Summary: 

In this episode of Wellness Your Way, Megan Lyons hosts Dr. Naomi Parrella, a family physician and obesity medicine specialist. Dr. Parrella shares her unique background, having started her life in Japan, and how it influenced her perspective on wellness. The conversation delves into the importance of circadian rhythms, the impact of our gut microbiome on these rhythms, and the significance of maintaining a regular eating and sleeping schedule for optimal health. Dr. Parrella also discusses the concept of metabolic health, emphasizing the importance of regular exercise, a balanced diet, and avoiding sugary drinks. The conversation concludes with a discussion on the medication Ozempic, its benefits, potential side effects, and the importance of maintaining digestive health and hydration while on the medication.

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Transcription:

Megan Lyons:

I got it. Thank you so much, Dr. Naomi. Oh, got to start again. Thank you so much Dr. Naomi Perella for coming on Wellness Your Way. I am very excited to have you here today.

Dr. Naomi Parrella:

Oh my gosh, Megan, I am so excited to be here. So thank you.

Megan Lyons:

Of course. Well, we’ve already had so much fun chatting before we started recording. I think we have so much to cover today, and I’ve already read your formal bio to the audience, but please just tell us in your words how you got here and who you are.

Dr. Naomi Parrella:

Yes. So I’m a family physician, obesity medicine specialist, and one of the things that might be a little unique for me is that I started my life in Japan. So I was born in Japan and my first school years were at a Buddhist preschool. And in Japan every day when you start school, you start with exercise and all the students have to go out into the yard and we have to go exercise together and this is a standard thing. And long story short, I sort of saw the changes in differences in education, the way we think about food, nutrition, et cetera, throughout our life, moving to the us living in Chicago and then living in Wisconsin and became a doctor as a result.

Megan Lyons:

Wow, I did not know that. And that’s incredible. And when you say it, I’m just kind of like, duh, why doesn’t everyone start the day with exercise? As an elementary school child, it makes so much sense to help them focus, but here we are. We don’t do those things. Yeah, that’s really interesting. Thank you for sharing that. Now you’re an expert in so many things, so we’re going to cover a lot today. But one of the things that I thought we would start with our circadian rhythms because a lot of people know what that is in theory, but they don’t really know how it impacts them on a daily basis. So can you give us the background of what a circadian rhythm is and what impact it actually has on us day to day?

Dr. Naomi Parrella:

Yeah, absolutely. So circadian rhythm is basically the cycles that our body goes through. Nature has circadian rhythms, so most people are familiar with the sleep wake cycle, which is about 24 hours, and that’s really run by a place in our brain called the super chiasma nucleus. And that’s sort of the biological clock that tells the body when to do whatever it needs to do in the day and at night, and it helps us figure out our sleep and wake cycles that is really relevant for the body to sort of pace itself and know what to do and be prepared for all the activities it needs. So for example, a lot of people know about melatonin, which helps with sleep and melatonin increases as we’re getting ready to sleep. Some people who have disrupted sleep patterns will take melatonin to try and signal to their brain time for sleeping. That’s a circadian pattern. Then in the morning we’ll have higher cortisol levels that start rising. Cortisol is also a stress hormone and that rises naturally in the morning, and that helps us wake up and feel alert in the morning for when that peaks about an hour after we wake up. So circadian rhythm is basically the body regulating itself on a 24 hour time clock, and that happens in the gut with immune system throughout the whole body. It’s sort of a way of everybody coordinating together.

Megan Lyons:

Very interesting. You said it happens in the gut. How does our microbiome influence this circadian rhythm?

Dr. Naomi Parrella:

Yeah, so it’s a bidirectional pattern, which means what you eat, the timing affects your gut microbiome, which are all the microorganisms that live in our gut and in response, that gut microbiome kind of changes. So if you are eating at a regular time, your body will sort of arrange itself to be able to best absorb nutrients and best do what it can do to take care of you with all the foods and drinks that you’re having. If you have an irregular pattern, gut microbiome can’t be prepared. So it might be dysregulated, it’s not ready for things. You might have bloating or distension discomfort, but that entire pattern signals also to the brain. And so the brain affects the gut because it can expect when you’re going to eat or not eat based on your routines. And the gut also talks back to the brain says, oh, we’re having these foods or these toxins and so on. So it’s a bi-directional communication. And the circadian rhythm is a way your body could optimize if you sort of have a regular rhythm.

