METABOLISM, MINDSET AND DIABETES
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Episode 229:
Show Notes
Episode 229:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:23) Good morning, my lovely friend. How are you today? It is spectacular here in Melbourne on this beautiful sunny morning and I'm joined by the most wonderful, bestest person in the whole wide world, Dr Mary Barson. Hello, my gorgeous friend. How are you today?
Dr Mary Barson (0:35) I'm lovely, thank you so much. I'm good, lovely Lucy. I am doing well. I'm feeling well, well today and reflecting on the fact that I'm feeling well with gratitude today because it's coming up to World Diabetes Day on November 14th. This is a topic extremely close to my heart because I am just one of those people who is extremely, extremely genetically primed to develop type 2 diabetes, insulin resistance and type 2 diabetes. I've got polycystic ovarian syndrome, which is, you know, well in control and in remission with lifestyle changes, which is great. I had gestational diabetes with both my kiddos and needed some injectable insulin with my most recent baby, who's now two years old. Both my parents have got type 2 diabetes. There was a time when I would have thought that it would be inevitable that I would also develop type two diabetes. And I really don't want to because it is an incredibly serious condition, but I definitely don't feel that that is the case now at all. I think my most recent blood tests were great, you know, I had an HbA1c of 5.1 and my insulin was three and things were all really, really good. So I'm metabolically well, despite my strong genetic loading for developing type two diabetes. So I'm really grateful for that. And I think that it is a great time to talk about all things diabetes in this auspicious time leading up to World Diabetes Day.
Dr Lucy Burns (02:20) Absolutely. So I thought I'd start with just maybe describing a few of the different types of diabetes because when we talk about diabetes, there are actually separate diseases. So the first one is what's known as type one diabetes. It used to be called Juvenile Diabetes that's actually a misnomer. It's type one diabetes most commonly developed in childhood and it's an autoimmune condition. So the antibodies attack the pancreas, the pancreas stops making insulin and blood sugar rises. And, you know, people present or kids usually present usually quite unwell. It's not, that's your first sign is you present really unwell. So they've lost some weight. They're very thirsty. They're drinking. They are vomiting and it's like, what's going on? And people sometimes think they've got some, maybe some gastro and it doesn't get better and they become quite unwell. And it's really, you know, often an emergency situation. Not always, but sometimes.
Dr Mary Barson (03:24) I've seen quite a few kids with that first presentation. Yeah, yeah.
Dr Lucy Burns (03:27) And it's pretty harrowing, I think, for families and, you know, it's a whole thing in itself, you know, to manage. So that's certainly one sort. The next sort is what is commonly known as type 2 diabetes, which is the lion's share of diabetes when we talk about diabetes, that's what a lot of people are referring to. It's a completely separate disease process to type 1 diabetes. They're completely different. It's confusing. They even share the same name. Yeah. Yeah. They should really have different names. That's right. But anyway, yeah, they are so different. But we need to get, for any of you who are Australian, you'll know Jimmy Rees as a comedian who does the thing where he decides, you know, the person that decided the packaging. Have you ever seen that? And it's, he'll go, who decides the packaging of strawberries? And they go, Oh, well, you know, we'll give plastic packaging with cling wrap topping. And then he'll go, great, great. And that's the same packaging then for raspberries. No, no, no, don't be stupid. We do, you know, clear packaging with hard labels for those ones. Oh, okay then. And so that's the same packaging we'll then use for apples. No, Jason, don't be ridiculous. We use paper bags for apples. And it's a bit like whoever decided to name some of her conditions. Why don't we call them all diabetes? Yes, Jason, that's a good idea. No, Jason, that was a stupid idea. So anyway, if you don't know what I'm talking to, please Google Jimmy Rees. He's very funny.
Dr Mary Barson (05:08) Yes, you do. What other types are there? Tell us more about type 2 diabetes, actually, I think deserves a bit more time.
