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Unlocking Stubborn Fat Loss with Robbie Clark · Wellness by Designs - Practitioner Podcast

• 0:14
  Speaker 1: Music.
• 0:15
  Speaker 1: This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook.
• 0:20
  Speaker 1: This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook.
• 0:24
  Speaker 1: Joining us today is Robbie Clark, an accredited practising dietitian and an exercise scientist.
• 0:31
  Speaker 1: Today, we're going to be talking about how to overcome stubborn fat loss.
• 0:35
  Speaker 1: Welcome to Wellness by Designs, robbie.
• 0:38
  Speaker 1: How are you?
• 0:40
  Speaker 2: I'm really well, thanks, andrew, and it's great to be with you, as always.
• 0:49
  Speaker 1: Great to be chatting.
• 0:50
  Speaker 1: It's been a long time, I'd like to say between drinks, but we haven't.
• 0:52
  Speaker 1: Let's dive right in Robbie.
• 0:56
  Speaker 1: So we've all come across patients with stubborn fat loss.
• 0:58
  Speaker 1: You know they just can't get over that ledge.
• 0:59
  Speaker 1: Either they've reached some level of success or I've even had one patient that just couldn't even get the fat loss going.
• 1:06
  Speaker 1: Tell us what's going on here.
• 1:08
  Speaker 1: When do you stop current approaches and take stock of what's going on?
• 1:15
  Speaker 2: Yeah, I think we've all had that client, as you said, and it can lead to a lot of frustration because you think, as a practitioner, you're doing the right things and only to just not yield the results that you or the client are looking for.
• 1:29
  Speaker 2: So it can cause a lot of frustration, but I think it's a no-brainer.
• 1:34
  Speaker 2: All our practitioners we do a thorough investigation and an assessment.
• 1:39
  Speaker 2: That's the first and foremost thing that we need to be doing.
• 1:42
  Speaker 2: That's the first and foremost thing that we need to be doing.
• 1:45
  Speaker 2: You're looking at what they've currently been prescribed in terms of interventions or in terms of investigations and see what has been done to date and therefore you're filling the gaps.
• 1:56
  Speaker 2: And I think investigating resistant fat loss, especially when all the traditional methods, like diet exercise, just don't get the results that you're looking for it does require a more comprehensive assessment and investigation, and I think that that's where some of these more functional tests can really provide great insights into these various underlying factors that might be contributing to that stubborn fat loss.
• 2:24
  Speaker 1: Okay, so let's delve into there a little bit.
• 2:26
  Speaker 1: What sort of investigations do you tend to work with?
• 2:31
  Speaker 2: Yeah, I think firstly it's the obvious ones.
• 2:33
  Speaker 2: You're really looking at what might be additional factors, and these are typically hormones.
• 2:40
  Speaker 2: So you might be looking at a thyroid function test, where you're looking at your TSH, your free T4 and your free T3, because these are all critical for your metabolic rate, and you're also looking at the thyroid antibodies as well, which a lot of mainstream medicine or GPs don't typically investigate.
• 3:00
  Speaker 2: But this is obviously assessing autoimmune thyroid conditions like Hashimoto's.
• 3:04
  Speaker 2: But this is obviously assessing autoimmune thyroid conditions like Hashimoto's.
• 3:06
  Speaker 2: Hormone panels are always great, whether it be salivary, urinary, in addition to blood, because that can really break down the metabolites.
• 3:15
  Speaker 2: And we're looking at things like cortisol, your estrogen, progesterone and testosterone as well, and even the precursors, like an adrenal hormones, your DHEA as well.
• 3:26
  Speaker 2: Vitamin D very important.
• 3:32
  Speaker 2: We also know that mainstream medicine doesn't like to prescribe vitamin D anymore, but that can tell a huge insight into somebody's immunity.
• 3:37
  Speaker 2: And then I typically do a comprehensive metabolic panel.
• 3:42
  Speaker 2: So that's looking at your liver, kidney function, electrolytes, your blood, glucose levels, fasting insulin and also the HbA1c and you can see where I'm kind of going with that, which is looking at potential investigation for things like insulin resistance, polycystic ovarian syndrome or any other metabolic dysfunction that's occurring polycystic ovarian syndrome or any other metabolic dysfunction that's occurring.
