Indirect calorimetry. A tongue twister of a word, but a game changer to metabolic health. Kirsty Woods of Metabolic Health Solutions from Perth, Australia has observed how valuable it is for research, particularly for polycystic ovarian syndrome, fatty liver, diabetes - basically anything associated with metabolism, but it's not just that.
A technology usually confined to laboratory and study purposes, she is determined to show its greater use beyond research. Experiences with different patients who benefitted from the interpretation of the data are a preview of how the knowledge gained from indirect calorimetry helps in clinical use, weight loss management, and the prevention of different diseases.
In this episode, Kirsty Woods provides concise explanations on metabolism and fat burning, addresses diet and lifestyle, and explains how, despite resistance to new technology, she knows the impact this technology would have, giving us a glimpse of a future that places value on metabolic health.
Quick Guide:
01:42 Introduction
04:54 The use of indirect calorimetry
19:35 The discordance with people burning fat, but not generating ketones
22:11 Burning fat as a sign of metabolic health
29:04 The resistance that comes with every innovation
33:14 Checking which fuel is being used
39:04 Metabolic health and its impact on the body
53:53 How surgery can change how our bodies make use of the foods
56:28 Exercises that are beneficial for people
1:02:28 Closing and contacts
Get to know our guest:
Kirsty Woods of Metabolic Health Services is a Registered Exercise Physiologist. Her expertise includes metabolic health services including complex obesity, PCOS, and fatty liver.
“And the more, once they understand what's going on, they're more inclined to be able to do the recommendation, or for the first time, they understand that it's not just them having lack of willpower, and there is hope, which unfortunately learned hopelessness is a big one in the clinic that prevents people from even trying because they've been through the wringer by the time they come to see me.”
Connect with her:
Blog: https://www.metabolichealthsolutions.org/ecal/how-to-optimise-fat-burning/
Twitter: https://twitter.com/LowCarbEP
Metabolic Health Solutions on Facebook:
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
Indirect calorimetry. A tongue twister of a word, but a game changer to metabolic health. Kirsty Woods of Metabolic Health Solutions from Perth, Australia has observed how valuable it is for research, particularly for polycystic ovarian syndrome, fatty liver, diabetes - basically anything associated with metabolism, but it's not just that.
A technology usually confined to laboratory and study purposes, she is determined to show its greater use beyond research. Experiences with different patients who benefitted from the interpretation of the data are a preview of how the knowledge gained from indirect calorimetry helps in clinical use, weight loss management, and the prevention of different diseases.
In this episode, Kirsty Woods provides concise explanations on metabolism and fat burning, addresses diet and lifestyle, and explains how, despite resistance to new technology, she knows the impact this technology would have, giving us a glimpse of a future that places value on metabolic health.
Quick Guide:
01:42 Introduction
04:54 The use of indirect calorimetry
19:35 The discordance with people burning fat, but not generating ketones
22:11 Burning fat as a sign of metabolic health
29:04 The resistance that comes with every innovation
33:14 Checking which fuel is being used
39:04 Metabolic health and its impact on the body
53:53 How surgery can change how our bodies make use of the foods
56:28 Exercises that are beneficial for people
1:02:28 Closing and contacts
Get to know our guest:
Kirsty Woods of Metabolic Health Services is a Registered Exercise Physiologist. Her expertise includes metabolic health services including complex obesity, PCOS, and fatty liver.
“And the more, once they understand what's going on, they're more inclined to be able to do the recommendation, or for the first time, they understand that it's not just them having lack of willpower, and there is hope, which unfortunately learned hopelessness is a big one in the clinic that prevents people from even trying because they've been through the wringer by the time they come to see me.”
Connect with her:
Blog: https://www.metabolichealthsolutions.org/ecal/how-to-optimise-fat-burning/
Twitter: https://twitter.com/LowCarbEP
Metabolic Health Solutions on Facebook:
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
S3E12 Kirsty Woods
SUMMARY KEYWORDS
people, metabolic, fat, burning, clinic, metabolically, metabolism, sorts, individuals, ketones, physiology, patients, health, fat stores, exercise, weight loss, insulin, bit, glucose, diabetes
SPEAKERS
Announcer, Jack Heald, Kirsty Woods, Dr. Philip Ovadia
Announcer 00:10
He was a morbidly obese surgeon destined for an operating table and an early death. Now he's a rebel MD who is fabulously fit and fighting to make America healthy again. This is Stay Off My Operating Table with Dr. Philip Ovadia.
Jack Heald 00:37
Welcome back, folks, it's the Stay Off My Operating Table podcast with Dr. Philip Ovadia. Today we are talking to tomorrow. That's right. I am recording this on Tuesday afternoon, speaking to someone who is in the future. Kirsty Woods, Perth, Australia. I think it's Perth, guys. It’s Perth, right?
Kirsty Woods 01:05
Yeah, in Perth, Western Australia. So nice and early here this morning. But thank you guys for having me. And I look forward to chatting all things health and metabolism and anything else that pops up.
Jack Heald 01:18
Well, the first question I want to ask you is what is the future like?
Kirsty Woods 01:24
It's a little bit rainy, but hopefully, all good in particularly in terms of the development of science and everything else.
Jack Heald 01:37
Okay. I'm done being an idiot, at least for a little while. Phil, tell us what Kirsty is here with this.
Dr. Philip Ovadia 01:42
Yeah, I've really been looking forward to having this conversation with Kirsty for quite a while now. She has been doing some amazing work that I think brings a little bit of a different spin to the approach around metabolic health. And we'll certainly get into some of the interesting work that she has been doing, both from sort of a research and a clinical standpoint. So, Kirsty, welcome. And why don't you kind of introduce yourself a little bit to our audience, let them know a little bit about your background, and maybe how you got interested in metabolic health?