Dr Lucy Burns (05:18) Well, yeah, again, type 2 diabetes and there are a few little subtypes that will fall into this, which are probably on the scope of here where we've got things like MODY and type kind of 3A and really more specialised sort of versions. But in general, type 2 diabetes is a disease of insulin resistance, and it usually will have hyperinsulinemia, so high levels of insulin at the start for a long time, often decades. And then if left unchecked or if managed in the traditional way, it will often result in burnout of the pancreas and then very low levels of insulin. And we'll come back to type 2 diabetes, but I think just to finish off the third type is, as you've mentioned, gestational diabetes, which is really an extension. It's sort of like it's very similar to type 2 diabetes, but it just happens in pregnancy, and it's related very much to the levels of progesterone in our blood during pregnancy. And we know that progesterone is one of our normal female hormones that in pregnancy is designed to, you know, help gestate the baby. And as part of that, it makes us all women. Insulin resistance is a useful thing because insulin resistance means we store body fat. And you can imagine. Helps the baby grow. It's a growth factor too. Yep. Keeps, you know, supply for breastfeeding for, you know, again, thinking about times where we didn't have refrigerators, where we had to go and hunt and gather our food. It was very, very useful. Not quite so useful now. I'll tell you what is used, what, I don't know if you have any of these mares, but I have what I like to sort of refer to as a little bit of pregnancy trauma around the insulin resistance that I experienced not knowing anything about it back 25 years ago. And in fact, 24 years ago today, November the 12th, is my eldest daughter's birthday.
Dr Mary Barson (07:45) Happy birthday lovely one.
Dr Lucy Burns (07:47) So 24 years ago, I know. And as part of that, I put on 32 kilos in my pregnancy.
Dr Mary Barson (07:55) That was the insulin resistance of pregnancy. Yep.
Dr Lucy Burns (07:58) It was. And you know, my obstetrician gave really helpful advice of, you know, don't put on too much weight. It's like, mate, I'm not doing anything differently. In fact, if anything, I was really, really, particularly the first pregnancy where you're often really, I was really pedantic. I was off to pregnancy exercise class, which was called preggy bellies. I was eating well. All of the things, and basically I just gained, gained, gained, gained weight, not just around my belly either. I'd like to say it was all around my belly. It wasn't, it was also around my bottom.
Dr Mary Barson (08:30) Mm mm Yeah, it was a traumatic experience, especially when you didn't understand why and it wasn't explained to you why that insulin resistance state that happens in the last, certainly the last trimester of pregnancy is normal and you know, women will gain weight normally. I had an experience with my second pregnancy when I was officially diagnosed with gestational diabetes with my second pregnancy, looking back at my blood tests, I can see that I've had it with my first one, but that was when the guidelines were a little bit different. Well, according to current guidelines, I would have had it with my first pregnancy, but it wasn't diagnosed because the guidelines were different back then. I wore a continuous glucose monitor throughout most of that pregnancy because I wanted to, you know, have nice steady blood sugars despite having gestational diabetes. And that gave me this kind of immediate feedback, which I think really helped me understand what was happening in my body. And helped me avoid that, which was good. I did gain some weight because that's normal and natural, but not heaps and heaps and heaps.
Dr Lucy Burns (09:32) Yeah, yeah. I often now think, wow. And again, you know, I wasn't a low carbetarean back then. I was eating sandwiches and you know, pasta, probably pasta galore, I'd say, because, you know, I was tired and, you know, it's easy to cook. So, you know, I look back now and think, well, I can see why I stacked on 35 kilos or 32 kilos. The advice my institution gave me of don't put on too much weight like that was so unhelpful. It would have been nice to know now what I know then, which was that, you know, again, you don't have to do a ketogenic diet in pregnancy or anything like that, but to have, you know, maybe not eaten breakfast cereal, two sandwiches for lunch and pasta for tea every day.
Dr Mary Barson (10:18) Yeah. Focus on your protein and your real food. That's right. Could have been helpful. Yeah, exactly.
Dr Lucy Burns (10:23) Exactly. Exactly. So let's talk a little bit about CGMs then because they're super popular, you know, wearable technology is the new black, so to speak, what are your thoughts on this Miss useful or not useful?
Dr Mary Barson (10:42) I think that they are really helpful to sort of lean into technology can be such a useful tool. Let's, I mean, let's use this with the example of insulin resistance and type 2 diabetes. And as you alluded to Lucy, lots of people have got insulin resistance for up to 10 plus years before they might be diagnosed with type 2 diabetes. And if their insulin resistance hadn't been diagnosed earlier, this is all, you know, 10 years in which they could have potentially had the right advice and to be able to turn their health around and to not get type 2 diabetes. But even once people have been diagnosed with type 2 diabetes. There is a lot you can do with your lifestyle to turn it around. You can reverse it in many, many cases, and you can certainly stop it from progressing and progressing and progressing and progressing with the right lifestyle changes. It's complex, but there are some simple aspects to it, that if you reduce the amount of sugar and the amount of starch that you eat and prioritise your real food, then your body's going to need to make less insulin, which is going to help heal and rebalance your insulin signalling within your body, within yourselves. It's really complex. Like insulin resistance is a complex metabolic disorder. But it is very true that the less sugar and starch you have, the more balanced your insulin can be and you can have talked to someone who's perhaps, you know, it's sitting in front of me in the GP consult room. And let's say for argument's sake that it's a person who's got a brand new diagnosis of type 2 diabetes and they are motivated, they are frightened, they do not want this, you know, because this is serious, like. This is not at all trivial.
