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Episode 247:
Show Notes
Episode 247:
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 (0:12) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:16) Good morning gorgeous friend, how are you this morning? I hope you're having a fabulous day, starting off with you know feeling energised and awake, maybe you are, maybe you're not, who knows. But I am joined by my effervescent bubbly friend who will just certainly inject some joy into your day today. Dr Mary, how are you lovely?
Dr Mary Barson (00:38) I'm pretty good I have to say, I am good. Look, it's summertime, kids back at school, Max is in daycare, life has got a little bit more of a routine. I loved school holidays, I did, but I also hated school holidays, I did. It's just, it's such a juggle, it's such a juggle. I mean the precious summers with your children are precious, so I do my best to cherish them. But yeah, a little bit of system and order is good too. So I am feeling good, I am loving life right now. How are you beautiful?
Dr Lucy Burns (01:14) Yeah good, good, a bit like you, well no not at all like you, I have no small children. I also do love summer, as you know, I am a summer person, I love sunshine, I like it warm, I have you know, do lots of swimming, which is my movement, the best movement for me. So I do love that. I have felt like I've been living in a shared household for the past maybe a year, because my adult children and their while their boyfriends weren't living with us, they seem to be living with us. And so I'd go into the kitchen and they'd be like, and six adults in a house, it's quite a lot.
Dr Mary Barson (01:55) Share housey, very share housey.
Dr Lucy Burns (01:57) Yes, yes, yes, you go to use something and it's in the sink, or you go to get something out of the fridge and someone's already eaten it. So very much share housey. Anyway, one of my girls, so my eldest daughter has finished uni, she's graduated, she's working, she's you know now a grown-up, she's got a grown-up job, she works as a horse vet, and she's moved out. And her boyfriend, he didn't stay, so they've gone. And on top of, and lots of you will know that not only do, I have had lots of sort of adults living in the house, we also have had a lot of pets throughout our life. Anyway, Ruby took with her two dogs and a cat, so it now feels like, yeah, our house is much, much less busy.
Dr Mary Barson (02:51) I know enough about your household to know that it still leaves a lot of animals, but I can imagine that it does feel like a relatively emptier nest.
Dr Lucy Burns (03:01) It does, yes, it does, it does, it does. We have got a very young, enthusiastic, exuberant Border Collie, who you will definitely relate to, and he is, you know, one part hilarious, one part annoying, but, and in fact, one part hairy, the hairiest hound I've ever met. But um, but no, he's good.
Dr Mary Barson (03:24) My Border Collie gets dreadlocks, it's, yep, it's a thing, ha, and more maintenance, more maintenance.
Dr Lucy Burns (03:30) Well, lovelies, we've got some great things, I think, to talk about today. I'm excited. One of the things that I think is really important, we've spoken about this over time, but just to re-emphasise, you know, our favourite thing of lifelong learning. So, Miss, what are your thoughts on this?
Dr Mary Barson (03:58) Yeah, my thoughts are that it's really important to remain open-minded and humble in, I think, in all fields of life, but particularly in, you know, the health weight loss space. As new scientific information becomes available, there's a constant evolution in science, there's a constant evolution in our understanding, and we should remain open-minded and committed, I think, to that lifelong learning. And that remaining open-minded sort of fosters that curiosity and that willingness to learn. And this really helps people, I think, stay informed, stay nimble, and allows you, for yourself, to be able to make the best decisions for your own health and well-being, but also for you and I, Lucy, as weight management doctors and metabolic health doctors. It allows us to stay up-to-date, but also allows us to learn and evolve as we need to learn and evolve. And we were reflecting, you and I today, about just how much we have, how much we have learned and how much we've evolved over the time that we've worked together, which is, I mean, coming on to be like five years now. Nearly five years. Yeah, crazy.
Dr Lucy Burns (05:26) I know. And it's interesting. I mean, when we first started this, it's because we had learnt a new process. We had learnt that, you know, the way we had looked at weight loss in particular around calorie counting, you know, hadn't been helpful to you or me. Or our patients. Yeah, so many patients. And, you know, and again, everyone's story is a little bit different. And our stories are different. You know, your story is around insulin resistance, polycystic ovarian syndrome, obesity from a very young age. Mine was more around dieting, even. You know, again, I kind of look back and go, oh my God, I started my first diet when my BMI was 21. Like, I was actually thin. It's crazy, isn't it? So the experience then of societal pressure and the diet culture and how our two pathways have both similarities and differences.
