WHAT IS INSULIN RESISTANCE?
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Episode 198:
Show Notes
In this compelling episode, Dr Mary and Dr Lucy set the stage by unveiling a hidden epidemic that silently looms over modern society: insulin resistance. Describing it as "the epidemic of our time," the doctors illuminate the profound impact of insulin resistance on global health and well-being. With their expertise in weight management and metabolic health, they embark on a journey to demystify this pervasive yet often overlooked condition, inviting listeners to delve deeper into its complexities and implications for human health.
Defining Health and Metabolic Health
They begin by discussing the definition of health according to the World Health Organisation (WHO), emphasising the importance of physical, mental, and social well-being. Dr Lucy highlights how the term "healthy" has been weaponised and highlights the subjective nature of health.
Understanding Insulin Resistance
Dr Lucy explains that insulin resistance, often accompanied by high blood insulin levels (hyperinsulinemia), is a significant factor contributing to metabolic health issues. They discuss how insulin resistance can go undetected for years and only gets diagnosed when it has already caused significant damage.
Recognising Signs of Insulin Resistance
The hosts outline potential signs of insulin resistance, including skin tags, central obesity, and acanthosis nigricans (skin pigmentation). They emphasise the importance of early detection through blood testing to address insulin resistance before it progresses further.
Effects of High Insulin on Health
Dr Mary explains the role of insulin in the body, emphasising its function in glucose metabolism and cell regulation. They discuss how insulin resistance and high insulin levels contribute to various chronic diseases, including type 2 diabetes, heart disease, Alzheimer's, and polycystic ovarian syndrome (PCOS).
Causes of Insulin Resistance
Dr Lucy discusses the multifactorial nature of insulin resistance, attributing it to both genetics and lifestyle factors and the significant impact of the modern food environment, characterised by processed foods and high sugar intake, on the development of insulin resistance.
Strategies to Improve Insulin Sensitivity
Drs Lucy and Mary outline the Four S’s—Sustenance, Strength, Sleep, and Stress—as pillars of lifestyle interventions to lower insulin levels and enhance metabolic health. They talk about the importance of embracing real food, prioritising muscle strength, optimising sleep quality, and implementing stress management techniques.
Embracing a HOTI Lifestyle
The episode concludes with a powerful message encouraging listeners to become "HOTIs" (Healthy On The Inside). Drs Lucy and Mary explore that thriving internally leads to external vitality, inspiring individuals to embark on a journey toward optimal metabolic health and well-being.
In a world grappling with the pervasive challenges of metabolic dysfunction, Episode 198 of the Real Health and Weight Loss podcast serves as a beacon of knowledge and empowerment. Dr Mary and Dr Lucy impart invaluable insights and actionable strategies, empowering listeners to reclaim their metabolic health and thrive as HOTIs. Through education, awareness, and lifestyle modifications, individuals can embark on a transformative journey toward lasting well-being.
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Episode 198:
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) Hello, lovely friend, Dr Mary here. We have just had International World Health Day and I am joined by my fabulous colleague, Dr Lucy. Lovely Dr Lucy, how are you today?
Dr Lucy Burns (0:34) I am awesome. Thank you for asking Dr Mary. So last month, I presented at the newly formed Australasian Metabolic Health Society at their very first course for doctors. So metabolic health is what I would perceive to be, you know, one of the greatest threats to humanity, certainly to our health. And I thought, given we've just had World Health Day that maybe what we could do is start with, you know, a bit of a definition of health. Start also then, you know, just deal a little bit further with what metabolic health means and how it affects everybody. And the way I look at it it is robbing people of the third of their life like I like to divide our life into thirds, you know, you've got your first third where you sort of, you know, you're young, your child, young adolescent, young adult, then you've got your middle third, where you're working, raising your family, and then you've got your final third, where often you're, you know, maybe into retirement, and you sort of reap the rewards of all the work you've sown, and people are being robbed of this and so I thought this would be a great topic to chat about.
Dr Mary Barson (1:52) It is, yes, insulin resistance is quite possibly an epidemic you've never heard of, and it is the epidemic of our time. Yes. Okay. So what is health? WHO have a nice definition of health, which I like, and I'll share that, then I'll get your opinion on what health is, Lucy. So I think this is a good one, the World Health Organisation defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. I like that one.