• 4:11
  Speaker 2: Finally, I will then also probably look at a lipid profile, because we know that cardiometabolic go together, so we really want to investigate and assess the cardiovascular risk as well, which is your LDLs, your HDL, your total cholesterol, your triglycerides.
• 4:23
  Speaker 2: And then also looking at inflammatory markers, because inflammation is a key driver to a lot of this stubborn fat loss that we see.
• 4:33
  Speaker 2: So CRP and also ESR are just great little insights.
• 4:38
  Speaker 2: And finally, gastrointestinal health tests, which people tend to do last, but doing that and putting that higher up the list could save you a lot of time and headbanging against the wall.
• 4:54
  Speaker 2: And even SIBO as well small intestinal bacterial overgrowth, because we know that there's a huge link between obesity, metabolic dysfunction and also gastrointestinal health as well.
• 5:13
  Speaker 1: With regards to things like cortisol, when you're dealing with a patient who's obviously stressed and distressed and I'm remembering this patient who you know, with the first poke at her weight loss, she actually put on weight from, you know, a nice whey protein, but there was so much stress involved in her life, Indeed, she was almost under this pressure.
• 5:39
  Speaker 1: She was like a bubble about to burst the pressure, not the vision.
• 5:43
  Speaker 1: She was like a bubble about to burst the pressure, not the vision, but there was so much inflammation that I saw there and I was just going, oh, we're poking at this with a stick, we're not getting right down to what's really going on.
• 5:57
  Speaker 1: But what was really interesting to me is the impatience of this patient to want to go and delve further.
• 6:07
  Speaker 1: They just wanted something now and I'm like that's not going to happen.
• 6:10
  Speaker 1: It's not, it's not, it's obviously not worked.
• 6:13
  Speaker 1: What you've tried before hasn't worked.
• 6:14
  Speaker 1: Why do you want me to do another one of those things that you've tried before, and this time for it to work?
• 6:19
  Speaker 1: So how, then, do you get across to these people what has happened isn't working?
• 6:24
  Speaker 1: We either change tack or don't do it.
• 6:24
  Speaker 1: How do you get across to these people what has happened isn't working.
• 6:26
  Speaker 1: We either change tack or don't do it.
• 6:27
  Speaker 1: How do you get across?
• 6:29
  Speaker 2: that message.
• 6:31
  Speaker 2: Yeah, I think it's more about the education piece and it's the empathy which I think a lot of practitioners have right regularly in their practice particularly we functional medicine practitioners where maybe the system has failed them with either a misdiagnosis or an underdiagnosis.
• 6:52
  Speaker 2: So you're really just wanting to communicate with them that you're wanting to rule out a lot of factors and then look into new things that haven't been investigated to date.
• 7:03
  Speaker 2: And when you start talking about possibilities around new complications or new causes, then they get more excited because they really understand that, okay, sure, this has not been looked into, so therefore I might go along with this, and you find that at that point of despair that they will typically take you up on that offer.
• 7:28
  Speaker 2: So therefore I might go along with this and you find that at that point of despair that they will typically take you up on that offer.
• 7:32
  Speaker 1: But again it comes away, how it's communicated and educated.
• 7:36
  Speaker 1: Yeah, so, with regards to, you're talking about looking at the gut and it's critical that at least at some stage that this is looked at.
• 7:42
  Speaker 1: And now, obviously that depends on where they're on with their journey, how much money they've got, how much money they're willing to put in.
• 7:49
  Speaker 1: I get, I understand there's so many variables, but you know, speaking with people like Jackie Bowker and this beautiful positive speech that she has, you know, everything negative is actually a positive because it gives you information, brilliant messages that she translates Awesome.
• 8:09
  Speaker 1: So, talking about things like testing the gut for inflammatory markers, or indeed inflammatory microbes, that might be say, you know, carbohydrate harvesters, the formicities.
• 8:24
  Speaker 1: Be say, carbohydrate harvesters, the formicities how do you get across?
• 8:31
  Speaker 2: the importance of doing this to patients.
• 8:32
  Speaker 2: Yeah, absolutely.
• 8:33
  Speaker 2: And firstly, I'm really assessing what their current symptoms are of their gut, because that in itself is a bit of an indicator and usually if there is some inflammatory or systemic inflammation that's going on in the body, there's going to be some gastrointestinal disruption as well.