Dr Lucy Burns (12:28) Yeah. And I think it's worth highlighting that because in the days gone by people often referred to type 2 diabetes as having a touch of sugar. I've just got a touch of sugar, which is like, yeah, there is no such thing as a touch of sugar. It is a serious, serious condition and in fact, I think we just looked up some stats. It is the leading cause of kidney failure in Australia. It's one of the leading causes of blindness. And the thing in particular that I think is terrible about being blind is that it comes, you know, towards the end of your life when you, you're frail. So perhaps your vision, like, you know, maybe you can't do all the things that you used to do. And so your vision is super important. You know, it allows you to do things, to watch TV, to read books, to connect with your friends, to drive, and. Once it's gone, it's gone, like, that's it, all of those things are taken away. So it's a really massive burden on your healthspan if you don't have your vision.
Dr Mary Barson (13:44) Absolutely. And bringing it back to that beautiful person sitting in front of me in the doctor's office with their new diagnosis, this beautiful person, they don't want to lose their sight by the time they're 70. They don't want to have to have vision loss. you know, their foot was amputated. They don't want to lose their kidney function and spend their life on dialysis. They don't want these things. However, human brains being what they are difficult for us to grasp the long-term consequences of behaviour change. Like we can want. to, you know, look at reducing our sugar, reducing our starch, making this work for us. How can I have a beautiful, joyful life by eating and eating less sugar? You want that but the consequence of in 40 years time, I'll be in diastrates if I don't do this is not easy for our brains to grasp. And if you're not finding that easy to grasp, it doesn't mean there's something wrong with you. It just means you're human. But bring in technology, chuck a CGM, a little needle into your arm, little, it's a tiny little needle. Well, it has time but hardly at all, very comfy and it gives you this immediate feedback of what your blood sugar is doing, not your blood insulin, but your blood sugar. So it brings all of the consequences, if you like, of what you eat and how you move and how you sleep immediately, immediately into the short-term future right now. And so you can see that you eat the breakfast cereal and your blood sugar spikes. That is immediately helpful, useful information. So right, well, next time. I will have hemp seed porridge for breakfast or eggs or some leftover dinner and empowers people to work with their body, you know, and also I think it's like you can empower people to show how movement is another aspect of it that, you know, if you see your blood sugars rising, have a glass of water and just move your body a little bit. And you could use your body to bring your blood sugars down, like that is also really, really helpful and powerful. And I think that they're great. And I use them quite a lot in my patients. They're not necessarily cheap, especially outside of that diagnosis of diabetes of type one diabetes in particular, that's where they're subsidised, but they're helpful.
Dr Lucy Burns (16:03) Yeah. And I think it's interesting. So, you know, we've spoken a lot about behaviour change and the various techniques that you can employ, to do the thing that you kind of know you want to do. So, you know, as we go, the helpful thing, what are the things that we can do to ensure that we are more likely to do the helpful thing? Certainly, accountability and feedback are some of the most powerful external drivers that you can employ and that's where this CGM comes in. So not only can you have feedback immediately, again, depending on what you're doing and who you're working with, but you can also share CGM results. So I've certainly had patients where they've shared their CGM results with me. And so it's like this little, Ooh, maybe I don't really want Dr Lucy to say that maybe you could log in every day and check what's happening. Yeah, absolutely. With their consent. Yeah, yeah, absolutely. Yeah. I can't see them unless they consent, but they would also come with their results and then we'd look at them together and then we go, Oh, okay tell me, you know, and my question is never, you know, judging is never helpful, but it's more like, tell me about what's going on here. Be curious. Yes. And the other thing that I think a CGM can be helpful for is to see if you get any blood glucose rises with stress. And we certainly see that in people with type 1 diabetes, that it's really common. Sometimes people with type 2 diabetes will still show a glucose rise with stress. And I guess the other thing where they will get a glucose rise is that isn't concerning exercise. So Miss, can you explain to our listeners why we get a blood glucose rise on a CGM with exercise?