Kirsty Woods 02:25
Yeah, perfect. So, I'm an exercise physiologist, which I believe over in America has a slightly different name of physical therapist, I believe. And essentially 11 years ago now, I got reintroduced to technology with the fancy name of indirect calorimetry for small medical company called Metabolic Health Solutions, or back then with Energy Testing Solutions. And I was given a box and my role to say, Hey, can this work in clinic with real people? Because we know it's such a valuable tool in research. So, take that to the future, which is now can definitely say yes, it can, looking at specific areas of polycystic ovarian syndrome, the fatty liver, the diabetes, anything associated with metabolism. So, unlike many of the hosts, it's not so much of a personal journey, but supported by the data. I can't unsee what I've seen, so yeah, and so I'm on here today.
Jack Heald 03:39
Okay, so what have you seen? I'm sorry, I may be jumping the gun. But...
Dr. Philip Ovadia 03:43
No, I was just gonna say, before we get into that, just to sort of make a little bit of a distinction for our audience, most physical therapists here in the US, which I would agree is roughly equivalent to what you do, but most physical therapists here in the US focus on the sort of movement aspect and the technical aspects and kind of rehab from injury. I think we have very few physiologists who are really trying to understand how our bodies work and the sort of metabolic machinery that is going on within our bodies that you've been looking into. And so, with that as a launching point, why don't you explain to our audience what indirect calorimetry actually is, because I think many won't be familiar with it. It's really not a technology that gets used much these days outside of the laboratory setting. So, let's start with that.
Kirsty Woods 04:54
Yeah, absolutely. And it's interesting that you say, most physical therapists get involved with the rehab side and it is the same in Australia. But essentially, we have the best understanding along with dieticians and those sorts of things of the physiology and metabolism both at rest and obviously in during exercise. So hence that deviation into that area. So indirect calorimetry, it is a hard word to say, took me a good couple of months to use that tongue twister. But essentially, it's a tool that measures your metabolism. So, to a breathing test that analyzes your oxygen, and your carbon dioxide, which is essentially the key components of your metabolism, so we can have a look at if your metabolism is fast or slow, whether you're burning fat or glucose, keeping in mind that the body is designed to burn fat. It is key for things like, obviously, weight loss management, but also nice stable energy, prevention of fatty liver. And then we can also have a look at your indicators for mitochondrial function, looking at the oxygen as well.
Dr. Philip Ovadia 06:12
I think it's real interesting, as much as we talk about metabolic health and focus on it here, we rarely actually measure this, like in the clinical setting. Obviously, we realize its importance, but most people would not have had any sort of actual assessment of what their metabolism is doing. And I think that can provide us with some unique insights.
Kirsty Woods 06:48
Absolutely, as sometimes saying clinic, why guess when you can test because as you say, we always referring to metabolism, yet, we're using some guesswork, particularly when it comes to the assumption that someone might have a slow metabolism, or the assumption that everyone burns 80% of fat, yet in the cohorts, particularly that we see, definitely not the case.
Jack Heald 07:14
Okay, so as the resident dummy, you're getting all that information from the breath? Okay, that's seriously cool. Phil, do we have this technology in the US?
Dr. Philip Ovadia 07:36
Yeah, so we have the technology here in the US, but it's mostly reserved for laboratory settings, and research projects, it's fairly unusual to see it used sort of in the clinics by physicians. It can be done, but it's rarely done is what I would say. And I think Kirsty would probably agree that in Australia, that's probably largely true as well, she's really one of the few, her and her company are one of the few organizations that I know of that are really putting this into practical use in the clinic with people outside of a research setting.
Jack Heald 08:28
So, when I look at this, my thing that I track my glucose and ketones with, filtered me onto this thing, that's what when it says if I want to manually enter numbers, and it asked me for the source, and one of the choices is breath, that's where that would come from.
Kirsty Woods 08:51
Not essentially. So, this is where it gets a little bit complex. I believe what that device is measuring your ketones in the form of acetone, which is in your breath. We're looking at is all pathways of fat metabolism, not just the outcome which is a ketone, which we know that there's some complexities and we can put a website, which I found and posted recently about measuring ketones, but just because we're measuring ketones doesn't mean that we're essentially losing fat. Because if you load up on supplements, you can be producing them because it's what's leftover, not necessarily what your body's utilizing.
Jack Heald 09:39
Okay, I gotta ask, what supplements will read as ketones? And is that in your blood, in your breath in your urine, what?
Kirsty Woods 09:51
So, there's a couple of forms, but it's essentially ketone esters that for example, might be used in Alzheimer's research. Or there are some marketing sort of schemes over here, which do have a role, but particularly in the weight loss chronic disease space, it's another fuel that your body needs to use, as opposed to utilizing its own body fat stores. So, when we produce ketones from our own fat metabolism, it has other various physiological effects than just supplementing and raising them in the blood, which obviously, we can dispense off through our breath and urine as well, whatever is not used.
Jack Heald 10:40
Phil. We're probably deep into the weeds here. And I've got, I could ask a lot of questions. But I also realize I'm sure there's some specific things you want Kirsty to talk about. So, I'm gonna step back and wait until what feels like a more opportune time to ask my maybe not so intelligent questions.
Dr. Philip Ovadia 11:04
Well, Yeah and this is a very, this isn't a simple concept. This isn't a simple issue by any means. And I think that's part of the barrier why this hasn't been put into more clinical use, because quite frankly, most physicians don't understand the physiology to this level. So maybe Kirsty to help us out a little bit, you could give us an example, perhaps a patient or a client that you've worked with, where this type of testing has really given unique insight when they were perhaps struggling for weight loss or other metabolic problems.