• 8:50
  Speaker 2: So you find a lot of these people do have some gut issues, whether it be as simple as bloating, gas, reflux or worse.
• 9:00
  Speaker 2: They're on things like proton pump inhibitors and medications that are treating gourd or reflux.
• 9:07
  Speaker 2: And that's when I really want to know OK, well, how long has this been going on for?
• 9:11
  Speaker 2: And also, if there's diarrhea, constipation, pain and noticeable steatorrhea, so fat in the stool and things like that.
• 9:23
  Speaker 2: So when they start ticking all these boxes, you're like, okay, that hasn't been looked into yet.
• 9:28
  Speaker 2: So I think you really benefit into this type of testing.
• 9:33
  Speaker 2: And then it's more around discussing and communicating the mechanisms linking gut bacteria to metabolic health.
• 9:43
  Speaker 2: So you're really trying to communicate that well with them.
• 9:46
  Speaker 2: So, like you mentioned the energy harvesting um, you know there's certain bacteria that are more efficient at extracting um calories from the diet, which can lead to increased energy absorption and fat storage.
• 9:59
  Speaker 2: So these are things that the person starts going okay, I did not know that, um.
• 10:05
  Speaker 2: And then it's looking at how this test can also look into their gut barrier function.
• 10:11
  Speaker 2: So then you explain that an imbalance in the gut microbiota can certainly compromise the integrity of the gut barrier, which then leads to that intestinal or increased intestinal permeability, or that leaky gut, as we like to call it in industry, which then allows for all those endotoxins to cross over into the blood barrier and that is a flow on effect to all those other symptoms they might be experiencing, like foggy brain, cognitive impairment, forgetfulness, lapse in memory, all these type of things that you start putting the pieces of the puzzle together and of course the number one thing we see is dysbiosis, which is usually due to that imbalance of bacteria which can lead to that again, increased intestinal permeability and also inflammation in the gut and we know that chronic inflammation is the key driver for metabolic dysfunction and also things like insulin resistance as well.
• 11:15
  Speaker 1: Do you tend to, though, favour, let's say, the word attack or addressing inflammation, or do you address the gut as a milder sort of thing, or addressing inflammation or do you address the gut as a milder sort of thing?
• 11:31
  Speaker 2: Well, andrew, don't you think they go hand in hand?
• 11:33
  Speaker 2: It's kind of like a chicken and the egg situation it's.
• 11:34
  Speaker 2: You know, is gastrointestinal dysfunction leading to the inflammation or is the systemic inflammation that this person has causing the gut issues that they might be experiencing?
• 11:44
  Speaker 2: Both might hold the key as to why these type of clients struggle with their fat loss.
• 11:50
  Speaker 2: So, in my opinion, you can definitely address both at the same time, and we know that the gut microbiome and the microbiota is a complex and dynamic community that significantly influences metabolic health and that includes the insulin sensitivity component.
• 12:10
  Speaker 2: So again, it's not just about blood work anymore and looking at what someone's fasting insulin is.
• 12:16
  Speaker 2: It's looking at the microscopic level as to how this bacteria might be influencing how your body is actually metabolizing these type of hormones in your body.
• 12:31
  Speaker 1: How important is the right diet and which one?
• 12:33
  Speaker 1: Because we've got data on Mediterranean long-term for everything, but then you've got shorter term and indeed there was some long-term gains with, for instance, keto.
• 12:44
  Speaker 1: I don't know about carnivore diets and things like that.
• 12:47
  Speaker 1: We know that the SAD diet is exactly that Standard American Australian Diet.
• 12:52
  Speaker 1: Whichever one you want to use, it is just not working.
• 12:56
  Speaker 1: But which one do you favour?
• 13:00
  Speaker 2: Yeah, I think.
• 13:01
  Speaker 2: Well, first of all, as a dietician, I obviously do a lot of intervention with food and nutrition.
• 13:08
  Speaker 2: It's really making sure, first and foremost, there aren't any nutrient deficiencies, because we know I mean, I get a lot of people coming to see me who are already following a particular protocol, whether they've listened to a podcast about it or they've heard an influencer talk about it and you know what worked for them, think that's going to work for them individually, which is not necessarily the case, as we know.
• 13:33
  Speaker 2: So I get people coming to me thinking, oh yeah, look, I've got this stubborn fat loss.