Dr Mary Barson (17:58) It's because we get mobilisation of our glycogen stores. So mobilisation of the energy that we store. So our body can store energy in two main ways. We can store carbohydrates in the form of glycogen in our liver, and in our muscles, and then we store energy as fat, you know, hopefully mostly in our fat tissues, but sometimes also packed in around our internal organs, which is not great. And when we exercise, we get this sort of mobilisation of the glycogen that can cause these transient spikes.
Dr Lucy Burns (18:33) Absolutely. And the other thing to note is that the CGMs are recording. It's called interstitial levels. So your interstitium is the little sort of bit between your cells. It's not actually your blood. So your blood is contained within your arteries and your arterioles and your veins and your vein, venule, venule, venules, venules. Yep. Venules, yeah, we never use that word. Arterials. Don't use it very much. Anyway, little bean. No. Anyway, so it's an approximation. And again, that's something to always be mindful of for anybody using a CGM, to note that it's an approximation, it's not necessarily absolute. But the other words, I would like to live, give a little cautionary tale, again, I guess around reassurance. of CGMs. So CGMs are really useful when you can see what is causing your levels to go high. So you can go, Oh my God, I ate that bowl of rice and wow, look at my blood glucose. It's 12. And then two hours later, it's now four and I feel terrible and what's going on. So that's really useful. I've also had situations where I know that people's pancreases are really, really good. So what happens is that, and this is what we've done in the past, glucose tolerance test. So glucose tolerance test is where you go to the pathology place, you go fasted, they do a blood test, you drink, the sugary drink and then at one hour and two hours they'll take separate blood test results and you can combine those tests with an insulin level and I think they're super effective. So I've seen plenty of results where the blood glucose is almost rock steady, like in fact, one lady I can remember her blood glucose zero at zero, one and two hours were both all in the fives.
Dr Mary Barson (20:31) And this is after they have 75 grams of glucose. That's a big load of glucose that they challenge you with. Yeah.
Dr Lucy Burns (20:37) So it's like, she's just had 600 ml of Coke and blood glucose is completely normal. And you go, Oh, awesome. And then her insulin levels came and her insulin levels were high in the 200s. So a normal insulin curve really shouldn't go around over 45. And again, these are Australian units. So ideally fasting insulin should be roughly, and again, there's no perfect, but roughly under 10, one hour a day. In response to this 75 gram load should be roughly about 45, and then it should be coming down to about 30. That's a normal, metabolically flexible person's response. This lady's was her fasting was about 20, her one hour was 220, and her two hours was about 260. And it's like, oh, so interesting. So she's highly insulin resistant but normoglycemic.
Dr Mary Barson (21:40) So with her, a CGM could be potentially falsely reassuring, which I think is you got to take it in that the data, you know, within, the context of, you know, of what it's actually telling you. Blood sugar is a bit downstream, isn't it? Like you could, you could be developing insulin resistance and all of the problems associated with that, the problems associated with high insulin, weight gain, increased inflammation, all kinds of things, but your hardworking pancreas is still able to keep, you know, the wheels on this, this rickety, rickety car and, and keep the blood sugar under control. Whereas it won't be able to do that forever, but it's doing it for now. And so, yes, yeah, it's not everything. The CTM is not everything.
Dr Lucy Burns (22:27) No. And I think that's really important for us to remind our, you know, lovely listeners that insulin resistance does precede type 2 diabetes often, as you mentioned earlier, a decade beforehand. You've got plenty of time to turn that ship around. Symptoms, if you're thinking, well, how do I know if I've got insulin resistance? So we know that if you're storing your body fat around your middle, then that's often a sign of insulin resistance. If you've been diagnosed with fatty liver disease and you're not a heavy drinker, it's probably insulin resistance. If you've ever had gestational diabetes, you're more likely to be insulin resistant. If you've got lots of skin tags then, that's a sign of insulin resistance. And then a weird sign, and I don't know the pathogenesis of this, but people can get something called acanthosis nigricans, which is sort of dark, like the pigmentation of the skin under your arms, around your neck, some people on your forehead, sometimes on your forearms. It's also changing the skin texture, it's sort of a velvety texture. So that's quite a light sign. So, again. Plenty of time to turn the ship around.
Dr Mary Barson (23:59) Yes. And how do you turn the ship around? I mean, all the guidelines say you start with lifestyle, start with lifestyle. That's it. But I don't know. I certainly, I didn't learn much about how to help people change their lifestyle in medical school. So it's easy, I think, in the medical profession to just play lip service to the change of lifestyle. But what, what's actually helpful here? Lovely, Lucy.