Kirsty Woods 11:50
Yeah, absolutely. And I think you hit the nail on the head with some of the challenges with this sort of technology, as we mentioned, it's used in elite athletes, and in research because of the valuable data. But unfortunately, because of some of the interpretation, the big cumbersome calibration of these machines, and also the cost, it's not frequently used in clinic, however we see it, as we want it to be like a blood pressure cuff, and every time to test the world metabolism. And that's where as the device I'm using ECAL is a little bit different. It's designed by practitioners, for practitioners, in terms of the software behind it. So, you don't need 10 years of physiology experience, the user pretest protocol and all those sorts of things. So, we can dive into that a bit later. But I just thought I would preface with that. Now, obviously, all well and good, but how do we apply this to patients? And the real thing is we get referrals for the conditions I've mentioned before. And a lot of the patients I see, they're not people having takeaway every day. It's motivated individuals who are getting frustrated because they're not getting expected results. So, for example, one that comes to mind is a lady who was doing HIIT training most days through one of the gyms over here. So, she was really putting in the gym. She was eating what is typically healthy. Yet, when she presented to clinic after having every blood test under the sun, everyone says it's fine, just keep doing what you're doing. But obviously, at the individual level, that's very frustrating and disheartening. We showed her that she wasn't burning fat. And that is essentially life transforming for some people for the first time.
Jack Heald 13:57
She was doing high intensity interval training.
Kirsty Woods 13:59
Sorry, what was that?
Jack Heald 14:00
She was doing high intensity interval training, committed to it, motivated, dedicated, and wasn’t burning fat.
Kirsty Woods 14:09
It wasn't working for. And essentially, a little bit of the physiology behind that, as we hear in some of the studies, 80% of Americans are not what we call metabolically healthy based on some markers. So that in a lot of individual works, but this patient who's not what we call metabolically flexible is not burning a lot of fat. She's not burning fat at rest for one reason or another. When she goes to do that exercise, she's going to be depleting the glucose in her muscles called glycogen. She's going to end up a bit fatigued and hungry, release cortisol, which is really not going to help her cause. So, in actual fact, by taking back the exercise a notch and specifically looking at diet so we know that reduced carbohydrate. Loads can work in many of these individuals, because it helps to reduce the hormone insulin which can switch off that fat burning. So, by focusing on that getting her fat burning, metabolically healthy, we were able to start to see some results.
Jack Heald 15:18
Say that bit about insulin switching off fat burning again. Remember, I'm the resident idiot.
Kirsty Woods 15:29
Yeah. So, insulin is that hormone that we tend to associate with diabetes. But even before we get to that point, there're some studies looking back 10 years beforehand, your insulin, which is released in response to carbohydrates, can play all sorts of games. And so, what it can tend to do is it can stay elevated and released more than we should, which says, hey, let's burn this glucose in our system. And in order to do so, it has to switch off that fat metabolism, which is fine, it's the way the body is designed. But if you can't switch back into fat burning, once that glucose is gone, that's where you get the cravings, that's where you get the energy slumps, that's when you have issues with weight loss, sleep, all those things tend to clump together. So, what we find is people are trying to reverse their diabetes, improve their sleep, improve their energy levels, improve their pain, which can be overwhelming. But if we focus at the key driver, which is metabolism, we can get the changes in the whole of the person. And that's what this person reported is not only changes in weight, but in terms of energy for the kids, day to day work, sleep, all those other aspects, which are really, really important for the patient, not so much in study and research. But for the N equals one, it can't be neglected.
Jack Heald 17:03
I go down that path more Phil, but I...
Dr. Philip Ovadia 17:08
Yeah, no, I think we should dig into that a little bit more. Because many people listening to this are probably going to think, well, we've heard me and many others talk about lower your carbohydrate intake and eat real food. And that's the way to get metabolically healthy. And what they're thinking to themselves, what unique insights do you get from this type of testing. On one situation, I think, would be useful for us to dig into that I think does come into play very often is that some people, when they're trying to lose weight, end up under eating and over exercising, and not having that the correct balance there. And that ends up working against themselves because basically, their metabolism shuts down. And I think that's one situation where this testing would be very useful for people to see that, understand it, and get the tools, get the information really needed to be able to correct that.
Kirsty Woods 18:26
Absolutely. So early on, I mentioned, I can't unsee what I've seen in clinic. Obviously, the individual transformation’s one we've been through the diabetes reversal and all those sorts of things through that time. But the number one thing is in terms of physiology, you learn one way, particularly at university, about carb loading and exercise space. And then in clinic, I'm putting that into practice, and it's not having an impact. Yet, as I say, looking at some therapeutic carbohydrate restriction, which doesn't necessarily need to be ketogenic and develop those ketones for some individuals, I can see that they switch to fat burning, so having that advantage of looking at things from a physiology as a pose to a guideline perspective. As I said, it's blown my mind and enabled me to hopefully help so many and many more with the likes of this podcast and what we're driving to do at Metabolic Health Solutions. Bring this to more people as well.
Dr. Philip Ovadia 19:35
No, I was just going to kind of circle back to something what Jack was alluding to earlier, do you oftentimes see that sort of discordance I guess where people will be burning fat when you do the metabolic testing, but they're not necessarily generating the ketones? So that if you're using just a ketone meter, you might not be getting the right picture of what's going on with their physiology.
Kirsty Woods 20:07
Absolutely. And once again, in the show notes, we can show a graphic that we're looking at what's going on at a cellular level, or an indicator or a cellular level at rest. And so sometimes we see people who are doing a pharmacy program and they get disheartened. And we can show them that they are burning fat, or, on the flip side, showing them that maybe they're not being given the right product, or call, because a lot of these programs are just equal, everyone gets the same thing. They might be eating too much, or eating too frequently. There's some hormonal and pathology type problems as well. So, there's no one size fits all, which unfortunately, we try to cookie cutter, those sorts of things. So that's where, for example, looking at someone's fat burning can differentiate some of those level levels of therapeutic carbohydrate restriction. Some people are metabolically healthy, they're active. To them, carbohydrate reduction might look like 150 grams, yet someone with diabetes, it might have to be 50, or 20 grams. So, you can have a look at those levels. Because why go to some levels when it might not be necessary. And then on the flip side, why introduce it if it's not necessary? So, we do get some patients who are actually metabolically healthy, they're burning fat. So, for those individuals, it might be more important to have a look at something like intermittent fasting, because they have access to their fat stores. So instead of for example, having breakfast, they can have their own body fat for breakfast, they're not going to get those starvation signals, and decline their metabolic rate, which might not be the case for someone who's not burning fat. So, it can help to differentiate as well.
