep apnea.

Dr. Andrew Wong:

Because poor sleep does contribute to metabolic and flexibility correct

Dr. Ben Gonzalez:

100% It contributes to insulin resistance and include it contributes to the inability of your body to recover properly, the hormones that need recovering while you’re sleeping a lot People don’t know this. But right around 11 o’clock at night, right around 11 o’clock at night, that’s when your hormones begin to kind of go down, go down, go down and down. And then they start to and I’m speaking in general here, and then that’s the recovery. That’s the physiologic recovery phrase between about 11 and 230 in the morning, that’s a physiologic recover your body’s physiological recovering. And then between 230 and about five o’clock, 530. That’s the mental recovery, the mental recovery happens, as your hormones start to come up and around. This is in a normal state, at around 536 o’clock, your cortisol starts to rise, your testosterone start to rise. And for those people who automatically wake up around six o’clock, those that’s the alarm, your body’s normal alarm clock, that cortisol coming up, that to stop from coming up. And it peaks later in the morning, and it starts to go down again, the middle afternoon, goes up on the you know, on the later in the afternoon, early evening, that’s that second wind, right, goes up and then comes back down again, for recovery. That’s normal recovery, that all of that is disrupted, with, with the poor sleep and poor sleep habits all of its disrupted. So

Dr. Andrew Wong:

I think what you’re saying is that sleep deprivation is a tidal wave that messes with all your hormonal cascade. And

Dr. Ben Gonzalez:

this is why and I knew when I went into trauma and emergency medicine years ago, that I knew I was going to take I was taking 10 years off my life, I knew that I was going to do that simply for one reason, one reason only, first of all, the choice of trauma, but but all the things that go along with that. The poor sleep at nights, the night shift, and then the bad eating habits, you know, eating late at night, the nurses who bring with the good hearted nurses who bring in and other doctors who bring in the doughnuts, you know, to help treat the docs, you know, you know, and the coffee and the Korean shirt, all that stuff and disrupt so it is it is under pre sleep as an underappreciated discussion.

Dr. Andrew Wong:

Ben, do we need zen music in the emergency rooms? Would that be helpful? But a meditation room and the right read outside the telemetry or something?

Dr. Ben Gonzalez:

breaks something right? Yeah,

Dr. Andrew Wong:

something right.

Dr. Ben Gonzalez:

Here, you actually bring a good point that one of the things that I have was looking for my phone, I tried to put it away. And one of the things I have on my phone is a nice little app that gets the size of my aura ring that I that I use five minutes, just five minutes, right around eight, nine o’clock in the evening, no matter what I’m doing or how stressed I am or deadlines or I’m working on my book or whatever. I turn on that app, five minutes. And I just I find a place in the house. And I just I listened to that kind of that self that meditative app, the music that sound just to calm the brain down even if I have some deadlines, even if I’ve got a lot going on grandkids are coming over whatever. I do that faithfully one of the reasons for for all this, you know, this self awareness in myself is I think you already know this, Andy, but I’m a cancer survivor. Did you know that Yeah. So I’m a cancer by bone cancer. My face had my half my face taken off thrown in the trash and the new face put it right. And and that was over. That was a nearly 3540 years ago. Yeah. But cancer survivors know this every day, we think of these things, even 40 years after every day, I think we’ve seen so each choice I make has to do with decreased whether I want to feed the cancer, or starve the cancer. And this is the same thing, the same narrative I give my patients I don’t want to put fear in my patients. I don’t do that at all. But what I do as I say, Do you want to feed the disease or starve the disease, but that in your mind with each choice you make and sometimes I feed the disease, sometimes I’ll have that cake sometimes I’ll go out and do my thing late at night and I’ll eat late. But my, my, the majority of my choices are to starve the disease

Dr. Andrew Wong:

and the net effect is beneficial.

Dr. Ben Gonzalez:

Now, now I want to be clear about something about that too. There’s no such thing I don’t like to use the word moderation at all, you know, eat this food moderation. It’s like telling somebody to use cocaine in moderation, it will be okay. Right? You know, so I don’t like that phrase that term. I never use that term do this in moderation. It’s it’s more of a make the right choice. Make a choice for yourself and choice, choose whether you’re going to starve the disease or feed the disease. And that’s a better narrative and people my patient base and to respond to that very well.