Megan Lyons:

Very interesting. So if we have a regular rhythm of eating, maybe not to the precise minute, but approximately we’re eating at the same times, we’re sleeping at the same times, maybe even we’re getting sunlight at the same times, our body can really function optimally, which makes both our brain and our gut happy because they’re communicating constantly. And then I would take it potentially further and say, when you have a healthy microbiome because you’ve done all these things to optimize your circadian rhythm, then your body gets even better at absorbing the nutrients. It’s like a virtuous cycle where you start feeling better and better and better, and who knows if it starts in the gut or starts with the sunlight or whatever, but it’s all pointing in the right direction. Correct.

Dr. Naomi Parrella:

Yeah, exactly. So a lot of people say the gut is the first place you have an interaction with the outside world. We put something in the body and then the body has to do something with it. But your gut is that’s determined, right? What’s absorbed, how it’s absorbed, speed of absorption, all of that makes a difference. And then to your point with light and entering the eyes that goes directly into your brain shares information with the sup chisme nucleus, which allows your body then to pace itself with the time zone that you’re in, which is why the light exposure is so important, both light exposure during the day and not having light exposure when you’re not supposed to have it at nighttime. So you’re signaling to your body the appropriate signals so that your body can do what it needs to do.

Megan Lyons:

That’s great. You just mentioned when we’re not supposed to have light at night, so I think people know, although they like to do earmuffs or pretend they don’t hear, we don’t need that blue light at night, so please talk about that or anything else that we’re commonly doing that’s disrupting our appropriate rhythms.

Dr. Naomi Parrella:

So we all know about light and there’s sort of some mixed information there, but the blue light does seem to cause the melatonin, it disrupts melatonin. And melatonin is that hormone that tells your body sort of that it’s nighttime. So if you disrupt it, so your hormones aren’t, people think about menopause or other kinds of hormones, but there’s hormones that talk to the brain that tell us what to do and when to do it. And sleep is something that all animals do. And if we are using either a chemical caffeine or light blue light at a time when we’re trying to have sleep and rest and repair for the body, it’s very disruptive. And so again, that light goes into your brain directly speaks to that part of the brain that’s your biologic clock, and that sort of resets it, right? It’s like, Ooh, I thought it was supposed to be nighttime, but it’s not. So even though I’ve paced myself all day for the sleep time, now I’m going to have to extend. So that’s a little bit more stress on the body because it’s not paced itself for that. So that’s the circadian rhythm, and again, working with your circadian rhythm is so much more powerful with regards to benefits than working against it where your body doesn’t know when it’s going to get to repair or recover.

Megan Lyons:

Great. I’m curious, you said there’s some misinformation out there. Do you want to share anything about that?

Dr. Naomi Parrella:

Yeah, so I think a lot of people think they have to be so strict and they have to change all their light bulbs and they have to, we’re not saying that you should have your social life, you should still be able to go out and do things. But for the most part, if you can allow yourself some grace and know, okay, sometimes I’m going to be off track, you don’t have to beat yourself up about it. Okay. Routines, nobody is 24, 700% perfect. So the key is to just recognize what’s going on and then allow your body most of the time to have some kind of a routine where when you’re eating, when you’re getting light exposure and when you’re not getting light exposure and that allows the body then to regulate, sleep becomes more normalized, it becomes easier to do that, and your body can adapt.

So if you have those one-offs or jet lag because you traveled across several time zones, that’s okay. And I have many patients that’ll come in and they’ll be stressed out because they’ve had a deviation, I know I should be doing this and I’m not doing this, or I am looking at my phone all night long. Okay, well recognize and then just get back on track. It’s not permanent damage forever after your body’s designed to heal and thrive. And so if we can allow a little bit of grace and just recognize, okay, well I can adapt and I’m resilient, I can get back on track. That’s

Megan Lyons:

The key. Yes, I could not agree more. Sometimes it’s kind of motivating when maybe you did look at your phone all night and then you feel a little crummy the next day, or you notice you have more cravings or you’re reaching for more caffeine or whatever. It’s like, oh yeah, that’s why I do it. It’s not this dogmatic thing. I actually want to feel good. And that didn’t make me feel as good as possible.