Jack Heald 22:11
Oh, my gosh, a bunch of things. So, first of all, the first thing that I thought of was, quote, eat your own body fat for breakfast, unquote. That's going to be the title of this of this particular episode. That will catch people's attention. But I don't understand. I want to understand a little better. So, with for people who are already burning fat, though, I'm going to back up one question, because this is where the where second question comes in. The first question was, is burning fat the sign of metabolic health?
Kirsty Woods 23:03
Essentially, yes. So, when we talk about some of the studies we talked about before, and quoting people metabolically unhealthy, some things that we look at is your blood sugar levels, your triglycerides, which your fats in your bloodstream if they've got the presence of fatty liver, all those sorts of things. Yet, when we take a step back, essentially, that's all derived from the way the body works inside with the metabolism, and requires the ability to burn fat, so that you can use your body fat, not store around your liver, you can use your glucose efficiently so that blood sugar levels don't rise.
Dr. Philip Ovadia 23:43
Yeah, and I would just say the ability to burn fat is probably what defines metabolic health. You don't necessarily always need to be burning fat when you're metabolically healthy. But I think one of the underlying root issues with people who are not metabolically healthy is that they are unable to burn fat for energy.
Kirsty Woods 24:08
Yeah, and look, we've seen it in clinic we have people come from an overnight fast and they don't have that ability to switch back and that's the problem is they can't adapt to what's happening in their, with their fuel in the body.
Jack Heald 24:26
Okay, so, first of all, wow. That's probably the first time I've actually had a clue what it really means to be metabolically healthy from a functional standpoint. I've understood from a theoretical standpoint, but now, that makes way more sense. Okay, the next question about fasting. So, you said with some people who already have the ability to burn fat, they may not need carbohydrate restriction. They may just need to skip a meal. Or maybe I'm a little confused there. Could you expand on that a bit? And who are those people that are metabolically healthy? But yeah, expand on it.
Kirsty Woods 25:10
Well, that's the interesting thing is similar to the best analogy I have is blood pressure. We generally get an indication of what someone's blood pressure might be. But there's always exceptions to the rule. So those people are the ones I test. And that's how they present. So, some of them are overweight, which we might not expect them to be burning fat. But it's generally the ones who are overweight, but what we call insulin sensitive so they don't have the diabetes and those sorts of issues yet. So, they're the ones that, as I said, if they're burning fat, they can tend to say I'm not hungry in the mornings. And that's another sign as well. They're the individuals who it might be a matter of energy and versus energy out. And the ability to restrict that time feeding to access those fat stores and get some other hormonal changes that occur with that. But on the flip side, you may speak to people saying I've tried this intermittent fasting, I hear it's really good for weight loss, but they end up hungry and fatigued and not losing weight. And that's most probably because they're not accessing the fat stores, they're just depleting their muscle glycogen, the glucose in there, they're getting hungry, those sorts of aspects. So, it's about tailoring those things to the individual.
Jack Heald 26:35
Okay, so if, if you're attempting this form of losing weight of getting more healthy, and you are experiencing hunger, and then tiredness during the day, that's likely an indication that you're not making use of the fat that's in your system. Am I understanding that right?
Kirsty Woods 27:05
Yeah, absolutely. We also need to keep in mind things like your salts and electrolytes, borrowed function and those sorts of things. But as a general premise, they're the sorts of reports we get from patients once they start to burning fat. They're like, I can't believe I'm not ravenously hungry. They don't, it feels really weird for them.
Jack Heald 27:27
I would just like to highlight for our listeners that it's entirely possible to eat your own body fat for breakfast. You're not chewing it, I guess. But wow. I realized, Phil, that's what you've been saying for two years now. But it's taken a while to soak in here.
Kirsty Woods 27:51
And that's why often we see the therapeutic carbohydrate restriction, married with the intermittent fasting, because that enables them to get into fat burning, which makes the fasting easier. But it may not be necessary for everyone to do them both.
Jack Heald 28:11
It’s probably blindingly obvious to everybody else. But it's, the pity just dropped for me.
Kirsty Woods 28:17
And that's where I use indirect calorimetry or the metabolism testing as a tool to help people's understanding because a lot of the topics we're chatting about and particularly metabolism are complex. So, if I can use their own data to explain what's going on, often the penny drops. And the more, once they understand what's going on, they're more inclined to be able to do the recommendation, or for the first time, they understand that it's not just them having lack of willpower, and there is hope, which unfortunately learned hopelessness is a big one in the clinic that prevents people from even trying because they've been through the wringer by the time they come to see me.
Dr. Philip Ovadia 29:04
Yeah, and this is where I think the test don't guess paradigm comes into play. And it would be great if we were able to do this more widely for people and earlier in the journey, so they don't get to that point of frustration that nothing has worked and kind of get that defeated attitude. So, what are the barriers to making this more mainstream? Why don't you think this type of testing is common worldwide really? In Australia, here in the US and, and I think really worldwide, this is an issue, but this type of testing is not common.
Kirsty Woods 29:51
So, there's a couple of aspects which I mentioned before in terms of complexity and cost and those sorts of things. But I think the biggest thing, as with a lot of some of the other health interventions coming out, is change. And change takes time. So if we can make the path of least resistance, so for example, having a device that's the size of a shoebox in clinic and not inconvenient, and has that software to help the interpretation until then, which is what we're developing at the moment is something called Enable, which is that back software to say, Oh, this patient over here matches this patient, that for example, Kersey seen or this endocrinologist seen, they did this, they got these results, automatically, you're finding a metabolic twin that says, hey, here's some interventions that can help this specific individual. So, I think that is one of the challenges. It's innovative, which naturally comes with some resistance, but the more we can educate, overcome some of the expenses, the cumbersome nature of some of these devices and some of that support. I think there's no reason why we can't.