Dr. Andrew Wong:

Yeah. And let’s let’s actually pivot now to hormones into labs. So, and I think they tie together so in terms of lab work, I know we can and kind of test is functional medicine practitioners different labs that might be measuring metabolic flexibility or insulin resistance. If you’re working with a patient that’s trying to lose weight or trying to improve your insulin resistance, you know, just trying to feel better overall what labs would you consider ordering here? So,

Dr. Ben Gonzalez:

my basic lab panel includes it and helped me out in case I forget some things you can beat me up because, you know, you know, my lab panel. So to start with, with basically insulin resistance is you know, I get the breakdown of the cholesterol, you think the NMR or the nuclear magnetic resonance breakdown of that along with insulin resistance and insulin resistance score. I can even give you the numbers for requests threes three 4.3649 Yeah, 36749 the quest lab to give you the breakdown, the NMR breakdown plus the insulin resistance and the homeless score, the homeostasis catalysts and assessment insulin resistance score those are easy things to obtain get involve anyone see we get the high sensitivity or the cardiac C reactive protein I’m assuming the base getting right complete metabolic panel the CDC all that the let’s see. Where

Dr. Andrew Wong:

are you with fasting insulin how low

Dr. Ben Gonzalez:

insulin another good one to get usually when I’m getting the insulin resistance score or the home IR that usually satisfies that usually comes with a free insulin sometimes it depends on which lab you’re getting it from what lab you’re getting it from, but yeah, the free insulin is useful now. In fact, that’s an underutilized This is a whole nother discussion, the diagnosis of insulin resistance and diabetes. Just the diagnosis itself. It’s under it’s under diagnosed. We tend to use what ends up him going down and see and fasting glucose, right? Yeah, yeah. But but I go by the Dr. Joseph craft method of looking at insulin as a better markers. Better marker of early of catching things early.

Dr. Andrew Wong:

Same. Yeah,

Dr. Ben Gonzalez:

the postprandial insulin levels. There was a study 2015 Oh, my gosh, who published it, but in 2015, there was a study that looked at, I’ll think in seconds, I’ll think about it. Anyway, just think 2015 looked at diagnosed coronary disease patients over 4000 looked at the European Heart Journal. That’s it, the European Heart Journal published study in 2015. They looked at just the fasting glucose, the hemoglobin a one C, and I believe that the oral glucose test as well, at diagnosed coronary disease patients with no diabetes, they’re not diagnosed with diabetes. In fact, some were told they don’t have diabetes, everything’s fine. And they looked at over 4000, and a third of them using using that old criteria. A third of them had all our diabetes. Wow. And two thirds had high risk prediabetes. Now imagine using the insulin resistance approach to diagnosis. Pretty much probably 100%. Right? Every single part. Yeah. Which makes sense. It makes sense. The root cause of all non infectious diseases for heart disease is insulin resistance, right. So we under diagnosed, so I like to Homa IR score, of course, the hemoglobin a one C, the postprandial free insulin. And among other things, there are advanced testing as well. But when

Dr. Andrew Wong:

we look at fasting insulin and maybe trying to get it under eight, at least, or certainly under five with even better, do you have any numbers like that?

Dr. Ben Gonzalez:

Absolutely. I agree with you. 100%. You know, I think the reference range that they use is anything below 24

Dr. Andrew Wong:

is great. Yeah. Which is ridiculous. Right? Right. Yeah,

Dr. Ben Gonzalez:

let’s not get ridiculous.