Dr Lucy Burns (2:34) Yeah, I like that one. I like that. I think we need to be mindful that the word health or healthy in particular has been weaponised, in many of, you know, discussions that go on in social media, and sort of have a moral tone to it. You know, people go, they're not very healthy and it's this sort of, you know, judgment, or that foods are not healthy, even to the point of scientific literature, where they will talk about healthy fats, for example, as though the word healthy is an objective term. So I think, healthy, that's a subjective term that people use to describe, you know, something much in the same way that the word pretty or beautiful it's there but it's highly subjective. And so, you know, heart, healthy, grains, for example, you know, doing something that is healthy, you can almost substitute it for good, holy, moral. So, I want to be very clear that, and because it's part of, you know, common parlance, we will still use that word. But at the end of the day health is the definition that you've described, I think, Miss.
Dr Mary Barson (4:00) Yes and what leading question alert, what do you think, is one of the main factors out there that is robbing us of our health? Why are we not as healthy to set subjective terms as we want to be particularly, you know, in that in our later years in life?
Dr Lucy Burns (4:22) Well, having just presented at the Australasian Metabolic Health Society, the root cause of poor metabolic health, and we'll talk about what metabolic health even means is insulin resistance. So, insulin resistance and hyperinsulinemia, which is just a very fancy way of saying high blood insulin are slightly different terms, but used interchangeably often and at the end of the day, have very much a similar result on the health of the body or the human or the health of the human's body and mind. So we will use them intermittently, we will talk about high circulating insulin, we'll talk about insulin resistance. And when we're feeling very fancy, we'll talk about hyperinsulinemia. But at the end of the day, they all result in the same process and that process is that it becomes harmful to our body and causes chronic diseases that is manifesting often for a long time before we're aware of it.
Dr Mary Barson (5:35) That is a key point. Most people with insulin resistance don't know that they have it. It's a silent killer in that regard and it's often not discovered until quite late in the disease process, which I think is a travesty because there is so much that you can do to stop it in its tracks to reverse it. There's a lot you can do by, you know, making those healthy interventions for yourself in a way that improves your health, you can do it but before insulin resistance and high blood insulin wreaks irreversible damage to your health.
Dr Lucy Burns (6:17) Yeah, absolutely and there's some signs that people can have that they may not even be aware of that they're not diagnostic but they're like a little warning sign, or maybe I've got insulin resistance. So, you know, I think people always go, how do I know? How do I know? Ultimately, the only way to really know is through blood testing, like we don't have home blood testing like you can do with glucose, there has to be a blood test that you have at a pathology lab. And we can do a fasting level, you know, what's your insulin levels when you're not eating anything, or we can get a little bit fancy and do one that's like a glucose tolerance test where you have some glucose drink, and you measure the both usually the insulin and the glucose at the one hour and the two-hour mark. Or sometimes we can create a formula, using something that's called the HOMA-IR and it's just a mathematical formula where we plug some numbers in and that will give us like a quotient that will tell us you know, whether you’re insulin resistant or not, but the symptoms or those signs, or what could you look for that would give you a clue, there are a few. In particular one, that many people have, they don't realise is a skin tag. So people that have skin tags on their neck or under their arms in the groin, maybe you know, under your, under your boobs, if you're a female. Lots of people have one here and there and that's, that's normal. But if you find you've got lots, it's a bit of a clue, so we see that. And the other clue is if you store your body fat, around your middle, rather than around your bottom and legs, especially if you're female. So if you're an apple not a pear, then you're more likely to be insulin resistant. If for some people, they can get some pigmentation on their skin, and this might be again under arms, groin, but it can be on your forehead or side of your neck or forearms, and you get this sort of brownish sort of velvety pigmentation and at first, you might think it's sort of dirt and to try and rub it off but it doesn't, it doesn't go. And again, that's something called Acanthosis Nigricans and it is often associated with high circulating insulin. So, there are a couple of just signs before you've even seen the doctor as to what might be going on. But there maybe you could talk a little bit more about why we care so much about high insulin like why is it a big deal?