Dr. Naomi Parrella:

Absolutely. And this is why human connection is so important because people will help. What is your patterns? Yes. So when we interact with somebody else and we’re like, gosh, I don’t know why I’m unable to eat the way I intended to, or I didn’t work out, or whatever it is, coaches other people can help reflect back to ourselves so that we become more aware and able to make those great changes.

Megan Lyons:

I love it. That’s great. I have two more questions about this. One is you mentioned people turn to melatonin. I have my own opinions about this, but I’d love to hear yours and when you use it or if it’s a hard no or always or what.

Dr. Naomi Parrella:

Yeah, so I would be curious with your expertise on your opinions about melatonin for sure. So I don’t think, well, the brain makes its own melatonin, and so if you are permanently supplementing, your brain will stop making its own melatonin. And that I don’t think is the goal. So I would recommend periodically, let’s say you’re going across time zones and you want to reset, absolutely fine if you’re using in a few days and then you’re off a few days, but you need to really cycle again. The body doesn’t want you to take over the hormone regulation of your brain forever. So I think it’s important to cycle on and off if somebody is using the medication like a supplement.

Megan Lyons:

I agree completely. It always kind of baffles me that it’s so widely available over the counter since it is a hormone and it can have lasting implications like that. A couple months ago or six months ago, I was fortunate enough to go to Egypt and some really cool places, and I did take melatonin for two days when I got there and two days when I came back. And I think like that, it’s great, but I think people using it just like, oh yeah, I bought these melatonin gummies at whatever, and now I take six per day every day. I’m like, okay, well let’s try to see if we can reregulate your rhythms so that you don’t disrupt your body’s own production of melatonin. And I think oftentimes it can be harder because you can’t just go, go, go, which I want to do still go, go, go, and then poof, take something and all of a sudden I’m asleep. Our bodies don’t work that way. We need to wind down, we need to look at of course, when we’re eating and what we’re doing to relax our mind and all of that kind of stuff. But I am just not a big fan of melatonin all the time. So I think we’re aligned there.

Dr. Naomi Parrella:

Totally. Yeah, absolutely. Yeah, the human body is really amazing. So if we sort of know how to signal to the body, body will do what it’s supposed to do, right? Yes. I mean it’s much better designer than we are. Yeah,

Megan Lyons:

Yeah, agreed. So also you mentioned in there eating according to our circadian rhythms or optimal timing for eating. We’ve had lots of different opinions, which I love on this, but I’d love for you to tell us your thoughts on the rhythms of eating.

Dr. Naomi Parrella:

So there’s so many different ways to eat in a healthy way. So there’s a lot of very strong opinions and dogmatic approaches to nutrition and eating. So I kind of embrace all of them in their different ways. So there’s pearls of wisdom across all, and each person has a different pattern, different culture, different life cycle that they’re in that determines that. So one of the things that I recommend with regards to circadian rhythm, optimal nutritional profile absorption and managing your gut microbiome and the mood and the immune system, all that stuff, 12 hours of not eating or drinking other than water, just giving a break so your body can do what it needs to repair. So that’s probably the number one thing that I think is super important. The second piece would be I’m not a huge fan of snacking unless it’s somebody who is very malnourished or is unable to tolerate larger quantities of food at a time and needs to get appropriate nutrition. But most people get their nutritional needs met in three or less times of eating or calorie intake in a day period. So whether you compress it, whether you do one meal a day or two meals a day, or you switch things up, three is sufficient. It’s more than enough if you’re eating adequately during those three times. So those are my two biggest, most important thoughts around that, and especially for setting the circadian rhythm.

Megan Lyons:

I love that. That’s great. And every time I say a 12 hour eating window, people are like, oh, that’s so easy. And then they try to practice it, and many people are not doing that regularly. So it is if we’re counting, oh, that sugar that you put in your coffee or that bite of cookie that you had before bed or something like that, it is a lot harder for people than it sounds, but I think that’s a really great goal to start out with those 12 hours and then see if you want to adjust further from there. That’s really fantastic. I am also on board with the less snacking snack meals over snacks for sure. I’m curious though, I do not find it feasible for people to get all of their nutrition in one meal a day, and I’m happy to be told otherwise, but do you see that actually working in practice?