Dr. Andrew Wong:

Like at that level, you are at that level, if we thought that a 24 was high, we’d be we’d be promoting cancer, we’d be promoting heart disease, right. You know, I mean, these are things that that level of incidence kind of promote, really,

Dr. Ben Gonzalez:

I have an interesting example patients that I saw about three years ago with artificial intelligence in medicine and and the use of artificial intelligence for diagnosis or diabetes and pre diabetes, this patient was seen by major group and they they got a got three labs over the years some of their annual labs and they she brought to me she came to me because she was having problems losing weight, significant problems with weight loss resistance. And she brought me all her labs and One lab printout said your hemoglobin ANC was 6.1. And do you have pre diabetes? And what was the and there was advice? What do you think the advice was advice was to exercise more, eat less. And we’ll check it in a year. Now it’s that right drives you nuts. Right. But that’s not the profoundness of this the the issue with this was that she brought me a series over the past of the previous five years of the printouts and advice from the doctors about what to do with her. And so she had hemoglobin a one C, five years prior a 5.4. The next year was 5.6. And the next year, it was 5.7. And the following year, right, so there’s this pattern all up to 6.1. And the exact same advice for past five years of you know, exercise more, eat less lose some weight. Remember what I said earlier about that’s the worst advice you could give us a as a medical provider. Well, this she’s a perfect example of why? Because she took the advice she did she exercised March, she ate less. And what did that get her with her insulin resistance five years of, of increasing your risk for coronary disease, the number one killer of men and women in this country. And and her metabolic inflexibility and your insulin resistance. And so, you know, it took me just basically less than a year to get her in the right place. And because we address those things, and happy person, that’s a beautiful example of, of how, first of all, how are we under diagnosed, and now it’s sneaking into the artificial intelligence. And it’s much tougher to change AI algorithms than it logarithms than it is algorithms than it is. In textbooks.

Dr. Andrew Wong:

Right? Yeah, I think that’s why you and I still have a job because, you know, we have to look at it from a personalized perspective, not just a cookie cutter. It kind of reminds me of we have to bring up Einstein. Now the quote about insanity is doing the same thing over and over again expecting a different result, right? I mean, every year, the same exact advice, I think we could go into ai ai Google Chatbot. And, you know, kind of say that or we can be more personalized, which I think is what you know, you and I and all the functional practitioners out there doing. And I think that’s what everyone deserves really, you know, that kind of more personalized approach to being medical more metabolically flexible. The other thing I wanted to bring up and you brought this up earlier, Ben is that age and genetics are both related to metabolic inflexibility. And in fact, as we all get older, we just naturally all can eat the same, you know, entire pizza that we could, you know, did in our 20s, or right, you know, carbs or you know, whatever. And so we have to be not just like sitting passively by the shore of this, we really want to be active participants in their own health care, and be proactive and preventative. Yeah,

Dr. Ben Gonzalez:

you can’t do we can expect the same outcomes, doing the same things that you did when you were 2030. And for each decade brings a new physiology to your body. And if you’re a woman, each age time you have a pregnancy or birth brings a different human being, to human be to new human beings are born on that day. And that’s a new a new woman, and a new baby. And your physiology is different. And, and I’m not I don’t like to say for better or for worse, it’s for the better, you’d be, you know, women become a more empowered, beautiful individual, with each baby and each pregnancy they have. And, and and you can’t expect to do the same things prior to that and get the expect at the same outcomes. So yes, that’s where exercising differently as you age, you know, cardio when you’re younger is great. And then as you get older, we start shifting towards more weight bearing exercises, right, especially if you’re a woman. And then if you’re doing strong weight bearing exercises, and I’ve seen this in women, especially women, as you age a weight bearing exercises, but not getting the results. And you see this if you go to the gym, you you see that same person on the treadmill or in the weight room and they got the big belly and, and they’re working hard, you know they are. But they look the same year after year after year. It’s because those things that we talked about earlier, the hormones, the insulin resistance markers, the inflammatory markers, all those things. And by the way, if you’re interested in in the listeners interested in the exact labs that I get, I can I can send or you can request them, you know that that lab list that I have from I can send you that but if you’re not measuring those things as we age, then then you know, you’re not going to get the same, you know, improved outcome.

Dr. Andrew Wong:

Well, thank you so much, Ben for this wide ranging and really, truly important conversation because really metabolic flexibility is something we all need. As we all get older and hopefully we all get, you know biologically more healthy. Even as we chronologically age, right? And yeah, we love this conversation, then how, thank you so much? how can listeners learn more about you and work with you?