Dr Mary Barson (06:35) And how they kind of converged on this common thread that brought us together, which was metabolic health, low carb, real food, and the psychological management, the psychological aspects of healthy change. That's what brought us together. But we've evolved, haven't we? From our early days, if we listen to the first episodes of our podcast, you know, there's a lot more subtlety and nuance into what we do and recommend now, even compared to back then.
Dr Lucy Burns (00:00) Yeah, absolutely. And I think it's easy to be an evangelist. And, you know, we were probably, in fact, I was, I would have, I would say to myself, I was keto, I was a keto evangelist. I wouldn't have called myself a keto evangelist, because that sounds a bit wanky. But I would definitely have described myself as being keto. And I was very much promoting keto to, you know, anybody who wants to listen. That might be the, there's the evangelical definition coming in there. And that really about, you know, the lower your carbs, the better.
Dr Mary Barson (07:50) And I was there with you. Yeah.
Dr Lucy Burns (07:53) Yeah. Yeah. And again, it is really, it's a really helpful tool for many, many people.
Dr Mary Barson (08:01) You've hit the nail on the head. It's a really helpful tool for many people. But you and I being open minded, being curious, and I like to think that we are, although we may have been evangelical at times, because we were so passionate about how helpful this tool was for us and for others, we were taught by our beautiful patients, by our clients and even by our own experience, that there are some times when a really low carbohydrate diet, like a really low ketogenic type diet is not appropriate, not wanted, not doable. And then rather than just shutting those people down, people who didn't want to or couldn't or just like completely ignoring this new evidence that emerged as we grew, as we learn, we dived into that and we leant into that and we took a broader approach and our approach has sort of grown. And now we're not so evangelical about ketogenic diets. In fact, you know, we think you can be keto if you want, but you don't have to. Now we've really put far more emphasis on whole foods, on prioritising your protein and all of the other aspects, which we always thought were important, but now understand just how incredibly important they are or the other aspects of your metabolic health like sleep and stress and gut health and strength training and building up a far more nuanced picture that I think is far more helpful, far more useful for many more people. But it does mean that sometimes we butt against other people in our health community who want to pick a fight, essentially a fight, don't you?
Dr Lucy Burns (09:50) Yeah, well, you know, I guess for us, we try not to engage in fights. There are certainly people within our community, people we've even interviewed on our podcast who have philosophies that I just don't agree with. I think that, you know, the phrase we like to use is a one trick pony. I think that that's unhelpful. They're dogmatic, it's their way or the highway. If you don't want to do it my way, then go find someone else. And, you know, and again, they're entitled to do that. They're a person. And that's one way you can do it, but it's not our way.
Dr Mary Barson (10:29) No, and I think you've got to be wary of that dogma and guard against that dogma, because, you know, in health and weight loss, people can become very dogmatic with people believing there is only one correct way. It's their way or the highway. But being open minded ensures that you don't become fixated on just one thing or just one method. And that allows you to consider all the other valid approaches that might suit an individual or a person better or a combination of approaches, because it's not just one thing. It's not this or that. It's sort of it's kind of all the things. Everybody's so different. But that's, you know, one health blogger, for example, may have discovered the key to their health and it might be carnivore or plant based or ketogenic. And then they can be they can become absolutely convinced that if you just do what I do, then you'll be like me. So do what I do. And if you're not like me, then you're doing what I'm doing. But that is not how humans work. You know, each individual's body metabolism and responses to interventions vary greatly. And so if we want to serve people and help people, then we need to be humble and acknowledge that what works for one person might not work for another. And we need to have you need to encourage a sort of personalised, flexible approach to health and weight loss.