Jack Heald 31:15
You're building not... It's not just a device that measures. It's also an expert system, that...
Kirsty Woods 31:23
Digital health platform. And can I correct you there, it's not me personally. I wish. But essentially, my role is to say, does this have real world impact, so similar to all the great things they do on rats and in research, that's all well and good, but we need to make sure it works in the real world, that practitioners can understand and we can really have the impact that we're after.
Jack Heald 31:55
Is this the kind of thing that a patient could say to his doctor, hey, please do this, and the doctor could find a way to get it done?
Kirsty Woods 32:05
At the moment, even though it is a bit more restricted than we would like or have the ability to have the impact on, they most probably can. So over here in Australia, most universities do offer testing. So there generally is a way to get that done. Unfortunately, it's the interpretation and what to do with that is the missing link.
Jack Heald 32:32
Right, that was my next question.
Kirsty Woods 32:36
We do, myself, we have a dietician on board and some other collaborators. If that is the case, feel free to reach out. And I'll try and pop up in contact with someone who might be able to help from that aspect online. But yeah, it can definitely get tested so that at the least if you want to make sure that your metabolisms not slow, it can be tested. But once again, be weary of some of these devices, which only test metabolism, you're missing that next critical stage, which is are they burning fat?
Jack Heald 33:12
Okay, now I'm confused.
Kirsty Woods 33:14
Because I did go off on a bit of a tangent there. So similar to cause, these indirect calorimetry or metabolic carts had features. So, some of them only have an oxygen analyzer. And that's how we're able to tell if someone's metabolism is fast, or slow. Now, with the added benefit of a CO2 analyzer, we can see the byproduct and it's the ratio of those two gases, which enables us to have a look at what fuel they're using. Because fat is what we call an efficient fuel. It uses a lot of oxygen, doesn't give off that much waste in the form of CO2. So that can be an environmental debate as well if we want it to be.
Jack Heald 34:05
I think we just found the trigger. End global warming, burn your own body fat. We can make this a political win for everybody. I like it.
Kirsty Woods 34:19
Yeah, a little bit out of my realm, shall we say, but has been noted. On the flip side, is when you burn carbohydrates, you tend to give off a lot more carbon dioxide, which means the ratio of that to the oxygen is one on one. So that's how we're able to tell.
Jack Heald 34:41
Is this the oxygen that you expire or oxygen that you're taking in?
Kirsty Woods 34:47
So great question. So, in the in the air that we're breathing, there's about 21% Oxygen. We measure what you breathe out, which essentially is the utilization. As machines, unfortunately, humans aren't very efficient. Out of the 21% in the atmosphere, we breathe out about 16 to 17%.
Jack Heald 35:11
And the rest of it is CO2.
Kirsty Woods 35:15
The rest of the air’s nitrogen and CO2, so we're measuring, essentially, something called FeO2 which is, and the volumes and the percentage, which enables us to have a look at that. And that's beyond, as I said, there's a lot of engineering, which I do hear some of these terminologies that go into sciences like this. But essentially, as the practitioner, the software enables me to calculate that so that I can get useful data. Because if I say, here's your CO2, it doesn't really mean too much.
Jack Heald 35:57
Okay? So, in the same way that my Keto Mojo device checks my glucose and my ketones, and then does a calculation, says this is your glucose ketone index, am I saying that right, Phil? Here's your GKI, it's a ratio that I have yet to figure out how to calculate myself. You're comparing the ratio of gases in the breath, and that is a more accurate way of measuring what we're burning for fuel.
Kirsty Woods 36:43
Yeah, so essentially, that ratio, if anyone does want to look further into this is called respiratory exchange ratio...
Jack Heald 36:52
Respiratory exchange ratio, okay.
Kirsty Woods 36:55
Q which is respiratory quotient at rest. So, it is representative of what's happening at a cellular level, at rest. And this is how they also have a look at, you would have seen people on a treadmill with things over their mouth, tubes. That's the same technology. But what they're looking at is the point at which the RQ goes above a certain point, to look at their VO2 Max and those sorts of things. So, it's the same technology, but we're using it at rest, because number one, that's how we spend most of our day. And even in athletes, that impacts their recovery, their sleep, and all those other important aspects of performance.
Jack Heald 37:41
I'm so glad that we are finally having this conversation, Phil, because I was talking to someone this past weekend, and they said, what do you do? And I told him about this podcast. And I said all the centerpiece of it is metabolic health. And they said, well, what does that mean? And I realized, I don't really have a good explanation. I don't have a good description of what it means to be metabolically healthy. It's like porn. I know when I see it. But I don't actually know that you can use that, by the way, Phil. I didn't have a good understanding of what of what the difference between metabolically unhealthy and not was. So okay.
Kirsty Woods 38:32
And I think that's really important, because a lot of patients and you might experience the same, few come focusing on the white side of things. But as we know, we can get people who are normal weight, who have cardiovascular disease, fatty liver, diabetes, and that comes down to, obviously, their metabolic health where they're storing weight. So, it's not just a simple narrative and story, you need to have a look at what's going on inside.
Jack Heald 39:04
I want to ask you about, I'm on your website, metabolichealthsolutions.org. And I will remind the listeners this stuff will be in the show notes. You talk about results and weight loss, which everybody's gonna assume is happening and reduced central obesity. What's what is central obesity mean?
Kirsty Woods 39:25
So that's the weight that we store around that midsection.
Jack Heald 39:29
So that's, I assume that's what it was.
Dr. Philip Ovadia 39:32
Yeah, the visceral fat that we talk about is really what central obesity comes down to.