Dr. Naomi Parrella:

So here’s how I think about it. A one meal a day or omad program works really well for somebody who’s very self-regulated and has times of non-med meaning eating more frequently around. So a lot of people are like, you have to do the same thing for the rest of your life. That’s just not, no, that’s actually not true. And you’ll go through times when you have a cold or when you’re working out more and you need to eat more, there’s going to be different times in the life that, so I don’t think anything is like a hundred percent all the time. And that’s the part that throws people off because many patients will come in, they’ll say, I need some structure. Tell me what to do, and I’m just going to do it. Give me all the rules. I want all the lists, and that’s not how life works.

How long are you going to walk around with a list, right? And then you’re going to come back and say, oh, I fell off. I’m terrible. I should have done this. I know what I should do. No, actually you’re doing exactly what you should do. You should have some variety. You should allow your body to signal you. If you get off track, come on in, we’ll assess is it a problem? Is it okay? Maybe it’s beneficial. So the omad thing, I worry about sarcopenia, which is the loss of muscle and ultimately bone as well. So as we get older, Amanda, I don’t think is a good idea. I think it’s too easy to lose muscle and not put that back on. But I think if you’re using it as a reset after you’ve had all, you can eat cruise or something, totally fine in finite chunks of time or cycling. So we’ve all heard of the fast mimicking diet or different cycles where you have periods of time where you might change how you eat. You can kind of think of it that way.

Megan Lyons:

Really interesting. Thank you for that reframe. I can definitely get on board with that and thinking, oh goodness, if some of my clients who are on the border of sarcopenia committed to Oma D for the rest of their lives, that would not work out so well. So we’re aligned on that. Yeah,

Dr. Naomi Parrella:

Totally agree. Yeah.

Megan Lyons:

So we’re kind of shifting into the food side metabolism. Let’s transition from circadian rhythm over to weight loss, which is your expertise. And instead of talking about weight loss, you often talk about metabolic health, which I really, really love. Why do you focus on this and why do you think that’s more important than just your weight, for example?

Dr. Naomi Parrella:

Okay, so this is my favorite topic. Great. Yeah, absolutely. So weight is one measure of how somebody is doing. So we know this in children, right? Babies, we want to make sure that they’re gaining weight appropriately and getting taller and all of that weight once we’re at our top height can change for a number of reasons. So you could be gaining muscle. So when I’m taking care of bodybuilders and body sculptors where I can’t even pinch any fat off their body, they might have an overweight or obese BMI, and that is ridiculous because I would not tell them to cut their fat on their body because they don’t hardly have any. So body composition is more important and where the extra fat tissue is more important. So if somebody has excess weight and they have let’s say A BMI of 40, which would be class three obesity, that weight doesn’t tell me what that person looks like, what their metabolic health profile is.

Somebody could have type two diabetes, have had a heart attack, a stroke, gout all the time, high blood pressure, a med list that doesn’t even fit on my computer screen. Or it could be somebody who is actually very active, may be carrying extra fat tissue, but it’s not around their organs and it’s under their skin outside of the muscles. That individual is going to have a very different metabolic than somebody who has had all these other chronic health problems because the fat tissue is around their organs and creating a lot of inflammation. So I like metabolic health better because it tells us how your body’s using fuel and what access you have to fuel. So the difference between being alive and being dead is that we use fuel and we have fuel to use. So once you can no longer use fuel, you’re dead. So this is what keeps us alive and keeps us well. And when that becomes impaired, our metabolic health suffers. It means our metabolism, the ability to burn fuel is disrupted and not working as well. Then we start having health problems because the body can’t do the repairs it needs to do, it’s unable to respond to the hormones, the signals, and then we start having more and more chronic health conditions.

Megan Lyons:

That’s so insightful. Thank you for that. And I think the system tends to be a little slow to change, and maybe when BMI was first utilized, it could have been a directionally correct tool because if we look several decades ago, people who were overweight or obese tended to almost always be metabolically unhealthy. And now we’re seeing this kind of, I don’t like the term that I’m sure is in your head, but people who might not look overweight or obese, but they’re metabolically unhealthy or like you said, someone who might have a lot of muscle, but they’re metabolically healthy. We can’t tell as much. Now what I think we might have been able to tell before when BMI was originated. So we just need to move on from that tool. And I think when people hear metabolic health, if they’ve been listening for a long time, they get it. They know what you’re talking about. But maybe for some of those newer people, if you’re saying we need to measure their metabolic health, what does that mean? What are we measuring?