• 13:39
  Speaker 2: I haven't achieved it.
• 13:40
  Speaker 2: They're either on a low calorie diet, they're on a low carb or ketogenic diet, thinking that carbohydrates are actually the devil and that's what's the cause of their stubborn fat loss.
• 13:51
  Speaker 2: But it's not until I do that reeducation and look at everything as a whole.
• 13:56
  Speaker 2: So when you ask me about what type of dietary protocol is appropriate, it's again looking at the individual.
• 14:05
  Speaker 2: And if I have these answers at my fingertips say the results from a complex gastrointestinal test like the GI map test or the gut 360, whatever pracs want to use that's giving you a really good indicator as to how their gut is actually responding to the dietary protocol in itself, because we know there are specific things that are important for certain foods.
• 14:33
  Speaker 2: Bacteria Fiber is probably the most important.
• 14:37
  Speaker 2: So, of course, if you've got people who are on a carnivore diet, who are not consuming a lot of plant-based foods or whole grains, which then contain this really important fiber for our gut health, their microbiome will be significantly different to, say, someone who might be on a more plant-based, vegan, vegetarian-style diet.
• 15:01
  Speaker 2: So again, it's looking at what they're lacking and trying to make sure that there is a nice balance.
• 15:09
  Speaker 2: Prebiotics are obviously important.
• 15:11
  Speaker 2: Probiotics are important, are important.
• 15:20
  Speaker 2: We know that saturated fat or too high levels of saturated fat can certainly influence or elevate levels of inflammatory markers in the gut, and then also even artificial sweeteners have been shown to alter the gut microbiome as well.
• 15:32
  Speaker 2: So again, I've got a little bit of a checklist that I'm looking at in terms of their consumption or lack thereof and then making the assessment on the back of that.
• 15:44
  Speaker 1: I've got to ask a comment.
• 15:46
  Speaker 1: I wonder if I've noted, like I've seen in the past, patients with inflammatory bowel disease being put on to a milk-based liquid diet short term, but that's it, only that.
• 16:03
  Speaker 1: Um, I look here, you know about the carnivore diet and you see other people using some other restrictive diet.
• 16:13
  Speaker 1: Let's, instead than restrictive, let's call it, at least for the short term, oligoantigenic.
• 16:21
  Speaker 1: And I wonder, I don't know, but I wonder if any of these might have a place over the short term, only having this effect of just saying let's just give the gut a rest for a second.
• 16:35
  Speaker 1: Then you must heal it because you can't stay on that nutritionally deficit diet long term.
• 16:42
  Speaker 1: But in the short term, I wonder if part of that um, not, it's not attraction part of the key to the therapy, if you like, is that oligo antigeneticity.
• 16:53
  Speaker 1: I think I made up a new word then.
• 16:55
  Speaker 1: Have you ever used that Like?
• 16:59
  Speaker 1: Does it chill with you?
• 17:02
  Speaker 2: Yeah, I think.
• 17:03
  Speaker 2: I mean there is certainly emerging research around that approach from a dietary perspective for inflammatory bowel disease, but there's also some interesting research around intermittent fasting as well.
• 17:15
  Speaker 2: So, as you say, it goes back to giving the bowel a bit of a rest and that you're not providing a huge dumping of food immediately, especially upon waking, and that might give it a little bit of a rest and digest ability, so to speak, which can also be beneficial.
• 17:35
  Speaker 2: But in terms of an oligoantigenic diet, you know, as you say, foods to include it is restrictive because you're looking at simple, non-allergenic foods for these type of people, you're looking at specific vegetables, you're looking at specific fruits and, again, it might lack things like protein for a lot of people, which is problematic at the end of the day.
• 18:05
  Speaker 2: So you really need to see how the person is responding individually, because I've had some people who might respond well and others who just don't at all.
• 18:18
  Speaker 1: Right, okay, so let's move on to supplements.
• 18:21
  Speaker 1: What supplements do you use?
• 18:22
  Speaker 1: What are you like here?
• 18:23
  Speaker 1: Let's go your top five.
• 18:25
  Speaker 2: You know what sort of things do you find has most bang for buck when you're looking at helping somebody with, um, what stubborn fat loss yeah, and you know, I think it's important to note here, when we're also we're looking at this, it's like what, if I were to recommend anything, it's on the back of results, right.