Kirsty Woods 39:40
Around the organs. That's the biggest risk for metabolic health. We also have a look at neck which is a newer one that we've introduced, particularly for the likes of sleep apnea. For example, we now know that another fat deposit site, not just around the organs, can be in your neck. So, we use that as a proxy for patients in terms of their metabolic health as well.
Jack Heald 40:07
Well, as I'm looking at this list of things mean weight loss, reduced fat mass improved fat utilization, insulin resistance, diabetes, I'm thinking, yeah, all of those things make sense. And then we get to this PCOS fertility, how in the world does metabolic health relate to PCOS and fertility?
Kirsty Woods 40:28
Very interesting. So, I'll start with a story to make it real world. It's not just all science and data. I’ve seen a patient back in 2018, who I’ve seen at the chemists the other day, she goes, I'm sorry, I don't think you know, I have a three-year-old healthy boy. Thank you. So, with the education and the understanding she got what's happening for her own body, she continued her own journey. And when she was on holiday, she fell pregnant naturally, and got to cancel her fertility specialist appointment. Because they were looking at the root of IVF. So that doesn't happen every day. But that's the impact it can have. So, taking that a step back, we see a lot of people, for example, with PCOS. So that's polycystic ovarian syndrome. From where metabolism comes into it, their ovaries are essentially insulin resistant. They're producing, some of the cells are producing too much testosterone, there's hormonal imbalances. So, by getting the body working as it should, reducing the carbohydrate load for some of these individuals means that these thecal cells don't produce as much testosterone, and we can balance that out, get them burning fat again. So not only are they getting the benefits in terms of fertility from the weight loss side of things, they're also getting it from the return of their menstrual cycles. And those sides of things as well. So, it's the hormonal components and the weight loss components when you said sleep improves your metabolic health, they have big impacts on those sorts of areas.
Jack Heald 42:31
So, it sounds like the message there is a poor metabolic health has an impact, can have an impact on a woman's fertility, as well as weight, diabetes, the stuff that we can all know about.
Kirsty Woods 42:59
Yes, absolutely. So once again, this is where we open these pathways to help individuals in their understanding, and this is why as I said, some people with PCOS aren’t actually overweight. And once again, because that is a symptom, but if we bring it back to basics of what's happening with their metabolism, as opposed to overwhelming them, why did they have excess hair, why they're having troubles with the menstrual cycle, this, that and the other, if we bring it back, we can have a bit more of an impact. So, another example, hopefully not to blow your mind too much looking at your face there, Jack, and hopefully Phil as well, so, for example, a couple of other areas where this technology can give us some real big insights. There was one study done, which had a look at the fat burning for before they went into weight loss surgery, and those that burnt fat going into weight loss surgery had better outcomes. So once again, metabolic health drive, the impact of not only weight loss surgery, but recovery from knee surgery, because of its impact on things like inflammation.
Dr. Philip Ovadia 44:26
Yeah, we certainly, I think there have been now a few people looking at this, Dr. Rob Cywes, who's a bariatric surgeon here in Florida, has looked extensively at this and you're exactly right. People who undergo weight loss surgery, bariatric surgery and don't address the underlying metabolic health issue that led to them becoming morbidly obese in the first place oftentimes get very disappointing results from the weight loss surgery. They'll typically lose weight initially, but then end up regaining it, because they haven't addressed that underlying physiology. And so that, it's yet another example of sort of missed opportunities, I think, within healthcare these days. And stepping back to the PCOS issue as well, again, I think PCOS is oftentimes one of the first manifestations for women of metabolic health issues, and it doesn't get recognized or even if it does get recognized as a metabolic health issue, oftentimes it doesn't get addressed from the sort of root cause metabolic health issue of what you're eating. And those patients with PCOS oftentimes get put on one of the common medications used for PCOS is Metformin, which is a diabetes drug, typically. And so, it's sort of addressing the metabolic health issue, but it's not really getting at it, and what would be the preferred way of looking at the diet and lifestyle issues there?
Kirsty Woods 46:21
And I think something like Metformin definitely has a role as an adjunct therapy. But if their lifestyle, they're not sleeping, which obviously, sorry, not obviously, but can change some of their hormones and prevent them from burning fat, which is maybe why when you have poor sleep, you tend to want the wrong things and be a bit tired. If they're not addressing those key components, it's not going to have as much of an impact. It might maybe impact the progression, but it's not addressing the key issues of a good adjunct therapy, similar with my views on a lot of the new weight loss drugs out there and those sorts of things. But once we address the physiology, it gives them the best bang for the buck when they're using those.
Jack Heald 47:11
I guess it makes sense. Here's my comment. I didn't realize that it just hadn't occurred to me that in addition to insulin, that poor metabolic health could affect other hormones as well. I just mean, I'm the resident idiot, I thought, okay, you're metabolically unhealthy, you probably got an insulin problem. But it never occurred to me that you could also have other screwed up hormones as a direct result, and I assume I'm not taking this too far, as a direct result of the same metabolic ill health.
Kirsty Woods 47:49
Yes, similar to we simplify body equals energy and energy out, we can't look at things just from one aspect. We have a lot of feedback systems. And the way that things spark other aspects of metabolism and physiology, so we need to look at things as a whole, and people as a whole. People have diabetes. They're not diabetes.
Jack Heald 48:19
Yeah, I like that. Alright. If you don’t mind Phil, I want to address one more thing on her website. You also talked about chronic pain.
Kirsty Woods 48:31
Yes. So once again, similar to the fertility aspect, is if we're helping people lose weight, we're reducing the stress on their joints. However, the amount of times in clinic, someone might report or I ask, Oh, how's your knee pain? Two weeks? Oh, actually, it's better. And that's because once again, when the body's working as it should, there's less inflammatory factors, less insulin, which is pro inflammatory. And it can have a cascade of events that improve that pain aspects. So, Fibromyalgia is a common thing that we might see improve when people improve their metabolic health. By all means, they might not be what's considered normal, but they do get some symptom relief.