Dr. Naomi Parrella:

Yeah, absolutely. So there’s different markers that you can measure on your body. The easiest thing you can tell is actually if your waistline is growing and you’re not pregnant, then you are having some metabolic disruption because that means that there’s fat tissue being distributed around your gut, where your organs are. So that alone is one of the easiest ways. You don’t even have to have a doctor’s appointment or anything. You can just see how are my pants fitting? Oh my gosh, they’re getting tight. Okay, here we go. Let’s go turn this around. It can be turned around. The other ways you can do that is there’s what’s called metabolic syndrome is a diagnosis in medicine that we use using specific markers because it’s very easy to use numbers. So again, a waist circumference. Now, this is really for Caucasian population because it might be a little bit less, for example, Asian population, but 40 inches for a man at the waist versus 35 inches for women.

If you’re above that, that would be a marker of metabolic dysfunction. If you have elevated blood pressure greater than or equal to 1 30 85, you’d also be considered to have some evidence of metabolic dysfunction. If you’re a cholesterol panel you’re in, we’re talking about triglycerides and HDL, we are not talking about total cholesterol, we are not talking about LDL, we’re talking about triglycerides should be less than one 50. I like it even less than that, but that’s a metabolic health marker. And then HDL, again, for men and women would be different. For men less than 40 is problematic for metabolic health and for women less than 50. So once you have those numbers, then the last number, which I think is super helpful, has to do with your blood sugars. So an A1C of 5.7 or above or blood sugars that are elevated particularly chronically as well as I like to look at a fasting insulin level. But all those numbers can kind of give you an idea of what’s going on with your blood sugars. And the last number, which isn’t part of the diagnostic criteria for metabolic syndrome, is c-reactive protein. So again, showing markers of inflammation, uric acid, showing how your body’s managing, for example, fructose and stress. Those would be some of the things that are easy to measure just with blood or an office visit.

Megan Lyons:

I love that. And even if we don’t include those last two, which I really think are fantastic, I love measuring inflammation and uric acid is a great one as well, but even if we just look at the five official diagnostic criteria, there was that study a few years ago now that said 88% of Americans are metabolically unhealthy, so 88% of us do not reach all five of those criteria, which is eye opening for a lot of people. When I say it, it’s really you get to be in the elite. If you can get all of those five into the optimal levels, and like you said, we’re constantly shifting, so it’s something that we can keep working towards. I’ve seen so many people and you’ve seen so many more not be metabolically healthy and then get into the category of metabolically healthy. So I want people to hear it is possible, not doom and gloom, that it’s 88%, but it is possible, right?

Dr. Naomi Parrella:

It’s absolutely possible. And as a matter of fact, it’s usually possible relatively quickly, which is what’s so surprising people. It takes many years to get to the state where we’ve sort of overloaded the body, but the body is really excited to get into a good space. So if you give it the right nutrients and the right response, it will respond very quickly. I’m always so surprised at how quickly certain disease processes can be completely turned around. Yes, because when I was in med school, we were not taught that you can turn things around. We were taught you can slow it down, but now my patients have shown me it’s totally possible.

Megan Lyons:

Yes. Amazing. So imagine you have one of those hypothetical people coming into your office and they’re metabolically unhealthy. They have maybe four of those five markers out of range. I know you’ll say every person’s individual, and I will too. And so I kind of roll my eyes at this question, but I’m going to try it anyway. What are a couple of the top strategies that you would focus on to help them shift into that healthy category?

Dr. Naomi Parrella:

Sure. One of the first things I ask people to do other than get some labs or show me the recent labs would be to have them track for few days what time they’re eating or drinking things and what it is.

Great. I don’t care about quantities or portion size. People come back and they’ll be like, was this part of the bird and I baked it, I don’t care. I just want to know it was a chicken and that you had it at five o’clock. Just understanding the timing. Again, this comes back to circadian rhythm. Are you eating around the clock and not giving your gut any rest? That’s going to be a problem, period. So if you can allow yourself just that single thing of 12 hours I’m not eating and within this 12 hour window I am eating, just make it so simple. That’s the first most powerful thing

Megan Lyons:

To do. I love that. That’s great. Everyone listening can do that.

Dr. Naomi Parrella:

And the second thing would be if you are drinking sugar, stop. Just don’t do that. That’s the number one. It’s basically giving yourself an IV infusion of poison, right? The body cannot handle that, so just don’t do that. That’s so simple. And if you’re going to do that, minimize, and I don’t mean a little bit all day long. I mean minimize the number of times in the week. So give your body a break from all of that and your body will do amazing things. So those two things alone, everything else falls into place after that.