• 18:47
  Speaker 2: It's not just like here you go, try this, see if it works.
• 18:50
  Speaker 2: We're really looking at things that have been, have a bit of evidence behind them that might really improve things like dysglycemia, dyslipidemia, insulin resistance, things that are obviously then picked up and said all right, this is one of the triggering factors to your stubborn fat loss.
• 19:12
  Speaker 2: We need to support that.
• 19:13
  Speaker 2: And let's be clear, these people might also be on medications.
• 19:18
  Speaker 2: So they might be on things like metformin if they have already been diagnosed insulin resistant.
• 19:24
  Speaker 2: So I will typically then concurrently support them with that through, say, these type of supplementation.
• 19:34
  Speaker 2: So things that I like in these scenarios is good old berberine.
• 19:39
  Speaker 2: I think any practitioner who's done any form of cardiometabolic, even gut improvement, is looking at berberine.
• 19:49
  Speaker 2: We know it can improve metabolic function through many different mechanisms, such as activating the good old activated protein kinase to enhance that glucose uptake and also fatty acid oxidation.
• 20:03
  Speaker 2: We have seen in certain research that it improves insulin sensitivity and also reducing insulin resistance.
• 20:12
  Speaker 2: It modulates the gut microbiota and reduces those endotoxin levels that I talked about has anti-inflammatory properties, antimicrobial properties and it also enhances mitochondrial function.
• 20:26
  Speaker 2: So, needless to say, oh, actually one of the good things I see also about berberine is that it inhibits the hepatic gluconeogenesis and reduces that intestinal glucose absorption, which is what you want in, obviously, people who have dysregulation or cannot manage their blood glucose levels appropriately.
• 20:48
  Speaker 2: And there are some practitioners out there who argue that berberine supplementation is just as good as metformin in terms of treating insulin resistance out there.
• 21:03
  Speaker 2: So huge fan One you have heard of we've talked about many times before, andrew is myoinositol.
• 21:14
  Speaker 2: It has so many benefits for different population groups, especially amongst those women who experience things like polycystic ovarian syndrome and endometriosis.
• 21:27
  Speaker 2: So it does have a great metabolic effect on the body by improving insulin sensitivity, because it enhances insulin signaling, which then reduces that insulin resistance and promotes the glucose uptake.
• 21:44
  Speaker 2: It then helps regulate that ovarian function that we see in that PCOS, like we talked about lipid metabolism.
• 21:54
  Speaker 2: So it reduces serum lipids and that hepatic fat accumulation, which is really important.
• 22:01
  Speaker 2: So we don't want to see the fatty acid, so I'm sorry, we don't want to see our liver enzymes being elevated.
• 22:08
  Speaker 2: So that's where I'm looking at those results.
• 22:11
  Speaker 2: It has anti-inflammatory effects because it lowers those levels of pro-inflammatory cytokines effects, because it lowers those levels of pro-inflammatory cytokines and it also might improve the good old endothelial function as well by enhancing the vascular health within the body.
• 22:28
  Speaker 2: So two major ones are pretty much at the top of my list and just to name a few more.
• 22:35
  Speaker 2: Things like chromium are also also good, which has been shown to improve glucose metabolism, and also things like cinnamon, which can be used as a spice, a natural spice, in the diet.
• 22:50
  Speaker 2: Alpha lipoic acid I'm a huge fan of yes, yeah, and that's because it has antioxidant properties as well.
• 23:01
  Speaker 2: So it's really helping reduce oxidative stress and any inflammation that's occurring, and also it is working towards insulin sensitivity by also enhancing that insulin signaling as well.
• 23:15
  Speaker 2: That insulin signaling as well.
• 23:23
  Speaker 2: It works on mitochondrial functioning and also can look at, has the anti-inflammatory effects, like I mentioned, and lipid metabolism.
• 23:28
  Speaker 2: So it has so many great things there that we're trying to recalibrate, so to speak.
• 23:36
  Speaker 2: And then through the diet alone, people can just try to increase their green tea intake throughout the day due to the great polyphenols that are in there, which we know can also improve the gut microbiome.
• 23:51
  Speaker 2: It can reduce beta-glucuronidase if those levels are high.
• 23:56
  Speaker 2: So we need to increase polyphenols in the diet if we see elevated beta-glucuronidase in our stool tests.