Jack Heald 49:28
It kind-of all comes back to metabolic health.
Dr. Philip Ovadia 49:31
Yeah, that leads to a question that I was going to ask before as to how quickly do you see these changes occurring specifically when you're looking at the indirect calorimetry and the respiratory quotients and all that. How quickly when people make the dietary changes and the associated changes with activity, how quickly do you see these things shift?
Kirsty Woods 50:00
Oh, metabolism can change within three to five days. So, in the clinic personally, I generally do a couple of weeks follow up, just to make sure that we're actually on the right track for that individual. It doesn't work for everyone. If not, why not having a look at some of those other factors and pathology and tweaking things up? Also addressing any issues that they might have with compliance as well, problem solving there, because it's not as easy as just doing it. But essentially, the advantage of getting it in in such a short-term timeframe is we can see whether they're on the right track, but also before their weight has significant change, which is all they've known up until now. And if particularly middle-aged females, that doesn't move too much, they give up. But if they can see that they're changing their fat burning, or they're putting fasting in place, and not reducing their metabolic rate, the more motivated they’re to continue. And the likes of supplementation or exercise, I would say most probably about six to eight weeks for some of those things might not be as dramatic. But everyone's different.
Jack Heald 51:14
So, I'm thinking about people who have had bariatric surgery, seen very little result, keep the weight on or maybe lose a little or maybe gain more. Does this change in the intestines or the stomach, I know some of them, they shrink the stomach or whatever? Does that change how we make use of food? In particular, I've got a friend who had the balloon put in I think it is, and it's in his stomach. And so, he has to be very careful about what he eats and the amount he eats. And if I could be wrong about this, but I was under the impression that he had to be really careful about the amount of fat that he consumed, which seems backwards.
Kirsty Woods 52:18
Interesting. So essentially, from my understanding, the balloon is a physical restriction to reduce the amount of food, which is a problem for some people. Because if you're over eating on anything, you're not going to be accessing your fat stores, you're going to be using what you're putting in. So that's one of the reasons it can help. When you've got a foreign object in your stomach, that can present a lot of people get the reflux and, and those sorts of issues, and complaints, nausea, so, more so that might be a reason why they can't eat a lot of fat, or I know a lot of people who have surgery don't deal well with eating a lot of, for example, meat, because of the texture brings reflux, which can be a huge issue. Because if they're getting inadequate protein, they're losing their muscle, which is another thing that might be worth monitoring the muscle on fat through something called bioelectrical impedance under pretests conditions, so that we can make sure that they're getting the optimal outcomes. Because in that scenario, if they're losing muscle, not getting the key nutrients, they're going to be fatigued, they're going to lose their hair, and they're going to regain the weight, which is what we often see. So, when people say, surgery, and these tools are the easy way out, I quickly pull them up because they are, there's definitely its challenges. There are tools in the kit. But once again, let's take it a step back. Think of the physiology and what might be going on for these individuals.
Jack Heald 53:53
And then the follow up question is for those individuals who have had some sort of surgery on their intestines, resection in their intestine or something, does that also change how our bodies make use of our food?
Kirsty Woods 54:09
Yeah, in a couple of ways. So particularly when they have some of the sections of their stomach removed that produced some of the hunger hormones, so that's why they've generally gone from what we call banding which is just a physical restriction of the stomach to a sleeve which is cutting off some components of their stomach, which release hunger hormones, because that hunger regulation and cravings can be a big issue for some of these individuals, but once again, things like your adequate protein, making sure that you're burning fat so that you get nice stable energy and you don't send off those starvation signals can definitely help.
Jack Heald 54:51
What about the gallbladder? How's the gallbladder play into this?
Kirsty Woods 54:56
So, the gallbladder releases something called bile which is generally yellow in color and in illustrations which helps break down fat. However, if someone has, for example, had their gallbladder removed and they're struggling with some gastrointestinal upsets, you might want to do one of the following is that's worked for certain individuals is number one reduce the amount of fat, is once again is if you're accessing your fat stores, your diet doesn't necessarily need to be high fat. It is high fat, but from your own body fat stores, not external sources. Number two is we know that the liver because the gallbladder sends this power to the liver also can produce some bile to help in this process. If your gallbladder is removed, make sure you eat at similar times of the day so that the body is geared up to release that bile to help in the digestion particularly initially about your body's adapting. There are some bile acid supplements and those sorts of things, Diet Doctor, if you guys are familiar with that website, has a really good article on diet, particularly specifically low carbohydrate diets and gallbladder if people are having concerns or experiencing any issues.
Dr. Philip Ovadia 56:28
Kirsty, one other topic that I wanted to touch on that we haven't really gotten to, is the activity part of this. And I'm wondering what kind of insights you've gained from having this testing available in terms of the types of activities, the types of exercise that you find to be most beneficial for people?
Kirsty Woods 56:53
And the short answer to that is it depends. So going back to what we were talking about earlier, is the patient who wasn't burning fat, doing a lot of HIIT, really trying hard. But actually, taking back that exercise, allowing her body to access her fat stores and become metabolically healthy was more important than the exercise component. So, exercise is in terms of weight loss, by itself isn't that effective, but in conjunction with diet can be really effective not only in weight loss, but more so weight loss maintenance, because of its role in insulin sensitivity. So, it plays a role like Metformin in PCOS. And also, that muscle maintenance that stimulus to make sure that people have that metabolically active tissue to help. So, when someone is burning fat, that's a different kettle of fish. Those guys can benefit from the heat and the power workouts and those sorts of things. Because they're accessing the fat cells, they're not going to get those detrimental impacts that someone who's not going to burn fat would. Now also what's really important is going back to that muscle. We're finding you're getting adequate protein, but you do need that stimulus. So, resistance-based training is really important for a lot of our patients. And I'm not talking about going to the gym and pumping weights, I'm talking about doing some sits to stand sort of exercise or pushups against the wall for certain individuals is enough stimulus to help maintain that muscle mass in conjunction with adequate protein. So, in short, if you're burning fat, you can get most benefit from exercise, and particularly the high intensity stuff, which makes some changes in liver enzymes, for example, for the fatty liver. At a recent conference, they had a look at a four-by-four protocol, HIIT protocol to help fatty liver, which works in some individuals. For those that don't respond, I suspect, it's because of their metabolic health. They definitely want to be focusing on lower intensity sort of exercise at the start in conjunction with the resistance-based training.