Dr Lucy Burns (24:23) Yeah. So I think there are two things. To be honest, most people know some of the things they should be doing. Most people know it's not helpful to sit all day watching television, that sort of stuff. So, we do need to know what to do, but then we actually need to do it. So the knowledge is step one, and step two is the implementation. So the knowledge, again, we talk about the four S's or sometimes the six S's, depending on what day of the week it is, they're really, really fundamental for improving insulin resistance. So you know, if we start with the number one S, which is our sustenance, and again, low carb is a powerful way. To give your pancreas, I mean, it makes sense. You give your pancreas a rest. It doesn't have to work so hard. You reduce your insulin levels, opening access to your stored fat, empty your organs of fat, empty your liver out, and empty your pancreas out. Your body's so much happier. So much happier. So number one, sustenance. What's number two, Miss?
Dr Mary Barson (25:42) I always choose the five for my attention. I'm going to go with number two is stress.
Dr Lucy Burns (25:49) Yes, absolutely. And again, as we saw, and you can see this particularly if you've ever seen a CGM on a type 1 diabetes, you see the profound effect on their blood glucose that stress has. We know theoretically, I mean, we all learnt this in medical school that cortisol increases glucose, but it's like we forget about it actually in the real world.
Dr Mary Barson (26:18) Yep. That's what I tell myself when something, I can feel myself getting stressed. I'm like, this is not worth the rise in my blood glucose. Just take a few centring breaths. It's very helpful. Helpful for me to remember. How important stress management is.
Dr Lucy Burns (26:33) Absolutely. And people, again, we've said this a number of times, but I think it's worthwhile repeating that stress management is not the absence of stress ores like nobody has that. We all have stress ores in our life. That is normal. So what it is about how you react to those stress ores? That's the management part of it. Not. Let's get rid of the stress in the first place. It's how you react to it. Let's go live on a desert island. Yeah. The next S sleep. I love sleep. So sleep again, sleep is your superpower. You can just, when I say sleep is your superpower, it is more complicated than, you know, just go to bed early. But honestly, for some people that is. That is all they need to do. So lots of us start watching Netflix all night or half the night. Lots of us don't have good sleep practices. And so it's really about, okay, optimising what you can. If you have sleep apnea, you know, wearing your CPAP machine, if you think you have sleep apnea, getting diagnosed because by improving the quality of your sleep, that has enormous flow on effect to your metabolic health and metabolic hormones and all your organs.
Dr Mary Barson (27:54) Next S, strength or not being sedentary. Could be either.
Dr Lucy Burns (28:00) Yeah. Yeah. So, Miss, can you explain why is strength important?
Dr Mary Barson (28:11) It's extremely important. Our muscle is one of our most metabolically active organs and Improving your muscle, improving your muscle strength, and getting more muscle in your body benefits you in myriad ways. Like there actually is no aspect of your health that it doesn't help, but very specifically it helps you become less insulin resistant. It helps improve insulin signalling right down at the level of the cells, right down the level of the subcellular structures, like the mitochondria, it is a powerful medicine that helps your insulin work better and also helps you be stronger, avoids falling, gets better bones, improves your longevity, does all kinds of great things. That also really helps with metabolic health.
Dr Lucy Burns (29:00) Indeed, indeed. And then if we want to sprinkle in some of the other S's, sunshine. And the reason we talk a little bit about sunshine is that humans are circadian. We are supposed to be awake in the day and asleep in the night. We're not really supposed to be up watching telly all night. Some of us have to work at night and that's slightly unfortunate, but it's the way our society is given. So if you have the luxury of not working the night shift. Then we really want people to recognise that the power of morning sunlight is really helpful for lots of things. So for cortisol levels, which we've already spoken briefly about, for melatonin, again, part of our sleep hormone. And now there's even evidence that perhaps it's useful within that metabolic framework leptin, more to come on that. What we do know is that morning sunlight is free. It has no side effects. It's incredibly therapeutic. And all you have to do is actually get out of bed. So again, a bit like sleep, you have to go to bed, but then you have to get out of bed. Okay. So that's right. That's it. And then social connection, again, probably a little, you know, not directly related to insulin per se, but we just know that humans as a whole, we're social creatures. We know that loneliness is a risk factor for poor health and that social connection is not having thousands of friends or being in a crowd necessarily, but it's having just a number of deep connections, people that you feel safe with.