• 24:03
  Speaker 2: So green tea is a fantastic way of being able to incorporate that, and I like it for so many more reasons than a metabolic enhancer, as they like to call it in industry, where they've got supplements for green tea which I don't necessarily recommend.
• 24:24
  Speaker 2: But, more to the point, great natural green leaf matcha green tea can really do the trick in those situations.
• 24:34
  Speaker 1: Yeah, a couple of things on dosage I've noticed, for instance.
• 24:39
  Speaker 1: Firstly, there's a little bit of jockeying about dose with myo-inositol and, for instance, there was a professor who might I say, professor Annabelle Teed, gave one of the best podcasts ever on polycystic ovarian syndrome and the incredible work they're doing at Monash Uni syndrome and the incredible work they're doing at Monash Uni.
• 25:02
  Speaker 1: Hats off to you.
• 25:03
  Speaker 1: But she's not in favour of myo-inositol and in polycystic ovarian syndrome and I suspect that one of the issues she's faced is the extremely low levels of myo-inositol that you get in some supplements.
• 25:13
  Speaker 1: You know 200, 300 milligram.
• 25:15
  Speaker 1: I've seen like 60 milligram in one um.
• 25:18
  Speaker 1: What dosage do you use with this and things like berberine, um, ala, indeed as well yeah, absolutely so you're looking at.
• 25:27
  Speaker 2: In terms of my own isotol, you're looking at about 1000 to 2000 milligrams per day.
• 25:32
  Speaker 2: It really depends on, obviously, all the other things that might be going on for this particular client.
• 25:38
  Speaker 2: But, for example, anyone who wants to learn more about hormones.
• 25:43
  Speaker 2: I'm a huge fan of Dr Kerry Jones, who's now at Rupa Health in the United States but who was previously working for Precision Analytical, who does the Dutch test, so she was the medical officer for them and she is just knows so much about hormones and so that's typically her recommendation with everything.
• 26:08
  Speaker 2: In terms of berberine, you're looking at about 500 milligrams three times a day with meals is what the research is showing.
• 26:18
  Speaker 2: That is typically a good dose for berberine.
• 26:23
  Speaker 1: Yeah, yeah, yeah.
• 26:24
  Speaker 1: And alpha-lipoic acid, which I've often termed chilli-flavoured battery acid.
• 26:33
  Speaker 1: My only sort of caution there is be careful if you're giving it in a capsule form to anybody who might have a silent reflux or a sliding hiatus hernia, because if you burp that up, oh my God, it is horrible.
• 26:49
  Speaker 1: So I often get people to take that with the first mouthful of food and push it down.
• 26:55
  Speaker 1: Make sure they don't erectate that up.
• 26:58
  Speaker 2: Definitely, I couldn't agree more.
• 26:59
  Speaker 1: Yeah, yeah dosage on that.
• 27:01
  Speaker 1: I remember in the early days they were using huge dosages in patients with diabetics, like up to 1800 milligrams a day.
• 27:08
  Speaker 1: Not really achievable when you're looking at a supplement regimen, but what do you typically use?
• 27:16
  Speaker 2: Yeah, so again, dependent on the individual, but you're looking at around 500 to 1000 milligrams per day.
• 27:21
  Speaker 2: It certainly doesn't need to be as high as that 1800.
• 27:26
  Speaker 2: And it's more cost effective, obviously, in those lower dosages as well.
• 27:32
  Speaker 1: Yeah, and chromium, now this is another one.
• 27:36
  Speaker 1: So the TGA restricts the good forms of chromium, the polynicotinate and the picolinate to a total of 50 micrograms per day in any dosage form.
• 27:50
  Speaker 1: Yeah, so 25 micrograms in a tablet means you're allowed, to say, to take two tablets a day, 30 micrograms in a tablet, and it's one tablet a day, because two would exceed the 50.
• 28:01
  Speaker 1: But there's no restriction on no restriction that I can see about the chromic chloride, the poor sister which you know it's something, but it's not as good, it's not as well absorbed as the good forms.
• 28:17
  Speaker 1: What sort of dose do you tend to go up with, therefore, to chromium or with chromium?
• 28:24
  Speaker 2: Yeah, so you're looking at about 500, starting at micrograms and then that can go up to 1,000 micrograms.