Dr Lucy Burns (11:55) Yeah, absolutely. And I think sometimes I mean, we've described it before and I'll just go through it again for anyone who hasn't heard this. We are you know, I love this kind of Christmas tree analogy. So the Christmas tree analogy is where you've got you know, you've got your solid base and you've got your branches of your tree. And they're the things that most people should probably be doing. So they are things like eating whole foods, prioritising protein, getting good sleep, managing stress, basically the pillars of all of our teaching, all of our programmes. And that is going to benefit everybody, every single person. Then there are some nuances of the decorations or the baubles. And, you know, they can be things like, you know, it might be that they're helpful, but they may or may not be helpful for each person. And so they could be things like, you know, potentially some sort of, let's say, rare gut species of bacteria, for example. It might be something like diet soft drinks. Okay, so if somebody is doing all of the things and they have diet soft drink, well, diet soft drink is not going to be the thing that is causing their weight gain, for example. And you can go and find lots of arguments for and against diet soft drinks. Now, I'm not ever going to say to you that diet soft drinks are good for you. They have no nutritional value. Do I ever drink diet soft drinks? Well, yeah, I do. Sometimes I have diet tonic. There's one brand that uses sweeteners that are quite helpful, but that brand's not always available. And so sometimes I use the other brand. And again, I think overall, it's such a small thing. It's not the only thing. So I guess what the Christmas tree analogy is that sometimes we can get focused on the shiny baubles and we spend all of our time focusing on that. But yet the issue is that we're sleeping three hours a night, that we're maybe eating all of our calories, all of our caloric intake. So all of our food is eaten between 8 p.m. and 10 p.m. And we're not focusing on that. We're focusing on the fact that we're still drinking diet coke or something along those lines.
Dr Mary Barson (14:36) That's right. There are those fundamental pillars that everyone can work on. Everyone would benefit from sleep, strength, real food, and stress management. Everybody, like everybody's life, could be improved by these things. And finding a way to work on those for you is going to be different. So even like from a mindset point of view, mindset skills that are useful for one person might be useful for another. But there are those fundamental pillars. And then once you've got those fundamental pillars in place, then there's a lot of visualisation and personalisation. And we all need to be, you know, empowered to know what to do and how to do it. And we do need to guard against dogma. And the way that we help people, the way that we guide people, it has evolved. It's not drastically different. Like I'm not saying we were used to say that, you know, everybody has to drink beetroot juice every day. And now we're against beetroot juice. There's nothing like that. I don't think we've ever mentioned beetroot juice. But we have that, I think, because we're open minded and because we work in these spaces, we become more experienced. With that experience, there's been more nuance and more subtlety, I think, that we've allowed to come in. And I think that's really helpful.
Dr Lucy Burns (15:54) Oh, absolutely. And we've talked over the last couple of months about the, I guess, the advent of weight loss medications. Now, when you and I first started, there was only one injectable weight loss medication. It was expensive. It needed to be injected every day. And the studies weren't that good. It was underwhelming, wasn't it? Yeah, very underwhelming. It was. And so the average weight loss for people after two years using these medications was six percent of their body weight. I remember thinking, wow, so if you weigh 120 kilos, you're going to spend $500 a month injecting yourself every day. To lose like eight kilos.
Dr Mary Barson (16:58) Yeah. And expose yourself to all the dangers and side effects as well. It didn't seem like a good deal. Yeah. It wasn't something that you and I routinely prescribed.
Dr Lucy Burns (16:59) Not at all. Now, you know, the newer medications are far more effective in the numbers. There are issues with them. I wouldn't say there's lots of issues, but there are issues and they need to be discussed. And I think that there are people who, again, it's actually the same with every single medication. If you're a doctor, every single medication, there is a risk and a benefit. And when the benefit outweighs the risks of either taking or not taking. And again, sometimes the risk is not taking it. If you've got uncontrolled type two diabetes and you don't take medication, you've got risks, disease risk. If you've got type two diabetes and you take medication, there are risks with medication. That's why people talk about them. So I think there are things that, again, five years ago, people, if somebody said to me, what do you think about injectable weight loss medications, Dr Lucy, I would have said, don't waste your money. Honestly, don't waste your money. Times have changed. And I now don't think it's like everyone should have them. But I think that it's something that we need to look at as another tool in our toolbox lever to pull any analogy you like. And recognise that for some people, it's useful. It's the same with bariatric surgery. Probably five years ago, again, I was a little bit more evangelical about lifestyle medicine, maybe a little more naive. You know, this we're currently interviewing people about bariatric surgery, about their experiences, because I think the worst thing a doctor can do is make somebody feel bad about the choices they've made around their health.