Dr Mary Barson (9:02) Yeah, I think it could be useful to take one little step back and say, you know, what is insulin? Most people are going to be familiar with the word but they may associate it with like as a drug treatment for diabetes, for example but Insulin is a hormone that we make. So it's a protein that our body makes. In this case, it's made by our pancreas, which is a little gland sort of tucked away behind our stomach and our pancreas makes this hormone and releases it into the blood, it circulates around our blood and it has a vital role to play in how many vital roles its most important role is it dictates how every single cell in our body, you know, from our brain right down to the tip of our toes, how every single cell in our body uses fuel, but it also dictates the size of the cell, how the cell behaves, how big the cell gets lots of other factors as well. Most people will be familiar with insulin's role in taking the sugar out of our blood after we eat a meal that contains either sugar or starch, those carbohydrates are broken down into their sugar components, and they're released into our bloodstream. High blood sugar is extremely dangerous, even life-threatening if it gets too high, and our body releases insulin in response to this, and then our body can then take that sugar, and can allow cells to take it up so they can either burn it for fuel fat cells can then store it as fat. Our liver can store it as glycogen or as fat muscle cells store it as glycogen, and allows us to essentially use that fuel. And insulin has, like every single cell in our body has got insulin receptors, and pretty much every single cell nobody and every single organ in our organ system in our body responds to insulin in different ways and it's right when it's functioning normally. In fact, you know, you would be dead without insulin but the problem is that for many of us, insulin has started to function abnormally, and we are, our body is becoming intolerant to the amount of sugars and starches in our diet, and having to our body has to respond by making more insulin to deal with the sugars and starches and we get into this state of insulin resistance, which is a complex metabolic disorder, which we can unpack a little bit. And in response to the insulin resistance, our body has to make more insulin. So it's that combination of high circulating insulin and insulin resistance, which is so problematic, but then that high circulating insulin plays a significant role in a devastating number of hideous chronic illnesses, including type two diabetes, heart disease, neurodegenerative disorders, like Alzheimer's disease, disorders of reproductive systems, such as polycystic ovarian syndrome, and even many cancers. So it's not a benign situation at all.
Dr Lucy Burns (12:12) No, I heard as a way to try and explain a little bit of insulin resistance, which was this idea that insulin is, as you mentioned, to every cell has receptors and it's a bit like a loudspeaker and it signals a transporter. So the transporter is called GLUT4 and it signals this transporter to take the glucose or the sugar from the blood and sort of carry it into the cell. So the problem comes when the transporter, it's a bit like a can't hear it anymore. So it's a bit like when you're watching telly and there's background noise. So you turn the telly up, and so that you can hear it, so the concept is still the same. So we need more insulin to do the same job, so that basically, we turn the telly up, we get more insulin and more loudspeakers, and the pancreas so kind makes more insulin for us, in order to do that same job of transporting the glucose into the cells. And as you mentioned, up until recently, and look, honestly, when I was a junior doctor, we knew nothing of this. So this is not old, old science, we knew nothing about this, and the syndrome, that it was called syndrome X, which sounds so kind of sci-fi because we didn't know what was going on, we had no concept. And over time, it became clearer that you know, high circulating insulin was at the root cause of syndrome X, which then you know, became renamed metabolic syndrome. And metabolic syndrome has it there's a number of conditions that cluster together, all with the same root cause. But in particular, you know, high blood pressure, dyslipidemia, it's called which is just fancy name for low HDL and high triglycerides, usually, and fatty liver disease. And you don't even need to have all of them to have metabolic syndrome. And in fact, apart from hypertension and fatty liver disease, it's now been renamed metabolic fatty liver disease, metabolic or so. So MAFLD; Metabolic Associated Fatty Liver Disease, so we do know, it's all they're all the same thing. They're all the same thing.
Dr Mary Barson (14:38) And so incredibly common and widespread and a driver behind so many of these illnesses that are robbing us, robbing us of our health.
Dr Lucy Burns (14:52) Yeah, absolutely to the point where sometimes it's become so normalised. So you know, we've had situations where fatty liver is no longer reported on ultrasound because it's so normal. It's sort of considered our eyes just a normal, a normal variant, except that it's not. And the same, you know, with triglycerides, like I remember, as a doctor before I became a lifestyle medicine doctor, you know, again, I was back in the old days of prescribing statins for everyone with high cholesterol. And even when they had high triglycerides in it, they didn't do anything, I still prescribed them because I knew I had no idea, no idea what to do.