• 28:34
  Speaker 2: But again, you're looking at their diet as well, right?
• 28:39
  Speaker 2: So you're looking at all the other chromium and all those other nutrients.
• 28:45
  Speaker 2: You're looking at all the other chromium and all those other nutrients, mind you, that we've talked about.
• 28:49
  Speaker 2: That could be coming from the diet as well, but that's when you want to kind of play with those numbers to make sure that you are looking at that.
• 28:58
  Speaker 2: But for those who don't know, and again because I'm a dietician, I try to really optimise the diet.
• 29:04
  Speaker 2: Foods that are typically or relatively higher in chromium are things like broccoli barley, if they can tolerate, obviously, wheat and gluten grapes, surprisingly, but more like the dark-coloured variety of grapes.
• 29:19
  Speaker 2: So the red grapes, the black grapes, even green beans, brewer's yeast, the black grapes, even green beans, brewer's yeast, oats, and then of course, nuts and even tomatoes are quite a good source and also they're rich in antioxidants like lycopene, which are fantastic at the same time, and also potatoes and, of course, lean meats as well.
• 29:44
  Speaker 1: But I like that use of oats as well.
• 29:46
  Speaker 1: You know, I see a lot of bodybuilders using oats as a sort of mainstay of their breakfast and I wonder if they're using it to help even out the blood sugar swings throughout, you know, later throughout the day with the use of chromium.
• 30:02
  Speaker 1: That's interesting, great segue.
• 30:04
  Speaker 2: Yeah, great segue.
• 30:05
  Speaker 2: Yeah, great, great segue, because that is also so important.
• 30:08
  Speaker 2: If we're talking about um stubborn fat loss, right, you're looking at um glycemic index, but again, that is one component of it.
• 30:17
  Speaker 2: People really just focusing on the glycemic index, which is the rate that your body is absorbing the glucose or the sugars from the carbohydrate-based foods, but not necessarily focusing on the glycemic load, which is the full amount of glucose that is being put into a meal in itself.
• 30:42
  Speaker 2: So, yeah, that's definitely something I educate my clients on as well is showing them things like foods that are high, moderate or low glycemic index and then also looking at the dosage and how much they're consuming in one particular sitting they're consuming in one particular sitting.
• 31:09
  Speaker 1: Yeah, so basically glycemic index alone, and carrots are bad or watermelon is bad, glycemic load, and you realize.
• 31:12
  Speaker 1: No, it's actually a really good, healthy food with no problem attached to it at all.
• 31:16
  Speaker 1: What about movement exercise?
• 31:20
  Speaker 1: You're an exercise scientist.
• 31:21
  Speaker 1: There was a thing some years ago about, instead of doing cardio first and strength training later, about swapping them to do strength training first.
• 31:32
  Speaker 1: Take us through this, or indeed what?
• 31:35
  Speaker 1: What are your?
• 31:35
  Speaker 1: What do you favor nowadays?
• 31:38
  Speaker 2: yeah, definitely, and research is always emerging and changing.
• 31:42
  Speaker 2: So what was recommended, recommended, recommended before, may not necessarily be the case six months' time, 12 months' time.
• 31:50
  Speaker 2: First and foremost, I think it's important to note that people have different abilities and maybe restrictions, but all I recommend, first and foremost, is move more.
• 32:03
  Speaker 2: We are seeing such an epidemic of prolonged sitting and they're calling, you know, prolonged sitting the new smoking, purely because of all the effects it has on the body, which can lead to risks of developing chronic health diseases and conditions.
• 32:23
  Speaker 2: And we know, in terms of our metabolism, it requires movement in order to optimize that.
• 32:31
  Speaker 2: So, in order for our metabolic rate to behave or to improve, we need to be moving frequently.
• 32:39
  Speaker 2: So, first and foremost, just sit less, move more.
• 32:42
  Speaker 2: First and foremost, just sit less, move more.
• 32:45
  Speaker 2: If we're talking about exercise prescription, we know that there are several types of exercise that have been clinically proven to enhance metabolic function and therefore improve insulin sensitivity which is the overarching goal here promote glucose metabolism and support over or metabolic health, and they include your aerobic exercise, so that's cardio, your resistance or strength training, your HIIT training, so that higher intensity interval training, and also yoga and Pilates as well.