Dr Mary Barson (18:51) Apart from anything else, it's so counterproductive to them being healthy. And so many of our beautiful people have had bariatric surgery, like large numbers of patients, our clients and our community members have had bariatric surgery. And they've been our greatest teachers, I would say, really about learning about the realities of this. And yeah, I mean, it's a tool. It's a tool that has its uses, has its problems.
Dr Lucy Burns (19:15) Yeah. And again, when we think about it, you know, five years ago, anyone speaking to me about meal replacements and protein powders, I would have, you know, got out my skewer and stabbed them in the eye. I'm now recognising that actually for some people, these are useful. On a mass marketing campaign, you know, they have somehow dodged the ultra processed food label. And that drives me nuts. That's a separate issue. But for some people, they're useful.
Dr Mary Barson (19:48) Yeah, that's right. That's right. And it's all about that individual, you know, individualisation, because we're all so different. One size fits one sometimes.
Dr Lucy Burns (19:57) Yes. Yes. And sometimes people who are doing everything, and we see this too, there is not one more lever that they could possibly pull. They are doing everything. And yet their body is still hanging on to fat. So why, you know, to quote Julius Sumner Miller, why is it so?
Dr Mary Barson (20:19) Exactly. And you've got to be open minded about that.
Dr Lucy Burns (20:23) Yeah, the answer is we don't know because we don't have all the answers yet. There is going to be stuff that is going to come out about obesity management that we don't know.
Dr Mary Barson (20:32) Yes, that's right. And I can't wait to learn it when it does come. Keep expanding the edges of our understanding.
Dr Lucy Burns (20:41) Absolutely. Because that is how you bring everyone along with you. You know, if you want to be tribal and stick to your one gun, that's fine. You again, you know, you can do that. But you alienate people that need assistance, that people need help. When you consider all the possibilities, think about all of the options, you're much more inclusive. Absolutely. Yeah. I think for so long, you know, and again, people living in, you know, and again, whatever phrase you like, people have all different ways they describe it. People describe living in a bigger body, living with obesity, living, you know, again, there are people who embrace the fat word. I'm fat. They're happy. They're proud of that word. Doesn't matter whatever the word is. What we do know is that people have been discriminated against for years. And by not being open as a health care provider, you can continue that discrimination for them. And that's not fair.
Dr Mary Barson (21:53) No, not fair and not at all helpful.
Dr Lucy Burns (21:58) Indeed. Indeed. So, lovelies, I guess the summary of all of this is that, yeah, you're not going to hear us beating a giant drum for one thing. We are not. And it can feel a little bit like we don't stand for anything, like we're not pro-keto, we're not anti-keto, and we're not. But that's the whole point. And look, even ultra-processed food, I bang on about that. I bang on about the harms of it, about the marketing around it. But that doesn't mean I'm perfect.
Dr Mary Barson (22:38) I think if we were going to make a sign that we'd had a packet, it'd be something like we are all for a subtle, scientifically proven, nuanced response that's individualised to people's needs, which is not very catchy, but I think that's what we stand for.
Dr Lucy Burns (22:53) I think you're right. I think you're right. And coming back to that thing, it's what you do most of the time that makes the difference, not what you do. You don't need to be perfect. You honestly don't. No, perfect is nothing. We need to have awareness and honesty with ourselves because sometimes we'll say things like, oh, well, it's all right. Dr Lucy says I don't need to be perfect. You know, as I eat two doughnuts every day for months, I wonder why I'm not feeling well. Probably not helpful. Yeah. So honesty with yourself is helpful, but you do not need to be perfect. Our body is an incredible detoxing machine. Can manage. It manages to metabolise alcohol, which, from a body point of view, it does not like, from a brain point of view, it likes it a lot. So it can do incredible things. And we just need to know that consistency trumps perfection every day.
Dr Mary Barson (23:55) I love that. Yeah. We could put that on a sign, perhaps.
Dr Lucy Burns (24:00) Yeah, yeah, yeah, yeah, yeah. Again, we have to. Yeah, yeah, no. I was just going to bring in some Trump reference, but I think I'll just decline that for the
Dr Mary Barson (24:10) probably best for now. Yeah, yeah. Leave those on later. OK.
Dr Lucy Burns (24:15) Indeed. All right. Lovely friends. We'll be back soon with another episode of the Real Health and Weight Loss podcast. Take good care.
Dr Mary Barson (24:30) Bye, gorgeous people.
Dr Lucy Burns (24:45) 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.