Dr Mary Barson (15:33) And it could even be there is still a reluctance out there in some pockets of the medical community to measure insulin and to test for insulin resistance because there is perhaps still an idea that well, okay, we'll do it. But what can you do about it, there's nothing that you can do, it's just a, it's just a chronic onward progression towards type two diabetes. So what's the point, of course, there are things you can do if you have insulin resistance. And I think it's also important to pick a part here the difference in blood glucose, measuring blood glucose and measuring blood insulin, because historically, we've placed a lot of emphasis on measuring blood sugar and it's a diagnosing type two diabetes on the basis of people's blood sugar, either their fasting blood sugar or their HbA1c which is looking at their blood sugar control over the last three months and the genesis of this. So if you can imagine that type two diabetes is a really significant insulin resistance, it's almost like when insulin resistance has become so significant that the body is no longer able to actually control blood sugar. But for decades before then, our body's compensating. So we're not tolerating with the amount, not tolerating the quantity of sugars and starches that we're eating in our bodies making more insulin, and the cells aren't coping with it. Also, they're hiding their GLUT4 receptors, so then our pancreas starts screaming at ourselves, making even more insulin and so you have to take this sugar, you just have to, and then the cells are unhappy, they're not liking it, because insulin resistance increases, they try and hide their glucose receptors even more, and then they scream even louder and then overuse insulin creeps up and up and up and up. But the body is compensating it is managing to deal with the sugar, it's managing to deal with the carbohydrates is going, it's going, it's going, it's going it's going until they can't cope anymore. And this is when things really started to progress and that is the point in time when blood sugar becomes elevated. That is the point in time when type two diabetes is diagnosed. But before that decades before, then there is this whole opportunity to intervene before we get there.
Dr Lucy Burns (17:45) Absolutely, absolutely. And I think this is the missing piece in a lot of, in a lot of people's knowledge, the recognition that insulin and glucose are completely different things. So glucose is a fuel, we either eat it or cleverly we can make it and Insulin is the hormone that comes in response to that glucose level. So they are hand in hand but they're not the same thing and I think for a long time, we thought that glucose was the problem and it is, but that insulin was just sort of an innocent bystander trying to do its job. But in fact, we now know that insulin itself, high circulating insulin is an independent source of pathology. So when you get the double whammy of high glucose and you've had high insulin, it's no wonder our poor old body has trouble.
Dr Mary Barson (18:50) What causes insulin resistance is complex, absolutely. But let's you know, broad brush strokes why are people becoming insulin resistant with high circulating insulin.
Dr Lucy Burns (19:00) Yeah, it's like lots of our chronic diseases there is it's multifactorial, but the two factors come down to genetics and lifestyle. So you can I mean, we all know, we've all seen people who have, you know, what, what would probably be considered terrible lifestyle choices, but managed to get away with them. But for most people, that doesn't happen. So you'll have genetics that are involved there and the tricky thing with genetics, because people go—Oh, can't be genetics. I mean, we've been evolving for, you know, 1000s of years, how come all of a sudden, it's genetics? And that's because of epigenetics. And we've always had these genes but their genes, the expression of those genes, is changing and again, that's multifactorial. Things like you know, a baby or a fetus's exposure to glucose levels in the uterus or the womb will increase the baby's chance of being insulin resistant. You know, there's lots of talk currently around plastics, environmental toxins, and endocrine interrupters, all of which I have a modicum of knowledge, but by no means an expert. So we've got those sorts of things going on but the biggest change that has happened is our food environment. And it is the number one thing that we see the introduction of those processed, that processed food, the process starches into societies and within not very long, like a decade, they'll go from being a population that on as a whole is reasonably healthy to a population as a whole, that is dealing with metabolic syndrome and type two diabetes. And, you know, we see this in Australia in our indigenous community, you see it in China, where processed foods being juiced, you know, much more recently, and India and yet populations are suffering.