Jack Heald 59:17
I want to make sure, I want to try to summarize what I heard you just say and make sure I got it right. If you are metabolically healthy, which we are defining as you are accessing your own fat stores as an energy source, in that case, high intensity interval training is good for you in terms of both health and maintenance. However, if you're not metabolically healthy, if you're not currently accessing your own fat stores as energy sources, but are primarily getting your energy from your glucose...
Kirsty Woods 59:58
Yes, correct,
Jack Heald 1:00:01
Then high intensity interval training, not only won't help, it may actually set you back. For those who are listening and not watching, Phil is shaking his head yes, as well.
Kirsty Woods 1:00:17
And that's why, as I said, some of the frustration comes from patients is we know that HIIT training has benefits. And as a general rule, some in the past, we might have been scared of it. But even those who aren't as healthy, it's generally safe and feasible for most patients. But it's not right for everyone.
Jack Heald 1:00:44
There's people out there, I know right now listening who are going that’s it, that's what it is. I've been working my ass off in the gym, and nothing is helping.
Kirsty Woods 1:00:57
And we also need to make sure that they're getting adequate recovery. So not overtraining. And the components of we can't neglect things like sleep, either. Yeah, so I know we've focused a lot of on nutrition and exercise. But once again, there are other key components or pillars that build a house and that some metabolic health as well, we need to make sure we've got all those in check.
Jack Heald 1:01:28
Well, I'm going to assume based on just the sheer volume of knowledge that bubbles within you, and a lot of which we've gotten to access today, that coming to see you is wildly expensive. And that's the only reason that people don't do it.
Kirsty Woods 1:01:47
Look, thank you for giving me a bit of a big head, but not the case. So once again, is I see people privately and through a GP referral, which, under a couple of $100, I can get an initial assessment with which is over about an hour in our clinics with either myself or one of the dieticians, us personally, but the big hope is once again to make this accessible. So, we can make it accessible in terms of the amount of people that are doing it, but also in terms of the cost. I’m really lucky to be a part of a team that's really passionate about this, which means it can be accessible to most not everyone but accessible to most.
Jack Heald 1:02:36
So, for those who are physically within reach of you, how do they find out more so that they can maybe come see you or one of your fellow practitioners in a clinic?
Kirsty Woods 1:02:52
Absolutely. So, the website is most probably the best place, there's a clinics, they can click on the clinics, and it has aspects there. But also, don't be afraid to reach out because we have a lot of collaborators and those sorts of things who aren't specifically one of our clinics because they're more so what we call proof of concept clinics to say, let's make sure this works and trial some of these components, whether it be originally testing in real world, and now moving forward testing some of these digital software components to make it as effective as we can.
Jack Heald 1:03:30
For those not within physical range of a clinic, what do you offer other than just knowledge?
Kirsty Woods 1:03:39
We do have a Facebook MHS clinics where I do some short videos, share the latest research that might be a good place to start. As mentioned, if you're able to get access to some testing, we might be able to help virtually there. But yeah, just really passionate about being able to help and educate people. So, they may be the best platforms if there is any practitioners here, Twitter's maybe a better platform where I post case studies and once again, some research but more so tailored to that area.
Dr. Philip Ovadia 1:04:25
And if I'm correct, one of the efforts that metabolic health solutions is also working on is trying to make this technology more accessible for practitioners to be able to put into use in the clinic worldwide.
Kirsty Woods 1:04:45
Absolutely. So, at this current stage, obviously, here in Australia and the UK and also Singapore, they're being used by endocrinologist. The English Institute of Sport practitioners, dietitians, exercise physiologist, but once again is the vision is to make that broad us so that we can really test the world's metabolism as mentioned before, and help with some of these key understanding so that we can move forward to the future for lack of better word of how we started the podcast.
Jack Heald 1:05:25
I like it. So, I'll remind our listeners, we’ll provide contact information for Kirsty and Metabolic Health Solutions in the show notes. Phil, anything else? Before we wrap it up?
Dr. Philip Ovadia 1:05:38
There's that I guess to circle back with how we open the episode, I would say the future is bright. And I think as we get more and more insight into all of this and are able use this testing in the clinics, we will be able to help more and more people. So, all right. Thank you for everything you and your team are doing Kirsty.
Jack Heald 1:06:02
Yeah, thank you for turning the lights on for me. I feel a lot.
Kirsty Woods 1:06:07
Thank you so much for having us. And hopefully, we can help the penny drop for a lot of individuals of we're bombarded with all this information out there. But when we can't relate it to ourselves or someone that we see, it can become rather challenging. So, there is hope, which is great.
Jack Heald 1:06:29
This has been good. All right. Well, I think we're done. Y'all follow Dr. Phil on Twitter @ifixhearts. And then follow Kirsty, what's your what's your Twitter? What is your Twitter handle?
Kirsty Woods 1:06:46
@LowCarbEP
Jack Heald 1:06:47
@LowCarbEP. Very good. All right. For Phil, for Kirsty, I'm Jack. We'll talk to you next time.
Jack Heald 1:07:04
America is fat and sick and tired. 88% of Americans are metabolically unhealthy and at risk of a sudden heart attack. Are you one of them? Go to ifixhearts.co and take Dr. Ovadia's metabolic health quiz. Learn specific steps you can take to reclaim your health reduce your risk of heart attack and stay off Dr. Ovadia's operating table. This has been a production of 38 atoms