Megan Lyons:

That’s really fantastic. I love it because people can do it, and I love your emphasis on don’t drink your sugar because so many people think, oh, well, it can’t be just that. It has to be some kind of fancy combination of whatever. I don’t know. There’s always a new fad diet out there, but really if we come back to those basics, just don’t drink your sugar. That’s very powerful and hard to do for some people. I understand. But simple, easy to understand, powerful. That’s great. I love the two. I’m going to push you for one more. If there was a third step, what would it be?

Dr. Naomi Parrella:

Yeah, so I have a couple more. So actually, number one, we don’t want to be hungry, so that’s absolutely not cool. So that means you have to have protein salts and water. Those are the things that are going to drive people to be hungry. If you’re dehydrated, if you don’t have enough salts in your diet or you don’t have enough protein, bring me hungry. So a lot of people say, well, I got hungry, so I ate some bread, I got hungry, so I had a cookie, I got hungry. So whatever it is, and really those are not fitting any of those criteria. Bread is very dry, it might not have any electrolytes in it for you, the salts, and it’s probably not having enough protein to cause that satiety, that satisfaction. So I think just recognizing if you’re hungry, it’s protein, water or salt period. Just make sure you’re getting adequate amounts of that. So that would be important. And the other piece is you have to feed your gut microbiome. That’s the fiber and the fermented foods. So if you’ve got some fermented food, you’ve got some fibrous veggies, and then you’re having your protein and you’re drinking lots of water throughout your day, your body has everything it needs to build you a castle, right? It’s going to really thrive in that space.

Megan Lyons:

Yes. Oh, love it. I wonder if you have someone, I have people say this all the time, okay, well, I ate protein and fi, ate a big salad with chicken and I put salt on it. Let’s say good quality, pink Himalayan salt, and I had a bunch of water and I’m still hungry an hour and a half later. Then what

Dr. Naomi Parrella:

I would be very curious what’s going on in sort of their bigger picture. So a sleep, stress levels, physical activity, I would be very, very curious, are they taking any kind of medications? What else are they having in between? People forget to count their cough drop, for example. That’s a sugar bomb. So there’s certain things that can really cause the body to get dysregulated. So if you are stressed, and it could be from not getting enough sleep, it could be from having an infection, it could be just because things are crazy. So there can be a lot of different reasons for stress, but what stress does is it raises that cortisol, again, that hormone that usually is cycling once it’s pumped up, cortisol’s job is to get you ready to fight a lion. So what it’s going to do is it’s going to melt down all the tissues in your arms and legs, and that includes the fats.

It includes any kind of glycogen storage so that you have sugar in your bloodstream, you’ve got the fats in your bloodstream and your muscles. So then you’ve got all these amino acids in your bloodstream. Now you can go fight that lion, but if you are not going to fight that lion, all of those extra nutrients are circulating in the bloodstream and they have to go somewhere, otherwise it’s going to poison you. So your body is going to store them around your belly, and there we go. The waistline starts growing metabolic dysfunction. It’s never where we want it to go. It’s always around the belly that then again, those cells will also want to continue to be fed in the future. You’re going to potentially have more cravings, you’re going to want to eat more, and it’s just suspicious cycle because nobody comes into my office and saying, I am having so many broccoli cravings. How do I control that? Yeah, nobody’s doing that, right? The cravings are usually for something that’s like an IV push of sugar. So there’s something to drink that’s sweet or something that’s highly ultra processed that adds blood sugar rapidly into your system. And there you go. It’s going right back to your belly.

Megan Lyons:

Got it. That was a great explanation. So we can’t touch on weight loss and even metabolic health these days without talking about ozempic. I would love to hear your thoughts, and I can’t imagine anyone hasn’t heard of it, but let’s just talk about what it actually does in the body and then your thoughts on it.