Dr Mary Barson (21:14) I think it could be useful to talk about the ways in which high circulating insulin affects our health and it's increasing this pattern of ill health that we're seeing, and it does it in myriad ways. And you could sort of lump it into various organs, you know, brain, heart, reproductive system, that you go through every organ, in fact, but I think that we should, should probably limit it, to sort of deepen the understanding of how this is really, really serious. And it needs to be taken extremely seriously. This is why we get sick, and why we actually don't have to, or if we are already sick, what we can do to improve our health in simple and safe ways, powerful and safe ways. So yeah, I've got polycystic ovarian syndrome. So we could start there if you like that insulin affects every single cell and organ in our body and our ovaries. If you're a woman who responds to insulin and dislikes all of the other organs, and when this is normal insulin signalling, it's all well and good but insulin resistance in the ovaries and elevated insulin inhibit the ovaries' ability to turn androgens of the male sex hormones into estrogen so the female sex hormones inhibit the aromatase activities, the enzymes that do this, so it can result in increased male sex hormone so the androgen levels for women are supposed to have some definitely, but having them in the wrong balance and at the wrong time can affect fertility. And it can also cause symptoms like acne and unwanted hair growth, which can be really distressing. Insulin also directly affects our luteinizing hormone secretion, which is one of the sorts of the orchestrator hormones of our reproductive health. So it can really affect women's reproductive health and polycystic ovarian syndrome it's really common and really devastating and is at its heart, due to insulin resistance. It's not just your ovaries, it's your brain as well. Insulin resistance has been associated with decreased fuel utilisation in our brains, which can cause all kinds of problems. It has been associated with the laying down of the beta-amyloid plaque in Alzheimer's disease and some people even refer to Alzheimer's disease as type three diabetes. It's the effect of insulin resistance in the brain research is still ongoing, but there is very compelling evidence that it does this. And your heart as well, insulin resistance elevates blood sugar, as we were talking about before, it increases our aldosterone hormones, which makes us hang on to more salt and hang on to more fluid, which means that we retain more fluid which increases our blood pressure. Also, insulin resistance and high circulating insulin increase our inflammation throughout our whole body and it's really interesting how this happens, because in the right, normal balanced amounts, insulin is actually anti-inflammatory, but too much insulin is pro-inflammatory and it is the inflammation combined with high blood sugar combined with the way that insulin affects fats in our blood, that dyslipidemia that you were talking about earlier, that drives atherosclerosis and heart disease, which is what we know is a really, really serious issue. So it's fingering in all of these pipes. It really is really a very significant issue for having already hammered that point home.
Dr Lucy Burns (24:48) Absolutely, and you know, even further so there is a new phrase that is now coined called CKM, which is Cardio, Kidney Metabolic Dysfunction, so CKMD, because of insulin, so we know I mean, we know glucose is not good for kidneys, we know this, we know that the leading cause of dialysis and chronic renal failure is type two diabetes and we see these devastating communities but actually what happens is that when people are diagnosed, they've often already got kidney disease and we used to think that we just diagnosed them too late i.e. you know, they'd had type two diabetes for ages and we didn't know. Actually now what we're realising is that it's the insulin, the insulin itself, the high insulin is damaging to what's called the Podocytes, which I love that little word Podocytes, which means little feet, their little feet, cells that are part of the filter of the kidney. So the filter of the kidney, which is the whole, its kidneys, the whole job is being compromised, way, way, way, way before blood glucose levels are being elevated.
Dr Mary Barson (26:06) It's kind of frightening.
Dr Lucy Burns (26:09) It is! it is because people are relying I think on blood glucose and you know, if your HbA1C, which is your measure of blood glucose over three months, if that's okay, then you know, you're okay, except maybe you're not. And I don't mean to say this to be alarmist but I think it's helpful because you can, you can do something. So it's not like, I'm just going to frighten you and bad luck, you can't do anything. It's actually you can do something about this. The other interesting thing that I never realised is that the insulin-like growth factor, that causes cells to grow, that you are mentioning, is also our blood vessels, our blood vessels have tiny little muscle cells in them, called smooth muscle and that grow. And so it becomes instead of like a nice flexible vessel becomes like a stiff old hose, which is part of the whole blood pressure thing that then you know, again, flow on effect to the kidneys flow on effect to the eyes flow on effect to the brain flow on effect to the heart, the damage is so immense but the benefit of fixing this or optimising it, balancing it doing whatever word you want to do, is also immense, like think of every single organ that you can, you know, save, nurture love look after simply by taking measures to lower your insulin. It's not rocket science.
Dr Mary Barson (27:48) It's powerful, and it's cheap. It's cheap.
Dr Lucy Burns (27:52) So I guess that comes to the next question then, what do people do to lower their insulin and improve their insulin sensitivity?