Dr. Ben Gonzalez:

So, a couple of ways. First of all my clinics in Silver Spring Maryland Atlantis medical Wellness Center. And the website is just that Atlantis med center.com. That’s one way to get ahold to me but to get a hold of me directly. Instagram, I have a great social media team that if you if you direct message on my Instagram, and the Instagram is my name, all one word, Ben Gonzalez, that’s Gio NZ al EZ underscore M D. If you direct message there, I have a wonderful team and they they’re very responsive. And you can reach me through that. Yeah, this we just barely touched on this, didn’t we?

Dr. Andrew Wong:

I know. There’s so much today tip of the iceberg. I think for now, at least till the next time, what is one thing you wish? Everyone listening knew about metabolic flexibility, just that take home

Dr. Ben Gonzalez:

empowering yourself, if you’re if you’re, if you’re a patient, you’re a lay person, a non medical provider here. The number one thing to do is empowering yourself with the knowledge that yes, you’ve been trying to do the right things. But empower yourself to ask your doctor, ask your provider. What can you do? First of all, please measure my insulin resistance. Just please measure it, and give the lab gig to take the pick list with you. It’s okay. I love it. When a patient brings me a list. I know, it’s especially if you have a 15 minute appointment, their doctor and doctors got so many things they got to do. And then all of a sudden the patient brought a list and oh my gosh, no. Give it to him say look, this is what I really want. As someone who’s supposed to be in charge of my health, I really would like this. So empower yourself to understand that you are in charge of your health. So ask your doctor what you want. It’s okay. The healthcare system kind of beats us up and it makes it kind of puts a rift between patients and doctors, right. It almost turns us into enemies when we should be friends and we should be you know, work together for your partners. For your dogs who are listening to this. Look up Dr. Joseph craft and his way of looking at insulin and his studies on looking at it in diagnosing insulin resistance. Just do that one thing. And and I think it opened up your eyes to what’s going on with with metabolic disease in this country.

Dr. Andrew Wong:

Thank you. Thank you, Ben. And that’s not the same Kraft that created Kraft macaroni and cheese, I’m sure but I don’t think they’re related. Okay, all right. Never know, but could be you know, two sides of the family or something. Just a real quick epilogue. And bonus here. The Miracle mineral magnesium. We wanted to talk about that real quick. Any, any sort of lab bank you’d like there? Yeah. Thanks for bringing that

Dr. Ben Gonzalez:

up. Yeah, because that does play a powerful role in insulin resistance. It really does. So I just saw this somewhere I think it was online somewhere talked about someone was trying to sell something and camera what it was, but they talked about serum magnesium levels are so important. You want to wait till it’s less than 1.8. And so but actually, you don’t serum magnesium levels aren’t a sensitive way in checking for someone’s magnesium levels. It’s the red blood cell magnesium levels that are more sensitive. And I I like to keep my patients between 5.8 and 6.8 in their magnesium levels. Okay, and and I believe the you’ll see that, you know, the lab says again, like we talked about in another lab reference range that even four point ones Okay, and it’s not, it’s not 5.86 points where I like to keep the red blood cell magnesium level. I’m glad you asked that question. So

Dr. Andrew Wong:

we want to thrive not survive, I think is what you’re saying. Like the Shaka to I’m gonna do that. You know, the Hawaii Shaka,

Dr. Ben Gonzalez:

though? It’s an old habit. Yeah. Oh, I

Dr. Andrew Wong:

thought you were a surfer because that’s actually I am a surfer.

Dr. Ben Gonzalez:

There you go core surfing for decades. Awesome. That’s

Dr. Andrew Wong:

definitely great for grounding and you know, good for metabolic flexibility as well. Thank you so much, Ben, for being on our podcast again. And we’ll talk to you soon.

Dr. Ben Gonzalez:

All right. Take care. And thank you again for inviting me. I appreciate it.

Dr. Andrew Wong:

Thank you for taking the time to listen to us today. If you enjoyed this conversation, please take a moment to leave us a review. It helps our podcasts to reach more listeners. Don’t forget to subscribe so you don’t miss our next up sewed some conversations and thank you so much again for being with us