• 33:24
  Speaker 2: So there is a whole range of exercises that people can engage in rather than just one alone.
• 33:31
  Speaker 2: But I will be clear I am a huge advocate and promoter of incorporating strength training and resistance training because obviously that's working on improving and increasing lean muscle mass and that is one of the most important factors when you're trying to optimize your basal metabolic rate at the end of the day.
• 33:58
  Speaker 2: And we know also the biochemical reactions that occur when we are building or increasing lean muscle mass.
• 34:07
  Speaker 2: So, for example, it provides more storage for glucose, and we know that our muscles are one of the largest glucose storage sites in our body.
• 34:19
  Speaker 2: So more muscle mass means greater capacity to uptake and store glucose, reducing blood glucose levels and improving insulin sensitivity.
• 34:31
  Speaker 2: So that's very important off the bat.
• 34:37
  Speaker 2: We also know that it can improve muscle insulin signaling pathways, so it basically works on the insulin receptor activation, and resistance training enhances that activation of insulin receptors on muscle cells and this improvement in that activity boosts the entire insulin signaling cascade that we see within the body, making cells more responsive to insulin.
• 35:08
  Speaker 2: So big tick there and that's really important.
• 35:12
  Speaker 2: And also we know that as a result of strength training it can reduce the intracellular sorry, the intramuscular fat that people might experience when they go and get a DEXA scan, for example.
• 35:28
  Speaker 2: So I have a lot of clients coming to me with a DEXA scan and we're really able to look at where they're holding that fat mass and looking at that intramuscular fat, which is what we're trying to reduce in these scenarios, and then that can just help with the decreased lipid interference as well, because we know that high levels of intramuscular fat can interfere with insulin signaling and, like I said, it all starts there.
• 35:59
  Speaker 1: Yeah, what about, like, we've spoken about the intramuscular fat, the wagyu marbling in humans, but what about things like fatty liver disease as a hurdle, if you like, to overcome before fat can be metabolised?
• 36:20
  Speaker 1: In the extremities, I'll say, but rather than visceral fat, the abdominal fat, that sort of thing?
• 36:29
  Speaker 2: Yeah, absolutely.
• 36:30
  Speaker 2: And in correlation to that, you're also looking at their lipid markers as well.
• 36:36
  Speaker 2: We know that the liver is the main organ responsible for producing cholesterol, so you're looking at levels of cholesterol in these people as well.
• 36:45
  Speaker 2: And they're triglycerides.
• 36:47
  Speaker 2: So by establishing what their liver enzymes are doing, you can see if there is risk of non-alcoholic fatty liver disease or just fatty liver in general.
• 37:00
  Speaker 2: And then you want to really improve the function of the liver, because you know that it's going to be inhibited if it is experiencing excess or a fat that is being, or that visceral fat that is coating the liver itself.
• 37:16
  Speaker 2: So, yeah, I would typically look at what's going on there and then if we do need to do a small amount of support or detoxification, then I'll certainly include that as well in order for it to work more optimally, for sure.
• 37:32
  Speaker 1: Right, there's so much we could go into here.
• 37:35
  Speaker 1: Robbie, I tell you this is a seminar, not a podcast, but I can't thank you enough for taking us through some real hit points.
• 37:43
  Speaker 1: This has been great today, Like this has been just one point after another.
• 37:47
  Speaker 1: It's fantastic stuff.
• 37:48
  Speaker 1: Your brain like I don't know if you need a coffee after this.
• 37:51
  Speaker 1: It seems like you've just gone rah.
• 37:53
  Speaker 1: It's fantastic information.
• 37:56
  Speaker 1: Thank you so much for giving that to us today.
• 37:59
  Speaker 1: It's been awesome.
• 38:00
  Speaker 2: Oh, it's my absolute pleasure.
• 38:02
  Speaker 2: I just love sharing education and knowledge with everyone.
• 38:05
  Speaker 1: And thank you everyone for joining us today.
• 38:08
  Speaker 1: Remember we'll be putting everything that we can up on the Designs for Health website to help you, help your patients, overcome stubborn fat loss.
• 38:17
  Speaker 1: And, of course, you can pick up on all the other podcasts again on the Designs for Health website.
• 38:21
  Speaker 1: I'm Andrew Whitfield-Cook.
• 38:23
  Speaker 1: This is Wellness by Designs.