Dr. Naomi Parrella:

Absolutely. So ozempic is otherwise known as semaglutide or semaglutide depending on who you are. And that’s exactly the same medicine as wegovy as well. Okay. So ozempic and wegovy are the same, and that medication is called a GLP one receptor agonist medication, meaning basically hits receptors in both the brain and the gut, which causes people to feel satisfied with much less food. And it also slows the movement of food through the gut so that you feel more full longer, and it changes the hormone distribution. Basically, it increases your insulin response to foods that would raise your blood sugar, and it decreases glucagon secretion. So it essentially helps people lose weight, bring down blood sugars if their blood sugars go high, and that’s what it’s doing. So you’ll hear people being on ozempic, particularly in the news a lot right now, and they talk about, oh, I used to be a bag of cookies person and now I’m a one cookie person. I’m satisfied after one cookie. I now feel control. So the number one most common word I hear is control. I didn’t have control before, and now I have control. I’ve also heard people say, wow, now I know what it feels like to be normal, even though we know normal in the US means metabolically unhealthy, but right. So there’s this experience of control over food, which many people have struggled with.

Megan Lyons:

All right, so as a recovering control freak, I think that sounds nice. Is it the miracle cure that it’s made out to be?

Dr. Naomi Parrella:

Well, so I think there’s a lot of sensationalization of ozempic, wegovy, and actually the newer ones, Manjaro and zep bound, which is otherwise known as Tirzepatide, which hits two receptors. But these injectable weight loss medications are really quite powerful, and they cause essentially a burning state where you’re going to burn tissues in the body. Now, if you’re strength training, if you are eating adequate protein in the times that you are eating, you’re staying hydrated, it can be very effective in helping somebody, for example, reverse their disease process to lose weight, to feel, again, control and feel much better. If however, somebody is not appropriately assessed and evaluated and taken care of in this space, it can cause burning of muscle tissue and muscle loss. Again, shortens lifespan. It increases risk of all the diseases, cancers, cognitive dysfunction, et cetera, mood disorders. So we have to make sure that somebody who’s taking these medications that A, they understand the risks and we can talk about risks and side effects of the medications, but also that you’re doing the things necessary to make it that this medicine has more benefits than negatives, and that would be not eating within three hours of bedtime.

If you eat within three hours of bedtime, the food is sitting in the gut, it hasn’t had a chance to move forward because this medication stops that movement. It slows it down, so you’re going to have reflux. You could even vomit, very unpleasant. So that would be one thing. Secondly, getting adequate protein. If somebody is not eating very much because they feel full very quickly from this injectable medication, then the problem is even if it’s a salad or you have bread or you have a cookie first, you’re not going to have enough space or be interested in having the protein that your body needs. So now you’re going to burn off your own muscles. So that’s number two. And then number three, you have to make sure you’re having adequate hydration because people are not as interested in eating. They forget to drink water. And so it’s very easy to get dehydrated. And not only that, because the food moves through the gut so slowly, if you don’t keep pushing fluids, that food will dry out and become like a brick. And one of the concerns with the medication is this risk of bowel obstruction. You just don’t want that. So that’s something that stay hydrated. You also don’t want your kidneys to fail from dehydration. So again, stay hydrated. So those are the three things that you just have to make sure you’re doing. I

Megan Lyons:

Love the push on digestive health on muscle and making sure we’re getting that protein on hydration. That’s really powerful for people to hear if they are on the medication or if they do go on it. A fourth thing that has made me stumped basically is the insulin mechanism where we’re having our bodies secrete more insulin, like you said, which is good because it lowers our blood sugar from that food that we’re eating. And in the short term, people are showing lower fasting insulin, which we talked about is a marker of metabolic health. That’s amazing. But something that concerns me is if someone’s on this medication for 10 years and their body’s just having to do more and more insulin than is natural, it feels wrong to me. Do you have any concerns with that and long-term pancreatic health?

Dr. Naomi Parrella:

Yes. So I am probably one of the few weight loss doctors. That’s not like all in. So everything I think we have to recognize these medications have not been around long-term, right? So this is something that we don’t actually know long-term implications. We do know that high insulin, insulin is a growth hormone. It tells your body to grow. If you’re done growing taller, it’s only one other way to grow. So if you’re working out in the gym all the time, great, you’re going to build some great muscle. But that’s not how most of us want to spend our days. So what we’re talking about is a state of increasing insulin, like you said, in an abnormal pattern. And contrary to what we would expect early on in many patients, we’ll see their fasting insulin actually increases after they start their GLP one. Oh, interesting. And that’s not what you would expect in somebody who’s losing weight.