Dr Mary Barson (31:02) Yes. And that's how we can be metabolically well. So I mean, that's good. That's all fantastic knowledge there and information. But if you feel like you're struggling with the implementation, how do you work through that?
Dr Lucy Burns (31:19) Yeah. So implementation is always, it's a mindset. Our brains are funny. They all have the same stories. Our brains will say stuff like, well, I can't implement because, you know, I'm a, a single mum of two kids, one's 10, one's two, and I'm the sole breadwinner in the family. So I'm way too busy to do any of that.
Dr Mary Barson (31:46) Sounds strangely familiar. I wonder who that person is. It's me. Yeah.
Dr Lucy Burns (31:55) Or that story in somebody's head might be, well, you know. It's all fine, but you know, I have a disability and I can't exercise and I don't have any muscle mass and I've got a family history of type 2 diabetes so really I can't do any of that. That might be also someone we know. So that might be someone we know too, Lucy. So I think it's worth recognising that your brain is very good at giving you reasons why you can't do things and they're often legitimate. But we need to be able to work past those and go, okay, well, I hear what you're saying, brain, but what can I do to move past that? What can I do that's in my power? So, you know, as you know, I'm not doing strength training. I can't do strength training. But what does that mean? Well, that means I have to be really mindful of that and go, okay, well, then I have to double down on the other S's, you know, the sleep, the social, the social connection, that's a fun one for me, the sunlight, and again, I don't always get that right either, but it means that I need to work out a way that I can. So the implementation comes from, it comes from your brain. So it's between your ears.
Dr Mary Barson (33:16) Yeah. And it's the stories that you tell yourself and you can change those and you can change your brain. Your brain is, it's neuroplastic to use that term. And just because you've always told yourself one story, you know, like I'm a solo mum. I can't go outside and exercise in the morning. Like I just, I can't, I can't, I can't go to the gym in the morning. I can't go for a walk. I just can't, I have to stay in the house until my kids wake up. But you know, that doesn't mean that I can't do it at other times. You know my time is really limited, but that doesn't mean that I still can't carve out bits of time here and there for strength training, for cooking, for stress management. I still can. And you need to focus on what you can control and pay attention to what your brain says, and you don't always have to believe your brain.
Dr Lucy Burns (34:14) No, absolutely. And knowing that it can sometimes take a little while to get it right. And as you know, we all love an analogy. I love an analogy. I'm the queen of analogies, but again, we look at it like gardening, you know, gardening, you, you don't plant a garden and then leave it. And it just, you know, tends to itself. It doesn't, it needs constant, work, and it'll be different work in different seasons. And our lives are very much like that. So you know, some seasons for growth, some seasons for pruning, some seasons are for, you know, just having a little rest. There's always going to be times where it comes and goes. You don't have to be perfect all of the time, and you don't have to do all of the things all of the time. What we need to do is most of the things most of the time. That's it. That's what you do most of the time that counts. Yeah. Absolutely. Absolutely. And I guess, you know, this is, this is what we do day in, day out with all of our programs, with all the people that we help is helping them unpack the stories that are in their head, the things that are holding them back and working out, well, what, what are new stories? What are new ways that we can do it? You know, what do you need? Do you need, you know, accountability? Do you need to be telling somebody, I plan to do this and therefore, I want everyone to know, but not everyone. Maybe I just want a few secret people like Dr Mary to know, but that's what, that's the sort of stuff that we do. It's until you're then ready for your own self-accountability.
Dr Mary Barson (36:03) That's what we do with our support groups, with all of our things. Yeah. Learn to work with your beautiful brain.
Dr Lucy Burns (36:11) Absolutely. It all comes down to metabolism and mindset. That is the formula for a happy, healthy life. Improve your metabolism, and manage your mindset. Again, you know, I know there are other things that can go on, but the, you know, the two big rocks, they're it. I love it. Metabolism. Mindset. Both are within your control. Excellent lovelies. Yes. Beautiful people. If you know where we are. If you want any help from us, Momentum our monthly membership for women is currently open. We are taking new enrolments. We'll put the link in the show notes, but it's just rlmedicine.com/momentum. And it is your one-stop shop for all things metabolic and mindset.
Dr Mary Barson (37:07) Love it. see you later gorgeous ones.
Dr Lucy Burns (37:09) All right, beautiful peeps. We will see you next week. Bye souls.
Dr Lucy Burns (37:13) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
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