Dr Mary Barson (27:58) So there are a few things that should do and they're all pretty cheap. Number one is to look at how you are nourishing your body. And it may well be and in fact, it is if you are someone who's got insulin resistance and higher circulating insulin, either a little bit or a lot, that you would benefit from reducing the sugar and reducing the starch that you ate, and definitely reducing the processed food, the hyper-processed food that you eat, and learning to love and embrace real food, that real food that's naturally lower in sugar, and naturally lower and starches are going to be the most powerful intervention that you can take for your health. It's not the only one, but it is a really important one.
Dr Lucy Burns (28:51) And in some ways, we've distilled it to the Four S’s. So as one of the S is being sustenance, because not that's a word that we use a lot, but it just fits with that S paradigm. So sustenance, which is your food, which has, as you mentioned, Mary is very much low, you know, for us lower carbohydrate, food nutrition. So that's your sustenance and that can also incorporate some intermittent fasting as we discussed in our most recent episode last week. So that's kind of your S. Strength is your next s so we know that muscle is your metabolic organ, the more muscle you have, the more protected you are. And this is where you know it's I'm so acutely aware of this having not much muscles so again lots of you will know but if you're a new listener to our podcast, I have muscular dystrophy which means I don't have a lot of muscle mass my muscles they just sort of fading away. So the ability therefore for my body to store its glucose and utilise its glucose is much more more impaired. Plenty of people with muscle-wasting diseases end up with type two diabetes, just related to that metabolic function. So the more muscle you can build, the better your metabolism. The more sensitive those muscles become, the less insulin, you know, coming back to the telly, you can turn down the telly by increasing your muscle mass.
Dr Mary Barson (30:28) Yes, with strength training a little goes a long way. Absolutely, it does. Indeed, you don't need to be a bodybuilder but you do need to move around and lift some heavy things and heavy things can be your own body weight. That's pretty heavy. Yeah.
Dr Lucy Burns (30:42) So we've got sustenance, we've got strength, what's next Miss?
Dr Mary Barson (30:47) Ah sleep. Sleep is so important being in a sleep-deprived state and that is another chronic epidemic of our time, increases insulin resistance to a significant degree and so ensuring that you get good quality sleep, that you prioritise your sleep and that you take measures to ensure that your sleep is as good as it can be. Give yourself a non-negotiable eight-hour window, limit your caffeine later in the day, and look at your alcohol, all of these things help your sleep. And if you've got good sleep, then you're going to improve your insulin sensitivity. Sleep is vital. Absolutely.
Dr Lucy Burns (31:32) So we've got sustenance, we've got strength, we've got sleep and our final S, which we talk about quite a lot on this podcast is stress. So again, recognising that stress is inevitable, nobody lives in a stress-free existence and that's not what we're aiming for. What we need to do is to develop the skills to manage that stress, so that we can look after ourselves when times are tougher, when things are a bit rocky. It's just a skill problem, that's all and when you've learned really good stress management techniques, you do, you get you get better your your metabolism improves. It's like a flow-on. So the better you are at managing your stress, the better you become at managing your stress,
Dr Mary Barson (32:18) Which it could spiral upwards. That's right, you spiral upwards. I love that. That's right. Stress increases our insulin resistance and managing it increases that insulin sensitivity and yet look, again, I'd say a little bit goes a long way. Yeah, you don't need to completely transform every aspect of your house and you know, leave your job and go live on a tropical island. Small steps that you can fit into your daily life are going to dramatically improve your insulin resistance, decrease your insulin sensitivity, and turn your whole health around.
Dr Lucy Burns (32:56) Absolutely. Therefore, on this World Health Week, you too can become you know, basically a being that is thriving and when you're thriving, you become what we love to call a HOTI; Healthy On The Inside that will most definitely be reflected on the outside but we all want to strive to be fabulous HOTIs healthy on the inside.
Dr Mary Barson (33:28) That's right. You're a HOTI. Lucy, I'm a HOTI. And we want everybody in the world to be a HOTI too!
Dr Lucy Burns (33:35) Absolutely. All right, HOTIs we'll see you all next week. Bye for now.
Dr Mary Barson (33:40) Bye gorgeous ones!
Dr Lucy Burns ((33:45) 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.