So that makes me concerned, and I’ve actually talked to several scientists about this. We can’t quite figure out what’s going on unless it’s that your protein is being broken down your muscles, and that’s causing a right. We just don’t know what’s going on in this space because that’s an abnormal response. So I don’t think we know in animal models, there have been studies that show that in animals there is an increase in the number of pancreatic cells. There has also been pancreatic tumors that have been formed from some of these medications and early studies. Interestingly, in January, 2014, I think there was a meta-analysis that was published on a bunch of studies in humans saying, oh, we don’t see an increased incidence of pancreatic cancer in humans. Of course, we haven’t used this medication long enough to really know for sure, but so I am extremely concerned, and that is one of the things I talk to my patients about is we don’t know you’re taking this risk and you have to be okay with, we might find out down the road, oh, I wish we did not do that. Yeah, I just dunno.

Megan Lyons:

It’s a tough space for you to be in because of course, all you want is what’s right for that individual patient. And if we had full information, it would be easier to make a decision and it still probably wouldn’t be one way all yes or all no. But there’s that little bit of absence of information, which I’m sure makes it tough. But you are excellent at what you do and some of the things that I’ve seen about you and your patient success stories and all of that are just fantastic. So I know people will want to learn more from you and get some help from you. I will ask you to share where the audience can learn more. But just before I do that, if there’s one more tip that we haven’t covered about anything, circadian rhythm, metabolic health, weight management, or something similar. One more tip I would love to hear.

Dr. Naomi Parrella:

Yeah. I think the number one most important tip, actually probably more than all of this, is the importance of interpersonal connection. Amazing. So connecting with other humans, just like you and I are doing right now, and that you do with your community, people going out, socializing every time we have a positive interaction with another person and somebody smiles at you and you feel hurt or you feel like a connection with somebody, it raises the hormone balance in the body in a health promoting way. And so oxytocin is one of the hormones that gets increased with this sort of bonding connection experience. And when that happens, that counters cortisol, that stress hormone. So that’s helpful to health. And one of the cool things about oxytocin is it’s one of the few hormones in the body that has a positive feedback loop. So most of the time when you have a hormone go up in your body, it tells your brain don’t make so much of that hormone.

So that’s called a negative feedback loop. It sort of shuts that down so your body has had enough of it. Oxytocin is super cool because it has a positive feedback loop, meaning the more you bond with people, the more you can bond with people, the more you experience that wonderful feeling. So it builds on itself. So of course, the more positive you add to the world, the world then can ripple that out. It doesn’t run out. It doesn’t have a negative feedback loop. It’s positive. And because it lowers cortisol, it helps with losing weight around the waistline, it helps with sleep, it helps with circadian rhythm and cravings. I mean, it is so, so powerful, and a lot of times people will get confused and they say, I want to eat better, so I’m not going to go out with my friends. No, no, no, no, no. That means that’s a wrong diet plan for you because I want you to be socializing. I want you to go out and have a life and encourage people to connect and really deeply connect. I think that’s the most important tip.

Megan Lyons:

Oh, I love that you ended on that. That was fantastic. So please do tell people all the ways they can learn more about you and get some help from you.

Dr. Naomi Parrella:

Sure. So I am at Zero Longevity. That’s, it’s an app. It’s the world’s first fasting app, so you can find me there. I do some events through Zero. And then secondly, I am also at Rush University, and I am the chief of lifestyle medicine there. So you can definitely find me there very easily. That’s in Chicago, and we’ve got a bunch of clinics all around Chicago and Indiana, so feel free to come and visit. And otherwise, Zero is probably the best way to get ahold of me.

Megan Lyons:

And Zero is available to anyone, even not patients of yours. Correct?

Dr. Naomi Parrella:

Exactly. So Zero is a free app. You can get that through any of your app stores, and we have the fasting app, we’ve got Fat burning Guide, we have live events. It’s just really having a lot of fun paying attention to our health, and it’s the number one fasting app. So come join us.

Megan Lyons:

It’s really an amazing resource. I will include the links to all of that in the show notes. I know people are going to run over there to check it out, but I want to thank you so much for your wisdom today, for your time and sharing with us. I really enjoyed this conversation,

Dr. Naomi Parrella:

Megan. Always a pleasure. I am just so, so thrilled with what you’re doing, rippling out your message to the world, and thank you and your community for just being curious and seeking more.

Megan Lyons:

Thank you.

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